International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Diabetes Mellitus and the Outcome of Critically Ill Patients: A Record-Based, Observational Study
Anshuman, Sushant Satya Priya, Narendra Kumar
Introduction: Patients with diabetes who are in critical condition are more likely to have complications. However, it is unknown how diabetes would affect ICU outcomes. Additionally, there is a dearth of information from Indian ICUs. In this study, we sought to determine the association between diabetes mellitus and a particular ICU outcome, including ICU stay time, ICU mortality, and ICU cure rate. The value of the capillary blood glucose level at the time of ICU admission and the length of ICU stay was also attempted to be correlated. Method: This observational study was based on hospital records. The records of patients who were hospitalized in the ICU of ABC IN XYZ were used to collect anonymous data. The record section was used to gather information about the capillary blood glucose level at the time of ICU admission, the length of ICU stay, and ICU mortality. Results: 80 patients (34.14%) with diabetes were found among the 240 patients whose data were obtained. The length of time spent in the ICU was discovered to be much longer for diabetics than for non-diabetics. (p = 0.02) The amount of time spent in the intensive care unit and the capillary blood glucose level at the time of admission were found to be marginally positively correlated. However, there was no statistically significant difference between the two groups in terms of mortality or ICU cure rates. Conclusion:  We deduced from the current study that the existence of diabetes affects the length of an ICU stay and that there is a positive relationship between the capillary blood glucose level at the time of ICU admission and the length of an ICU stay. Diabetes had no effect on ICU mortality or ICU cure rates.

2. Clinical Method of Estimating Endotracheal Tube Cuff Pressure with the Manometer
Sudip Bhargava, Vaishali Kanojiya, Vinay Yadav, Sweyta Shrivastava, Sumit Bhargava, Pawan Gurha
Objective: To compare the manometer method with the cuff sealing pressure method to assess the cuff pressure and study the incidence of post operative morbidity and correlate it with the duration of anesthesia. Whether existing method of assessing endotracheal cuff pressure is acceptable or a better monitoring modality (manometer) is needed for assessing endotracheal cuff pressure. Methods: Hundred ASA grade 1, 2 or 3 adult patients of either sex scheduled to undergo elective surgeries under general anesthesia requiring endotracheal intubation were enrolled for the study. They were randomly divided into two groups (N= 50 in MM as well as the CSP group In MM group the cuff pressure was regulated by using the manometer and in CSP group by the clinical auscultation and recording the cuff pressure at the end of each hour. The incidence of post operative respiratory complications were assessed in the PACU and 24 hours post operative. The post operative respiratory complications were quantified according to the scoring system. Results: Oxygen and nitrous oxide mixture is most suitable for inflation of endotracheal tube cuff as it maintains stable intra cuff pressures throughout the surgery. Excessive intra cuff pressures increases the incidence of laryngotracheal morbidity. Keeping the intracuff pressures within normal limits is very important aspect of maintaining general anesthesia with endotracheal tube intubation. Conclusion: The two methods – cuff sealing pressure and manometer method are both equally effective in maintaining the intra cuff pressure to the prescribed limits. Ideally all patients who have been intubated should have cuff pressure monitoring. Because of the cost involved, it may not be possible to have a cuff pressure monitor in every operating room. Our study seems to suggest that the Cuff Sealing Pressure Method which requires no equipment may be quite effective in maintaining intra operative cuff pressure.

3. A Comparative Study of Conventional Care Regimens and Azacitidine in the Patients Suffering from Higher-Risk Myelodysplastic Syndromes
Jagdish Prasad Sunda, Veer Teja Singh, Surabhi Chakraborty, Pankaj Kumar Sharma, Preshita Vanjare
In this study, azacitidine and conventional care treatments were compared for their average survival rates and their tolerance. The study was conducted on 87 patients having the age more than or equal to 75 years and suffering from the high-risk Myelodysplastic Syndrome.
Patients were selected randomly. Azacitidine was given to 38 patients of average age 75 Years, 75 mg/m2/day subcutaneously x 7 days every 28 days. 49 patients were undergone conventional care treatments having an average age of 77 years. AZA significantly improved the Overall survival rate vs CCR (HR: 0.43 and 2-year Overall Survival rates were 56% vs 16%, respectively. In terms of tolerance, Azacitidine was observed to be better than the conventional care treatment. Comparatively, for Azacititnie and Conventional care treatment Grade, 3-4 anaemia was 13% and 4%, Neutropenia was 61% and 17% while thrombocytopenia was 50% and 30% respectively. After concluding the Tolerance limit and the effectiveness azacitidine can be the first-choice treatment in patients suffering from Myelodysplastic Syndrome.

4. Use of Azacitidine in the Myelodysplastic Syndromes/Acute Myeloid Leukaemia
Kamal Sachdeva, Elson Tonderai Mberi, Alex Mushikita Nkandu
Acute myeloid leukaemia risk and increasing cytopenias are characteristics of myelodysplastic syndromes (MDS). Since the majority of patients with MDS are not candidates for more intense chemotherapy, supportive care including transfusions, antibiotics, and hematopoietic growth factors has long been the cornerstone of MDS treatment. The first chemotherapy drug to be licenced by the U.S. Food and Drug Administration for the treatment of MDS was the hypomethylating agent 5-azacitidine (AZA), which marked a significant advancement in the treatment of the condition. In comparison to supportive care alone, azacitidine showed a greater response rate and a longer overall survival in Phase III trials. It is also a well-tolerated medication that can be administered IV or SC according to different outpatient schedules. Future research is anticipated to compare the efficacy of azacitidine and decitabine and to assess the activity of AZA when combined with other epigenetic modifiers. This study explicitly discusses the function of azacitidine in the therapy of MDS and provides a summary of the current MDS treatment landscape.

5. Role of Physical Activity, Genetics and Chronic Diseases in Neuromuscular Disorders: A Cross Sectional Study
Neeta Mishra, Navin Kumar, Kalika Gupta, Kush Davda, Vipin Narayan Sharma, Nishkamini
Introduction: A recent report published by the World Health organization “Neurological disorders, public health challenges” stated that about one billion people worldwide suffer from neurological disorders & 6.8 million people die annually from these disorders. In India the burden of neurological and musculoskeletal disorders is ever increasing and keeping that in mind  there is an urgent need to plan services in a socio-culturally appropriate and cost effective manner so that the existing services can be optimally utilized. Aim: Identify the risk factors associated with neurological and musculoskeletal disorders. Physical activity of the patients with neurological and musculoskeletal disorders was compared. Disease wise disability caused was also compared. Methodology: This was a hospital based cross sectional study conducted at Geetanjali College of Physiotherapy located in Geetanjali Medicity with institute of Geetanjali Hospital and College, Udaipur. Consisted cases of ND & MSD attending GCP and the referral calls for ND & MSD from GMCH to GCP. Result: Majority of study subjects were from risk factor HTN (58.5%) had maximum stroke (37.4%) followed by head injury (12.9%) peripheral neuropathy (2.0%) facial palsy, diabetic neuropathy, paraplegia and GBS each (1.4%) and Parkinson’s disease (0.7%). Among physically active subjects, 37% had tuberculosis infection. Conclusion: Hypertension, stroke, head injury are the major risk factors for neurological disorders. Hypertension and smoking were the major risk factors for musculo-skeletal disorders.

6. An Evaluation of Phenotypic Characteristic of Subjects Having Blood Transfusion Reactions
Dipankar Baruah, Gitali Devi, Abhinanda Barua, Abhijit Bharali, Umesh Chandra Dutta, Rashmi Rekha Goswami
Background: Out of 35 blood group system and over 600 different blood group antigens discovered so far, some are considered as important i.e., ABO, Rh, Kell, Kidd, Duffy, MNS, Lewis, Lutheran and P. Few of them are clinically significant and are associated with transfusion reactions. Materials and methods: This are a prospective, cross -sectional analytical study conducted at the Blood Bank, Department of Pathology, Fakhruddin Ali Ahmed Medical College & Hospital. (FAAMCH), Barpeta, Assam, for a period of one year from 17/05/2016 to 16/05/2017. A total of 240 samples (120 from recipients having blood transfusion reaction and 120 from respective donors) were typed for the presence of antigens of Rh, Kell, Kidd, Duffy, Lutheran, Lewis, MNS and P blood group system. Result & Observation: Rh D antigen was found to be the most common antigen observed in both the recipient and donor. For the Kidd blood group system, 85% recipient and 87.5% donors were typed as JKa antigen positive. Thus, screening and identification of red cell antigens and their phenotype frequencies of various blood group systems for patient having blood transfusion reaction as well as their respective donors have shown some differences in antigenic phenotype. Conclusion: Red blood cell alloimmunization occurs due to genetic disparity between donor and recipient antigen particularly in multitransfused cases. Leucoreduced packed RBC’s or irradiated blood products can help to reduce the incidence of transfusion reaction, still reaction can occur due to alloimmunization to other potent blood group antigens. Study on antigen frequency of various blood group system in local donor population and also knowledge on frequency of alloimmuzitation and type of alloantibodies in multitransfused patient may have an impact on the incidence of transfusion related reaction as corresponding antigen negative blood from donor database may be transfused to the patient to reduce the rate of adverse blood transfusion reaction and thereby improve blood safety to a great extent.

7. Anatomic Study of the Profunda Femoris Artery and its Circumflex Femoral Branches: A Cadaveric Study
Ch Jwalaram Kumar, Suresh Babu Kottapalli, Sudhir Modala, D. Krishna Chaitanya Reddy
Introduction: The successful outcome of any surgical or diagnostic intervention in the femoral region influenced by the knowledge on the anatomical variations of the profunda femoris artery (PFA) and its branches including medial and lateral circumflex femoral artery. The variations of PFA must have been taken in account to prevent unpredicted and unpleasant problems. The present study was designed to identify the anatomical variations of the profunda femoris artery and its branches in terms of their origin and course. Material and Methods: A source of 52 lower limbs belonged 26 human cadavers were dissected, out of which 20 are male and 06 are females with age ranging from 26 years to 65 years. By following standard dissection procedures, the parameters including site of origin, distance of origin, and variations of profunda femoris artery was collected. Similarly, source, and distance of origin and variations of medial circumflex femoral artery (MCFA) and lateral circumflex femoral artery (LCFA) were recorded. Results: In 73.08% of limbs, PFA was arising from posterolateral aspect of main trunk of the femoral artery. The interspace between mid-inguinal point to site of origin of PFA was 3-4 cm in 50% of right and 53.84% of left lower limbs. The medial and lateral circumflex femoral artery has been identified as a direct branch from profunda femoris artery. The interspace between origin of LCFA and PFA was 1 to 2 cm and MCFA and PFA was 2-3 cm. Conclusion: A detailed anatomical knowledge on variations of site, source, and course of origin of PFA and its branches is a fundamental during surgical and diagnostic procedure and catheterization of vessels in the femoral triangle.

8. Evaluation of Hearing Outcomes in Cases of Otitis Media with Effusion in Preadolescents Treated with Adenoidectomy
Pranat N. Majmundar, Hetal H. Chauhan, Nirmal P. Patel
Background and Aim: As a result of adenoid hypertrophy, Otitis Media with Effusion (OME) develops. But in youngsters, OME-related hearing loss frequently goes undetected. This results in a lack of attention, poor cognitive development, and poor academic achievement. The purpose of this study is to evaluate the prevalence and outcomes of adenoidectomy in instances of otitis media with effusion and hypertrophied adenoids in an Indian tertiary care setting. Material and Methods: The otorhinolaryngology department at a tertiary care facility in India carried out the study over the course of a year. A total of 100 children with bilateral serous otitis media between the ages of 5 and 12 were included in the study. Pure tone audiometry and tympanometry were carried out both prior to surgery and on a regular basis after the adenoidectomy (along with tonsillectomy when indicated). It was assessed how much hearing results had improved on average. Results: In our group, sore throats, nasal discharge, snoring or nasal obstruction, deafness, and ear fullness were the most frequent presenting complaints. At 15 days, 1 month, and 2 months after surgery, there was a statistically significant improvement in hearing as compared to the preoperative hearing levels. Conclusion: Adenoidectomy, along with tonsillectomy when necessary, provides very good, long-lasting hearing improvement in children with hypertrophied adenoids and otitis media with effusion, and should always be considered in such patients in order to improve eustachian tube function and eliminate potential sources of infection. OME can be diagnosed non-invasively using tympanometry.

9. Adverse Drug Reaction Pattern of First-Line Anti-tubercular Drugs in a Tertiary Care Hospital of Northern India
Chetan Sharma, Dinesh K Badyal, Neeru Mittal, Gaurav Gulrez
Background: Adverse drug reactions add directly or indirectly to health care burden in form of hospitalization or mortality. ADRs (adverse drug reactions) of antitubercular drugs are rarely reported but are important cause of morbidity and mortality. Methods and Material: Patients were called on the days fixed for evaluation. All the information regarding the observed ADRs was noted down in the suspected ADR reporting form version 1.3 issued by Indian pharmacopoeia commission ministry of health and family welfare, Government of India and was also informed to the treating physician. ADRs were followed up till its resolution and management. The causality of the ADR reported was evaluated using WHO UMC causality assessment scale. ADR form was submitted to AMC, CMC Ludhiana. Results: Total of 107 ADRs were reported from 80 patients in our study. The most common system involved was gastrointestinal system (42.06%) presenting with hepatotoxicity, vomiting and diarrhoea. Causality assessment according to the WHO-UMC revealed that majority of ADRs was in probable category followed by possible category with some of the ADRs in certain category. No death was reported due to any of the ADRs. Most of the ADR’s occurred within 30 days from the start of treatment. Conclusions: ADRs to antitubercular drugs are frequent. Efficient pharmacovigilance can lead to early detection and better management of the ADRs with antitubercular drugs.

10. Comparison of Mandakini Dressing Vs Standard Dressing for Diabetic Foot Ulcers
Subhadarsini Mohapatra, Abhinav Deep, Ghilman Zafar, Sanjeeva Kumar Choudhary, Ved Rajan Arya, Sarfaraz Nawaz, Sharad Syangden, Sanjay Namdar
Offloading is a crucial therapeutic approach that is vital for both avoiding and curing diabetic foot ulcers. There are many distinct unloading modalities, each with advantages and disadvantages of its own. Which method is the best that can be easily applied and that can aid in ulcer healing is crucial in clinical practice. The primary cause of neuropathic diabetic foot wounds is pressure combined with cycles of recurrent stress, which compromises the integrity of the skin and soft tissues. The proper debridement of nonviable tissue and sufficient pressure relief form the basis of any therapeutic strategy for neuropathic diabetic foot ulcers (off-loading).

11. Experience with Bile Duct Damage after Laparoscopic Cholecystectomy from a Tertiary Care Facility
Mohneet Kaur Riar, Amrinder Pal Singh Thind, Amandeep Singh, Rajeev Kumar Shaw, Sharique Nizami, Saurabh Kumar, Srikant Gupta
Introduction: A frequent illness is bile duct stones. In the United States, over 750,000 cholecystectomies are carried out each year, and approximately 30 million people suffer from bile duct stone disease. The study’s goal is to understand the risks, prevalence, kinds, causes, timing, clinical manifestations, various imaging modalities, and therapeutic approaches for BDIs. Method:  At LSK Hospital in Kishanganj, 110 patients participated in an observational study. We monitored and followed up on every patient who underwent laparoscopic cholecystectomy with BDIs. The investigation lasted for a full year. All BDI cases from September 1, 2020 to October 31, 2021 were included. Ahead of time, the Institutional Ethics Committee gave its consent. Before taking part in the trial, each patient provided written informed consent. Results: During the course of the trial, 110 patients in all were observed. These patients were primarily female and had a mean age of 43.7 ±18.1 years. Eleven instances required the change of laparoscopy to open surgery. This procedure was carried out due to BDI in 8 cases and due to a short cystic duct with adhesions, irritation, and difficulty during laparoscopy in 2 cases. In 4 patients, BDI was noted, and in 3 more, BL took place. Three of the four cases of BDI were discovered intraoperatively, and two were discovered postoperatively. End-to-end anastomosis over a T-tube and Roux-en-Y hepaticojejunostomy were used to surgically treat the cases that were discovered at the time of surgery. Conclusion: Long-term follow-up for such patients should be performed, and the surgeon doing the laparoscopic cholecystectomy should be knowledgeable about the care of such injuries.

12. Surgical Antibiotic Prophylaxis Practices in Tertiary Care Hospital before and After Implementation of Antimicrobial Stewardship
Neelam R Attar, Rajashri Waidande, Nirmala D Dhumak, Divya S Yadav, Nilam N Pawar, Deepmala Kulkarni, Sulochan Chikkud
Objective: To study surgical antibiotic prophylaxis practices in tertiary care hospital before and after implementation of Antimicrobial stewardship. Material Method: SAP practices data with respect to selection of antibiotic, timing of administration, dosing of antibiotic, repeat dosing intra operatively and discontinuation of antibiotic after 24 hrs of surgery was collected for 1 year and analyzed. Antibiotic policy was introduced as a part of antimicrobial stewardship program and training given. Same data was collected for consecutive year and analyzed. The difference in practices was observed. Results: There was overall improvement in surgical antibiotic prophylaxis parameters. Selection of antibiotic was compliant in  75.4% cases. Compliance with antibiotic timing increased from 63.2% to 94.2%. Appropriate dosing of antibiotic improved from 86% to 92%. Intra operative antibiotic dose was repeated in all cases exceeding 4 hours of surgery. In only 15 % cases antibiotic was stopped after 24 hours of surgery. Conclusion: Introduction of guidelines, implementation through Training, effective communication, reminders, feedback and continuous monitoring along with coordinated team work with surgeon can help us implement SAP guidelines effectively.

13. A Cross Sectional Study of Microbiological Pattern of Tracheal Aspirate in Tracheostomized Patients in a Tertiary Care Centre
Nagle Smita, Singh Priyanka, Chavan Shrinivas, Verma Bhavini
Background: Over the past few decades, hospital acquired infections have grown more complicated. The danger of nosocomial infections is increased by the frequent use of invasive procedures in critical care units (ICUs), such as tracheostomy. With a rise in the prevalence of bacteria resistant to antibiotics, treatment of these infections with more broad-spectrum antimicrobials has created serious issues. Aim: To study various microbiological pattern of tracheal aspirate in tracheostomized patients of tertiary care hospital. Materials and Methods: The study is a tertiary care hospital based, cross sectional observational study, which was conducted with 150 tracheostomized patients to assess the various microbiological pattern of tracheal aspirate on day 1 of tracheostomy and day 7 post tracheostomy in these patients. Results: 150 tracheostomized patients of age 12 to 70 years were included in the study. Clinic-epidemiological factors of the patients and microbiological pattern of tracheal aspirate were assessed. Factors such as intubation status pre tracheostomy, duration of hospital stay and antibiotics given were statistically significant for the tracheal aspirate microbial growth pattern on day 1 of tracheostomy and day 7 of tracheostomy. Conclusion: The current study shows that patients receiving tracheostomy therapy have a significant chance of developing lower respiratory tract infections, which are typically brought on by gram-negative bacteria such Pseudomonas aeruginosa, Klebsiella pneumonia, and Acinetobacter spp.

14. Study of Conduction Abnormalities in Acute Myocardial Infarction
Renuka, P. Thirunavukarasu, P. Balamanikandan
Myocardial infarction is the most common non-communicable disease responsible for increasing mortality worldwide, especially in India. The aim of the study is to record electrocardiograph in acute myocardial infarction patients and interpret conduction abnormalities associated with it to prevent mortality and morbidity.
This study was conducted in District Headquarters Hospital & DNB Postgraduate Teaching Institute, Virudhunagar. It is a cross sectional study conducted for a period of 14 months between March 2020- April 2021 with a sample size of hundred patients.
In our study incidence of conduction abnormalities in acute MI is 63%. Incomplete right bundle branch block is the most common conduction defect followed by left anterior hemi block. Anterior wall MI is the most prevalent followed by inferior wall MI. Increased Risk of mortality in patients presenting with High degree heart blocks.
Hence as per our study it’s always better to evaluate conduction abnormalities in MI patients so have proper observation and follow up to reduce morbidity and mortality.

15. Prevalence of Menopausal Symptoms among Postmenopausal Women in Rural South India: A Cross Sectional Study
Sindhu L, Raghunath Elango, Karthikeyan V
Introduction: Menopause is a natural event that occurs due to decline in production of hormones, estrogen and progesterone which may lead to physiological and psychological effects or symptoms. They can be categorized into Somatic, Psychological and Urogenital symptoms. Due to the gradual increase in life expectancy, health of post-menopausal women has become a public health concern which can have a direct impact on the quality of life. Aims and Objectives: To study the prevalence of menopausal symptoms using Menopausal Rating Scale (MRS). Material and Methods: This cross-sectional study was conducted among 270 participants in villages of Kuppam mandal, Chittoor District, Andhra Pradesh during the period February 2017 to January 2018. Using cluster sapling method out of 63 villages in Kuppam mandal, 27 villages were selected and 10 samples were collected from each village. A semi structured questionnaire and Menopause Rating Scale was used to record the data and assess the symptoms. Collected data were entered in MS Excel 2010, and Epi-Info v7.1 was used to analyze the data. Results: Range of age among the study group was observed as 31 years to 58 years. 80.7% of the study participants were above the age of 50yrs. The most common symptom observed in the study group was Joint and Muscular discomfort (76.6%) as somatic symptom, Irritability (37%) in Psychological symptom and Bladder problems (21.1%) in Uro-Genital symptom observed. 14.1% and 9.6% of the study participants experienced moderate and severe symptoms based on total MRS score. Conclusion: A significant proportion of study participants were presented with moderate and sever symptoms based on Menopause Rating Scale, which will directly affect the quality of life in these individuals.

16. Usefulness of HPLC & Hematological Parameters in Laboratory for Evaluation of Abnormal Hemoglobin Variants in Western-Tribal Part of India
Jitendra Kumar S Parmar, Bharti J Babariya, Deepa Gupta, Manjula J Babariya, Prateek Agrawal, Chintan Doshi
Introduction: Hereditary disorders of abnormal Hemoglobin variants are one of the commonest genetic disorders worldwide. Three broad groups of these disorders are: structural variants (hemoglobinopathies), thalassemias & hereditary persistence of fetal hemoglobin (HPFH). “β thalassaemia belt” where β thalassaemia more coomon include Mediterranean region, Africa, Middle East, some areas of India, Pakistan, and Southeast Asia. In India, average carrier rate for β thalassaemia is 3%. Objective: The objectives of this study are 1) to find out prevalence of various abnormal hemoglobin (Hb) variants by HPLC method in given period, 2) to compare hematological parameters among various abnormal hemoglobin variants. Materials and Methods: A Retrospective Study was conducted in a Laboratory in Tertiary care hospital at western-tribal part of India during July 2022 to August 2022. HbA, HbA2, HbF and other abnormal variants of hemoglobin were studied by HPLC (High Performance Liquid Chromatography). Hematological parameters tests were also done. Results: 2944 patients samples run in HPLC analyzer, and abnormal hemoglobin variants found in 160 cases. These 160 patients had abnormal Hb chromatogram on HPLC. β Thalassemia trait constituted 66 cases followed by 66 cases of HbS trait-heterozygous, 11 cases of HbS disease/anemia-homozygous , 6 cases of Compound HbS homozygous with β thalassemia trait, 6 cases of HbE trait-heterozygous, 3 cases of HbE disease-homozygous and 2 cases of HbD punjab. Conclusion: Various hereditary Hb disorders identified at Shree Vinoba Bhave Civil-Hospital, DNH (Dadra & Nagar Haveli-Union Territory) situated at western part of INDIA & this study reflectes problem magnitude, which may represent iceberg phenomenon. These hereditary Hb disorders are easily identified on HPLC platform via screening of antenatal women, school & college students. Policy makers, Health care department & various NGOs play important role in preventing these disorders via screening and education programmes.

17. Student Opinion on Use of Information Technology (IT) in Medical Education: A Cross Sectional Study
Anitha P, Narayana Krishnappa, Ruchi Dhar
Introduction: Computer assisted learning is more relevant than ever in this era of information technology boom for pursuers of professional courses. E-learning has been introduced as part of competency-based curriculum for Indian medical graduates by the Medical Council of India in 2019. Studies assessing readiness in computer skills of students and attitudes towards use of information technology in medical education will help better implement the e-curriculum. This study is an attempt to extract the opinions of students for including computer knowledge as part of foundation course. Materials and Methods: In this cross sectional, descriptive analytical study, 150 1st year MBBS students from a tertiary care teaching medical hospital, answered a carefully structured questionnaire assessing 3 aspects: Attitude towards use of IT in medical learning, level of computer skills and preferred e-learning modalities. Analysis of data collected was by inferential statistics. Results: 64% students used some sort of gadget regularly and 97.7% students had access to internet. 52.3% students preferred Flipped classrooms over traditional chalk and talk methods. Most users had basic and intermediate level of computer software application knowledge (45.5% each). 92% students felt a need for computer lab for acquisition of preliminary training skills with 62.6% favouring inclusion of learning management software (LMS) in new curriculum. 90% students used social media for more than an hour every day and 86.4% insisted on having a structured learning application in line with Facebook or WhatsApp. Conclusion: This study reveals that there is a need to modify the conventional teaching methods and efficiently use computer for academic purpose in medical students. Though majority of the students have knowledge and awareness about the internet usage it is not being utilized properly as an educational tool. This can be achieved by effectively implementing a program to create awareness of uses of internet and social media for e-learning in undergraduate programme.

18. A Study to Assess Patients Satisfaction Attending Out Patient Department at Government Tertiary Care Hospital in Junagadh District, Gujarat
Zalavadiya DD, Vala MC, Hala NA, Nimavat KA, Mehta DP, Khandhedia SA
Background: Qualitative aspect of health care delivery has been emerged to be focused as a critical area for patient management. To reform the health care system, it is very crucial to persuade the demands of Patients. Therefore, it is very necessary to assess the care to the clients/ patients in terms of satisfaction. Methodology: A cross sectional descriptive study was conducted on patients visiting the OPD of various departments of the facility. It includes purposive sample of 150 adults between ages of 18-70 years attending OPD of various departments during the month of May in 2019. Various factors to assess the patient satisfaction were perception about the hospital admission process, pharmacy services, cleanliness, behavior of hospital staff & over all perception about the hospital. Results: 88.7% patients were satisfied for timely registration. 95.3% patients were satisfied with the behavior of doctors. 85.3% patients were satisfied with the privacy maintained by doctor. 60% patients got their reports on time. On seeing overall patients’ perception, 86% patients were satisfied with hospital services. Conclusion: Patients’ satisfaction is one of the crucial aspect to care for providing better treatment and this should be well considered by hospital management and all the staff. Patients’ satisfaction regarding various service provisions was overall found satisfactory in the study.

19. Comparison of Effectiveness between Intravenous Ferric-Carboxy Maltose and Iron Sucrose in Treatment of Anemia Complicating Pregnancy
Purnima Saxena, Somya Saxena
Introduction: Anemia during pregnancy is most frequently caused by iron deficiency. Both the mother and the growing foetus may suffer negative effects. The goal of the current study was to examine the effectiveness of iron sucrose and intravenous ferric carboxy maltose (FCM) in treating anemia in pregnant women. Material and Methods: In this prospective observational study, 100 pregnant women between the ages of 14 and 35 weeks who had been diagnosed with iron deficiency anemia received either FCM or iron sucrose treatment for the condition during the months of August 2021 and August 2022. By measuring serum ferritin and hemoglobin levels again two weeks and six weeks after medication ended, the effectiveness of the treatment was evaluated. Results: The level of hemoglobin and S. Ferritin were more increased in FCM group compared to Iron Sucrose group in the duration of 6 weeks after completion of treatment. Conclusion: Compared to iron sucrose, ferric carboxymaltose is more effective at treating iron deficiency anaemia, which can complicate pregnancy.

20. Study of Physiological Ocular Changes in Pregnancy
Jayesh Kumar C. Sadhu, Vishal Bavarva
Background: Women have a vast array of ocular and systemic changes during pregnancy. During pregnancy, the eyelid, conjunctiva, cornea, lens, retina, optic nerve/tract, and orbit are all affected. Increased pigmentation of the eyelids, ptosis, modifications to corneal and refractive status, and a drop in intraocular pressure are examples of physiological changes. Postpartum, these normally get better. Aim: The aim of this study was to compare ocular alterations throughout the three trimesters of pregnancy and to assess the various physiological ocular changes occurring in pregnancy in women without additional co-morbid ocular or systemic disorders. Materials and Methods: It is Observational Cross section study included first 300 pregnant women between the age group of 18 to 35years (100 from each trimester) presented to tertiary care hospital, Jamnagar for routine check-up. Results: Total 300 women participated in this study. Out of 300 Pregnant Women 230 (76.66%) Women Show Physiological Ocular changes. These changes are more common in the age group of 21 to 30 years. Lid Cloasma and Occular Migrain are two most common Physiological Ocular changes seen in pregnancy. These changes are more common in first and second trimester as compared to third trimester. Conclusion:Lid chloasma, Refractive error, Low intraocular pressure, Ocular migraine are more common physiological changes during pregnancy. These changes are more common in the age group of 21 to 30 years. Occular Migrain, Krukenberg Spindle, Low IOP, Lid Pigmentation are more common in first and second trimester as compared to third trimester.

21. γ-Glutamyl Transferase as a Marker of Oxidative Stress in Pre and Post-Menopausal Women
Stuti Soni, Gora Dadheech, Mamta Singh, R.C. Gupta
Introduction: Menopause is a physiological process in women representing complete cessation of menstruation and gradual decrease of estrogen secretion. The antioxidant substances present in the body play a role in combating the oxidative stress in menopause. Since, the enzyme γ-glutamyl transferase plays an important role in the metabolism of the endogenous antioxidant reduced glutathione (GSH), it can reflect the antioxidant ability in vivo. Aim: The present study was conducted to investigate γ-glutamyl transferase as a possible marker of total antioxidant capacity (TAC) of plasma. Materials & Method: The study included 50 female volunteers, selected from medical & paramedical staff, and healthy attendants of patients as per inclusion and exclusion criteria and were divided into two groups. Group I: Premenopausal women (n = 25); Group II: Postmenopausal women (n = 25). Venous blood samples were collected using aseptic techniques in plain vials for estimating estradiol hormone and Gamma GT and whole blood was collected in EDTA vials for the estimation of Ferric reducing ability of plasma (FRAP) which is a marker of antioxidant capacity. The data collected were analyzed using unpaired “t”-test for evaluating the level of oxidative stress in pre and post-menopausal women and the variations in the levels of gamma GT in the two groups. The results were expressed as Mean ± Standard Deviation (SD). Results & Conclusion:Depressed estrogen synthesis in postmenopausal women enhanced oxidative stress and lead to deficit of total antioxidant capacity of plasma. A significant increase in serum GGT in the post-menopausal group relative to the pre-menopausal group was found which was to compensate and correct the reduced glutathione levels by increasing its biosynthesis. Thus, GGT can be used as a marker of total antioxidant capacity of plasma and oxidative stress.

22. Assessment of the Impact of Corrected Maternal Anemia on Perinatal Outcome in Terms of Birth Weight and Gestational Maturity and its Comparison with Babies Born to Anemic Mothers
Bheemsen Kumar, Sanju Kumari, Gopal Shanker Sahni
Aim: The aim of the present study was to assess impact of corrected maternal anemia on perinatal outcome in terms of birth weight and gestational maturity and its comparison with babies born to anemic mothers and burden and severity of anemia in pregnant women. Methods: The present study was conducted at Department of Pediatrics SKMCH Muzaffarpur, Bihar, India for one year. Total 120 present women of 20+-4weeks of gestation with singleton pregnancy attending OPD of department of obstetrics & gynecology at NMCH for one year and were enrolled after taking informed consent. Results: A total of 120 women with pregnancy around 20+4 week’s gestation were included in this study. As per hemoglobin levels and WHO definition of anemia, 6 (5%) antenatal mothers had severe anemia, 78 (65%) had moderate anemia and 36 (30%) had Hb levels >10gm/dl. 78 women with moderate anemia i.e. hemoglobin level between 7-10gm% constituted our study group. Out of 78 women 4 were lost to follow up, one who developed PIH, one with bleeding and 12 who did not show improvement in hemoglobin level due to irregular intake or intolerance were excluded from this study. Conclusion: From the present study we concluded that; anemic mothers had higher chance of delivering preterm and low birth weight baby, which again is an important determinant of survival and quality of life a child.

23. A Cross-Sectional Assessment of the Clinico-Demographic Profile of Diarrheal Patients of Pediatric Age
Mohammad Asghar Ali, Anjum Equebal, N. P. Gupta
Aim: To focus on the clinical and socio-demographic profile of infants and children presenting with acute diarrhea. Methodology: This cross-sectional study was conducted in the Department of Pediatrics, DMCH, Darbhanga, Bihar for a period of 1 year (January – December 2022). House-to-house survey was done and data was collected by interviewing the mothers of selected children from 6 months to five years. The children were selected by a systematic random sampling technique. A total of 300 children under five were examined. Various parameters analyzed were age and gender distribution, chief complaints, feeding practices, nutritional status and estimation of dehydration. The data was accumulated and entered in a worksheet computer program. For all tests, confidence level and level of significance were set at 95% and 5% correspondingly. Results: The mean age of patients was 2.62+1.56 years. 52 were toddlers in this group. The remaining were infants and pre-school children. Out of 300 patients 156 (52%) males exceeded 144 (48%) females. Similarly in the case of Exclusive breast-feeding: Exclusive breastfeeding (EBF) for 6 months was given in a large no. of patients i.e. 150 (50%). 24% were given for 5 months, 16% were given for 4 months, and 10% were given for 7 months. A majority of patients (156, 52%) were not given bottle feeding while the remaining (144, 48%) were given. Maximum patients (126, 42%) had no dehydration whereas remaining 36% patients had some dehydration and 22% had severe dehydration. Conclusion: Less than half of the children under research had some-dehydration. Dehydration and malnutrition can also be prevented through patient education, availability of safe drinking water, adequate sanitation and hygiene.

24. Feto-Maternal Outcome Assessment among Pregnant Women Presenting with Thrombocytopenia: An Observational Study
Priyanka Shahi, Ila Priyanka, Geeta Sinha
Aim: The objective of this study was to study the maternal and fetal outcome among pregnant women presenting with thrombocytopenia. Methods: The present study was conducted at Department of Obstetrics and Gynecology, Patna Medical College & Hospital, Patna, Bihar, India for the period of one year. Pregnant women with singleton pregnancy with period of gestation 28 week onwards who attended ANC & found to have thrombocytopenia after screening were included. The study was performed after the approval of ethical committee of institute. Sample size 100 patients were included in study. Results: Mean gestational age was 38.42 ± 1.69 weeks. 15% were < 37 weeks, 70% were in 37 to 40 weeks and 15% were >40 weeks. The mean platelet count was 106907±30136/ μL. Majority of women had mild thrombocytopenia (62%). 36% women had moderate thrombocytopenia and only two had severe thrombocytopenia. Association of thrombocytopenia with other medical illness was evaluated in our study. It was found that anemia was associated in 8 women, four women had ITP and hypothyroidism was found in only two women. Rest all women have no diagnosed other medical illness. In our study it was found that PIH was associated with 25% of thrombocytopenic women. Among the 25 women who had PIH, majority of them had gestational hypertension in 60% followed by pre-eclampsia in 24%. Severe pre-eclampsia was noted in two (8%) women. Only two had eclampsia (8%). Conclusion: Most common cause of thrombocytopenia during pregnancy was gestational thrombocytopenia but other underlying causes must be considered as well. A careful examination and simple laboratory test are needed so that a serious condition that may require specific and urgent management (examples HELLP syndrome, severe pre-eclampsia, TTP, HUS, AFLP) is not missed. Management of pregnant women with platelet disorders requires a multidisciplinary approach.

25. A  Study on the Impact of Blood Pressure and Serum Electrolytes Level on Ejection Fraction in Acute Myocardial Infarction Patients
Sujit Kumar, Rashmi Singh, Shailesh Kumar Pankaj, Rita Kumari, Kiran Narayan
Aim: This study aims to find out the role of BP and serum electrolytes in patients of AMI and to assess the efficacy of PCI as well as to predict the prognosis in AMI patients. Methods: A total of 50 patients of AMI were included in this study. We included those patients who visited to  NMCH, Patna, Bihar, India for 12 months, for treatment. All patients were male. This study was a longitudinal, interventional study. Results: It has been noticed that 50% of patients have normal systolic BP while 40% have high SBP and few (10%) have low SBP. All patients have normal diastolic BP. About 80% of patients with normal SBP showed improved EF after PCI while 80% of patients with low SBP and 75% of patients with high SBP showed improvement in EF. Hence, it is found that those patients who had abnormal SBP showed less improvement in EF (P = 0.93). Pulse rate of 80% of patients was in normal range while some of them have tachycardia (12%) and some have bradycardia (8%). The result showed that 58% of cases have normal serum calcium level, while 42% of cases showed hypocalcemia and only 1 case (2%) had hypercalcemia. We found that 75.9% of patients who have normal serum calcium level showed improvement in EF and 85% of hypocalcemia patients showed improved EF after PCI. There was only one patient with hypercalcemia and he showed improvement in EF. Conclusion: Increased serum sodium and potassium level are associated with poor prognosis, while lesser age and normal BMI are associated with improved prognosis in AMI patients after PCI.

26. A Cross -Sectional Study of the Factors Influencing Satisfaction of the Quality of Antenatal Care Services in Health Facilities
Rashmi Singh, Sujit Kumar, Shailesh Kumar Pankaj, Rashmi Singh
Aim: The objective of this study was to determine factors influencing the quality of ANC services in health facilities in Patna. Methods: This was a cross-sectional study conducted in Patna.  Random sampling was used for sampling procedure. All households of mothers having the youngest child of 3 years and below were visited. All respondents who did not consent or unwilling to participate; aged below 18 years; incapable of answering the questionnaires were excluded from the study. A  total of 1000 women gave their consent for participation. Results: The mean (SD) age was 28.3 (6.1) years ranging from 18 to 49 years. 55% of females were in the age group 20-29 followed by 55% in the age group 30-39. 76%  of them were housewives  and the rest were engaged in other jobs.  The majority of the respondents made more than nine antenatal visit during their last pregnancy (73%) followed by 5–8 times (20%) and only 7 % had 1–4 times antenatal visits. 60% of them booked antenatal visit before the third month followed by 32% who booked between 3 and 5 months of gestation.  39% were attended by both doctor and nurse. On an average 18 min were required to attend the clinic. It was reported that 19% did not have any out of pocket expenses. Conclusion: The study concludes that ANC services provision has an influence on the expectant mothers’ satisfaction.

27. A Comparative Clinical Assessment of Intrathecal Dexmedetomidine and Fentanyl as an Adjuvant to Isobaric Levobupivacaine in Patients Posted for Lower Limb Orthopaedic Surgery
Anil Kumar Singh, Amit Kumar, Veena Horo, Arjun Prasad
Aim: The aim of the present study was to compare the efficacy and safety of 25 mcg of fentanyl vs 5 mcg dexmedetomidine as an adjuvant in 0.5% of 2.5 ml of isobaric levobupivacaine in lower limb orthopaedic surgery. Methods: The present study was conducted in the Department of Anesthesiology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. The study participants were randomly divided into three groups. The study population consisted of 90 adult patients who were classified as American Society of Anesthesiologists (ASA) physical status I or II, undergoing elective lower limb orthopaedic surgery under spinal anesthesia. Results: In the present study, male dominated in all the three groups as compared to females. The patients were more in ASA I as compared to ASA II. The mean time for onset of sensory block was 11.04 ±4.21 min in the saline group and 8.76±2.99 min in the dexmedetomidine group and 2.28±1.42 min in the fentanyl group. The mean time taken to achieve maximum sensory block in group A was 16.18±4.83 min, in group D was 14.16±3.42 min and in group F it was 5.52±1.67 min so maximum sensory block was achieved earlier in group. Peak level of sensory block attained in the fentanyl group was T4 and the peak level of sensory block in dexmedetomidine group was T6 and in the saline group peak level was T8. Conclusion: Dexmedetomidine group has longer onset of and duration of sensory block and effective postoperative analgesia and fewer side effect as compared to fentanyl group.

