International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Suture Mesh Fixation versus Tacker Mesh Fixation in Laparoscopic Inguinal Hernia Repair
Gopi Tupkar, Rajeshwar Kamineni
Abstract
Introduction: Laparoscopic hernia mesh repair is standard management option for adult symptomatic inguinal hernia to establish inguinal floor using mesh. However, the ideal method of mesh fixation is still controversial. The present study was designed to assess the efficacy of suture mesh fixation and tacker mesh fixation in the patient undergoing laparoscopic hernia repair. Material and Methods: A source of 44 participants diagnosed with inguinal hernia undergoing laparoscopic hernia repair above 21 years if age were recruited. Study participants were randomly divided in to group 1 managed with suture mesh fixation and group 2 managed with tacker mesh fixation. Results: The mean duration of surgery was 75.67 min and 54.35 min and mean duration of hospital stay was 2.46 days and 2.18 days in suture and tacker groups respectively. Post operative pain and discomfort was seen in 27.28% and 22.72% in both groups. Seroma formation was observed in one case of suture group and scrota swelling in one case of both groups. The duration for return to routine activity was <1 week in 77.28% and 72.72% and >1 week in 22.72% and 27.28% and duration for return to work was <2 weeks in 81.82% and >2 weeks in 18.18% of participants in suture and tacker groups respectively. Conclusion: The suture mesh fixation and tacker mesh fixation are effective in the laparoscopic hernia repair. However, suture fixation was cost-effective than tacker fixation, but tacker fixation group showed less duration of surgery.

2. Impact of Inspiratory and Peripheral Muscle Training in Cases with COPD: A Prospective Observational Study
Prasanna Kumar Reddy, Sreelekha Kotte
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by continual respiratory symptoms and controlled airflow in the respiratory tracts. Breathing exercises can rehabilitate the lung function in COPD including continuous training of breathing patterns and exercises to respiratory muscles. The present study was designed to assess the role of inspiratory muscle training and peripheral muscle training in pulmonary function and exercises capacity progression in cases with COPD. Materials and Methods: A source of 80 cases with symptoms and spirometry suggestive of moderate to severe COPD patients above 30 years were recruited. Participants were randomly divided into group IMT (n=40) undergone inspiratory muscle training and group PMT (n=40) undergone peripheral muscle training. At the baseline and end of the session quality of life by COPD assessment test score, mRC dyspnea scores, exercise capacity by 6 minutes walking distance and lung function by Forced Expiratory Volume in one second (FEV1) were assessed. Results: The COPD assessment test score was 24 and 17 in group IMT and 22 and 16 in group PMT at baseline and after sessions respectively (p<0.05). The mean 6 minutes walking distance showed increase from baseline to end of sessions. The mean FEV1 was 50±8.98 and 51±9.18 in group IMT and 45.8±7.88 and 46.5±7.67 in group PMT. Conclusion: IMT was an effective method to improve the inspiratory muscle strength, pulmonary function, quality of life and without changes in the dyspnea in cases with COPD. Similar outcome was found in terms of peripheral muscle training.

3. Comparative Study on Effect of Rocuronium and Atraconium Induced Rapid Precurarization on Succinylcholine Induced Fasciculations, Post-Operative Myalgias and Intubating Conditions
Sonam Dubey, Manoj Sahu, Ashish Kumar Dubey, Mansi Srivastava, Shatkratu Dwivedi
Abstract
Background: Succinylcholine gained widespread use rapidly because of its onset is very fast and duration is ultra-short. However, its utility is compromised due to its adverse effects. succinylcholine-induced muscle fasciculations, myalgia is attenuated and prevented by use of multiple drugs. Aims and objectives: To evaluate the rapid precurarization technique using rocuronium and atracurium induced rapid precurarization on succinylcholine induced rapid fasciculations, post-operative myalgias and intubating conditions. Materials and Methods: A comparative observational study comprising of 60 patients was conducted where selected patients either received ROC 0.1 mg/kg or ATR 0.1 mg/kg, and 10 sec later propofol 2 mg / kg IV was given. A balanced anaesthetic technique was used for all patients. Assessment of fasciculations, myalgia and intubating conditions was done using a 4-point rating scale. All patients were evaluated up to the third postoperative day for the presence of POM. Results: The severity and incidence of post-succinylcholine fasciculations decreased in the ROC group as well as in ATR group. However, significant decrease was observed in ROC group. Similarly, a decrease in the severity and incidence of post-succinylcholine myalgia was observed in both the groups, where ROC group showed significant decrease as compared to ATR group. No significant change in the intubating conditions was observed between both the groups. Conclusion: Severity and incidence of post operative myalgia and fasciculation were significantly decreased by pre-treatment with rocuronium in contrast to atraconium. Hence, ROC is a better option than ATR to combat succinylcholine-related complications like fasciculation and myalgia.

4. Relationship between Depression and Thyroid Dysfunction in Patients Attending a Tertiary Care Hospital
Kalavathy Selvaraju, Velayutharaj Alwar, Nivedha Pandiyan, Balaji Karunakaran, Thamarai Rajappa, Balaji Selvaraju, Praveen Kumar Muthusami, Venkatesan Agambaram
Abstract
Introduction: Patients with thyroid disorders are more prone for depression and depression may be accompanied by various thyroid abnormalities. In the advancement of technologies and adoption of modern lifestyle practices, people are more prone to stress or depression and if it is left untreated, may results in serious complications. Beck depression inventory scale is a simple, self-rating scale is used to assess the mental status of the patient. Objective: The main objective of the study is to explore the association between depression and thyroid dysfunction. Materials and Methods: This prospective observational study consists of 100 patients who attended the medicine outpatient department. Their mental status was assessed by using Beck’s depression inventory scale and Free T3, Free T4, TSH was estimated from their serum samples. Frequencies and proportion were used. The association between depression and thyroid dysfunction was determined using chi-square test. Results: Majority (59%) of the study subjects was above the age group of 40 years of age and 57% of them were females. About 52% of them had thyroid dysfunction and almost 74% o had co-morbidities other than thyroid dysfunction. The prevalence of depression was found to be 65% among the study subjects. Also the depression was found to higher (77%) among the patients with subclinical hypothyroidism than those with normal and other thyroid derangements which is statistically significant. Conclusion: Our present study even though of 100 patients, it is concluded that whenever the diagnosis of depressive psychosis is confirmed, we may also have to rule out subclinical hypothyroidism.

5. Association between COVID Vaccination and Disease Severity among Hospitalized Patients in a Tertiary Care Hospital: A Cross-Sectional Study
Sheela Samini Seelan, M. Arun Karki, N. Nallathambi, S. Rewathy
Abstract
Introduction: The ongoing COVID-19 pandemic and its unprecedented global societal and economic disruptive impact, highlight the urgent need for the development of safe, effective, affordable, and deployable vaccines against COVID-19. Among the several vaccines approved by the World Health Organization, BBV-152 (COVAXIN) and AZD1222 (COVISHIELD) are approved in India. As on 1-Apr-2021, around 9 million people were fully vaccinated and around 59 million had received one dose of vaccine in India. Hence, this study was aimed to study the association between disease severity and disease progression from mild to moderate/severity. Methodology: This cross-sectional study was conducted in a private medical college at Tamil Nadu between April 2021 to May 2021 (one month period). The study included 100 participants who were aged more than 45 years admitted for COVID infection. Disease severity was assessed as per the guidelines issued by Ministry of Health and Family Welfare, and the patient vaccination status was ascertained based on the patient’s testimony (also corroborated with a vaccine certificate). Results: The gender ratio observed was 1.6:1. The mean age at presentation was 59 years for mild disease, 60 years for moderate disease and 61 years for severe disease. The prevalence of moderate disease was 65% among non-vaccinated, and 15% among vaccinated individuals. The prevalence of severe disease was 25% among nonvaccinated individuals, and 5% among vaccinated individuals. Conclusion: Vaccination provides significant protection against moderate and severe COVID-19 disease.

6. To Study Risk-Factors and Variation in Clinical Presentation of Vernal Keratoconjunctivitis in Patients of 2-21 Years of Age
Nitin Mehrotra, Govind Singh Titiyal, Utkarsh Mishra
Abstract
Background: There appears to be variability in the prevalence of different subtypes, based on geography and atopic history, which raise a that the pathogenesis of the different subtypes may be different. Objective: To study risk-factors and variation in clinical presentation of vernal keratoconjunctivitis in patients of 2-21years of age. Methods: This cross-sectional study was conducted among 94 patients (2-21 years of age) diagnosed with vernal keratoconjunctivitis, attending the outpatient Department of Ophthalmology, Government Medical College and Sushila Tiwari Memorial Hospital, Haldwani in Kumaon region of Uttarakhand. Results: 87% of patients in our study belonged to plains while only 13% belonged to the hills. This difference can be attributed to difference in ecological and climatic characteristic of the habitat of the patients. Majority of our subjects presented with moderate intermitted form (47.9%) of the disease. The comparatively less severe form, the isolated limbal subtype of the disease was seen in 38.3% of our study subjects when compared with the study conducted in peninsular India having only 12.6% of isolated limbal VKC. This significant difference can again be attributed to difference in climatic conditions of the two population being compared. Conclusions: Maximum incidence of patients was observed in the month of July, which corresponds to hot and dry months of the year in the place of study.

7. Baseline C – Reactive Protein is Associated with Incident Cancer and Survival in Patients with Cancer
Sunita Rathi, Kumar Vaibhaw, Mahesh Kumar Singh
Abstract
Aim: We hypothesized that baseline plasma C-reactive protein (CRP) levels are linked with incidence cancer in the general population and early death in cancer patients. Methods: 500 baseline CRP-measured participants were followed for 1 year. The follow-up was 100% complete. We excluded individuals with a cancer diagnosis at baseline. Results: CRP greater than 3 mg/L and the highest quartile had multifactorial adjusted hazard ratios for early cancer death. Localized cancer patients with elevated CRP died earlier than those with metastases. Conclusion:Cancer-free people with elevated CRP risk cancer of any kind, lung cancer, and possibly colorectal cancer. Elevated baseline CRP also predicts early cancer death, especially in individuals without metastases.

8. A Clinical and Demographic Profile of Tonsillitis Patients during the COVID-19 Pandemic
Meena Maruti Ohal, Sattien Arun Maran
Abstract
Background: Tonsillitis is a common public health problem seen by otorhinolaryngology surgeons. It has socio-occupational and economic impact. Most of the tonsillitis is treated by antibiotic but some can lead to life threatening complication if not treated on time and not diagnosed the impending complication. Aim and Objectives: The objective of this work was to study the epidemiological and complications profile of acute and chronic tonsillitis and their distribution, followed by final outcome of the treatment adopted in a tertiary care Hospital, Portblair, ENT Department. Materials and Methods: This is a retrospective study over a 12-month period from September 2020 to Aug 2021 including 225 patients who presented with tonsillitis and/or their complications were analysed. Their demography, clinical findings, types of tonsillitis, month wise distribution of types of disease and final outcome after medical treatment was analyzed. Results: Two hundred and twenty five (225) patients were studied. The mean ± SD of cases studied was 23.32 ± 12.98 years with minimum – maximum age range was 02 – 60 years. In this study there were 92/225 (40.9%) males and 133/225 (59.1%) females with a male to female ratio of 1:1.44. 76.88% of the patients showed a good outcome, 14.22% showed a moderate outcome, 07.55% showed an average outcome and 00.88% showed poor outcome. 19/ 225 (08.44%) of the patients who showed poor and average response were advised tonsillectomy after the COVID-19 pandemic in this study. Conclusions: Chronic Tonsillitis was a common throat disorder observed during COVID-19 pandemic. Males were more commonly affected. The increased attendance of patient’s throat complaints was high due to awareness and similarity of symptoms of tonsillitis and COVID-19 disease. Low socio economic groups were more affected. The common types of tonsillitis were parenchymatous type, follicular type. Complications due to acute infection frequently observed were peritonsillar abscess, neck abscess. Medical treatment with Amoxycillin and clavulinic acid combination was highly responsive with 76.88% responding well.

9. Electrophysiologic Diagnostic Patterns Analysis in Patients with Guillain Barre Syndrome in Tertiary Care Centre
Sekar, Arunraj Ezhumalai, Ravichandran R, Ravikumar V
Abstract
Introduction: The Guillain-Barre syndrome (GBS) is an acute immune-mediated neuropathy and is recognized clinically by the presence of acute, rapidly progressive flaccid weakness, diminished or absent reflexes and albumin cytological dissociation in cerebrospinal fluid. Each subtype may have a different immunopathogenesis therefore, may have different approach treatments hence identification of these subtypes is important. The aims of the study were to identify the incidence of patients meeting electrophysiological criteria for demyelinating or axonal subtypes based on the well-established Rajabally’s criteria. Materials and Methods: All patients aged clinically diagnosed as GBS and meeting the Brighton diagnostic criteria for diagnosis of GBS were included in the study. Retrospective analysis of clinical and electrophysiological data of 50 Guillaine barre syndrome (GBS) patients of the Thanjavur Medical College, Thanjavur were done. Results: Age of the patients ranged from 10-70 years with mean age of 37.8 years of age in this study. Flaccid weakness was present in almost all patients. On analysing electrophysiologic pattern of GBS patient’s 58 percent showed pure demyelination and 12% of patients showed pure axonal pattern with 14 percent of patients showed either of the patterns. Conclusion: Our study was showing predominantly demyelinating variant note in 72 percent of patients and F wave abnormalities were noted in 56% of patients. suggesting a slight preponderance of AIDP (acute inflammatory demyelinating polyneuropathy) variety in India. Early detection and characterization of GBS in is useful in timely intervention to reduce morbidity and disability and also useful to assess the prognosis.

10. A Study on Comparison of Efficacy of Sodium Valproate and Nortriptyline in the Management of Migraine
Komala R., E. Amudhan Arvind, Femi Retna J.
Abstract
Introduction: Migraine is a common disabling neurological disorder that affects men and women equally. Often recurrent, severe, disabling and long-lasting migraine attacks needs prophylaxis for extended period. The two frequently used drug in prophylaxis are Nortriptyline and Sodium valproate. Therefore, we planned this study to evaluate effectiveness and acceptability of above drugs in prophylaxis of migraine. Material & Methods: This Prospective observational study was done in 200 patients. The basic features of all patients were noted which included incidence of headache and severity of migraine pain assessed using VAS score. Efficacy was assessed by noting the reduction in number of migraine attacks and severity of pain at different timelines. The adverse drug reactions were noted in due course. Results: At the end of three and six months of drug therapy patients displayed noteworthy progress in alleviation of migraine symptoms. 50 percent of patients in Nortriptyline group and 70 % of patients in sodium valproate group had > 50% improvement at three months. Similarly the reduction at six months was 63% and 82% respectively. ADR was higher in valproate group with 67% incidence. Conclusion: Sodium valproate had superior effectiveness at the end of 3 months and 6 months. In terms of acceptability, nortriptyline was better in comparison with sodium valproate.

11. Comparing the Effectiveness of Intrathecal 1% 2-Chloroprocaine with and Without Fentanyl on Quality of Subarachnoid Block in Patients Undergoing Elective Caesarean Section
Surbhi Kothari, Dipti Saxena2, P.S. Gandhi, Tanya Mishra
Abstract
Background: Subarachnoid block (SAB) is a safe and effective alternative to general anesthesia for lower limb surgical procedures. Preservative-free 1% 2-chlorprocaine is a short-acting local anesthetic agent suitable for daycare surgical procedures. Opioids are proven adjuvants in local anesthetics for potentiation of analgesic action. Aims and objectives: To assess and compare the effect of intrathecal 1% chloroprocaine given with and without fentanyl as an additive on the quality of subarachnoid block in patients undergoing Elective Cesarean section. Materials and Methods:  This observational and comparative study was conducted with 96 patients with ASA status 2, aged 18 to 40, undergoing elective cesarean section (ECS) surgery under subarachnoid block. Subjects were enrolled in two groups GROUP-A includes the patients receiving 3ml 1%2-chloroprocaine with 25mcg fentanyl as an additive, and GROUP-B includes the patients receiving 3ml 1% 2-chloroprocaine without fentanyl. The duration of analgesia and time to unassisted ambulation, onset, and duration of sensory and motor blockade, the maximum height of sensory block, 2-segment regression, hemodynamic parameters, time to voiding, home discharge eligibility, and side effects were also recorded. Results:  Recorded demographic and hemodynamic parameters, the onset of sensory block, and the onset of motor block were comparable between both groups. The sensory block and analgesia duration were statistically longer in Group A than in Group B (P< 0.0003). The adverse effects (hypotension, bradycardia, nausea/vomiting, shivering) were comparable in both groups. Conclusion: 2-chloroprocaine with adjuvant fentanyl prolonged the duration of sensory block and post-operative analgesia in patients undergoing ECS.

12. Comparative Study on Efficacy of Fistulotomy and Ligation of Intersphincteric Fistula Tract (LIFT) Procedure in Management of Fistula-in-Ano
Prashant Kumar, Mohammad Nehal Ahmad, Ajit Kumar
Abstract
Background: One of the most often seen benign anal diseases in general surgery is fistula in the ano. This research intends to examine the differences between the results of open fistulotomy and those of the ligation of the intersphincteric fistula tract (LIFT) surgery. Methods: Sixty people were analysed in a year-long comparative research at the Department of Surgery. The research comprised people of both sexes who had been identified as having an anal fistula. Individuals having a history of fistula formation, Cancer of the distal rectal region, Crohn’s disease, and other butt-centered diseases were not considered. Data analysis made use of descriptive statistics, a t-test, and the Fischer exact chi-square test. Results: The participants’ mean ages were 458.05 for the fistulotomy group and 408.65 for the LIFT operation group. According to the breakdown by sex, there were twice as many men as females (20). There were 26 inter-sphincteric fistula and 4 trans-sphincteric fistula in the fistulotomy group, whereas there were 25 inter-sphincteric and 5 trans-sphincteric fistula in the LIFT group, respectively. Just one patient in the fistulotomy group (4%) and two patients in the LIFT group (8%) were found to have a wound infection. Two patients in the fistulotomy group had ano-incontinence. Fistulotomy typically required 8 weeks of recovery time, but the LIFT surgery required just 4. In the LIFT group, four patients had recurrence whereas the fistulotomy group had none. Conclusions: Compared to open fistulotomy, the recovery period for the LIFT surgery is quicker, and the risk of postoperative anal incontinence is reduced, making it the preferred treatment option for fistula in the urethra.

13. A Study on Role of Ultrasonogram in Diagnosing Malignancy in Thyroid Nodules
P. Balamurugan, A. Mahaboobkhan, S. Kanaga Durga, D. Jayaraja
Abstract
Palpable thyroid nodules are noted in 5% of general population. High-resolution ultrasound depicts nodules in up to 67% of the population. Malignant nodules have seen less than ten percentage. To standardize thyroid nodules reporting TIRADS (Thyroid Imaging Reporting and Data System) was developed. It’s used to classify the nodules into benign and malignancy and planned early FNAC and further treatment. Aim: To evaluate the Ultrasound features of thyroid nodules and to detect the characteristic radiological features of benign and malignant nodules and by using TIRADS (Thyroid Imaging Reporting and Data System), which would prove findings to detect the Malignant nodules. So, they advised early FNAC and early detection of malignant nodules and further management. Materials and Methods: Total of 400 patients underwent ultrasonography during the study period. Shape, echogenicity, content, calcification, margins of the nodules and cervical lymphadenopathy were analysed by ultrasound and FNAC done for TIRADS category 3 to 5 nodules lesions. The USG and FNAC results were compared and analysed. Results: Increased hypoechogenicity, Taller than wider shape, micro–lobulated margin and microcalcification commonly seen in malignant nodules and confirmed by FNAC. Iso echogenicity / Hyper echogenicity, wider than taller, macro calcification and mixed content (Solid/cystic content) commonly seen in benign nodules. Conclusion: The Ultrasound findings of Increased hypoechogenicity, Taller than wider shape, micro–lobulated margin and microcalcification commonly seen in malignant nodules and FNAC needed for these nodules which included in TIRADS category 4a, 4b and 5 and early detection malignant nodules and further management.

14. Assessment of Risk Factors for Chronic Kidney Disease: A Case Control Study from Visakhapatnam, Andhra Pradesh, India
Devi Madhavi Bhimarasetty, Jayasree Palla, Sateesh Babu Kaki, Sindhura Moparthi
Abstract
Background: Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence, prevalence and often associated with poor outcome. The approximate prevalence of CKD is 800 per million population and the incidence of End Stage Renal Disease (ESRD) is 150 – 200 per million population. Objective: To identify risk factors for Chronic Kidney Disease among patients undergoing dialysis in a tertiary care hospital. Methodology: An observational case control study was carried out in the Hospital during August –October 2018, among 60 subjects of whom 30 were cases and 30 were controls. Cases and controls were matched for age and gender. Data was collected using Pretested semi structured interview schedule after taking informed consent. Data was entered in MS EXCEL. SPSS version 16 was used to calculate ODDs ratio. Results: Among both cases and controls 22 were males and 8 were females. Modifiable risk factors like hypertension (OR 32.5), diabetes (OR 10.5), smoking (OR 2.75), alcoholism (OR 2.4) family H/o CKD (OR 3.2) and analgesic abuse were observed to be more among cases compared to controls. Conclusion: There is a need for better care in patients with diabetes and hypertension. Periodic check-ups in subjects with known risk factors can lead to early detection of chronic kidney disease.

15. Serum Ferritin Levels and their Relationship with Growth Parameters in Thalassemic Children
Kaur A, Bhattal H, Saini R, Gupta S, Singh K
Abstract
Background: Beta-thalassemia major patients suffer from anemia due to hemolysis and erythropoiesis dysfunction. Regular blood transfusions lead to the deposition of iron in the main organs, specifically if proper iron chelation therapy had not been introduced. Objective: The present study was undertaken to determine effect of serum ferritin levels and pre-transfusion hemoglobin on growth parameters. Methods: The study was a hospital based observational study where 30 children between age group of 2 to 18 years with confirmed diagnosis of beta thalassemia major on regular blood transfusion and chelation therapy were included. Results: 80% of children (4 out of 5) with mean pre-transfusion hemoglobin b/w 5-8 g/dl had weight after 1 year of study below 3rd percentile. A significant association was observed between mean serum ferritin level and weight or height after 1 year of study. Conclusion: Along with maintaining desired pre-transfusion hemoglobin level via regular blood transfusion, it is important to have effective iron chelation therapy to reduce iron overload in the body.

16. Comparison of 0.5% Hyperbaric Ropivacaine and 0.5% Hyperbaric Buprenorphine for Elective Surgery under Spinal Anaesthesia
Athyun, P Naga Kartheek
Abstract
Background: Bupivacaine is 40% more powerful than the recently developed ropivacaine. Spinal anesthesia produced hyperbaric with ropivacaine, and dextrose is reported to be effective (SA). In this investigation, the clinical effectiveness of 0.5% bupivacaine and 0.5% ropivacaine for SA was compared at equivalent hyperbaric dosages. Methods: A total of n=60 cases were allotted randomly in two groups of n=30 each with Group I receiving intrathecal 15 mg (3 ml) of 0.5% Hyperbaric Bupivacaine. And group II received intrathecal 15 mg (3 ml) of 0.5% Hyperbaric Ropivacaine which is prepared aseptically immediately before injection by adding 1 ml (250 mg) of autoclaved 25% dextrose ampoule (10 ml) to 2 ml of a commercially available sterile preservative-free isobaric solution of 0.75% Ropivacaine. Results: Both groups were comparable in the distribution of cases by weight, and height. The onset of sensory block was earlier in group II as compared to group I however, the peak time to sensory block was more in group II as compared to group I, and the duration of sensory block was considerably greater in group II as compared to group I the details have been given in table 1. As far as the motor block is concerned the onset of the motor block was earlier in group II and the duration of the motor block was also significantly longer in group II. Conclusion: Both groups had a sensory and motor block that began almost simultaneously. Hypotension and bradycardia complications were less common in the ropivacaine group. In terms of block quality, ropivacaine is equivalent to the widely used hyperbaric 0.5% bupivacaine (in 8% glucose), but because of its quicker recovery time, it is a helpful drug for spinal anesthesia during procedures of moderate length.

17. Comparison of the Obesity Indices in Populations from Gaya, Bihar by Age Group and Gender
Anisha, Dipti Panwar
Abstract
Background: Obesity is understood to be a chronic condition that can lead to a number of metabolic, cardiovascular, and neurological issues. Obesity is becoming more common worldwide, especially in developing nations. All age groups and both sexes are affected. The existence and severity of comorbidities linked to obesity, as well as the body mass index (BMI), are used to distinguish the progressively worsening stages of obesity. In order to determine the burden of this lifestyle disorder across age groups and sexes, the current study aims to examine the prevalence of overweight, obesity (stage 0, 1, and 2), and morbid obesity in adult residents of Bihar (Gaya) state. This will allow for the development of a comprehensive action plan that will target the appropriate group with targeted preventive measures. Method: Based on their BMI, the presence and severity of problems connected to obesity, and their BMI, 120 participants were surveyed and classified as non-obese, overweight, obese, or morbid obese. Point prevalence was calculated and compared across a range of age groups for both genders. Result: The study participants made up of 41.4% non-obesity, 15.8% overweight, 29.3% obese, and 13.1% severely obese. In both sexes, the prevalence of all three conditions—overweight, obesity, and morbid obesity—rose with age. For “overweight” and “obesity,” females across all age categories had a higher frequency than males. However, the gender gap shrank as the disease’s severity increased, so that for morbid obesity, the ratio of men to women was reversed (by 2) moreover, ladies reached the peak prevalence of overweight and obesity a little later than males did. Yet, the same age group (41–50 years) in both genders exhibits the highest frequency of morbid obesity. Conclusion: Females are more likely than males to be overweight or obese across all age categories, with peak prevalence occurring a little later in females than in boys. Nonetheless, there were more males than females who had morbid obesity. Gender disparities in prevalence diminished as severity increased.

18. Evaluation of Obesity Indices for Hyperglycemia Prediction in the Adult Population of Gaya, Bihar
Anisha, Dipti Panwar
Abstract
Background: Diabetes mellitus is recognized to have an association with obesity. Body Mass Index (BMI), Waist Circumference (WC), and Waist-Height Ratio are a few of the obesity markers that can be used to evaluate and categorize obesity status (WHtR). The goal of the current study was to evaluate the predictive value of these obesity markers for hyperglycemia. Methods: We assessed the levels of BMI, WC, WHtR, and Random Capillary Blood Glucose (RCBG) in 180 adult volunteers from Gaya, Bihar, India. To evaluate associations and differences of measured parameters among various categories, Chi-square, unpaired Student’s t-test, and Pearson correlation were used. The best obesity indices to predict hyperglycemia (RCBG 130 mg/dl) and cut-off values for prediction were found using receiver operating curve analysis. Results: It was discovered that RCBG levels were substantially linked with age of individuals, WC, and WHtR (but not BMI). Compared to BMI and WC, the largest proportion of patients were classed as obese by WHtR. The best obesity indicator for predicting hyperglycemia in both male and female patients was likewise discovered to be WHtR. Conclusion: In adults who appear to be in good health, WHtR can be utilized as a convenient, non-invasive, and cost-effective obesity index for screening and hyperglycemia prediction. Consequently, it is possible to further urge selected people to have blood glucose tests done in order to detect diabetes and prediabetes early.

19. In Sedentary Post-Pubertal Boys and Girls, High-Intensity Exercise Alters the Hematological Profile: A Comparative Study
Anisha, Dipti Panwar
Abstract
Background: In addition to damaging red blood cells (RBCs) and causing hemolysis due to osmotic and mechanical stress, high-intensity exercise also promotes intensity-dependent leukocytosis as a result of enhanced white blood cell trafficking in circulation. The purpose of this research was to look into how post-pubertal boys and girls who were inactive could have their hematological profiles altered by high-intensity exercise. Method: Twenty sedentary post-pubertal boys and twenty sedentary girls had blood drawn before and right after exercise to measure hematological parameters like RBC count, hematocrit, and hemoglobin concentration (Hb), total leukocyte counts, and differential count. Results: RBC count, hemoglobin, and hematocrit did not differ significantly across groups before and after exercise. In post-pubertal males, hematocrit and hemoglobin levels were considerably greater before and after exercise (P <0.002). Before the exercise, there was no significant intergroup variance in the leukocyte count, however, both groups’ post-exercise counts increased significantly (P 0.002). Post-pubertal boys had considerably (P <0.02) greater monocities and neutrophilia. While there was no discernible intergroup variation in the percentage change of monocytes, eosinophils, or basophils, the percentage rise in neutrophils was considerably (P <0.02) larger in boys than in girls. Girls had considerably (P <0.002) greater absolute lymphocyte counts and percentage increases following exercise compared to boys. Although the relative eosinophil count dramatically decreased in both groups, the absolute eosinophil count greatly increased, perhaps as a result of the faster rate of lymphocyte and neutrophil mobilization. In the aftermath of exercise, the basophil count was similarly disturbed. Conclusion: Except for the presence of neutrophils and lymphocytes, gender did not seem to significantly affect the exercise-induced disturbance in the hematological profile at the post-pubertal stage.

20. Correlation of Folic Acid, Homocysteine and Vitamin B12 Levels in Neonates with Neural Tube Defects and Their Mothers with the Disease Occurrence
Ashish Chhabra, Jai Kumar Mahajan, Jyotdeep Kaur, K.L.N. Rao
Abstract
Aims: The study aimed at elucidating relationship between folic acid (FA), homocysteine and vitamin B12 levels in neonates with neural tube defects (NTDs) as well as their mothers with the occurrence of the disease. Material and methods: The prospective case control study included 26 neonates with NTDs and their mothers in group-I. Neonates with minor illnesses with their mothers formed the control group (Group-II). Both neonates and mothers were subjected to the measurement of folic acid, homocysteine and vitamin B12 levels in their blood. Results: Neonates were comparable with regard to the age, gender and maturity. Most of the neonates (46%) had defects at lumbosacral region. Group-I neonates had significantly lower FA levels in serum, red blood cells (RBCs) and whole blood when compared to group-II (p-values <0.001, <0.001, 0.005). Whole blood and RBCs FA levels were higher and serum FA levels were lower in group-I mothers in comparison to group-II (p-values <0.001, 0.10, 0.310). Homocysteine levels were found to be significantly higher in both mothers and neonates in group-I (p-values 0.023, 0.030). Vitamin B12 levels were lower in group-I mothers and neonates (p-values 0.135, 0.695). Conclusion: Both maternal and neonatal hyperhomocysteinemia play an independent role in the development of NTDs whereas vitamin B12 deficiency carries moderate risk. There is dissociation between maternal and neonatal folic acid levels as high maternal FA levels may not reflect in their neonates. Evaluation of defects in placental FA receptors and transporters which prevent FA transfer to developing fetus may help to understand this enigma.

21. Effect of Pre-Operative Discontinuation of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists on Intra-Operative Arterial Pressures after Induction with Etomidate
Sattipalli Bindu, Sumanth Gutta, Sherry Mathews, B. Deepraj Singh
Abstract
Background: Hypertension is a leading preoperative risk factor among patients of all age groups and dominates in the group aged 50 years and older, continuation of ACEIs/ARBs was associated with an increased risk of intraoperative hypotension. Aim and Objective: To stud effect of pre-operative continuation of ACEI or ARA therapy on intraoperative blood pressure (BP) in surgical patients after induction of etomidate. Material and Method: This was a randomized prospective double-blinded study conducted in Department of anaesthesia, of our institute for the period of 6 months in which 50 patients were included after getting informed consent, and followed inclusion and exclusion criteria. Patients were randomized with random number technique into two equal groups, Group A and Group B. Results: There was no significant difference was observed in mean age group of patients between the groups, also gender distribution and ASA distribution between the groups were statistically not significant. Mean difference of SBP, DBP and MAP  between before induction and at 1 minute after induction between the group was not significant, but after 1 min till 15 min it was statistically significant, and later on it was comparable. Conclusion: Our study found that etomidate is a favourable agent for induction even in patients who continue on ACEI or ARA drugs, but there are less studies are available with etomidate. More studies are required to prove efficacy of etomidate in continuation of ACEI or ARA during surgery.

22. Analysis of Anaesthetic Outcome of Ropivacaine Alone and Combination with Dexmedetomidine in Caesarean Section
Prachi Gupta, Girij Arun Bhople, Ashwin D Patil, Sushil Vishnu Boraste
Abstract
Background: Ropivacaine is an amino amide family of local anaesthetics that has been introduced not too long ago. It has been used for regional blocks since some time but recently its use has been seen in spinal anaesthesia, according to several recent reports. Intrathecally given dexmedetomidine is a highly selective 2-adrenergic agonist. At the spinal cord level, dexmedetomidine principally affects 2 receptors. The combination of Ropivacaine along with Dexmedetomidine has been seen in rather few studies hence we have conducted such a study to observe the efficacy of these drugs. Aims and Objectives: To find out the efficiency of the sensory and motor block with ropivacaine alone and ropivacaine with dexmedetomidine. Methods: A prospective analytical interventional comparative randomized study was conducted from February 2021 to January 2023 on patients who are undergoing cesarean section in the department of anaesthesia in tertiary care hospital. The study considered 80 patients of ASA physical class I and II who were posted for cesarean section at our hospital were selected for the study. The study population was randomly selected based on the closed-sealed opaque envelope technique into 2 groups as mentioned above, with the dose of 13.5mg Ropivacaine alone and the other group with 13.5mg Ropivacaine with 5mcg Dexmedetomidine. Results: The time of onset and completion is fast in a sensory block of RD. the total duration of anaesthesia in the body is highest in RD of the sensory block than in the motor block. The motor blockage is similar in both the groups and highest on scale III compared to I. nausea is the most common complication (15%) seen in ropivacaine the bradycardia in RD (5%). The onset of analgesia is fast in the RD group. Conclusion: Present study concluded that ropivacaine with dexmedetomidine produces a rapid and more prolonged motor and sensory block and provides a longer duration of postoperative analgesia as compared to ropivacaine alone.

23. Neglect of Exclusive Breast Feeding Practice: A Cause of Concern among Lactating Mothers in Garhwal Region of Uttarakhand, India
Tripti Srivastava, Vyas Kumar Rathaur, Sarika Palepu, Tumul Nandan
Abstract
Background: The correct knowledge, attitude and practice of breast feeding has proven to reduce illness and deaths in children. So, this study aimed to find the same among women in a hilly region of Uttarakhand. Material and Methods: This cross sectional study was done in women attending the immunization clinic at a tertiary care centre. Consecutive sampling was done to interview 1000 women by administering a semi-structured questionnaire. Data entry was done in MS Excel 2013 and data analysis was done using STATA 17 software. Results: In this study, a substantial percentage of participants (27%) did not follow exclusive breast feeding practices. Among the women who initiated breast feeding, most of them did it within the recommended duration of an hour of birth (73.4%).Most common reason for delay in initiation of breast feeding was lower segment caesarean section. Alarming finding of the study was most participants (81.7%) thought that breast feeding should be stopped after six months of age and also if the child falls ill. Higher birth order of the child was significantly associated with appropriate breast feeding practice among lactating mothers. Conclusion: More focus should be laid on counselling of lactating women who are primi-gravida and had lower segment caesarean section regarding appropriate breast feeding practices.

24. Outcome of Localised Bone Graft in the Instrumented Posterior Lumbar Interbody Fusion
DJ Ramesh, DK Sridhar, Dubey Ashish, Dixit Anuj, S Vijay, Kiran Sunil
Abstract
Introduction: Pain in lower back is major factor leading to disability globally, affecting more than half a billion people worldwide. Among all musculoskeletal disorders degenerative spondylolisthesis and spinal stenosis most commonly requires intervention and about 10% to 15% of these patients needs surgical intervention. Many surgical methods are available, among these the most popular type of surgical treatment is posterior lumbar interbody fusion (PLIF) with pedicle screw fixation. Intervertebral cages and bone graft taken from the iliac crest have typically been employed in a safe and frequent manner for interbody fusion, as use of cage and iliac crest bone harvest reported to be associated with major or minor complications. Thus, Intervertebral space can be filled with bone pieces acquired intraoperatively from the spinous process alone. Objective: To evaluate functional outcome post-surgery and assess complications associated with surgical procedure. Material and Methods: 36 participants were chosen for the study based on inclusion and exclusion criteria from patients hospitalized to the Hospital and Research Centre, between September 2020 and November 2022 who complained of chronic low back pain and underwent spine surgery (PLIF with localised bone graft). Result: In present study mean age found to be 45.78±11.75 years with male preponderance (66.7%), 25 (69.4%) participants diagnosed with lumbar disc herniation, 7 (19.4%) participants diagnosed with infective spondylodiscitis, and 4 (11.1%) participants diagnosed with spondylolisthesis. Mean VAS improved from 8.17±1.0 pre-operatively to 2.86±1.17 at 6th month follow-up, and mean ODI improved from 46.94±7.43 pre-operatively to 23.33±7.77 at 6th month follow up. Total of 8 (22.2%) participants suffered from major or minor complications treated accordingly. Conclusion: Local bone obtained intraoperatively can be used as a viable source of bone graft without any need of cage for fusion of lumbar interbody.

25. Evaluation of Prevalence and Risk Factors of Nausea and Vomiting in the Postoperative ENT Surgery Patients
Zafeer Ahmed, Sreejith Sreenivasan, Vasanthakumari TN
Abstract
Background: Incidence of nausea and vomiting is high among the post-operative patients undergoing ENT surgeries. In spite of advancement in the anesthetic drugs and techniques understanding the mechanism of post-operative nausea and vomiting (PONV) remains a dogma to both the surgeon and the anaesthetist alike. Management of such patient in the post operative ward remains as a challenge to the participants of Post-operative unit. Aim of the Study: To find out the incidence, risk factors and management of PONV among the patients undergoing ENT surgeries. Materials: 218 postoperative ENT patients were monitored for the presentation of PONV in a tertiary Hospital for during March 2021 to February 2023. Patients belonging to both genders and aged between 03 and 65 years were included. Demographic factors and risk factors were analyzed based on their contribution to produce PONV. Results: Among the 218 patients there were 69/218 (31.65%) in the paediatric age group between 03 and 15 years. The mean age was 19.25±2.35 years. The remaining 149/218 (68.34%) patients were aged above 15 years. The mean age was 38.15±3.11 years. The distribution of patients in the age groups selected were not significantly different; p value was 0.211 (p value more than 0.05). Intravenous induction of anaesthesia was significantly more prone to produce PONV than inhalational induction, (p value 0.025; p significant at <0.05). Conclusions: The overall incidence of PONV among the patients undergoing ENT surgeries was 41.74%. The risk factors of PONV were age, gender, motion sickness, previous history of PONV, smoking, thiopental induction, use of opioids pre and post operatively and presence of pain. PONV could be assessed and treated judiciously when a definite protocol is developed in every Hospital. The nature of surgery contributing to PONV was inconclusive from the study.

26. Role of Magnetic Resonance Imaging in Assessing Non-Traumatic Lesions of Orbit
Verma MK, Verma V
Abstract
Background: Optical imaging techniques are the major investigation modalities of eye at present, but they have limitations as diagnostic and prognostic tools. Objectives: Present study was aimed to study the role of magnetic resonance imaging in assessing non-traumatic lesions of the orbit and to characterize them according to location & intensity. Materials and Methods: Present study was a hospital based cross-sectional study done at a tertiary care hospital of central India region. 60 patients with non-traumatic primary orbital lesions presenting with symptoms of proptosis, diminution of vision, diplopia, or with suspected metastasis to the orbit or invasion from intra- or extracranial lesions underwent MR imaging of orbit according to the following protocol. Results: Out of 60 patients, 23 had inflammatory lesions, 15 had malignant neoplastic lesions, 10 had vascular lesions, 7 had benign neoplastic lesions and congenital lesions each. Retinoblastoma was common intraocular lesion among pediatric age and lymphoma was most common malignant lesion in adult population. Cavernous hemangioma was common vascular lesion in adults. Conclusion: MR imaging is valuable for evaluation of orbital neoplasms, as it provides critical anatomic information about ocular structures involved, peri-neural spread, and intracranial extension.

27. Isolation, Identification and Antifungal Susceptibility Testing of Various Candida Species in Tertiary Care Hospital
Patel B C, Patel D D, Bin Najeeb M A, Kamath N, Kamaljeet
Abstract
Background: Testing for antifungal susceptibility and identification of Candida to the species level has critical importance in the treatment of fungal infections. This study set out to do two things: (1) isolate and identify the species of Candida from various samples of individuals clinically suspected of having candidiasis; and (2) assess the susceptibility pattern of the Candida species isolates against the routinely used anti-fungal medications. Material & Methods: From September 2021 through September 2022, a cross-sectional analysis of patients with clinically suspected candidiasis was done in the Department of Microbiology at a tertiary care center in Silvassa. Colony morphology on Saboraud’s Dextrose agar and HiCrome Candida differential agar was used to identify Candida species isolated from various sources positively. Testing for antifungal susceptibility was conducted using the disk diffusion method as recommended by CLSI M44-A2. Results: A total of 205 eligible samples of were included in this study. The mean age of the study participants was 37.05 ± 23.03 years. Majority were between 18 to 60 years of age group. Proportion of males and females were almost equal (49.3% and 50.7% respectively). The most of the samples was urine (62.9%) followed by blood (13.7%). Candida Albicans was the most prevalent Candida species in the analysed sample (65.9%), followed by Candida Krusei (13.7%), Candida Tropicalis (10.7%) and Candida Glabrata (9.8%). The amphotericin-resistance patterns of Candida albicans, Candida glabrata, Candida krusei, and Candida tropicalis were 24.44%, 25%, 25%, and 9.09%, respectively. In 20.74% of the samples, Candida albicans was resistant to fluconazole, 51.84% to clotrimazole, 11.11% to ketoconazole, and 12.59% to nystatin. Clotrimazole was the medication with the highest rate of resistance among the four Candida species. Conclusion: In hospital settings, Candida spp. have emerged as the major pathogens responsible for opportunistic infections. To decrease morbidity and mortality, early isolation, species identification, and antifungal susceptibility testing are critical for doctors to pick the optimal treatment strategy for patients.

28. A Comparative Study on Efficacy of High Flow Nasal Canula versus Standard Oxygen Therapy in Children with Bronchiolitis: A Randomized Controlled Trial from South India
Guna, S. Murugesa Lakshmanan, P. Ramasubramaniam, S. Prasanna
Abstract
Background: Prompt instigation of suitable non-invasive respiratory support like oxygen therapy, heated humidified high flow oxygen through nasal canula (HHHFNC), Continuous positive airway pressure are chief intrusions to evade mechanical ventilation in severe bronchiolitis. Objectives: 1. To assess and compare the clinical improvement and the clinical outcomes with HHHFNC and conventional oxygen therapy in children with bronchiolitis 2. To estimate the danger of treatment failure with HHHFNC and conventional oxygen therapy. Materials and Methods: It is a single centre, prospective, and randomized control study at Paediatric ICU of a tertiary care hospital in Madurai, Tamil Nādu from July 2019 to September 2020.Hundred children who were aged between 6 to 18 months admitted in hospital due to bronchiolitis. Results: Total 100 children with 50 were allotted in each group. Clinical response in heart rate, respiratory rate, Work of breathing and SPO2 in children with bronchiolitis who received HHHFNC treatment at different time intervals at 2 hours, 4 hours, 6 hours was better than those received conventional oxygen therapy and difference was statistically significant. Treatment failure was very less (8%) in HHFNC treatment compared to 28% of in oxygen therapy group (P <0.05). there was a 57% decrease in management failure in HHFNC therapy group in comparison with conventional oxygen treatment. Conclusion: This RCT discovered that HFNC treatment had a proven clinical benefit over conventional oxygen therapy in managing kids admitted with bronchiolitis.

29. Clinical and Histopathological Correlation of Hysterectomy Specimen in Abnormal Uterine Bleeding according to PALM-COEIN Classification
G. Surya, R. Sankareswari, S. Revwathy, Sukanya Mukherjee
Abstract
Background: Abnormal Uterine Bleeding (AUB) defined as “bleeding that is abnormal in volume, regularity or timing for past 6 months.” It accounts for two thirds of Hysterectomies in premenopausal women. Hysterectomy is indicated when patient symptoms are not improving with medical management. According to FIGO, Causes of AUB is classified as structural and nonstructural causes under PALM – COEIN classification (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified). Aims: (1) To analyze the clinical causes of AUB. (2) To correlate clinical and histopathological findings in AUB patients undergoing hysterectomy. Methodology: This study is a retrospective observational study. Women who underwent hysterectomy in view of AUB at Trichy SRM Medical college and Hospital over a period of six months from September 2021 to February 2022 were included in the study. About 50 women who underwent hysterectomy in view of AUB during that study period were included in the study. Details like demographic details, duration of AUB, menstrual abnormalities, parity, comorbidities, clinical findings, ultrasound findings, histopathological findings were collected from Medical Records Department (M.R.D) and entered in proforma. The causes of AUB were analyzed, their clinical findings were correlated with post-hysterectomy histopathological findings. Statistical analysis done using SPSS software version 22. Clinical and histopathological correlation was done, p value of <0.05 was considered significant. Results: Majority of the study participants were in the age group of 41-50 years (46%). Dysmenorrhea was reported in 30% of study population. 80% of the women were multiparous. About 54% of cases had anemia. Fibroid was the most common clinical diagnosis(AUB-L) about 48% for which hysterectomy was done. The most common endometrial histopathology was secretory endometrium seen in 46% of cases. There was significant correlation between clinical diagnosis and hysterectomy histopathology findings. Conclusion: Histopathology is mandatory for confirming diagnosis and for further optimal management.

30. Fetomaternal Outcome of Teenage Pregnancy in a Tertiary Care Hospital: A Retrospective Study
Hemachithra D., Sankareswari R., Revwathy S., Sukanya Mukherjee
Abstract
Background: Teenage pregnancy is associated with series of maternal and fetal complications like anaemia, pre-eclampsia, preterm delivery, increased LSCS rate due to cephalopelvic disproportion, fetal distress, low birth weight, still birth. Early motherhood can also affect the psychosocial development of the infant. Hence the present study is conducted to assess the incidence of teenage pregnancy and various maternal and neonatal outcomes of these pregnancies. Objectives: To study the maternal and fetal outcomes in teenage pregnancy. Materials and Methods: A Retrospective Observational study was conducted among 50 pregnant mothers admitted in labour ward as Teenage pregnancy at Trichy SRM Medical College Hospital and Research Centre, Trichy from June 2021 to February 2022. Data was collected and entered in MS excel and analysis done using SPSS software. Appropriate descriptive and inferential statistics were used, considering p value of < 0.05 as significant. Results: The mean age of mothers is 17 years. About 84% are primi mothers and 16% are multi gravida mothers. About 54% had LSCS and 46% had normal vaginal delivery. About 80% of mothers had comorbidities. Among those with comorbidities, Anemia is most followed by others like Gestational diabetes mellitus, PIH, followed by PROM. About 64% had low birth weight and 36% were of normal birth weight. 70% had APGAR score of less than 7/10. About 20% of newborn had NICU admission. About 4% of perinatal death occurred. Conclusion: Teenage pregnancy has to be reduced by employing various health promotion strategies like school education, promotion of contraceptive usage etc. The complications can be reduced by providing the appropriate antenatal care, timely management and referral of mothers.

31. Obstetric Hysterectomy: A Clinical Study in a Tertiary Care Unit in South India Over 2 Years
Ajeetha Banu M, Durga Devi C, Shameema Begum M
Abstract
Background: Obstetric hysterectomy is an obstetric emergency. It is an indicator of severe acute maternal morbidity. It is a single criterion defining maternal near miss. Obstetric hysterectomy is the last resort opted to save the mother despite curtailing the reproductive potential of the women. This is often performed when medical and surgical measures have failed. It’s performed in the phase of unrelenting and life-threatening obstetric haemorrhage. Objective: We aimed to study the incidence, demographic factors, indications and maternal complications of obstetric hysterectomy. Materials and Methods: This retrospective study was conducted for a period of 24 months on 80 women who underwent obstetric hysterectomy in Government Rajaji hospital, Madural, Tamilnadu from January 2021 to December 2022. Results: Out of 31224 deliveries, hysterectomy was done for 80 women. Incidence is 2.56 per 1000 deliveries. Abnormal placentation was the leading cause followed by atonic PPH, traumatic PPH, sepsis and secondary PPH. Conclusion: Obstetric hysterectomy is definitely a life-saving procedure. but its incidence can be reduced by reducing the incidence of lower segment caesarean section.

32. A Study of Analysis of Prevalence of Mandible Fracture among School Going Age Group in Vadodara District of Gujarat, India
Vasudhara Rathwa, Ashit Bharwani, Mayursinh G Dodia
Abstract
Background: Children under the age of 15 account for about 5% of all face fractures, and children under the age of 5 have a far lower incidence. Their incidence rises when children begin school. Between puberty and adolescence, it surges as well. There is a male majority throughout all age groups. Objectives: This retrospective study examined the causes and patterns of paediatric mandibular fractures. Methodology: The clinical records of 100 children (50 males and 50 females) aged 0 to 15 years who presented with mandibular fractures from July 2019 to June 2021 were retrospectively reviewed. The sex, patient age, site of fracture, etiology of trauma, and monthly variations of the fractures were recorded. Descriptive statistics, the z-test and chi-square test were used for statistical analysis and the P-value less than 0.05 was considered as a significant. Results: 100 children (male-to-female ratio 1.01:1) sustained 121 mandibular fractures. Within the study sample, the 6-to-10-year age group and fall from the height (72%) was the cause of mandibular fractures in majority of subjects, followed by sports injury (18%) and Road traffic injury. (8%). The most common site was the condylar region (33%) followed by Symphysis/ Parasymphsis (42%), body (13%), and Body / Angel (12%). Conclusion: We would like to draw the conclusion that falls are the main reason for mandibular fractures and that condylar fractures are the most frequent form of fracture. According to the study’s findings, there was no discernible gender difference in the incidence of mandibular fractures.

33. Efficacy of Platelet Rich Plasma Dressing versus Normal Saline Dressing in the Management of Diabetic Foot Ulcers
Rajeshwar Kamineni, Gopi Tupkar
Abstract
Introduction: Diabetes mellitus and its associated foot ulcers are at alarming pace in India. Conventional dressing with normal saline and other techniques of ulcer wound healing including platelet rich plasma have gained great importance due to their rapid healing rate by synthesizing local active growth factors. The present study was designed to assess the efficacy of plasma rich platelet dressing versus normal saline dressing in the management of diabetic foot ulcers. Materials and Methods: A source of 64 participants with diabetic foot ulcers admitted in the Department of General surgery above 40 years of age were recruited. Participants were randomly divided into group 1 (n=32) treated with normal saline dressing and group 2 (n=32) with platelet rich plasma (PRP) dressing and followed up for 6 weeks duration to check the status of the wound (length, width) and reduction area. Results: The mean wound contraction rate after 4 weeks of treatment was 8.41±1.65 and 17.82±5.18, wound reduction was 10.53±2.84 and 36.26±6.20 and duration of wound healing was 6.97 weeks and 4.12 weeks in normal saline group and PRP group respectively. In PRP group, early rate of healing was observed in 18.75%, 25%, 34.38% and 15.62% at 1, 2, 3 and 5 weeks respectively. Conclusion: PRP dressing was effective treatment option for the management of diabetic foot ulcers than the normal saline dressing group in terms of higher rates of wound contraction, wound reduction and duration of healing.

34. A Cross-Sectional Study of Mucocutaneous Adverse Reactions in Patients on Anticancer Drug Therapy
Swati Tripathi, Sanjay Meena, Kapil Vyas, Kalpana Gupta
Abstract
Background: The discovery of newer anticancer drugs over the last few decades has led to an improved life expectancy in patients diagnosed with carcinomas. The diagnosis of mucocutaneous reactions in such patients is especially difficult, given the complexity of their illness and immunosuppressed state leading to varied clinical presentation as well as due to the combination protocols used for the treatment of carcinomas. Aims: This study was undertaken to know the spectrum of various mucocutaneous adverse reactions in patients undergoing chemotherapy. Materials and Methods: This was a cross-sectional study carried out from 1st February 2015 to 30th June 2016 comprising of 98 patients attending the cancer centre of a tertiary health care hospital. The study included patients with different malignancies presenting with adverse effects involving skin, mucous membrane and appendages due to anti-cancer drugs. Results: The most common adverse effect was anagen effluvium which was observed in 35.7% of patients, nail changes in 23.4%, xerosis in 15.3%, and other less commonly seen dermatological manifestations included hyperpigmentation in 8.16%, photosensitivity in 3.06% and erythroderma in 3.06% patients. The most common chemotherapeutic agent responsible for mucocutaneous adverse effects was paclitaxel which was used in 33.6% of the total number of patients in our study, followed by cyclophosphamide used in 16.3% patients, 13.2% patients treated with cisplatin, and other drugs like carboplatin and adriamycin were also responsible for adverse effects. Limitations: The limitation of our study was the inability to find a significant association of a specific drug as the cause of particular mucocutaneous reaction as the chemotherapy consisted of various combination protocols. Conclusion: We conclude that mucocutaneous changes are a common side effect of chemotherapy. Counselling the patient prior to the initiation of chemotherapy would increase alertness thereby improving their quality of life.

35. A Prospective Observational Study to Determine the Role of GCRBS (Glasgow Coma Score, Creatinine, Respiratory Rate, Bilirubin, Systolic Blood Pressure) Score in Assessing the Severity of Plasmodium Falciparum Malaria
Sanjay Gulhane, Kashyap Bhojak, Harshal Joshi, Sheela Pandey
Abstract
The main objective of the research is to determine the role of GCRBS (Glasgow Coma Score, Creatinine, Respiratory Rate, Bilirubin, Systolic Blood Pressure) score in predicting severe plasmodium falciparum malaria infection. Material and Methods: This prospective observational study was conducted over the period of 12 months at the Department of General Medicine in tertiary care public hospital. 100 patients who were diagnosed with falciparum malaria, admitted and willing to participate in the study were included in the study based on the inclusion and exclusion criteria after getting approval from the Ethics committee of the Hospital. Results: In our study, 73% belonged to the age group 21-40 years, while 23% belonged to the 41-60 years age group and there were only 4 patients above 60 years of age. Mean age was 35.2 years. Fever was the chief presenting symptom in 98% patients followed by chills and rigors 90%, vomiting 55%, headache 52%, myalgia 50%, sweating 34% and pain in abdomen 25%. While convulsions were present in only 2% patients. On general examination 17% patients had tachycardia, Hypotension was present in 6 % patients. Pallor was present in 33%, icterus in 14 %. Per abdomen examination revealed 43% patients had splenomegaly, 14 % hepatomegaly, while 18% had hepatosplenomegaly. Conclusions: The GCRBS score seems to be a very good working tool as it is very easy to calculate and helps clinician to predict the severity and mortality in falciparum malaria.