28. Cytological Diagnosis of Metastatic Lymph Node Lesions: An Observational Study
Amit Kumar, Jyoti Kumari
Aim: The aim of the study was to find out the cytological diagnosis of metastatic lymph node lesions. Methods: The present study was conducted in the Department of Pathology, Bhagwan Mahavir Institute of Medical Science, Pawapuri, Bihar, India and study of all metastatic lymph node on FNAC samples reported over a period of nine months. Results: The age of the patient ranged from 24 to 80 years with a mean of 60.4 years. The incidence was seen to peak at the age range above 60 years showing 144 cases (60%), followed by 84 cases (35%) in the age group 40 to 59 years. There were 12 cases (5%) below 40 years of age. The incidence of metastasis were more in female (144 cases, 60%) as compared to male (96 cases, 40%). The most common subtype of metastatic malignant tumor was adenocarcinoma and was observed in 156 cases. The metastatic lymph nodes were located in anterior and posterior cervical triangles, supraclavicular area, axilla, abdomen and inguinal region. The most common sites were the cervical triangles comprising 120 cases followed by 72 cases from supraclavicular nodes. Conclusion: Cytology evaluation along with proper clinico-radiological correlation is quite useful in diagnosing metastasis with good degree of certainty. To conclude, in developing countries, like ours, FNAC is a cheap quick and reliable method to assess suspicious lymphadenopathy.

29. Assessment of the Efficacy of Low Concentrations of Local Anaesthetics (0.1% Bupivacaine and 0.1% Ropivacaine) with 2 µg/Ml Fentanyl as Epidural Analgesia: A Randomized Clinical Study
Amit Kumar, Anil kumar Singh, Arjun Prasad, Veena Horo
Aim: The present study was conducted to assess the efficacy of low concentrations of local anaesthetics (0.1% Ropivacaine and 0.1% Bupivacaine) with 2 µg/ml Fentanyl as epidural analgesia. Methods: The present study was conducted at Department of Anesthesiology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. All enrolled patients were informed regarding the study and their written consent was obtained. 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of Bupivacaine 0.1% + Fentanyl 2µg/ml and Group II received 10ml of Ropivacaine 0.1% + Fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analysis. Results:  There was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificant when compared in two groups. Conclusion: The use of local anaesthetics (bupivacaine and ropivacaine) in low concentrations with opioids (fentanyl) offer high maternal satisfaction in terms of quality of pain relief with fewer adverse effect.  Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl. However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

30. A Case Control Assessment of Glycated Haemoglobin & Total Protein and Albumin Levels in Patients with Type 2 Diabetes Mellitus
Shailesh Kumar Pankaj, Sujit Kumar, Rashmi Singh, C P Jaiswal
Aim: To evaluate the glycated haemoglobin, total protein and albumin levels in patients with type 2 diabetes mellitus. Material & Methods: A case control study was carried out at Department of Pathology, NMCH, Patna, Bihar, India for one year to evaluate the glycated haemoglobin, total protein and albumin levels in patients with type 2 diabetes mellitus. The protocol was explained to the subjects and those who gave their informed consent were recruited for the study. A total of 122 subjects comprising of 61 diabetic subjects and 61 controls aged between 40 and 73 years were recruited for the study. Results: The mean level of HbA1c was significantly higher in the diabetic subjects when compared with control group (9.71± 1.30Vs 5.58± 0.65; p=0.000). There were no significant differences observed between the age, the serum levels of Albumin and Total protein in the test and control subjects (p>0.05). There was no significant correlation between age, HbA1c, total protein and albumin in diabetic subjects. Conclusion: This finding implies that there was a poor glycemic control in the diabetic subjects studied. Therefore, there is need for better management of diabetic patients through medication and use of diet and exercise.

31. To Study the Association Between Body Mass Index (BMI) and Hand Grip Strength on Bone Mineral Density in Type 2 Diabetic Males and Females of North Bihar
Kunal Kishor Gautam, Pratima Singh, Seema Kumari, Rajiva Kumar Singh, Archana Gautam
Aim: This work aims to study the association between body mass index (BMI) and hand grip strength (HGS) on bone mineral density(BMD) in type 2 diabetic males and females of North Bihar. Materials and Methods: This study involves five hundred(500) subjects comprising of both diabetic and nondiabetic, males and females, of age group 30–70 years. Quetelet index was used to calculate BMI and handgrip dynamometer was used for measurement of Hand Grip Strength (HGS) using a. maximum isometric tension i.e., T max in kg and endurance time (ET) in seconds, i.e., time of onset of fatigue for 70% of the Tmax. BMD is measured in distal end of tibia by using bone sonometer. WHO compliant- T score and Z score were used for analysing results. Results: BMI had a weak negative correlation with BMD and HGS max (P = 0.037) among diabetic patients. BMD had a weak positive correlation with HGS max (P = 0.0139) and ET. Non-diabetic males have significantly higher HGS(P = 0.05). In non-diabetic females, both HGS(P < 0.001) and ET(P = 0.04) were significantly higher. There was no significant difference in the BMD between T2DM and non-diabetics. Conclusion: We observed no significant difference in BMD among non-diabetics and diabetics in our study, whereas osteoporosis was more likely common in diabetics though not significant statistically. Muscle strength(HGS) was found to be lower among diabetics as compared to non-diabetics. Hence, regular assessment of muscle strength by HGS and timely assessment for osteoporosis is advised.

32. Examining the Role of Hematological Parameters among COVID-19 Patients: An Analytical Study
Jyoti Kumari, Amit Kumar
Aim: This study was aimed at examining the role of hematological parameters among COVID-19 patients in Bihar. Methods: The study was conducted at Bhagwan Mahavir Institute of medical science, pawapuri, Bihar, India for 7 months to compare hematological parameters of red blood cells (RBCs), platelets, and white blood cells (WBCs) among patients with and without COVID-19 diagnosis. In this study, 500 patients were recruited, a study group of 250 patients testing positive and a control group of 250 testing negative. Results: The result showed that 160 (64%) of COVID-19 patients were male and 90 (36%) were female, while 150 (60%) of non-COVID-19 patients were male and 100 (40%) were female. The age range of COVID-19 patients was 20-90 years old; 150 of these (60%) between 30 and 60 years old, 75 (30%) over 60, and the remaining 25 (10%) below 30. The non- COVID-19 patients’ age range was 20-88; 150 of these (60%) between 30 and 60, 55 (22%) over 60, and the remaining 45 (18%) below 30. Regarding the clinical information of COVID-19 patients, 79 of them (31.6%) were attending the hospital in critical status, 54 (21.6%) with mild symptoms, 50 (20%) asymptomatic, 52 (20.8%) with moderate symptoms, and 25 (10%) with severe symptoms. Regarding the COVID-19 patients’ situation during the study period, 175 (70%) recovered and were discharged from the hospital, 25 (10%) were still ICU patients at the end of the study period, 15 (6%) were isolated in hospital wards, and 35 (14%) unfortunately passed away. Conclusion: Our study results indicate that mild anemia associated with leukopenia may have diagnostic value for COVID-19. Careful assessment of hematological parameters, at baseline and throughout the disease path, will assist physicians in formulating personalized approaches to treatment and promptly offer intensive care to those in greater need..

33. A Randomized Comparative Evaluation of Dexmedetomidine and Clonidine as an Adjuvant to 0.5% Bupivacaine in Epidural Anaesthesia for Lower Limb Orthopaedic Surgeries
Amit Kumar Prasad, Vikash Kumar Singh, Asim Shekhar, Uday Kumar
Background and Aims: Alpha-2 adrenergic receptor agonists like dexmedetomidine and clonidine are used as an adjuvant to local anaesthetic agents in epidural anaesthesia. The aim of our study was to compare the effect of adding dexmedetomidine and clonidine as an adjuvant to  bupivacaine in epidural anaesthesia on the onset and duration of sensory and motor block and their safety profile in lower limb orthopaedic surgeries. Methods: This prospective randomized study included 100 patients aged 18-60 years of American Society of Anaesthesiologists physical status I/II scheduled for elective lower limb orthopaedic procedures. Written informed consent was taken from all the patients. Patients were randomly divided into two groups of 50 patients each. Group A patients received 15 ml of 0.5% bupivacaine plus 1 μg/kg of dexmedetomidine while the patients in Group B were given 15 ml of 0.5% bupivacaine plus 2 μg/kg of clonidine through epidural catheter. Results: Patients in dexmedetomidine group had significantly earlier onset of sensory block to T10 dermatome, highest level of sensory block and time for complete motor block was also significantly less when compared to the clonidine group. The dexmedetomidine group showed superiority over clonidine group in postoperative block characteristics like the weaning of sensory and motor block, postoperative analgesia. Sedation scores were also better in patients receiving dexmedetomidine as adjuvant. The incidence of side-effects like nausea, vomiting, dry mouth, shivering were comparable in both the groups and statistically non-significant. Conclusion: Dexmedetomidine is a better adjuvant to local anaesthetic agent than clonidine for epidural anaesthesia and analgesia as it results in early onset and establishment of sensory and motor block, prolonged postoperative analgesia and better sedation.

34. Outcome Assessment of Locking Plate Fixation in Displaced Intraarticular Fractures of Calcaneum
Ranjan Kumar Prakash, Kumar Mayank, Dilip Kumar Singh
Aim: The aim of the present study was to evaluate the functional and radiological outcome of intra-articular calcaneal fractures managed surgically with a plate in terms of bohler’s and gissane’s angle, rate of radiological union and AOFAS score. Methods: The Prospective study was conducted at Department of Orthopedics, JLNMCH, Bhagalpur, Bihar, India for the period of one year and a total of 30 patients with intra-articular calcaneal fractures meeting the inclusion and exclusion criteria were chosen for the study. Results: In our study, patients between the ages group 18 yr and 60yr with a mean age of 33.36yr were included. The majority of the patients in the study were males, with 90% of the study population. In this study, 60% of the patients had right side involvement and 40% of the patients had left side involvement. The most common mode of injury in the study group was falling from height followed by RTA. The most common fracture type in our study was Sander’s type II, followed by type IV. Type III was the least common. In all the patients included in the study, surgery was delayed until the appearance of wrinkles on the skin to avoid the complication of wound dehiscence and for appropriate wound closure. The number of days from the injury to surgery varied from 4 to 14 days with an average of 7.8 days. The average time period for the radiological union was 13.64 weeks in the study population. Conclusion: We concluded that with proper pre-operative planning, the timing of surgery, intra- operative expertise of the surgeon, and post-operative care, surgical management of intra-articular fracture using a locking plate, gives a better outcome and minimal complications.

35. A Prospective Hospital-Based Assessment of the Clinical Features of Hyponatremic Dehydration in Acute Gastroenteritis
Anjum Equebal, Mohammad Asghar Ali, N. P. Gupta
Aim: To estimate the incidence of hyponatraemic dehydration in infants and children aged till 12 years and to evaluate clinical features associated with acute gastroenteritis associated dehydration. Methodology: A prospective observational study was conducted in Department of Paediatrics, Darbhanga Medical College & Hospital, Darbhanga, Bihar for 11  months (December 2021 – October 2022) . Study  population  consisted  from Infants  to  children  aged  till  12  years  attending  the pediatric  Department  both  OPD  and  IPD  care  for  acute gastroenteritis  are  enroll  in  the  study  who  is  satisfying the criteria for Moderate to severe dehydration. A total of 100 Children including neonates are enrolled in the study. After   obtaining informed  consent  from  the  parents  of  cases,  they  are subjected  to  detailed  history  and  clinical  examination and  the  findings  were  entered. Blood samples were collected and serum electrolytes & serum Calcium were measured and compared with that of the clinical aspects of the patient i.e diarrhea, vomiting, thirst, fever, abdominal distention and convulsions followed by urine analysis. Results: Out of 56% males, 22 were hyponatremic (39.4%) and out of 44% females, 17 were hyponatremic (38.6%). Hyponatremia was found in 31 subjects with high incidence in  lower  age  group  in  both  the  genders.  Males (39.4%) were more affected than females (38.6%). Lowest sodium level was 127mmol. Among 100 individuals, 36% had severe dehydration and rest of them had some dehydration (64%). The number of episodes  of  loose  stools  were  correlating  with  the extent  of  dehydration. Higher the episodes, the severe was the dehydration. Vomiting were associated with diarrhea in 61% subjects whereas 39% subjects only complained of diarrhea. Only 11 individuals showed hypokalemia without hyponatremia. About 3 subjects showed hypokalemia with hyponatremia. Conclusion: This study, like others before, found electrolyte imbalance in more than half of the gastroenteritis children. It can be said that electrolyte disturbances are very common in children with acute diarrhea. The degree of dehydration and the age of less than 12 months seem to be good prognostic factors for electrolyte imbalance. Early diagnosis and treatment are very important to prevent complications.

36. A Hospital Based Retrospective Assessment of the Efficacy of Short Course Intravenous Methylprednisolone in the Management of SSNHL
Raj Kumar Chaudhary, Deepak Kumar Raman, Rana Pratap Thakur
Aim: The aim of this study was to determine the efficacy of short course intravenous methylprednisolone in the management of SSNHL. Methods: A retrospective review of the record data of the cases with SSNHL who received short course methylprednisolone therapy was conducted in the department of ENT-head and neck surgery, Anugrah Narayan Magadh Medical College and hospital, Gaya India for 6 months. Record data of 50 patients who met the inclusion criteria were included in the study. Results: There were 32 males (64 %) and 18 females (36%). The age of the patients ranged from 18 to 72 years, with the mean age being 40.59 years. In the age group 0-20 years there were four (8%) patients, in 20-40 years there were 25 (50%) patients, in 40-60 years there were 14 (28%) patients, and in >60 years there were 7 (14%) patients. Thirty one (62%) were admitted within three days of presentation and 19 (38%) were after three days. At presentation, 6 (12%) patients had mild hearing loss, ten (20%) had moderate, and 34 (68%) had severe hearing loss. The presence of vertigo, tinnitus or comorbidities didn’t have any significant bearing on hearing recovery. Conclusion: Short course intravenous methylprednisolone is effective in the treatment of SSNHL with minimal side effects.

37. Sociodemographic Characteristics of Patients with Snakebite: An Observational Study
Ashok Kumar, Ravi Kumar Raman, Rajan Kumar
Aim: The present study was conducted to understand the sociodemographic profile of fresh cases of snakebite in Bihar region. Methods: It was an observational, prospective and cross-sectional study. The study was conducted at department of general medicine Patna medical college and Hospital, Patna, Bihar India. Hundred admitted cases of symptomatic snake bite in the Patna medical college and Hospital were selected for the study. The age range was 16 to 60 years. The study was conducted for the period of one year. Results: The result shows that there were 30% patients belonged to the age range of 16 to 26 years. 25% patients belonged to the age range of 49 to 60 years. 20% patients belonged to the age range of 38 to 48 years. 25% patients belonged to age range of 27 to 37 years. It can be seen in that 73% cases were in the age range of 16-48. The descriptive analysis of the sociodemographic details shows that 60% patients were male and 40% were females. The result shows that 90% patients belonged to rural areas whereas only 10% patients belonged to urban areas. The result shows that 90% patients belonged to lower socioeconomic status and 10% patients belonged to middle socio-economic status. Conclusion: The present study concluded that majority of the snakebite fresh cases belonged to male gender. Majority of cases fell in the age range of 16-48 years, majority of cases belonged to lower socioeconomic status and rural areas. The time of seeking treatment has reduced because of awareness about snake bite treatment and better transport facility.

38. Digital Media: A Trendsetter in Surgical Learning
Harshal A. Chohatkar, Yamini S. Sorate, Vinayak J. Shenage, Shridhar Radhakrishnan
Background: Digital media is an efficient, immediate, accessible and potentially inexpensive medium for the widespread publication, sharing and discussion of educational material, therefore, it is gaining popularity among the medical sector as an electronic learning platform. However, there are many benefits, and also certain limitations to use of digital media as education tool. This study was conducted to audit the use of digital media by surgeons and its potential as an education tool. Methods: We conducted this online survey among the surgeons for a period 7 months under the Department of General Surgery, Tertiary Care Hospital in Rural Northern Maharashtra. The online questionnaire containing 25-items, probed the specifics of digital media use for surgical education. It was created using google forms. The validity of the questionnaire was assessed by 10 independent faculties and the Cronbach alpha for questionnaire was 0.89. This questionnaire was posted on Facebook groups, few professional Instagram pages and closed surgical groups on WhatsApp. The collected data was entered in the MS excel spread sheet and the descriptive analysis of the variables was done using the same. Results: Respondents included were practicing general surgeons (54%), orthopedic surgeons (16%), gynaecologists (8%) and other specialists and super specialists. Most common purpose of digital media use was learning and teaching both (58.7%). YouTube (90%) was most preferred digital media application followed by WhatsApp (57.5%), Facebook (52%), Pubmed (47.5%), Slideshare (47.5%) google platforms (42.5%) and Instagram (20.5%).   Operative surgery videos (89.5%) and live teaching videos (61.5%) were found most useful. Majority felt digital media was helpful for surgical learning (91%) and it is helping them to learn surgery fast (43%). However, many also believed that conventional learning is superior (72.5%) and irreplaceable (73.5%).  Conclusion: Despite many accepted advantages digital media has not gained trust of surgical fraternity to become main learning tool and is continuing to serve as a complementary tool in surgical learning.

39. Comparing Intravenous and Oral Esmoprazole on Intra Gastric PH in Patients with Peptic Ulcer Bleed (PUB)
Bashir Ahmad Mir, Nishat I Iram, Abhishek Gupta, Farhat Mustafa, Khalid Iqbal
Background: Oral and intravenous proton pump inhibitors (PPIs)are used in patients with peptic ulcer bleed (PUB) for acid suppression clot stabilisation. Aim: To compare acid suppression produced by standard doses of oral vs. Intravenous esomeprazole in patients with peptic ulcer bleed after initial endoscopic stabilisation. Methods: A randomized study was done on twenty patients admitted with peptic ulcer bleed with stigmata of recent hemorrhage who after initial endoscopic treatment were divided into two groups; one receiving oral while other receiving intravenous esomeprazole. The mean pH in the oral group was 7.06 ± 0.44 while the mean pH in the intravenous group was 6.78±0.27. There was statistically no difference in intragastric pH for 72 hrs with esomoprazole given either orally or IV (p=0.1). Thus oral esomeprazole is as effective as intravenous esomeprazole.

40. An Evaluation of Chest Computed Tomographic Features in Multi – Drug Resistant Tuberculosis
P. Balamurugan, S. Kanaga Durga, D. Jayaraja, S. Thaiyalnayaki
Introduction: Diagnosis of drug sensitive Tuberculosis and Multi drug resistant tuberculosis (MDR – TB) starts with identifying acid fast bacilli (AFB) from sputum but to confirm the diagnosis sputum culture is mandatory which often takes at least two to three weeks. Similar failure to first line anti-TB treatment in MDR-TB and drug sensitive TB lead to misdiagnosis and deferred treatment with rise in pathogen spread. So we are in need an alternative way of early diagnosis and treatment. Objectives: 1. To evaluate the chest tomographic features of multi-drug resistant tuberculosis (MDR-TB) patients 2. To detect the characteristic radiological features of MDR-TB, which would prove as findings to detect the doubt of MDR-TB in a patient with tuberculosis. So, they referred to gene expert for early detection and further management. Materials and Methods: Total of 405 patient’s underwent CT-chest during the study period and 100 cases proved MDR – TB in the study. Age, Gender, history of anti-tuberculosis drug taken and CT chest features were analyzing for the MDR – TB patients. Results: Multiple thick-walled cavity and consolidation with cavitation were more commonly seen in MDR-TB patients. When these findings were present, they were extensive and involved all lobes. Pleural effusion, fibrosis, atelectasis, bronchiectasis and mediastinal lymphadenopathy is more commonly seen in multi drug resistant tuberculosis patients. Conclusion: The feature of multiple thick-walled cavities, consolidation with cavitation with extensively noted in multiple lobes of bilateral lung fields should raise the doubt of multi-drug resistance Tuberculosis. These patients should be refers to gene-expert to confirm the diagnosis and further treatment / Management.

41. An Analysis of the Role of MRI in Patients with Neurological Deficit in Spinal Tuberculosis
Shereen D, Suresh D
Spinal tuberculosis is a destructive form of tuberculosis. Neurological complications are the most dreaded. Spinal tuberculosis in the thoracic spine is most commonly associated with neurological complications as it has a narrow spinal canal. Neurological deficit in TB is of two types 1) early onset and 2) late onset. Early onset spinal tuberculosis with active disease causing neurological deficit would require active treatment with or without surgical decompression. Late-onset paraplegia due to healed disease caused by the bony transverse ridge, granulations, mixed lesions, and vertebral subluxation may require surgical treatment. Patients with acute compressive symptoms underwent emergency MRI and decompressive surgery and showed good neural recovery. The late-onset neurological deficit with myelomalacia changes and dry lesions showed poor neural recovery. MRI played a key role in patients with neurological deficits by diagnosing the disease, identifying the location, and characterizing the lesions. MR imaging by assessing the cord status, nerve roots, and cauda equine was able to prognosticate and helped in treatment planning. The present study was conducted to correlate MRI findings with neurological status and determine the role of MRI in these patients.

42. A Study on Albuminuria and Thrombocytopenia as Prognostic Indicators if Acute Kidney Injury in Hemotoxic Snake Bite
Renuga, P. Thirunavukarasu, R. Shanmugam
Background: Snake bite is one of the most avoidable reasons of death and the occurrence of snake bites is on a growing trend due to numerous elements. The gravest complication of snake bite is acute kidney injury and our study is to evaluate albuminuria and thrombocytopenia as early prognostic indicators of acute kidney injury in snake bite. Methodology: A hundred patients who got admitted in the Department of General Medicine in District Head Quarters hospital & DNB Post Graduate Teaching Institute, Virudhunagar for a duration of 6 months from September 2019 to February 2021 with a history of snake bite were undertaken for study and they were monitored with blood urea, serum creatinine, urine albumin and platelet count and correlate with the factor which category of patients was moving ahead towards developing AKI and how identifying albuminuria and thrombocytopenia helps in the evaluation of progression of cases to AKI. Conclusions: In patients with snake bite, patients who had albuminuria and thrombocytopenia are associated with the development of acute kidney injury.

43. Prospective Study Comparing the Effect of Atorvastatin and Atorvastatin with Vitamin D3 Granules on Lipid Profile of Hyperlipidemic Patients
Derangula Sambasivaraju, K R Suresha, Sadgunothama Goud Kamparaj, S. Srimanth Madanna, Ravi H. Kudthni
Background: Lipid imbalances are considered to be a risk factor for cardiovascular disease. Vitamin D supplementation combined with atorvastatin has been proven in studies to have synergistic effects in decreasing serum cholesterol concentrations. The current study compared the effect of combination of 1000 I.U of Vitamin D3 and Atorvastatin 10 mg per day to Atorvastatin 10 mg per day on serum total cholesterol, HDL, LDL, VLDL, and Triglyceride readings in hyperlipidemic patients. Methodology: Between January 2022 and December 2022, 100 patients with Dyslipidemia were studied in the outpatient department at Viswabharathi Medical College & General Hospital, Kurnool. Out of 100 patients, 50 received atorvastatin 10 mg/day orally for 4 weeks, whereas the remaining 50 received atorvastatin 10 mg and vitamin D3 1000 IU/day orally for 4 weeks. The plasma lipid profile was evaluated prior to intervention, as well as at the baseline, 4th week of the treatment, at 3 months and at 6 months. Results: The mean total cholesterol, the mean Low Density Lipoproteins, very Low Density Lipoproteins & Triglycerides were significantly reduced and the mean High Density Lipoproteins significantly increased in atorvastatin + Vitamin D3 group than in atorvastatin group at the end of 3 months. Conclusion: Plasma lipid profile improved significantly (P<0.05) in both groups. However the improvement was more in the atorvastatin + vitamin D3 group compared to atorvastatin treated group.

44. Prevalence of Induced Clindamycin Resistance in Methicillin Resistant Staphylococcus aureus Strains Isolated in a Tertiary Care Hospital
Akshatha P, D. Sarada
Introduction: Clindamycin is an essential alternative antibiotic in the treatment of Staphylococcus aureus infections. The limited treatment choices for MRSA emphasise the necessity of selecting the correct antibiotic. The occurrence of inducible clindamycin resistance, which can lead to treatment failure, is the main issue with using clindamycin for such infections. The D-Test was used in this investigation to detect inducible clindamycin resistance in methicillin-resistant S. aureus isolates. Methods: A D-test employing erythromycin and clindamycin was done according to CLSI standards to determine inducible clindamycin resistance. Four phenotypes were interpreted as methicillin-sensitive (MS) (D-test negative), inducible MLSB (iMLSB) (D-test positive), constitutive MLSB, and sensitive to both. Results: Of the 470 isolates tested, 80 (17.02%) were MRSA. The prevalence of iMLSB, cMLSB phenotype, MS phenotype and sensitive phenotype in MRSA isolates was 22(28%), 24 (29%), 4 (5%) and 30 (38%), respectively. The majority of MRSA isolates originated from Skin & nasal swabs. All S. aureus isolates showed 100% sensitivity to vancomycin and Gentamycin. Conclusion: This study highlights MRSA-induced clindamycin resistance. Thus, clinical microbiology laboratories should focus on D-zone assays to identify inducible MLSB resistance from constitutive. Increasing MRSA produced clindamycin resistance and antibiotic usage have increased sensitivity, prompting epidemiological investigation.

45. To Study the Magnetic Resonance Spectroscopy in the Evaluation of Intracranial Pathologies at Tertiary Care Centre, Gujarat
Ajay Chaudhary, Arun Makwana, Sanket Mathukiya, Niyati Gosai, Gaurav Desai
Background: Magnetic Resonance Spectroscopy (MRS) is a method for detecting and quantifying metabolites. The MRS method contrasts with conventional magnetic resonance imaging (MRI). Because MRS provides physiological and chemical information, not just anatomy. Objectives: To study the magnetic resonance spectroscopy in evaluation of intracranial pathologies. Materials and Methods: This cross-sectional study conducted among 50 patients who were undergone for MRI brain and subsequent MRS of region of interest. The metabolites were observed in the spectrum and any alteration in form of increase or decrease in above mentioned metabolites was noted. In case of tumors final diagnosis was obtained by histopathology where possible while in non-neoplastic cases final diagnosis was obtained by clinical course and follow up. Results: In our study 23 of 27 tumors (85%) showed contrast enhancement. Among non-neoplastic lesions, tuberculous lesions are the most common (48%), followed by demyelination (17%), encephalitis (13%), and toxoplasmosis (8%). Choline is elevated in 90% of tumors, NAA is decreased in 93% of neoplastic pathologies, and lipids are elevated in 56% of tumors. In tumor diagnosis, the sensitivity, specificity, PPV, and NPV MRI + MRS were all 96%. Conclusion: MRS is an important diagnostic and research tool in clinical neuroscience. MRS is a very useful tool when combined with conventional MRI for glioma grading. It also plays an important role in narrowing the differential diagnosis of metabolic brain diseases. MRS is also important in diagnosing stroke and demyelination of the brain.

46. Knowledge, Attitude and Practice of Paramedical Staff Working in a Medical College and Hospital towards Antibiotic Use and its Resistance: A Cross-Sectional Study
Lalit Mohan Sika, Gurukrushna Mohapatra, Somanath Sethi, Jigyansa Mohapatra
Background: Antibiotic misuse is common and contributes to antibiotic resistance, particularly in less-regulated healthcare systems like India. Antibiotic knowledge is well known to be relatively low among patients and the general public in many countries. Antibiotic misuse is especially noticeable in India, which is one of the largest global consumers of antibiotics for human health. Objective: To assess the knowledge, attitude, and perceived practices of paramedical staff working in a medical college and tertiary care hospital regarding antibiotic usage and resistance. Methodology: This is a cross-sectional quantitative questionnaire-based study in a tertiary healthcare medical college and Hospital in eastern India. Total of 341 paramedical staff were provided with a pretested self-administered questionnaire. The survey questions focused on key topics such as antibiotic knowledge, attitude, and perceived antibiotic usage practices. Result: The majority of participants were under 40 years old and graduates. They understood antibiotic resistance well (81.81 percent) and side effects (91.2 percent). However, there was a widespread misunderstanding about the indications for antibiotic treatment, with only 17.00 percent agreeing that antibiotics play no role against viruses. The overall attitude was poor, with 65.98 percent expecting antibiotic prescriptions for short-term fever and the common cold. An alarming 92.96 percent of children expected antibiotic treatment for an ear infection. Compared to other paramedical staff, nurses and pharmacists had four times the knowledge about antibiotics. There was no significant relationship between antibiotic prescription patterns and doctor trust. Conclusion: Most participants knew a lot about antibiotic resistance and its side effects. Still, their attitude and usage practices are poor, and outcome-based education, such as frequent Continuing Medical Educations and awareness campaigns, could effectively bridge the gap between knowledge and practice.

47. A Study of Association between Serum Testosterone Levels and Clinical Aspects of Schizophrenia
Mamta Singh, Gora Dadheech, Shikha Mathur, R. K. Solanki
Background: Sex disparities in schizophrenia especially in negative symptoms may be related to the action of sex steroid hormones. Objective: The purpose of this study was to analyze relationship of serum testosterone levels with respect to clinical psychopathology laying emphasis on negative symptoms in male patients with schizophrenia. Material & Methods: The study population consisted of two hundred male schizophrenia patients and fifty age matched healthy individuals. Sociodemographic data and history of illness were noted in semi-structured proforma. Clinical psychopathology was assessed by Positive and Negative Syndrome Scale (PANSS). Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) and Calgary Depression Scale for Schizophrenia (CDSS) were also used to exclude the effects of extrapyramidal symptoms and depression. Serum testosterone level was measured by chemiluminescence method. Data were analyzed by chi square test (x2) and z-test. Pearson’s correlation analysis was used for association of testosterone level with PANSS sub-scale scores. Results: Mean testosterone level was significantly lower in schizophrenia patients (381.90±158.29; p=0.001) as compared to healthy subjects (520.51±145.94). A significant inverse association was detected between PANSS negative sub scale scores and testosterone levels (r = -0.211; p = 0.034). There was no correlation with other PANSS sub scale items (i.e., positive symptoms, general psychopathology and total scores), age of onset and disease duration. Conclusion: The present study indicates that either lower level of testosterone may have a role in presentation of negative symptoms in schizophrenia or the pathophysiological processes of disease affected the testosterone levels. Therefore, clinicians are advised to monitor levels of testosterone in patients with predominant negative symptoms of schizophrenia and enquire about sexual dysfunction and infertility. Lower level of sex steroids is a point of concern as these patients are at high risk of osteoporosis and cardiovascular co-morbidities. In near future therapeutic strategies targeting testosterone could be useful in ameliorating the negative symptoms of disease.

48. Open Reduction and Internal Fixation of Posterior Acetabular Fractures in Young and Middle Aged Patients: A Prospective Study
Singh Balvinder, Jain Ankesh, Meena Ashu Kumar,  Kumar Ramesh, Ali Syed Sahil
Background: Acetabular fractures are one of the most challenging fractures for an Orthopaedic Surgeon to manage. Even in the most experienced hands, the prognosis and outcome remains guarded sometimes. The purpose of the present study was to evaluate the outcome after operative treatment of posterior fractures of the acetabulum. Methods: 24 patients who had been followed for a minimum of 1.5 years after operative treatment of an elementary posterior wall fracture of the acetabulum were included in the study. Functional outcomes were assessed with use of the Merle d’Aubigné score. The duration of follow-up ranged from 1.5 to 3 years (mean 2.3 years). Results: The mean score was 15.12. (Standard Deviation, 2.43; Range, 9 to 18), indicating overall good-to-excellent clinical results.75% of the patients achieved good or excellent results overall. The number of excellent to good results was 87.5% when the surgery was carried out within first 7 days. There was no incidence of Avascular Necrosis in this study. Conclusions: The acetabular fractures are a result of high energy trauma with associated multiple injuries with 8.3 % patients having associated haemothorax, 8.3 % having pelvic/abdominal visceral injuries, 33% having fractures at other sites and 16% associated with head injuries. In 29% of cases, the injuries were associated with posterior dislocation of hip. Most affected age group was 20 – 30 years (37.5%) followed by 30 – 40 years (33%). RTA was the causative factor in 91% of the cases. There was a significant difference in outcome when surgery was done early (1 – 7 days) (p = 0.0295) and post-reduction incongruity was ≤ 1 mm (p = 0.0447).

49. Collagen versus Conventional Dressing in Management of Chronic Non-Healing Ulcers in a Tertiary Care Hospital
Banurekha R, Deebapriya A P, Sivasankar R
Introduction: Wound dressing plays an important part in the healing of chronic ulcers. The decision to use newer dressing materials like collagen or conventional methods like povidone iodine depends on previous experience, cost, clinical and available resources. Objective/Aim: To compare the effectiveness of collagen dressings with conventional dressing materials like povidone iodine in the treatment of chronic non healing ulcers in patients who are admitted in General surgery wards of a tertiary care medical college hospital. Materials and Methods: This prospective, parallel group comparative trial done in patients admitted with chronic ulcers during the period from August 2021 to October 2022 compares the effectiveness of collagen granule dressing with conventional dressing material povidone iodine in the treatment of chronic non healing ulcers. The parameters age, sex, duration of ulcer, pain, rate of healing, duration of hospital stay, infection, need for split skin graft and patient compliance were studied. There were 60 patients during this study period who were randomized by lottery method into collagen dressing and conventional dressing groups. The observations were entered into Microsoft excel and SPSS version 22 was used for analysis. Datas were analysed statistically by unpaired t test for numeric variables, chi square and Mann whitney u test for categorical variables. P value less than 0.05 was considered significant. Results: Significant advantages of collagen dressing over conventional dressing in terms namely pain, rate of healing, duration of hospital stay, infection, need for split skin graft, and patient compliance were observed. No significant difference found in terms of age distribution, sex preponderance and duration of ulcer. Conclusion: Collagen dressing had statistically significant less pain, faster healing rate, less duration of hospital stays, low infection rate, less need for skin grafting, better patient compliance and can be used as a suitable alternative to conventional dressing like povidone iodine in patients with chronic non-healing ulcers.

50. A Retrospective Study on Transfusion of Blood Components in Obstetrics at a Tertiary Care Centre
Lavanya Sabesan, Priyadarshini Manoharan
Background: Blood transfusion is an indispensable implementation in obstetric emergencies in saving lives. Appropriate utilisation of blood components reduces the maternal mortality and morbidity. The objective of this study is to analyse the indications of transfusion of blood components in obstetrics in Government Mohan Kumaramangalam Medical College Hospital, Salem. Methods: This is a retrospective study done on women who received blood transfusion in obstetrics from the month of December 2021 to November 2022 for a period of 1 year. Patients receiving blood transfusion for various reasons during the study period were included in the study and data collected. Results: A total of 4532 patients received transfusion of blood components during the study period in the department of obstetrics. Out of which 3420 patients received transfusion for anaemia (75.4%), 828 cases for atonic PPH (18.2%), 122 cases for HELLP (2.6%), 18 cases for placental abruption (0.39%), 36 cases for traumatic PPH (0.79%), 24 cases for placenta previa (0.52%), 18 cases for thrombocytopenia (0.39%), 21 cases for ruptured ectopic pregnancy (0.46%), 4 cases for uterine rupture (0.08), 6 cases for haemolytic anaemia and DIC each (0.13%), 19 cases for incomplete abortion (0.41%), 5 cases for complete abortion (0.11%) and 5 cases for molar pregnancy (0.11%). Conclusion: In this study, anaemia was found to be the highest contributor to blood transfusion in our tertiary care centre.

51. Critical Review of Covid-19 Associated Mucormycosis of Nose and Paranasal Sinuses in A Tertiary Care Hospital in Ongole, Andhra Pradesh
Dakshinamurthy, Ravindra Babu Kota, Sandeep Vemu, Tadi Saiprasad
Background: Mucormycosis is a fungal infection caused by filaments of Mucoraceae which invades blood vessels culminating in a lethal opportunistic infection. During the second wave of COVID-19, all over India a spurt of increased reporting of Mucoraecea infection was experienced. Compromised individual immunity system was suspected. Its early diagnosis and suitable surgical intervention were essential to decrease morbidity and mortality. Aim of the Study: To study the demography, clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis and to evaluate the clinical outcomes in each case. Materials: A cross sectional study from the Department of ENT of Government Medical College Hospital, Ongole; 350 COVID-19 RT-PCR positive patients presented with clinical symptoms and signs of Mucormycosis between February 2021 and February 2022 were analyzed. All age groups and genders were included. Mucormycosis proved on microscopic examination of the aspirate or histopathologies of tissue specimens were included. Clinical findings, risk factors, comorbidities, outcome of the disease, biochemical and hematological investigations, radiological signs, nature of fungal elements isolated, treatment instituted were noted. Surgical procedures included were Functional Endoscopic sinus surgery, extended Endoscopic sinus surgery, Medial maxillectomy, ethmoidectomy, Sphenoid exploration, frontal sinusotomy, Orbital exenteration and Skull base surgeries. Antifungal treatment consisted of administration of liposomal Amphotericin B and posaconazole. Results: 350 patients included in this study; 268/350 (76.57%) males and 82/350 (23.42%) females with a male to female ratio of 3.26:1. 211 (60.28%) patients living in rural areas and 139 (39.71%) living in the urban areas. 324 (92.57%) patients were positive for COVID-19 (RT-PCR) test and 26 patients were negative. There were 233 (66.57%) patients who were obese with more than 30 BMI index and 117 (33.42%) who were with less than 30 BMI index. 299 (85.42%) patients were diabetic and 51 (14.57%) patients were non diabetic. Vaccination was taken 188 (53.71%) of the patients and not taken by 162 (46.28%) of the patients. Mortality rate was 09/350 (02.57%). It was observed that the variables such as Living area, COVID-19 (RT-OCR) test positivity, obesity, Diabetes mellitus and usage of steroids were significantly associated with Mucormycosis in this study. Conclusions: Mucormycosis was found to be common in males, from the rural areas. Other significant risk factors for Mucormycosis were COVID-19 (RT-OCR) test positivity, obesity, Diabetes mellitus and usage of steroids. The most common clinical symptoms and signs among were nasal obstruction with noisy breathing, blood stained nasal discharge, headache, periorbital swelling, reduced vision, Ptosis, external ophthalmoplegia, and facial pains were common. Surgical management reduced the morbidity and mortality of Mucormycosis in this study.

52. Comparative Study on Buteyko Breathing Technique and Pranayama on Pulmonary Function and Quality of Life in COPD Individuals
Vydadi Seetharamaraju, Raghavendra Sherikar, Swaroop Chand Bhansali, T Jaya Chandra
Introduction: COPD is a preventable and treatable clinical condition. The aim of the study was to compared the effectiveness of buteyko breathing technique (BBT) and Pranayama on improving pulmonary function in quality of life among the COPD individuals along with conventional physiotherapy. Methods: It was a prospective study conducted in the department of Physiology, Mallareddy womens Medical College. Individuals of both gender aged between 40 – 60 years medically stable COPD were included in this research. Study participants were divided into group A and B. Initially FEV1 and FVC were evaluated. Along the conventional physiotherapy, BBT was the option for group A and pranayama for group B for 5 days in week and continued for 6 weeks. At the time of the recruitment the study members were trained with the respective techniques. The time of the session was twice a day, at least 2 hrs before food. Techniques were carried as per guidelines. Finally the outcome was assessed with the help of pulmonary function test, FEV1 FVC ratio. The quality of life was assessed by 36-item short form; t test was used to find the statistical analysis. P<0.05 was considered to be statistically significant. Results: Total 60 members were included; the Mean+SD values of FEV1/FVC for group A were 58.333+2.26242 and 75.367 + 1.3472, respectively for pre and post-test; statistically there was significant difference (P = 0.000); whereas for group B, Mean+SD values were 57.267+1.7006 and 65.66 + 4.0542 respectively for pre and post-test; statistically there was significant difference (P = 0.000). Statistically there was significant difference in SF36. Conclusion: BBT as well as Pranayama relived the individuals from COPD symptoms; but superior results with BBT. Large samples with long term followup is recommended.

53. A Prospective Study on Clinical Features of Anomalies of Cortical Development and Incomplete Hippocampal Inversion
Sanjay Kumar
Objective: To research the prevalence and clinical traits of incomplete hippocampal inversion (IHI) and malformation of cortical development (MCD) in persons with uncontrollable seizures. Materials and Methods: 416 of the 3220 epileptic patients in our prospective study, who attended our epilepsy clinic between 2012 and 2014, experienced uncontrollable seizures. To determine whether MCD and IHI were present in any patients, a thorough clinical history, neurological examination, electroencephalography (EEG), computed tomography (CT) scan, magnetic resonance imaging (MRI) brain, and neuropsychological assessment were all carried out. Results: 85 patients out of 416 with uncontrollable seizures had MCD and IHI verified (48 males, 37 females). 39 patients (9.37%) and 46 (11.05%) patients, respectively, had IHI and MCD, respectively. No statistically significant differences were found between the MCD and IHI groups among patients in various age groups, genders, seizure types, duration and onset, seizure frequency, clustering, status epilepticus, EEG, febrile seizures, and family history, according to the results of the chi-square test. Statistically significant differences (P < 0.05) were observed between the MCD and IHI groups for change in seizure semiology and in intelligence quotient (IQ) and memory quotient (MQ) scores obtained using Wechsler’s adult intelligence scale III and Wechsler’s memory scale. The IHI group showed higher IQ and MQ scores when compared to the MCD group. Furthermore, IHI occurred along with MCD in 6.52% (N = 3) of the population. Conclusion: Patients with MCD and IHI frequently experience uncontrollable complicated partial seizures. Hippocampal volumetric tests should be used to examine people with intractable epilepsy who have normal intellect and MRI results in order to determine whether they have IHI. Due to the clinical similarities between isolated IHI and MCDs, isolated IHI can be thought of as a type of MCD.

54. Comparison of Nalbuphine and Fentanyl on Hemodynamic Response in Patients Undergoing Laparoscopic Surgeries under General Anaesthesia
Hardikkumar Patel, Bhargavkumar Patel, Shivrambhai Prajapati, Nisarg Patel, Dixitkumar Modh, Dhvani Jhaveri, Nareshkumar Kalsariya
Introduction: To prevent hemodynamic response to laryngoscopy, intubation and pneumoperitoneum various drugs are used. Opioids are commonly used in premedication, being a good analgesic, to support analgesia during surgery and to provide pain relief in immediate postoperative period. Among opioids, Fentanyl and Nalbuphine effectively control the hemodynamic stress response associated with laparoscopic surgeries In the present study, we compared the hemodynamic parameters of Fentanyl and Nalbuphine during laryngoscopy and endotracheal intubation for induction of general anesthesia. Materials & Methods: In this study total 50 patients undergoing laparoscopic surgeries were randomly divided into two groups. Total 25 patients of Group N received Inj. Nalbuphine 0.2mg/kg diluted in 10 ml NS injected slowly before induction. Another 25 patients of Group F received Inj. Fentanyl 2µg/kg diluted in 10 ml NS injected slowly before induction. The pulse rate, blood pressure, ECG, oxygen saturation and respiratory rate were noted at 0 minute, thereafter every 5 minutes for the initial 15 minutes, then every 10 minutes till 2 hrs and then every 2 hourly up to 16 hours in post-operative period Result: Intraoperative HR and SBP stability was better in group N compare to group F (p<0.0001). Post extubation SBP changes were not statistically significant. Fentanyl is better than Nalbuphine in attenuating the rise in DBP after laryngoscopy and intubation but Nalbuphine is more efficacious in control of DBP during intraoperative period than Fentanyl. Conclusion:The hemodynamic stress response to laryngoscopy and endotracheal intubation was less with Fentanyl as compared to Nalbuphine. However, Nalbuphine provides better hemodynamic stability than Fentanyl intraoperatively.

55. Neonatal Safety Cabinet: A Clinical Apparatus that Reduces Chances of Nosocomial Infections in Neonates
Gunwant Vijay Ahire, Sanket Sonawane, Mohan Buche, Pramod Shinde, Jaideo Ughade
Introduction: Neonates are more prone to get infections in two cases, either by the natal or intrapartum transmission of microorganisms from mother to infant derived from the maternal birth canal. It’s quite difficult to reduce the chances of infection at the time of parturition but we will be able to reduce chances after delivery with the help of this specialized cabinet. Neonates which are hospitalized within the NICU are more susceptible to acquiring nosocomial infections easily. They may acquire these by coming in direct contact with the infected person or also can be infected by inanimate sources which have infected pathogens. The basic principle to develop this cabinet has arrived from Biosafety cabinets which are generally used in laboratories to maintain aseptic conditions. Aim: The Goal of this Cabinet is to reduce the chances of nosocomial infections which generally occur in neonates by exposure to the environment of the neonatal or clinical wards. Material and Method: The cabinet is designed in such a way that it is easy to handle and safe to use for neonates. UV light for self-sterilization of the inner surface of the cabinet. A sensor for UV light is also fitted so that, neonates will not get any exposure to UV even accidentally also. The sensor and buzzers with give an immediate alert. Visible light is used to monitor babies’ movement so that they will be under observation. Fans and exhausts are used to avoid suffocation in the cabinet, this also helps to maintain temperature and normal atmospheric pressure as that is in the ward. Various sensors detect power cut-offs. Oxygen cylinders are used to provide additional oxygen supply. For a sterility check-up, the settled plate technique was used. Nutrient agar was used to grow microbial colonies. Result: The temperature and pressure were found to be the same as that of the environment because of the complete aeration and exhaust system of the cabinet. It was also found safe to be used for neonates. The actual motive was to maintain a sterile environment inside the cabinet that was successfully studied with the help of microbial analysis. Inside and outside cabinet air microflora was studied by the settle plate technique. The results are as per the observation table which indicates that the total count of colonies by settle plate technique was 78 outside the cabinet (inside the ward) and 21 inside the cabinet respectively. In this way, it was found that this cabinet successfully reduced the chances of infection by 73.1%. Conclusion: By using the settle plate technique we examined the microflora inside and outside of the cabinet to evaluate the sterility as well as safety regarding harmful microbes. It was observed that with the help of this Cabinet, we are able to reduce the chances of infection by 60-70% which is also with this prototype model which means we can succeed in preventing nosocomial infections by up to 90% with the help of a well-established cabinet.

56. Study of Mid-Shaft Clavicle Fracture Treated with Precontoured Locking Compression Plate at Tertiary Care Hospital
Hardik R Patel, Pankaj Shantilal Rathod
Background and Aim: The majority of displaced mid shaft clavicle fractures do not require surgery. Non-union, delayed union, and improper union are all risks associated with non-operative therapy of these fractures with axial shortening. The purpose of the current study was to examine a tertiary hospital’s precontoured locking compression plate treatment of a mid-shaft clavicle fracture. Material and Methods: The current study is a prospective, observational analysis carried out at the orthopaedics department of the medical college and affiliated hospital. A two-year study period was involved. The study included young individuals, closed fractures, and displaced clavicle fractures. Clavicle fractures were treated with a locking compression plate that was precontoured. Follow-up was conducted every two weeks until three months, then once a month until six months, then once every two months until one year. Results: Mean age was recorded to be 46.57 ± 15.23 years, majorities of the male, had road traffic accident (81.25 %) and unilateral clavicle fracture was found in majority of the patients (96.87 %). Results were analyzed both clinically and radiologically. Mean operation time was 49.41 ± 15.70 minutes and return to activity was noted in 8.81 ± 8.60 weeks. Conclusion: Utilizing a precontoured clavicular locking compression plate, which is biomechanically stable and enables stable angular and multi-planar fixation of distal fragment regardless of bone quality, produced positive results in the fracture fixation of the small distal fragments of the lateral end clavicular fractures. In order to achieve maximal compression, quick fracture healing, and early mobilisation, precontoured locking compression plates have been equipped with compression mechanisms.

57. Histopathological Study of Oral Squamous Cell Carcinoma in Tertiary Care Hospital
Desai Bhumiben Rajeshkumar, Matariswa Samanta, Pawan Nikhra, Vishakha Behl, Praveen Kumar, Kavita Gupta, Nitesh Mangal
Background: Oral cancer is one of a major health problem in some parts of the world especially in the developing countries. Accurate diagnosis of the lesion is the first step for the proper management of patients and histopathology is considered as the gold standard. The objective of the study was (1) To assess the prevalence and identify the different variants of oral squamous cell carcinoma according to age, sex and site. (2) To study the histopathological findings of different variants of oral squamous cell carcinoma. Materials and Methods: It was a cross-sectional study carried out in a tertiary care center from April 2021 to September 2022. After the surgery, histopathological department received the specimen in formalin filled container and perfomed routine grossing and H&E staining procedure. The parameters included in the study were age, sex, site of the lesion and histological diagnosis. The analysis was done by using excel sheet. Results: 120 patients of oral lesions were identified during the period of study. The age of patients varied from >40 to 80 years and Male to Female ratio was 2.2:1. Buccal mucosa (48%) was the most common site involved which was followed by tongue (24%) Squamous cell carcinoma (33.7%) was the most common lesion present in our study. Conclusions: Our study concluded that squamous cell carcinoma was the most common malignant lesion of oral cavity. Histological typing of the lesion is important for confirmation of malignancy and it is essential for the proper management of the patient.

58. Comparative Study of Lichtenstein’s Mesh Repair versus Modified Bassini’s Repair for Inguinal Hernia
Deepak Ranjan Nayak, Nagendra Rajsamant, Ajaya Kumar Sahu, Akshyapad Pattnaik
Introduction: An inguinal hernia, which manifests as a bulge in the groyne, is a chronic condition that is likely as old as man. Over the previous few decades, hernia repair has changed, going from anatomical repairs to mesh hernioplasties to laparoscopic repair. The concept of tension-free hernioplasty – Lichtenstein mesh repair was developed in response to an unsatisfactory rate of recurrence, prolonged postoperative pain, and recovery time following tissue repair, as well as our understanding of the metabolic basis of inguinal hernias. The tension-tree mesh repair is clearly better to the conventional tissue approximation approach, as shown by numerous comparative randomised experiments. However, simple and affordable tissue restoration techniques like Bassini’s offer an edge. Materials & Methods: The purpose of this comparative randomised study, which included 70 patients, was to examine the clinical presentation, risk factors, and complications associated with surgical procedures over an 18-month period. Of the 70 patients, 35 were assigned to the group LMR (Lichtenstein’s Mesh Repair) and 35 to the group MBR (Modified Bassini’s Repair). Without discrimination, all patients diagnosed with inguinal hernias who were admitted to the department of general surgery at SCB Medical College in Cuttack were included in the study on a serial basis. Regardless of the patients’ gender, all patients who visit the surgical outpatient department of general surgery at the SCB Medical College in Cuttack with symptoms of a swelling and/or pain in the inguino-scrotal region are diagnosed with an inguinal hernia. Results: A total of 70 patients participated in the trial, with 35 (or 50%) of them being assigned to each group. In the current study, all patients were chosen regardless of the kind of inguinal hernia, with the distribution between the two groups being identical. Of the patients, 20 (28.6%) instances were of the Direct type and 50 (71.4%) cases were of the Indirect type. The presentation of an indirect hernia was 2.5 times greater than a direct hernia. The LMR group’s mean surgery time (41.747.29) was significantly (p-value 0.05) lower than the MBR group’s (47.117.51), showing that patients needed less time on the operating table, lowering the risk of associated complications, including anaesthetic ones. Residents also found LMR to be simpler to perform than MBR, requiring a smaller learning curve. Only 2 patients, or 5.7%, of those who underwent Lichtenstein’s mesh hernioplasty in the current study experienced post-operative wound infection. In the MBR group, there were none. P-value (p > 0.05) was not significant. Conclusion: While the current comparative analysis does not clearly demonstrate any advantages of one repair over the other, Lichtenstein’s mesh hernioplasty offers better outcomes in terms of recurrence and relative ease of the repair procedure when compared to modified Bassini’s repair. In this study it was found that, time taken for lichtenstein mesh repair was significantly less. As the duration of study was fix cannot comment a strong status about recurrence but recurrence is less in lichtenstein mesh repair.

59. Study on Assessment of Self-Directed Learning Readiness in the First Year MBBS Students
Pratima P., Kalyani P., Padma Geethanjali M., Ramesh Chandra P.
Background & Objectives: Self-directed learning (SDL) is regarded as the main tool which is an integral part of a student-centered medical curriculum. It is the degree to which a student acquires the ability, attitude, and personal characteristics required for self-directed learning. The objective of the present study was to explore the readiness for Self-Directed Learning (SDL) among first-year MBBS students enrolled at Government medical college, Srikakulam. Methods: 150 first-year MBBS students were recruited to participate in this study. Among 150 students, 126 students participated in the study. Data was collected using Fischers 40-item Self-Directed Learning Readiness Scale (SDLRS). The student’s response to each item of the Self-Directed Learning Readiness Scale was obtained on a 5-point Likert scale. Using SPSS 25, the data were analyzed. The Self-Directed Learning readiness was categorized as high (>150 scores) and low (<150 scores). Results: The mean SDLRS score was 140.87±12.43 with 41 (33%) students scoring more than 150 indicating high readiness. The mean scores of self-controls (SC), self-management (SM), and desire for learning (DL) were 52.30±5.66, 46.03± 6.05, and 42.53± 5.72 respectively. The mean score for self-control was the highest of all the three components of the SDLRS followed by self-management, while the least mean score was for a desire for learning. Conclusion: The present study revealed that the overall SDL readiness of participants was not up to the mark. Students had the ability for self-control and were motivated to self-management skills. However, they need guidance, and motivation to improve their self-learning skills.

60. A Comparative Study of Pulmonary Function Tests among Smokers and Non-Smokers in a Tertiary Care Hospital
Mohit Malge, B.V. Surendra
Background: Cigarette smoking has a significant impact on pulmonary function. Pulmonary function testing is a common procedure for diagnosing and monitoring respiratory disorders. In this study, the pulmonary function tests of smokers and nonsmokers were compared. Materials and Methods: Between January and June 2022, a case-control study was undertaken among smokers and nonsmokers. A total of 100 participants were recruited, 50 of whom were nonsmokers (controls) and 50 of whom were smokers (cases). PFT measurements were performed three times on each patient, with the greatest level recorded. Unpaired t test was used to analyse the data. Result: Pulmonary function parameters were significantly reduced in smokers and obstructive pulmonary impairment was commonest. The mean FVC, FEV1, FEV1/FVC, PEFR, FEF25%-75% in nonsmokers and smokers were 3.15±1.02, 2.62±0.92: 2.81±0.97, 2.17±0.75: 85.12±26.32, 82.13±21.85: 7.12±2.12, 5.86±1.98: 3.86±0.83, 3.12±1.21 respectively. Conclusion: Smokers had significantly lower lung function tests than nonsmokers, with obstructive pulmonary impairment being the most frequent. Thus, spirometry can detect a variety of lung problems at an early stage, reducing eventual morbidity.

61. An Analytical Assessment of the Different Clinical Manifestations and Outcome of TBM in Relation to BCG Vaccinated, Non- Vaccinated and Nutritional Status of the Children
Anjum Equebal, Mohammad Asghar Ali, N. P. Gupta
Aim: The objective of the present study was to evaluate the different clinical manifestations and outcome of TBM in relation to BCG vaccinated, non- vaccinated and nutritional status of the children. Methods: The present study was conducted at Department of Paediatrics, Darbhanga Medical College & Hospital, Darbhanga, Bihar, India from April  2022 to November 2022 and 50 children with definite or probable tuberculous meningitis (TBM) were included. Local cultural values and ideas were respected. Confidentiality was assured. The nature and purpose of the survey were explained in detail to them in their own language. Results: The common symptoms observed were fever 90%, altered sensorium 62%, vomiting 60% and convulsions 56%. Other symptoms observed were cough, headache. The common signs present were GCS below 10 in 57% of cases, meningeal irritation in 64%, and McEvan’s sign in 60%. Also seen were hemiparesis 43%, CN palsy 43%, fundal changes25%. All signs were significantly more common in malnourished children except GCS10-14. Tuberculomas, conscious variety and focal involvements are seen more commonly in well-nourished group among vaccinated patients. All atypical features of TBM are more common in well-nourished group when compared to malnourished children except encephalopathy. Other typical features found were Ophthalmoplegia (3), brain stem syndromes (2), serous meningitis (2), conscious type (3), encephalopathy (2) and focal infarcts in 4 cases. Conclusion: It was concluded that clinical patterns in TBM vary according to nutritional status of the child and severe malnutrition carry very poor prognosis. Knowing different clinical patterns of the disease helps in early prognosis and thus in preventing deaths due to TBM among children.

62. A Prospective Hospital-Based Study to Evaluate the Utility of the Hematological Scoring System (HSS) in the Early Diagnosis of Neonatal Sepsis
Ashok Kumar, Ajay Kumar
Aim: The aim of the present study was done to evaluate the utility of the hematological scoring system (HSS) in the early diagnosis of neonatal sepsis. Methods: The prospective study was conducted in the Department of Pathology, Jannayak Karpoori Thakur Medical College & Hospital, Madhepura, Bihar, India for the period of one year. A total of 200 neonates in the department of pediatrics and neonatology were included in the study. Results: A total of 200 neonates were classified into three categories, sepsis (n=90), probable infection (n=40), and normal (n=70), based on the clinical examination and laboratory findings. The total number of culture positive cases was 90 (45%) and culture was bacteriologically negative in 120 (60%) cases. The total number of preterm babies was 110 (55%) while 90 (45%) were term babies. Preterm babies were more affected by sepsis than term babies. There were 120 (60%) males and 80 (40%) females. Five (12.5%) of the normal neonates had score ≥5 suggesting the presence of sepsis, 15 (21.42%) had scores 3-4 suggesting possibility of sepsis, and 50 (71.42%) normal cases had scores ≤2 which suggested less likely sepsis in these cases. Conclusion: Diagnosis of neonatal septicemia may be difficult as the early signs of sepsis may be subtle and different at different gestational ages. The HSS is a simple, quick, and cost-effective tool which can be used as screening test for early diagnosis of neonatal sepsis.

63. A Safety and Efficacy of Supracostal Access in Percutaneous Renal Surgery: A Single Center Experience
Sanjay Kumar Gupta, Rajesh Kumar Tiwari, Ahsan Ahmed, Rohit Upadhyaya, Khalid Mahmood
Background and Purpose: During percutaneous renal surgery, subcostal access is preferred because it carries no risk of injury to either the lungs or pleura. However, in some situations, a supracostal approach may pro- vide more direct access and achieve a more satisfactory result than the subcostal approach. In this prospec- tive study, we evaluated the safety and efficacy of supracostal approaches in percutaneous renal surgery. Materials and Methods: Between November 2020 and Aug 2021,60 patients underwent percutaneous renal surgery with a supracostal approach either as the sole or as a secondary access. The indications were staghorn stones, up- per caliceal stones, upper ureteral stones, secondary ureteropelvic junction obstruction, disturbed lower caliceal anatomy, and high-lying kidneys. The puncture was above the eleventh rib in 12 procedures and above the twelfth rib in 48 procedures. All patients were examined for equal air entry on both sides of the chest, and all had chest radiography performed immediately after surgery to exclude pneumothorax or hydrothorax. Bleeding was assessed with evaluation of preoperative and postoperative hemoglobin, levels and vital signs; ,urine was also examined for gross hematuria. A routine nephrostogram was obtained for all patients. Results: Supracostal was the sole access in 63.3% of patients and a secondary access in 36.7% of patients. Intraoperatively, bleeding occurred in one patient. Hydrothorax in another patient necessitated insertion of an intercostal chest drain. A renopleural fistula developed in another patient 2 days postoperatively that ne- cessitated placement of a chest drain and Double J stent. Access in both patients with pleural complications had been above the eleventh rib. The mean drop in hemoglobin level was 0.79 ± 0.72 g/dL. Our overall stone- free rate was 88.9%. Conclusion: Supracostal access above the twelfth rib is relatively safe; however, access above the eleventh rib should be limited to necessity because a higher incidence of pleural complications can be expected. A chest radiograph should be obtained immediately postoperatively for early detection of hydrothorax or pneumothorax.

64. A Prospective Observational Study to Determine the Association of Prolonged Assisted Mechanical Ventilation (AMV) with Fluid Balance and Pediatric Index of Mortality 2 (PIM2) Score
Rajesh Kumar, Nikki Kumari, Vikash Chandra, Alka Singh, Md. Athar Ansari
Aim: This study was conducted to determine the association of prolonged Assisted Mechanical Ventilation (AMV) with fluid balance and pediatric index of mortality 2 (PIM2) score. Methods: This prospective observational study was conducted over a period of 12 months in the pediatric intensive care unit (PICU) at Nalanda Medical College and Hospital, Patna, Bihar, India after obtaining approval from the institutional ethics committee. The study enrolled all patients admitted in the PICU of age 29 days to 12 years, who fulfill the inclusion criteria during the 12-month period. Results: This was a study of 50 participants of which infants (<1 year) were maximum (26, i.e., 52%). Males outnumbered females comprising 58% (29) of the study population. Maximum number of admissions (16) had central nervous system involvement followed by respiratory system involvement. Out of the 50 children admitted in PICU during the study period, 35 (70%) children had prolonged mechanical ventilation. 33 patients had positive fluid balance ≥ 15%. 30 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 30 patients who had PIM2 score ≥ 5 required prolonged mechanical ventilation. The Pearson chi-square test was applied to test the significance of association between positive fluid balance and prolonged mechanical ventilation. P value was 2:25 × 10−7 which is <0.05 suggesting rejection of null hypothesis and statistically significant association between two variants. Conclusion: There was a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.

65. A Comparative Study to Assess the Efficacy of Addition of Dexmedetomidine to Levobupivacaine in Brachial Plexus Block
Sanjay Kumar, Jitendra Kumar, Kumar Saurabh
Aim: To assess the effect of levobupivacaine 0.5% alone and with dexmedetomidine 100 µg as an adjuvant to levobupivacaine 0.5% on the onset and duration of sensory and motor block, the duration of perioperative analgesia, complications and sedation score. Methodology: This analytical comparative study was carried out Department of Anesthesiology, on 80 patients in IGIMS, Patna, Bihar, India for one year. The participants were divided randomly into two groups of 40 each using sealed envelope technique. The first group (LD group) was administered 1 ml (100µg) dexmedetomidine with 39 ml of 0.5% Levobupivacaine. The second group was given 1 ml of 0.9% normal saline and 39 ml of 0.5% Levobupivacaine as anesthetic agent. Saturation of oxygen (SpO2), heart rate, diastolic blood pressure, systolic blood pressure, were noted at 0, 5, 10, 15, 30, 60, 90, and 120 minutes. Side effects like heart rate less than fifty per min (bradycardia) and blood pressure less than 20% with respect to resting conditions (hypotension) were treated with appropriate measures. Then we noted the period of motor and sensory blocks once the surgery is started. Results: In the LD group males and females were 65% and 35% respectively. In LS group, it was 55% and 45% respectively. All the study participants in LD group did not require post-operative analgesia while all in LS group were given Postoperative analgesia. 30% in LD group were slightly drowsy compared to 100% in LS group. The mean duration of onset of sensory and motor block was nearly 4 min earlier in LD group compared to LS group (5.42 vs 9.21 min of sensory and 8.40 vs 12.33 min of motor). The mean duration of sensory block (533 vs 921.75 min) and motor block (553.73 vs 943.18 min) were approximately 400 minutes lesser respectively between both the groups. The duration post-operative analgesia was 579 and 980.74 min in both the groups respectively. All the results were statistically significant. 23.3% of study population in LD group had bradycardia compared to 0% in LS group. No other adverse effects was recorded in the study subjects. Conclusion: Based on the findings of this study, perineural infiltration of dexmedetomidine as an adjunct to 0.5% levobupivacaine decrease the sensory and motor block duration. It also decrease the duration of analgesia and also provides a good intraoperative sedation as well and helps to reduce the postoperative analgesic requirement.

66. Prospective Comparative Assessment of Cemented and Un-Cemented Hemiarthroplasty Management of Fracture Neck of Femur in Elderly Patients
Rajeev Kumar, Sanjeev Kumar Shukla, Bimlesh Kumar Bimal, Vidya Sagar, Raman Kumar
Aim: Comparative study between cemented and un-cemented hemiarthroplasty management of fracture neck of femur in elderly patients. Methods: The prospective comparative study was done at tertiary health care centre of north india and ethical clearance was taken for 2 years  included 50 cases of intracapsular fracture neck of femur in the elderly aged more than 60 years where 25 patients were treated by hemiarthroplasty using uncemented fenestrated prosthesis whereas 25 patients were treated with hemiarthroplasty using cemented non-fenestrated prosthesis. Results: 50 patients with fracture neck femur were operated on for hemiarthroplasty, cemented or uncemented, during the study period. The mean age was 66.30 ± 5.78years with the cemented cohort and 64.36 ± 6.20years in the uncemented cohort. Of these, 22 (44%) were men and 28(56%) were female. The most common mechanism of injury was a trivial fall (88%) as opposed to a road traffic accident (12%). Conclusion: Bipolar hemiarthroplasty whether cemented or uncemented is an excellent treatment for fracture neck femur. No significant difference between both methods in terms of functional outcome. Cemented hemiarthroplasty results in more blood loss and takes more operative time but is associated with less post-operative pain and complication and better functional outcome.

67. Effect of Surgical Decompression on Intrathecal Pressure Variation Proximal and Distal to the Site of Injury in Patients of Acute Spinal Cord Injury of Dorsal Spine
Manish Kumar, Parimal Bhaskar
Object: Extradural decompression supplemented with stabilization of the injured vertebral segment is the gold standard for treating traumatic spines. Any effective surgical modality should not only be undoing the reversible harm caused by the primary cord injury but should also be contributing to reduce the potential deleterious effects of the secondary cord injury including the increased intra-thecal Pressure (ITP) inside relatively non-compliant intact dura. ITP has been reported to be increased after decompression but distal to the site of injury which actually may reduce vascular perfusion of the cord and be negating the likely benefits of the performed surgery. The objective of the present study was to evaluate the effect of surgical decompression on ITP both proximal and distal to the level of injury and exploring decompression’s true efficacy in acutely injured thoracic spinal cord injury (SCI). Methods: The present study comprised of twenty patients of thoracic spine injury presenting within 7 days of injury who underwent surgical decompression and posterior instrumentation. After giving general anaesthesia, all patients were put in prone position on the operating table keeping both the hips flexed to nearly 60 degrees using bolster under torso to open up interlaminar spaces. Lumbar puncture (LP) was performed through L4-5 space using 18 G epidural needle inserting a catheter and connecting it to pressure transducer to record intra thecal pressure. Midline posterior approach was utilized for exposing the injury site. Another epidural needle was inserted percutaneously and manoeuvred through an interlaminar window created through the inter-laminar space proximal to the site of injury. A second catheter was inserted through this needle into the intrathecal space and connected to another pressure transducer and the monitor. Decompression and posterior instrumentation were done in the standard manner. Both catheters proximal and distal to site of injury recorded the ITP before, during and after the decompression and were maintained for 72 hours. Results: Surgical decompression produced reduction in ITP proximal to the level of cord injury while it caused no change in ITP distal to the cord injury. Mean ITP proximal to the cord injury before and after decompression was 24.70± 6.78 and 19.10± 4.16. Mean ITP distal to the cord injury before and after decompression were 17.25 ± 5.36 and 17.15 ± 5.03 respectively. No adverse events related to pressure monitoring were noted in any patient. Conclusions: Surgical decompression in acute SCI not only removes the extradural compression but also restores flow of the cerebrospinal fluid (CSF) and normalizes increased ITP all along the thecal sac. Decreased ITP both proximal and distal to the site of injury brings improvement in the spinal cord perfusion pressure (SCPP) further enlarging benefits of the surgical decompression.

68. A Prospective Randomized Comparative Study of Oxiport Laryngoscope Blade versus Miller Laryngoscope Blade for Intubation in Neonates and Infants during General Anesthesia
Jitendra Kumar, Kumar Saurabh, Sanjay Kumar
Aim: To compare oxiport laryngoscope blade and miller laryngoscope blade for neonatal and infant intubations. Methodology: This controlled interventional study conducted in the Department of Anesthesiology, IGIMS, Bihar for one year in which 120 neonates/infants in groups of 60 each posted for surgery in paediatric operation theatre over a period of 6 months were included in the study. Patients posted for elective surgery were assessed during the pre-anaesthetic check a day prior whereas those taken up for emergency procedures were assessed on the day of surgery. Full-term neonates and infants up to 6 months of age of either sex requiring general anaesthesia with endotracheal intubation for elective as well as emergency surgery were included in the study. This comprised three groups: thoracic, abdominal and miscellaneous surgeries. Monitoring used included electrocardiogram and pulse rate on cardioscope, pulse oximetry, capnometry, noninvasive BP, nasopharyngeal and skin temperature. For the purpose of this study to quantify desaturation data, it was graded as mild desaturation (lowest SpO2 up to 90%), moderate desaturation (lowest SpO2 between 85% and 89%) and severe desaturation (lowest SpO2< 0.05 was considered as statistically significant. Results: The mean lowest level of saturation attained in Group O was 98.37% ± 2.28% as compared to 97.38% ± 3.83% in Group M and p value was <0.001 which was statistically significant. The incidence of mild desaturation (SpO2 up to 90%) was 87.24% in Miller group and 93.75% in Oxiport group. The incidence of moderate desaturation (SpO2 between 85% and 92.5%) was 3.26% in Miller group and 6.25% in Oxiport group. Incidence of severe desaturation (SpO2 <85%) was 9.5% in Miller group and 0% in Oxiport group (Chi-square test P = 0.028). Both groups were comparable with respect to the type of surgery (abdominal, thoracic, miscellaneous). Abdominal surgeries were associated with a higher number of severe desaturations (80%) compared to thoracic (10%) and miscellaneous (10%) surgeries. Conclusion: Apneic laryngeal oxygen insufflation with Oxiport laryngoscope blade decreases the incidence and rate of desaturation with a better hemodynamic stability as compared to Miller blade while intubating neonates and infants.

69. A Prospective Assessment of Exercise-Induced ECG Changes in Healthy Children and Evaluate the Effects of Gender and Four Different Formulas of Heart Rate Correction
Naveen Kumar, Subhrajyoti Tripathy, Kripa Nath Mishra
Aim: To investigate the exercise-induced ECG changes in healthy children and evaluate the effects of gender and four different formulas of heart rate correction of Bazett, Fridericia, Framingham and Hodges on ventricular repolarization parameters pre-and post-exercise. Methods: A prospective study was Department of Pediatrics, DMCH, Darbhanga, Bihar, India. over a period of one year and children who underwent TET and had the following criteria were included in the study. A total of 100 children from the hospital OPD were study participants. Conclusion: Diastolic time decreased more than systolic time with exercise and systolic time to diastolic time increased with exercise. Hodges’ and Fridericia’s formulas resulted in the longest and shortest QT and QoT, JT, and JTP, respectively. Thus, using a single value as the cut-off for long QT syndrome can lead to under or over-diagnosis. Nomograms incorporating data on age, heart rate, and heart rate correction formula are indispensable for accurate long QT diagnosis. Furthermore, gender differences in ventricular repolarization parameters are not generally present in 5 to 14-year-old healthy children. The lack of U wave in this study may implicate the need for more careful investigation in the presence of U wave in the treadmill exercise testing of healthy children.

70. A Hospital Based Clinical Assessment of the Impact of Hypotensive Epidural Anesthesia on Distal and Proximal Tissue Perfusion in Patients Undergoing Total Hip Arthroplasty
Kumar Saurabh, Sanjay Kumar, Jitendra Kumar
Aim: To investigate tissue oxygenation in a clinical setting, using non-invasive near-infrared spectroscopy. Methodology: The study conducted in the Department of Anesthesiology, IGIMS, Patna,Bihar, India for one year.Patients aged 18 to 70 years undergoing THA under HEA were enrolled. Data on patient demographics (age, gender, ethnicity, comorbidities) and intraoperative events (fluid balance, duration of surgery) were recorded. SmO2 was measured by continuous sampling of non-invasive near- infrared spectroscopy (NIRS) at two standardized locations above and below the level of neuraxial blockade [(a) deltoid and (b) vastus lateralis of the quadriceps femoris muscle]. Stroke volume (SV) and CO were recorded continuously using a validated non-invasive bioreactance monitor. Other continuously recorded parameters included heart rate (HR), invasive mean arterial pressure (MAP) and arterial oxygen saturation (SO2). The observation period was divided into quintiles to facilitate analysis. Results: Average age of the patients was 58.37+14.6 years. Mean BMI was 25.84+6.44 Kg/m2. 40% were males and 60% were females. Mean procedure time was 134.3+15.8 minutes. Notably, no patients had significant cardiopulmonary disease and only four cases were there who had hypertension, hyperlipidemia or rheumatoid arthritis. From the unadjusted regression analysis, we found an intermittent and significant decline of mean SmO2 in the vastus lateralis muscle during the first part of the surgical procedure in patients undergoing THA using HEA (nadir 2nd quintile: 71.07% vs. 63.33%, p<0.0001). Mean HR showed a modest but significant increase over the same period [66.18 (SD ± 9.08) vs. 74.59 bpm (SD ± 7.64); p=0.0001, respectively]. No significant change was seen for mean CO over time [3.55 (SD ± 0.68) vs. 4.08 L/min (SD ± 1.28); p=0.0515, respectively]. Conclusion: The study showed a significant unadjusted decrease of muscle tissue oxygenation saturation of the vastus lateralis muscle in patients undergoing THA using HEA. The SmO2 in the deltoid muscle remained unaffected. Except changes in MAP, no other studied covariates impacted significantly on outcomes. Therefore, further research with a larger number of patients is needed to determine if these findings are of clinical significance.

71. A Retrospective Study to Investigate the Association between NPAR and Outcomes of Stroke
Rajeev Kumar, S.K. Astik, Subham Bhaskar, Narendra Kumar, Ajay Kumar Sinha
Aim: The aim of the present study was to investigate the association between NPAR and outcomes of stroke. Methods: The present study was conducted at Department of General Medicine Nalanda Medical College and Hospital, Patna, Bihar, India from two years and total 1000 participants were included in the study. The vital signs, medications, demographic information and other essential data of the patients admitted to intensive care unit were collected. Results: The subjects were categorized into 3 groups based on NPAR values: group A: NPAR < 20.5 (330); group B: NPAR 20.5–25.0 (330); and group C: NPAR >25.0 (340). Compared with group A, participants in groups with higher NPAR (>25.0) showed lower SBP, bicarbonate, MBP, hematocrit, hemoglobin, and DBP, and had higher levels of creatinine, BUN, potassium, chloride, heart rate, respiratory rate, PT, APTT, INR, and increased the proportion of CHF, renal disease, pneumonia, respiratory failure, and mortality. In addition, tertiles were not significantly related to age and gender in our study population. For 30- day all-cause mortality, in an unadjusted model, the HR (95% CIs) in group B and C were 1.17 (0.85, 1.63) and 1.55 (1.13, 2.11), respectively, in comparison with group A. This association was significant after adjusting for age, gender, ethnicity, sodium, chloride, CHF, CAD, AF, renal disease, liver disease, COPD (HR= 1.45, 95% CI: 1.05, 2.00). The trend was also statistically significant (P = 0.0196). For 90-day all-cause mortality and 365- day all-cause mortality, a similar relationship was also observed. Conclusion: A strong correlation was present between increased levels of the novel biomarker NPAR and increased risk of mortality in stroke patients.

72. Effiсасy of a Lосаl Anaesthetic Сосktаil Injection with and without Роsteriоr Сарsulаr Infiltration for Роst-Орerаtive Раin Соntrоl in Раtients Undergoing Simultaneous Bilateral TKA: A Prospective Comparative Study
Parimal Bhaskar, Manish Kumar
Aim: This comparative study was aimed to evaluate the effiсасy of а lосаl anaesthetic сосktаil injection with and without роsteriоr сарsulаr infiltration for роst-орerаtive раin соntrоl in раtients undergoing simultaneous bilateral TKА. Methods: This was a prospective comparative study including 60 patients undergoing simultaneous bilateral TKA. The study took place at Patna Medical College and Hospital, Patna, Bihar, India for the period of one year. Results: Results of the study were analyzed in 60 patients (120 knees). Females were found to be more in number who were diagnosed with primary knee OA and underwent simultaneous bilateral TKA compared to males. Male to female ratio was 0.56:1, mean age at which the patients underwent the procedure was found to be 61.62±7.7 years and mean BMI of the patients who underwent TKA was found to be 25.74±3.01 kg/m2. There were no significant differences in pre-operative parameters such as VAS scores, knee flexion, extensor lag and KSS between the two groups. Conclusion: The study successfully demonstrates that posterior capsular infiltration when included in LIA technique provides a better pain control and also early functional recovery after TKA.

73. A Hospital-Based Assessment of the Effectiveness of Surgical Management of Malignant Glaucoma in Phakic Eyes
Amit Rajan, Farmood Alam, Arun Kumar Sinha
Aim: This study aimed to provide additional data on cases of phakic eyes characterized by long time intervals between malignant glaucoma onset and surgery and to assess the therapeutic safety and efficacy of surgery. Methods: The present study was conducted at Department of Ophthalmology,  Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for one year  and included consecutive patients who underwent core vitrectomy-phacoemulsification-intraocular lens (IOL) implantation-capsulo-hyaloidotomy at least 1month after the onset of malignant glaucoma. Results: This retrospective study reviewed 10 consecutive malignant glaucoma patients who underwent core vitrectomy, phacoemulsification, IOL implantation, and capsulohyaloidotomy. All eyes had been diagnosed with primary angle-closure glaucoma (PACG); 8 eyes (80%) developed the condition after trabeculectomy. The mean onset to surgery interval was 6.9 months. Significant preoperative and postoperative differences were detected in the IOP (P=0.046), number of IOP lowering medications used (P=0.004), and ACD (P=0.005). Complete success, qualified success, and anatomical success was achieved in 38.5%, 77%, and 100% of the eyes, respectively. Conclusion: Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.

74. Study of Etiology of Convulsions in Children between 1 Month and 5 Years of Age at SKMCH, Muzaffarpur, Bihar
Jayprakash Kushwaha, Gopal Shankar Sahni
Background: Seizures are a frequent issue that the pediatric emergency room evaluates. The various causes of seizures include brain tumours, idiopathic epilepsy, febrile seizures, CNS infections, metabolic, developmental problems, traumatic brain injury, vascular accidents, and metabolic disorders. The current study sought to determine the cause of convulsions in children between the ages of 1 month and 5 years old who were admitted to the pediatric unit at the SKMCH, Muzaffarpur, Bihar. Children between the ages of 1 month and 5 years who are admitted to a pediatric ward at the Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, were evaluated for the prevalence of convulsions. Methods: Between January 2022 and June 2022, 100 instances of convulsions in children between the ages of 1 month and 5 years were admitted to the pediatric unit at SKMCH, Muzaffarpur, Bihar. The study involved taking a thorough medical history, performing a physical exam, and conducting pertinent tests, such as complete blood counts, serum electrolytes, serum glucose, serum calcium, CSF analysis, EEG, and neuroimaging (CT/MRI brain) studies. Demographics, clinical presentation, laboratory examinations, EEG, and neuroimaging were all recorded variables. Results: In our analysis, febrile seizures accounted for 32% of all seizure types. About 24% of cases involved epilepsy (idiopathic or unprovoked), and 33% had symptomatic seizures brought on by different conditions such CNS infections, metabolic disorders, traumatic injuries, and vascular diseases, among others. The remaining 11% were brought about by various other factors. Conclusion: This hospital-based study sought to understand the cause of convulsions in children between the ages of 1 month and 5 years. Children’s seizures might have a variety of underlying pathologies. In our study, febrile seizures were the most frequent cause of convulsions, followed by epilepsy and symptomatic seizures with an infectious aetiology of the CNS, with viral encephalitis being the most frequent.