36. A Descriptive Cross-Sectional Study to Assess Prevalence of Mal-Nutrition in School Going Children
Rahul Meena
Abstract
Background: To determine the prevalence of malnutrition in 6-14 yrs old children. Methods: A cross sectional descriptive study was carried out involving 1000 children in the age group 6 to 14 years from urban and rural areas. Results: In present study (based on Weight-for-Age criteria), majority of the study population (80.00%) were well nourished, 19.00% children were found underweight and 1.00% were overweight. Conclusion: This study shows that malnutrition are also widely prevalent in schoolchildren in rural and urban, and it underlines the need for nutrition interventions to target them.

37. A Study of Fetomaternal Outcome in Placenta Previa
Mahendra Kumar, Priyanka Meena, Sanjana Jourwal, Chandan Atrey, Mohd Shakeel
Abstract
Background: Prevalence of Placenta previa is found to vary between 0.5% of all pregnancies. Placenta previa is one of the major causes of antepartum hemorrhage and is also important cause of maternal and perinatal morbidity and mortality in India. Methods: This is a prospective study conducted in the department of Obstetrics & Gynaecology, Govt. Medical College, Kota from Dec-2020 to Nov-2021 on cases of placenta previa diagnosed by clinical or ultrasonography were included in the study. All case records were obtained from medical record section. Informed consent was taken from all the patients. Detailed history was taken including age, gestational age, history of still birth or pregnancy loss, family history of diabetes, past history of diabetes, obstetric history. Results: Low lying placenta was the most common type of placenta previa in 42.00% cases. Out of 100 cases 16.00% cases had PPH (postpartum hemorrhage). 30.00% baby birth weight was<2.0 kg. Conclusions: Managing a case of placenta previa during pregnancy poses a great challenge to every obstetrician in present day obstetrics due its increased risk of maternal and perinatal complications.

38. A  Descriptive Cross-Sectional Study of Breast Feeding Practice
Rahul Meena
Abstract
Background: Breastfeeding practices play an important role in reducing child mortality and morbidity. This study describe the breastfeeding practices. This study was describe the breastfeeding practices and factors affected initiation and duration of breastfeeding. Materials and Methods: The cross sectional study on mothers with infants less than 1 year who came to immunization center for vaccination were included in the study. Total 600 mothers include in this study. Results: Our study was showed most of the mothers initiates breastfeeding (98%) and the others(2%)were not able to initiates and Only. 38% of the mothers did the exclusive breastfeeding until  6 months and started weaning after 6 months. A total 57% of mothers in our study prematurely started weaning. Conclusions: The study emphasizes the need for breastfeeding intervention programs, especially for the mothers during antenatal and postnatal check-ups. The information regarding the advantage and duration of breastfeeding need to be provided for the community as a whole.

39. Evaluation of Effect of Different Intraorifice Barriers on Fracture Resistance of Endodontically Treated Teeth during Non-Vital Tooth Bleaching: An Invitro Study
Divya Panday, Nishant Choudhary, Prince Soni, Sakshi Chokhandre
Abstract
Background: Intracoronal bleaching is a simple solution to treat non-vital teeth with discoloration. Aim: To compare fracture resistance of teeth that were treated endodontically, after placement of different intraorifice barriers in non-vital bleaching. Materials and Methods:  Sixty extracted human maxillary incisors were root canal treated, followed by removal of coronal 3mm of gutta-percha. All the samples were split into 4 groups (n=15) with Biodentine as intraorifice barrier (Group 1), MTA as intraorifice barrier (Group 2), Light cure GIC as intraorifice barrier, followed by light curing (Group 3), Control- The removal of gutta percha from the coronal part will not take place (Group 4). 35% carbamide peroxide was applied in the pulp chamber of all the samples, and was be changed every 7 days. Samples were subjected to fracture resistance testing using universal testing machine. The data was analysed using one way ANOVA and unpaired student t test. Result: The fracture resistances of all the groups were compared. The mean and standard deviation of fracture resistance in Group 1 (Biodentine) was 1139.58±187.28 N, Group 2 (MTA) was 885.81±167.14 N, Group 3 (Light cure GIC) was 1019.58±202.32 N and Group 4 (Control) was 719.50±179.78 N. The Fracture resistance of the groups were – Group 1 (Biodentine) ≈ Group 3 (RMGIC) > Group 2 (MTA)  > Group 4 (Control). Conclusion: Fracture resistance of endodontically treated teeth undergoing intracoronal bleaching is improved by using intraorifice barrier. Maximum improvement occurs in teeth with Biodentine as the intraorifice barrier.

40. Utilizing Patient-Reported Outcomes, a Comparison of Limb Salvage Vs. Amputation for Nonmetastatic Sarcoma Patients Results from Measurement Information Systems
Saroj Kumar Parida, Akash Samal, Subham Agrawal
Abstract
Objective: A scoring tool called the Patient-reported Outcomes Measurement Information System (PROMIS) enables comparisons between patients with uncommon disorders and those with more common illnesses or the general population. For nonmetastatic sarcoma patients, PROMIS results were compared between limb salvage and amputee patients to the general population. Methods: The analysis covered 130 patients. Amputation and limb salvage cohorts of patients were separated, as well as groups based on the length of follow-up (1 to 10 or 12+ months). Results: Seven PROMIS domains were examined, and patients who had just undergone surgery and those in the limb salvage group both received higher ratings. In comparison to the population, the limb salvage group also exhibited better emotional health. Conclusion: PROMIS values have improved in both patients and limb salvage patients. One year following surgery. Patients undergoing limb salvage have better emotional health than the general public.

41. A Hospital-Based Study Examined the Results of Retrograde Nailing for Surgical Stabilisation of Femur Distal 1/3rd Fracture Shaft
Saroj Kumar Parida, Amit Das, Akash Samal
Abstract
Objective:  6% of all femoral fractures are in the 1/3rd distal of the femur. The objective of this research was to assess the effectiveness of retrograde nailing in surgically stabilizing a distal 1/3rd fractured shaft femur. Methods: Retrograde nailing was used to treat 55 patients with 1/3rd distal of femur fractures in both genders. Modality of injury, kind of fracture, range of motion (ROM), time from injury, length of surgery, amount of time needed for fracture healing, and functional evaluation using Lysholm knee grading were among the parameters highlighted. Results: 25 of the 55 patients were female and 30 were male. 31 patients had RTA injuries, 11 had sports injuries, 10 had fallen, and 4 had other types of injuries. The type of fracture was closed in 31 cases and complex in 24. Mean knee flexion (degree) measurements were 42.5 at 1 month, 90.1 at 2 months, 112.4 at 5 months, and 121.3 at 12 months. The difference was noteworthy (P <0.04). Lysholm’s knee rating was Excellent in 35 patients, good in 15, and fair in 5. The difference was noteworthy (P< 0.04). Conclusion: It was shown that retrograde nailing is a suitable therapeutic option for distal femur fractures. This procedure involves surgical stabilization of the distal 1/3rd fracture shaft of the femur.

42. Evaluation of the Result of Internal Lisfranc Fracture-Dislocations
Saroj Kumar Parida, Anshuman Mishra, Udit Sourav Sahoo
Abstract
Background: Lisfranc joint injury is uncommon and can fail to notice at the initial assessment and treatment. Once ignored, late reduction is difficult and requires extensive dissection. Lisfranc joint injuries are known to result in functional loss and chronic pain due to residual ligamentous instability, deformity, and/or arthritis; osteoporosis may also occur due to antalgic gait without weight bearing. This recognition is important, as most of the injuries are either misdiagnosed or overlooked, such as in patients suffering from polytraumatic injuries, possibly becoming a permanent source of pain after the major fractures have healed. Methods: The present study is a prospective study conducted in the Department of Orthopaedics in S.C.B Medical College & Hospital, Cuttack from January 2021 to December 2022 on patients presenting with Lisfranc Fracture-Dislocations. Results: The findings showed that we achieved excellent in 10% of the cases. Good outcome in 85% of cases, Fair outcome in 5% of the cases and no patient had poor outcome in our study. Average AOFAS (American Orthopaedic Foot and Ankle Score) being 77.1. Conclusion: It can be concluded from the present study that operative management with CC (Cannulated Cancellous Screws) Screws and K Wires is an effective means of treatment based on biomechanical principle with good functional outcome and minimum complication.

43. A Comparison of the Functional Results Following Closed Reduction of Displaced Paediatric Supracondylar Humerus Fractures Mended with Two Lateral or Crossed Percuteneous Kirschner-Wire
Subham Agrawal, Saroj Kumar Parida, Amit Das
Abstract
Objective: To assess the functional results of percutaneous cross-K wire fixation for humerus fractures of Gartland types II and III. Methods: 70 patients with supracondylar humeral fractures who received closed reduction and fixation by two crossed Kirschner wires were included in this prospective research carried out by SCB Medical College, Cuttack from January 2021 to April 2022. Children under the age of 14 who had closed fractures of Gartland types II and III were included, however patients who had open, irreducible fractures due to vascular injury were excluded. The patients’ functional status was evaluated using Flynn’s criteria after a 12-month follow-up period. Results: The patients’ average age was 8.0 years. Among 42 children (59.7%), trauma sustained while playing was the primary cause of injury, and 28 (57.4%) of the fractures were of the Gartland type III variety. All children’s unions occurred within 5-7 weeks after birth. According to the functional outcome, 40 (51%) participants had excellent results, 20 (31%) good results, 10 (18%) fair results, and none had bad results according to Flyn’s Criteria. Conclusion: A satisfactory functional outcome, brief hospital stays, and few problems are the consequences of percutaneous Kirshner wire fixation.

44. Oral Cancer Screening among the Rural Indians: A Community Based Prospective Study
Gogineni Tarun Chowdary, V Ajay Chanakya, P Sriphani, B Sriram, T Jaya Chandra
Abstract
Introduction:  India is the second country reported highest number of the oral cancer (OC) cases next to breast cancer. Paan consumption and tobacco, socioeconomical factors such as exposure to silica, smoke and other carcinogenic agents also cause cancer. With this, a community based study was conducted to diagnose OC among the smokers. Methods: This was a community based ongoing research. Study was conducted in the department of Surgical Gastroenterology, GSL Medical College. Study protocol was approved by the Institutional Ethics committee. Adults > 18 years who have smoking habit were included in this research. With the support of primary health workers and also undergraduate students of this organization, door to door survey was conducted to create the awareness about OC. After getting consent, the oral cavity was examined and the findings were recorded. Biopsy specimen was collected from the lesions and the specimen was transported to the institutional laboratory, OC was confirmed as per the guidelines. The study participants were divided into 2 group; those have habit of smoking tobacco and consume alcohol in first group and non-smokers, non-alcoholics in 2nd group. Chi-square test was used to find the association; P>0.05 was considered to be statistically significant. Results: In group 1, total 1024 members were screened; OC was diagnosed in 34 (100%) members. Gender wise, 643 (63%) were males. In the diagnosed OC individuals, 1.26 was male female ratio; statistically there was no significant difference. Statistically, there was significant difference between the socioeconomic status and education, respectively. Tongue was leading (16; 47%) site followed by buccal mucosa (9; 26.5%). Conclusions: The prevalence of the OC is high among those habituated with smoking and alcohol. OC causes significant mortality and morbidity among those patients, when diagnosed late in the course. The treating specialist should pay attention not only teeth, but also oral mucosa which may help in the early diagnosis and treatment.

45. Utility of the Bladder Flap at Cesarean Delivery: A Randomized Controlled Trial
Subhra Bharti, Anjali Suman, Joydeb Mukherjee, Miss Jeny
Abstract
Objective: To assess the implications of doing a lower segment caesarean delivery without performing the bladder flap creation step. Specific objectives: Total operating time is a primary outcome measure (from skin incision to closure of the skin). Secondary outcome measures include time from skin incision to delivery, time from skin incision to fascial closure, blood loss, hematuria, dysuria, retention of urine, febrile morbidity, analgesic use, hospital days, wound infection, newborn outcomes, and readmissions. [Time frames: On the first post-op day and during the four-week post-op visit]. Method: We randomly assigned the development of the bladder flap (n = 130) or its omission (n = 120) in 250 women undergoing primary and repeat caesarean births at 30 weeks of gestation or more. Other abdominal surgeries outside caesarean deliveries were prohibited, as were planned vertical uterine incisions and emergency caesarean deliveries. Total operational time served as the main result indicator. Secondary outcomes included urinary tract infection, endometritis, bladder injury, incision-to-delivery and incision-to-fascial closure times, estimated blood loss, postoperative microhematuria, discomfort, and hospital days. The intention-to-treat premise guided the analysis. Result: There was no change in the overall operating time (50 [range 17-123] minutes compared with 50 [range 15 – 177] minutes; P=0.20), although the median skin incision to delivery interval was shorter with the bladder flap removed (8 [range 0- 42] compared with 11 [range 3-71] minutes. There were no bladder injuries in either group, and there were no notable differences in endometritis, estimated blood loss, change in haemoglobin level, postoperative microhematuria, postoperative discomfort, hospital days, or urinary tract infection. Conclusion: The bladder flap does not result in an increase in intraoperative or postoperative problems after first or subsequent caesarean births. Time from incision until delivery is reduced, but overall operating time seems to remain constant.

46. To Compare the Effect of Dexamethasone and Dexmedetomidine Given as Adjuvant with Ropivacaine in Transverse Abdominis Plane Block in Total Abdominal Hysterectomy
Tanya Mishra, Bipin Arya, Ankit Agrawal, Dipti Saxena, Surbhi Kothari, Kirti Singh, Rohit Sharma
Abstract
Background: Several adjuvants have been used to improve the efficacy of the transversus abdominis plane (TAP) block because it has been used as an effective component of multimodal analgesic treatment for major abdominal surgeries. Dexmedetomidine and dexamethasone are two important additive when given as premixed with ropivacaine in transverse abdominis plane block, in terms of analgesic drug requirement and duration of post-operative analgesia in total abdominal hysterectomy patients. Aims and Objectives: To compare the analgesic effect of 0.2% ropivacaine as an adjuvant with dexamethasone 4mg and dexmedetomidine 10 mcg in transverse abdominis plane block for post-operative analgesia in total abdominal hysterectomy. Materials and Methods: This study was conducted on 120 adult patients randomly allocated into two groups of 60 patients each. In Group A, the patient received 20 ml of 0.2% of ropivacaine with dexamethasone 4mg on either side, while in Group B, the patient received 20 ml of 0.2% of ropivacaine with dexmedetomidine10mcg on either side. Statistical analysis was done using appropriate parametric /non-parametric tests and chi-square tests. Results: The duration of post-operative analgesia was significantly longer in Group B than in Group A (174.30 ± 24.24 minutes and 273.57 ± 13.25 minutes, respectively) (p<0.05). The total mean dose of post-operative analgesia was lower in Group A (1.3± 0.5) than in Group B (2.3 ± 0.5). Numerical rating scale was lower in Group A at 2, 4, 8, 12 and 24 hours compared to Group B (p<0.05). Conclusion: Using dexamethasone as an adjuvant to ropivacaine improves the efficacy of TAP block in terms of duration and requirement of analgesia than dexmedetomidine with a significant reduction of post-operative analgesic requirement without any adverse effects.

47. Comparison between Dexmedetomidine and Ketorolac as an Adjuvant to Local Anaesthetic for IVRA to Prolong Post-Operative Analgesia
Videet Shah, Karthikeyen RK, Pramod Patil, Dhanashree Mahajan
Abstract
Introduction: Intravenous regional anesthesia (IVRA) is a technique for inducing anaesthesia in a part of the limb by injecting a local anaesthetic intravenously into an extremity that is isolated from the remainder of the circulatory system with a tourniquet. Dexmedetomidine is an α2-adrenoreceptor (AR) agonist and ketorolac works by preventing the production of inflammatory mediators. Aims and Objectives: To compare the efficacy between Dexmedetomidine and Ketorolac as adjuvants to local anaesthetic for IVRA to prolong post-operative analgesia. Materials and Methods: A randomized observer-blind prospective study was conducted on patients who are undergoing intravenous regional anesthesia for upper limb surgery. They were divided into two groups group D Lignocaine 0.5% solution, 0.6ml/kg (maximum- 40ml) + Dexmedetomidine 30mcg and group K Lignocaine 0.5%, 0.6ml/kg (maximum- 40ml) + Ketorolac 15mg, 30 patients in each group. Post-operative patients were observed in recovery for two hours before being transferred to the appropriate ward. Timing of drug injection, beginning of sensory and motor block, pain from tourniquet, and initial demand for painkillers were all reported. Results: The mean time for the requirement of first rescue analgesia (140.67 vs 131.23 mins; p-0.26) and VAS score at the demand (6.47 vs 6.17; p-0.47) were comparable in cases of group A and group B respectively. Mean systolic blood pressure was comparable between the two groups at baseline and throughout surgery till 2 hours follow-up period (p>0.05). Mean diastolic blood pressure was comparable between the two groups at baseline and throughout surgery till 2 hours follow-up period (p>0.05). Conclusion: The study has concluded that lignocaine and dexmedetomidine are both almost beneficial but the duration of the post-operative analgesia between the two groups was statistically significant.

48. Immunohistochemical Detection of Bone Marrow Micrometastasis in Cases of Colorectal Malignancies
Maheswari S., Rekha M., Duraisamy R.
Abstract
Colorectal carcinoma is one of the tumors with high incidence of cancer related death rate mostly due to metastasis. Tumor spread to blood and bone marrow is the most crucial step in systemic tumor spread. Disseminated tumor cells (DTC) / Micrometastasis are defined as occult cancer cell clusters less than 0.2 mm which can be by Immunohistochemistry (IHC) by epithelial specific antigens like cytokeratin. IHC techniques can pick as few as 1 to 2 tumor cells in 1 × 106 hematopoietic cells. Patients with presence of DTC in bone marrow had shown to have a shorter survival time and have shorter distant metastatic disease-free survival time than patients with negative bone marrow status. Many studies have proved the detection of DTC in bone marrow is an independent prognostic marker which can help in planning the appropriate treatment strategy. Aims and Objectives: To study the incidence of bone marrow micrometastasis and its prognostic significance in colorectal malignancies. Material and Methods: This is a 3-year study proposed and conducted in the Tirunelveli Medical College Hospital during September 2011 to July 2013. 50 patients with small biopsy proved diagnosis of malignancy in colorectal region were selected. All patients were followed and resected specimens were evaluated. Tumor Sections were studied to note the microscopic type of tumor, grade, depth of invasion and number of nodes positive for metastatic carcinomatous deposits under light microscopy. Patients were followed post operatively and before administration of chemotherapy bone marrow aspirations were taken for all 50 patients. Bone marrow smears were prepared and fixed in methanol, of which 3 smears were stained with Leishman stain and 3 smears were fixed for imunostaining (pancytokeratin). Observation and Results: Out of 50 cases 11 cases showed presence of disseminated tumor cells (DTC) in bone marrow. 3 cases from T2 stage and 8 cases from T3 stage were positive for DTC. 5 cases of N1 stage and 6 cases of N2 stage were positive for DTC. All 12 cases with well differentiated morphology (12 cases) were negative whereas 4 out of 22 cases with moderately differentiated and 7 out 16 of cases with poorly differentiated morphology were positive for DTC. 11 out of 39 cases at DUKE Stage C were positive but both Stage A (4 cases) and Stage B (7 cases) were negative. Conclusion: Our study has enumerated the importance of detection of disseminated tumor cells in Bone marrow aspirates of colorectal malignancies using IHC (Cytokeratin). Bone marrow micrometastasis detection rate increases with increase in grade of tumor, depth of invasion and stage of tumor. Our study also concludes that disseminated tumour cells in Bone Marrow aspirates of colorectal carcinoma could have an independent prognostic value which helps the surgeons and oncologists to plan a appropriate treatment strategy.

49. Observational Study on Effect of Application of Amniotic Membrane Graft in Patients with Ocular Surface Disorders
Parvatha Sundari, J. Yavana Rani, J.S. Rasiga Thivya, M. Marimuthu4, V. Nandhini
Abstract
Background: In this study, we wanted to evaluate the effect of amniotic membrane graft in patients with ocular surface disorders. Materials and Methods: This was a hospital based observational study conducted among 50 patients who presented with ocular surface disorders to the OPD of Department of Ophthalmology at Government Rajaji Hospital, Madurai, over a period of one year from 2020 to 2021, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The tear break-up time (TBUT) value among 50 cases of various ocular surface disorders (P value was < 0.001) was significant. In the improvement of symptoms after amniotic membrane transplantation among 50 cases with ocular surface disorders, the p value was < 0.001 which is significant. When in the presence or absence of epithelialisation after amniotic membrane transplantation among 50 cases of patients with ocular surface disorders, the p value was < 0.001 which is significant. In the evaluation of healing of corneal ulcer, the p value was 0.024 which is significant. In the evaluation of recurrence in pterygium cases, the P value was 0.010 which is significant. Conclusion: It was found that amniotic membrane grafting has benefits like no immunological reaction, cost effective, readily available and had fewer complications. Since vision improvement by amniotic membrane graft (AMG) grafting is a temporary one, ultimately patients needed other mode of surgeries. In institutions where AMG is available, we can use it as a temporary measure till cornea is available for keratoplasty.

50. Magnesium Sulphate versus Ketamine Nebulisation on the Incidence of Post-Operative Sore Throat – A Randomised Control Study
Shashwathi Siddaramappa, Puspanjali Jena, Sudarshini M.
Abstract
Background: In this study, we wanted to evaluate the efficacy of Magnesium Sulphate and Ketamine nebulisation in prevention of Post-Operative Sore Throat (POST). Methods: The present hospital based randomized comparative clinical study was conducted on 140 patients, who underwent surgeries with endotracheal intubation, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: At 0, 6 and 12 hours post extubation, there was significant difference in Post-Operative Sore Throat grades between Magnesium Sulphate and Ketamine groups (p < 0.0001, p = 0.04 and p = 0.014 respectively). Conclusion: Both Magnesium Sulphate and Ketamine nebulisation reduced the frequency and severity of Post-Operative Sore Throat, but Magnesium Sulphate nebulisation has been shown to be significantly better than Ketamine nebulisation in this regard, contributing to a smoother recovery and greater patient satisfaction.

51. Clinical Correlation of Platelet Indices in Preeclamptic Patients without Hellp Syndrome
Afjalur Rahman, Rumen Chandra Boro, Hem Kanta Dev Sarma, Rajesh Das
Abstract
Background: Although the pathogenesis of preeclampsia is poorly understood, there are studies which have shown that Platelets play a pivotal role. Platelet count has been shown to be a rapid procedure to estimate the severity of pregnancy-induced hypertension. Raised mean platelet volume (MPV) and platelet distribution width (PDW) have been shown to be correlated with severity of the disease, whenever there is decreased Platelet count. Hence, this study will be undertaken to see if there are associations between Platelet indices and severity of preeclampsia in cases without HELLP Syndrome. Materials and Methods:  A prospective case-control study was done  in the Department of Obstetrics And Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, on 106 women divided  into two groups  – Non-severe preeclampsia group (n=53) and Severe preeclampsia group (n=53). Platelet indices  viz. Platelet Count, Mean Platelet Volume, Platelet Distribution Width, Plateletcrit and Platelet Large Cell Ratio were analyzed. Results: Findings showed that there was a statistically significant decrease in Platelet Count (p<0.05) and an increase in Mean Platelet Volume (p<0.05) and Platelet Distribution Width (p<0.05) in mothers of severe-preeclampsia group. Furthermore, Platelet Count was significantly decreased (p<0.05) and Plateletcrit was significantly decreased (p<0.05) in severe preeclampsia mothers. Conclusion: Platelet indices could be used as biomarkers for early diagnosis of severity of preeclampsia.

52. Evaluation of Hypertensive Retinopathy in Patients of Essential Hypertension with High Serum Lipids: A Clinical Study
Meenakshi, P. Satyavathi Devi, B. Trimurthulu, V. Satya Srinivas
Abstract
Background: In this study, we wanted to evaluate the different phases of hypertensive retinopathy fundus findings and correlate the findings with lipid profile (LDL, HDL, VLDL, triglycerides and total cholesterol) in essential hypertensive patients. Materials and Methods: This was a hospital based prospective observational study conducted among 80 patients who presented with essential hypertension after thorough evaluation by the physician to the Department of Rangaraya Medical College Kakinada, from December 2019 to August 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: In hypertensive retinopathy and duration of hypertension, duration in years the p value < 0.0001, was statistically significant. In relationship between dyslipidaemia and duration of hypertension, the p = 0.0001*, was statistically significant. In relationship between LDL with grades of retinopathy the p = 0.0001*, was statistically significant. Total cholesterol showed significant relation with grades of retinopathy. Triglycerides showed statistically significant relationship with grades of retinopathy. HDL showed statistically significant relationship with grades of retinopathy. In relationship between dyslipidaemia and grades of retinopathy, p = 0.0001*, statistically significant. Conclusion: The blood pressure in malignant hypertension should be lowered gradually to allow sufficient time for the auto regulation of the blood flow to adapt itself. Therapy must be initiated as soon as possible to prevent the development of hypertensive retinopathy. Hence, physicians and the ophthalmologists must pursue a joint and coordinated approach to prevent visual loss and risk factors from hypertension.

53. Meconium Stained Liquor and Pregnancy Outcome
Manjula A. Patil, Ravindra S. Pukale
Abstract
Background: Meconium staining of amniotic fluid is associated with an increased risk of adverse perinatal outcome due to birth asphyxia, fetal distress, intra-partum fetal death, low Apgar score, meconium aspiration syndrome and neonatal death and hypoxic ischemic encephalopathy with its sequelae. In this study we wanted to evaluate the maternal characteristics and risk factors for MSAF along with the fetal outcome and mode of delivery in patients with meconium-stained liquor during labour. Materials and Methods: This study was conducted among patients in labour who were admitted in AIMS, BG Narara over a period of two years from 2016 to 2018, after obtaining ethical committee clearance from the institutional ethics committee, and informed consent from the study participants. Data was entered in MS Excel software and analysed. Results: In our study total of 183 babies were born with meconium-stained liquor out of which 51.3% were thin meconium and 48.63% were thick meconium. Among babies with thick meconium 60.09% and 70% babies had suspicious and abnormal CTG patterns respectively. 89.65% of thin meconium babies had vaginal delivery but 69% of thick meconium babies had caesarean section. 11(34.37%) babies in thin meconium group and 21(65.62%) babies in thick meconium group weighed less than 2.5 kgs at birth. 87% babies were asymptomatic and needed only routine care while 24 babies went to NICU out of which 11 needed ventilator, 9 has MAS and 4 had birth asphyxia. Conclusions: Meconium-stained liquor alone is not associated with an adverse neonatal outcome. 87% of babies remained asymptomatic in spite of MSL and required only routine care. Increasing Grade of MSL is associated with increased adverse outcome. Association of MSL with abnormal CTG is associated with poor outcome, increased caesarean section rate, increased neonatal complications.