75. Study of Clinical Profile and Outcome of Acute Lower Respiratory Tract Infection in Children Aged between 2 Months to 5 Years at SKMCH, Muzaffarpur, Bihar
Jayprakash Kushwaha, Gopal Shankar Sahni
Background: In underdeveloped nations, acute respiratory infections are the main cause of illness and mortality in children under the age of five. In order to better understand the clinical profile and factors influencing the outcome, the current investigation was conducted. Methods: Hospital based case series study conducted at Department of Pediatrics, SKMCH, Muzaffarpur, Bihar. The study conducted from December 2021 to November 2022. Total 200 ALRI cases in the age range of 2 months to 5 years who met the study eligibility requirements for pneumonia were examined for their clinical profiles and outcomes using a predesigned proforma. The chi-square test was used to assess the data. Results: Male children (58%) and newborns (53.5%) had a greater incidence of ALRTI cases, according to our research. PEM (60.5%) and anaemia (73.5%) were prevalent. Parental smoking, the length of EBF, and gestation at birth were all substantially (p< 0.05) correlated with pneumonia severity. With a mean hospital stay of 5, 7.43, and 10.36 days, pneumonia cases in the range of 1.5%, 77.5%, and 21% respectively. The need for changing medications and length of stay were substantially (p <0.05) correlated with the severity of pneumonia. 4.5% of cases required mechanical ventilation, while 56.5% of cases needed oxygen. The most frequent diagnosis was bronchopneumonia (33.5%), and the most frequent consequence was sepsis (6%) Death rates were 3%. Conclusions: The incidence of several risk variables among ALRI cases as well as outcome and severity predictors have been established by the current investigation. By boosting EBF and immunisation, managing malnutrition effectively, raising living standards, and teaching parents about the dangers of smoking, ARI burden and severity can be decreased.

76. One Year Cross-Sectional Study of Maternal and Perinatal Outcome in Severe Pre-Eclampsia
Jyoti Kumari, Madhu Priya, Pallavi Singh
Background: Pre-eclampsia is a major global contributor to maternal and neonatal morbidity and mortality. The majority of referrals to tertiary care centres are for pre-eclampsia. This study’s goal is to determine how patients with severe pre-eclampsia will fare maternally and perinatally. Methods: The Department of Obstetrics and Gynecology at SKMCH, Muzaffarpur, Bihar, conducted this prospective study from January 2022 to December 2022. There were 240 women in total who had developed severe pre-eclampsia after 34 weeks of pregnancy. Women with a history of many pregnancies, anaemia, pre-existing hypertension, epilepsy, diabetes, or vascular or renal causes were not allowed to participate. After a thorough history, examination, and investigation, patients were handled in accordance with the established protocol. The preferred medication for treating convulsions was magnesium sulphate, while labetalol or oral nefidipine was used to regulate blood pressure. Results: Out of 240 occurrences of severe pre-eclampsia, most (70%) included women in their 20s and 30s who were also mostly primigravida (79.16%). The most frequent presenting symptom in the current study was edoema (80.8%), which was followed by headache (40.8%). 56.6% of women with severe pre-eclampsia gave birth naturally while 43.5% underwent caesarean sections, most often as a result of a botched induction or a stalled labour. In patients with severe pre-eclampsia, maternal complications such as PPH, eclampsia, acute renal failure, HELLP syndrome, pulmonary edoema, and maternal fatalities were observed in 1.66% of cases. In our study, patients with severe pre-eclampsia experienced low birth weight in 80% of cases, foetal growth restriction in 20%, intrauterine foetal death in 5% of patients, and perinatal mortality in 12% of cases. Conclusion: Patients with severe pre-eclampsia and eclampsia are more likely to experience maternal and perinatal problems. Preventing severe pre-eclampsia and eclampsia requires good antenatal care, early diagnosis, and fast treatment.

77. Study of Clinical Profile of Infant of Diabetic Mother and Evaluation of Perinatal Outcome: An Observational Study
Mithun Kumar, Anshu Kumari, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Background: Because of sedentary lifestyles, urbanisation, and rising rates of obesity, diabetes has now spread throughout the world and is becoming more common in developing countries like India. Pregnancy-related cases of diabetes are continuously increasing, most likely concurrently with the increased prevalence of obesity among women of childbearing age. Women who have diabetes are more likely to experience perinatal/neonatal difficulties (such as prematurity, respiratory distress, and metabolic abnormalities including hypoglycemia and electrolyte derangements) and foetal issues (such as congenital malformations, foetal growth abnormalities, and stillbirth). The purpose of this study is to evaluate the perinatal outcome and the clinical profile of a diabetic mother’s infant. Methods: From May 2022 to October 2022, the current observational study was carried out in department of Pediatrics at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. The study includes a total of 46 infants delivered to diabetic mothers. An oral glucose tolerance test, history, and HbA1C are used to screen for gestational diabetes. Preeclampsia, macrosomia, foetal congenital abnormalities, preterm, and perinatal death are only a few of the severe maternal and newborn outcomes associated with poor early glycemic management of the mother during the prenatal period. Result: 46 infants in total were studied. The most frequent complication is hypoglycemia (40%) followed by hyperbilirubinemia (28%), polycythemia (12%), respiratory distress (26%), macrosomia (28%), cardiac anomalies {septal hypertrophy (21%), PDA (17%), and VSD (8%)}. Less common complications are cleft palate (4%), undescended testis (8%). Conclusion: In this study, we discovered that newborns of diabetes mothers with uncontrolled hyperglycemia had a higher incidence of metabolic and structural problems. To optimise maternal and newborn outcomes, it is crucial to keep track of glucose management and HbA1C levels. Neonatal morbidity risk is directly correlated with maternal blood sugar levels. To identify a neonate with asymptomatic hypoglycemia, strict glucose monitoring is necessary.

78. Prevalence of Acute Bacterial Meningitis (ABM) in Children Aged between 6 months to 5 years with First Complex Febrile Seizures: A Cross-Sectional Study
Mithun Kumar, Anshu Kumari, Jiteshwar Prasad Mandal
Background: The most frequent presentation seizure in children is fever with seizure. Fever with seizure can be caused by either febrile seizures or very serious conditions like meningitis. It is a frequent reason why children visit the emergency room, and it can happen in as many as 10% of those children. It is generally known that acute bacterial meningitis and febrile seizures are related. Methods: The study was conducted in the department of Pediatrics at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar between November 2021 and April 2022. The study includes children between the ages of 6 months to 5 years, admitted for their first complex febrile seizure. Results: Out of the 250 study participants, the prevalence of ABM was 44.4% (n=8) in the 6–12-month age group, 33.3% (n=6) in the 13–24 month age group, 11.1% (n=2) in the 25–36 month age group, and 11.2% (n=2) in the 37–48 month age group. In the 49 to 60-month age group, there were no patients with ABM. Conclusion: According to the findings, a distinct group of children under the age of 2 years, who arrive with their first episode of complex febrile seizure are more likely to have meningitis.

79. Efficacy of Pregabalin and Gabapentin in Treatment of Neuropathic Pain at a Tertiary Care Hospital: A Prospective Study
Preksha Barot, Jitendra Vaghela, Radhika Panchal, Sohil Makwana
Background and Aim: One of the most common pain-related disorders, neuropathic pain (NeP), is frequently underdiagnosed and undertreated. Pregabalin (PGB) and gabapentin (GBP) are both used to treat neuropathic pain, however there is equipoise. Pregabalin and gabapentin’s effectiveness in treating neuropathic pain at a government tertiary care hospital was evaluated in the current study. Material and Methods: The cases were split into two groups at random. Pregabalin was given to Group 1 (N=80) (300 mg). For 24 weeks, Group 2 (N=80) got one dose of Gabapentin (600 mg) every day. The Douleur Neuropathique 4 questions are used to diagnose neuropathic pain, which is then quantified using a pain rating system. Efficacy of drug was based on their capability to decrease neuropathic pain at regular intervals. Results: Since the mean pain rating scores for groups 1 and 2 at the first day of OPD are 7.94 and 7.96, respectively, there is no discernible difference between them (baseline). But by the fourth week, group 1 is significantly different from group 2 in terms of pain rating (p 0.005). Similar to this, group 1 is statistically significantly more effective than group 2 at week 24. Conclusion: Pregabalin and GBP were both significantly effective, in our opinion. According to effectiveness, pregabalin 300 mg taken once daily improved symptoms and signs more than gabapentin 600 mg administered once daily. According to the study, pregabalin is more effective than gabapentin for treating neuropathic pain.

80. Comparison of Efficacy and Tolerability of Fixed Drug Combination of Brimonidine and Timolol with Timolol Monotherapy
Rutviben R. Sadatia, Neil R. Patel, Sachi Jaydipsinh Chavda, Bhavisha N. Vegada
Aim: The purpose of this study is to assess and contrast the efficacy and tolerability of 0.5% timolol delivered as monotherapy and a fixed medication combination of 0.2% brimonidine and 0.5% timolol in patients with POAG. Material and Methods: The included 120 patients were divided into two different groups as follows: group A included 60 patients in Fixed dose combination of Brimonidine Timolol group; taken as study group and group B with 60 patients who received For a period of 12 weeks, timolol 0.5% eye drops were administered morning and evening as the control group. Each patient had their own case record form and was registered as a POAG case. Following enrollment in the trial and the start of the study medicines, follow-up was conducted at 2, 4, 8, and 12 weeks. Change in intraocular pressure (IOP) from the starting point to the target pressure served as the main efficacy end point. The assessment of tolerability included both subjective and objective evaluation of adverse ocular and systemic effects. Results: At the conclusion of the trial, group A experienced a considerable reduction in intraocular pressure when compared to group B. Unpaired “t” test statistical analysis is carried out. Conclusion: For the treatment of primary open angle glaucoma, brimonidine-Timolol fixed combination is more efficient and secure in decreasing IOP than Timolol monotherapy. Additionally, the neuroprotective properties of brimonidine may prove useful in long-term halting the disease’s progression.

81. Evaluation of High Sensitivity C-Reactive Protein in Patients Diagnosed with Asthma: Comparative Analysis
Diksha Yadav, Pradipkumar H Damor, Anil G Gupta, Parth A Gupta
Background and Aim: The first acute-phase protein to be described is called C-reactive protein (CRP), and it is a very sensitive systemic marker of tissue damage, infection, and inflammation. Raised CRP levels have been linked favourably to existing asthma, respiratory impairment, and bronchial hyperresponsiveness. In this investigation, we assessed the connection between the blood CRP level and inflammation among asthmatic patients. Material and Methods: The study’s participants were split into two groups: A control group of 41 healthy individuals and 41 asthmatic patients makes up the study group. The best measurements of forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) were taken using the Spirolab, MIR, and 3 ml of blood was drawn for the assessment of hs-CRP. The serum was separated using the hs-CRP detection kit (nephelometry) by Genrui Biotech. Inc., and in accordance with the protocols, the reference range for the two groups’ hs-CRP levels was determined. Results: In comparison to the control group, asthma sufferers’ FEV1 and PEFR were significantly lower. When the values of the hs-CRP in the two groups were compared, it was discovered that the study group’s value was higher than the control group’s. Compared to asthmatic individuals with stable clinical condition, those whose levels were measured after an acute exacerbation had more pronounced hs-CRP elevations. In the current investigation, adult asthmatic patients’ hs-CRP levels were considerably greater than those of middle-aged patients. Conclusion: Future studies on the impact on the long-term result may be useful in limiting the undesirable and irreversible changes of asthma. Hs-CRP can be considered a good biomarker for assessing the severity and stability of asthma.

82. Sub-Acute Intestinal Obstruction in A Uterine Leiomyoma: A Case Report
Tara Thomas, Minnu Dev, Usha Christopher
One of the most prevalent benign tumours in women of reproductive age is uterine leiomyoma. Depending on the location, size, and quantity of the myomas, different symptoms may result. We describe a rare instance of sub acute small intestinal obstruction brought on by large uterine fibroids, which manifested as severe abdominal discomfort and repeated vomiting episodes. When the CT and MRI pelvis revealed a huge fibroid uterus that was creating an extrinsic mass impact on the terminal ileum and subacute small intestinal blockage, the patient, who was already known to have uterine fibroids, was investigated for the reason of acute abdomen. An adhesion band was seen during surgery linking the myoma to the ileum, where a constriction band had developed and was the source of the obstruction. Small bowel resection anastomosis was performed after a total abdominal hysterectomy. To minimise delays and unforeseen consequences, intestinal obstruction should be checked out in situations when a large uterine leiomyoma presents with symptoms of an acute abdomen.

83. Evaluation, Diagnosis and Management of Benign Breast Diseases in Surgical Outpatient Department in Rural Hospital: A Prospective Study
Navneet Kumar Dubey, Alok Srivastava, Prabhat Vikram Singh, Ravi Sinha
Introduction and Aim: A comprehensive strategy involving not just surgeons but also radiologists, pathologists, and oncologists is needed to address the widespread and difficult problem of benign breast disease.
Material and Methods: A thorough physical exam was performed after taking a thorough medical history. For the confirmation of the diagnosis among 100 female patients with benign breast illnesses, one or more of the specific investigations, such as FNAC and ultrasound, were performed after making an accurate clinical diagnosis.
Results: Benign breast lesion are the commonest breast diseases affecting women. In our study fibroadenoma, breast abscess and fibrocystic disease were common. The incidence for fibroadenoma, was high in 20-30 yrs and for breast abscess and fibrocystic disease 31-50 yrs. Dominant symptoms were lump and pain. FNAC is very efficient investigation in diagnosing & good in fibrocystic disease. Surgical Excision was done among majority of patients (71%) in fibroadenoma followed by Incision and drainage (19%) in abscess and Conservative Treatment (10%) in mastalgia, fibrocystic.
Conclusions: Fibroadenoma in USG finding was among majority of patients (71%) followed by abscess (19%), B/L mastits (6%) and Fibrocystic disease (4%). Fibroadenoma FNAC finding was among majority of patients (71%) followed by abscess (19%) and Fibrocystic disease (4%).

84. A Comparative Study of Pre-Operative Rectal Diclofenac Suppository and Intramuscular Diclofenac for Assessment of Post-Operative Pain in Patients Undergoing Laparoscopic Surgeries under General Anesthesia
Srishti Jain, Dipti Saxena, Atul Dixit
Background: Post-operative pain management is a major concern despite many advances. Intramuscular diclofenac administration causes complications requiring an alternative route of administration. Rectal diclofenac suppositories are available and are proven to be safe for use. Aims and objectives: To compare the effectiveness of a pre-operative rectal diclofenac suppository (single dose) with intramuscular diclofenac (single dose) for postoperative pain among patients undergoing laparoscopic surgeries under general anesthesia. Materials and Methods: Consented 77 patients undergoing elective laparoscopic surgeries, with American Society of Anaesthesiologists Grade I and II, age 18-70 years, and body mass index ≤30Kg/m2 were divided into Group R (n=37, pre-operative rectal diclofenac suppository) and Group M (n=40, receiving pre-operative intramuscular diclofenac). Post-operative pain at 1 hour, 2 hours, 6 hours, 12 hours, and 24 hours, rescue narcotic analgesic requirement, post-operative hemodynamic fluctuations, and complications or adverse drug effects like mild rash, headache, and nausea within 24 hours postoperatively were assessed. Results: Baseline characteristics were similar between the groups (p>0.05). Mean pain scores were significantly lower in Group R compared to Group M at 1 hour (2.11±0.311 vs. 2.90±0.379; p<0.001), 2 hours (2.29±0.611 vs. 3.48±0.640; p<0.001), 6 hours (3.61±0.547 vs. 4.65±0.736; p<0.001) 12 hours (3.04±0.542 vs. 4.83±1.062; p<0.001) and 24 hours (2.87±1.359 vs. 5.05±0.714) respectively. The total dose of rescue narcotic analgesia was more in Group M (109.75±15.440 mg) compared to Group R (59.86±10.703 mg; p<0.001). Conclusion: Rectal diclofenac suppository provides better analgesia than intramuscular diclofenac in patients undergoing laparoscopic surgeries under general anesthesia.

85. Comparison of Surgical Outcome After Non-Descent Vaginal Hysterectomy and Total Laparoscopic Hysterectomy-An Observational Study
Kranti Chandrajai, Akanksha Singh, Alem C Phom, Vandana Gupta
Background: Hysterectomy is a common gynaecological surgery. This surgery can be performed following several different approaches. Aim: To compare the intra- and postoperative outcomes including complication rates among the patients undergoing Non-Descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH). Material and Methods: This was a single centre, hospital based prospective study involving a total of 80 patients who underwent hysterectomy at the study institute. The study outcomes- Operating time, change in haemoglobin level, amount of blood loss, post operative pain score, ambulation, complications, and duration of hospital stay were measured and compared in the two groups. Results: The duration of surgery, mean blood loss, pain score, change in haemoglobin level were significantly lower among the patients who underwent NDVH in comparison to TLH (p<0.05). There was no intraoperative complication(s) in any group. However, 3 participants in each of the two groups developed postoperative complication. Most common postoperative complication was fever. The duration of postoperative ambulation was similar in both the groups (2 days). However, the duration of postoperative hospital stay was shorter among patients who underwent NDVH in comparison to TLH (p<0.05). Conclusion: NDVH done through natural orifice is less invasive as compared to the TLH, leaves no scar on abdomen, needs lesser handling of intestine, is quicker, low pain score and lower blood loss during surgery. All this resulting in shorter duration of hospital stays and quicker discharge.

86. Comparative Study between Use of Single Layer Interrupted Extra Mucosal Technique versus Double Layer Continuous Technique in Intestinal Anastomoses
Mihir K. Shah, Keerthi, Ravikiran, Sneha Parmar
Introduction: The anastomotic approach chosen is based on the location of the anastomosis, the quality and caliber of the bowel, and the underlying medical process. However, personal surgical experience and inclination continue to play a significant role in the decision to conduct a specific anastomosis. The two-layer technique’s sole noticeable drawback is that it takes considerable effort and time to complete. Recent papers have advocated for a monofilament plastic suture-based single-layer continuous anastomosis. This anastomosis can be created more quickly, for less money, and with a potentially lower risk of leaking than any other approach. Aims and Objectives: To compare single layer interrupted extra mucosal technique versus double layer continuous technique in intestinal anastomoses. Methods: This was prospective randomized control trial carried out on admitted patients and posted for resection and anastomosis surgery. Subjects was divided into two groups by alternative technique, namely, Group A. Patients, who received Single layered interrupted extra-mucosal anastomosis and Group B patients, who received double layered continuous intestinal anastomosis. In double layer anastomosis, anastomosis done using a 3-0 polygalactin continuous suturing for inner mucosal layer and a 3-0 silk interrupted for outer seromuscular layer. Each bite included 4 to 6mm of seromuscular wall. All single layer extramucosal interrupted anastomosis are constructed using a 3-0 Polygalactin round body needle suture beginning at the mesenteric border. Stitch advancement was approximately 5mm. Results: In Group A (single layer) the range of time taken for closure was between 7.67 minutes to18.00 minutes and mean duration was 14.35 minutes to perform an anastomosis, in Group B (double layer) the range was between 16.83 minutes to 24.83 minutes and mean duration was 21.43 minutes to perform a double layered anastomosis per operatively. The mean difference between two groups was 7.08 minutes, t value was 11.9 minutes and p<0.001, which is highly significant. Conclusion: The study has concluded that single layer intestinal anastomosis requires much lesser duration than double layer intestinal anastomoses technique.

87. Association of sFRP4, a novel serum biomarker, in patients with Endometriosis
Priyanka Gupta, Maya Malviya, Dimpal Rochlani, Neelam M Pawar
Introduction: An inflammation mediator, called secreted frizzled-related protein 4 (sFRP4), is closely associated with endometrial tissue. The purpose of the study was to test the feasibility of sFRP4 as a non-invasive diagnostic biomarker in different grades of endometriosis and to study the presence of sFRP4 in the peritoneal fluid of these patients. Aims and objectives: To correlate serum & peritoneal fluid (PF) levels of sFRP4 in women with endometriosis. Materials and methods: A hospital based cross-sectional case control study was carried out on women who were admitted for operative laparoscopy for the diagnosis of endometriosis. Based on their grading according to the revised American Society of Reproductive Medicine (rASRM), 22 patients with endometriosis aged 18– 45 years and 21 age matched healthy controls were included in the study. sFRP4 was estimated by ELISA method. Results: Mean of serum and saline wash of POD levels of sFRP4 in endometriosis patients was found to be 8017.0 ± 2577.8 pg/ml &3718.9 ± 1650.8 pg/ml, respectively & that in serum of controls was 3871.0 ± 2077.8 pg/ml. Serum sFRP4 levels of cases were significantly elevated when compared to controls (p<0.0001). Total serum sFRP4 levels were positively correlated with saline wash of POD sFRP4 (r=0.743, p<0.001). Conclusion: An increase in serum sFRP4, correlates with peritoneal fluid concentrations, and accompanies with increasing grades of endometriosis.

88. Medium to Low Dose Prednisolone Therapy (MLDPT) for ‘Remitting Seronegative Symmetrical Synovitis with Pitting EDEMA’ (RS3PE) on Novel Anticancer Therapy. Onco-Rheumatological Case Series, Systematic Review And Meta-Analysis
Srilakshmi S, Deepti Agarwal, Sandeep Kansurkar, Shreeniwas S. Raut
Aim of the work: To report series of ‘remitting seronegative symmetrical synovitis with pitting edema’ (RS3PE) in oncology setting with novel anticancer therapy and systematic review of treatment of this entity. Patients and Methods: Retrospective data collection of patients who had RS3PE after starting novel anticancer therapy with tyrosine kinase inhibitors(TKI) or immune checkpoint inhibitors in last one year. Systematic review of previous case reports with similar presentation and meta-analysis of treatment given was done. Results: Total 4 cases (2 males and 2 females) presenting as RS3PE with background of malignancy were detected. Three patients had metastatic renal cell carcinoma (RCC) and were on treatment with pazopanib. One patient had head and neck squamous cell carcinoma (HNSCC) and was on treatment with nivolumab. All patients responded to medium to low dose prednisolone therapy (MLDPT). None of the patients had long term sequelae. One of the patients had to discontinue inciting therapeutic agent temporarily, not due to arthritis but due to underlying co morbidities. Conclusion: MLDPT is effective therapeutic strategy in RS3PE with malignancies on novel anticancer therapy. With systematic review of literature we tried to throw light on causation, mechanism, profile, natural history and therapeutic significance. We have also reviewed efficacy of various drugs used in treatment of RS3PE as per reported literature.

89. An Observational Assessment of Mortality Rates among Intubated and Mechanically Ventilated Subjects with Gram-Negative Pneumonia and to Explore Associated Risk Factors for Mortality
Preeti Kumari, Uzma Raihan, Kumar Saurabh
Aim: To describe mortality rates among intubated and mechanically ventilated subjects with Gram-negative pneumonia and to explore associated risk factors for mortality among these subjects. Methodology: This was a retrospective, observational cohort study conducted in IGIMS, Patna, Bihar, India using hospital records containing information on in-patient care, ambulatory care, and emergency department visits. The databases are derived from administrative data and contain encounter-level, clinical, and nonclinical information including all listed diagnosis and procedures, discharge status, patient demographics, and charges for all patients. The study sample included adults age ≥ 18 y (as of the index date) who were hospitalized with invasive, continuous mechanical ventilation; were discharged between April 1, 2020 and June 30, 2021; and who had a primary or secondary diagnosis of Gram-negative bacterial pneumonia. The study collected demographic, clinical, and admission characteristics. Mortality and risk factors associated with mortality were evaluated in the full study population. All the data was collected and analyzed.  Results: During the study period, a total of 763 patients were admitted who were incubated and mechanically ventilated, out of which approximately 400 subjects were diagnosed with Gram-negative pneumonia. More than half of the included subjects (61.75%) were male, and 52.5% were ≥ 60 years old. Most subjects (80%) utilized the emergency department during their hospitalization. The mortality rate among included subjects during the index hospitalization was 23.25%. 6% patients had previous hospitalization history due to Respiratory Tract Infections (RTI) and 4.5% due to chronic pulmonary diseases. In the present analysis, subjects with concomitant sepsis had the highest risk of mortality followed by subjects age ≥ 60 years and those with any prior hospitalization within 30 days. Comorbidities upon admission with the highest risk of mortality included cancer, liver disease, renal disease, and congestive heart failure. Presence of diabetes (with or without complications) was found to be associated with a lower mortality risk. Conclusion: From our study, it can be concluded that mortality was high in mechanically ventilated subjects with Gram-negative pneumonia. The main risk factors for mortality identified in this analysis were the presence of sepsis, the presence of cancer, the presence of liver disease, and age ≥ 60 years. Further prospective research is needed to confirm these findings and to explore potential healthcare intervention strategies that would improve outcomes in this patient population, especially among those at greatest risk.

90. A Prospective Observational Study to Examine the Roles of Parenting Stress and Parenting Self-Efficacy as Mediators between Child Behavior Problems and Parental Anxiety/Depression
Amit Kumar
Aim: The current study sought to examine the roles of parenting stress and parenting self-efficacy as mediators between child behavior problems and parental anxiety/depression. Methods: This was a cross-sectional descriptive study investigating depression and burden among caregivers of ASD patients. Participants were all caregivers who brought ASD patients to the outpatient at Department of Psychiatry ,Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. Participants included 50 caregivers, of whom the majority was mothers of ASD patients. Results: In the present study, there were 70% females and 30% were males. 70% were mothers as caregivers with the child. 60% were married in the study. Only 34% patients were giving care to the child. Most of the caregivers were doing full time job. As for the ASD patients, 88% were boys. The mean age of the patients was 6.4 (SD 3.4). Most of them (92%) were classified into the moderate and high function group. Significant correlations were also observed between the caregiver burden and months after diagnosed, the number of patient’s problems and the number of hours that the caregiver spent with patient. Conclusion: The prevalence of depression in and severe burden on caregivers of autistic children from the present study was low. Factors related to the burden were months after diagnosed, the number of patient’s problems, the number of hours that caregiver spent with patient, patient’s communication problems and inappropriate or odd repetitive behaviors.

91. A Hospital Based Clinical Assessment to Determine the Clinical Outcomes of Patients with Soft Tissue Sarcoma
Alok Ranjan, Nisha Khanna, Vivek Ranjan, Aakarsh Sinha, Kalpana Jha, Prabhat Kumar Lal
Aim: The aim of the present study was to assess clinical outcomes of patients with soft tissue sarcoma. Methods: The present study was conducted at IGIMS, Patna, Bihar, India for one year and 200 patients were included in the study. Demographic characteristics (age and sex), tumor-speci9c factors (site, histology, size, depth, surgical stage, and histologic grade), and treatment-speci9c factors (surgical margin and histological margin) data were collected from the patient medical records and reviewed. Results: Male to female ratio was 40 to 60%. Median age was 53.5 years (range 18–84). Most patients had favorable RMH score (less than two 172/200, 86%); the remaining 14% of patients had an RMH score of two. Overall survival based on RMH score trended toward favoring lower scores, (Hazard Ratio = 2.0 (0.9, 4.6) for 1, 2 vs. 0, but was statistically inconclusive). Median OS was 24 months for RMH score 0 and was 12 months for patients with score 1–2 (P = 0.08). Performance status was also favorable with 192 patients (96%) with an ECOG 0–1. We found 14 different subtypes of sarcomas with 15 bone sarcomas and 50 soft tissue sarcomas. Conclusion: STS present a treatment challenge due to their low incidence and atypical anatomic and histopathologic features. However, regardless of the treatment, long-term vigilance is required for these patients.

92. A Hospital Based Observational Assessment of the Clinical Features of Hyponatremic Dehydration in Acute Gastroenteritis
Brajesh Kumar, Sumit Kumar, Gopal Shankar Sahni, Prashant Kumar
Aim: The aim of the present study was to evaluate the clinical features of hyponatremic dehydration associated with acute gastroenteritis. Methods: The study was done in SKMCH, Muzaffarpur, Bihar, India. The Study population consisted from Infants to children aged till 12 years attending the paediatric department both OPD and IPD care for acute gastroenteritis are enroll in the study. A total of 100 Children including neonates were enrolled in the study. The duration of the study was six months Results: 100 cases were studied and analyzed to detect Gastroenteritis associated dehydration and its clinical features as a possible risk factor for hyponatremia. It was found that 60% of the males were having acute gastroenteritis while it was 40% in female subjects. The data also reveals that higher incidence of acute gastroenteritis was noted between 6 to 24 months of age while the lower incidence was found in the subjects above 36 months of age. Hyponatremia was occurred in 36 subjects with high incidence in lower age group in both the genders. Males (40%) were more affected than females (30%). Conclusion: The clinical impression of the type of dehydration and electrolyte disturbances was fairly consistent with serum electrolytes values. This suggest that routine estimation of serum electrolytes is not necessary however it is necessary whenever electrolyte imbalance is suspected on clinical grounds and in cases which do not respond satisfactorily with routine fluid electrolyte therapy.

93. A Prospective Hospital-Based Study to Determine the Spontaneous Course of SCH and to Identify the Risk Factors, Which Enhances the Occurrence of Overt Hypothyroidism (OH)
Rajeev Kumar
Aim: The aim of the study was to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH). Methods: This was a prospective observational study conducted at Department of General medicine, PMCH, Patna, Bihar, India for 2 years. A total of 50 patients were recruited in this study. Results: Mean ± SD age, BMI and WC were 42.23±12.79 years, 26.49±4.82 kg/m2 and 94.12±19.81 CM, respectively. There was no significant age, BMI and WC difference between male and females’ group. Central obesity was present in 84%, 80% and 85.71% all, males and females respectively and there was no significant difference between males and females. Diabetes mellitus (DM) was present in 30%, 53.34% and 20% all, males and females respectively. Anti-TPO antibody was present in 34%, 20% and 42.85% all, males and females respectively. At one-year follow up examination 11 (18.97%) patients progressed to OH (defined as TSH ≥10 IU/L). In anti-TPO positive group rate of progression to OH was 29.42% while in negative group it was 16.16%. Rate of progression was significantly higher in anti-TPO positive group as compared to negative (p<0.023). Conclusion: In a cohort of 50 patients followed for one year only the presence of anti-TPO antibody was predictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.

94. A Cross Sectional Study to Assess the Incidence of Aerobic and Fungal Infection in Post-Operative Wound Infection
Anupama Singh, Ranjit Kumar Singh
Aim: The aim of the study was to isolate aerobic bacterial and fungal infections from post-operative wounds. Methods: The study was a cross sectional study which was carried in the Department of Microbiology, Netaji Subhas Medical College and Hospital, Bihta, Bihar, India for one year. Out of 210 samples, 100 samples were culture positive (47.61%). Total 100 patients with post-operative wound infection either sex or any age, who had surgical wound pus, discharge, or signs of sepsis were include in this study. Results: Among 100 positive samples 60 (60%) were males (Table 1). The age wise distribution of the gender has been shown in the with maximum no. of culture positive samples in age 25-35 years (36%) followed by 35-45 (17 %) and then followed by 45-55 (16%) of age group respectively. The predominant bacterial isolates S. aureus (35%), P. aeruginosa (22%), E. coli (15%), Proteus spp. (7%), K. aerogenes (6%), Streptococcus spp. (5%) and one fungal isolate C. albicans (10%). Conclusion: It has been concluded that wound infections in this were polymicrobic in nature and, in most cases, associated with S. aureus, E.coli and Pseudomonas aeruginosa. A continuous inspection should be carried out to monitor the susceptibility of these pathogens and chose appropriate regimens both for prophylaxis and treatment of surgical wound infections.

95. Comparative Assessment of the Diagnostic Efficacy of Malignancy in Adnexal Masses by International Ovarian Tumor Analysis (Simple Rules) Versus Risk of Malignancy Index
Swati Sinha, Hit Narayan Prasad
Aim: The objective of this study was to compare international ovarian tumor analysis (Simple rules) versus risk of malignancy index for the pre-operative diagnosis of malignancy in adnexal masses. Methodology: The study was carried out using data prospectively collected from consecutive patients. It evaluated the diagnostic performances of the SRs models and variants of the RMI (I–III) within a population of women who underwent surgery to remove adnexal masses at the Department of Obstetrics and Gynaecology, IGIMS, Patna, Bihar for one year. A total of 200 patients were included in the final analysis. Results: In the final analysis, 200 patients with 150 (75%) benign and 50 (25%) malignant adnexal masses were included.  Endometriomas (20%, 40/200) and serous cystadenomas (14%, 28/200) were the most common benign diagnoses. Among the malignant masses, 7% (14/200) were BOTs. The patients with malignancies were older, were more likely to be post-menopausal and to have a family history of OC, and had higher CA125 levels than those with benign tumors (all P < 0.05). Regarding the ultrasound findings, the malignant tumors had significantly greater diameters, more solid tissue, wider solid tissue components, > 10-cyst locules, more papillary projections, and more ascites compared with the benign masses (all P < 0.001). None of the patients with malignant tumors had acoustic shadows. Conclusion: ADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI.

96. An Observational Study to Assess the Association between Blood Groups and Blood Hemoglobin Levels in People Residing in the Rural Area of Bihar
Kumari Ranjana
Aim: The aim of the present study was to assess the association between blood groups and blood hemoglobin levels in people residing in the rural area of Bihar. Methods: The present study was conducted at Department of Physiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar for 1 year after taking the approval of the protocol review committee and institutional ethics committee. 100 adults (males and females) who are in the age group of 18-32 years were included in this study. Results: In our study, adults with hemoglobin concentration less than 10g/dl were taken as anemic. Total 30 adults are anemic, while remaining 70 adults are non anaemic. 45 adults are females out of which 55 are anemic whereas 60 adults are males where only 10 males were found to be anemic. 27 adults are blood group A, 4 with blood group AB, 35 with blood group B and O blood group adults are 34. Among the A blood group, 4 adults were anemic, among blood group B, 10 were anemic, among blood group AB, 2 were anemic and 14 adults with O blood group were anemic. Conclusion: Individuals with blood group B are more prone to anaemia followed by blood group O, AB and least is with blood group A.

97. Role of Doppler Ultrasonography in the Evaluation of Hashimoto’s Thyroiditis
Pratik Kumar, Santosh Kr. Prasad, Sanjeev Suman, Vijay Shankar Prasad
Aim: To evaluate the utility of color doppler ultrasonography along with quantitative spectral doppler parameters in the assessment of Hashimoto’s thyroiditis. Methods: The study was conducted at Department of Radiology, Patna Medical College, Patna, Bihar, India for one year and 100 patients were included in the study. All patients were well informed regarding the study and their consent was obtained. Patients were divided into four groups such as group A (normal); group B (early untreated thyroiditis); group C (chronic thyroiditis under treatment/ follow-up); group D (nodular hyperplasia with thyroiditis) based on grey‑scale ultrasound findings, thyroid function test and auto-antibody levels. Following grey scale examination, Doppler study was performed, and the vascularity of both lobes was assessed. Quantitative spectral doppler parameters including resistivity index (RI) and acceleration time (AT) were recorded. RI and AT values were obtained by measuring automatically from proximal segment of the first main parenchymal branch of the inferior thyroid artery. Results: 100 cases were evaluated with age ranging from 27 years to 55 years with the maximum number of cases in the age group of 41 to 50 years (44%). 32 cases were males and 66 were females, 2 patients identified themselves in other gender category. On assessment of the colour doppler pattern, 36 patients had Pattern 0, 37 patients had Pattern I, 24 patients had Pattern II, and 3 patients had Pattern III. Pattern I was the most common pattern overall (37%) and in category B (48%) and C (50%) patients; pattern 0 was more common in category A(66%); pattern 2 was the commonest pattern in category D patients (46%). On assessment of spectral doppler parameters, mean RI in category A, B, C, D were 0.54, 0.40, 0.47 and 0.48 respectively. Mean AT value in category A, B, C, D were 26.3, 71.5, 47.1, 45.3 respectively. RI values of category B (Early untreated thyroiditis) were significantly lower than category A (Normal). AT values of category B, C and D were significantly longer than AT compared to category A. Statistically significant difference was not found in RI values of category A when compared to category C and D.  Significant differentiation could not be made between category C and D on either RI or AT values. Conclusion: Doppler ultrasonography in Hashimoto’s thyroiditis is a promising diagnostic imaging modality.  Routine use of doppler study in addition to greyscale ultrasound is helpful in diagnosis especially in doubtful cases.

98. Association of Interleukin-6 (IL-6) and High-Density Lipoprotein Cholesterol (HDL-C) with Disease Severity of Coronavirus Disease 2019 (COVID-19)
B.Uma Maheswari, R. Thamarai, A. Velayutharaj, Balaji.K, K. Sivakumar
Introduction: IL-6 is the key molecule of cytokine storm in COVID -19. Dyslipidemia is a common complication in patients with Coronavirus disease 2019 (COVID-19), but the association of dyslipidemia with the severity of COVID-19 is still unclear. In this study, we aimed to investigate the biochemical alterations of High-Density Lipoprotein Cholesterol (HDL-C), and Interleukin-6 (IL-6) in COVID-19 patients and their relationships with the disease severity. Materials and Methods: We conducted a retrospective single-institutional study of 99 consecutive confirmed cases of COVID-19. Serum IL-6 and HDL-C concentrations, demographic and clinical profile were collected during hospital stay. Duration of study was from September 2020 to August 2021. Descriptive statistics were applied to summarize the demographic data. Results are reported as mean with standard deviation. Receiver operating characteristic curve (ROC) analysis was used to compare biochemical markers. Results: Serum HDL-C levels had a significant positive correlation with SpO2 with correlation coefficient r = 0.589. Serum IL-6 had a negative correlation with SpO2 with correlation coefficient r = -0.632. The AUC for IL6 and HDL-C in predicting COVID severity is 0.982 and 0.985 respectively. Conclusion:HDL-C is decreased and IL-6 is increased with the disease severity.

99. Prevalence and Risk Factors of Hypertension among Bank Employees of Davangere City, Karnataka
Ruchi Dhar, Ritu Kashyap, Anitha P
Background: Hypertension is a chronic disease which is globally one of the most important risk factors for Coronary vascular diseases. Hypertension has several risk factors of which sedentary lifestyle and mental stress are the major contributors. Bank employees are exposed to higher levels of these risk factors and hence they form an important high-risk group for screening of hypertension. There is not much of information on the prevalence of hypertension among bank employees at the global level as well as in India. Undertaking a study of such nature would help us to understand the problem and make appropriate interventions on a larger scale. Hence this study was conducted to determine the prevalence of Hypertension and its risk factors among the bank employees of Davngere city. Methods: A cross-sectional study was conducted among 390 bank employees of Davangere city. All the study subjects were selected by using probability proportionate to size technique. Data was collected using a pre-tested, semi-structured questionnaire. Height, weight, hip circumference, waist circumference and blood pressure were measured and recorded. Data was analyzed by using MS Excel and Open-Epi Info software version 2.2. Results: The prevalence of hypertension was found to be 30.3% among the bank employees and it was highest in the age- group of 55-60 years (30.5%). The prevalence of smoking among hypertensive employees was 31.4 % and among normotensive employees was 25.7%. This difference was not found statistically significant.

100. The Burden of Liver Disease in Eastern India: Epidemiology and Analysis of Different Biochemical Parameters to Know the Risk Score for CLD Patients
Prasanta Kumar Parida, Swarup Kumar Patnaik, Subhasis Pradhan, Manjit Kanungo, Debakanta Mishra, Jimmy Narayan, Kanishka Uthansingh, Sarat Chandra Singh, Biswadev Mohapatra, Girish Kumar Pati
Background and Aim: Chronic liver disease (CLD), with its various etiology and presentation, is a common cause of hospitalization in tropical countries. This CLD study includes etiology diagnosis, clinical feature examination, and associated disease and complications detection. The aim of the present study was to identify aetiological factors of CLD in and around the Eastern Indian population from two centers. Secondly, to investigate clinical, biochemical, ultrasonographic, endoscopic, and histopathological features of various CLDs. Material and Methods: This was a one-year observational study of 245 patients with CLD who attended the OPD and inpatients at the Dept. of Gastroenterology, SCB Medical College and Dept. of Gastroenterology and Hepatobiliary Sciences, IMS SUM Hospital, Bhubaneswar. A total of 248 patients with CLD were included prospectively for the observation study. Clinical findings, laboratory investigations, ultrasonography, and an upper GI endoscopic study were used to diagnose chronic liver disease (CLD). All the data entered in the excel sheet were analyzed by SPSS version 16 to know the significance value p < 0.05. Results: As observed from the study, the age group that participated was 30-39. A fraction of 54% of patients’ Child Purgh Score was in the Class A group, while a fraction of 46% was among the Class B CP scoring group. Among the CLD patients, the High Blood ammonia level was about 58%, and the low normal ammonia level group was about 12%. A fraction of 53% of patients was under the Oesophageal varix Griding, and 41% were under the mild PHG among the selected group. Conclusion: The current study provides a much-needed and valuable sketch of clinical patterns, aetiologies, regional differences, and overall trends in CLD access and utilization in India. Furthermore, the profile described here serves as a baseline for future comparisons.

101. Functional Outcome Analysis of Prosthetic Replacement of Comminuted, Displaced Proximal Humerus Fractures in Elderly Individuals: A Prospective Observational Study
Muthu Vignesh, Avinash Manoharan, Maheswaran Jawaharlal Nehru
Introduction: Proximal humeral fractures are observed commonly among the elderly population, especially women. Almost half of these fractures occur at home, majorly after falls. Recently replacement of the fractured head or hemiarthroplasty (HA) of the shoulder for displaced comminuted proximal humeral fractures has shown promising results with better acceptance when compared to ORIF. Aims and Objectives: To assess the functional outcome of prosthetic replacement of comminuted, displaced proximal humerus fractures in elderly individuals. Methods: Design: Prospective observational type. Study duration: Two years. Study tool: Using a semi-structured pre-tested tool that included Constant Murley scores for functional outcomes. Data was collected using datasheets and entered in Microsoft Excel and analyzed using SPSS version 20. The compassion of Constant Murley scores was compared between the Neer’s III and IV parts across the follow-up months. A p-value of less than <0.05 was considered statistically significant. Results: We included around 20 patients who had Neer’s III and IV class of proximal humerus fractures. The majority of our study participants were males, belonging to 60-70 years age group. We observe that almost 90% of the study participants recovered well without any post-operative complications. We observed that the distribution of raw Constant Murley scores was statistically different between the class of fractures, at the first third and eighth month of follow-up respectively. Whereas in the first year and second year of follow up we did not find any statistically significant difference. Conclusion: Hemiarthroplasty can be considered as a vital option of comminuted, displaced proximal humerus fractures among elderly individuals.

102. The Efficacy of Botulinum Toxin-A versus Methyl Prednisolone Acetate Injection in Reducing Pain and Improving Functional Outcome in Plantar Fasciitis
Geetha, K. Premalatha, J. Jeyakhar
Background: Heel pain due to Plantar fasciitis is one of the most commonest complaints seen among foot disorders. Many conservative management and interventions like corticosteroid injection is the treatment commonly done  in Plantar fasciitis, but there is level B evidence that Botulinum toxin  can be probably effective and recommended for reducing pain in Plantar fasciitis. AIM: The Efficacy Of Botulinum Toxin-A Versus Methyl Prednisolone Acetate Injection In Reducing  Pain And Improving Functional Outcome In Plantar Fasciitis A Randomized control study. Methodology: Hundred Participants with plantar fasciitis was selected  in PMR Outpatient Department in Government Institute of Rehabilitation Medicine Hospital, Chennai and divided into two groups by Simplified Randomized control study. Group 1 received Botulinum toxin-A injection  and Group 2 received  methylprednisolone acetate injection followed by scheduled exercise to both groups. Participants were assessed  before and  after intervention at 2months,4months,6months  using Visual Analogue Scale, FAAM Score. Conclusion: This study shows that in Botulinum toxin group1 there was significant  reduction  in VAS pain score and  improvement in functional level after intervention and it was maintained after 6 months with no complications. In steroid group2 there was significant reduction in VAS pain score and FAAM score up to 3-4 months but that was not maintained after 4 months.

103. Evaluation of Ultrasound-Guided Erector Spinae Plane Block with a Combination of Ropivacaine 0.5% with Dexmedetomidine (1mcg/Kg) with Ropivacaine 0.5% Alone for Post-Operative Analgesia in Thoracic Surgeries
Saladi Venkata Akshay, Kumbha Gopi, Gajera Manthankumar Pravinbhai, Sandeep Rathore
Background: Dexmedetomidine can significantly prolong the efficacy of local anesthetics for nerve block, lessen post-operative pain, reduce the dosage of local anesthetics and opioids, and lessen adverse responses, according to several studies. Evidence is limited in India’s setup. Aims and Objectives: To evaluate the effect of dexmedetomidine co-administered with or without ropivacaine 0.5% for post-operative analgesia in thoracic surgeries. Materials and Methods: Sixty patients (age: 30-75 years and body mass index: 18–25 kg/m2) undergoing thoracic surgeries were randomly divided into Group R (n=30; patients who received ropivacaine 0.5% alone) and Group RD (n=30; patients who received a combination of ropivacaine 0.5% with dexmedetomidine (1mcg/kg). Intravenous compound general anesthesia was given and maintained, followed by an erector spinae plane (ESP) block. Onset time, block duration, and pain severity were recorded using a visual analog scale (VAS) scores at 0.5 h, 6 h, 12 h, 24 h, and 48 h postoperatively. The time taken to get out of bed for the first time and the length of post-operative hospital stay were also recorded. Quality of life score at 24 hours, the analgesia satisfaction of patients, and the occurrence of adverse reactions or complications were also recorded. Results: The onset time was shorter for Group RD than for Group R (P < 0.001). The erector spinae muscle block duration was longer in Group RD than in Group R (p<0.001). Compared with Group R, the VAS scores at 6 h (p<0.001), 12 h (p<0.001), 24 h (p<0.001), and 24 h (p<0.001) postoperatively were significantly lower in Group RD, whereas at 0.5 h VAS score did not differ substantially between the groups (p=0.572). Compared with Group R, the QoR-40 score was significantly higher (P < 0.001), and the time taken to get out of bed for the first time and length of post-operative hospital stay was significantly shorter in Group RD (P < 0.05. No significant difference in terms of ESP block-related adverse reactions and complications were reported between the two groups (p>0.05). Conclusion: Dexmedetomidine (1mcg/kg) as an adjuvant to 0.5% ropivacaine for ESP block is better than 0.5% ropivacaine alone for overall analgesia and post-operative rehabilitation of patients undergoing thoracic surgeries.

104. A Comparative Study of Efficacy of Intrathecal Levobupicaine and Bupivacaine for Caesarean Section
Koribilli Harish Kumar, Manpreet Singh, Sukhmanpreet Kaur
Introduction: A balancing method for caesarean birth is spinal anaesthesia. It provides total muscle relaxation and quick onset of anaesthesia. Objective: To evaluate and contrast the beginning, length, neonatal outcome, cardiovascular parameters, and adverse medication reactions. Material and Methods: It was a double-blind, prospective study. There were enrolled a total of 60 patients, 30 in each group. 8.5 mg of isobaric levobupivacaine and 15 g μg of fentanyl were administered to Group A, and 8.5 mg of hyperbaric bupivacaine and 15 μg of fentanyl were administered to Group B. Result: There was a statistically significant difference between the two groups in the time it took for the sensory and motor blocks to start and in how long they lasted. Conclusion: For spinal anaesthesia during caesarean section, the combination of isobaric levobupivacaine and fentanyl can be used as a safe and effective substitute to hyperbaric bupivacaine and fentanyl because it offers similar sensory block characteristics, early motor recovery that enables early mobilisation, stable hemodynamics, and good foetal health.

105. A Management Conundrum of Cesarean Section Scar Ectopic Pregnancy
Jaspreet Kaur, Amandeep Singh, Koribilli Harish Kumar
The prevalence of caesarean scar ectopic pregnancy (CSEP) is rising as a result of more frequent C-sections and improved diagnostic tools. To lower mortality and morbidity, it is crucial to make an accurate and timely diagnostic and treatment plan decision. It is necessary to have both radiologist and gynaecologist expertise. Keep in mind that there is a high degree of mistrust, and that any delay in management could have negative effects. Here is a case study featuring three instances involving CSEP and its traditional line of management. The diagnosis was established using the patient’s medical history, clinical examination, blood levels of beta-human chorionic gonadotropin (-hCG), hysteroscopy, ultrasonography, and histology. All the 2 patients were treated mostly with methotrexate, preserving future fertility. Ultrasound scans and serum hCG were used for the follow-up.

106. A Study of Demographic Trends in Leprosy Cases a Silent Menace Still Prevalent in the Post-Elimination Era
Niladri Sekhar Das, Ashok Prasad, Dipmala Das, Atanu Roy
A persistent inflammatory disorder of the skin and peripheral nerves, leprosy. Leprosy was declared eradicated as a public health issue worldwide in 2000 and in India on December 31, 2005. Following that, leprosy services in India were included into the General Health-Care System, which resulted in a decrease in attention and funding. There is no time for complacency as maintaining the progress gained in leprosy control thus far is a significant task. In many states, there are still areas of high endemicity with prevalence rates above 2. Our results from a tertiary care facility show that epidemiological control is subpar and that disease transmission is still occurring. Dermatologists should continue to be at the forefront of developing the skills of undergraduate and graduate students, medical officers, and field workers in order to address this.

107. Clinical and Radiological Findings of Patients with Screw-Fixed Dorso-Lumbar Spine Fractures in a Tertiary Center
Prashant Priyadarshi, M Azam
Background: According to estimates, injuries to the dorsolumbar spine account for 75% of all spinal fractures. This investigation was done primarily to assess the clinical and radiological results of screw-stabilized dorsolumbar spine fractures and to examine any associated side effects. Materials and Methods:  In 55 cases of dorsolumbar spine fractures admitted to tertiary care facilities, prospective research was conducted. The patients had dorsolumbar fracture pedicle screw fixation surgery, and the results were evaluated clinically and radiologically utilising two views of a radiograph (AP and Lateral). Results: With the help of screw fixation, about 35 patients with dorsolumbar spine fractures improved. The decrease in the kyphotic angle, AVBCP, and improvement in Beck’s index served as indicators of the improvement. The majority of patients also said that the surgery had outstanding results. Conclusion: In conclusion, the pedicle screw fixation is still the preferred implant for treating fractures of the dorsolumbar spine.

108. A Retrospective Study Showing the Value of the Triple Tumor Markers CA19-9, CA125, and CEA in Predicting the Advanced Stage of Carcinoma Gallbladder
Somen Jha, Pankaj Kumar
Introduction: The assessment and prognosis of carcinoma gallbladder are determined using a combination of serum tumor markers (GBC). The purpose of the study was to determine the significance of using CA19-9, CA125, and CEA together in metastatic GBC and to determine the cut-off values for each of these tumor markers. Method: This research involved 40 cases of advanced GBC and was done retrospectively over the course of a year. Based on the results of the CECT scan, the patients were divided into groups for locally progressed and metastatic stages. All patients had their CA19-9, CA125, and CEA levels evaluated. These two groups of GBCs were used to analyze these tumor markers. R statistical software version 3.6.2 was used to conduct the statistical analysis. Results: Out of 40 instances, 17 (77%), 15 (71%) and 8 (38%) patients with metastatic illness had increased CA19-9, CA125, and CEA levels. The ROC curve was used to calculate the cut-off values for CA19-9, CA125, and CEA, which were >108 U/ml, 55.3 U/ml, and 2.55 μg/l, respectively. For the diagnosis of the metastatic stage of the cancer, CA19-9 exhibited the best sensitivity (78.2%), followed by CA125 (69.5%), and CEA (68.3%). Combining these tumour markers increased their specificity to the greatest extent. Conclusion: However, their cut-off level is statistically insignificant in predicting metastatic GBC. The combined use of triple tumor markers boosts its specificity in the diagnosis of advanced stages of GBC.

109. Evaluating Clinical Outcomes and Costs of Arthroscopic and Open Procedures in Patients with Degenerative Full-Thickness RTC
Prashant Priyadarshi, M Azam
Background: Rotator cuff tears have long been known to produce discomfort and impairment. The method of treating rotator cuff tears has changed throughout the years, moving from an open operation to a mini-open technique to an all-arthroscopic approach. On whether one method produces better results, there is disagreement. This study looked at how arthroscopic and open treatments performed on patients with degenerative full-thickness rotator cuff injuries in terms of clinical and financial outcomes. Materials & Methods: From February 2019 to February 2022, a prospective study was undertaken in the orthopaedics department at Patna Medical College & Hospital in Bihar, India, with cases being followed up for at least three years. 40 patients of either sex with non-massive full thickness rotator cuff injuries participated in this study. After three years of follow-up, surveys are used to calculate The American Shoulder and Elbow Surgeons Shoulder Score (ASES), which is a measure of quality of life. Results: It was statistically insignificant (P>0.05) that patients with rotator cuff tears were an average age of 56.5 years for small open repairs and 57.2 years for arthroscopic repairs. The adjusted ASES scores during the preoperative and postoperative periods did not substantially differ between groups (P > 0.05 and P > 0.05, respectively). Additionally, both groups’ individual pain, pleasure, and function levels shown a considerable improvement. Conclusion: This study supports the continued use of arthroscopic repair methods by demonstrating that the short-term outcomes of arthroscopic and mini-open rotator cuff surgery are comparable.

110. A Comparative Study to Detect Tuberculosis in Pregnant Women with and Without Diabetes
M.N. K. Dhanalakshmi, Aparna Chowdary Chaliki, Gunta Raja Sekharam, Anusha T
Introduction: Diabetes mellitus (DM) was reported to be the major issue to control the spread of tuberculosis (TB). With these, a study was conducted to find the utility of FS in the diagnosis of pulmonary tuberculosis (PT) among the pregnant women. Methods: It was a prospective study, conducted in GSL Medical College. In this research sputum samples which were submitted to institutional Microscopy centre were considered. In this research, pregnant women with DM, symptoms of cough for > 2 weeks were considered. Non cooperative members and non DM were not considered in this research. Then the participants were provided with sterile, plastic containers and they were asked to collect the sample. Collection of sputum sample, smear preparation as well ZN and fluorescent staining (FS) were carried as per the protocol. The data were analysed using SPSS version 21. Chi square test was used to find the statistical analysis. P <0.05 was considered to be statistically significant. Results: Total 106 participants were included in this study. Maximum (32.8%; 34) in 21 – 25 years group; the mean age of the study members was 31.3 years. Total 8 (100%) PT cases were detected using FS. By using ZN staining 5 (4.5%) PT cases were detected; statically there was no significant difference. Maximum PT cases were detected in in 21 – 25 (5; 62.5%) years group. Conclusion: FS technique has better diagnostic yield to detect pulmonary tuberculosis among the pregnant women with DM. But small sample and short duration of the study are the limitations of the research.

111. Awareness about the Notification of Tuberculosis among Private Practitioners in Madurai District: A Cross-Sectional Study
Jayapriya B, Balamurugan PV, Hareesh A
Introduction: Tuberculosis (TB) notification is defined as the process of reporting diagnosed TB cases to relevant health authorities, whom in turn report them to the World Health Organization (WHO) through National TB Programmes (NTPs). While TB cases detected in the public sector health facilities generally get notified, a large proportion of cases that are detected and treated in the private sector do not get notified. Increasing the awareness about notification of TB will increase the notification by private sector including practitioners, labs and pharmacies. This study is aimed at assessing the awareness of private practitioners about recent developments in the notification of TB and to educate them regarding the RNTCP guidelines. Materials and Methods: This is a descriptive cross-sectional study. Two hundred allopathic doctors, irrespective of their field of practice, both private practitioners and Govt. doctors with private practice were included in the study. A self – administered validated semi-structured questionnaire was given to the participants to assess their awareness about the notification of TB. After collecting the answered questionnaire, the participants were given a pamphlet with RNTCP guidelines about notification and the provisions that are available for TB patients and the facilitating practitioners. Results: Nearly 95% of the study participants and all participants of Medicine and its allied specialities were aware about the notification of Tuberculosis. Majority of the participants correctly pointed out the benefits of notification ie., contact screening, monetary benefit to the patient and improvement in the uniformity and quality of treatment. Only 27.5% were aware about NIKSHAY app. Only 31% were aware about the monetary benefit to the practitioner upon notification. Only10 (5%) respondents had a fear of breech in the confidentiality of the patient and 12(6%) respondents lacked time. Some of them didn’t know whom to notify. At the end of the study, the details of whom to notify in Madurai district and the benefits of notification were given to the participants as a pamphlet. Conclusion: The first step towards better management of TB is to notify the cases to RNTCP. Increasing the awareness about various aspects of case notification will go a long way in achieving the goals of RNTCP. At the end of the study, the participants understood the importance of notifying cases.

112. Correlation of Inflammatory Markers with Radiological Findings in Novel COVID-19 Diseased Patients in a Tertiary Care Centre in South India
Tamilmani, M. Subarathi, K.R. Minu Meenakshi Devi, V. Yogeswari
Background: In December 2019, SARS-COV-2 infection emerged in Wuhan, China causing COVID-19 and subsequently spread throughout the globe. Systemic inflammation has been reported as a predictor for COVID-19 outcomes. Elevated levels of inflammatory markers are shown to be associated with endothelial dysfunction, cytokine storm and coagulopathy in COVID-19. Raised inflammatory markers influences the mortality in severe Covid-19. Objectives: The aim of the study is to correlate the inflammatory markers with CT severity score among COVID-19 patients. Materials and Methods: Retrospective cross–sectional study conducted among 250 patients admitted in the COVID 19 isolation wards confirmed by RT-PCR. The study was conducted over a period of six months (April 2021 to September 2021) based on data’s from the central laboratory registers in Biochemistry & CT Severity Score from the medical records. Results: Statistically significant elevation in Ferritin, CRP, LDH and D dimer among the severely affected group of patients is noted, all four markers are positively correlated with CT scores & increases with increase in the disease severity. It is observed that SpO2 decreases with increase in the severity of the disease. Conclusion: In this study we found significant correlation of the raised inflammatory markers and the CT severity score and the disease severity which highlights the prognostic significance of the inflammatory markers that would guide us in the diagnosis and management of critically ill patients at the earliest.

113. Non HDL Cholesterol as a Better Predictor of Coronary Heart Disease Risk in Obesity
Tamilmani, V. Yogeswari, K. Menaka Shanthi, K.R. Minu Meenakshi Devi
Background: Elevated triglyceride (TG), low density lipoprotein(LDL-C) and lower high-density lipoprotein cholesterol (HDL-C) levels found in metabolic syndrome , type 2 diabetes and Obesity are commonly associated with coronary heart disease (CHD). Non-HDL-C (total cholesterol minus HDL-C) provides a measure of the overall cholesterol content of atherogenic lipoproteins, and hence predicts the potential risk conferred by elevated levels of atherogenic TG-rich remnants. Aim: This study aims to assess whether there is increases risk of CHD in Obese individuals with elevation of non HDL cholesterol and its correlation with LDL cholesterol. Settings and Design: This is an observational case control study with 307 participants. Materials and Methods: 158 cases of CHD cases and 149 controls were recruited for this study.3mL of venous plasma was collected and analysed for lipid profile, glucose. Non-HDL cholesterol was calculated from cholesterol and HDL values. Obesity was identified by calculation of BMI. Statistical Analysis: The analysis of the results was done using unpaired ‘t’ test, Pearson correlation. Results: Non HDL cholesterol is increased significantly in CHD patients with obesity than controls. Conclusion: Non HDL cholesterol is a better predictor of CHD and is comparable to LDL cholesterol in Obese individuals.

114. Bacterial Urinary Tract Infection Prevalence and Associated Risk Factors in Patients
Jitendra Prasad, Malvashree
Background: Urinary tract infections (UTIs) are a major source of morbidity and comorbidity in people with underlying illnesses and account for most hospital visits worldwide. Knowing UTI risk factors can help manage the condition quickly. Method: This study isolated and characterized bacterial etiological agents to assess UTI prevalence and related variables. This cross-sectional study collected and analyzed100 clean catch midstream urine (MSU) samples aseptically. Questionnaires and laboratory testing for chosen underlying illnesses provided UTI risk factors. Results: Escherichia coli was the most common bacterial uropathogenic with (41%), followed by Klebsiella pneumonia (6%), Enterococcus faecalis (7%), UTI was associated with age <9 years, female gender, married persons, genitourinary tract abnormalities, diabetes, hospitalization, and indwelling catheter 6 days (p < 0.05). Conclusion: Hospitalized, female, married, genitourinary tract anomalies, indwelling catheter, and diabetic patients should be screened for UTI..

115. Clinical Study of Visual Field Defects in Occipital Lobe Lesions
Tanushree V., Deeksha Bekal, Madhuri P., Ayesha Musthafa
Background: Visual field defect due to occipital lobe lesion can impair day-to-day activities and reduce the quality of life. Occipital lobe lesion usually do not cause neurological manifestation other than visual field defects. Hence visual field assessment is an important tool to localise the same. Methods: All patients detected with occipital lobe lesions on neuroimaging were included in the study for a duration of one year. Visual field defects were examined on the Humphrey visual field analyser. Results: Total 4 patients with occipital lobe lesions were studied. All 4 patients were males. Causes of occipital lobe lesion were head injury and stroke. Inferior altitudinal defect was seen in two patients. One patient had Homonymous inferior quadrantanopia and another patient had Homonymous hemianopia with superior quadrantanopia. Conclusion: Uniqueness of this study, reports varied presentation of Visual field defects in Occipital lobe lesions which emphasises the importance of early and systematic evaluation for visual rehabilitation.

116. Clinical Study of Carotid Cavernous Fistula in a Tertiary Care Centre
Tanushree V., Ashwathi M., Madhuri P., Ayesha Musthafa
Background: CCF is the most common arterio-venous malformation affecting orbit. Hunter in 1757 was the first physician to report the arteriovenousfistula. Benjamin Travers, in 1809, described the first case of unilateral pulsatile exophthalmos probably resulting from CCF. CCF is the abnormal communication between cavernous sinus and carotid arterial system resulting in rise in pressure in sinus and structures draining to it. Materials and Methods: Nine patients who presented to our tertiary care centrewith symptoms suggestive of Carotid Cavernous Fistula, between January 2019 to March 2020 were subjected to a structured ophthalmic evaluation. All patients clinically diagnosed with CCF underwent imaging of brain with bilateral orbits and were referred to neurology team for further management. Patients were followed up subsequently. Results: Out of nine patients, seven developed CCF secondary to trauma and 2 patients had spontaneous CCF. Patients presented with diminution of vision, pulsatile proptosis, cork screwing of vessels, restricted eye movements, secondary glaucoma, corneal oedema and orbital bruit. CT orbit and brain with Contrast CT angiography was done in all patients. Eight patients underwent endovascular embolization with coiling. Conclusion: Carotid cavernous fistula is a rare and sight threatening condition with or without a history of trauma.

117. Quantification and Classification of Diabetic Macular Oedema Based on Optical Coherence Tomography in Non-Proliferative Diabetic Retinopathy Patients of Type 2 DM
S. I. Thasneem Suraiya, E. Rajeswari, K. Selvi, S. Subha Shankari, R. Surendar Kumar
Background: In this study, we wanted to evaluate the quantification and classification of diabetic macular oedema based on optical coherence tomography in non-proliferative diabetic retinopathy (NPDR) patients of type 2 diabetes mellitus (DM). Methods: This was a hospital based cross sectional analytical study conducted among 100 patients who presented with diabetic history with symptoms of pain and vision complaints in the Department of Ophthalmology, Government Rajaji Hospital, Madurai, over a period of one year after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Majority of the participants who were moderate to severe had problem in the right eye. Significant difference exists in mean para foveal thickness of study participants by one way ANOVA test (p = 0.0001). The OCT parameter – spongiform macular oedema with severity of fundus by Chi square test which was found to be statistically significant (p = 0.03). The OCT parameter – cystoid macular oedema with severity of fundus by Chi square test which was found to be statistically significant (p = 0.02). The OCT parameter – distorted inner retinal layers with severity of fundus by Chi square test which was found statistically significant (p = 0.0001) and there was 32 % positive correlation with positive status with severity of fundus (p = 0.0001). The OCT parameter – ellipsoid zone disruption with severity of fundus by Chi square test which was found statistically significant (p = 0.003) and there was 32 % positive correlation with positive status with severity of fundus (p = 0.0001). The OCT parameter – ERM/VMT with severity of fundus by Chi square test which was found to be statistically significant (p = 0.02). Conclusion: Cystoid macular oedema is seen more commonly than spongiform macular oedema. Ellipsoid zone distorted inner retinal layers, inner retinal cyst parameters of OCT was measured and mostly seen in severe NPDR and indicates cystoid type of macular oedema. On calculating the parameters with the help of OCT, central and para foveal thickness were found to be more in the severe NPDR patients. VMT is predominantly seen in the severe NPDR patients who have cystoid macular oedema, and the measured macular oedema is also found to be higher in this type of macular oedema.

118. A Prospective Randomised Study Comparing Proseal-LMA Insertion Conditions Using Fentanyl-Propofol versus Dexmedetomidine-Propofol
Sarita Fernandes, Janhavi Sankhe, Anju V Kumar, Pooja Ramchandani, Nikita Sara Thomas
Introduction: LMA insertion without use of muscle relaxant requires adequate depth of anesthesia and a certain degree of jaw relaxation. Inadequate depth can lead to coughing, bucking, gagging and laryngospasm. Propofol is commonly used because of its superior jaw relaxation and suppression of airway reflexes. The drawback is apnea due to its respiratory depressant effect and a decrease in cardiac output. A number of adjuvants have been used in an attempt to decrease the dose of propofol and improve LMA insertion conditions. Aim: The aim of our study was to compare Pro-seal LMA insertion conditions using propofol induction after pre -treatment with either fentanyl or dexmedetomidine. We compared the insertion conditions, the number of attempts needed for successful placement, the dosage of propofol needed and the haemodynamic variables. Materials & Methods: In this prospective randomized study 320 patients of either sex, ASA I or II, aged 18-60 yr were randomized into two groups: Group FP received fentanyl (2µg/kg diluted in normal saline to a volume of 10ml over 10min) and Group DP received dexmedetomidine (1 µg/kg diluted in normal saline to a volume of 10ml over 10mins) . Patients of both groups were given a bolus of Inj. propofol 2mg/kg. Ninety seconds after propofol bolus, jaw thrust was given and LMA Pro-seal insertion was attempted. In case of difficulty, additional bolus of Inj. Propofol 0.5mg/kg was given every 30seconds till the patient allowed jaw thrust and another attempt at LMA insertion was made. If the placement of LMA was not satisfactory, the LMA was removed, additional propofol bolus of 0.5mg/kg given and insertion reattempted 60 seconds later up to a maximum of three attempts. The overall conditions for LMA insertion were scored as excellent, satisfactory and poor after grading the following: jaw opening, ease of insertion, coughing and gagging, swallowing, patient movement and laryngospasm. Results: The parametric data like hemodynamic parameters and demographic data were analysed using student’s t-test. Non-parametric data such as PLMA insertion conditions and number of attempts were analysed using Chi-square test. p<0.05 was accepted as statistically significant. The Mean insertion score of patients receiving Dexmedetomidine (6.72±0.841) was significantly better than fentanyl (7.08±1.028) (p=.001). There was no significant difference in the number of attempts needed for PLMA insertion. In the fentanyl group, LMA was successfully inserted in first attempt in 148 patients, second in 11 patients and third in 1 patient. With dexmedetomidine, insertion was performed in first attempt in 152 patients, second attempt in 8 patients and no patient required third attempt. The mean propofol dose required in both groups were comparable, fentanyl group (127.75±16.896 mg) v/s Dexmedetomidine group (126±14.845 mg). The difference in the mean heart rate following infusion of study drugs was significant. 76.27±5.123/min in the Fentanyl group v/s 72.7±4.256 /min in the dexmedetomidine group. Immediately after LMA insertion and thereafter at 1,2,3,5,7 and 10min the heart rate in patients, who received Dexmedetomidine was significantly lesser than those who received Fentanyl . The systolic, diastolic, and mean arterial pressures measured at these intervals were also significantly lower in the dexmedetomidine group. Conclusion: We found the PLMA insertion score to be better with Dexmedetomidine. However, there was no significant difference in the number of attempts of LMA insertion and propofol dose requirement between Dexmedetomidine and Fentanyl groups.

119. An Observational Study of the Incidence of Cavity Problems after Open Cavity Mastoidectomy and the Perioperative Factors Involved in the Causation of Cavity Problems
Tausif Ahmad, Rajkumar Prasad
Objective: To investigate the prevalence of cavity issues following open cavity mastoidectomy and the perioperative variables that contribute to cavity issues. Methods: This 15-month prospective observational study was carried out in the ENT Department of Nalanda Medical College and Hospital in Patna, Bihar. In total, 120 individuals who underwent open cavity mastoidectomy and were included in the study totaled 120 patients. Results: In our study, postoperative cavity issues were 33.33% more common. The gender split among the 40 patients who had cavity issues was 25 men (62.5%) and 15 women (37.5%). The age ranges between 31 and 40 were shown to have the highest frequency of cavities, followed by 11 to 20 and 41 to 50. Of the 40 patients who had cavity issues, sclerotic mastoid represented 72.5%, cellular mastoid 5%, and diploeic mastoid 22.5%. The main issue in 38 of the 40 problem cavities (or 95% of them) was prolonged discharge from the mastoid cavity. Wax buildup was found in the cavity in 13 cases (35.5%). In 9 instances (22.5%), vertigo persisted past the early postoperative phase. In 2 cases (5%), perichondritis of the pinna was discovered. Persistence or/development of facial palsy in post- operative period was found in 9 cases (22.5%) and recurrent cholesteatoma was seen only in 6 cases (15%). 3 Cases had postoperative wound infection (7.5%). Conclusion: We draw the conclusion that sclerotic mastoids were slightly more likely to experience cavity difficulties than other types of anaesthesia (general vs. local).

120. Clinicopathological Evaluation of the Patients with Hoarseness of Voice: A Prospective Study
Tausif Ahmad, Rajkumar Prasad
Introduction: A world of complicated circumstances makes it nearly difficult to imagine a life without communication, but the human voice is a remarkable gift. The human voice is utilised to convey a variety of thoughts and feelings in addition to spoken language. The human voice has many different aspects, including crying, singing, and expressing. A change in the typical quality of voice is referred to as hoarseness. Method: From June 2020 to December 2021, this cross-sectional study was done at Nalanda Medical College in Patna, Bihar. Regardless of their age, gender, or length of illness, 150 individuals who presented with hoarseness of voice were included in the study. An extensive clinical, ENT, and history evaluation was performed. According to the classification created by Kaufmann and Isaacson, vocalists were divided into four tiers. Results: A total of 150 cases were examined, with a male to female ratio of 1.67:1. Ages of the patients ranged from 12 to 80. Hoarseness was most frequently reported among labourers (42.05%), with vocal cord paralysis being the most common cause (23.00%) and smoking being the most prevalent risk factor (64%). Conclusion: Hoarseness can be caused by anything from minor infections to dangerous cancers. Most of the patients that visit the OPD at our tertiary centre, which is on the outskirts of the city, are from rural areas, and the majority of these patients work as labourers and have a habit of smoking cigarettes.

121. The Role of PET-CT in the Assessment of Lung Masses in a Tertiary Care Centre: A Prospective Study
Harihar Nath Tiwari, Subhadra Choubey
Objective: To investigate the diagnostic value and precision of PET-CT in assessing lung masses in the subjects of our study. Methods & Materials: From 1 April-30 August 2022, the Department of Radiodiagnosis and Department of Nuclear Medicine at Patna Medical College Hospital in Patna, Bihar undertook this prospective cross-sectional study. Included were patients who were suggested and referred for the assessment of lung masses found on chest X-ray or by CT. During the study period, all patients who were referred for a lung mass examination were included. This investigation was conducted on a Siemens Biograph Sensation 16 device. Results: The study population’s mean and SD ages were 61.233 and 10.101. There were 30 patients, of which 10 (33%) were female and 20 (67%) were male. Conclusion: PET CT is sensitive for spotting osseous involvement and subclinical adenopathy.

122. In Patients with Resectable Oral Squamous Cell Carcinoma of the Tongue, Prognostic Factors, Failure Patterns, and Survival Analysis Were Examined
Harihar Nath Tiwari, Subhadra Choubey
Purpose: Resectable oral tongue squamous cell carcinoma has little evidence on treatment results (OTSCC). In this investigation, treatment outcomes for resectable OTSCC were evaluated, failure patterns were investigated, and potential clinicopathological prognostic variables influencing treatment outcomes were identified. Materials and Methods: It is a retrospective review of 202 patients with resectable OTSCC who underwent main upfront surgery, adjuvant radiation, and concomitant chemotherapy as needed. Results: The average follow-up period was 35.2 months (range, 1.2 to 99.9 months). Locoregional control (LRC) lasted an average of 84.9 months (95% confidence interval: 67.3-102.4). The LRC rate across three and five years was 68.5% and 58.3%, respectively. Increased pT stage, increased pN stage, and the presence of extracapsular extension (ECE) were substantially linked with worse LRC, according to multivariate analysis. At the time of study, the median overall survival time (OS) had not been attained. The 3- and 5-year OS rates were, respectively, 70.5% and 66.6%. Increasing pT stage and the presence of ECE were strongly related with a worse OS, according to multivariate analyses. Conclusion: In resectable OTSCC, locoregional failure continues to be the primary factor in treatment failure. Given the low LRC and OS, there is potential to significantly improve the prognosis. Strong prognostic variables include the pathological T-stage, N-stage, and ECE. To confirm whether adjuvant therapy improves treatment outcomes in instances with lymphovascular invasion, depth of invasion and perineural invasion and to assist doctors in customising adjuvant therapy, more study is needed.

123. Comparison of Functional Outcomes between Posterior and Lateral Approaches for Primary THA
Kamal Kishore, Shamir Rahman
Background: The whole hip prosthesis is anticipated to carry out a mechanical function by transmitting motion and weight load. Since these two procedures are the most often used and both offer sufficient exposure for complete hip replacement, we evaluated both. There is disagreement over the relative benefits of these strategies, despite the fact that no study has definitively shown that one is superior to the other. In this paper, the problems associated with choosing a surgical strategy are discussed. Materials & Methods: 30 patients receiving complete hip replacements at the orthopaedic department of Patna Medical College Hospital in Bihar, India, from October 2021 to October 2022 were the subject of a prospective study. Both a posterior gluteal splitting strategy and a lateral muscle splitting approach were performed on 15 individuals each. They were all admitted in rooms designated specifically for individuals having total hip replacements. There was a thorough clinical examination and history taken. Range of motion, discomfort, function, and the Trendelenburg test were all evaluated prior to surgery. All of these patients had evaluation exams three months after their operations. Results: The average age was 55.42. The typical follow-up period was 110.52 days. To assess pain and function, the Harris Hip Score was collected both before and after surgery. The posterior method was significantly different from the lateral technique. Conclusion: We came to the conclusion that total hip arthroplasty utilising either the lateral method or the posterior route produces equally satisfactory results for the functional outcome, gait, and Trendelenburg test.

124. Deep Inspiration Breath Hold Technique Reduces Liver Dose in Right-Sided Breast Irradiation
Harihar Nath Tiwari, Subhadra Choubey
Purpose: Deep inspiration breath hold (DIBH) is an effective method for cardiac sparing in individuals with left-sided breast cancer. The current study’s objective was to ascertain if DIBH is helpful in lowering liver and other organs at risk from radiation exposure during right breast irradiation (RT). Materials and Methods: Twenty right-sided breast cancer patients were included in this investigation. With two distinct computed tomography scans of free breathing (FB) and DIBH, three-dimensional conformal RT plans were created for each patient. The contouring of nodes was done in accordance with the recommendations of the Radiation Therapy Oncology Group. Organs at risk and target volume coverage dose-volume histograms were assessed and examined. Results: In comparison to FB plans, DIBH plans demonstrated a significant reduction in mean liver dose (5.59 ± 2.07 Gy vs. 2.54 ± 1.40 Gy; p = 0.0003), V20Gy (148.38 ± 73.05 vs. 64.19 ± 51.07 mL; p = 0.0003), and V10Gy (195.34 ± 93.57 vs. 89.81 ± 57.28 m.  In DIBH plans, right lung dosages were also dramatically decreased. With the use of the DIBH approach, heart and left lung dosages exhibited a slight but statistically significant improvement. Conclusion: We demonstrate that the radiation doses to the liver, lungs, and heart are greatly reduced when DIBH is used to treat right-sided breast cancer.

125. Aero – Digestive Foreign Bodies in Tertiary Care Hospital of Madhya Pradesh: A Retrospective Study
Jyotsna Kubre, Vandana Pandey, Saladi Venkata Akshay, Shubhi Kapuskar
Background: There is plenty of data available regarding ingestion and aspiration of foreign body in young children. Children between the age of 1-4 years, are at maximum risk for foreign-body aspiration or ingestion due to their inquisitive nature and tendency to explore objects with their mouths. Aim and Objective: To audit data regarding most common type and site of foreign body, common age group of presentation, intervention done, mode of anaesthesia provided and perioperative complications. Materials and Methods: A retrospective study was conducted by analysing data of patients who underwent bronchoscopy and oesophagoscopy for aerodigestive foreign body from January 2021 to January 2022 at Department of Anaesthesiology, Gandhi Medical College and Hamidia Hospital, Bhopal. Patients were audited for age, gender, types of foreign body, site (location), intervention for removal of foreign body (FB), mode of anaesthesia and perioperative complications. Result: The youngest patient in our study was 8 months old while the oldest was 60 years old. The male: female ratio of 3:2. The most common site of impaction was cricopharynx in food passage (66%) and right bronchus in FB airway (65%). The most common foreign body digestive tract was coin (60%) and FB airway was organic type i.e peanut (50%). Most of the cricopharynx foreign body were removed by oesophagoscopy and direct laryngoscopy under general anaesthesia and controlled ventilation whereas bronchus foreign body were removed by bronchoscopy under general anaesthesia intermittent positive pressure ventilation. Major Complications such as desaturation (<90%), bradycardia, bronchospasm, wheeze, stridor were noted in patients with foreign body aspiration in which bronchoscopy were performed. No such complications noted during oesophagoscopy, laryngoscopy. Conclusion: The majority of FB aspirations occurred in children aged three years or less with more common incidence in males. Peanut was the most common aspirated organic foreign body with a majority being localized in the right bronchus & coins were the most common foreign body in cricopharynx. In majority of the patients, the aspirated foreign bodies were retrieved successfully by rigid bronchoscopy under general anaesthesia with intermittent positive pressure ventilation & ingested foreign body were retrieved by oesophagoscopy under general anaesthesia.