54. Drug Prescription Pattern in the Treatment of Acne Vulgaris: An Observational Study
Seeba Hussain
Abstract
Background: With excessive sebum production, follicular epidermal hyperproliferation, inflammation, and Propionibacterium acnes activity, acne vulgaris is the most prevalent skin condition of the pilosebaceous unit. It affects about 80% of teenagers and can cause physical disability as well as serious psychological and social problems. This study seeks to assess the prescription pattern and its justification in the drug treatment of acne vulgaris. Methods: This prospective, hospital-based, observational research assessed the subjects’ demographics, disease status, and drug therapy information while taking into account the inclusion and exclusion criteria. Results: A total of 346 patients’ prescription records were examined; 45.1% of the male patients had an average age of 21.9 ± 40.3 years. Grade II (53.17%) had the highest prevalence among the four grades of Acne Vulgaris, followed by Grade I (26.58%), Grade III (13.87%), and Grade IV (6.35%). There were 514 drugs recommended for topical use, with tretinoin alone accounting for 19.46% of those prescriptions, followed by benzoyl peroxide (12.45%), tretinoin and clindamycin (17.12%), clindamycin alone (10.51%), etc. There were 98 medications given for systemic use, with Doxycycline accounting for 55.1% of those, Azithromycin for 34.7%, Isotretinoin for 6.12%, and Erythromycin for 4.08%. Conclusion: Most prescriptions were logical and did not allow for polypharmacy.

55. Ultrasonography Foetal Biometric Parameters for the Early Diagnosis of Intrauterine Growth Retardation
Seeba Hussain
Abstract
Method: A prospective observational research was carried out from 2020 to 2022 in the Obstetrics and Gynecology Department at Katihar Medical College, Katihar. 100 antenatal participants who were chosen from the outpatient department participated in the research. The gestation period for each woman’s singleton baby was 28 to 30 weeks. Result: Uterine Artery doppler S/D Ratio: abnormal (Right 16%, Left 12%), Uterine doppler Artery RI Ratio: abnormal (Right 15%, Left 21%), Uterine doppler ED Notch: 8%, Umblical doppler Artery S/D Ratio: Abnormal 15%, Umblical doppler Artery RI Ratio: Abnormal 19% Discussion and Conclusion: Additionally useful predictors of IUGR are biometric USG markers, particularly abdominal circumference and its relationship to head circumference and femur length. It has been suggested that uterine Doppler testing during the second or third trimester be used as a screening method for early onset IUGR, particularly that linked to preeclampsia. Ultrasound biometry and Doppler velocimetry was conducted on 100 clinically suspected cases for evaluation of IUGR pregnancy. Standard biometric measurements were used to calculate the EFW, which was then reported as percentiles. Resistance indices, systolic and diastolic ratios, and colour flow and pulse Doppler measurements of uterine umbilical vessels were made. Reviewing maternal and field charts allowed researchers to determine the pregnancy result. The results were analysed using a statistical analysis system.

56. Verapamil Used as an Adjuvant to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgery: A Prospective Randomised Control Study
B. Velmurugan, S. Sekar, G. Manikandan, K. Karunakaran
Abstract
Calcium is crucial in the development of pain. Due to the blockage of rapid sodium channels, verapamil (a calcium channel blocker) has been found to have strong local anaesthetic activity. It has quick channel blocking effects akin to those of local anaesthetics. The purpose of the study was to determine whether rescue analgesia was necessary in the first 24 hours and how much of it was needed. This study involved 60 patients. Group 1: Participants underwent a supraclavicular brachial plexus block guided by ultrasonography using 30mL of 0.25% Bupivacaine and 2mL of sterile water. Group 2: Participants underwent a supraclavicular brachial plexus block with ultrasound guidance using 30 mL of 0.25% bupivacaine and 5 milligrammes of verapamil (dilute it as 2ml). The sensory blockade lasted for 307.8322.77 minutes in Group 1 and 399.5025.40 minutes in Group 2. The difference in duration between Groups 1 and 2 has a P value of 0.0001, which is very significant. The motor blockade lasted 295.8018.43 minutes in Group 1 and 327.3322.39 minutes in Group 2. The difference in duration between Groups 1 and 2 has a P value of 0.0001, which is very significant. Rescue analgesia lasted for 375.8037.38 minutes in Group 1 and 434.0668.20 minutes in Group 2. With a highly significant P value of 0.0001, Group 2’s rescue analgesia lasted longer than it did in Group 1. Block was effective in every patient, and every patient who was enrolled in the research finished it. Age, sex, weight, kind of surgery, length of surgery, and patient satisfaction were all similar between the two groups. Similar values for pulse rate, systolic, diastolic, and SpO2 were found in the two groups. The addition of verapamil to bupivacaine as an adjuvant prolongs the duration of the sensory and motor blockade in the ultrasound guided supraclavicular approach to block the brachial plexus in addition to its quick onset. Thus, the least analgesic doses needed. The risk of problems is also low because the procedure is performed under ultrasound supervision.

57. Retracted by Authors

58. Novel Inflammatory Score: C-Reactive Protein/Albumin Ratio in Pancreatitis
Sonawane Shreya, Gawade Maindad Gayatri C., Padwal Meghana K., Maindad Dadasaheb, Nagpal Akhil, Barsode Supriya, Shinde Sudhir
Abstract
Background and Objectives: To prevent the complications in pancreatitis, identification of the biomarker at an early stage for screening and prognosis is the need of time. CRP is an easily detectable positive acute-phase protein. A negative acute-phase protein albumin is an indicator of nutritional status. Both independently can be used as prognostic markers. Based on these, combining inflammation and nutritional status, the novel inflammatory prognostic score CAR (CRP/albumin ratio), can be studied in the pancreatitis patients. We planned this study to evaluate the relationship between CAR, amylase, lipase and severity of pancreatitis. Objectives: (1) To associate CAR score and enzymatic biomarkers. (2) To classify pancreatitis based on pain in abdomen and its association with CAR. Observation and Results: The result of biochemical parameters like albumin, CRP, amylase, lipase was obtained after processing samples on autoanalyzer in 75 clinically diagnosed cases of pancreatitis. The correlation between the calculated ratio, CAR with biochemical parameters was done along with universal pain symptom severity score. The mean value of CAR was found as 2.204 mg/g. The mean age in yrs was 43.42 yrs, Pain score 0.96, CRP 64.55 mg/L, albumin 3.54 g/dl, amylase 292.468 U/L, lipase 512.36 U/L.CAR was positively correlated with age in yrs, CRP negatively correlated with albumin, amylase, lipase. CAR was found to be highly statistically significant with CRP and albumin with p value < 0.001. No statistically significant correlation between the universal pain score and CAR, serum albumin, serum amylase and serum lipase was found. Interpretation and Conclusion: CAR (CRP/albumin ratio) can be used as a novel, promising, easy, repeatable, cost effective, mathematical, inflammatory and comprehensive score as a predictive marker of pancreatitis severity before going for invasive and costly radiological investigations as it is derived from routinely done laboratory parameters.

59. Clinico-Epidemiological Profile and Treatment Outcome of Multi-Drug Resistant Tuberculosis Patients of a South Indian District: An Observational Study
Rajesh Kumar B, Senthilkumar A, Janani Akshaya Murugan, Hariprasad Ramasamy, Prabhakaran Rathinam
Abstract
Background: Multi Drug Resistant Tuberculosis (MDR-TB) is a major public health problem that threatens progress made in TB treatment and control. India is the largest share of the global MDR TB burden (27%). Among 30 high burden countries India accounts for 26% of the global TB incidence. The Global Stop TB Strategy outlines and defines the Programmatic Management of Drug Resistant TB (PMDT). Prompt identification of presumptive MDR-TB patients, diagnosis and initiation of treatment is crucial to prevent the transmission of MDR-TB and reduce high morbidity and mortality. Aim: The study aims to assess the clinico-epidemiological profile and treatment outcome of MDR TB patients in Madurai district, South India. Methods: 67 microbiologically confirmed multidrug resistant tuberculosis patients diagnosed between July 2020 and March 2021 were enrolled. Clinical and demographic data of all eligible patients was collected. Patients were evaluated with physical examination, CXR, sputum AFB, CBNAAT, LPA and treated and followed up as per PMDT guidelines. Data was entered in Microsoft Excel and analysed using SPSS version 21. Results: The study consisted of 43 (64.2%) males and 24 (35.8%) females. The mean age was 46 years. But most were 51-70 years 29 (43.3%) followed by 31-50 years 27 (40.3%) and 15-30 years 11 (16.4%). Of the 67 patients, 35 (52.2%) were previously treated, 32 (47.8%) were newly diagnosed patients, 36 (53.7%) were non diabetics and 31 (46.3%) were diabetics. HIV positivity rate was 3 (4.5%). Of all the patients, 22 (42.8%) and 18 (26.9%) were found to be smokers and alcoholics respectively. Treatment outcome is better in 31-50 years age group, males, non-smokers, non-alcoholics, non-diabetics, non-HIV patients and newly diagnosed pulmonary MDR TB patients. Conclusion: Decentralized management of DR-TB under NTEP PMDT guidelines ensures early diagnosis, prompt treatment initiation, counselling to patients and family members, follow-up monitoring of nutrition, adherence and adverse events which predisposes to effective management of DR-TB patients.

60. Comparative Evaluation of Ease and Efficacy of Three Drug Combinations- Dexmedetomidine and Propofol, Fentanyl and Propofol, Fentanyl and Midazolam for Fiber-Optic Intubation
Nupur Khewle, Sakshi Goyal, Vikas Kumar Gupta, Rashmi Pandey, Krishna Raj Pai
Abstract
Background: Awake nasal or oral fiberoptic intubation (AFOI) is the technique of choice in airway management of known or unknown, anticipated or unanticipated difficult airway, unstable cervical fracture, severe cervical stenosis, severe facial burn, limited mouth opening due to diseases of temporomandibular joint, mandibular-maxillary fixation, vertebral artery insufficiency. Various drugs have been used to aid in fiberoptic intubation for optimal intubating conditions and sedation. Aims: To observe the efficacy and ease of intubating condition during fiberoptic intubation using drug combinations of Dexmedetomidine and Propofol, Fentanyl and Propofol, and Fentanyl and Midazolam. Materials and Method: An observational, prospective clinical study was carried out on 90 patients aged between 20-60 years of both sex of ASA grade I and II, undergoing elective surgeries under general anaesthesia. Patients were divided into three groups containing 30 patients in each group to facilitate fiberoptic intubation, Group D (n=30)- received Dexmedetomidine and Propofol, Group F (n=30)- received Fentanyl and Propofol, Group M(n=30)- received Fentanyl and Midazolam. Intubation conditions, post intubation score, depth of sedation, intra-op vitals and post-op complications were documented. Results: Satisfying intubation condition was observed in more patients in group D as compared to group F and M. The vocal cord movement was grade 1 (open) in 28 cases of group D, 27 cases of group F and 21 cases of group M. Whereas, cough score was >/=2 in 1, 5 and 9 cases of group D, F and M, respectively. Limb movement grade was 2 or more in 2 cases of group D, 4 cases of group F and 10 cases of group M. only 1 attempt was taken for awake fiberoptic intubation in 29 cases of group D, 27 cases of group F and 21 cases of group M. Whereas, 2 or more attempts were taken in 1 case of group D, 3 cases of group F and 9 cases of group M. Remarkable increase in the heart rate was found in group M than group D and F. Similarly, the increase in the heart rate was higher in group F than group D. Desired Ramsay sedation score of 3 i.e., 26 participants of group D, 25 of group F and 15 of group M.   The occurrence of post-op complications related with fibreoptic intubation were significantly less in Dexmedetomidine and Propofol, and Fentanyl and Propofol group than midazolam with fentanyl.

61. Study of Efficacy of Microdebrider in Endoscopic Sinus Surgery
Vamshi Krishna Rao Koppula, M Vineel Reddy, Manoj Gunde, A Shreya Reddy, P Durga Reddy
Abstract
Background: The usage of microdebriders in endoscopic sinus surgery has increased recently. In this study, the benefits of the microdebrider in endoscopic sinus surgery are assessed in terms of blood loss during surgery, field visibility, operating time, and postoperative recovery. Methods: The patients underwent Diagnostic Nasal Endoscopy. Using a 30-degree Hopkins Rod Endoscope 1st pass, 2nd pass, and 3rd pass were done. Middle meatus was examined in all patients and the polyps were graded according to the following classification. Score ‘O’ No polyps present; score I polyps confined to middle meatus; score II Polyps beyond middle meatus (reaching inferior turbinate or medial to middle turbinate); score III Polyps almost or completely obstructing nasal cavity. CT scan of paranasal sinuses: patients were subjected to CT and PNS and the degree of opacification and expansion of involved sinuses were noted. Results: Out of n=50 cases operated in this study n=3 cases were operated for 120 minutes, n=4 cases were operated for 100 minutes, and n=4 cases were operated for 90 minutes. Similarly, n=13 cases required a time of 80 minutes, n=11 cases were operated for 70 minutes, n=10 cases were operated for 60 minutes and n=5 cases were operated for 50 minutes. In the n=30 cases of grade II polyp, the mean duration of surgery was 80 minutes and out of n=8 cases of grade III polyp the mean duration of surgery was 110 minutes.  In this study based on the per-operative visibility was graded according to Boezaart & Van der Merwe Grading system. Conclusion: In this study, the benefits of using a microdebrider during endoscopic sinus surgery were minimal blood loss during operation, even for grade III Polyposis, the typical surgical time was shorter, and the surgical field was visible. The study group’s postoperative recovery went well, and there was excellent mucosal preservation following the surgery. Therefore, the use of soft tissue shavers or microdebrider in endoscopic sinus surgery could be advantageous and hence advocated to be used in cases wherever it is feasible.

62. Thyroid Dysfunction and its Effect on Quality of Life in Patients of Anxiety Disorders
Piyush Gupta, ManishBorasi, Ankit Chaudhary, Manishi Singh, Anudeep Joshi
Abstract
Objective: To study thyroid dysfunction and its effect on quality of life in patients of anxiety disorders. Methods: A cross sectional study in total 90 patients diagnosed with Anxiety disorders as per ICD 10 after applying inclusion criteria and taking informed consent were included in the study. Data was analysed keeping in view the aims and objectives of the study. Results: The results of the present study indicated higher levels of anxiety in patients with hypothyroidism. Most of the patients belonged to the 18–30 years of age group, female preponderance, educated till primary school, belong to upper lower and lower class of the society and resided in rural areas. Domains 1, 2, & 4 of WHOQOL BREF were found to be significantly associated with Anxiety disorder with hypothyroidism in comparison to Anxiety disorder alone or Anxiety disorder with hyperthyroidism. Mean anxiety score for hypothyroidism was found to be higher as compared to euthyroidism and hyperthyroidism and this difference in mean anxiety scores was found to be statistically significant. Conclusion: Holding educational programs and protocols about thyroid disease to improve the mental health is suggested. Results indicated the relationship between anxiety, thyroid disorders and quality of life; therefore, it is necessary to pay attention to their importance in such patient’s care and treatment programs design. The present study suggested the usefulness of a longitudinal study exploring the temporal correlation between anxiety and thyroid disorders, as it could shed further light on this topic.

63. Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in Cat III, IV, V Cases: Validating at a Tertiary Care Centre
Tamilselvi V, Divya Rajendran, Boobalan S, Ravikumar
Abstract
Background: The introduction of the Bethesda System of Reporting Thyroid Cytopathology (TBSRTC) represents a major step towards reproducibility, standardization, and greater predictive value of thyroid fine needle aspirates (FNAs). Materials and Methods: We retrospectively reviewed thyroid FNAs between June 2019 and June 2022, classified them according to the Bethesda System of reporting, found out the distribution of cases in the indeterminate categories III, IV and V, as well as calculated the risk of malignancy (ROM) in each of these categories by follow-up histopathology. Results: Of the 250 FNA thyroid aspirates, the distribution of Cat III AUS /FLUS (Atypia/follicular lesion of undermined significance) and Cat IV FN/SFN (follicular neoplasm/suspicion for a follicular neoplasm) were 94 cases (38%) and 125 cases (50%) respectively. Cat V SM (suspicious for malignancy) constituted to 31 cases (12%). Risk of malignancy reported on follow-up HPE were AUS/FLUS 9.5%, SFN 26% and SM 78%. The Sensitivity, specificity, positive predictive value and negative predictive value in our study were 82%, 88%, 78% and 90% respectively. The Diagnostic accuracy was found to be 86%. Conclusion: Surgical follow-up in all indeterminate categories (III&IV) is mandatory to appropriately assess the risk of malignancy associated. NIFTP (Non-Invasive Follicular Thyroid neoplasm with Papillary-like nuclear features) reduced ROM in each of the Bethesda category III, IV and V in our study. Hence, individual institutions need to adjust the cytological criteria based on the occurrence of NIFTP. The high specificity and diagnostic accuracy found in our study recommends TBSRTC to be an effective thyroid FNA classification and provides the clinicians with comprehensible cytopathology reports.

64. Clinicopathological Study of Psoriasis Cases in A Tertiary Care Hospital
Srimahalakshmi. A, J. Maheswari, V. Iyswarrya
Abstract
Introduction: Psoriasis is a chronic papulosquamous disorder characterized by erythematous scaly plaques. The prevalence of psoriasis according to WHO ranges between 0.9% -11.4%. In India prevalence ranges from 0.44-2.8%. It affects all the age group with no sex predilection, still two age related   peaks have been reported, first around 20-30 years of age and second around 50-60 years of age. It usually affects the extensor aspects of the extremities. There are many clinical variants chronic plaque psoriasis, others being guttate psoriasis, pustular psoriasis, unstable psoriasis and erythrodermic psoriasis. Aims and Objectives: To determine the incidence of psoriasis according to the age, gender, site of lesion and analysis of various types of clinical presentation. Materials and Methods: Fifty clinically and histopathologically confirmed cases were taken and its incidence of age, sex, site and type of clinical presentation were analysed. Observation and Results: Out of 50 patients, 17 patients  (34%) belongs to 41-60 years, 24 patients were males(48%), site of lesion being lower limb (82%) and erythematous scaly  lesion  occupied (80%) among the various clinical presentation. Conclusion: In our study group, Males were found to be predominant, the age group was 41-60 years, the most common site being lowerlimb and erythematous scaly lesion was the most common type of clinical presentation. FNA classification and provides the clinicians with comprehensible cytopathology reports.

65. Comparative Analysis of Dexmedetomidine and Lignocaine for Attenuation of Hemodynamic Response during Laryngoscopy and Intubation
Harshad N. Mehta
Abstract
Background and Aim: The hemodynamic response to laryngoscopy and endotracheal intubation has been reduced using a variety of pharmaceutical and non-pharmacological techniques. The goal of the current study was to examine the effectiveness of Lignocaine (1 mg/kg), Dexmedetomidine (0.5 mcg/kg), and a combination of these two low doses (Dexmedetomidine and Lignocaine) in reducing the hemodynamic response to intubation. Material and Methods: After receiving approval from the institutional ethics committee, 150 ASA grade 1 patients ranging in age from 20 to 60 years were included for the study. mg/kg and inject 2 mcg/kg of fentanyl 10 minutes before labour. An aesthesiologist who was not engaged in the trial preloaded the study medicines into coded syringes and diluted them with normal saline to a volume of 10 ml. Dexmedetomidine 1 mcg/kg was infused over 10 minutes and normal saline over 3 minutes for Group A. Group B was given a 10 ml infusion of normal saline over 10 minutes and 1.5 mg/kg of lidocaine over 3 minutes. Dexmedetomidine 0.5 mcg/kg was infused over 10 minutes in Group C, followed by lignocaine 1 mg/kg over 3 minutes. Results: It was found that the mean HR and BP in group DL remained below baseline value during the entire study period of 15 mins post intubation. Conclusion: When compared to lignocaine (1.5 mg/kg) alone or a high dose of dexmedetomidine (1 mcg/kg) alone, a combination of low dose dexmedetomidine (0.5 mcg/kg) and lignocaine (1 mg/kg) efficiently reduces the pressor response during laryngoscopy and intubation without causing any hemodynamic adverse effects.

66. Determination of Epidural Catheter Position by Fluoroscopic Technique and Analysis of Efficacy of Epidural Analgesia: A Prospective Observational Study
B. Velmurugan, S. Sekar, G. Manikandan , T. Shanmugapriya
Abstract
Epidural Anaesthesia with insertion of catheter is a commonly practicing technique to provide intraoperative anaesthesia and also for the post operative analgesia. But when we combine the epidural anaesthesia with General or spinal Anaesthesia, we often may not able to confirm the catheter position and its efficacy as sometimes it may end in failure later to produce anaesthesia or analgesia as desired. Hence we tried to identify the position of the tip of the epidural catheter with injection of a contrast agent with fluoroscopy in the immediate post operative period and compared the efficacy of post operative analgesia with catheter position for the patients in whom the epidural space identification was done using the conventional and common technique of loss of resistance to air. Methods: Study subjects were the patients who scheduled to undergo elective infraumbilical surgery using spinal anaesthesia combined with epidural anaesthesia. Study objective were explained & consent obtained from the 50 patients who agreed to participate. In this study, loss of resistance to air was used to identify the epidural space and all the cases were submitted for fluoroscopy imaging using contrast agent to ascertain the tip of the catheter and the spread of the contrast which was compared with the analgesic efficacy in the postoperative period. Observations: The epidural catheter placed in the intended space that is two spaces above the point of insertion was about 20%, one space above was 28%, on the same space of insertion was 32% with paravertebral and intra vascular placement of 12% and 8% respectively. We found that the incidence of the wrong or misplacement of the epidural catheter were high for the conventionally used loss of resistance to air technique for identifying the epidural space which may necessitate to use increased volume of the drug to make the analgesia effective in the malpositioned catheter patients or failure in the wrongly placed catheters. Conclusions: The conventional use of the loss-of-resistance to air technique to identify the epidural space, frequently ends up in inappropriate placement of epidural catheters. Hence, when performing this procedure, catheter position ascertained by fluoroscopy may guide to adjust the dose of the analgesic drugs or to alter the position of the catheter to avoid the failures and to provide successful postoperative analgesia.

67. Comparative Study of Safety and Efficacy of Tramadol versus Paracetamol as Post-operative Analgesia after Caesarean Section
Saikat Kumar Sarkar, Ashis Kumar Mukhopadhyay, Sanjay Vashisth, Alpana Chhetri
Abstract
Aims: To compare the degree of safety, efficacy and acceptability of paracetamol & tramadol as postoperative analgesia after Caesarean Section. Method: It is a comparative prospective observational study carried out between April 2021-October 2022 (18 months) in the post recovery ward of the department of Obstetrics & Gynaecology Chittaranjan Seva Sadan College of Obstetrics Gynaecology & Child Health, 200 patients undergoing caesarean section under spinal anesthesia, excluding the patients who fall under exclusion criteria were included in the study. Out of 200 patients, 100 patients were chosen randomly, Group 1 received intravenous paracetamol 1gm infusion over 10-15 minutes 6 hourly for 4 doses & Group 2 received 100 mg tramadol infusion over 10-15 minutes in 100 ml normal saline 8 hourly for 3 doses. The degree of pain relief was measured on a numerical rating scale (NRS) of 0-10 (0 indicates no pain, 1-3 indicates mild pain; 4-6 indicates moderate pain,7-10 indicates severe pain). The aim was assessed 2,6,12,24 hours after completion of surgery. Additional analgesia (rescue analgesia) before 8 hours, if required (NRS Score>=6) were managed by giving injection pethidine 50 mg. intramuscularly. Statistical Analysis was performed with help of Epi Info (TM) 7.2.2.2. Results: t-test showed that the mean postoperative NRS of the patients administered with Tramadol was significantly higher than the patients treated with PCM (p<0.0001). Fisher exact test showed that a proportion of side effects was are available for control of pain but our study shows that efficacy, safety & acceptability of paracetamol infusion is better than intravenous tramadol and thus paracetamol infusion may be opted for better post-caesarean section pain management higher in Tramadol group (12.0%) as compared to PCM group (0.0%) (p<0.0001). There was no side effect in PCM group. Conclusion: In the post-operative period innumerable analgesics are available for control of pain but our study shows that efficacy, safety & acceptability of paracetamol infusion is better than intravenous tramadol and thus paracetamol infusion may be opted for better post-caesarean section pain management.

68. A Study on Isolation and Identification of Candida Species from Various Clinical Samples in a Tertiary Care Hospital
Sangeetha C Patil, Krishna S, Haafiza Begum, Pushpalatha H
Abstract
Introduction: Candida is a yeast-like fungus that is a common human commensal. As the host’s resistance to infection is reduced, either locally or systemically, they become pathogens and cause illnesses. The present study was conducted to isolate, identify and characterize Candida species from various clinical samples at VIMS, Ballari. Materials and Methods: This prospective Study was conducted in the department of Microbiology, VIMS Ballary from October 2022 to April 2023. A total of 6781 clinical samples were examined. Gram stain, germ tube test, and inoculation on commercially available CHROM agar were performed for these isolates. Results: Candida isolates were found in 186 of the 6781 clinical specimens. Majority of isolates were from urine (47%) followed by sputum (30%), vaginal swab (16%), blood (4%), and pus (3%). Candida albicans (42%) was the most isolated species followed by C. tropicalis (25%), C. grablata (16%), C.krusei (13%), and C. Parapsilosis (4%). Conclusions: Candida albicans was identified as a prevalent pathogenic yeast in our study. The capacity to identify inherently resistant organisms is aided by the ability to characterise Candida to the species level. CHROM agar is a rapid, easy, and low-cost method for identifying such species.

69. Prevalence of Candiduria and Characterisation of Candida Species in Urinary Tract Infections from a Tertiary Care Hospital
Sangeetha C Patil, Surekha Y A, Vanitha Shree T.V, K. Ram Mohan Reddy
Abstract
Introduction: Candida species are the most prevalent human fungal diseases, according to reports. In recent decades, the incidence of urinary tract infections (UTIs) caused by Candida microorganisms has grown. The purpose of this study was to determine the Candida species responsible for UTIs in tertiary care hospitals. Materials and Methods: Candida species were detected separately using the germ tube test, colony staining on CHROMagar medium, intracellular beta-glucosidase enzyme activity, and glucose absorption pattern in 2868 urine samples acquired from patients with suspected UTI. Results: Out of 2868 urine samples, Candida species were isolated in 87 samples. In our study 40.2%, 32.2%, 16.1%, 10.3% and 1.2% of the isolates were identified as C. albicans, C. tropicalis C. glabrata, C. krusei and, C. Parapsilosis respectively. Patients between the ages of 21 and 40 were related with the largest number of Candida cases, while women were associated with the highest number of Candida cases. Conclusion: C. albicans has been identified as the most frequent fungus responsible for urinary tract infections.

70. Comparative Assessment of Clinical and Functional Outcome of Different Modalities of Meniscus Repair
Bimlesh Kumar Bimal, Rajeev Kumar, Sanjeev Kumar Shukla, Shailesh Kumar, Nishant Kashyap
Abstract
Aim: The objective of the present study was to compare clinical and functional results of meniscus repair treated with various modalities. Methods: The present study was conducted at tertiary care centre north  India for two year s having meniscus injury identified on the basis of clinical examination and MRI findings, the patients were treated with menisceal repair techniques. The study population was made up of 50 that is 30 knees with medial meniscal lesions and 20 knees with lateral meniscal lesions. Results: This study represents a case series of 50 athletes who underwent repair of isolated meniscal lesions of the knee. Cases of discoid meniscal lesions and combined ligament injuries were excluded. The mean age of the patients was 22.9 years ranging from 12 to 50 years. The meniscal injury on right knee was 30 cases and left knee were 20. The most frequent type of tear in the medial meniscus group was the bucket handle tear that was seen in 8 of 30 knees, while the most frequent type for the lateral meniscus group was the longitudinal tear that was seen in 13 of 20 knee. Conclusion: All meniscus repair techniques outside in, inside out, and all inside technique combination of all yields comparative clinical and functional outcome and statistically difference of result is not significant. Excellent to good results were in 99.66% cases.

71. Assessment of Clinical and Lab Profile of Seropositive Celiac Diseases in 1-5 Years Old Children Suffering from Severe Acute Malnutrition
Rajeev Ranjan, Krishna Murari, Brajesh Kumar
Abstract
Aim: The objective of this study was to study clinico-laboratory profile of seropositive Celiac Diseases in Severe Acute Malnutrition. Methods: The present study was single centric hospital based observational prospective study was conducted at Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar for one year. Total 110 children with Severe Acute Malnutrition in age group 1-5 years, admitted in MTC were enrolled and screened for celiac serology. Out of these 100 cases celiac serology was positive in 30 cases with sero-positivity of 30%. Results: Out of total 30 seropositive cases, 14 (46.66%) cases were seropositive for both tTg and only tTg-IgG were positive in 9 (30%) and 7 (23.33%) cases, respectively. Seropositivity of only Serum tTg IgA and only tTg IgG was maximum (4/9, 44.44%; 3/7, 42.86%) in age group 1 while sero-positivity of both tTg-IgA and IgG was maximum (7/14, 50%) in age group 4-5 years. The mean age, mean weight and mean height in seronegative v/s seropositive was1.69±1.24 v/s 2.65±1.54,6.81±1.88 v/s 7.24±2.24 and 74.95±10.20 v/s 81.23±12.49. The difference among the all three parameters was statistical significant (P- value<0.5). While mean MUAC was 11.10±1.41 v/s 11.26±1.17. The difference in MUAC in seronegative and seropositive cases was statistically insignificant (p-value>0.5). The mean age of starting gluten containing diet in seronegative and seropositive group was 8.47(±2.98) and 8.35 (±2.15) respectively. This difference was statistically insignificant (P-value>0.05). Conclusion: Recurrent diarrhoea and blood in stool was common presenting feature on admission in celiac seropositive patients suffering from severe acute malnutrition. Vit. B12 and Folic acid deficiency were also observed as a common finding in seropositive patients.

72. An Observation Assessment of the Aetiopathological Profile of Small Bowel Perforation and its Management Outcome
Santosh Kumar Sharma
Abstract
Aim: The objective of the study was to study the various causes, incidences and clinical features of small bowel perforations and various surgical procedures. Methods: The present study was conducted in the Department of General Surgery, NMCH, Patna, Bihar, India and the duration the study was one year (October 2021 to September 2022)  and all the patients of small bowel perforation of both sexes and of different ages were included. 50 patients were included in the study. The protocol was reviewed and approved by the ethical committees of this institution. Patients were included after taking their informed consent for the study. Results: In the present study, majority of the patients (36%) were of age group 36-45 followed by (28%) 26-35 age groups. There were 40 (80%) males as compared to females 10 (20%). In this study, 35 cases (70%) of perforation were due to peptic ulcers. Next order cases due to trauma consist of 10 cases (20%). Tubercular perforation was seen in 2 patients (4%), and due to Crohn’s disease, only 1 case was found. Typhoid perforation was seen in 1 case. Malignant perforation was in 1 case (2%) which was found to be gastrointestinal stromal tumours after histopathological examination. In this study, free peritoneal fluid was found in 43 cases (86%). Free gas in the peritoneal cavity was found in 40 cases (80%) due to third space fluid collection and escape of bowel gas into the peritoneum, respectively. Mesenteric lymphadenitis and thickened omentum were found in 2 cases (4%) due to tuberculosis and malignancy. Conclusion: Duodenal perforation is the most common cause of small intestinal peforation. Smoking and consumption of alcohol & NSAIDS are the most important risk factors for small bowel perforation. Patients mainly presented with abdominal pain and distension with features of peritonitis. X-ray abdomen suggested of pneumoperitoneum in most of the patients. Resuscitation followed by closure of perforation with omental patch was the most common management procedure done.

73. An RCT: Comparing the Outcome of Nasal Prong and Nasal Mask Interfaces in Preterm Infants on CPAP Support Due to Respiratory Distress
Krishna Murari, Rajeev Ranjan, Brajesh Kumar
Abstract
Aim: This study was conducted to compare the outcome of nasal prong and nasal mask interfaces in preterm infants on CPAP support due to respiratory distress. Methods: A randomized controlled trial was performed at Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for the period of one year.  Results: A total of 148 preterm infants were assessed for eligibility to the study of which 28 newborns were excluded from the study as they did not meet the inclusion criteria. A total of 120 babies were enrolled in the study, of which 12 babies were ventilated due to CPAP failure and 8 babies left against medical advice before the study could be completed and hence were excluded. Finally, 100 participants completed the study. 50 participants were enrolled in Group A (nasal prongs) and 50 in Group B (nasal masks). The mean duration of CPAP administration in Group A (nasal prongs) was 4.536 ± 0.86 days and in Group B (nasal masks) was 5.205 ± 0.614 days (P = 0.0778). Babies in Group A had an average hospital stay of 21.36 ± 5.14 days, and babies in Group B had hospital stay of 24.58 ± 7.31 days (P = 0.7900). CPAP failure was seen in 10 (20%) babies in Group A and 11 (22%) babies in Group B (P = 0.7395). Conclusion: Based on our study, we concluded that the use of binasal prongs and nasal masks as interface during CPAP therapy makes no difference in overall outcome of nasal trauma in the patient. Both were found equally effective and comparable to each other.

74. A Hospital-Based Observational Assessment of the Demographics and Antimicrobial Susceptibility Patterns of Lower Respiratory Tract Infections in Intensive Care Unit
Monti Bori, Anup Gohatre, Ajeet Kumar
Abstract
Aim: The aim of the present study was to assess the distribution and antimicrobial susceptibility patterns of lower respiratory tract infections over a six–month period in the medical and surgical intensive care units of a teaching hospital in UP region. Methods: This was a retrospective study conducted at Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India for the period of 6 months. This institution is an academic teaching hospital and is one of the local tertiary referral units. However, this study was restricted only to the medical and surgical ICUs. Total number of patients (medical and surgical admissions) seen at our Institute during the study period was 1200; out of whom, 200 patients required intensive care. One hundred and forty patients were enrolled for the study after considering the inclusion and exclusion criteria. Results: A total of 140 patients were included in the study, out of which 98 (70%) were males. Amongst different age groups, maximum patients were above 60 y (25%) and the least were between 18–30 y (14.28%). The bacteria were isolated predominantly from the tracheal aspirate (85.72%), compared to broncho–alveolar lavage (14.28%) with a statistically significant difference between them. Out of all the isolated organisms, A. baumannii (n = 44; 31.42%), P. aeruginosa (n = 35; 25%) and Klebsiella (n = 32; 22.85%) were the most positive isolates, S. aureus and Enterococcus were equal (n = 4; 4%). Other pathogenic bacteria were E. coli (n = 12; 12%) followed equal number of Pneumococcus and CONS (n = 2; 2%), S. aureus and Enterococcus were equal (n = 4; 4%). In the gram–negative isolates, A. baumannii was most susceptible to colistin (93.87%) followed by minocycline (81.63%) and amikacin (65.30%). In the gram–positive isolates, S. aureus was equally susceptible to linezolid (75%) and vancomycin (75%); and 100% of the isolates of Enterococcus were susceptible to vancomycin. Conclusion: Gram–negative pathogens were predominantly responsible for lower respiratory tract infections. Moreover, antimicrobial resistance rate was high with the most commonly used antibiotics and also to higher antibiotics such as carbapenems.

75. Outpatient Prescription Audit at a Tertiary Care Center in South Asia
Suryawanshi N. R., Gosai T. R.
Abstract
Background: Globally medicines prescribed, dispensed or sold are inappropriate. Irrational use of medicines includes problems like polypharmacy, overuse, underuse or misuse of drugs adding to burden of morbidity and mortality. There is wastage of resources, drug stock depletions. Prescription audit is a quality improvement process that seeks to improve patient care through promotion of rational use of drugs. This study aimed to assess prescription pattern and prescribing behaviors of the medical professionals according to the WHO-recommended core prescribing indicators at a tertiary care center in the region of south asia. Materials/Patients & Methods: It is a Cross- sectional, Observational study, conducted at a Tertiary care center. Data collected prospectively for a period of 1 month. Total 600 patients recruited. Simple Random sampling method was used. Case record form consisting of all relevant demographic & auditing parameters is used. Hospital Pharmacy dispensing point is used for data collection. Data collection was done by investigators. Evaluation of Prescribing indicators, Patient-care indicators, Health Facility indicators, Other Medication related problems was done. Statistical analysis was done using frequencies, averages/means, and percentages. Results: Total 600 prescriptions were evaluated for the Audit, out of which 46.8% were Male & 53.16% were Female cases. Majority of the study subjects belonged to the age group of 41-50 years (19.33%). The average number of drugs per encounter was 3.95±1.8 and the percentage of drugs prescribed by generic name was 56.75% (n=1348) while 43.24 % (n=1027) of drugs were prescribed with brand names. 32.16 % of the dispensed drugs were not from hospital formulary. Out of total drugs prescribed only 49 (2.06%) were not from NLEM/State EML. In other words, 97.93 % of drugs were prescribed from NLEM/State EML. 38 % (n=228) prescriptions contained at least an antibiotic. The number of antibiotic drugs were 228 (13.30 %.) and percentage of prescriptions prescribed with at least an injection was 5.5 % (n=33). Conclusion: This study on prescription pattern audit done using the WHO core prescribing, patients care and health facility indicators highlights that generating data on morbidity, which forms the basis for preparing the list of essential medicines. Mechanisms necessary for improving prescription practices are suggested. On comparing the current usage of drugs with the standard treatment guidelines will enhance the effectiveness of treatment and render it cost-effective.

76. A Study of Patterns of Prescription of Statins
Ateendra Singh, Rajesh Kumar Jangir, Jitendra Singh
Abstract
Background:  To study the pattern & use of guidelines of prescription of statins at a tertiary care centre. Methods: this study was conducted on Patients with indications for statins presenting to cardiology OPD, Medicine OPD at S.K. Government Medical College, Sikar, Rajasthan, India within a period of 9 months. Results: Atorvastatin was found to be more commonly prescribed (n=179), which is about 73.7% as compared to Rosuvastatin (n=64) which is about 26.3%. In our study, 75 (68.8%) patients of primary prevention group and 104 (77.6%) patients of secondary prevention group were receiving Atorvastatin and 34 (31.2%) patients of primary prevention group and 30 (22.4%) patients of secondary prevention were receiving Rosuvastatin on their prescription. In the primary prevention group, 91 (83.5%) patients were receiving statins according to guideline and 18 (16.5%) were receiving not according to guidelines. In the secondary prevention group, 108 (80.6%) patients were receiving statins according to guideline and 26 (19.4%) patients were receiving statins not according to guidelines. Conclusion: In our study, there were prescriptions with only Atorvastatin and Rosuvastatin. No prescription with other statins was found. Atorvastatin was being more commonly prescribed as compared to rosuvastatin. More than two third of patients in our study were receiving prescriptions according to guidelines.

77. Clinical Profile, Nerve Conduction Velocity Studies & Aetiological Diagnosis in Patients with Peripheral Neuropathy (PN) at a Tertiary Health Care Center
Sumit Biniwale, Jitendra Kodilkar, Asmita More, Devanshu Kakani, Sanjivani Sankhla, Jeetendra Singh
Abstract
Neuropathy is a prevalent chief complaint in Indian clinical scenario with varied aetiopathogensis as causation. This study aims to bring up the most predominant causes and the effective decrease in quality of life as a reflection due to peripheral neuropathies. Objective: This study was conducted to underline the aetiology and create clinical profile of patients suffering with peripheral neuropathies. Nerve conduction study based screening test with the dependent calculation of CAP PRI questionnaire scoring for determination of quality of life was done. Methodology: The design of the study was a prospective observational clinical study. Patients, ages ranging from 18 to 80 years, suspected for peripheral neuropathies with the physician’s advice to undergo NCS were included in the study. Patient evaluation through NCS was done on the day of admission and at the time of discharge if the patient was hospitalized and CAP PRI scores from on a scale of 0 (no), 1 (a bit), 2 (a lot) were calculated. Results: 168 patients, Sex: 130 male and 38 female were screened and enrolled for the study. A high prevalence of neuropathies was observed in type 2 diabetes and the overall prevalence rate was 27.2. Nutritional deficiencies specifically B12 showed a prevalence of 4.2%. Trauma related neuropathies served to make a case of 43.7% in our tertiary care centre. Others remained under AIDP which succumbed and the other aetiologies remain undiagnosed. Conclusion: Trauma related nerve damage remained the reason for highest deformity, disability and reduced quality of life in our study. We did find a prevalent proportion of patients suffering from diabetes related neuropathy which is confirmed by our study. Nutrition related formed an often over looked section of neuropathies though, our study’s results remain to bring them to the forefront.

78. To Study the Association between Early Pregnancy HbA1C and Pre-Eclampsia
Sujithra, Narmadha R, S. Cyril Prabha
Abstract
Background: Pre-eclampsia is a potentially serious condition that may lead to adverse effects in both mothers and neonates. Early detection and intervention may decrease morbidity. It is found that pre-eclampsia is associated with high HbA1c especially when GDM is detected early 1, 2. Aims: To study the association between early pregnancy HbA1C and pregnancy outcomes (pre-eclampsia) and perinatal outcomes (Birth weight). Objectives: To use early pregnancy HbA1c as a marker for pre-eclampsia. Materials and Methods:
Inclusion criteria: All antenatal women attending OPD in a tertiary care centre before 12 weeks of gestation. Exclusion criteria: (1). Overt diabetics. (2). HbA1c ≥ 6.5. (3). Hemoglobinopathies. (4). Anemia(hb<10). (5). Chronic renal disease. (6). Multiple pregnancies.
Patients were selected based on the above criteria. In this study, 100 patients were enrolled, and Blood was drawn for HBA1c levels at their first antenatal visit or before 12 weeks of gestational age along with other routine antenatal investigations. All of them were subjected to a 75gram GTT at 22-26 weeks of gestation, and values were interpreted using (IADPSG 2010/WHO 2013) criteria HbA1c was measured using HPLC (high-performance liquid chromatography) method. The objective of the study was to detect pre-eclampsia in patients with HbA1c (≥ 5.7 & ≤6.5) which is taken as a standard cut-off. Variables studied were abortions anomalies, mode of delivery, maternal weight gain, baby’s birth weight, Parity, previous history of GDM, family history of diabetes, maternal age. Statistical Analysis: Statistical analysis was performed using IBM SPSS version 20.0.The categorical variables were expressed using frequency and percentage. The numerical variables were presented using mean and standard deviation. To find the statistical significance of agreement of early pregnancy HbA1C cut off value with GDM, McNemars test was applied. To find the association of categorical factors with HbA1C chi-square test were used. Results: Pre-eclampsia is associated with GDM14 as seen in previous studies and higher HbA1c level detected in early pregnancy. Its early detection can prevent both the diseases reducing morbidity in both mother and the fetus.

79. Early versus Delayed Initiation of Anti-Retroviral Therapy in HIV–TB Co- Infected Patients on Anti Tuberculosis Treatment
Lawrence. P, Praveen Kumar. M, Sheela Shamini. S, Arunkarki Malayappan
Abstract
Introduction: The optimal time to initiate antiretroviral therapy (ART) in HIV-TB coinfection is challenging due to the higher incidence of TB-Immune Reconstitution Inflammatory Syndrome (IRIS) and other adverse effects. HIV-TB coinfection poses a challenge of drug interaction between ART and antitubercular treatment (ATT) and higher mortality in this subgroup. Previous research has shown that early ART initiation increases the chance of TB-IRIS but decreases HIV-TB-associated mortality. Aim: To assess the proportion of TB-IRIS, CD4 cell count, HIV disease progression and TB treatment outcome during early vs. delayed ART initiation in HIV-TB coinfected patients on ATT. Materials and Methods: The present study was a unicentric prospective comparative clinical trial conducted at the Tertiary care hospital in collaboration with the institutional ART centre from January-2013 to January-2014. After initial screening of HIV-TB coinfected patients, 60 eligible participants were enrolled in the study and further randomly divided into two groups using a simple randomization technique. Group-A (n=30) received ART within 2-8 weeks of ATT initiation and Group-B (n=30) received ART after 8 weeks of ATT initiation. These patients were assessed to compare the proportion of TB-IRIS, CD4 cell count (at baseline, 6- and 12-month interval), HIV disease progression, and TB treatment outcome. The data was statistically analysed using the Student’s T test for baseline parameters and the chi-square test for treatment comparisons between the two groups. A p-value of less than 0.05 was considered statistically significant. Results: There was no statistically significant difference in baseline characteristics and laboratory parameters. Among the 60 patients with HIV-TB coinfection who were initiated on ART, there was no significant difference in proportion of TB-IRIS, tuberculosis treatment outcome or mortality in either of the groups. There was a significant improvement in 6-month (p=0.016) and 12-month (p=0.001) CD4 cell counts in early ART initiation group. Conclusion: The CD4-cell count improvement which is statistically significant in Group-A denotes slower HIV disease progression. With a statistically non-significant rate of increased TB-IRIS in Group-A, it is preferred to initiate ART before 8 weeks (early) in HIV-TB coinfection patients who were on ATT.

80. An Observational Cross Sectional Study on the Relationship between Estimated Creatinine Clearance and Acid Base Status in CKD Patients
Major Durga Shankar, Md. Aftab Alam
Abstract
Background: Chronic renal failure (CRF) is a prevalent condition that is typically detected later in its course. It is a condition that leads to end-stage renal disease and causes a long-term deterioration in renal function. Congenital and genetic abnormalities, renal artery disease, glomerular and tubular problems, and physical factors like stones, trauma, etc. are the main causes of CRF. Our goal was to identify the variables measuring acid-base balance in patients with chronic renal failure (CRF) and the correlation between those variables and creatinine clearance. Methods: From January 2022 to December 2022, this cross-sectional study was carried out at Department of Medicine, Katihar Medical College and Hospital, Katihar, Bihar. This study included 220 CKD cases overall who visited the Department of Medicine during the study period. Results: With the exception of H+ (r= -0.280) and Aniongap (r= -0.266), which have a negative correlation with creatinine clearance, all acid-base balance parameters in the current study had a positive connection with creatinine clearance (correlation coefficient r = 0.282 to 0.378). Only two of them, arterial sodium and potassium (r = 0.078 and 0.055 respectively; p values of 0.247 and 0.420 respectively), did not correlate with creatinine clearance. Conclusion: In this work, we attempted to close the knowledge gap about the relationship between electrolyte and acid-base disorders and eCrCl.

81. Relapses in Children with Steroid-Sensitive Nephrotic Syndrome and Their Predictive Factors
Mithun Kumar, Anshu Kumari, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Abstract
Background: Frequent relapses (FR) are a common occurrence in patients with steroid-sensitive nephrotic syndrome (SSNS). FRs are regarded as one of the key issues because they are linked tohigh prevalence of sequelae. The objective of our study was to assess the various variables that might be connected to the occurrence of relapse in SSNS. Methods: 80 children with SSNS were treated from January 2022 to December 2022 in the department of Pediatrics at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Two categories of study participants were created: FR and infrequent relapses (IFR). The study participants ranged in age from one to fourteen years; 45 individuals had FR (56.3%) and 35 had IFR (43.7%). 55 patients (68.7%) were male, while 25 (31.3%) were female. Results: The prevalence of FR was higher in children living in urban areas and was high across all age categories, with the exception of those aged 1 to 5 years. Regarding age, gender, location of residence, and renal functioning, there was no discernible difference between the two groups. The presence of hematuria, the duration of treatment to respond, and the dose of steroid required were all significantly higher in the FR group. Conclusion: With knowledge of predictors of relapses in SSNS, clinicians can easily spot potential FR and monitor them closely.

82. Study to Evaluate the Incidence of Urinary Tract Infection (UTI) in Febrile Children under age of 5 years and to Assess the Reliability of Microscopic Urine Analysis in UTI Diagnosis
Mithun Kumar, Anshu Kumari, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Abstract
Background: In order to determine the prevalence of urinary tract infections in children who are febrile and to evaluate the reliability of microscopic urine analysis in the diagnosis of urinary tract infections, this study was conducted. The study emphasises the importance of strongly suspecting UTI in febrile children in order to avoid complications in the future because it is frequently missed in children. The purpose of the study was to ascertain the prevalence of urinary tract infection in febrile children under the age of five and to evaluate the reliability of microscopic urine analysis in the diagnosis of UTI. Methods: From July 2022 to December 2022, a prospective study was conducted in the department of Pediatrics at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. From the enrolled febrile patients, urine was taken and sent for regular microscopic analysis, culture, and sensitivity testing. Results: In this study, 120 febrile children were included, and of those, 6 had positive urine cultures, indicating a 5% prevalence of UTIs. For significant pyuria (>5 pus cells/HPF), chi-square analysis was performed, and a sensitivity of 100% and an accuracy rate of 95.8% were calculated. Conclusion: Children who present with a febrile illness frequently have UTI, which should be highly suspected. The gold standard for identifying UTI is urine culture. Urine microscopic analysis is a powerful method that aids in UTI diagnosis.

83. A Comparative Study of Early versus Late Laparoscopic Cholecystectomy in Post Endoscopic Retrograde Cholangiopancreaticography Patients
Abhishek, Deepak Pankaj, Nitesh Kumar, Mohal Kumar, Vibhuti Bhushan, Pradyot Shahi
Abstract
Background: After endoscopic sphincterotomy, it is predicted that early planned laparoscopic cholecystectomy decreases recurring biliary problems and lowers operational morbidity and hospital stay. Our study objective is to determine the benefits of early laparoscopic cholecystectomy over late laparoscopic cholecystectomy in patients who have undergone ERCP at IGIMS in Patna, Bihar. Methods: From January 2022 through December 2022, the Department of Surgery at the Indira Gandhi Institute of Medical Sciences, Patna, Bihar, conducted this prospective study. All patients who had laparoscopic cholecystectomies for CBD calculi following ERCP were included in the study, and they were divided into two groups based on how long had passed between ERCP and the laparoscopic cholecystectomy. Operating time, conversion to open cholecystectomy, intraoperative bleeding needing transfusion, hospital stay, and postoperative complications such infection, CBD damage, and pancreatitis were all taken into consideration when comparing outcomes. Results: In this study, 60 individuals who had choledocholithiasis with cholelithiasis-like symptoms were included. Of those, 22 underwent late laparoscopic cholecystectomy and 38 underwent early laparoscopic cholecystectomy after ERCP. According to a comparative analysis, shorter intervals are linked to lower conversion rates, post-operative blood transfusions, and wound infections, which serve as proxy indicators for lower intraoperative adhesions and other problems. A shorter period is also linked to a shorter hospital stay, which shows less strain on hospital resources and average costs. Conclusion: Endoscopic retrograde cholangiopancreatography performed quickly followed by laparoscopic cholecystectomy is a safe and efficient way to treat cholelithiasis brought on by choledocholithiasis. To verify the results of this study, a bigger sample size will need to be examined for a longer period of time.

84. A Comparative Study of Effectiveness and Safety of Ferric Carboxymaltose and Iron Sucrose in Treating Iron Deficiency Anemia in Pregnant Women
Rishita Ranjan, Seema
Abstract
Background: The most frequent cause of anaemia in the world is iron deficiency, which has serious negative effects on both pregnant women and their unborn children. Currently available options for treatment include red blood cell transfusions, which have an inherent risk and should be avoided, oral iron supplementation, which can be ineffective and poorly tolerated, and intravenous iron, which can be used in patients who are unable to tolerate or respond to oral iron. Iron treatment administered intravenously may lessen the need for allogenic blood transfusions. A novel intravenous iron formulation called ferric carboxymaltose claims to be equally safe and effective as iron sucrose. Given that it allows for the administration of a considerably bigger iron dosage at once, it may even have better compliance. The goal of the study was to assess the effectiveness and safety of IV ferric carboxymaltose versus iron sucrose in treating mild iron deficiency anaemia in second and third trimester pregnant women. Methods: From November 2021 to October 2022, the Obstetrics and Gynecology department at Darbhanga Medical College and Hospital, Laheriasarai, Bihar, conducted a hospital-based, randomised prospective study. To identify iron deficiency anaemia, baseline haemoglobin, peripheral smear, and serum ferritin levels were assessed. 120 pregnant women who met the study inclusion requirements were divided randomly into two groups, with 60 in Group C receiving ferric carboxymaltose and 60 in Group S receiving saline (Received iron sucrose). Three weeks following therapy, haemoglobin levels were measured to evaluate the outcome and compare the two groups safety and efficacy. Results: The age range with the highest prevalence in the current study was 21 to 30 years, which was represented by 80% in group C and 73.3% in group S. The mean age of the study population in groups C and S was similar (25.2±3.54 vs. 24.8±4.58 years). Both groups sociodemographic traits, obstetric history, vital signs, and pretreatment haemoglobin levels were equivalent (p>0.050). 63.3% of the women in group C had post-treatment haemoglobin levels of 11 or greater, compared to 46.7% of the women in group S, and the mean post-treatment haemoglobin levels were similar in group C and group S (11.016±0.789 vs. 10.73±0.821 gm%; p=0.174). In this study, 43.3% of the women in group C had a post-treatment mean increase in haemoglobin levels between 2.0 and 2.5 gm%, compared to 50.0% of the women in group S. Conclusion: Administration of ferric carboxymaltose during the second and third trimesters of pregnancy is well tolerated and has no known clinical safety issues. Even when ferric carboxymaltose was delivered in a significantly higher dosage than iron sucrose, both ferric carboxymaltose and iron sucrose have a comparable safety profile. If intravenous iron therapy is required in the second or third trimester of pregnancy, ferric carboxymaltose should be taken into consideration as the preferred medication.

85. A Cross Sectional Study of Maternal and Perinatal Outcomes in Twin Pregnancy in a Tertiary Care Center
Sadia Farooque1, Seema
Abstract
Background: Multiple pregnancies are linked to higher maternal and foetal risk; as a result, they need special consideration. The purpose of this study was to assess the perinatal outcome and pregnancy problems in twin pregnancies. Methods: From November 2021 to October 2022, a cross-sectional study was conducted on all twin births at the Darbhanga Medical and Hospital, Obstetrics and Gynecology Department, Laheriasarai, Bihar. There were 120 births of twins. Analysis was done on maternal information, prenatal problems, and foetal outcome. Results: The age range of 20 to 29 years and multigravida had the highest prevalence of twin pregnancies at 2.09%. The most frequent foetal presentation was vertex-vertex. The most common delivery method was a caesarean section (76.6%). The most frequent maternal consequence was preterm labour (75%), which was followed by anaemia (60%). Birth hypoxia (35%), intrauterine growth restriction (13.3%), hyperbilirubinemia (10%), and newborn sepsis (3.3%) were perinatal complications. The LBW status of the newborns was 85%. In our study, perinatal mortality was 15%. Conclusion: Improved mother and newborn outcomes in twin pregnancies will result from the utilisation of antenatal care services, the detection and anticipation of problems, intrapartum management, and appropriate NICU facilities.