126. Resistant Clubfoot: Can Surgical Correction Sustain the Corrected Deformity?Jayaram, M.V. Sudhakar, S. Siva Kumar, P. Anil Babu
Introduction: Abnormally dense collagen fibers constitute the histological changes affecting Achilles tendon, tibialis posterior, tibionavicular, and calcaneonavicular ligaments. The deformity in club foot requires early and focused attention which is possible by involving and impressing the parents. Ponseti technique developed in 1940 and popularized subsequently has become a popular technique to correct the deformity. This technique involves serial manipulations and POP castings, each one lasting for 5 to 7 days, and maintenance phase to preserve the corrected deformity till the child starts bearing weight and beyond. The study is about persisting deformity even after surgical correction. Materials and Methods: The study is in 38 cases of CTEV, who have missed the follow-ups, serial manipulations and Ponseti casts before the child has assumed weight bearing, walking, the rapid succession casts are applied which failed to correct the deformity below 1 of pirani score. These children are subjected for soft tissue release and POP casts. Results: Even after missing the initial Ponseti serial manipulations and serial castings, the post-surgical correction period is also seen with irregular follow up to continue casts. The results were analyzed with Chi square test and Paired t test. Discussion: The involvement parents is of utmost importance in getting the deformity correction, with or without surgical correction of CTEV deformity.

127. Quality of Life of Post Menopausal Women in Rural Andhra Pradesh: A Cross Sectional Study
Sindhu L., Karthikeyan V., Raghunath Elango
Introduction: Quality of Life’ has been defined by World Health Organization (WHO) 1as individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. Menopause occurs because of a decline in the production of ovarian hormones, estrogen and progesterone. This leads to many physiological and psychological effects/ symptoms. These symptoms can significantly disrupt a woman’s daily activities and her sense of well-being. Menopausal health condition of women has become public health concern; it is observed that menopausal symptoms and socio demographic factors affect their quality of life. Aims and Objectives: (1) To assess the Quality of life (QOL) among post-menopausal women in rural community. (2) To determine the association between socio-demographic factors and poor quality of life among them. Material and Methods: This cross-sectional study was conducted among 270 participants in villages of Kuppam Mandal, Chittoor District, Andhra Pradesh during the period February 2017 to January 2018. A semi-structured questionnaire was used to record the socio-demographic factors of the study participants and WHOQOL-BREF16 instrument was used in this study to assess the QOL of post-menopausal women. The data were entered into MS Excel 2010 version and further analyzed using Epi-info version 7.1. Results: The lowest age among the subjects was 31 years and the highest age was 58 years. The mean age of the subjects was 51.8 ± 4.9 years. We observed 38.5% of the individuals in our study had experienced Poor or Very Poor quality of life. In our study we observed that 41.7% of the individuals more than 50 yrs and above had experienced Very poor and poor quality of life. Among the married women, only 36.0% perceived poor QOL. However, among the Divorced/ Separated/ Widowed women, 50.0% perceived poor QOL. Among the married women, only 36.0% perceived poor QOL. However, among the Divorced/ Separated/ Widowed women, 50.0% perceived poor QOL. Conclusion: The prevalence of poor quality of life (QOL) among the post-menopausal women was 38.5%. The variables such as nuclear family, illiteracy, non-adoption of family planning method of tubectomy, induced menopause and presence of one or more chronic medical conditions were found to be ‘predictors’ of poor QOL among them..

128. Role of Immunohisto Chemistry and its Correlation with Histopathological Grading and Severity of Psoriatic Disorder
Iyswarrya, Srimahalakshmi A.
Introduction: Skin diseases are the leading cause of non-fatal burden of diseases in India. Psoriasis is one of the main dermatological disorder with psychological distress. Psoriasis is a chronic, disfiguring, inflammatory dermatosis in which both genetic and environmental influences have a critical role. Psoriasis is a complex Tcell mediated disorder characterized by presence of CD4+ and CD8+ T cells in dermis and epidermis, T cell activation is followed by cytokine release leads to cascade of reaction including abnormal keratinocyte proliferation, neutrophil migration, potentiation of Th1 cell response and angiogenesis. Vascular alteration observed in lesions are considered to be most important feature of the disease. Angiogenesis plays an important role by promoting inflammation through recruitment of inflammatory cells. Angiogenesis in skin lesions and activation of endothelial cells via cytokines form a bridge between altered keratinocytes and immunological component of the disease. The study was done to represent the importance of angiogenesis in disease process and its implication in the disease severity. Aims and Objectives: 1) To study the histomorphological features of psoriasis. 2) To assess the expression of monoclonal antibody CD34 with reference to severity of lesion. Material and Methods: This retrospective study includes 50 cases received from the dermatology outpatient clinic in Government Mohan kumaramangalam Medical College, salem from November 2018 to June 2020. Assesment of severity of the clinically confirmed cases was done using Psoriasis Assessment severity index (PASI) Score method. Punch biopsy was taken from the lesional area, the biopsy tissue was processed and stained with hematoxylin and eosin stain. After staining, the slides were examined under light microscope and various histological parameters were studied and observations were recorded. Followed by immunohistochemistry using CD34 was done. Using CD34 staining, Micro vessel Density (MVD) was evaluated with hot spot method. The score is calculated. Finally, the intensity of staining was compared and correlated with PASI score. Observation and Results: In the present study, Severity of psoriasis was assessed using PASI score. Out of 50 cases, 33 patients (66%) had score < 10 and 17 patients (34%) had PASI score > 10. In this study 66% of cases was graded as mild psoriasis and 34% were graded as moderate / severe type psoriasis. All the patients with severe degree of CD34 staining had moderate/severe degree of psoriasis. And two patients with moderate/severe degree of psoriasis had moderate (2+) degree of CD34 staining. Patients with mild degree of CD34 staining had a mild degree of psoriasis. Conclusion: With respect to Micro vessel density patients with PASI score > 10 had high intensity of CD34 staining as compared with patients with PASI < 10. Thus, signifying angiogenesis as most important factor contributing the clinical progression and severity of the lesion.

129. Low Dose-Extended Letrozole versus Double Dose-Short Letrozole Protocol for Induction of Ovulation in Women with Polycystic Ovary Syndrome
Akansha, Ashraf Memon, Charmi Pawani
Background and Aim: The major factor for anovulatory infertility is polycystic ovarian syndrome (PCOS). As a new therapeutic option, letrozole and other aromatase inhibitors (AIs) may compete with clomiphene citrate (CC) to induce ovulation in this population. The purpose of the current study was to compare the effectiveness of the low dose-extended or long letrozole protocol and the double dose-short letrozole strategy in ovulation induction in individuals with polycystic ovarian syndrome. Material and Methods: This study was done on the diagnosed cases of PCOS patients with subfertility in the department of obstetrics and gynecology for the period of 1 year. Letrozole 2.5 mg tablets were given daily for 10 days to the low dose-extended letrozole group or experimental group and tabs were given to the double dose-short letrozole group or control group. Starting on the second day of menstruation or the first day of withdrawal bleeding, take letrozole 5 mg once day for 5 days. On day 12 of the menstrual cycle, transvaginal sonography was used to quantify the endometrial thickness and count of developing follicles using a technique called folliculometry. On days 21 through 23, mid-luteal serum progesterone was tested to confirm ovulation. Results: The mean LH levels of the two groups did not significantly differ from one another. In the third cycle, patients in the extended letrozole group (54.28%) and the short letrozole group (18.75%), respectively, achieved multifollicular development, bearing statistically significant differences. In the first cycle, group II had more patients grow dominant follicles (18 mm) than group I, however in the second and third cycles, group I patients had more patients generate dominant follicles (18 mm). While there was a higher percentage of ovulating patients in the low dose prolonged letrozole group (76.5% versus 71.9%), there was no statistically significant difference. Conclusion:Low dose-extended letrozole protocol can be a better alternative to double dose-short letrozole protocol in respect to significant increase in the number of growing follicles with a higher trend to raise the ovulation rate and pregnancy rate though there were no significant differences in dominant follicle size, endometrial thickness, ovulation rate and pregnancy rate between two groups.

130. Influence of Serum Lipid Profile in Type 2 Diabetes Mellitus Patients with Diabetic Macular Edema
Harsha Jani, Shashi Jain, Chandrakanta Kannoj
Background and Aim: Diabetic macular edema, is major cause of vision loss. Association of lipids in pathogenesis of DR and DME has been less clear. This study is undertaken to determine association of serum lipid levels and diabetic macular edema. Materials and Methods: An observational cross-sectional study was conducted from January 2021 to June 2022. Total 505 subjects were recruited based on inclusion and exclusion criteria, detailed history was elicited from patient about duration of DM, history of treatment received till now, presence of any other systemic illness. General ocular examination was done and anterior segment was evaluated by slit lamp biomicroscope, fundus examination was done by indirect ophthalmoscope and slit lamp biomicroscope using +90D lens. All patients of Type II Diabetes mellitus after examination were categorized into 3 groups, Subjects with no Macular Edema, Subjects with Nonclinically Significant Macular Edema, and Subjects with Clinically Significant Macular Edema. Relevant laboratory investigation like blood sugar profile, serum lipid profile, renal profile were done and then the association of serum lipid levels with macular edema was studied. Result: The mean total cholesterol and mean LDL among DM2 patients who had DME was 204.34 (19.27) mg/dl and 134.39 (19.12) mg/dl respectively and who didn’t have DME was 189.56 (24.36) mg/dl and 120 (24.75) mg/dl respectively. The difference in mean LDL and total cholesterol were statistically significant between two groups (p<0.01). Conclusion: Elevated serum lipid level showed a significant association with diabetic macular edema. Lipid lowering agents may help in reducing the occurrence of edema and vision loss in diabetic patients.

131. Association between First Day Drain Output and Complications in Incisional Hernia Repair
Anil Kumar Dadhich, Atul Sharma, Navneet Parashar, Vikesh Kumar
Background: Exudation of serum is a part of process of healing of a synthetic mesh implant in incisional hernia repair. The amount of serous discharge depends on the quality of surgical repair and is clinically identified as a seroma, increased drain output or prolonged drain output. Objective: The present study was conducted to know Co-relation between first day drain output and complication in incisional hernia repair. Methods: The study was a hospital based prospective observational study where 90 patients having incisional hernia and undergoing hernia repair surgery by conventional open method, using prolene mesh and same prophylactic antibiotic were followed by to see development of post incisional hernia repair complications. Results: Incisional hernia was more common in obese patients and High BMI is an independent risk factor for its occurrence. The amount of drain on the first day was significantly related to the presence of wound discharge and seroma development in the patients. Conclusion: Drain output on first day was linked to complications like wound discharge and seroma and apart from that these are more significantly linked to factors like surgical technique and patients’ comorbidity.

132. C-Reactive Protein and Depression: A Systematic Review on the Correlation between the Two Factors
Kajal Gupta, Nidhi Choudhary, Hritu Singh, Swati Agarwal
Background: Researchers have recently become interested in the potential link between increased C-reactive protein (CRP) levels and depression because there is evidence to suggest that these levels may affect the onset and progression of this mental health disease. As part of this systematic review, we analysed studies that looked at the connection between CRP levels in the body and the occurrence of depression in patients. Methods: The phrases “Anxiety,” “C-reactive protein,” “Depression,” “Depressive Disorders,” and “Inflammation” were thoroughly searched for in the databases PubMed, Web of Science, and Embase. The investigation produced 482 initial publications and restricted the search to articles published in the English language between 2010 and 2022. Results: Twelve papers were chosen for the review’s assessment. Five studies—three of which were systematic reviews that looked at several studies—did not find any conclusive links between changes in CRP levels and the prevalence of depression or any other related diseases. There were some relationships between the two factors that were noted in the remaining 7 trials. Conclusion: Although the majority of the clinical trials we chose for our review showed some sort of evidential correlation between elevated CRP levels and incidence of depressive disorders in the population under study, it was not possible to determine with certainty whether the two are directly or indirectly related. Therefore, we believe that more research and testing are necessary in this area.

133. Mean Platelet Volume (MPV) as a Prognostic Marker of Severe Pneumonia
Sumit Das, Prasenjit Das
Background: Platelets have historically been thought of as hemostatic and thrombotic factors, but their relevance in inflammation and immunity is rapidly growing. It has been established that platelet form and function may change significantly in response to pathological and physiological signals. The commonly used metric of platelet size and activity known as mean platelet volume (MPV) is easily accessible and precise. In patients with severe pneumonia (SP), association among mean platelet volume (MPV) and in-hospital mortality is unclear, despite the fact that MPV looks to be related with a bad prognosis of pneumonia. Methods: In this prospective hospital based observational study, 288 severe pneumonia patients from, 1st July 2021 to 30th June 2022, were included and cut off MPV was taken as 10.5 fl. Results: 34 incidences of fatality were noted while patients were hospitalized. 28 from high MPV group and 6 patients from low/ normal MPV group. Statistical analysis suggests that High MPV >10.5fl and normal or low MPV </=10.5fl related with poor outcome in severe pneumonia cases comparing with normal or low MPV (</= 10 fl) with P<0:001. Conclusion: High MPV level is an independent risk factor for in-hospital mortality in patients with severe pneumonia..

134. Biophysical Characteristics of Early Onset Type II Diabetes
Malarkodi Velu, Freethi Ramanathan, Christal Viji Shalini. C, Alamelu Mangai D
Introduction: Estimates by International Diabetes Federation in 2019 showed that 77 million individuals had diabetes in India. The early onset Type II diabetes is a prevalent disease among Indians which is understudied. The registry of youth-onset diabetes in India (YDR) has reported that over 25% of youth-onset type 2 diabetes were of age less than 25 years and over 57% were either overweight or obese and over 70% had HbA1C of more than 9% indicating poor control. The complications and severity of diabetes and hypertension is more in lean apparently healthy individuals. Objectives: To study the biophysical characteristics of early onset diabetics (onset <40 years – group I) and compare with late onset type II diabetics (onset >40 years – group II) with short duration of onset. Materials & Methods: Diabetics attending the Non Communicable Diseases out patient’s department in Mahathma Gandhi Memorial Government Hospital, Trichy for routine check-up were included in this study. All the subjects were not having any chronic complications of diabetes (nephropathy, neuropathy, retinopathy etc). Subjects were selected without history of ketoacidosis and on oral hypoglycaemics only. Blood samples were collected in appropriate vacutainers for the estimation of Fasting Blood Glucose, Post Prandial Blood Glucose, Total Cholesterol, Serum Urea and Serum Creatinine. Estimation was done photometrically using suitable reagents. For all the subjects the urine was tested for urine sugar and protein which was negative at the time of examination. Results: Total number of subjects were 116 out of which 37 were males and 79 were females. 52 % of group I induviduals had family history of diabetes whereas only 39% of group II had family history. Hypertension was present in 78% of group I induviduals and it was 56% in group II. The mean diabetes duration is about 3.7 years and mean BMI is 27.13. The total number of subjects under group I were 54 out of which there were 35 females and 19 males. In group II total number of subjects were 62 of which 44 were females and 18 were males. Obesity related disorders like dyslipidaemia, thyroid disorders were present in preobese category only in early onset diabetics including one cardiovascular disease, whereas dyslipidemia and thyroid disorder were distributed almost equally in all categories of BMI in normal onset diabetics. The hypertensives in the group I was more when compared with group II and the mean arterial pressure was comparably higher in group I (Fig: 4). Also, cholesterol and creatinine levels were found to be lower in early diabetics than late onset diabetes. Conclusion: The range of diabetes subgroups is becoming even more diverse in terms of association with other clinical conditions such as hypertension, thyroid dysfunction and other hormonal disturbances especially in early-onset multigenerational diabetes with genetic predisposition. The recent trend of normal or low BMI but metabolically obese is prevailing. Hence the disease is multifactorial and the progress is different in each individual.

135. Adverse Drug Reactions to Anti Retro Viral Therapy in a Tertiary Care Teaching Hospital
Femi Retna. J, E. Amudhan Arvind, Komala. R
Introduction: Acquired immune deficiency syndrome (AIDS) is a persistent and possibly lethal illness of the immune system caused by the Human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART), a blend of minimum 3 medications which had helped very much in reducing morbidity and mortality to a significant extent. All drugs used in treatment of HIV has many side effects related to it and is one of the main causes for altering or stopping drug management also irregular intake of drugs leads to poor compliance. Hence proper assessment of ADRs may help treating doctors to alter the medicament for managing HIV infection. Hence objective of our study is to estimate risk factors causing adverse drug reaction in relation to ART among HIV patients, and also to evaluate the causality and Severity of ADRs. Material and Methodology: This research work was done as an observational study by pharmacology department along with ART center in a tertiary care hospital. In our study 200 patients were included who were started with HAART and were for a period of next one year they were followed. Causality assessment of ADRs was done by Naranjo scale and Severity assessment of ADRs by Hartwig and Seigel’s severity scale. Results: In our study out of the 200 patients 75 (37.5%) had experienced ADRs. System wise most of ADRs were connected to Hematological (32%), GIT (27%) and CNS (23%). The majority of the ADRs were with ZLN regimen (74%). Naranjo causality evaluation revealed 62 % were possible, 31 % were probable and 7% were definitive ADRs. Also 49% were mild and 51% were moderately severe in intensity based on Hartwig & Seigels scale. Conclusions: Adverse drug reaction among PLHA on management with ART regimen is an important health issue compliance to treatment. So, constant monitoring is necessary to thwart life-threatening ADR and to improve treatment outcome.

136. Study of Vitamin D Deficiency in Patients with Congenital Ichthyosis in a Tertiary Care Hospital in South India
Priyanka Hemrajani, Sharath Kumar B. C., Mona Sharma, Rajesh Somkuwar
Vitamin D deficiency results in rickets in children and osteomalacia in adults. Skin is the major source of endogenous vitamin D and only 10% is derived from dietary sources. A prospective case control study was done in 50 clinically diagnosed cases of congenital ichthyosis attending dermatology outpatient department at a tertiary care centre in south India to determine the prevalence of vitamin D deficiency and rickets in patients with congenital ichthyosis.

137. Effect of Smartphone Usage on Hand Grip Strength among Healthy Young Adults
Thaarani Gandhi, Nachal Annamalai
Introduction: The use of smartphones, which offer numerous advantages like the ability to communicate and browse the internet, has seen a significant rise in popularity among younger people. On the other hand, it has negative impacts on our lifestyles too. Our major purpose is to assess handgrip strength, as well as to compute the average period of time spent using smartphones and to investigate whether or not there is a correlation between smartphone usage and handgrip strength among healthy young adults. Material and Methods: After obtaining ethical committee clearance from the institutional ethical board, a total of 122 participants aged between 18-30 years of both genders were taken. Hand grip strength was measured using digital hand grip dynamometer and the smartphone usage duration were noted. Results: The mean Age among the subjects was 20.5 (± 2.84) years ranging from 18 to 28 years. The mean smartphone usage duration (hours) has a significant negative correlation with Hand grip strength of dominant hand and non-dominant hand with a correlation coefficient of -0.75 & -0.61 respectively. Conclusion: We found that the excessive usage of smartphones can have a detrimental effect on hand strength, both on the dominant and non-dominant side of the user’s hands.

138. The Effect of Cypermethrin on the Fertility Index of Adult Albino Rats
Sonu, Renu Chauhan
Background: When given orally to male mice, cypermethrin significantly increased the weights of the testicles, seminal vesicles, prostate gland, and epididymis. Interstitial edoema, vacuolation in the early stages of the germ cell layer, thickening of the basal membrane, Leydig cell atrophy and Sertoli cells with dense residual bodies were all visible under the microscope in the testicular tissue that had been exposed to cypermethrin. Aim: This study was conducted to analyze the effect of cypermethrin on thé fertility index of adult albino rats. Methods and Materials: In this study 12 adult male Wistar albino rats, weighing 150-200 grams were procured from animal house of UCMS and associated GTB hospital, Dilshad Garden. Fertility index: (Johnson; 1970) was used to measure fertility. The seminiferous tubules in every tenth section of the testis were recorded. Means score (MS) was calculated by the number of tubular recorded at each score multiplied by the score and the sum of the products were divided by the total number of tubules recorded. The mean score was called fertility index which was taken as a parameter for the spermatogenic activity in the testis. Results: The mean score of fertility in control groups was 8.672±0.279. Marked decrease in fertility index was observed in experimental animals. The fertility index was 2.944±12.67 (p = ˂0.001), which is statistically highly significant. In experimental animals, many of the seminiferous tubules were hypo cellular with significant reduction of the numbers of nuclei. Some tubules were looking normal while germ cells were either completely or partially missing from other tubules. The normal architecture of germinal epithelium was lost in most of the tubules. Conclusion: The study revealed arrest of physiological process of spermatogenesis and tubular atrophy resulting in gross decrease in healthy sperm formation which in turn leads to infertility in adult albino Wistar rats.

139. KAP on Antibiotic Usage and Resistance among Second Professional Medical Students
Nitesh Mangal, Manjula Babariya, Jitendra Kumar, Chintan Doshi
Introduction: It is the bacteria and not the human that becomes resistant to antibiotics due to inadequate treatment and acquires ability to withstand antibiotics. The negative effects of antibiotic resistance on treatment outcomes, length of hospital stay, risk of death, and expense of healthcare are raising concerns on a worldwide scale. Material & Methods: A cross-sectional study was conducted at Pacific Institute of Medical Sciences, Udaipur. The data was obtained from second year students batch 2020 after completion of Antibiotic classes. Total 100 students participated in the study. Total 18 Questions given. Data were analyzed using MS Excel 2007. The survey was analyzed as percentage. Results: Students have good knowledge about antibiotics. Compare to knowledge, they have poor attitude & practice towards antibiotic usage & resistance. Conclusion: In our study knowledge about antibiotic students is good. But more education needed to improve attitude & practice among medical students. This will decrease malpractice among future doctors & also help in decrease antibiotic resistance.

140. Clinical Profile and Correlation of Serum Amylase and Lipase with mCTSI Score on Outcome of Acute Pancreatitis in a Tertiary Care Hospital
Banurekha R., Saravanan M., Malathi V.
Introduction: Acute pancreatitis is defined as the inflammation of the pancreas with variable involvement of nearby organs and other organ systems. Alcohol and gallstones are the most common causes of acute pancreatitis. Severe pancreatitis is associated with organ failure or local complications like necrosis, abscess, pseudocyst and extra pancreatic complications. Serum amylase, serum lipase and contrast enhanced computed tomography play an important place in diagnosis of acute pancreatitis and associated complications. Most of the scoring systems employ serum amylase; serum lipase and modified CT Severity Index (mCTSI) score to predict the severity, guide in management and reduce the mortality in acute pancreatitis. Objective/Aim: The aim of the study is to study the clinical profile of acute pancreatitis and to find out the correlation between serum amylase and serum lipase with modified computed tomography severity index (mCTSI) score in predicting the outcome of recovery and discharge or death in acute pancreatitis managed in a tertiary care medical college hospital. Materials and Methods: This prospective descriptive study was done in the wards of General surgery department in a tertiary care medical college hospital in 100 patients more than 18 years of age presenting with features suggestive of acute pancreatitis over the period from February 2021 to November 2022. Apart from routine blood investigations, serum amylase and serum lipase were done for all patients. Contrast enhanced computed tomography was done on all these patients in two to four days after the onset of symptoms and modified computed tomography severity index (mCTSI) score calculated. The observations of these patients were entered into Microsoft excel and SPSS version 22 was used for data analysis. Data were analysed statistically by unpaired t test for numeric variables and chi square test for categorical variables. The clinical profile of acute pancreatitis and the correlation between serum amylase and serum lipase with modified computed tomography severity index (mCTSI) score in predicting the outcome of acute pancreatitis namely recovery and discharge or death in acute pancreatitis was arrived. Results: In patients with acute pancreatitis, male to female ratio was 7:3. 70% patients had history of chronic alcohol consumption with male predominance. 34% had gallstone disease with female predominance. Pancreatic abscess was seen in 12%, pancreatic necrosis in 36%, pseudocyst in 36%, respiratory failure and ARDS in 34% of patients. Out of the 100 patients 84% of patients recovered and were discharged and the mortality rate was 16%. The modified computed tomography severity index (mCTSI) in patients who recovered and were discharged in mCTSI5 score range was 58.82%. The modified computed tomography severity index in patients with mCTSI5, the mortality rate was 41.18%. On correlation of enzymes serum amylase and serum lipase with mCTSI of 0 to <5 and from 5 to 10 the p-value for serum amylase and lipase were 0.183 and 0.090 which is insignificant and had a negative correlation. Conclusion: Acute pancreatitis was common in the age group of 30 to 40 years and alcohol and gallstones were the common cause in males and females. Pancreatic necrosis and pseudocyst were the common complications. Serum amylase and lipase values have a negative correlation with mCTSI score in predicting the clinical outcome of recovery or death in acute pancreatitis. mCTSI score when done within two to four days of onset of symptoms has got more diagnostic and prognostic value than enzymes in predicting the clinical outcome in acute pancreatitis.

141. Evaluation of Anti-Hyperglycaemic Effect of Ranolazine in Streptozotocin-induced Diabetic Rats
Porchelvi, R. Sarojini, T. Gowri Thilagam
Title: Evaluation of the anti-hyperglycemic effect of Ranolazine in streptozotocin-induced diabetic rats. Objectives: To evaluate the effect of the Anti-hyperglycemic property of Ranolazine in streptozotocin-induced diabetic adult albino rats. Methods: After measuring the normal baseline blood sugar for 24 adult male albino rats weighing 150 to 200 grams by tail venipuncture method, Injection streptozotocin was injected intraperitoneally at a dose of 45mg/kg to all rats. Fasting Blood sugar was estimated 72 hours after streptozotocin injection and rats with blood sugar of more than 250mg/dl were considered for the study and were randomly divided into 4 groups (control, standard, test group 1 & test group 2) with six animals in each group. Fasting blood sugar (FBS) was measured for all the animals on day1,3, 7,14, 21& 28 respectively. Cardiac puncture was done for all rats and blood samples were collected for estimation of Insulin on days 1 & 28. The results were finally tabulated and Statistical analysis was done using SPSS software. Results: There was a statistically significant reduction in the blood glucose levels and a significant increase in serum Insulin levels in the animals of Test 1 & Test2 groups in comparison with the standard & control groups. (p< 0.001). Conclusions: Ranolazine, an anti-anginal drug, has also got significant anti-hyperglycaemic properties and also increases the Insulin levels in streptozotocin-induced diabetic rats in comparison with the control rats. Hence, Ranolazine may help in the management of patients with type 2 diabetes mellitus (DM) by reducing glycaemic levels. As an added advantage, Ranolazine may also help to reduce the polypharmacy in patients with diabetes mellitus and angina thereby reducing the drug as well as disease-induced morbidity and mortality.

142. Atypical Presentation in Unstable Angina
Dilip Vyas, Deepak Tolia, Jitesh Tolia
Background and Aim: About all individuals with acute myocardial ischemia experience unstable angina (UA) due to coronary atherosclerotic disease. There is little research on the clinical and demographic characteristics that predict outcomes in UA patients. For their cost-effective management, it is crucial to have a better understanding and characterization of the factors that lead to hospitalisation and determine how long a patient stays there. Our current investigation uses a nationally representative database to determine the prevalence and factors that contribute to prolonged hospitalisation in UA patients. Material and Methods: Data were gathered from a 1-year prospective in the emergency department of the affiliated hospital. 100 patients who had been identified as having acute coronary symptoms participated in the trial. Depending on the type of their primary presenting symptom, patients were separated into three groups. Group 1: Myocardial ischemia’s “typical” symptoms. Group 2: “Atypical” chest pain has been defined as being mild, brief, non-classical in appearance, not exactly similar to previous cardiac symptoms, and Group 3: Dyspnea: Sudden, inexplicable shortness of breath is the main complaint. Results: At the time of admission, 70 patients (14%) experienced dyspnea, 30 (6%) had atypical chest pain, and 400 patients (80%) had usual chest pain. The resting heart rate, systolic and diastolic blood pressure, as well as the levels of blood sugar and creatinine at the time of admission, were all considerably higher in patients with dyspnea. Female gender, faster heart rate, diabetes mellitus, renal failure, high Killip class, and late presentation were all predictors of the absence of normal chest pain at presentation. Conclusion: Because atypical presentation negatively affects ACS patients’ care and outcomes, we shouldn’t let it influence our management decisions, especially for high-risk patients with conditions including diabetic mellitus, renal failure, advanced age, and COPD.

143. Study of Clinical, Hematological Profile and Complications of Dengue Fever in an Indian Tertiary Care Hospital: A Cohort Study
Maria Jyothi F. B, Divya Marina Fernandes, Narasimha Hegde
Background: In many regions of India, dengue is a serious health concern, and Mangalore is one of its endemic places. A number of variables, including altered hematological and coagulation parameters, have been linked to increased morbidity and death in dengue. Three clinical syndromes, including conventional dengue fever, dengue hemorrhagic fever, and dengue shock syndrome, can result from dengue virus infection. This study’s goals included examining the various clinical manifestations of dengue fever as well as its hematological characteristics. Methods: A total of 130 patients admitted to Father Muller Hospital with a fever greater than 38.50C and positive IgM tests for dengue were chosen. They were monitored from the time their fever started for twelve days or, if sooner, until they met the WHO’s criteria for discharge. Results: According to WHO criteria, 94 of the 130 patients in this research fall into the DF category, 28 into the DHF category, and 8 into the DSS category. Fever was present in every instance (100%) Myalgia (95.3%), joint pain (76.9%), headache (79.2%), nausea (56.9%), abdominal discomfort (56.9%), rash (45.3%), hepatomegaly (25%), bleeding (21.5%), and shock (6.1%) are other frequent symptoms. In patients with 26.1%, the Hess test was positive. 77% of patients had low platelet counts that met WHO criteria (less than 100,000/cu mm). Conclusion: Compared to DHF or DSS, dengue fever was a more frequent symptom. Each patient with a fever during an outbreak should have dengue fever seriously examined as a differential diagnosis. Fluid management and supportive care are the major treatments for dengue.

144. A Study of Surgical Management of Diaphyseal Fractures of Femur in Children using Elastic Nails
Rohit Raj, B. Vijitha, N. Manideep Reddy
Background: Fractures of the femoral shaft are common in children with lower limb trauma. Due to the need for early recovery and rehabilitation of patients, the care of juvenile femoral fractures has gradually shifted towards surgical procedures over the past decade, with the recognition that prolonged immobility may be hazardous to children as well. This study was designed to evaluate the outcomes and complications of elastic nail-assisted surgical treatment of femoral diaphyseal fractures in children aged 5 to 15 years. Material and Methods: In this prospective study, 20 patients of diaphyseal fractures of femur in children aged 5 to 15 years were treated by elastic nails during the period between 2020 to 2022.The outcomes & complications were evaluated. Results: Fractures were prevalent in men and were most prevalent between the ages of 5-8 years, followed by 9-12 years. In 12 patients, a common mechanism of damage from RTA was seen. The left side was largely affected. In 18 patients, the reduction of closed type was the most common. In 15 patients, the maximum length of hospital stay was between 5 and 10 days. In 15 cases, the maximum duration of union was 14 weeks. Four patients underwent limb amputations. One individual got limb lengthening. One patient was diagnosed with Infection, one with Varus Malalignment, and one with Knee Pain. 15 patients had an outstanding outcome, 4 had a satisfactory outcome, and 1 had a negative outcome. Conclusion: The diaphyseal fracture of the femur in children aged 5 to 15 years can be efficiently treated with elastic nails, since functional outcomes are excellent and complications are limited.

145. Disadvantages of Various Blunt Dissection Techniques in Laparoscopic Surgery: A Survey amongst Telangana Surgeons
L Sridhar, Rohit Phadnis, PawanHosamani, Faiz Hussain, Chodipalli Srinivas Vijayram, Juveria Fatima
Background:  Laparoscopic techniques have revolutionized the field of surgery and have taken it to new horizons. Nevertheless, there is still a lot of room for innovation in various aspects like blunt dissection techniques. This survey is based on the disadvantages of various blunt dissection techniques in laparoscopic surgeries. Methodology: Minimally invasive surgeons belonging to the state of Telangana were sent the survey as a google form about various problems generally encountered during blunt dissection and their responses were noted along with which the results of the survey were tabulated graphically and reviewed in the light of previously available data. Results:  Amongst 105 MAS surgeons, 93.3% chose suction cannula and 46.7% chose gauze piece with or without suction cannula. With suction cannula usage they faced difficulties such as, drop in pressure (86.7%), fear of injury to nearby structures (33.3%), and omentum or viscera pulled into the field (73.3%). With gauze piece usage, obscuration of operative field(33.3%), fear or loss of gauze piece(46.7%). With either technique they required conversion to open surgery(26.7%), frequency of change of instruments or gauzes >10 times (92.9%),prolongation of surgery(53.3%), increased morbidity(49%). Summatively on a scale of difficulty from 1 to 10, 60% more than 5. Conclusion: This survey and available literature review about blunt dissection techniques in laparoscopic surgeries revealed that there is still a lot of scope for new techniques or instruments in view of present difficulties.

146. A Study on Correlation of Gall Stones and Lipid Profile among Patients with Gall Stones in Tertiary Care Hospital
Satish Bhasale, Rahul Sontode
Background: Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults have gall stones.  The precipitation of calcium carbonate and phosphate is influenced by local gallbladder factors. Objective: To establish a relationship between serum lipid levels and type of gallstones. Methodology: The present prospective study was carried out at Department of Surgery of tertiary care centre during November 2021 to October 2022. A total of 100 patients diagnosed as having cholelithiasis and undergoing open or laparoscopic cholecystectomy surgery were included after obtaining informed written consent of patients. Data was summarized in percentages and proportions. Results: The patients ranged from 18 to 82 years and mean age among the distribution of cases was 44.16 ±18.12 years. Out of 100 cases, females (76%) were the most affected when compared to males (24%). Serum triglyceride levels were more among cholesterol stones with statistically significant. Conclusion: There was a positive correlation between Serum triglyceride levels and type of gallstones.

147. To Study the Clinical Profile Evaluation and Management of the Patients with Retrocaval Ureter
Sharanabasappa Rudrawadi, Nagabhushana M, Keshavamurthy R, Gaurav Kochhar
Introduction: A rare venous congenital malformation known as the retrocaval ureter (RCU), circumcaval ureter, or postcaval ureter is connected to aberrant embryological development of the inferior vena cava rather than ureter development. It was first thought to be an anomaly in the development of the ureter, but various investigations in embryology have led to the realization that it is actually an anomaly in the formation of the inferior vena cava. Methodology: Study period: 2007-2016. Site of the study: Institute of nephro-urology- Bangalore. Sample size: 14 symptomatic patients were treated for retrocaval ureter at our institute. Results: There were 14 symptomatic patients with retrocaval ureters . The patients’ average age was 31.71 years (range, 18 to 54 years). Three patients were female and eleven patients were men. Conclusion: Adults with RCU rarely experience upper urinary blockage. Although open surgical exploration is still a prevalent procedure for RCU, laparoscopy has recently gained popularity due to its safety, efficacy, and practicability.

148. Study of Metabolic Syndrome Prevalence in Patients with Hypothyroidism at JLNMCH, Bhagalpur, Bihar
Ranjan Kumar, Mayanand Jha, Deshraj Meena
Background: Atherogenic cardiovascular disease has a well-known antecedent in hypothyroidism and metabolic syndrome (MetS). MetS refers to a set of risk factors that accelerate the body’s atherogenic process by causing hypertension, hyperglycemia, dyslipidemia, prothrombotic, and proinflammatory states. Hyperlipidemia, diastolic hypertension, endothelial dysfunction, and cardiovascular disease are all brought on by hypothyroidism. Many explanations have been put out as to why hypothyroidism is also linked to higher cardiovascular morbidity. Finding the prevalence of the metabolic syndrome in people with hypothyroidism is the primary goal of this investigation. Methods: 100 patients known to have hypothyroidism, ranging in age from 20 to 60, were included in this study. All patients who came to the hospital were asked to provide a thorough history of both indoor and outdoor patients, and laboratory testing was also completed. The history of any hypothyroidism symptoms was noted, and laboratory test findings such as thyroid profile tests, glucose analysis, and cholesterol analysis were also noted. Result: Out of a total of 100 patients in this study, 32 were men and 68 were women. Male to female ratio was 2.125:1. 42.7 years old was the average age. Males had mean TC, TG, LDL, and HDL cholesterol levels of 179 mg/dL, 142 mg/dL, 92 mg/dL, and 34.5 mg/dL, respectively, whereas females had mean levels of 166 mg/dL, 140 mg/dL, 85 mg/dL, and 43 mg/dL. Male and female mean WC were 110.5 and 105.2, respectively. 60 (88.2%) females and 17 (53.1%) males had elevated TG (>150 mg/dL). 14 (43.8%) men and 62 (91.2%) women had low HDL C (≤40 mg/dL in men and ≤50 mg/dL in women). Higher WC was discovered in 66 females (97.1%) and 19 males (59.4%). With an incidence of 36% overall, hypertension was discovered in 6 (18.8%) males and 30 (44.1%) females. MetS, which has an overall frequency of 84%, was identified in 19 (59.4%) males and 65 (95.6%) females. Conclusion: This study found a strong correlation between MetS and subclinical hypothyroidism. The total prevalence rate of the MetS in this study was comparable to studies of hypothyroid individuals and slightly higher than rates reported in the general population in various investigations. The most prevalent TD among MetS patients from India was hypothyroidism.

149. Comparison of Effects of Intrathecal Clonidine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine (0.5%) in Lower Abdominal Surgery
Satyendra Kumar, Stuti Kumari, Bijoy Kumar, Ashok Kumar
Background: There are numerous trials combining adjuvant like fentanyl and clonidine with bupivacaine in the subarachnoid block to extend postoperative analgesia. Regarding the dosage and effectiveness of both intrathecal adjuvants, the evidence is contradictory. Some adjuvant can have their own negative consequences. Hence, the hunt for the optimum intrathecal adjuvant for bupivacaine continues. In order to compare the effectiveness, safety, and post-operative analgesia of intrathecal Fentanyl and intrathecal Clonidine as an adjuvant to hyperbaric Bupivacaine in patients having lower abdominal surgeries. Methods: The current study comprised 50 patients who were scheduled to have elective lower abdomen surgery under spinal anaesthesia. The patients were split into two groups: group I (n = 25) received 2.5 ml of hyperbaric bupivacaine (0.5%) together with 50 micrograms of clonidine intrathecally, and group II (n = 25) received 2.5 ml of hyperbaric bupivacaine (0.5%) along with 25 micrograms of fentanyl intrathecally. The assessment looked at the length of the sensory and motor blockade, how quickly it started, and whether rescue analgesia was necessary. Results: Patients’ age, height, weight, sex ratio, heart rate (HR), mean arterial pressure (MAP) during operation, and length of surgery did not differ substantially between the two groups. When compared to the Clonidine group (group I), the beginning of sensory blockade was substantially lower in the Fentanyl group (group II) (2.03±0.17 min) than it was in the Clonidine group (group I) (4.66±1.24 min). In the Fentanyl group, the duration of the sensory and motor blockage was much shorter. When compared to the fentanyl group (422.20±25.59 min), the time for the first dosage of analgesia to be required was similarly considerably longer in the clonidine group (479.44±29.0 min). Conclusion: 50 micrograms of Clonidine added to hyperbaric bupivacaine during lower abdominal procedures, the use of clonidine as an adjuvant in spinal anaesthesia provides longer post-operative analgesia than fentanyl without any negative side effects.