86. Peripartum Cardiomyopathy: An Overview of Maternal and Fetal Outcome
Shivani Roy, Equra Nafees, Prachitara Das, Renu Jha
Abstract
Background: Peripartum cardiomyopathy, also known as pregnancy related cardiomyopathy, is a rare illness wherein women who have never had heart disease acquire an idiopathic form of left ventricular systolic failure between the last month of pregnancy and five months after giving birth. Several hypothesised explanations have been put forth, such as hormone imbalances, inflammation, viral infections, autoimmune reaction, and genetic predisposition.
Aim: To study the clinical characteristics, perinatal and obstetric outcomes in women with peripartum cardiomyopathy. Materials and Methods: This prospective study was conducted in our Department of Obstetrics and Gynaecology, DMCH, Laheriasarai, Bihar in a total of 20 patients with Peripartum Cardiomyopathy within a period of 1 year (November 2021 to October 2022). Inclusion criteria: (1). A cardiac event developing in the final month of pregnancy or within five months of birth. (2). Lack of a different cause of heart failure. (3). No heart conditions prior to pregnancy. Exclusion criteria: (1). Parturients with a previous heart disease. (2). Pregnant women or women who delivered with a heart disease developed outside the standard time limit. Result: The majority of patients complained of exertional dyspnea, and the mean LVEF was 38% at the time of diagnosis. Three cases of maternal fatalities occurred, and in all three cases, the ECHO revealed global hypokinesia and NYHA Classes III and IV. Two patients who were NYHA Class 4 patients died intrauterinally. 5 patients gave birth to IUGRs. Conclusion: Pre-eclampsia, anaemia, and multiple gestations were linked risk factors that contributed to the bad prognosis for the mother when patients arrived at our clinic with Heart Failure and lower LVEF. It is crucial to identify the disease as soon as possible because its clinical manifestations might be subtle and have a significant risk of morbidity and mortality, particularly in the first three months after childbirth. Taking into account all of these variables, a multidisciplinary strategy (a team consisting of a cardiologist, perinatologist, obstetrician, and anaesthetist) is necessary for a healthy pregnancy result.

87. Role of Routine Urine Culture in Predicting Asymptomatic Bacteriuria in Pregnancy in DMCH Obstetrics & Gynaecology Department
Kumari Jyoti Rani, Shashibala Prasad
Abstract
Background: Pregnancy-related asymptomatic bacteriuria (ASB) might worsen and progress to pyelonephritis and sepsis. In addition to harming the mother, it also has an impact on the foetus by raising the prevalence of IUGR and preterm. The purpose of this study was to ascertain the prevalence of ASB and the importance of routine urine cultures in pregnant women who attended ANC (antenatal clinic). Materials & Methods: 112 pregnant women who attended the ANC OPD in total were enrolled in the study over the course of six months. Inclusion criteria: All pregnant women who are present at the ANC OPD are free of fever and urine symptoms. Exclusion criteria: (1). Frank UTI like symptoms (Fever, dysuria, increased frequency of urination). (2). Any history of taken antibiotics. (3). Any urinary anomalies. (4). Renal calculi. (5). Immune compromised patients (Like HIV, DM). (6). Mid-stream urine sample was collected and subjected for both microscopy and culture sensitivity. Results: Asbestosis was shown to be 17.85% prevalent, peaking at 55% in the second trimester. According to the study, a routine urine culture can accurately diagnose ASB. Escherichia coli was the most prevalent bacteria isolated (60%) and Nitrofurantoin was the most effective antibiotic. The text discusses the neonatal results. However, there were no neonatal deaths reported during the research period. Although there was no evidence linking asymptomatic bacteruria to anaemia and pre-eclampsia, the odd ratio was greater than one. Conclusion: This study demonstrates that ASB occurs often among expectant women. Regular urine cultures in ANC aid in the diagnosis of the illness, and quick ASB therapy can reduce mother and foetal mortality and prevent any obstetrical complications brought on by an ASB flare-up during pregnancy.

88. Case Series of 9 Cases for Rupture Uterus in Scarred and Unscarred Uterus
Sneha Jha, Seema
Abstract
Background: Uterine rupture is an important event leading to life threatening haemorrhage. Incidence varies between 1 in 2000 in develop countries to 1 in 200 in developing countries. Incidence of rupture among unscarred uterus has decreased has compared to scarred uterus due to increase rate of c-section and judicious use of uterine stimulant. Although diminished enthusiasm for TOLAC has decrease the incidence of rupture among previous c section but rates are still higher compared to unscarred uterus. Objective: To study the incidence, outcome on uterine rupture in DMCH, Laheriasarai, Bihar. Method: Retrospective study of case series of 9 patient in Department of Obstetrics and Gynaecology from December 2021 to May 2022 [after taking permission from ethical committee]. Result: 9 cases of uterine rupture out of 2880 deliveries reported with prevalence of 3.1%. 3 cases of previous 2 c-section, 1case of previous 3 c-section, 2 cases of previous 1 c section, 1 case of pre. 1 c-section with twin and 2 case unscarred uterus. Complication like hysterectomy in 33%, PPH in 77%, transfusion in 77%, maternal mortality 1, IUFD in 6 cases [66.6%], systemic infection in [33%]. Conclusion: Uterine rupture is in an cause of maternal mortality, morbidity and fetal mortality. risk factors are previous scarred uterus, multiparity, trauma, number of previous cesarean birth, version. Early diagnosis, rapid management and promotion of institutional deliveries can reduce the risk.

89. Study of Post-Partum Complications in Darbhanga Medical College and Hospital
Soni Kumari, Shashibala Prasad
Abstract
Objective: The post-partum period also known as the puerperium begins immediately after delivery of neonate and placenta and ends 6 weeks after delivery. It accounts for a number of complications seen and need a through assessment for maternal health management. Method: Collection of data from post-natal mothers attending obstetrics & gynaecology department in Darbhanga Medical College and Hospital with post-partum complications starting from June 2022 to December 2022. Results: Of the 162 patients studied, it was seen 65.44% cases were referred from PHC or delivered at home, developed complications and 34.56% cases developed complications during their stay in this institute. Most common complication seen was PPH followed by infection. Conclusion: The rate of complication is higher inhome delivery cases as compared to hospital delivery cases due to lack of trained personnel. Patients should be encouraged to attend antenatal clinics and delivery at different healthcare institute to avoid minor and major complications. Proper attitude and basic knowledge regarding labour delivery and associated hazard can minimize morbidity and mortality.

90. Comparative Study of Conventional Ultrasound with Strain Elastography in Breast Lesions
Priyal Chouhan, Khan Mohammamd Faraz Mohammad Farid Khan, Pranav Kumar Dave, Reshu Sharma, Kuldeep Yadav
Abstract
Breast cancer is the most common cancer among women all over the world. Similar trend is noted in India. An estimated 1.6 lakh new cases were diagnosed in India and 2 million across the world in the year 2018. Five-year survival of patients with breast cancer post-treatment in India is only 60 percent as compared to 89 percent in the United States of America. The high mortality rate in our country is probably due to lack of awareness and delay in diagnosis and treatment. The aim of this study is to compare the diagnostic performance of elastography with that of conventional ultrasound for characterizing breast lump. Material and Methods: A prospective study was conducted to evaluate 61 adult patients of both sexes above the age of 15 years with history of clinically palpable breast lump. An informed consent was taken from all the participants to perform ultrasound and elastography. The lesions were assessed according to BI-RADS criteria on ultrasound and afterwards, in the same sitting, elastography was performed by the same observer assigning the grades and strain score. Simple descriptive analysis, mean, median, proportions and frequency distribution with 95% CI were used in the study sample. Categorical data was analysed using percentage and chi square test. A p-value of <0.05 was considered significant. Results: Out of 61 cases, 56 cases were females and 5 cases were males. This indicated high incidence of breast abnormality in females. 49 cases were found to be benign on elastography. 48 out of 49 cases were found to be benign on cytology. 12 cases were malignant on elastography; on cytology correlation, 11 cases were malignant. 92% of sensitivity and 87% of specificity respectively was seen for ultrasound. Sensitivity and specificity of elastography score was 97.9 % and 87% and that of strain ratio was 92.3% and 97.9%. Combined sensitivity and specificity of 84.64% and 98.31% respectively was noted for cumulative analysis of elastography technique. Conclusions: Our study concluded that elastography is useful in all breast lesions, when used along with conventional grey scale ultrasound. This technique helps to downgrade or upgrade the categorization of the ultrasound breast lesion, subsequently avoids unnecessary cytology or biopsy, which in turn is beneficial as it is cost effective and time saving method and avoids psychological stress or trauma to the individual.

91. Socio-Demographic, Clinical Profile, Predictors and Outcome of Acute Renal Injury in Snake Envenomation
Narendra Kumar Prajapat, Mohammed Riyaz Bhati, Pinki Tak, Hardayal Meena, Rajesh Jain
Abstract
Introduction: Snakebites are a common reason for hospitalization in India. A recently published survey of snakebite deaths in India estimated that 45,900 people die from snakebites in India each year. Rajasthan, Uttar Pradesh, Andhra Pradesh and Bihar have the highest death rates. Local features of a snakebite include pain and swelling. Systemic features include tachycardia, hypotension, pulmonary edema, and renal failure. However, renal dysfunction is the most devastating manifestation associated with snakebite, particularly acute renal failure (AKI). This study was conducted to investigate the various factors that contribute to kidney injury in snakebite patients and to investigate the outcomes of snakebite patients with kidney injury. Method: It is a prospective observational study on 100 snake bite patients. A snakebite is confirmed based on the patient’s medical history and signs, bite marks (dental marks) at the claimed site, and possible identification of the snake (dead or alive – if purchased by patient or family). Patients were followed from admission until 3 to 5 days for the development of AKI, defined using urine output, serum creatinine, or glomerular filtration rate (GFR). Calculate GFR using the Cockcroft-Gault formula. Results: In our study, mean age was 44.60 ±11.6 years. Male to female ratio was 1.56:1 with male dominance. The mean interval between snake bite and presentation was 15.37 hours. Lower limbs were the affected site in all patients and 48% were viper bite. Ninety-eight percent of patients had local signs of inflammation indicating the vasculo-toxic venom. A total of 84% patients had coagulation abnormality and 60% had decreased urine output which were associated with increase severity of AKI. There was need for haemodialysis in 12 patients. Twenty six patients had thrombocytopenia which was not associated with the severity of AKI. Conclusion: From our study, we concluded that common manifestations of snakebite include cellulitis, coagulation abnormalities, and decreased urine output. The overall mortality rate from snakebite-induced ARI is 6%. Time to hospital admission and abnormal coagulation status are predictors of poor outcome in snakebite-induced acute kidney injury.

92. A Clinicoradiological Study and Treatment of Masses in Sinonasal Cavity Presenting at a Tertiary Care Medical Centre
Monika Patel, Sarita Gupta, Geetanjali Jaiswani
Abstract
Introduction: Various etiological factors for the development of sinonasal masses are human papillomavirus 6 and 11, allergens, air pollution, and industrial carcinogens, tobacco, alcohol, and occupational exposure to heavy metals (such as nickel and chromium), particularly for workers in the leather, textile, furniture, and wood industries. Aim and Objectives: To correlate the symptoms, signs with the clinical staging and To correlate the clinical features with the pathological staging. Material and Methods: The present study regarding “Clinicopathological study and management of masses in sinonasal cavity and nasopharynx” was carried out on both the outpatients and inpatients of Department of ENT at Saraswathi Institute of Medical Sciences, Hapur a tertiary care centre from July 2021 to Dec 2022. Only those patients presenting with mass in sinonasal cavity or mass diagnosed after complete clinical examination (including endoscopic evaluation) were selected for this study. Result: In the present study 98.21% study subjects had nasal obstruction, 73.21% study subjects had headache, 48.21% study subjects had bilateral complaint, 23.21% subjects had facial pain and 19.64% subjects had epistaxis. On CT scan 96.43% stud subjects had maxillary sinus involvement, 83.93% subjects had ethmoid sinus involvement, 23.21% had frontal sinus involvement and 32.14% subjects had sphenoid sinus involvement. Conclusions: On the basis of our present study we concluded that the work up, management and follow up of sinonasal mass is complicated by the multiple potential sites and stages of development. On CT scan majority of study subjects had maxillary sinus involvement, followed by ethmoid sinus involvement.

93. A Comparative Study of Pocket Shape Edges of Ridges on both Right and Left Side Thumb Impressions between Male and Female Students at SRVS Medical College Shivpuri Central India
Mahesh Dhoot, Manbahadur Rajpoot, K Vijay Kumar, Shailendra Rawal
Abstract
Introduction: The anatomy of fingerprints consist of ridges, edges on ridges, and different shapes of sweat pores. Ridges are of different shapes like concave, convex, peak, straight, table, pocket, angle, etc. Materials and methods: The study will be carried out on 400 undergraduate students of both sexes in the Shivpuri region, Madhya Pradesh. (Central India). Prints of the Bilateral thumb finger would be taken with printer’s ink and the thumbprints are taken on Executive bond paper treated with the chemical Ninhydrin. And focused under a microscope as latent prints. Results: As per the present findings we found that the highest number of pocket shape edges are 1 in 1 cm ridge. Out of 200 males, 146 males show 1 pocket edge and out of 200 females 84 females show 1 pocket edge in a 1 cm ridge on the right side. Out of 200 males, 73 males show 1 pocket edge and out of 200 females 96 females show 1 pocket edge in a 1 cm ridge on the left side. It is also observed that in 113 males and 82 females’ pocket edges are completely absent on the left side and in 52 males and 70 females’ pocket edges are completely absent on the right side. Conclusion: The study of shapes of edges of ridges of thumb impressions is the authentic method the for determination of sex in the field of criminology, forensic medicine anatomy, etc.

94. Prevalence of Adverse Drug Reactions in Patients of Internal Medicine Department in a Tertiary Care Hospital in West Rajasthan: A Prospective Study
Jai Narayan Kumhar, R.P. Acharya, Vinod Kumar Chhimpa
Abstract
Background: To study the prevalence of adverse drug reaction in internal medicine department. Methods: This prospective observational study was conducted for the duration of six months from June 2014 to November 2014 to analyse the occurrence of ADRs in hospitalized patients of internal medicine department at PBM hospital associated with Sardar Patel Medical College, a tertiary care teaching hospital in Bikaner, Rajasthan. Results: A total of 3892 patients were hospitalized in the study period of six months in the medicine department.  Out of which a total of 54 patients experienced an ADR, giving an incidence rate of 1.4%. Conclusion: Hospital based monitoring of ADR and reporting is an important programme to identify and quantify the risks associated with the use of drugs. This information may be useful in identifying and minimizing ADRs.

95. Evaluate the Adverse Drug Reactions Data Procured from in Patients of Internal Medicine Department in a Tertiary Care Hospital in West Rajasthan: A Prospective Study
Jai Narayan Kumhar, R.P. Acharya, Vinod Kumar Chhimpa
Abstract
Background: This prospective study is carried out to evaluate the ADRs in inpatients of Internal medicine department of P.B.M. Hospital, attached to S.P. Medical College, Bikaner (Rajasthan). Methods: This prospective observational study was conducted for the duration of six months from June 2014 to November 2014 to analyse the occurrence of ADRs in hospitalized patients of internal medicine department at PBM hospital associated with Sardar Patel Medical College, a tertiary care teaching hospital in Bikaner, Rajasthan. Results: The severity of ADR based on modified hartwig scale with gender distribution.  Table shows majority of ADR (59%) comes in mild category followed by moderate category in 41% of study subjects.  No subject shows severe ADR. Conclusion: We concluded that ADR monitoring and reporting by pharmacovigilance programme is needed to provide the optimum patient care.

96. Drug Utilization Pattern in Indoor Patients of Medicine Department at Tertiary Care Teaching Hospital in Southern Rajasthan
Vimlesh Kumar Meena, Rahul Meena, Sumitra Kumari Meena, Sunil Kumar Bairwa
Abstract
Background: Drug utilization studies (DUS) are used as powerful tool in the evaluation of healthcare systems. The principal aim of drug utilization research is to facilitate the rational use of drugs in populations. Present study has been planned to develop baseline prescription pattern of drugs in medicine indoor patients of M.B. hospital and To evaluate the cost analysis of each prescription in the medicine Department at Tertiary care teaching hospital in Southern Rajasthan. Methods: This prospective, cross-sectional, observational study. The study was conducted over a period of 12 months (Aug 2020 – July 2021) in Indoor Patients Of Medicine department, MB Hospital, Udaipur, a tertiary care teaching health center in southern Rajasthan. All the Patients (Male & Female) who were visiting the Indoor Patients Of Medicine department were included. Sample size of 200 prescriptions was taken into consideration. Result:  Total no. patients included were 200. Out of them 124 (62%) were male patients and 76 (38%) were female patients. Clinical diagnosis for which drugs were prescribed are Infectious disease (24%), Respiratory disorders (18.5%), CNS disorders (13%), CVS disorders (9.5%), GIT disorders (9.5%), Urinary tract disorders (6.5%), Endocrine disorders (5.5%), Poisoning (5%), Liver disorders (4.5%) and Anemia (4%). Cephalosporins were the most commonly used antibiotics (28.91%). No severe ADR was reported during the study. Conclusion: The study can be expanded in future including different units of medicine departments, surgery departments to evaluate generalized pattern of drug utilization as well as drug utilization in vulnerable groups including Paediatrics department and Obstetrics & Gynaecology department.

97. Correlation of Adiponectin in Metabolic Syndrome among Newly Diagnosed Patients of T2DM in a Tertiary Care Center of Kumaon Region of Uttrakhand
Seema Gupta, Sanjeev Shukla, Vivekanand Satyawali
Abstract
Introduction: The prevalence of metabolic syndrome (MS)and type 2 diabetes mellitus(T2DM) has reached epidemic levels. Thus there is a need to study novel biomarkers involved in their etiopathogenesis and associated cardiovascular complications. Adiponectin, an adipokine has been implicated in insulin resistance, inflammation, obesity, and atherosclerosis associated with metabolic syndrome. In the Kumaon region, studies regarding adiponectin and its relationship in T2DM and MS patients are lacking, with this the present study was planned. Material and Methods: Eighty seven newly diagnosed T2DM patients, enrolled in this study were divided into 2 groups. Group I comprised 48 cases of MS and rest 39 patients without MS were included in group II. All of the study subjects were assessed for anthropometric, clinical, and biochemical parameters. Results: Lower levels of adiponectin were found in group I than in group II(p<0.001). A significant and inverse correlation of adiponectin was observed with BMI, WC, HOMA -IR, hs-CRP, and triglyceride levels while a significantly positive correlation was seen with HDL-C in both the study groups. However, a stronger and better correlation was observed in the MS group than without the group. Conclusions: Adiponectin was found to be decreased and significantly correlated with raised BMI, insulin resistance, hs-CRP, and dyslipidemias in the study subjects.

98. To Determine the Association between Poly Cystic Ovary Syndrome and Thyroid Function Status in a Tertiary Care Hospital in Western Rajasthan
Garima Khatri, Sunita Bika, Mohan Singh, Mahima Saxena, Khushboo Joshi, Priya Yadav
Abstract
Background: Polycystic ovary syndrome (PCOS), a major and complex endocrine disorder among 5-20% women of reproductive age, is an important health issue which has not yet perceived as a serious concern of public health. Prevalence, aetiology, diagnosis, management, psychological issues, clinical practices and prevention are some most confusing aspects associated with PCOS.  PCOS and thyroid dysfunction are commonly found to occur together and both disorders share some common and overlapping features. The exact nature of this link is yet to be elucidated. Both these disorders cause various metabolic, reproductive and psychological syndromes. So, the present study was aimed to determine the association of thyroid function tests in PCOS patients and also to correlate them to body mass index (BMI) and waist -hip ratio (WHR). Methodology: In this cross-sectional study which was performed in Sardar Patel Medical College and Associated group of Hospitals, total 50 subjects were included, out of which 30 were cases (women with polycystic ovary syndrome) and 20 were controls (healthy women). Thyroid function tests which included T3, T4 and TSH were performed for both cases and controls and anthropometric measurements were done for estimating BMI, and waist hip ratio WHR in both the groups. Results:  Observations of our study show significant higher levels of TSH (3.83 ± 1.73µIU/ml ; p = 0.0005 ),  BMI (25.11±0.57 kg/m2 ; p = 0.0001)   and WHR (0.88 ± 0.01 ; p = 0.0001 ) in PCOS patients than controls ( TSH = 2.48 ± 0.72 µIU/ml, BMI = 23.31 ± 1.06 kg/m2, WHR = 0.85 ± 0.02) while level of T3 and T4 was significantly lower T3 (0.88 ± 0.21ng/ml ; p = 0.03), T4 (6.58 ± 1.62 µg/dl ; p = 0.0061) in PCOS patients than Controls(T3 = 1.01 ± 0.18 ng/ml, T4 = 7.63 ± 0.93 µg/dl). Conclusion: Based on our findings, this study demonstrates strong association of hypothyroidism in women with PCOS. It also indicates high fat distribution in PCOS patients. Females with high BMI and WHR  should be educated about the complications and made aware to loose wait to improve quality of life. PCR and FISH techniques could be helpful in molecular and cell biology researches. Epigenetic studies would also be helpful for finding the nature of this syndrome. Exposure to sunlight is also essential for women with polycystic ovarian syndrome.

99. Does Cadaveric Oath Influence the Mind-Set of the First Year Medical Students? A Study in Andhra Pradesh, India
Adabala N.V.V. Veerraju, Telagareddy Divya Jyothi, Boda Narayana Rao, Anand Acharya
Abstract
Background: Cadaveric oath is a pledge taken by the first year MBBS students on the first day of their anatomy dissection to pay respects to the human remains which remain as their mentor throughout their course. The objective of the study is to assess the influence of the cadaveric oath on the first MBBS students. Materials and Methods: This study would be conducted in the Department of Anatomy, KIMS and RF, Amalapuram after obtaining IEC (Institutional Ethical Committee) clearance. Data is collected by using predesigned semistructured questionnaire from all first year medical students using google forms. Results: The  mean score for question “ 5. You should have respect and sense of gratitude to people who donated their bodies.” is very high (4.89±0.44) and is strongly agreed by 93.3 % of the students. Only 30 % out of 150 students strongly agreed that cadaveric oath motivates them to donate their body for dissection and the mean score is 3.51±1.25. Conclusion: The study proved there is a positive impact of cadaveric oath on the first MBBS students which helps them inculcate the respect and dignity towards their mentor and also helps them in future practice to maintain good doctor–patient relationship.

100. Comparative Study of Intubating Condition and Duration of Action After Administration of Rocuronium Bromide and Vecuronium Bromide in Abdominal Surgery using a Train of Four
Nibedita Sahu, Anija Patanaik, D.V. Ravi Kumar, Ranjita Baksi
Abstract
Background: In this study, we wanted to compare vecuronium bromide and rocuronium bromide using TOF on adductor pollicis muscles with regard to the time of onset, conditions of tracheal intubation, and duration of action. We also wanted to compare the hemodynamic parameters in the patients under anaesthesia where either of the drugs was used to produce muscular paralysis. Methods: This was a hospital-based study conducted among 60 patients who presented with various types of elective abdominal surgical procedures to S.C.B. Medical College & Hospital, Cuttack, Odisha from January 2021 to December 2022 for a period of 2 years, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In a comparison of the meantime for the onset of action between the two groups here, the mean (SD) onset of action in group A (Rocuronium) was 98.60 (7.578) sec and group B (Vecuronium) was 154.80 (20.400) sec, which was statistically highly significant (t value -14.145 and P value 0.000). Conclusion: The advantage of Rocuronium, with its early onset of action, along with good to excellent intubating conditions and cardiovascular stability, makes this neuromuscular relaxant a safe and desirable choice for tracheal intubation in surgical procedures requiring general anaesthesia when there is no anticipated difficulty in intubation.

101. A Comparative Study of Short Term Results of Open Haemorrhidectomy versus Splaped Haemorrhoidopexy
Jayaprakash S., Suganya C., Santhanakrishnan, Tirumalaisamai
Abstract
Background: In this study, we wanted to evaluate the immediate post-operative complication of open haemorrhoidectomy with those of stapled haemorrhoidopexy (PPH). Methods: This was a hospital based prospective comparative study conducted among 100 patients who presented with haemorrhoids surgery to the Department of Karuna Medical College Hospital, Palakkad, a rural tertiary-care hospital, Kerala, from March 2016 to March 2018 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: There was no statistically significant difference in post-operative bleeding, return to normal activity and incidence of postoperative anal stenosis between the two groups. The duration of hospital stays in stapled haemorrhoidopexy group ranges from 1 – 6 days (median 2 days) whereas in open haemorrhoidectomy, it is 1 – 3 days (median 1 day). The p value was < 0.001 which was significant. Conclusion: The conventional Milligan Morgan open haemorrhoidectomy still holds its place as the “gold standard”, while the fascinating stapler haemorrhoidopexy is a good alternative but cannot replace it altogether and further research is needed regarding long term outcome, and the modality of treatment is tailored according to the need of individual patients.

102. Heart Disease in Pregnancy: A Multi Disciplinary Approach
Thennarasi, Nagasutha, Sophia Geraldin Xavarina S., N. Sumathi
Abstract
Background: Cardiac Disease is an important cause of maternal morbidity and mortality both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is 2-4%. It can be congenital or acquired. In developing countries Rheumatic heart disease continues to be the major cause of morbidity and morbidity. Objective of present study was to determine the maternal outcome in pregnant women with heart disease and early intervention. Outcome of the study will highlight the effectiveness of cardiac intervention in appropriate patients and its outcome both  maternal and fetal. Method: It is a prospective observational study. Conducted at Government  Rajaji Hospital, Madurai for a period of 12 months from January 2020 to December 2020. Government Rajaji Hospital is a tertiary care referral centre, a Cemonc hospital where 216 pregnant woman with previously established or newly diagnosed during pregnancy were included in the study. They were registered and monitored from the time of registration and followed up till 12 months postpartum period. Results: Incidence of heart disease in our hospital is 1.3%. Among 216 mothers, 85.6% cases are of Rheumatic heart disease. Most of them belongs to mild moderate valvular lesion. Among 59 severe mitral stenotic heart disease, percutaneous  mitral valve commissurotomy (PTMC) done for 11 cases. 11 of them delivered successfully without any adverse intrapartum and postpartum events. Overall mortality rate of heart disease complicating pregnancy in our institution is 0.4%.

103. A Retrospective Study on Penetrating Injuries Abdomen
Hukam Chand Meena, Khushbu Sharma, Abhishek Sharma
Abstract
Background: Penetrating injuries of abdomen are a major component of surgical emergencies. As it remains one of the commonest reasons for preventable deaths in any trauma systems. Objective: The present study was done with the objective to identify the factors that reduce morbidity, to formulate a better protocol in management and to find efficacy of CT in identifying peritoneal breach and visceral injuries. Methods: A series of 40 patients admitted with penetrating abdominal injuries over the period of 1.5 years (January 2021 to August 2022) in JMCH, Jhalawar, Rajasthan, India were enrolled in this study. Results: The most common age group affected was 31-40 years and male to female ratio was 7:1. The most common cause was found to be assault (80%). Out of 40 patients, 20 patients (50%) were immediately planned for early laparotomy the remaining 20 patients (50%) were stable and were subjected for CT abdomen with contrast. Out of those 20 patients, 18 patients (45%) were showing evidence of peritoneal penetration. Overall 8 patients (20%) were managed conservatively and 32 patients (80%) underwent laparotomy. Conclusion: Young males were predominantly involved. The commonest mode of penetrating injury is by stab wounds to abdomen. Patients with haemodynamic instability were taken for early laparotomy. CT is highly sensitive in predicting both peritoneal penetration and intra-abdominal visceral injuries.