150. Efficacy, Safety and Compliance of Intravenous Iron Sucrose and Intramuscular Iron Sorbitol in Iron Deficiency Anaemia of Pregnancy: A Comparative Study
Subhash Chandra Yadav, Kumar Mayank, Kaushal Kumar Mishra, Deepak Kumar
Background: In developing nations, anaemia is thought to affect approximately two-thirds of expectant mothers, with iron deficiency anaemia accounting for 95% of cases. In pregnant women, it is the most prevalent nutritional disorder. Among them, about 45 % of pregnant women suffer from moderate to severe anaemia. High prenatal morbidity and death are linked to anaemia. This study compares intravenous iron sucrose and intramuscular iron Sorbitol treatments for anaemia during pregnancy in terms of their effectiveness, safety, and rate of response. Methods: In this prospective investigation, 50 prenatal cases with gestational ages ranging from 16 to 32 weeks were examined. The cases were split into two groups at random. A total of 25 patients were treated in group A with intravenous iron sucrose, while a total of 25 cases were treated with intramuscular iron sorbitol. Both groups’ responses to therapy were investigated and contrasted. Results: In group A, the mean pretherapy haemoglobin was 6.49 g/dl, while in group B, it was 6.48 g/dl. Hemoglobin levels increased by 3.52 g/dl in group A and 2.33 g/dl in group B after 4 weeks after starting treatment. Statistically significant (P<0.01) difference existed. In group A it took an average of 6.37 weeks, whereas in group B it took an average of 9.04 weeks to reach the target haemoglobin (>11 g/dl). 8% (2) of the cases in group A exhibited grade 1 negative effects. 24% (6) of the patients in group B had grade 1 negative effects. (P=0.027) The difference was statistically significant. In neither group did anyone stop their therapy. Conclusion: For the treatment of moderate to severe anaemia during pregnancy, intravenous iron sucrose is a safe, practical, more efficient, and quicker acting therapy than intramuscular iron sorbitol therapy.

151. Study on Clinical Outcome of Stroke and Relation to Admission-Day of Blood Sugar Levels
Upendra Kumar Sahani, Vinayanand Jha
Background: Ischemic stroke, hemorrhagic stroke, and cerebrovascular anomalies such intracranial aneurysm, AV malformation, and cortical venous thrombosis are all examples of cerebrovascular accident. Stroke is the third most prevalent cause of mortality, behind heart disease and cancer. Stress and diabetes: Strokes caused by hyperglycemia can be fatal and have a bad prognosis. Diabetes increases the risk of stroke by two times compared to non-diabetics. The outcome of a stroke is influenced by a number of risk factors. The ones that are well examined are hyperglycemia, fever, and neuroprotective substances. The purpose of this study is to monitor blood glucose levels in diabetics and non-diabetics within twenty-four hours of the beginning of stroke and to assess the severity and prognosis of hyperglycemia in both groups. Methods: Between April 2022 and December 2022, 50 patients with acute stroke were admitted to the medicine department at Darbhanga Medical College and Hospital Laheriasarai, Bihar. The NIH stroke scale, or NIHSS, which considers the following clinical findings and assigns precise points for each criterion, is used to determine the severity of stroke for each patient. Results: Of the 50 patients in our study group, 22 had normal blood glucose levels and 28 had increased blood glucose levels on the day of admission. Another 16 individuals had stress hyperglycemia, and 16 patients had diabetes. Stress hyperglycemia affected one-third of the patients in the ischemic stroke group and one-fifth of the patients in the hemorrhagic stroke group. Patients with euglycemia recovered from acute strokes more quickly. 65 percent of individuals with euglycemia made a good functional recovery. Contrarily, only 3% of patients with admission-day hyperglycemia showed good functional recovery at the conclusion of a 30-day follow-up. Conclusion: Hyperglycemia on the admission day and stroke severity, magnitude, and outcome are correlated linearly. A larger-sized major stroke and a poor functional result in the form of increased mortality are observed to be associated with combined diabetes and stress hyperglycemia. The outcome of an ischemic stroke is well correlated with the glucose level on the day of admission. A strong predictor of mortality and a poor functional outcome following an acute stroke was an increased glucose level on the admission day. Therefore, prompt restoration of normoglycemia should be promoted even in the absence of strong evidence. In the interim, we must maintain good general stroke care, normal body temperature, fluid balance, and hemodynamics; otherwise, we run the danger of compromising the positive outcome, even in patients with normoglycemia.

152. Comparative Analysis of the Tension Band Wiring Approach with Cancellous Screws and K Wires for Treating Olecranon Fractures
Vikash Kumar, Rakesh Kumar
Background: Injuries that frequently occur in the emergency room include olecranon fractures. Open reduction and internal fixation with k-wires and figure-of-eight tension band wiring is the surgical treatment for misplaced fractures. An intramedullary cancellous screw and tension band wiring can also be used to repair it. The current study compares the outcomes of both surgical techniques and evaluates their benefits and drawbacks. Methods: Between February 2021 and January 2022, a prospective comparative study involving 40 olecranon fractures was conducted at the Department of Orthopaedics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Ten of the fractures were treated with tension band wiring and Kirshner wire, and the other ten were treated with an intramedullary cacellous screw and tension band wiring. Results: According to Colton’s classification, the majority of the fractures in our study were type II B fractures. According to the Mayo elbow performance score, the cancellous screw group had excellent outcomes in 16 patients (80%), acceptable results in 2 patients (10%), and fair results in 2 patients (10%). The K wire group had outstanding results in 10 patients (50%) and good results in 6 patients (30%). Both groups did not exhibit any subpar outcomes. Conclusions: According to the findings of this study, cancellous screws combined with tension band wiring for displaced transverse and oblique olecranon fractures produce better clinical outcomes than tension band wiring combined with K wire fixation while also avoiding costs, lost productivity, and potential complications from hard-surface removal.

153. Comparative Study of PLIF and TLIF Treatment in Adult Degenerative Spondylolisthesis
Pravin Patil, Anand Anerao, Eknath Gabale
Background:  In this study, the therapeutic effects of pedicle screw fixation and posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) on the treatment of adult degenerative spondylolisthesis are compared. Transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), two frequent surgical techniques for degenerative spondylosis and disc disease, both involve spinal fusion. For the treatment of lumbar spondylolisthesis, a number of surgical methods have been suggested, however there is still debate over the best surgical approach. The indications and contraindications for TLIF and PLIF are the same in both of these treatments. The posterior method of PLIF allows for great vision of anatomical structures, a 360-degree fusion using a single incision, and neural decompression while keeping posterior support systems. The drawback is a higher incidence of nerve root and dural injury. Aim: This study is to compare the therapeutic effect of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation on treatment in adult degenerative spondylolisthesis. Material And Method: The current study was conducted in the past. The study population included all patients who presented to the orthopedics department’s OPD. Patients in a retrospective analysis with adult degenerative spondylolisthesis at the L5-S1 or L4-L5 levels (grades I-II) had PLIF or TLIF. At first, 60 patients met the requirements for the trial, and 10 patients were lost to follow-up. 35 patients who were still eligible for analysis got PLIF with two cages. Results: Between the initial postoperative and the final postoperative follow-up, there were no appreciable changes in the rate of spondylolisthesis and reduction. The two groups had comparable rates of spondylolisthesis, reduction, and loss of reduction. There were no changes between the two groups in terms of disc height or intervertebral foramen height, both of which were superior to preoperative. Both groups saw similar intervertebral foramen and intervertebral space loss. Conclusion: In the treatment of adult degenerative spondylolisthesis, interbody fusion with either a PLIF approach or a TLIF technique yields positive results. The TLIF process is less complicated than the PLIF method and equally safe and efficient. The results of this study show that the TLIF technique provides a good substitute for the more conventional PLIF procedure.

154. Study of Complications and Outcome of Plasmodium Vivax Malaria Mono Infections in an Indian Tertiary Care Hospital: A Cohort Study
Divya Marina Fernandes, Maria Jyothi F. B., Venkatesh B. M.
Background: One of the most serious parasite infections that affects humans, Plasmodium vivax (P. vivax) malaria affects over 243 million people globally, with up to 2.5 billion individuals at risk and an estimated 70–80 million cases per year. Objectives: To study the complications and outcome of Plasmodium Vivax malaria mono infections in Father Muller Medical College Hospital, Mangalore. Methods: During the course of two years, a prospective cohort study was carried out at Father Muller Medical College Hospital. 200 individuals with a fever of ≥38.5°C and a peripheral smear or a malarial parasite fluorescence test that was positive for P. vivax made up the research cohort. Results: A total of 200 participants were included in the trial, 64 women and 136 men. Patients in their second decade made up the majority. Thirty-six percent of patients had vomiting, and forty-five percent of patients had jaundice. 53% of patients had hepatomegaly, while 47% had splenomegaly. 8.5% of patients exhibited ARDS. 3.5% of individuals had cerebral malaria, whereas 3% had acute renal damage. In 3% of instances, multiple organ dysfunction was seen. 4 people died in the trial as a result of multiple organ dysfunction. Conclusion: P. vivax mono infections can result in life-threatening consequences include acute respiratory distress syndrome, acute renal damage, cerebral malaria, and multi-organ dysfunction syndrome.

155. A Prospective Evaluation of the Efficacy of Platelet Count (Platelets) and its Indices in the Early Diagnosis of Sepsis
Nivedita, Sudarshan, Brajesh Kumar
Aim: The aim of the study was to evaluate the efficacy of platelet count (Platelets) and its indices in the early diagnosis of sepsis. Methods: This was a prospective study conducted at department of Pediatrics, JLNMCH, Bhagalpur, Bihar, India for the period of 18 months. Sample size of 100 patients was recruited as per hospital neonatal intensive care unit work load during the period of study. Results: The general characteristics of a study group showing 100 patients including 60 males and 40 females. On the basis of NNF guidelines, the patients were divided in three groups – 50% were clinically suspected sepsis (probable sepsis), 35% were with blood culture positive (culture positive sepsis), and remaining 15% in blood culture negative but CRP positive group (culture negative sepsis). The patients were divided into early and late onset. EOS was seen more in males (65%) as compared to females (35%). However, in LOS both male and females were equally affected. Conclusion: Platelets can be considered as an early diagnostic tool for neonatal sepsis as it is cheap, rapid, and easily available and does not require additional equipment.

156. Assessment of Prevalence of Metabolic Syndrome among Patients with Epilepsy on Antiepileptic Drugs: An Observational Study
Hemant Kumar
Aim: The aim of the present study was to evaluate the prevalence of metabolic syndrome among patients with epilepsy. Methods: This was a cross-sectional descriptive study conducted at Paras HMRI Hospital, Patna, Bihar, India. The participants were chosen from patients who attended an epilepsy outpatient hospital for 12 months. A total of 200 patients who met the study’s inclusion and exclusion criteria were chosen at random. Results: There were 135 males and 70 females among the subjects. Adults between the ages of 20 and 49 were chosen to represent those with the lowest age-related risk of coronary artery disease and metabolic syndrome. Monotherapy was used by 100 patients (50%). Valproate was the most commonly used monotherapy medication, accounting for 40% of cases. Carbamazepine (25 percent) and phenytoin (18%) were also used as single drugs to control epilepsy in a significant number of patients. Treatment lasted an average of 13.6 years (range 3–48 years).Within one year of onset, 140 patients (70%) began treatment. There was no significant link between the duration of epilepsy and the presence of metabolic syndrome. There was no link between the length of treatment and the number of drugs used and the presence of metabolic syndrome. There was no link found between drug use and cardiovascular risk factors such as diabetes, hypertension, or dyslipidemia. Conclusion: Antiepileptic medications, especially valproate and carbamazepine have significant effects on the lipid profile and abdominal obesity in patients on treatment. Metabolic syndrome is more prevalent among adult patients <50 years of age with epilepsy compared to the general population in the same age group. This difference could be related to the effect of the antiepileptic medications, especially valproate. There is a need to monitor patients on antiepileptic medications regularly for development of dyslipidemia and obesity.

157. A Retrospective Assessment of Mortality and Low Serum Bicarbonate Level in Patients on Hemodiafiltration versus Peritoneal Dialysis: A Comparative Study
Shashank Shekhar, Preeti Sinha
Aim: In this study, we observed the mortality rate in relation to risk factors including low serum bicarbonate level, coronary artery disease (CAD), and dialysis modality in patients on dialysis during a median follow-up time of 60 months. Methods: This was a retrospective study of a cohort of 100 dialysis patients which was conducted at Department of Nephrology, Indira Gandhi institute of Medical Sciences (IGIMS), Patna, Bihar, India for the period of 1 year. Results: We studied 100 dialysis patients, 66 males and 34 females, on mean age 62.1 ± 14.27 years old. The treatment modalities which were applied were predilution hemodiafiltration (HDF, n = 80), and peritoneal dialysis (PD, n = 20). 80% were with Hemodiafiltration/peritoneal dialysis, 40 5 were having hypertension, 30% were having CAD. We observed that the patients with CAD had higher age, beta2M, i-PTH, c-f PWV, PP, AIx, ox-LDL, and hsCRP but lower serum bicarbonate concentrations, BMI, and albumin than the patients without manifested CAD. We noted that the patients on HDF had lower i-PTH, serum bicarbonate levels, hsCRP, IR defined by HOMA-IR but higher albumin, ox-LDL, and beta2M than the patients on PD. We observed that the patients with serum bicarbonate levels <22 mEq/L were older, they had higher beta2M, HOMA-IR, i-PTH, hsCRP, ox-LDL, c-f PWV, PP, and AIx, but lower albumin level and lower urine volume in comparison to the patients with serum bicarbonate levels >22 mEq/L. Conclusion: Uncorrected metabolic acidosis and CAD were shown as independent significant predictors for mortality in patients on renal replacement therapy. PD may provide worse survival after 2–2.5 years of treatment initiation than HDF.

158. An Analytical Comparative Assessment of Prevalence of Hypothyroidism in Cirrhotic Patients and Normal Individuals
Subham, Deepak Singh Rawat, Ashok Kumar
Aim: The aim and objective of this study was to compare the prevalence of hypothyroidism between cirrhotic patients and normal healthy individuals. Methods: The prospective comparative study was conducted on 100 patients admitted at Department of General Medicine, Patna Medical College and Hospital, Patna, Bihar, India for one year and found to be clinically, biochemically and radiologically proved liver cirrhosis patients for the period of one year. All patients of age group 20-60 years male and female with confirmed case of liver cirrhosis were included in the study. Results: Among the 50 cirrhotic patients, 40 (80%) were males and 10 (20%) were females, while in control 30 (60%) were males and 20 (40%) were females. Among total number of 50 cirrhosis patients, 38 (76%) had history of alcohol intake & in control group 4 (8%) had history of alcohol intake. All were male subjects. Not a single female in either of the group had history of alcohol consumption. Conclusion: All cirrhotic patients should undergo for evaluation of endocrinological evaluation as these patients are associated with development of hypothyroidism. After diagnosis the treatment of endocrinological disorder especially hypothyroidism may increase survival.

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

160. A Hospital-Based Assessment of Diagnostic Efficacy of Hematological Biomarkers, Coagulation Profile and CRP (C-Reactive Protein) in COVID-19 Patients
Shambhwi Sharma
Aim: In this study, the roles of biomarkers from a peripheral blood sample were used in the diagnosis of COVID-19 patients who have history of fever and have been admitted to hospital are examined. Methods: The present study was conducted Department of Pathology, AIIMS, Patna, Bihar, India where the patients having history of fever were admitted during the period of 6 months. A total of 100 patients were included who were suspected cases of corona. RTPCR was done for all the patients and were categorized into covid negative and covid positive patients. Results: Out of 100 patients included in the study that came with history of fever and was admitted in hospital, RTPCR was done and 65% patients were positive. Out of which 66.2% were male patients and 33.8% were female patients. Hematological parameters were recorded and presented in a tabular data as described in Table 1. Parameters included were total leukocyte count, neutrophils, hemoglobin, lymphocytes, NLR, PLR, SII, and Platelets. In patient with negative test results, it was found that total leukocyte count, neutrophils, platelet, NLR and SII values were higher. Whereas, haemoglobin, lymphocytes and PLR was found to be higher in patients with positive test results. Conclusion: In our study, low values of leukocytes, neutrophils, platelets and high values of hemoglobin, Lymphocytes were found with a CBC test which is easily available are found to be valuable in terms of the initial diagnosis of COVID-19. In addition, low values of NLR and SII and high value of PLR and CRP are also indicative of COVID-19.

161. Retrospective Observational Assessment of the Hazards of OTC Availability of MTP Pills
Neelam Kumari, Alka Pandey, Manisha
Aim: The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Material & Methods: This study was a retrospective observational study carried out in Department of Obstetrics & Gynecology, PMCH, Patna, Bihar, India after due permission from the hospital authorities. Case sheets were analyzed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. Results: Pregnancy was confirmed by 50 women with urine pregnancy test and 1 woman had undergone USG along with UPT. 48% women consumed pills after 1-5 days of hospital visit. 46% women showed > 10 grams of hemoglobin level. Majority of cases reported were of incomplete abortion (56%) followed by Failed abortion (10%) and Incomplete abortion with sepsis (10%). Conclusion: Unsupervised medical abortion can lead to increased maternal morbidity and mortality. To curtail this harmful practice, strict legislations are required to monitor and also to restrict the sales of abortion pills over the counter and access to abortion pills for the public should be only through centers approved for MTP. Large scale prospective studies are required to assess the actual magnitude of this problem.

162. To Evaluate the Prevalence of Primary Headache Disorders and Their Burden in the Rural Community: A Survey Study
Hemant Kumar
Aim: The aim of the present study was to evaluate the prevalence of primary headache disorders and their burden in the rural community. Methods: A survey was done over a 12-months period Department of Neurologist, Paras HMRI Hospital, Patna, Bihar, India.  All persons in the age group 18-60 years were included in the study. A structured questionnaire based on ICHD 3 criteria for migraine, tension type headache migraine in local language was administered. A total of 1000 people were screened in the survey. Results: Out of 1000 subjects; 550 (55%) were in the age group 18–30 years and 459 (455%) were females. 12% (165/1255) of people suffered from headaches. 300 cases were married and 500 patients were doing clerical job, shop owners and farmers. The burden of headache was assessed by HALT index. 65% (78/120) of the people with headache reported minimal or infrequent impact of headache.  The HALT index showed that median days lost in the domain of vocation was 4 days, while for household and social activities were 2. Conclusion: PHDs are prevalent in the rural communities of developing countries and need urgent attention of primary care physicians, community health departments, governmental agencies and policy makers.

163. A Hospital Based Assessment of Different Clinical Manifestations and Outcome of TBM in Relation to BCG Vaccinated, Non- Vaccinated and Nutritional Status of the Children
Sudarshan, Nivedita, Mukesh Kumar
Aim: The objective of the present study was to evaluate the different clinical manifestations and outcome of TBM in relation to BCG vaccinated, non- vaccinated and nutritional status of the children. Methods: The present study was conducted at department of Pediatrics, JLNMCH, Bhagalpur, Bihar, India and 50 children with definite or probable tuberculous meningitis (TBM) were included. Permission for the study was obtained from the College authorities prior to commencement. Duration of the study was one year. Local cultural values and ideas were respected. Confidentiality was assured. The nature and purpose of the survey were explained in detail to them in their own language. Results: The common symptoms observed were fever 90%, altered sensorium 62%, vomiting 60% and convulsions 56%. Other symptoms observed were cough, headache. The common signs present were GCS below 10 in 57% of cases, meningeal irritation in 64%, and McEvan’s sign in 60%. Also seen were hemiparesis 43%, CN palsy 43%, fundal changes25%. All signs were significantly more common in malnourished children except GCS10-14. Tuberculomas, conscious variety and focal involvements are seen more commonly in well-nourished group among vaccinated patients. All atypical features of TBM are more common in well-nourished group when compared to malnourished children except encephalopathy. Other typical features found were Ophthalmoplegia (3), brain stem syndromes (2), serous meningitis (2), conscious type (3), encephalopathy (2) and focal infarcts in 4 cases. Conclusion: It was concluded that clinical patterns in TBM vary according to nutritional status of the child and severe malnutrition carry very poor prognosis. Knowing different clinical patterns of the disease helps in early prognosis and thus in preventing deaths due to TBM among children.

164. A Morphological Study of the External Carotid Artery with Reference to Adjacent Anatomical Landmarks in Cadavers
Vipin Kumar, Raag Reeti, Abhishek Prasad Sinha
Aim: The aim of this observational study was to establish the relationship of External Carotid Artery with reference to Adjacent Anatomical landmarks in cadavers. Methods: The present observational study was done in the Department of Anatomy, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India. 60 hemi-necks obtained from 30 formalin embalmed cadavers (20 male and 10 female) were dissected and the external carotid arteries were traced from the origin to termination. Results: The ECA took origin at the level of upper border of thyroid cartilage (TC) in 40/60 cases (66.66%). Higher level of origin was noted in the remaining 20 of 60 cases (33.34%). Higher levels of carotid bifurcation were further categorized keeping the TC as anatomical landmark. No lower levels of origin were noted in this study. The anteromedial position of the ECA relative to the ICA at the level of the carotid bifurcation was noted in all the cases. Conclusion: The exact anatomical knowledge of External Carotid Artery with reference to adjacent anatomical landmarks is helpful for surgeons to plan surgeries and prevent complications during various diagnostic and therapeutic procedures.

165. A Hospital Based Observational Evaluation to Determine Clinical, Microbiological, and Histopathological Characteristics of Patients Diagnosed with Burn Wound Infection
Puja Priyadarshini
Aim: The objective of the study was to determine clinical, microbiological, and histopathological characteristics of patients diagnosed with Burn wound infection along with a positive quantitative biopsy culture and their relationship with early diagnosis and progression to burn wound sepsis. Methods: This study included all the patients admitted in the last 6 months to the Nalanda Medical College and Hospital, Patna, Bihar, India and who were diagnosed with BWI and BWS, according to the American’s Burn Association (ABA) criteria. A total of 500 burned patients were admitted to the Burn Unit, out of these 50/500 (10%) developed BWI, based on clinical diagnosis, and 11/50 (22%) progressed to BWS. Results: Scalds were the most frequent cause, followed by contact burns; second-degree burns predominated. The majority had less than 20% TBSA burns in adults and less than 10% TBSA burns in children. However, 23 (46%) had major burns. Of these, 30 (60%) were adults and 20 (40%) children. Most of them presented with more than one burned anatomical area, and the most frequent regions involved were the upper limbs, followed by the lower limbs. All patients with BWS had major burns. Among the signs of infection, erythema was predominant (redness greater than 1 cm from the burn wound border), followed by edema, and exudate and eschar discoloration. With regard to clinical presentation, latency period was defined as the time between burn wound and first signs of infection; early if clinical signs were evidenced into the first 72 hours since admission in Burn Unit and late if occurred after this time. Most cases developed signs in the first 72 hours after arrival at Burn Unit (47; 94%), corresponding to early infection. Conclusion: BWI increases hospitalization time and number of surgeries, increasing the risk of sepsis and death. The QBC allows an accurate diagnosis with lesser false-positive cases that impact antibiotic resistance and mortality. Protocols targeting this problem are needed to decrease the impact of this.

166. CT Measurement of Pulmonary Artery Size in Interstitial Lung Disease to Evaluate Pulmonary Hypertension
Ashutosh Jha, Nain Kumar Ram, Vijay Kumar, Ram Kumar Gupta
Aim: We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension. Methods: The present study was conducted at Department of Radio Diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for one year and 500 patients were included in the study. Patients with a CT scan within 90 days of MRI and RHC were included. In order to meet inclusion criteria, a diagnostic quality CT pulmonary angiogram (CTPA) with a slice thickness of less than 5 mm was required. Results: We included 500 scans from 500 patients; 300 (60%) had RHC-confirmed pulmonary hypertension, with mPAP ³ 25 mmHg.  Compared with the non-pulmonary hypertension group, the group with pulmonary hypertension had greater MPAD, RPAD, LPAD and PA: Ao in both respiratory cycles, whereas the PA angle was greater in the non-pulmonary hypertension group. In the subgroup with pulmonary hypertension, the median MPAD was 34.60 mm in inspiration and 34.65 mm in expiration, while in the non-pulmonary hypertension group it was 30.00 mm in inspiration and 30.50 mm in expiration. For the cohort as a whole, the areas under the receiver operating characteristic curves (AUCs) for inspiratory MPAD and inspiratory PA:Ao (for RHC-confirmed pulmonary hypertension defined as Mpap ³ 25 mmHg) were 0.741 and 0.750, respectively. For the cohort as a whole, the cut-offs MPAD ³ 32.5 mm and PA:Ao ³ 0.94 yielded the most favourable diagnostic profiles. Conclusion: Findings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ³ 29 mm had high sensitivity and PA:Ao ³ 1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

167. A Hospital-Based Assessment of Visceral Obesity using ABSI and BMI in Type 2 Diabetes: An Analytical Assessment
Deepak Singh Rawat, Subham, Ashok Kumar
Aim: The aim of the present study was to examine the associations between two indicators and diabetes risk, and to investigate their performance in identifying diabetes compared with BMI and WC. Methods: A cross sectional study conducted in Department of General medicine, Patna medical college and Hospital, Patna, Bihar, India for 1 year on 200 type 2 diabetes patients. Weight, height and BMI and blood investigations (CBC, LFT, KFTS. electrolytes, HbA1C, HDL, LDL, triglycerides, thyroid profile) and USG abdomen was done to assess fat thickness. Results: The variable subcutaneous fat thickness (cm) was not normally distributed (Shapiro-Wilk test: p≤0.001). The variable visceral fat thickness (cm) was not normally distributed (Shapiro-Wilk Test: p=0.006). The 40% of the participants had V/S fat ratio: <2.5. 60% of the participants had V/S fat ratio: >2.5. There was a significant difference between the 2 groups in terms of ABSI Z-score (W=702.000, p≤0.001), with the median ABSI Z-Score being highest in the V/S fat ratio: >2.5 groups. Conclusion: ABSI was better in assessing visceral obesity compared to BMI so can be used along with other markers in assessing cardiovascular risk.

168. Assessment of Ovarian Tumors using Dynamic Contrast Enhanced Magnetic Resonance Imaging and Diffusion Weighted Imaging
Ram Kumar Gupta, Ashutosh Jha, Nain Kumar Ram, Vijay Kumar
Aim: The aim of the present study was to assess the ability of dynamic contrast-enhanced MRI (DCE–MRI), and Diffusion-weighted image (DWI) to describe uncertain ovarian masses. Methods: The present study was conducted at Department of Radio Diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for one year and we did transabdominal ultrasound and transvaginal ultrasound for all cases. We investigated 50 patients with 50 adnexal lesions. Results: The patient’s age ranged from 20 to 78 years old (mean 43.56 years). The main complaint was abdominal pain and/or abdominal distension; other cases came with different symptoms as subfertility or irregular vaginal bleeding. The histopathology of the assessed masses were 21 benign, 4 borderline, and 25 malignant. The age range for patients with benign tumors was 20 – 65 years (mean 39 ± 13 years) while those with malignant tumors, their age range was 21- 78 years (mean 46 ± 16.953 years). Benign masses included seven serous cystadenoma, six mucinous cysadenoma, three mature cystic teratoma, two ovarian fibroma, and fibrothecoma, and one tubo-ovarian abscess. There were four Borderline tumors (two serous and two mucinous). There were 25 invasive malignant masses (Nine Serous cyst-adenocarcinoma, six Mucinous cyst-adenocarcinoma, three Metastatic krukenburg, three Immature teratoma, two fibrosarcoma, and two clear cell carcinoma). Conclusion: DCE-MRI and DWI have accepted ability to distinguish between benign and malignant ovarian mass.

169. A Hospital-Based Assessment of the Role of Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis
Vijay Kumar, Ram Kumar Gupta, Ashutosh Jha, Nain Kumar Ram
Aim: The aim of the present study was to evaluate the role of Ultrasound elastography and MR elastography for assessing liver fibrosis. Methods: The present study was conducted at Department of Radio Diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for 12 months and 200 patients who underwent liver biopsy were enrolled. Results: There were 120 males and 80 females in the study. 60% patients were in <2 foci per x 200 field and according to fibrosis stage, 69 were Bridging fibrosis followed by 50 Perisinusoidal or periportal. 100 patients were Steatosis grade 5%–33%. No significant differences were found in demographic or serologic profiles between patients with and without discordance. Conclusion: Several MRI-based techniques have been developed for quantitative assessment of liver fibrosis. These techniques include MRE, DWI, texture analysis, perfusion imaging, hepatocellular function imaging, strain imaging, and T1r quantification. Of the many suggested techniques, MRE stands out as the most standardized and the one that has been most widely adopted in clinical practice.

170. A Retrospective Observational Clinicopathological Evaluation of Meningioma from Rural Setup
Ashish Kumar Jha, Poonam Mishra, Hari Shankar Mishra
Aim: The aim of this study was to determine the incidence of Meningioma among all CNS tumors occurring in the study period, age and sex predilection, location, and site preference for a population in a rural setup of Bihar region. Methods: This study was retrospective observational study at Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of 2 years. Out of 200 cases of CNS tumors operated, meningioma consists of 50 cases (25%). Ethical board permission was taken. Results: The average age of presentation was 44.1 years. Most common affected age group was 30-50 years comprising 26 cases (52%). Out of 50 cases 42 (84%) were intracranial menigioma and 8 (16%) were spinal meningioma. The most common clinical symptoms for intracranial cases were headaches followed by seizures and vomiting. Among intracranial meningioma, the most common location was convexity meningioma (40%) followed by parasagittal (12%). Meningothelial meningioma 20 (40%) was the commonest subtype followed by transitional 12 (24%), psammomatous, 5 (10%), fibroblastic 2 (4%), metaplastic 1 (2%) and others. Grade II meningiomas included atypical 2 (4%), clear cell 1 (2%) whereas grade III included all the cases of papillary 1(2 %) and anaplastic 2 (4%) meningiomas. Conclusion: The descriptive epidemiology of meningioma in our rural setup roughly correlates with the epidemiology elsewhere in India apart from the male to female ratio; which could be due to lack of seeking medical care among females in our society.

171. A Hospital-Based Assessment of the Association between Serum Vitamin D and Serum Ferritin Levels in Children with ADHD
Sudarshan, Nivedita, Brajesh Kumar
Aim: The aim of the study was to study the association between Serum Vitamin D and Serum Ferritin levels in children with ADHD. Methods: The study was conducted in the Department of Pediatrics, JLNMCH, Bhagalpur, Bihar, India for the period of 1 year. A total of 60 children meeting the inclusion criteria were enrolled in the study. Subjects included all new or follow-up patients with diagnosed or suspected ADHD and healthy children of the comparable sex and age group attending the pediatric outpatient department (OPD) were taken as controls. Informed and written consent was taken from parents and assent from children above 12 years of age to participate in the study. Results: 25 cases were diagnosed with ADHD and their results were compared to age and sex matched controls. Serum Ferritin and Vitamin D levels were measured in both cases and controls. Since we matched age, similar age distribution was present in controls. The study found a significant difference in the mean value of serum ferritin levels in cases and controls (p−0.035). No significant difference in the mean value of serum Vitamin D in cases and controls (p–0.550) was noted. Conclusion: ADHD is a common neurobehavioral disorder presenting in pediatric OPD with higher prevalence in males than females. Combined type was found to be the most dominant type of ADHD in the study population. We observed a significant difference in the levels of Serum Ferritin in children with ADHD and controls.

172. A Hospital Based Retrospective Assessment of the Baseline Pattern of Obstetric Sonography Referrals, Indications, and Findings
Nain Kumar Ram, Vijay Kumar, Ashutosh Jha, Ram Kumar Gupta
Aim: The aim of the present study was to assess the baseline pattern of obstetric sonography referrals, indications and findings at Tertiary care hospital in Bihar region. Methods: This study retrospectively evaluated the baseline pattern of obstetrics sonography referrals, indications, and findings of 1000 patients who underwent prenatal ultrasound scan at the department of radiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for a period of 18 months. Results: A good number, 900 (90%) of the respondents were married and majority 440 (44%) were civil servants, 630 (63.0%) had tertiary education. Their ages ranged from 16 to 47 years, with a mean age of 29.7±5.5 years, median age of 30.0 and 30.0 as the modal age. The predominant age range is the 26-30, with 370 (37%) respondents, followed by the 31-35 age range, with 250 (25%). The least number, 5 (0.5%) was from the 46-50 age range. The distribution of source of obstetric sonography referrals shows that the number of patients referred by physicians, 800 (80%), were higher than those referred by self, 150 (15%), and other healthcare workers, 50 (5%). 150 (15%) pregnant women were positive for the abnormalities suspected by physicians prior to requesting sonographic evaluation whereas, 850 (85%) were negative. A total of 20 positive cases (incidentalomas) were found as a result of routine antennal (ANC) scanning for general maternal reassurance. Regression analysis showed that the level of confirmation of abnormalities suspected during prenatal ultrasonography was statistically significant and well correlated with findings (r=0.510, p=0.011). Confirmation of PV-bleeding recorded the highest positive rate 25. Conclusion: Physicians were the main source of prenatal referrals at BSUTH, with the referral pattern greatly influenced by biosocial factors. Confirmation of fetal wellbeing was the commonest indication for referral, whereas, majority of findings were negative for the abnormalities the physicians suspected. Thus, establishing the baseline pattern of obstetric sonography referrals, indications, and findings in our environment, which are helpful for planning and future research.

173. Management of Patients of Liver Abscess in a Tertiary Care Hospital an Observational Study
Bilal Ahmad Lone, Ajay Verma, Mohammad Afzal Ud Din, Aijaz Ahmad Bhat
Background: Liver abscess is an uncommon condition that over past many years has seen changes in etiology diagnosis and treatment. With the advent of Laproscopy surgeons are now routinely performing drainage of liver abscess particularly pyogenic with safety and lesser time. Aim:  To study the clinical features, radiological findings and microbiological profile of liver abscess patients and to study the efficacy and outcomes of percutaneous drainage of patients with pyogenic liver abscess. Methods: This study was conducted in Department of General Surgery of Alfalah School of Medical Sciences and Research Centre, Dhauj, Faridabad, Haryana,45 patients with clinical and imaging (ultrasound and contrast enchased CT) features suggestive of pyogenic liver abscess and admitted to our department were included in the study based on inclusion and exclusion criteria. Detailed history, physical examination, baseline investigations, ECG and chest x-ray, ultrasound whole abdomen, contrast enhanced CT of abdomen and pelvis was done, and patients were followed till discharge from hospital premises. Results: Majority (23/45) of our patients were not having any kind of known or preexisting morbidity at the time of admission to hospital, these patients accounted for 60% of our study population. Imaging with both ultrasound and contrast enhanced computed tomography was done in all patients, 24/45 patients i.e., 53.33% of patients were having abnormalities evident on CT and 21/45 patients i.e., 46.66% were having features of pyogenic abscess on ultrasonography. We followed guidelines-based treatment for management of pyogenic abscesses. Majority 23/45 of our patients were managed by pigtail drainage i.e., 51.11%. 17/45 patients were managed by IV followed by oral antibiotics making this category of patients 37.77% of our total sample population. Open surgical drainage was done in four patients (8.88%), two out of them were directly taken for surgical intervention and other two after failure of pigtail drainage. Only one patient had to undergo USG guided pigtail drainage after failure of IV antibiotic therapy. Conclusion: Abscess can lead to sepsis and significant morbidity and mortality for patients. Patients with abscess, especially deep abscess, can be critically ill. Image-guided percutaneous drainage is very beneficial for these patients as it allows for successful drainage of the abscess with minimally invasive techniques. General anesthesia can be avoided, which may reduce hospital stay and also decrease the cost of care.

174. Comparative Study of Bun/Albumin Ratio (BAR) with D Dimer/Albumin Ratio (DAR), A Better Prognostic Indicator for Outcomes of Hospitalized COVID-19 Patients
Vignesh Prakash, Jolly Daniel, Vanitha Gowda MN
Introduction: On December 31, 2019, China reported cases of pneumonia of unknown etiology in the city of Wuhan, Hubei Province of China. With further investigations, the Chinese health authorities, on 7th January 2020 reported the agent as the novel Coronavirus, 2019-nCOV.  Initially, Wuhan and later the entire Hubei province was brought under stringent lockdown. Materials and Methods: This retrospective record analysis study involving laboratory investigations was carried out in a single center in the months of June and July 2022. The ethical clearance for this single-centre study was obtained from the Institutional Ethics Committee (IEC). This study included 112 patients, of ages more than or equal to 18 years, who were confirmed cases of COVID-19 with at least one reverse transcriptase polymerase chain reaction test positive and admitted for inpatient treatment for a minimum of 8 days or longer in the wards or ICU between May 2020 to March 2022. Results: A total of 112 patients who had a positive RT PCR test were identified and included in the study after excluding patients who had sought discharge against medical advice, who had been referred to other hospitals and patients with a history of chronic renal failure. The mean age of patients included was 60.25 + 15.66. Among these patients 76 (67.9%) were male and 36 (32.1%) were female. Of the 112 patients, 47 patients (42%) survived of which 21(32.3%) were male, 15(31.9%) were female and 65 patients (58%) did not survive, of which 44(67.7%) were male and 21(32.3%) were female. Conclusion: Through this study, we can see that all the parameters considered ie. Serum Albumin, Serum Blood urea nitrogen (BUN), D dimer, BUN/Albumin ratio (BAR) and D dimer/Albumin ratio (DAR) are very solid indicators of predicting the outcome of admitted COVID-19 patients.

175. Post- COVID Cutaneous Manifestations: A Retrospective Study at a Tertiary Care Centre
Ramesh Kumar, Vinod Kumar Jangid, Surendra Kumar, Neha Sharma, Asha Nyati
Introduction: COVID-19 disease is caused by SARS COV-2 virus. Though it primarily affects the lower respiratory tract, reports have indicated that specific cutaneous manifestations are associated with COVID-19. Objectives: To evaluate the persistent dermatologic long term sequelae of SARS-CoV-2  infection, among recovered COVID-19 infected patients. Methods: Baseline data were retrospectively collected from patient’s medical records from the department of dermatology over 1 year (January 2021–January 2022), at a designated tertiary care centre. The demographic data, severity of COVID disease, and pre-existing cutaneous and systemic co-morbidities were noted. Dermatologic, hair and nail manifestations were recorded. The results were statistically analyzed. Results: Record of total 972 patients were analyzed in our study, with 432 males and 340 females. Out of these, 88 cases (9.05%) had skin manifestations, of which 35 (39.77%) were male, and 53 (60.22%) were females. About 50% of cases experienced long term skin diseases after 6 months of the recovery. The majority, 47 (53.4%) of patients with skin manifestations, were in the age group of 30-50 years, followed by 31 (35.22 %) of patients in the 50 years age and above group.  Urticaria and Pruritus were the most common manifestations 26 (29.5%), followed by telogen effluvium 24 ( 27.7%), herpes zoster 16(18.1%), pityriasis rosea, acneform eruptions, acral erythema, irritant contact dermatitis, palmar keratoderma, aphthous ulcer with lip crackling, eruptive pseudo angiomatosis, aquagenic keratoderma, and others. Conclusion:Prevalence of cutaneous, hair and nail manifestations among COVID-19 patients was 88 (9.05%) in our study. More extensive research is required to establish our knowledge on the relation between skin and COVID-19.