104. The Study and Evaluation of Various Causes of Acute Pancreatitis
Hukam Chand Meena, Khushbu Sharma, Abhishek Sharma
Abstract
Background: With the improvement of socio-economic status in general population risk factors associated with the onset of acute pancreatitis has also increased, making it a formidable cause of mortality and morbidity in recent times. Objective: This study was conducted with the objective to evaluate the causes and severity of acute pancreatitis and to categorize the treatment given. Methods: 100 cases of acute pancreatitis were included in the study which was carried out for 1.5 years (January 2021 to August 2022) in JMCH, Jhalawar, Rajasthan. The common age group affected was 31-40 years with a male to female ratio of 9:1. Results: The most common cause of acute pancreatitis amongst males was found to be alcohol (88.89%) and gallstones amongst females (70%). Majority of cases were of milder severity in both the genders (male =88.89%, female=60%). All the patients were successfully managed conservatively (100%) and zero surgeries were performed. Conclusion:   According to the CT severity index grading system, the most common grade of acute pancreatitis is found to be mild grade, making conservative management treatment of choice which causes an overall decrease in morbidity and mortality of the patients.

105. Nonlinear Analysis (Poincare Method) of Heart Rate Variability in Type 2 Diabetes Mellitus Patients
Harvendra Singh, Kapil Gupta, Hemant Tahilramani, Himanshu Gupta
Abstract
Introduction: Diabetes Mellitus is a chronic metabolic disorder and poses a major medical health burden. The incidence of type 2 diabetes mellitus is increasing globally. Diabetes results in autonomic neuropathy associated with early vagal withdrawal, and increased sympathetic tone. The objective of the present study was to assess cardiac autonomic functions in type 2 diabetes mellitus (DM 2) patients using Nonlinear analysis (Poincare method) of Heart rate variability analysis. Methods: The Present study was performed in Department of physiology including 50 patients of type 2 Diabetes Mellitus (Cases) and 50 Healthy Age, Sex and BMI matched subjects (age range 35-50 years) after obtaining approval from institutional ethics committee of SMS Medical College, Jaipur. SD1, SD2 and SD1/SD2 parameters were used as nonlinear analysis (Poincare analysis) of heart rate variability. Results: Significant decrease of SD1/SD2 and non-significant decrease in SD1 and increase in SD2 was observed in diabetics as compared to healthy controls. No Significant changes were observed in heart rate and blood pressure between DM 2 patients and healthy subjects. Statistical Analysis: Unpaired t test was applied for statistical analysis of data of both groups where P valve <0.05 considered as statistically significant. Conclusions: Nonlinear analysis (Poincare plot method) can be used as an effective method for early diagnosis of cardiac autonomic neuropathy.

106. Comparison of The Efficacy of Different Treatment Modalities in Use for Plantar Fasciitis: A Randomized Controlled Trial
Sunita Kuldeep, Ravi Gaur, Rajeswari Jindal
Abstract
Background: Plantar fasciitis is a common musculoskeletal disorder presenting in the outpatient department of pain clinics. Multiple treatment options are available with limited benefits. Objectives- Thus, the present prospective randomized controlled clinical trial was conducted to compare different treatment modalities in treatment of plantar fasciitis with six months follow up. Materials and Methods: This prospective randomized controlled clinical trial recruited 60 patients with a diagnosis of plantar fasciitis from Dec 2021 till December 2022. The patients in the age range of 20-65 yrs having symptoms of plantar fasciitis of moderate to severe grade for a minimum of 6 weeks were included in the study. Patients with a Body Mass Index > 25, pain in hip, knee, any surgery of the affected lower limb, history of steroid use, psychological disorders were excluded from the study. The patients were randomly divided into four treatment groups: Group A – Conventional treatment with analgesics (n=15), Group B– Heat treatment with silicone heel pad (n=15), Group C – Active plantar fascia stretching with sham calf stretching with 1 mL of 4 mg/mL dexamethasone sodium phosphate, Group D – Active calf muscle stretching with sham plantar fascia stretch (n=15). To assess the pain, disability, and restrictions in activities of daily living Numeric pain rating scale, Foot Function Index & Foot and Ankle Disability Index were recorded at baseline, every week till 4 months & then at 6 months. The effectiveness of each treatment module in improving the functional ability & prevention of its recurrence were recorded. Results: 60 patients with a mean age of 45.7 ± 11.9 years were recruited. Out of 60, 41 were females and 29 were males. The mean BMI was 23.7 ± 1.4. Statistically significant difference was noted in all the groups post treatment with respect to both indices (p<0.05) (Table 2 & 3). The mean recurrence time was 12.4 weeks. On comparing foot function scores, statistically significant difference was found between Group A & B, Group A & C & Group A & D. On comparing foot & ankle disability scores, statistically significant difference was found between Group A & B, Group A & C & Group A & D & Group C & D. Conclusion: The study concluded significant improvement in pain & disability in the group prescribed plantar fascia stretching exercises and inj dexamethasone & calf muscle stretching group than the analgesic group.

107. A Study of Echo-Cardiographic Findings and Factors Affecting Severity of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease Patients
Sandeep Jain, Adil Aziz, Pradeep Jain
Abstract
Introduction: COPD (Chronic Obstructive Pulmonary Disease) is most prevalent respiratory ailment affecting the Indian population and contributes significantly to the mortality and morbidity of the disease. CVE (cardiovascular event) is the most prevalent cause of co-morbidities and the second most common cause of mortality, next to respiratory failure. Most common complication of COPD is Pulmonary hypertension (PHTN). Objectives: 1) To find out the prevalence of cardiovascular involvement in COPD patients. 2) To study the relation between severity of PHTN and culprit-factors, if exists. Material and Method: this hospital based cross sectional study was conducted at Department of Medicine, JNUIMSRC, Jaipur, Rajasthan, sample size was 102  randomly selected cases of clinically suspected COPD who attended OPD or got admitted in the Department. Their data were collected and analyzed with help of suitable statistical software. Result: In the present study, among 102 patients, 82 (80.39%) were males and 20 (19.6%) were female. Majority of the patients (90.19%) were smokers. The mean duration of tobacco use was 30.89± 6.80 pack years. Tricuspid regurgitation was measurable in 42(41.17%) patients. Pulmonary hypertension was observed in 38 (37.25 %) and cor-pulmonale in 20 (19.60%) patients.16 patients (15.68 %) had left ventricular diastolic dysfunction. Mild PHTN was observed in 13 (34.21%) patients. Moderate PHTN was observed in 15 (39.47 %) patients. Severe PHTN was observed in 10(26.32%) patients. As the severity of COPD increases frequency of PHTN also increases. The patients with PHTN were relatively older (p < 0.001). Patients with PHTN experienced significantly more number of exacerbations (p < 0.001). Smoking is also a positive factor in development of PHTN (p < 0.001). Conclusion: Echo-Cardiography is a helpful tool for timely management of  cardiovascular event in these patients.

108. A Study of Correlation of Postprandial Lipid Profile with Carotid Intima Media Thickness in Type 2 Diabetes Mellitus Patients
Siddharth Bharatiya, Maniram Kumhar, Harsh Tak, Vartika Saini, Deepak D, Veer Bahadur Singh
Abstract
Background: Study of Correlation of Postprandial Lipid Profile with Carotid Intima Media Thickness in Type 2 Diabetes Mellitus patients. Methods: In this comparative study in 150 type 2 diabetic patients with good control, duration of disease less than 5 years, with age from 30 to 50 years, body mass index less than 30 and non-smokers,   in department of Department of Medicine, JLN Medical College, Ajmer (Rajasthan) between September 2021 September 2022 with an aim to estimate the fasting Lipid Profile and postprandial Lipid Profile levels Carotid intima media thickness (CIMT) by Doppler ultrasonography and the correlation between variability of fasting Lipid Profile and postprandial Lipid Profile with Carotid intima media thickness (CIMT) in patients with type-2 Diabetes mellitus with duration of diabetes less than 5 years, were studied. They were categorized into three groups namely NN group; NA group and AA group. NN Group included whose both fasting and postprandial lipid profile is normal, NA Group included whose fasting lipid profile is normal and post-prandial lipid profile is abnormal and finally AA Group included whose both fasting and post-prandial lipid profile is abnormal. Results: The highest number of cases with high CIMT were found in Group AA ie (37) 50% followed by Group NA (29) 72.50%, and Group NN (7)19.44%. High. Significant A mean SD difference was observed among the groups. In groups AA, AN, and NN, the values were 1.27±0.16, 1.01±0.16, and 0.75±0.07, respectively. A significantly positive correlation was found between CIMT and postprandial serum lipid profile parameters viz. CIMT and postprandial Total Cholesterol; CIMT and postprandial LDL ; CIMT and postprandial TG ; CIMT and postprandial VLDL and negative correlation was found between CIMT and postprandial HDL. Conclusion:There is a strong correlation between carotid intima media thickness and both fasting and postprandial lipid levels. However, postprandial lipid levels have a greater connection with carotid intima media thickness than fasting lipid levels do. Significant postprandial lipid abnormalities, notably postprandial hypertriglyceridemia, are present in type 2 DM patients. Age, duration of disease, fasting triglycerides and postprandial triglycerides have a significant impact on the CIMT, whereas other variables do not have any significant impact on CIMT. Therefore, we recommend measurement of postprandial lipid profile and CIMT as a part of routine investigatory workup in type 2 diabetes mellitus patients.

109. Comparison of the Laparoscopic and open Methods for Appendectomy Clinical Outcomes
Mahendra K Faliya
Abstract
Background and Aim: The most frequent surgical procedure carried out during emergency surgery is an appendectomy. Both open (OA) and laparoscopic (LA) procedures are still used to perform appendectomy due to a lack of agreement regarding the best procedure. The goal of the current study is to assess the benefits and drawbacks of two surgical approaches, namely open and laparoscopic appendectomy, for this most prevalent abdominal emergency. Material and Methods: This observational study was conducted over the course of two years using data from patients who underwent open or laparoscopic appendectomy procedures for acute appendicitis. Patients undergoing open and laparoscopic appendectomy procedures had their surgical timeframes, conversion rates, complication rates, and length of hospital stay compared. Results: Finally, the study included 150 patients who underwent appendectomy within the designated study period. Of these, 50 (33.33%) underwent laparoscopic appendectomy, and 100 (66.66%) underwent open appendectomy. Laparoscopic surgery took longer to complete and required a longer hospital stay than open surgery, but both treatments had about the same rate of complications. In comparison to the open group, the laparoscopic group had higher incidence of intra-abdominal collection. Conclusion: According to the current study, a skilled surgeon can easily complete a laparoscopic appendectomy. Laparoscopic appendectomy was found to have a lower overall complication rate and shorter hospital stay, but surgical duration was slightly longer. Although there was a modest increase in intraabdominal collection among the laparoscopic group, this did not significantly affect the operative outcome. Although there is no agreement on the optimum strategy, both techniques are still actively used, leaving the decision to the patient and surgeon’s preferences.

110. A Hospital-Based Comparative Assessment of the Outcome of Revision External Dacryocystorhinostomy (DCR) With or Without Mitomycin C
Poonam, Pinki Kumari, Gyan Bhaskar
Abstract
Aim: The aim of the present study was to compare the outcome of revision external dacryocystorhinostomy (DCR) with or without mitomycin C. Methods: This prospective study was conducted on over 50 diagnosed patients with failed external dacryocystorhinostomy who arrived at the Regional Institute of Ophthalmology, IGIMS, Patna, Bihar, India for one year. Results: In 50 diagnosed patients with failed external dacryocystorhinostomy Group A underwent revision external dacryocystorhinostomy with Mitomycin–C and Group B without mitomycin–C. Maximum 40% of the patients were 41–50 age group in Group A (Mitomycin C) and 40.0% in 41-50 age group in Group B (without Mitomycin C). The mean age was 40.3±9.3 and 41.5±10.3 years in Group A and B, respectively (P = 0.800). The mean age of both groups was comparable. There were 12 (48%) males and 13 (52%) females in Group A, 10 (40%) males and 15 (60%) females in Group B. Out of 50 patients, 15 (60%) had left-sided failed dacryocystorhinostomy, and 10 (40%) had right-sided failed dacryocystorhinostom. Conclusion: Mitomycin C has a beneficial effect in preventing reclosure of the dacryocystorhinostomy stoma after revision external dacryocystorhinostomy and no significant complications resulting from its use.

111. A Prospective Hospital Based Cross-Sectional Assessment of the Profile of Ocular Trauma
Pinki Kumari, Poonam, Gyan Bhaskar
Abstract
Aim: The aim of the present study was to assess profile of ocular trauma in patients attending tertiary care center in Bihar region. Methods: This prospective cross-sectional study was carried out in  Regional Institute of Ophthalmology, IGIMS, Patna, Bihar, India for the period of one year. A total of 100 cases with a history of both mechanical and non-mechanical trauma attending the casualty and outpatient departments were considered. Results: Of the 100 cases, 25% (n=25) of ocular trauma was in the age group 20-30 years, and the least number of cases, 3% (n=3), were seen over 70 years. The pediatric age group (17 years and younger) constituted 17% (n=17) of the cases. Ocular trauma was 83% (n=83) in males and 20% (n=20) in females. 80% (n=80) of cases were from a rural background, and 20% (n=20) were from an urban background. In 45% (n=45) of cases right eye was involved, whereas in 40% (n=40) of cases left eye was affected. In 15% (n=15) of cases, both eyes were involved. There were 40% (n=40) close globe injuries, 25% (n=25) open globe injuries, and 35% (n=35) were adnexal injuries. Conclusion: Ocular trauma had male predilection and was common in young adults. The most common cause of eye injuries was automobile accidents. This necessitates the implementation of improved road safety measures in this region. Appropriate eye-protective devices like safety goggles, face shields, helmets, and glasses with special filters to protect from optical radiation must be worn.

112. An Analytical CrossSectional Comparative Assessment of Refractive Error and Related Ocular Morbidities between School Children
Prem Kumar, Sanjeev Prasad
Abstract
Aim: The aim of the present study was to compare the refractive error and related ocular morbidities between school children in Bihar region. Methods: An analytical cross‑sectional study design was adopted to screen school children from randomly selected schools in urban and rural areas of Bihar and duration of the study was 1 year. All children aged 5–15 years that were present in the school on the day of examination were included in the study. Seven urban and eight rural schools were then randomly selected. A total of 1680 students were allocated for the evaluation. Either due to the non‑availability of the consent form or the child itself, 1500 (89.9%) were included for the final evaluation.
Results: Out of 1500 students, 800 belong to urban school and 700 belong to rural areas. The gender distribution between groups was similar (P = 0.6). The proportion of preparatory and secondary students of rural and urban was significantly different (P < 0.05). The coverage of RE services among urban students was significantly greater than rural students. 70% urban students were and 35% rural students in preparatory. The prevalence of RE was significantly higher in urban as compared to rural students. The prevalence of hyperopia was significantly higher among rural students compared to urban school students (P = 0.001). The prevalence of myopia was significantly higher among urban students compared to rural students (P < 0.001). The prevalence of anisometropia was significantly higher in urban students compared to rural students (P = 0.001). The prevalence of strabismus was significantly higher in urban students compared to rural students (P < 0.001). The proportion of rural students with “functional normal vision” was significantly higher than urban students (93.42% vs. 65%). Conclusion: This study revealed that the most common cause of ocular morbidity was refractive error. The majority of the causes were either treatable or preventable. A simple school screening was an effective and an easy method for early detection of ocular problems.

113. Evaluation of Functional Outcome of Surgical Management of Both Bone Forearm Fracture with Locking Compression Plate a Prospective Study
Vikarm Singh Raigar, Ramashish Yadav
Abstract
Objective: This study aims to assess the functional outcome of using a locking compression plate in the treatment of both bone forearm fractures. Methods: The study was conducted at Department of Orthopaedics, Darbhanga Medical College & Hospital, Darbhanga, Bihar, India from August 2020 to August 2022. Patients aged between 18 and 60 years with closed bone forearm fractures were included in the study and treated with a locking compression plate for the radius and ulna. The Anderson et al. Criteria were used to evaluate patients after surgery. Results: The study comprised 50 patients with a mean age of 32.4 years. At six months post-surgery, the mean DASH score was 16.2, indicating favorable functional outcomes. The average time to union was 12.4 weeks. No major complications were reported in any of the patients. Conclusion: The use of a locking compression plate for surgical management of both bone forearm fractures leads to early union and good functional outcomes. It is a reliable and secure method for treating such fractures.

114. Effect of Lockdown Due to COVID-19 on Medical Education: Perspective of Medical Students about Online Classes
Sujata Gupta, Suresh Kotwal, Sonika Sangra, Sudesh Singh, Wahida Kouser
Abstract
Introduction: The World Health Organization declared COVID-19 as a pandemic on 11th of March 2020. This pandemic of covid -19 had serious implications for public institutions especially due to lockdowns. As a result of lockdowns, E-learning has rapidly emerged as an alternative to traditional classroom-based education. The main concerns among medical students is the quality of medical education due to online classes. Objectives: This study was conducted to assess perceptive of online teaching among medical students of new medical colleges of Jammu. Methods: This was a Cross-sectional study conducted among 389 medical students of new government medical colleges of Jammu division of Jammu & Kashmir situated in North India. The survey questionnaire included questions asking about socio-demographic data such as sex, age, phase of study etc. and their attitude towards online classes. Data retrieved from the online survey was entered into Microsoft Excel and then analyzed using SPSS version 25.A univariate analysis was used to explore the associations between sample characteristics and the perception of online classes during the COVID19 epidemic. Results: Majority of students (70.5%) were of view that lockdown has affected their studies .64% were not comfortable with online teaching learning method. 64.5% were not satisfied with this form of teaching and 69.2% don’t want this method to continue in future.61.2 % of students were not sure about overall effect of online teaching on studies while 23.9% were of opinion that online teaching has negatively effected their studies .On applying non parametric tests residence and college of students were found to be statistically significant relationship on the effect on studies. Conclusion: Despite the challenges posed by the covid pandemic, several resourceful initiatives like online learning techniques can be implemented to complete the curricula.

115. Meta-Analysis on Prevalence of Pediatric Community-Acquired Pneumonia in India
Vidhi Arora, Sangeeta Choudhary, Manita Bambha
Abstract
Introduction: A severe inflammation of the parenchymal tissue of the lungs is known as pneumonia. According to the location of acquisition, it can be categorized as community- or hospital-acquired; according to the etiological agents or mechanisms, it can be categorized as bacterial, viral, fungal, aspiration- or ventilator-associated; according to the involved lung anatomy, it can be categorized as lobar pneumonia, bronchial pneumonia, or acute interstitial; and according to the clinical severity, it can be categorized. Aims and Objective: To determine the pooled prevalence of Community-Acquired Pneumonia (CAP) from the included studies. Methods: The literature search was made by using MeSH keywords from ScienceDirect, Google Scholar, Cochrane library, PubMed, and Scopus. PRISMA diagram has been represented to show the steps of inclusion of studies. The statistical analysis has been done by MetaXL for the effective determination of pooled prevalence. Results: The meta-analysis showed the detailed statistical findings of the included studies and p=.000 implies that the pooled prevalence by Fixed Effect and Random Effects is significant in the population. Conclusion: The meta-analysis has concluded that the prevalence of CAP among the pediatric population in India is significant and this finding would help clinicians to make an early diagnosis of CAP by effective tests for the suspected individuals.

116. An Hospital Based Observational Assessment of Ectopic Pregnancy
Priyanka Rani
Abstract
Aim: The aim of the present study was to determine the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out among 100 cases were diagnosed with ectopic pregnancy in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 2 years. Results: 50% of the patients belonged to 20-25 age group followed by 26-30 (30%) and 31-35 age group (15%). According to socio-economic status, 65% belonged to low status followed by low 25%. According to parity, 75% were multipara followed by 15% nullipara. In the present study, 90% ectopic pregnancy was due to fallopian tube. 78% cases had ampullary fallopian tube ectopic pregnancy. The leading risk factors were previous abdominal/pelvic surgery, H/O Infertility, H/O PID, H/O suction evacuation, MTP Pill intake. In some patients multiple risk factors were associated. Conclusion: Early diagnosis, timely referral, improved access to health care, aggressive management and improvement of blood bank facilities can reduce the maternal morbidity and mortality associated with ectopic pregnancy.

117. Assessment of the Association between Severity of Liver Cirrhosis and Thyroid Profile in Patients with Reported with Thyroid Dysfunction
Maya Nand Jha, Ghanshyam Kumar
Abstract
Aim: This study was conducted to study thyroid dysfunction in patients of liver cirrhosis and any association between severity of liver cirrhosis and thyroid profile. Methods: This case-control study was conducted in the Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. A total of 100 liver cirrhosis patients (case) and equal number (100) of healthy controls were included in this study. The study was conducted for the period of one year. Results: A total of 100 liver cirrhosis cases (70 males and 30 females) and 100 apparently healthy controls (65 males and 35 females) were included in the final analysis. The mean age was 49.22 ± 7.22 years for cases and 49.14 ± 6.27 years for controls. Controls as compared to cases had higher free T3 (fT3) (2.45 ± 0.40 vs. 1.60 ± 0.50 pg/ml) and free T4 (fT4) (1.26 ± 0.21 vs. 1.15 ± 0.48 ng/ml), although the difference was significant only for free T3. On the contrary, TSH values of cases were found to be significantly higher as compared to that of controls (3.61 ± 0.95 vs. 3.01 ± 0.66 μIU/ml). Low T3 syndrome and hypothyroidism were common thyroid disorders (23% and 18%), normal thyroidal illness syndrome with low T4 and high T4 were observed among 16% and 12% cases, whereas out of 100 controls, 90 (90%) did not have any abnormality in thyroid functions. Only 8 (8%) cases were diagnosed as normal thyroidal illness syndrome with high T4 abnormality. The association of severity of liver disease was found to be significant only for fT3 levels while a significant increment in proportion of cases with thyroid dysfunction was observed with increase in severity of the disease, i.e., Category A (20%), Category B (70%), and Category C (90.0%). Conclusion: Liver disease cases as compared to controls had significantly lower fT3 levels and significantly higher TSH levels. Mortality rate of liver disease cases with thyroid dysfunction was also found to be significantly higher.

118. A Hospital-Based Study to Investigate Fluctuation of Intraocular Pressure (IOP) and Seasonal Variation of 24-Hour IOP
Shikha Shalini
Abstract
Aim: The aim of the present study was to investigate fluctuation of intraocular pressure (IOP) and seasonal variation of 24-hour IOP. Methods: The present study conducted in the Department of Ophthalmology, DMCH Darbhanga, Bihar, India for one year  and twenty healthy volunteers (10 females and 10 males) were recruited. Each subject received a comprehensive ophthalmic examination including slit-lamp and ophthalmoscopy examination, and no participant demonstrated any signs of ophthalmic and/or systemic diseases or had a family history of glaucoma. Results: The yearly fluctuation curve showed IOP in the summer months were lower than other seasons. This survey began in December and lasted until January. The lowest IOP was obtained during summer and the deviation between the lowest and highest IOP was an average of 0.4-0.5 mm Hg. Both eyes fitting curves yearly showed IOP fluctuation. It demonstrates that the winter months IOP are higher than those in the spring, summer and autumn months.  There was no significant relationship with other individual/environmental confounding factors. When evaluating temperature, IOP was significantly lower on hotter days (β=-0.9, P=0.012, temperature >24°C). The calculated β-value is rising with increasing of the sunshine duration, it gets to -0.5 when day length is above 48242.0s (about 13.5h). Moreover, the trend tests show statistically significant findings in temperature and sunshine duration. Conclusion: IOP is trend to be higher in cold days than warm days. IOP have negative association with both environmental temperature and duration of sunshine. On a season-to-season basis, 24-hour IOP is not highly reproducible in healthy volunteers.

119. A Comparative Clinical Assessment of the Efficacy of Valacyclovir and Famciclovir in Herpes Zoster
Satyadeo Ram, Asha Kumari, Veena Kumari
Abstract
Aim: The objective was to evaluate the efficacy of antiviral agent valacyclovir compared with famciclovir in the treatment of herpes zoster.
Methods: The present study is comprised of 100 patients who developed herpes zoster of both genders. All of the patients that were enrolled gave their consent. The ethical approval from the institutional ethical committee was done. The study was carried out at Department of Pharmacology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India over a one-year period. Data such as name, age, gender, etc. was recorded. All were divided into 2 groups of 50 patients each. Group I patients were prescribed valacyclovir 1000 mg thrice daily, and Group II patients were prescribed famciclovir 500 mg thrice daily. The treatment was given for 7 days.
Results: The result showed that group I had 22 males and 20 females and group II had 18 males and 24 females. The result showed that dermatome in group I and group II involved were thoracic in 30 and 26, lumbar in 6 and 6, cervical in 8 and 10 and trigeminal in 6 and 8 respectively. The difference was non-significant (P> 0.05). The result showed the VAS scores comparison at every follow-up visit between both the groups. The mean VAS scores on the day of presentation, i.e., the baseline scores in both the groups were almost similar, and the difference was not statistically significant. The mean VAS scores in the valacyclovir group were significantly reduced at day 29 (P < 0.05) in comparison to the famciclovir group. Results showed a greater number of totally pain-free patients at day 30, i. e., 40 (80%) patients in the valacyclovir group, while in the famciclovir group, 30 (60%) patients were reported to be totally pain free, although it was statistically insignificant (P > 0.05). Conclusion: In comparison to famciclovir, oral valacyclovir administered for 7 days during acute zoster infection offers significant benefit by providing a well-tolerated and greater resolution of pain while maintaining a favourable safety profile, making valacyclovir more efficacious and a better drug in the management of Herpes Zoster.

120. A Study of Hematological Profile in Patients of Chronic Kidney Disease Undergoing Hemodialysis in a Tertiary Care Hospital, South-West Bihar
Shipra Jyoti, Anam Imam
Abstract
Aim: This study was conducted to know various hematological abnormalities observed in CKD patients undergoing hemodialysis. Methods: The cross sectional study was conducted with the samples received in Department of Pathology from the hemodialysis unit, Narayan Medical College and Hospital, Sasaram, Bihar, India and the duration of the study was one year. A total of 100 cases of age >18 years were studied. All of the patients were undergoing hemodialysis at least 3 months prior to the commencement of study. Results: The cases studied ranged from age group of 20 to 86 years. CKD was more common in males, out of 100 cases, 70 (70%) were males and 30 (30%) were females. Hence, Male Gender was more prone to CKD. In the present study, 95% patients had anemia. Severity of anemia was correlated with the stages of CKD. In present study, 95% patients had anemia and Hemoglobin decreased with increasing stage of CKD. Severe anaemia (<7 gm %) was seen in 15 out of 25 CKD stage 4 patients. Normocytic Normochromic Anemia was present in (90) 90% of the patients of which 74% cases were Stage -5 CKD. Of the 100 patients, 60 (60%) patients showed normal Total leucocyte count, 20 (20%) patients showed Leucocytosis and 15 (15%) patients showed Leucopenia. In present study, although platelet count showed a decreasing trend with increasing stage of the disease, mean platelet count was normal in all CKD stages. Total mean platelet count was 2.24±0.97. In present study, serum iron levels were decreased with increasing of CKD stage but mean Serum Iron was normal in all CKD stages. Total mean Serum Iron was 51.04±34.67. Conclusion: In our study we found that anemia was prevalent 95% cases and the cause of anemia is understood to low erythropoietin levels but the data of that is not available in this study. Hb less than 9 gm% was statistically significant in CKD patients. Normocytic normochromic morphology was seen in majority of anemias.