176. COVID-19 Infection an Individual Risk Factor of Stroke
Arunraj Ezhumalai, Annapoorani, Kannan, Sridevi
Background: COVID-19 infection is associated with multi-organ involvement. Neurological manifestations are seen in COVID-19 infection due to endothelial damage and prothrombotic state. Thus the importance of early detection or identifying the patients with high risk for developing cerebrovascular manifestations that could end up in disability and a worse overall prognosis has lead to the study of stroke characteristics in association with COVID-19. Objective: To study the acute cerebrovascular accident (CVA) manifestations in patients infected with coronavirus disease 19 (COVID-19). Methods and Materials: Our study is a retrospective from July 2020 to September 2020 for a period of 3 months done in confirmed Covid-19 infection (SARS-CoV-2 RT-PCR- positive) who are admitted in our tertiary care hospital. Diagnosing of stroke was confirmed either by Computed Tomography(CT) or Magnetic Resonance Imaging (MRI) of the brain. The inclusion criteria were as follows: RT PCR confirmed Covid 19 cases, who developed acute cerebrovascular accident in the patient. Exclusion Criteria Include: Known case of  stroke, hyperlipidemia, diabetes mellitus, hypertensive cases and morbid obesity patients. Result: Out of 8489 covid-19 confirmed cases in our hospital nearly 10 cases developed neurological manifestations who had no other co morbidities or risk factors. Out of 10 patients, 7 patients were male and 3 patients were female. Out of 10 cases 20% of cases were among the age group of 25-40 years of age, another 70% belongs to 40-50 years of age & 10% of cases belongs to age group 50-60years. Thus majority of our cases were around age group 40-50 years. Majority of our patients (60%) developed cerebrovascular accident on day 3-6 of onset of symptoms. All our patients had high sensitivity C- reactive protein above 10mg/ml and  60%  had their serum ferritin value >550ng/ml. Majority of our patients had their D-dimer value >10000ng/ml. Most of our patients(50%) belongs to severe category of National Institute of Health Stroke Scale (NIHSS).Majority of our patients who developed stroke had improved (70%), nearly 10% had no improvement and 20% died. All our patients developed ischemic stroke. Conclusion: From our study we seen that middle aged male between 40-50 yrs. who are infected with covid-19 infection with no comorbiditites and with higher inflammatory markers had developed ischemic stroke when compared to the usual age >60 years with comorbidities in non-covid patients. Thus we conclude that covid 19 infection is to be considered as an individual risk factor for developing stroke . D-dimer level more than 3 fold increase and high C-reactive protein should alarm the physician to start on early treatment of steroids and anticoagulants.. Thus early detection of inflammatory markers and early start of anticoagulants and steroids resulted in good outcome of the patients. Repeat inflammatory markers should be done at the end of the treatment and if it is still elevated, patient should be discharged with oral steroids, antiplatelets and statins even with no comorbidities and symptoms. Anyhow studies with bigger sample size is needed to validate these results.

177. Descriptive Study on Tarantula (Hairy Spider) Setae Induced Ophthalmic Lesions
Rajendran Vijay, Anbazhaghan Amudha
Aim: The Aim of this study is to report the ocular clinical manifestations, course, outcome following the entry of Tarantula [Hairy spider] setae into the eye, and to create awareness among general practitioners for timely referral. Materials and Methods: This descriptive study included twenty-two patients from July 2021 to December 2022 for 18 months at a tertiary Eye care centre, Ariyalur Medical College, Ariyalur, Tamil Nadu with Tarantula [Hairy Spider] induced ophthalmic lesions. Patients were retrospectively reviewed for clinical features, site of lodgement of tarantula setae, demographic factors, management methods, follow-up and outcomes. The common clinical manifestations include catarrhal conjunctivitis, keratoconjunctivitis, conjunctival nodules, keratitis, iridocyclitis, iris nodules, vitritis, papillitis, or chorioretinopathy. This can occur due to direct mechanical injury with or without penetration of setae or a local toxic reaction. Ocular inflammatory reactions due to urticarial toxins released from setae of insects is graded according to CADERA classification. Results: If any visible hairs identified inside eye were removed from all patients with suture tying forceps. Majority of patients were fit with type 1 [conjunctival chemosis and inflammation] and also with type 2 [keratoconjuctival involvement with corneal abrasions]. Conclusion: Ophthalmic lesions due to Tarantula setae is relatively common in rural and forest areas. It has good visual outcome with timely referral and appropriate management.

178. A Hospital Based Study on the Patterns of Photodermatoses in a Rural Population Trichy
M.R. Agni Swetha, Jansy R., Bandhala Rajan M., Gopala Krishnan K.
Background: Photodermatoses are a group of disorders that occur due to an abnormal response to ultraviolet radiation (UVR) from the sunlight which has integral role in the pathogenesis of various dermatological disorders. This may broadly be classified as photo-allergic and phototoxic reactions. Materials and Methods: The present study was an observational hospital-based study and was conducted at Trichy SRM Medical College Hospital and Research Centre, Irungalur from August 2022 – November 2022 in patients with photodermatoses. A total of 30 patients aged more than 12 years with complaints related to any form of photodermatoses were enrolled. Results: The most common pattern of dermatoses observed was Polymorphous light eruption (PMLE-36.7%), followed by Photosensitive Eczema (PSE- 30%), Phytophotodermatitis (20%), Actinic Lichen Planus (Actinic LP -6.7%). Overall, the prevalence was 53.3 % in females, comprising Scaling (90%), Erythematous plaques (56.7%), Hypopigmented papules (36%), Hypopigmented macules (30%), Hyperpigmented papules (16.7%) and skin coloured papules (10%). Conclusion: Unawareness about phototoxic medications and inappropriate use of topical native medications lead to secondary dermatitis masking the underlying primary morphology making the diagnosis difficult. Correct diagnosis and appropriate education regarding photoprotection will help in reducing the incidence of photodermatoses. Above all these, sun protection is the very important measure to prevent the sun radiation effects.

179. A Hospital Based Longitudinal Study on Outcome of Clinically Diagnosed Infective Conjunctivitis Attending Tertiary Care Center
Lipika Panda, Madhumita Rout
Background: Conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside of the eyelid. It has two parts, bulbar and palpebral. Inflammation or infection of conjunctiva is known as conjunctivitis. Conjunctivitis can be classified into infective and non-infective types. Infective conjunctivitis include viral and bacterial conjunctivitis which are first and second most common cause of conjunctivitis respectively. Aim: To study outcome of clinically diagnosed infective conjunctivitis during course of infection or during the convalescence period. Materials and Methods: 180 consecutive patients with clinically diagnosed infective conjunctivitis attending OPD of tertiary care centre Bhubaneswar over a period of one year. They underwent slit lamp evaluation on every visit from the time of presentation till complete resolution of conjunctivitis. All of them were treated with 0.5% moxifloxacin eye drop and chloramphenicol &. polymyxin-B sulphate eye ointment. Those who developed superficial punctate keratitis 0.5% loteprednol etabonate eye drop was used. Follow up regularly till resolution. Statistical Analysis: Statistical analysis done by chi square test. Results: Greater incidence seen among age groups 20-40 years. 12% of infective conjunctivitis of our study population involve cornea in the form of superficial punctate keratitis. 7% of the study population develop transient dry eye. 3% of infective conjunctivitis was associated with subconjunctival haemorrhage. Recurrence of superficial punctate keratitis found 1.1% of the study population. Time taken for resolution of conjunctivitis was prolonged when cornea involved compared to those who didn’t have corneal involvement and was statistically significant. Conclusion: Outcome of clinically diagnosed infective conjunctivitis are superficial punctate keratitis, subconjunctival haemorrhage, dry eye. Time of resolution was prolonged when conjunctivitis showed corneal involvement as sequel.

180. Correlation of Serum Vitamin D Level with Glycemic Status in Children with Type 1 Diabetes Mellitus at Tertiary Care Teaching Hospital
Ravikumar, Jayalakshmi Pabbati, Santosha Mantha, J. N. George
Introduction: Studies have identified Vitamin D deficiency (VDD) to be prevalent in children with Type1 Diabetes Mellitus (T1DM) and is associated with poor glycemic control (HbA1c). Aim: To estimate serum vitamin D level (25(OH)D) and to evaluate its correlation with HbA1 c among children with T1DM at first visit. Setting and Design: A cross sectional observation study was done in department of pediatrics over a period of one year. Methods and Material: Newly diagnosed and established T1DM children of <12 years old were included. Children >12 years, on vitamin D supplementations, with renal disorder, endocrinal problems were excluded. 25(OH)D level and HbA1c estimation done for all children along with routine investigations. Statistical analysis: Categorical variables and means were analyzed with Fisher’s exact, unpaired t test and Analysis of Variance respectively. Association between variables were analyzed with Pearson correlation and multiple linear regression. P< 0.05 was considered statistically significant. Results: Total 70 children were included, 74.28% had VDD (25 OHD < 15ng/ml). We observed significantly higher mean HbA1c in VDD children compared to children with vitamin D sufficiency and insufficiency(p-0.008) and 25(OH)D levels were inversely correlated with HbA1c (p < 0.05). Multiple linear regression analysis showed a link between HbA1c and 25(OH)D (p<0.001) when adjusted for age, sex, and duration of the disease. Conclusion: The present study revealed high prevalence of VDD in children with T1DM. Considering the high prevalence, estimation of 25(OH)D to be considered routinely in T1DM children as improvement in vitamin D levels may improve glycemic control.

181. Endoscopic Sphenopalatine Artery Ligation as an Elective Procedure for the Management of Posterior Epistaxis in a Tertiary Care Hospital: A Descriptive Study
Steffi, Arun Magendran, G. Gandhi
Background: Epistaxis is one of the most common emergencies in ENT. Its prevalence ranges from 12% to 15%. Upto 90% of the epistaxis have their origin in Little’s area which can be easily treated with anterior tamponade, but 10% cases are of posterior in origin which requires more aggressive means of treatment. Aim & Objectives: (1) The success rate of Endoscopic sphenopalatine artery ligation as an elective procedure in the management of recurrent posterior epistaxis. (2) Post-op complications and long-term outcome following Elective Endoscopic sphenopalatine artery ligation. Methods: It is a retrospective descriptive study.40 patients with recurrent posterior epistaxis who underwent Elective Endoscopic sphenopalatine artery ligation in the period between 2021 July – 2022 July were followed up at the end of first, third, fifth week, second month and sixth month of post op period and success rate of this procedure was assessed using available records. Successful endoscopic sphenopalatine artery ligation was defined as “No” further epistaxis or rebleed within 2 months of the procedure. Descriptive statistical analysis was carried out including frequency and percentage. The results were tabulated. Results: There were 37.5% females and 62.5% males in the sample. The patient’s average age was 52.98 years old, with a standard deviation of 16.87 years. The location of the bleeding was found to posterior in all 40 of the cases (100%). In all the patients the procedure was performed under general anaesthesia. During the operation, there were no complications with any of the forty patients. Within the first two months after surgery, there was only one case of bleeding that occurred again. Conclusion:In the treatment of refractory/recurrent posterior epistaxis, an endoscopic ligation of the sphenopalatine artery is a surgery that is not only safe but also straightforward and successful. In addition, given the low risk of morbidity associated with the surgery, it is our standard practice to investigate the viability of this alternative therapeutic strategy at an early stage in the management of patients whose conditions do not improve with the use of traditional nasal packing.

182. A Clinicopathological Analysis of Lymphadenopathy at DMCH, Laheriasarai, Bihar
Rajiv Ranjan Singh, Renu Kumari, Ajit Kumar Chaudhary
Background: The lymphatic system includes lymph nodes. Viruses, bacteria, cancer cells, and other undesired substances are carefully filtered out of the body by lymph nodes. Lymphadenopathy is a prevalent clinical issue that commonly causes diagnostic conundrums. A frequent issue that is diagnosed as lymphadenopathy is lymph node enlargement. Lymphadenopathy is a term used to describe an anomaly in the size and function of lymph nodes; it is also used to describe abnormally enlarged lymph nodes that are more than 10 mm in diameter. Lymphadenopathy is a prevalent clinical issue that commonly causes diagnostic conundrums. Due to its early results, ease of use, and low risk to the patient, fine needle aspiration cytology (FNAC) has emerged as a key technique for the initial diagnosis and therapy of patients with lymphadenopathy. This study primary goal is to correlate clinical and pathological conditions that manifest as lymphadenopathy. Node biopsy and open lymph will also be used to assess the role of FNAC in diagnosis. Methods: From June 2018 to November 2018, the current study was conducted at Department of Pathology, DMCH, Laheriasarai, Bihar. The study involved 40 patients in total. Fine needle aspiration cytology (FNAC) was performed on each of the 40 patients. In each case, a pathological diagnosis was made. As needed baseline investigations, fine needle aspiration cytology, excision biopsy, throat, ear, and nose examinations were performed. Result: This study involved 40 patients in total. 15 of the 40 patients had IPD, and the others had OPD. In this investigation, FNAC and biopsy were performed on all patients. The majority of observers in this study had tubercular lymphadenitis. Out of 40 patients, 24 (or 60%) were men and 16, or 40%, were women. Age groups 30-40 years (22.5%), 10-20 years (22.5%), and 20-30 years (32.5%) had the highest percentage of patients, respectively. Out of 40 patients, 25 (62.5%) had Tubercular Lymphadenitis, and 5 (12.5%) had Chronic Non-Specific Lymphadenitis. Reactive lymphadenitis was discovered in 4 (10%) patients, malignant secondary tumours in 4 (10%) patients, lymphomas in 1 (2.5%), and non-lymphoma Hodgkin’s in 1 (2.5%) patients. Conclusion: Following a clinical assessment of the lymphadenopathy, FNAC is used as a trustworthy diagnostic test that is simple to use, cost-effective, and quick to produce correct results. The essential prerequisite for this is expert input. In lymphoma cases where a biopsy is used as a diagnostic technique, it is also beneficial. When the FNAC report is ambiguous, a biopsy is highly beneficial for an accurate diagnosis and course of treatment in nonspecific lymphadenitis. Hence, it was discovered that FNAC was a trustworthy, easy-to-use, and affordable approach for diagnosis in cases with lymphadenopathy.

183. Study of Thyroid Profile in Women with Menstrual Irregularities in Reproductive Age Group in Mithilanchal Area
Renu Kumari, Rajiv Ranjan Singh, Sheela Kumari
Background: By interactions with sex hormone-binding globulin and direct effects on the ovaries, thyroid hormones play a significant role in normal reproductive physiology. Infertility and menstrual abnormalities can result from thyroid disease. In the current study, thyroid-related symptoms, thyroid function tests, and menstrual patterns in women with thyroid disease were examined in the Mithilanchal area of North Bihar. Methods: This cross-sectional study was carried out at the DMC in Laheriasarai, Bihar, in the Department of Physiology. From July 2018 to December 2018, the Department of Obstetrics and Gynecology at Darbhanga Medical College and Hospital, Laheriasarai, Bihar, evaluated thyroid dysfunction in 70 women with irregular menstruation. All selected women of reproductive age (15–45 years) in Mithilanchal area who experienced irregular periods were registered. The study did not include women who were currently taking anti-thyroid medications or had a history of thyroid malfunction. Age, thyroid hormone level, and monthly irregularity type for each individual were noted. Thyroid hormones were determined using the ELISA method. Thyroid stimulating hormone (TSH) levels, serum free triiodothyronine (T3), and free thyroxine (T4) were used for the assessment of thyroid dysfunction. SPSS version 25 was used for data analysis. Results: With a range of ages from 15 to 45, the study population’s average age was 27.8 ± 5.3 years. Patients were divided into three groups based on their ages: 15–25 years, n=34 (48.57%), 26–35 years, n=23 (32.85%), and 36–45 years, n=13 (18.57%). 22.85% of people (n=16) had thyroid problems. Regular menstruation 67.14% (n=47), Oligomenorrhea 4.28% (n=3), Menorrhagia 15.71% (n=11), Polymenorrhea 7.14% (n=5), and Metropathia 5.71% (n=4) were the clinical manifestations of menstrual patterns. Of the 16 women with thyroid dysfunction overall, 41 (58.6%) had normal thyroid function, 28 (40%) had hypothyroidism, and 1 (1.4%) had hyperthyroid function. TSH levels were 2 mIU/L IQR on average (1.0-4.0). T3 and T4 levels were 2.83±1.13 pg/ml and 1.38±1.1 ng/dl on average, respectively. Conclusion: The current study discovered that among women of reproductive age with various menstrual irregularities, hypothyroidism is the most common thyroid malfunction. Menorrhagia, polymenorrhea, and oligomenorrhea were the most typical clinical manifestations. Thus, a thyroid function test should be required in all DUB cases in order to identify thyroid malfunction and determine whether or not the patient needs additional medical attention.

184. Comparison of Effect of Addition of Two Doses of Clonidine (40 microgram and 60 microgram) to 0.5% Hyperbaric Bupivacaine 2.75 ml, Intrathecally for Sub Umbilical Surgery
Shyam Kishor Thakur, Satyeshwar Jha, Hari Damodar Singh
Background: A powerful analgesic without any clinically relevant side effects, intrathecal clonidine is an adjuvant to local anaesthetics that increases both sensory and motor blocking of local anaesthesia. The main of the study to compare the effect of addition of two doses of clonidine (40μg and 60μg) to 0.5% hyperbaric bupivacaine 2.75 ml, intrathecally for sub umbilical surgeries. Methods: This prospective randomised controlled study involved 30 individuals. There were 30 patients split into 3 groups, with 10 in each group. A total of 2.75ml of 0.5% hyperbaric bupivacaine and 0.5ml saline were administered to group B participants. 2.75ml of 0.5% hyperbaric bupivacaine and 40μg of clonidine were administered to group C1 patients. Participants in group C2 received 60μg of clonidine and 2.75ml of 0.5% hyperbaric bupivacaine. Results: As comparison to the control group, clonidine groups C1 (177.25 secs) and C2 (156.25 secs) took longer for sensory block to begin (103 secs). Groups C1 (199 secs) and C2 (193 secs) had a longer mean time to motor block onset than the control group (177 secs). The mean motor block duration in group B (control) was much shorter (188 seconds) than in groups C1 (263 mins) and C2 of clonidine (284 mins). Conclusion: In comparison to control group B, both clonidine groups C1 (305 min) and C2 (314 min) had longer average analgesia times (219 mins). In comparison to control group B, clonidine groups C1 (187.05 mins) and C2 (211 mins) had longer mean two segmental regression times (128 min).

185. Study of the Spectrum of the Hypertensive Disorders in Pregnancy in a Tertiary Care Centre in South India
Vijayalakshmi M., Gayathri S.S., Balamurugan P.V., Agnes Synthiah S.
Background: Hypertensive disorders in pregnancy (HDP) are a spectrum of disorders which ranges from already existing chronic hypertension in the index pregnancy to complex multisystem disorders like preeclampsia which may lead on to the complications like eclampsia, HELLP syndrome, acute renal failure, pulmonary edema, stroke and left ventricular failure. This study was done to analyse the clinical spectrum of hypertensive disorders in pregnancy and also to determine the outcomes of pregnancies associated with hypertension in all patients who visited in the Department of Obstetrics and Gynaecology, Govt. Sivagangai Medical College and Hospital, Tertiary care centre, Sivagangai from Jan 2022 to Dec 2022. Aim of Study: (1) To analyse the epidemiological factors, complications of Hypertensive disorders spectrum in pregnancy in a tertiary care centre. (2) To analyse the maternal and fetal outcomes of pregnancies associated with hypertension. Materials and Methods: A prospective analysis was conducted in all antenatal women diagnosed with Hypertension and follow up was done in the puerperium at Govt. Sivagangai Medical College and Hospital (a tertiary care hospital) over a period of 1 year from January 2022 to December 2022. Inclusion criteria Antenatal women with BP more than 140/90 on two occasions six hours apart were included regardless of the Gestational age Exclusion criteria Antenatal mothers with normal Blood pressure irrespective of Gestational age. Results: In our study it was found that, among the 4944 mothers who had delivered in the hospital during the period of Jan 2022 to Dec 2022, 476 had Hypertension (9.6%). In this study, 12.6% were aged under 20 years and 31.2% were aged over 30 years and majority were in the age group of 20 yrs to 30 yrs (56.2%). Among the maternal morbidity, 30.3% constitute imminent eclampsia. Because of immediate diagnosis and management, further complications were prevented in these patients About 4.1% patients had eclampsia, of which 2.52% constitute Antepartum Eclampsia and 1.6% Postpartum eclampsia. In all Eclampsia patients, MRI brain was taken and found to have PRES changes in about 1.6% of cases. 3.4% cases were HELLP syndrome. Out of 476 patients, we had only one maternal death which constitute about 0.21% due to HELLP syndrome. Regarding Perinatal outcome, 28.1% babies had IUGR, which is one of the expected complications of hypertension disorders in early third trimester. 2.5% of babies were Intrauterine death occurred in 2.5%. 22.1% babies were delivered pre-term in view of hypertensive disorder to safeguard maternal life. Conclusion: Our study shows that prevalence of Hypertensive Disorder in Pregnancy was 9.6% in Sivagangai district among 21 to 30 yrs with majority of primigravida. The knowledge of risk factors for hypertensive disorders in pregnancy will aid in prevention of morbidity in this population. Early diagnosis and treatment by regular antenatal check-up are a key to prevent hypertensive disorders of pregnancy and its complications.

186. The Relationship between Optic Nerve Canal and Posterior Paranasal Sinuses and Categorizes Them with Delano’s Classification in South Indian Ethnics
Sakthivel, K. A. Dharan Venkatesh, V. Senthilnathan, M. Krishna Kumar
Background: The aim of the study is to evaluate the relationship between optic nerve canal and posterior paranasal sinuses and categorizes them with Delano’s classification in south Indian ethnics. To delineate the anatomy of optic nerve canal and posterior paranasal sinuses. To categorize their relationship according to Delano’s classification. Objective: The aim of this study was to observe the relationship of the sphenoid sinus and posterior ethmoidal cells with the optic nerve. Subjects and Methods: It is a retrospective study conducted in the department of Radio diagnosis in Trichy SRM Medical College Hospital and Research center, Trichy. A total of 100 reports of the patients who had taken CT paranasal sinus were taken for the study by convenience sampling. Coronal reformatted images are used to determine the course of optic nerve canal and its relationship to the posterior paranasal sinus. They were categorized into 4 types based on Delano’s classification. Results: Incidence of optic nerve into four types by relation to posterior ethmoidal and sphenoidal sinuses sinuses according to DeLano et al.,  showed Type 1 with proportion of 68.5% (137 nerves), type 2 was detected in 25.5% (51 nerves), type 3 was identified 4.5% (9 cases) and type 4 in 3 (1.5%) cases. Dehiscence of the bony wall of the optic nerve was found in 53(26.5%) cases of which 31(15%) were right sided and 22(11%) were left sided. Pneumatisation of anterior clinoid process was seen in 39 (19.5%) cases of which 17 (8.5%) was on right side and 22(11%) on left, bilateral in 7 (4% ) cases. Conclusion: Our study shows that CT examination is an ideal method for detection of bony variation of paranasal sinuses. Axial and coronal scans are necessary for visualization of position of optic nerve and for preoperative planning to ensure the safety and efficacy of paranasal sinus surgery.

187. Fractures of the Scapula: Results and Functional Outcomes of Operative Treatment
Kumar Rohit, Rajat Jangir, Vikas Verma
Introduction: Scapula fractures are uncommon and usually caused due to high-energy trauma. Although most scapular fractures do not require surgery; highly displaced and malunited fractures of the scapula can lead to pain and poor functional outcome. Some recent studies have demonstrated that operative treatment can lead to superior functional recovery and improved outcomes. The indications for surgical treatment of scapular fractures, however, remain controversial. The aim of this study was to describe the surgical technique and report patient-based functional outcomes and complications following open reduction and internal fixation in patients with scapular fractures. Material and Methods: The study comprised of 12 patients admitted in our hospital between January 2019 to December 2021 with scapula fracture meeting the inclusion criteria. After pre-operative X-ray and CT scan of scapula with 3D reconstruction Fractures were classified according to the revised (AO/OTA) classification system, after which surgery was carried out on these patients. An extensile or modified Judet approach was used depending on fracture configuration. The fracture was fixed using various combination of 3.5 locking and non-locking plates and lag screws. Patients were followed up for minimum of 12 months. Functional outcomes were measured using UCLA shoulder rating scores. Results: Mean age of patients was 33 years (range 25-45 years). Mode of injury was road traffic accident in 8 cases, fall in 3 cases and sports injury in 1 case. All patients underwent surgery for scapula fracture. Postoperative radiographs demonstrated restoration of anatomic alignment, length, and translation. All fractures maintained fixation and reduction. No implant failures or loosening or infection was noted. All fractures united clinically and radiologically at 6 months follow-up. The mean shoulder range of motion at the time of final follow-up was 155O (range, 90O to 178O) of forward flexion, 104O (range 80O to 122O) of abduction, and 50O (range 40O to 70O) of external rotation. The outcome was measured using the UCLA Shoulder rating scale. The mean score in our group was 32 (ranging between 20-35). 9 patients have excellent outcome, 2 had good results and 1 had poor results in our study. Conclusion: We thus conclude that open reduction and internal fixation of displaced scapular fractures is a reliable, effective and safe treatment option, which leads to good to excellent functional outcomes and reliable union rate.

188. Assessment of Association of Hypocalcemia with Severity of Disease in Patients with Dengue Fever in a Tertiary Care Hospital
Jitendra Kodilkar, Sonal Dhamanskar, Manaswini dixit, Sakshi Mishra, Jeetendra Singh
Introduction: Dengue hemorrhagic fever (DHF) is a major cause of morbidity and mortality in tropical regions. Serum free calcium (Ca2+) is known to be important in cardiovascular function. We therefore evaluated association between serum Ca2+ level and severity of dengue. Methodology: A cross-sectional study was carried out at a tertiary care private hospital in India. A probable case of dengue was diagnosed and classified according to World Health Organization criteria and confirmed by either IgM antibody, PCR, or NS1 antigen detection. Socio-demographic details were collected using an interviewer-administered questionnaire. Results: The sample size was 130. The mean age was 32.1 years, and the majority were males (n = 78, 53.8%). DHF was diagnosed in 69 patients (53%). Mean serum Ca2+ level of the study population was 1.05 mmol/L (range 0.72–1.22). Mean serum Ca2+ was significantly higher in patients with dengue fever (DF) (1.04 mmol/L) than in those with DHF (1.01 mmol/L) (p < 0.05).  Prevalence of hypocalcemia in DHF and DF patients was 86.9% (n = 60) and 29.7% (n = 11), respectively (p < 0.05). Conclusions: Serum Ca2+ levels may significantly correlated with dengue severity. Serum Ca2+ levels were significantly lower and hypocalcemia was more prevalent in patients with DHF than in patients with DF. Further studies are required to determine whether hypocalcemia can be utilized as a prognostic indicator and to evaluate effectiveness of calcium therapy in prevention of dengue complications in the patients.

189. Cerebrospinal Fluid Lactate as a Biochemical Marker for the Diagnosis of Meningitis in Pediatric Patients
Jyoti Kumari, Dev Kant, Anant Prasad
Objectives: This present study was to compare the cerebrospinal fluid lactate as a biochemical marker to distinguish for the diagnosis of bacterial and viral Meningitis in Pediatric Patients. Methods: All the investigation were done in all patients include complete blood count, serum electrolytes, blood culture, random blood sugar, chest x-ray and Mantoux test. CSF sample was analysed for cell count, glucose, protein, Gram statin, culture and sensitivity and lactate. CSF lactate estimation was done using dry chemistry method. Neuroimaging studies like CT scan and MRI scan were done in indicated cases. Patients were examined daily to assess clinical progress. At the time of discharge, children were subjected to thorough physical examination to assess the presence of any neurologic deficit. Results: Out of 55 cases, majorities of cases 31(56.36%) were males. Majorities of cases were males in both bacterial 13(65%) and viral meningitis 18(51.43%). The mean ± S.D. of CSF lactate level of bacterial and viral meningitis were 8.01 ± 2.12 and 2.45 ± 0.47 mmol/L respectively. P- value was found to be <0.0001, which is statistically extremely significant. Out of 20 cases of meningitis, 11(55%) patients were without complication and 9(45%) patients were with complications. Conclusions: CSF lactate was significantly higher in bacterial meningitis as compare to viral meningitis. High CSF lactate level in meningitis patients were associated with increased incidence of acute complications. Hence, CSF lactate level is one of the best diagnostic biochemical markers of bacterial meningitis and it should be used in hospital setting as a routine assay to distinguish bacterial meningitis from viral meningitis.

190. To Evaluate the difference in Amplitude and Latency of ERP Waveform of N400 between Semantically Coherent, Incoherent and Recoherent Sentences Processing
Yogi Ankur, Jetaji Lubaina, Kumar Bhupendra, Kumar Amit, Nath Vidhi, Choudhary Manoj Kumar, Soni Ramesh Kumar, Dube Amitabh
A prospective comparative study was conducted to evaluate the architectonics and mechanistic profile of semantic information processing as represented by ERP waveform of N400 along different virtual phase-time zones of human mind using set regimes of 45 paired sentences with three conditions namely Coherent, Incoherent and Recoherent. The evaluation exhibited significant violations across diffuse EEG electrodes (F3,F4,FCz FC4,C3,CZ,C4,CP3,CPz) depicting the bilateral activation of Frontal, Fronto-Central, Central And Centro-Parietal regions of brain proposing the phenomenal processing of semantics, not only confined to word knowledge, but also considering the other modalities i.e colors, textures, sounds, shapes, emotions associated with the formation of a particular letter or word segregated in neuronal pixels entangled with reasoning, planning, problem solving cubicles of human mind.

191. Lumbar Canal Diameter Evaluation by CT Morphometry Study of Indian Population
Saurabh Goyal, Tapendra Tiwari, Sunil Kast, Rinkey Baisoya
Background: To document dimensions of the lumbar vertebrae and bony canal in an Indian population and to compare with other studies from the subcontinent as well as from other parts of world. Methods: An observational study was conducted on the basis of a review of thin-cut (3 mm) computed tomographic images of lumbar vertebrae. A total of 302 patients were studied, and various dimensions were analyzed. Results: In general, the vertebral and bony spinal canal dimensions were found to be greater in male patients. Comparison of populations revealed statistically significant differences in the spinal canal between an Indian population and others. Conclusions: The dimensions of the lumbar vertebrae and bony canal thus obtained shall provide a baseline normative data for evaluation of patients presenting with low backache and lumbar canal stenosis in an Indian population.

192. A Comparative Study on the Sonography Versus Mammography for the Early Diagnosis of Breast Cancer
Shikha Rani, Tushar Anand, Firdause Rab
Objectives: This present study was to compare the accuracy of ultrasonography versus mammography for the early diagnosis of breast cancer in various age group of women. Methods: A total of 100 breast lesions women who had examined by histopathological procedure were enrolled in this study. A complete history and physical examinations were performed. Mammography and ultrasonography were performed to all histological diagnosed cases of breast lesions. Results: All 100 patients of breast lesions were with age group 25 to 65 years. Most of the patients 41(41%) were in age group of 51-65 years. 61 patients had benign and 39 patients had malignant lesions. In benign lesions, 21(47.73%) cases shown positive on mammography and 23(52.27%) cases shown positive on ultrasonography. In malignant lesion, 12(38.71%) cases shown positive on mammography and 19(61.29%) cases shown positive on ultrasonography. Ultrasonography had significantly higher sensitivity (71.79%) and specificity (86.88%) in breast lesion as compared to mammography sensitivity (51.28%) and specificity (70.49%) respectively. Conclusions: Breast cancer was commonly seen in old age women. And ultrasonography had higher sensitivity and specificity for breast lesion as compared to mammography. Hence, ultrasonography is one of the best choices of investigative procedures for early detection of breast cancer.

193. Prospective, Randomized Comparative Assessment of IV Fentanyl Vs Femoral Nerve Block to Facilitate Administration of Subarachnoid Block for Femur Fracture Surgeries
Monti Bori, Anup Gohatre, Shephali
Aim: The aim of the present study was to compare the analgesic efficacy of femoral nerve block and IV Fentanyl in femur shaft fracture patients for positioning them for neuraxial block. Methods: A prospective, randomized study was conducted on 50 patients of ASA I and II between the age group of 18-65 years undergoing surgical correction of fracture shaft femur under subarachnoid anesthesia at Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India for nine months. Results: There were 10 and 8 cases IN ASA I in group A and B respectively. The mean of demographic data were not significant. Difference in mean heart rate in both the groups after 10 min interval is statistically significant. Difference in mean SBP in both the groups after 10 min interval was statistically significant. Difference in mean DBP in both the groups after 10 min interval was statistically significant. Difference in mean MAP in both the groups after 10 min interval is statistically significant. Mean VAS at rest in group A & group B at 10 min (8.33 & 6.8), 15 min (5.33 & 7.30), 20 min (3.73 & 7.23), 25 min (1.53 & 6.47) 30 min (2.40 & 6.33) which were statistically significant. Difference in mean VAS at movement in both the groups after 10 min interval was statistically significant. Conclusion: Femoral nerve block has better analgesic efficacy compared to IV Fentanyl. Hemodynamic parameters are more stable when femoral nerve block was used for analgesia.

194. A Hospital-Based Retrospective Assessment of the Indications and Outcome of Surgical Management of Local Complications of Acute Pancreatitis
Ashok Kumar, Khurshid Alam, Mukesh Kumar
Aim: This study aims to evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methods: A hospital-based retrospective study was conducted in the department of surgery at Government Medical College, Bettiah, Bihar, India for 12 months. A purposive sampling method was utilized to recruit the patients. Results: 450 patients were admitted to the surgery department with the diagnosis of acute pancreatitis or with complications of acute pancreatitis. Among them, 60 patients had local complications due to acute pancreatitis. All patients were managed using the step-up approach, starting with conservative management and minimally invasive intervention when warranted. Twenty-five patients required surgical intervention due to failure of endoscopic or radiological intervention or positions of lesions being inaccessible to these techniques. Out of 25 patients, 56% were females. 52% had ethanol etiology and 36% had pseudocyst pancreatic fluid collection. According to the location, 68% were at body or tail. According to Clavien-Dindo classification, 32% were in grade 4 followed by grade 1 (24%) and grade 4 (20%). Conclusion: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

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

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

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

198. Universal Thyroid Screening in Pregnancy versus Targeted Case Finding
Radhika Pusuloori, K Dilzith Arora, K Krishna Jyothi
Background: Thyroid disorders are the second most common endocrinological disorders in pregnancy. With the severity of clinical consequences and the present prevalence rate, a universal screening program would be justified for identifying women with thyroid disorder. Aim and Objectives: To know the difference in universal thyroid screening and targeted case findings. Material and Methods: This was prospective study carried out in 200 pregnant patients with singleton gestation at the antenatal clinic of our institution, for the period of  one year during the first antenatal visit. Study was conducted after getting informed consent following inclusion and exclusion criteria At the same time patients with known hypothyroidism/ hyperthyroidism were excluded from the study. Results: 200 patients were screened. Mean age of patient was 26.45 years with SD of 2.12 Years and mean gestational age was 9 weeks. 35 patients had abnormal thyroid profile. Of which 20 had subclinical hypothyroidism, 9 had overt hypothyroidism, 4 had subclinical hyperthyroidism, 2 had overt hyperthyroidism. Of these 35 patients, 22 had risk factors, 13 had no risk factors. If high risk strategy for screening was used, we would miss these 13 patients, which approximates to one third of patients. Conclusion: From overall results and discussion with other study we can conclude that universal thyroid screening is much better than targeted case finding which misses around one third of patients with abnormal thyroid profile. The incidence of complications was more in patients with abnormal thyroid profile compared to those with normal thyroid profile.

199. Evaluation of Diabetes with Obesity as a Risk Factor
Pravin Nitnavare, Smita Gupte
Introduction: Obesity is a condition marked by pathological excess of body fat. Accumulation of harmful lipid species takes place in ectopic tissues. This results in local inflammation, thereby leading to endothelial dysfunction, insulin resistance, and non-alcoholic fatty liver disease. Hyperglycemia causes a series of dysregulated metabolic changes. Aims and Objective: To find out the effect of obesity in patients with type-2 diabetes mellitus. Methods: This is an observational study that was conducted on 100 patients with type II diabetes mellitus. The patients were divided into two groups, namely, the obesity group with 55 patients and the control group with 45 patients. The baseline characteristics of the patients were analyzed as other clinical and laboratory features related to diabetes and obesity. The parameters were analyzed and compared statistically between the two mentioned groups. Results: The study found that there are significant differences between the two groups in Fasting Blood Glucose, Total Cholesterol, LDL, SBP, and cardiopulmonary complications like Atrial Fibrillation, Frequent Pulmonary Infection, and Hypertension (p<0.05). It was found that there is a significant difference in BMI and Waist Hip Ratio (WHR) between the 2 groups (p<0.05). The fasting blood glucose is seen as high in the obesity group (154.23±4.65), and HbA1c % is slightly high in the obesity group. HDL levels are high in the control group (59.23±3.67) and LDL is seen high in the obesity group (229.35±6.5). Conclusion: The study has concluded that obesity can be considered a risk factor for diabetes which specifically impacts long-term cardio-pulmonary complications.

200. A Comparative Study on the Sonography Versus Mammography for the Early Diagnosis of Breast Cancer
Shikha Rani, Tushar Anand, Firdause Rab
Objectives: This present study was to compare the accuracy of ultrasonography versus mammography for the early diagnosis of breast cancer in various age group of women. Methods: A total of 100 breast lesions women who had examined by histopathological procedure were enrolled in this study. A complete history and physical examinations were performed. Mammography and ultrasonography were performed to all histological diagnosed cases of breast lesions. Results: All 100 patients of breast lesions were with age group 25 to 65 years. Most of the patients 41(41%) were in age group of 51-65 years. 61 patients had benign and 39 patients had malignant lesions. In benign lesions, 21(47.73%) cases shown positive on mammography and 23(52.27%) cases shown positive on ultrasonography. In malignant lesion, 12(38.71%) cases shown positive on mammography and 19(61.29%) cases shown positive on ultrasonography. Ultrasonography had significantly higher sensitivity (71.79%) and specificity (86.88%) in breast lesion as compared to mammography sensitivity (51.28%) and specificity (70.49%) respectively. Conclusions: Breast cancer was commonly seen in old age women. And ultrasonography had higher sensitivity and specificity for breast lesion as compared to mammography. Hence, ultrasonography is one of the best choices of investigative procedures for early detection of breast cancer.

201. Analysis of Short and Long Term Outcomes with Proximal Femoral Nail (PFN) and Proximal Femoral Nail Anti-Rotation (PFNA)
Sachin Gopalrao Saoji
Introduction: Femoral fractures cause major deaths and morbidity in the elderly. Surgical management has become the acknowledged procedure of choice for achieving appropriate decrease as well as engaging in regular exercise in the elderly osteoporotic participant. Dynamic Hip Screw (DHS) was thought that it was the standard method among most intertrochanteric fractures, but it didn’t work in reverse oblique fractures or unstable IT femur fractures with a weak lateral wall.
DHS referred to an extra medullary implant system. FN was an intramedullary system with a compression screw and an anti-rotation screw that performed admirably in unstable IT fractures. PFNA, a single helical blade with a locking system, was designed to minimize implant-related complications. PFNA improves angular and rotational stability in osteoporotic related bone, enabling involvement as well as muscle mass carrying on the injured area. Aims and Objectives: To find out the efficacy and safety profile of managements of femur fractures by using Proximal Femoral Nail (PFN) and Proximal Femoral Nail Anti-rotation (PFNA). Methods: A retrospective study was conducted on patients who came to the orthopedics department of our hospital. A total of 75 intertrochanteric fracture patients were included in the study. All intertrochanteric fracture cases that met the AO classification criteria as well as skeletally mature patients of either gender who had either PFN or PFN-A treatment were required to meet the inclusion criteria. The patients were classified as PFN or PFN-A patients and was determined for baseline characteristics and the respective outcome. These were statistically analyzed. Results:   The majority of the patients (53.3%) were between the ages of 61 and 80, with 20 patients older than 80 and 22.6% younger than 61. More men than women are present. 77.3% of the patients who had pretreatment radiographs were in the unstable group (AO 31-A2.2 to A3.3), while 22.7% of the patients were in the stable group (AO 31-A1.1 to A2.1). The mean score for the PFN group was 79.89, whereas the mean score for the PFN-A group was 80.12. Parker Palmer Mobility Scores following surgery were compared between the two groups. Its mean value was 8.02 in the PFN group and 7.75 in the PFN-A group. Complication rates for the PFN group were 7.5%, whereas those for the PFN-A group were 3.5%. Conclusion: The study has concluded that PFN-A has shown to be effective procedure as compared to PFN in terms of loss of blood, procedure time and the rate of complication.

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