121. A Hospital Based Retrospective Evaluation of Patients Underwent Laparoscopic Appendectomy at Emergency Theatre
Ashok Kumar, Sunil kumar Ranjan, Mukesh Kumar
Abstract
Aim: The aim of the present study was to study the efficacy of laparoscopic appendectomy, patients’ demographic profile as well as conversion rate of laparoscopic appendectomy to open appendectomy. Methods: A Hospital based retrospective study of patients who had undergone laparoscopic appendectomy at emergency theatre of Government Medical College, Bettiah Bihar for the period of one year was included for this study irrespective of age and sex. Total 50 patients were included in the study. Results: 30 patients out of 60 patients who had undergone emergency laparoscopic appendectomy were between 20 years to 40 years of age. During this, it was found that most of cases (44 out of 50, i.e., 88%) were diagnosed as acute appendicitis, 1 (2%) case as appendicular lump, 2 (4%) cases as appendicular abscess, 3 (6%) cases as appendicular perforation peritonitis. Most of the patients were presented with complains of pain localized in lower abdomen associated commonly with vomiting. The duration of hospital stay was shorter as 3 days for most of the patients (40%) under study. Conversion rate from laparoscopic appendectomy to open appendectomy was only 10% with cause being uncontrolled bleeding, perforation of base of appendix and appendicular lump, without any known mortality and case of redo during period of this study. Conclusion: Laparoscopic appendectomy is safe and efficient procedure with shorter hospital stay and less post-operative complication.

122. A Cross-Sectional Assessment of the Factors Influencing the Quality of ANC Services in Health Facilities
Binish Inam
Abstract
Aim: The objective of this study was to determine factors influencing the quality of ANC services in health facilities in Gaya district of Bihar. Methods: The study adopted a quantitative approach to determine factors influencing satisfaction of the quality of antenatal care services in selected health facilities in Gaya district. Cross-sectional survey design was used in this study. A cross-sectional research design was suitable in that it facilitated for a critical analysis of the relationship of several variables that were up for evaluation. A sample of 500 expectant mothers randomly selected for the study. Results: It was revealed that most of the participants were aged between 20-34 years who accounted for 60% followed by those aged between 35-49 years, which stood at 25%. The two age groups together accounted for 85%, which is regarded as the suitable reproductive age group and good candidates to get feedback from on ANC services. Further, 350 (70%) of the beneficiaries of ANC were married making it a larger proportion of participants having their partners motivating them on the importance of ANC. There was a strong positive correlation between the variables: quality of ANC service and patient satisfaction, the relationship was not very strong as most of the dimensions of ANC were influencing satisfaction slightly above. The empathy dimension was regarded to be the major predictor as it was rated highly in influencing for satisfaction with a Cronbach’s alpha score of above 0.8. However, the cost of service showed a strong negative correlation in relation to satisfaction. Conclusion: The study concluded that ANC services provision has an influence on the expectant mothers’ satisfaction. Different dimensions of antenatal care services influence satisfaction differently and a combination of several dimensions posts increased satisfaction.

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

124. A Hospital-Based Assessment of the Diagnostic Accuracy of in Order to Determine its Usefulness in the Planning of Parotid Gland Surgery
Fauzia Perveen, C.P. Jaiswal
Abstract
Aim: The aim of the present investigation was to assess the diagnostic accuracy of FNAC, on parotid gland swellings, in order to determine its usefulness in the planning of parotid gland surgery. Methods: The present study was conducted in the Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India and 100 patients were included in the study for the period of 2 years. All patients underwent FNAC under US guidance following clinical examination. In order to obtain homogeneous and comparable data, only FNAC performed in the Institute were considered. All details regarding demographic and clinical data, including age, sex, previous surgery, timing of symptoms, cytological and histological results, site and volume of the lesions, involvement of histological sample margins and relapses were saved in an electronic database. Results: FNAC samples were obtained in 100 cases. FNAC results were “non-diagnostic” in 22 cases (22%), “inflammatory/ benign lesion” in 70 (70%), “malignant neoplasm” in 8 (8%). In the present study, pleomorphic adenoma was in 45 patients (56.25%) and Warthin’s tumour in 20 (25%). Adenocarcinoma (2.14%) was the most common malignancy, followed by Mucoepidermoid carcinoma (2.5%) and squamous cell carcinoma (2.14%). The most common histopathological diagnosis was “benign lesion”, that occurred in 70 patients (87.5%). FNAC showed a sensitivity of 81% and a specificity of 99%. Accuracy for malignancy was 97%, accuracy for a benign lesion was 83%, overall diagnostic accuracy was 97%. Conclusion: Our study suggests that preoperative FNAC plays a useful role in the accurate diagnosis of parotid tumors. It is a safe and effective diagnostic modality for the treatment of patients with parotid tumors. Fine needle aspiration cytology is a reliable, cost-effective, well tolerated and an easy procedure to perform.

125. Comparative Assessment of the Efficacy of Triamcinolone in the Prevention of Recurrence of Keloids in the Pinna
Raj Kumar Pathak, Shambhu Saran
Abstract
Aim: This study was done to determine the efficacy of Triamcinolone in preventing recurrence of Keloid. Methods: 50 patients who underwent excision of keloid in a  Department of ENT, Darbhanga Medical College and Hospital Laheriasarai, Darbhanga, Bihar, India from December 2016 to November 2017.  were included in this study. They were divided randomly into two groups of 25 patients each. Surgery alone was performed in 25 patients and surgery with post-operative intra-lesional Triamcinolone injection was given weekly interval for 6 weeks in another 25 patients.  Patients were followed up for 1 year at every 3 months intervals. Results: In the age group of 11-20 years there were 20 patients. In the age group of 21-30 years there were 10 patients. In the age group of 31-40 years there were 16 patients. In the age group of above 40 years there were 4 patients. There were 48 female patients and 2 male patients. Recurrence was present in 7 patients at the end of 1 year. P-value was 0.02 which was significant. Conclusion: Thus it can be concluded that multi-modality treatment would fare better in preventing recurrence. However the best dosing schedule for steroid injections with regards to the amount of intralesional steroid to be given and the dosing frequency for the best possible results need to be determined.

126. Etiology and Staging of Neovascular Glaucoma: An Observational Study
Sanjeev Prasad, Prem Kumar
Abstract
Aim: The aim of the present study was to identify the most common cause and the frequent stage of presentation in patients with neovascular glaucoma. Methods: The present study was a prospective observational study, 120 eyes of 100 patients who underwent ophthalmological examination and diagnosed as having neovascular glaucoma in one eye or both the eyes at Department of ophthalmology, Lord Buddha Koshi medical college and hospital, Saharsa, Bihar, India were included in the study for the period of one year. Results: The present study was conducted in 120 eyes of 100 patients out of which 90 patients had either eye involvement and 15 patients had both eyes involvement. All Patients were aged between 14–84 years with a mean of 57.59 ± 12.6 years. Out of 100 patients, 80 (80%) were males and 20 (20%) were females. In the present study, most of the patients i.e., 60 (50%) presented in rubeosisiridis stage, 36 (30%) in angle closure stage and 24 (20%) in open angle stage. Out of 120 eyes, 78 (65%) had diabetic retinopathy in variable severity, 15 (12.5%) had inflammatory etiology, 12 (10%) had retinal vein occlusion and 12 (10%) had glaucoma (PXG and absolute glaucoma). Mean IOP in Angle closure stage is significantly higher than the mean IOP in other two stages (P = 0.000). Whereas there is no statistically significant difference between the mean IOP in rubeosisiridis stage and open angle stage (P= 0.950). Conclusion: In the present study, it was found that Proliferative diabetic retinopathy is the most common cause and rubeosisiridis is the most frequent stage of presentation in NVG.

127. To Evaluate Accuracy of Ultrasonography and Magnetic Resonance Imaging in Characterizations of Adnexal Lesions and its Correlation with Post Operative Histopathology
Anulatha Holla, Ashu Dixit, G Gurushankar, Ashish Dubey, Anand S.H., Apoorva Pooja, Anugrah Suresh, Samudyata, Skanda Udupa
Abstract
Introduction: Adnexal lesions are one of the most common gynecological pathologies are benign in nature, but the malignant ones (10 percent) if not timely intervened can be lethal. When there is a clinical suspicion of adnexal lesions primary modality of choice for diagnosis will be always ultrasonography with Doppler study. About 20% of assessed lesions could be deemed sonographically indeterminate. In such cases Magnetic resonance Imaging will be performed and comparing results of both modalities with gold standard procedure Histopathology of patients will be done. Accurate diagnosis will aid in further management. Aim of the study: To evaluate accuracy of Ultrasonography and Magnetic resonance imaging in characterizations of adnexal lesions and its correlation with post operative histopathology. Results: In the present study age distribution varied from 15-60 years majority were noted among 31-35 years constituting 24.3%. Main symptom was abdominal pain followed by abdominal discomfort. Most common histopathological diagnosis was hemorrhagic cyst ovary constituting to 21.6% among benign lesions, serous cystadenoma ovary constituting to 10.8%. Ultrasonography correctly detected all benign adnexal pathologies, however, MRI detected malignant lesions such as serous cystadenocarcinoma and mucinous cystadenocarcinoma which were diagnosed as benign lesions in Ultrasonography MRI pelvis showed sensitivity of 97%, negative predictive value of 75% over Ultrasonography which showed sensitivity of 88.8% and negative predictive value of 75%. Conclusion: As in few cases ultrasonography fails to accurately differentiate neoplastic etiology, MRI due to its excellent soft tissue characterization and anatomical delineation gives conclusive results.

128. Comparative Study of Ultrasound Guided Intra Articular-Triamcinolone Injection vs Platelet Rich Plasma in Active Phase of Adhesive Capsulitis
Ravishankar J, Sunil Kiran, Veeranna HD, Ashish Dubey, Anuj Dixit, Anulatha Holla
Abstract
Introduction: Unknown in its cause, adhesive capsulitis is a crippling shoulder ailment. There is a considerable reduction of both active and passive range of motion in addition to discomfort. Incidence rates range from 3% to 5% annually in the general population and can reach 30% in diabetics. Benign neglect, oral corticosteroids, intra-articular corticosteroid injections, intra-articular hyaluronic acid injections, physical therapy exercises, deep heat modalities, manipulation under anaesthesia, hydro dilation, and surgical release are few of the recommended treatments. A sample of autologous blood with platelet concentrations above baseline is referred to as PRP. Given the new advent of PRP as a biological agent promoting healing. Aim and Objectives of the study: To compare the efficacy of Ultrasound guided single intra-articular Triamcinolone VS Autologous Platelet Rich Plasma in active phase of Primary Frozen Shoulder, in terms of patient outcome and improvement in range of movements of shoulder joint. Materials & Methods: A prospective randomised interventional study conducted on 56 participants in central India who were selected according to inclusion & exclusion criteria’s. Participants were segregated randomly into Group A with intervention with PRP & group B with Triamcinolone injection to the shoulder joint. The participants were evaluated for functional range of movements, Visual analogue scale and SPADI score at the time of the injection, at the end of 6 weeks, 12 weeks & 18 weeks. Results: At 18 weeks, PRP treatment significantly improved the shoulder’s active and passive range of motion, VAS, and SPADI scores compared to corticosteroid treatment. No major adverse effects were observed. The improvement in VAS score, SPADI scores, ROM in participants who received PRP injections was statistically more significant in comparison to participants who received steroid injections as inferred by P value of <0.001. The complications like nausea, vomiting, skin rashes & hypotension occurred more in PRP group, they were transient and statistically not significant. Conclusion: In terms of the autologous nature of PRP and economic effectiveness, this study shows that a single PRP injection is superior than a corticosteroid injection.

129. Pediatric Cataract and Surgery Outcomes in Eastern India: A Hospital Based Study
Sandeep Kumar Tripathy, Udayanath Behera, Bibhujit Padhy, Prashant Kumar Panda
Abstract
Background: The current review of pediatric cataract cases operated between two years in the tribal dominate state in eastern India was carried out with the objective of profiling the cataract cases. Aim: We present the profile of cataract cases in children in under age 18 years and postoperative visual status in the eyes operated upon. Methodology: In a hospital setting, this cohort study used retrospective medical record retrieval. Pediatric ophthalmologists examined children and performed cataract surgery on their eyes. Personal information, as well as preoperative, intraoperative, and postoperative details, were recorded. In most cases, the surgical procedures included cataract extraction, intraocular lens implantation, posterior capsulorrhaxis, and anterior vitrectomy. We assessed the visual status of cataract patients before and after surgery. We conducted a univariate parametric statistical analysis. Results: Cataract affected 625 of 552 children’s eyes. Cataracts were bilateral in 71 children and unilateral in 481. Congenital cataracts were present in 97 (17.6 percent) of the eyes. Traumatic cataracts were found in 187 (33.9%) of the eyes. Males had a higher proportion of cataracts than females. There was a difference in the ‘number of cataracts’ between age groups. In 91 (16.4 percent) of the eyes, the vision after surgery was better than 6/18. In 243 (44 percent) of the eyes, vision could not be assessed. Conclusion: Early detection of cataract in children requires improved child health care. It is necessary to investigate and address the role of rubella and trauma in childhood cataract. Visual evaluation and postoperative care should be improved further.

130. Assessment of Anterior Knee Pain with Ultrasonography: A Comparison with Clinical and MRI Results
Omprakash Rathor, Om Prakash Shah, Om Prakash Suthar, Rajendra Didel
Abstract
Background: Anterior knee pain is a frequent clinical problem. It provides a common challenge to diagnose and manage. In this study we clarified the diagnostic accuracy of ultrasonography as a fast imaging technique in the assessment of patients with AKP and in comparison of the clinical and MRI assessment. Material and Method: In this prospective study we examined 178 Knees of 150 patients by clinically, Ultrasonographic and by MRI in patients who complain anterior knee pain. Result: The most common age group was between 25 and 35-year-old (35%). 28 patients (18.6%) had bilateral AKP. 32 knees showed positive MRI only, and 128 knees showed positive ultrasonography and MRI. Joint effusion was the most common finding (38%)followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%) by both ultrasonographic and MRI. The overall accuracy of ultrasonography was 83.4% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 90.5% for joint effusion, and 84.9% for Supra patellar fat impingement. Conclusion: Ultrasound can be a good alternative for Orthopaedic surgeon to management of anterior Knee Pain where patient need urgent treatment, in MRI unavailability and in contraindication of MRI.

131. Role of Autologous Platelet-Rich Plasma in Thin Endometrium in In Vitro Fertilization
Vineet Mishra, Zainab Raja, Rohina Aggarwal, Sumesh Choudhary, Kunnur Shah, Meet Patel
Abstract
Background and Aim: Patients with infertility still face unresolved issues related to thin or damaged endometrium. Endometrial thickness (EMT) is empirically preferred to be >7 mm among doctors, and refractory thin endometrium, which does not respond to conventional medical therapy, may be the cause of recurrent implantation failure (RIF). In the present study, we conducted Platelet-Rich Plasma (PRP) treatment and investigated its effect on the refractory thin endometrium. Material and Methods: 120 patients were the participants of a prospective study that ran from March 2022 to March 2023 at the Tertiary Care Teaching Hospital in India’s Department of Gynecology. After more than two cycles of prior medical therapy for enhancing the EMT, the primary inclusion criteria were EMT of less than 7 mm. From menstrual cycle day 10 of their frozen-thawed embryo transfer (FET) cycle onward, the participants received treatment with intrauterine infusions of autologous PRP twice or three times. ET was carried out three days after the final autologous PRP infusion. Results: The final oestrogen priming day or the previous-cycle hCG injection had a mean EMT of 5.4 mm. Thirty percent of the patients (n = 36) had the gestational sac verified. (n = 24) The live birth rate was 20%. All of the current pregnancies ended in live births free of obstetric issues. After receiving PRP therapy, the mean EMT was 6.2 mm. The EMT had an average increase of 0.7 mm. This distinction, nevertheless, was not statistically significant. The results of the treatment cycle were contrasted with those of each patient’s most recent ET cycle, which served as the control cycle. In the treatment cycle, the rates for clinical pregnancy, live births, and implantation were 12.6, 30, and 20%, respectively. Conclusion: An innovative method for helping infertile women with thin, resistant endometrium conceive more often is autologous PRP. PRP is free of adverse effects because it is made from the patient’s own blood. Also, because it is readily available, affordable, and administered locally, it can be a blessing for patients who are infertile.

132. Evidence of Tuberculosis as a Surgical Disease: A Prospective Observational Study
Rajesh Kumar Dora, Abhilash Panda, Dhirendra Nath Soren, Amar Kumar Behera, Debashisha Roy
Abstract
Background: Tuberculosis has been an enigmatic problem for surgeons and physicians alike since time immemorial. Many reviews have been done by different authors and attempts have been made to find out the signs, symptoms and early diagnosis of the disease. Even with the modern diagnostic aids, the diagnosis of this disease remains a dilemma. Aims and Objectives: The purpose of this study is to analyse various patterns of surgical manifestation of Tuberculosis, outline a scheme of management including the various surgical procedures available and correlate the histopathology findings. Material & Methods: All the cases of suspected Tuberculosis that are admitted in the Department of General Surgery, M.K.C.G Medical College and Hospital, Berhampur from August 2018 to July 2020. Cases were included according to the inclusion and exclusion criterias, and approval from the ethical committee was obtained. Patients were included after proper informed consent. Patients were subjected to biochemical, microbiological and radiological investigations, and their sensitivity and specificity were calculated. Patients were managed either conservatively or surgically, and the requirement of surgery in tuberculosis cases has been studied extensively. Observations and Results: Out of 83 patients in our study groups, most of the patients were in their 3rd or 4th decade of life, males were more affected when compared to their female counter-parts, maintaining ratio of 1:18. In the present study 78.5% of abdominal tuberculosis presented in acute manner and 21.2% with chronic features. Acute symptoms present in 63.6% of tubercular empyema. 14.28% of tubercular psoas abscess presented acutely and 85.72 % with chronic features. Loss of weight (90.36%) was the most common symptom of abdominal tuberculosis in my study followed by malnourishment and pallor (87.97 %). In tubercular empyema thorax 90.9% presented with chest pain followed by fever in 72.7% of the people. All the patients of tubercular lymphadenitis or cold abscess presented with fever followed by pain in 78.2% of the people. In present study 71.2% cases of abdominal tuberculosis had haemoglobin <11gm%, 80.8% of cases had ESR >30mm, in 76.14% CBNAAT was positive and in 30.38% cases Montoux Test. Conclusion: The most common age group of presentation was 21-30 years in the present study. Among the total 83 cases studied, 63 (75.9%) required surgical management according to the site of the lesion and pathology observed. Hence surgical intervention is an important aspect in the management of patients with TB with acute and chronic manifestations. The most common presenting symptom was weight loss followed by evening rise of temperature. Among the laboratory investigations done, CBNAAT was found to be more sensitive and specific than Mantoux test. Hence CBNAAT was considered as the gold standard test in this study. Among histopathological studies epitheloid granuloma with necrosis was the most common finding.

133. Retrospective Observational Study of Increasing Trend of Carcinoma Breast in Rural Region
Sunil Kumar Saxena, Jitendra Singh Dangi, Shalini Hajela, Ashish Kumar Dubey, Smriti Pandey
Abstract
Background: Breast cancer is a major global cause of illness and mortality. Breast cancer is still a serious public health problem despite improvements in diagnosis and treatment, especially in rural areas with limited access to medical facilities and screening program. Objective: This retrospective observational study aims to investigate the increasing trend of carcinoma breast in rural regions and identify factors contributing to this trend. Material& Method: Data were gathered from the medical records of individuals who received a breast cancer diagnosis throughout a five years period, from 2016 to 2022. Women with breast cancer who lived in rural areas and sought hospital treatment were included in the study. The patients’ demographic information, clinical traits, and therapeutic outcomes were examined. Results: The study discovered a significant upward trend in incidences of breast cancer in rural areas, with older age groups having a higher incidence rate. In contrast to metropolitan areas, there was a noticeable delay in diagnosis and treatment in rural areas. The increasing tendency was linked to reasons such as a lack of knowledge, ineffective screening programmes, and restricted access to healthcare services. Conclusion: In order to address this rising trend in breast cancer, the findings point to the necessity for better screening program and access to healthcare facilities in rural areas. Public health initiatives should emphasize raising breast cancer awareness and educating the public, especially elderly women in rural regions. Further investigation is required to pinpoint additional variables fueling the trend and to create practical countermeasures for prevention and early detection of carcinoma breast in rural regions.

134. Study of Fine Needle Aspiration Cytology (FNAC) for Diagnosis of Lesions of Liver Diseases Guided by Ultra Sound at GMCH, Bettiah, West Champaran, Bihar
Anita Kumari, Swanyakar Kaushalendra, Pradeep Kumar Singh
Abstract
Background: The main justification for fine needle aspiration (FNA) of the liver is the evaluation of mass lesions. Only the cytomorphological features can be used to diagnosis the majority of FNA biopsies of hepatic masses. It’s a good idea to have a backup plan in case the backup plan doesn’t work. The cytopathologist may gather significant information to include into the final diagnosis through discussions with radiologists and doctors on site. The main goal of a liver FNA is to evaluate a hepatic mass. FNA biopsy is quite beneficial for evaluating both non-neoplastic and particularly malignant mass lesions of the liver. Methods: From October 2018 to September 2019, this study was undertaken at the GMCH in Bettiah, West Champaran, Bihar. 78 male and 38 female patients with suspected liver diseases were assessed using FNAC and cytological techniques. Results: Fine needle liver aspirations were performed on 116 individuals. 38 women and 78 males were present. Ages of the individuals ranged from 2 to 92. The majority of patients underwent an ultrasound scan prior to the FNAC, which revealed further abnormalities and was thought to be suggestive of cancer. Several of the patients might have developed abscesses. There were 116 individuals, and 92 malignant lesions and 24 neoplastic lesions were suspected. Conclusion: Using Fine Needles for Aspiration Cytological diagnosis of liver lesions appears to be a trustworthy, secure, and cost-effective approach.

135. Maternal and Perinatal Outcome in Women with Gestational Diabetes Mellitus: A One Year Cross Sectional Study at SKMCH, Muzaffarpur, Bihar
Minakshi Bajpayee, Swarnim Swati, Abha Rani Sinha
Abstract
Background: Initial diagnoses of gestational diabetes include pregnancy-related glucose intolerance, which may have negative effects on the mother and the unborn child. Various maternal and perinatal outcomes linked to pregnancies complicated by gestational diabetes were the focus of the current investigation. Methods: From November 2021 to October 2022, 296 women who had been given a gestational diabetes diagnosis in the Obstetrics and Gynecology department at SKMCH in Muzaffarpur, Bihar, participated in this cross-sectional study. The hospital database’s patient medical records were used to extract maternal and perinatal data. Age, gestational age, parity, delivery method, BMI, infant birth weight, prenatal problems, and maternal and neonatal morbidity and death were all included in the data. All multiple-pregnant women who also showed breech in the delivery room were disqualified. In addition to the measurement of blood glucose levels and standard investigations, the estimation of platelet count and a kidney function test were carried out to assess the results for the mother and the foetus. Results: Of the 296 women who were diagnosed with gestational diabetes, 194 (65.5%) were between the ages of 20 and 30 years, followed by 84 (28.4%) who were between the ages of 30 and 40. Despite early detection and treatment of gestational diabetes, there was a greater prevalence of pregnancy-induced hypertension in 36 cases (12.2%), caesarean sections in 174 cases (58.8%), labour induction in 116 cases (39.2%), macrosomia in 8 cases (2.7%), and premature delivery in 10 cases (3.4%). While there were 10 (3.4%) deaths, there were 86 (29.1%) perinatal morbidities. Common causes of perinatal morbidity included neonatal hypoglycemia in 98 (33.1%) cases, meconium aspiration syndrome in 24 (8.1%), hyperbilirubinemia in 38 (12.8%), and the need for neonatal unit hospitalisation in 74 (25%) cases. 6 (2%) and 4 (1.4%) neonatal and intrauterine fatalities, respectively, were reported. Conclusion: In women with gestational diabetes, the prevalence of maternal and neonatal morbidity and mortality rose. During the 24 to 28 weeks of gestation, a 75 g oral glucose tolerance test was used to screen pregnant women for gestational diabetes. This helped with an earlier diagnosis and prompt care, which reduced problems. With the right gestational diabetes care, pregnancy outcomes may be enhanced.

136. Study of Port Site Infection Prevalence in Laparoscopic Surgery
Mohanish Kumar Sinha, Khurshid Alam, A. P. Singh
Abstract
Background: Even though port site infections are uncommon, they should be assessed and researched in order to raise the standard of healthcare. The benefits of laparoscopic surgery are generally established, but are there any drawbacks, such as infections at the port site? Does undergoing laparoscopic surgery ensure an infection-free recovery period? Complications at the port site are common. We want to know how common port site infections are among patients having various laparoscopic procedures, such as cholecystectomy, appendectomy, and hernioplasty, in our study. The purpose of this study is to determine the frequency and type of port site infections (PSIs) following laparoscopic procedures in patients of all ages. Methods: The study tracked and included patients of all ages and genders who underwent laparoscopic procedures from January 2018 to December 2018 throughout a one-year span. Port sites were carefully checked for any signs of infection, and samples were sent for culture and sensitivity testing if there were any concerns. Patients who underwent laparoscopic procedures were recorded and examined in accordance with predetermined standards to determine the prevalence of PSI as well as the factors influencing its likelihood. The port sites where the infection was suspected were swabbed using standard swab sticks. Results: 4 patients experienced port site infections out of the total sample size of 200. During the surgery, the portsites of both patients were contaminated. Age, sex, the kind of procedure, or the length of hospital stay had no effect on the rate of PSI in our study. Comorbidities or the type of surgery had no similar impact. Chi-square analysis was performed statistically. Conclusions: A rare side effect of laparoscopic surgery is port site infection. The rate of postoperative morbidity has decreased since the development of laparoscopy. Nonetheless, if the port site were unintentionally contaminated, there were found to be high probabilities of PSI.

137. A Prospective Study to Evaluate Diagnostic Laparoscopy Function in Patients with Intraabdominal Malignancy with a Focus on Staging
Mohanish Kumar Sinha, Khurshid Alam, A. P. Singh
Abstract
Background: The objective of this study is to precisely determine the amount of disease, guide appropriate therapy, and prevent needless intervention using staging laparoscopy. Regular laparoscopy prior to laparotomy, particularly in malignancies with ambiguous operability, aids in reducing needless laparotomies. Methods: Individuals with operable intra-abdominal cancers (carcinomas of the gallbladder, stomach, and colon) will have diagnostic laparoscopy, and the results will be compared to the results of the laparoscopy. Assessment of distant metastases (liver/peritoneum/omentum), resectability of the illness, and biopsies from lesions of ambiguous diagnosis are all included in laparoscopy. Results: Out of the 70 patients included in the study, 58 were radiologically operable, and 12 had unclear operability. Only 30 of these 58 individuals had final resection after a diagnostic laparoscopy revealed they could be surgically removed. 28 patients were left, of whom 14 had isolated peritoneal metastasis, 6 had only hepatic metastasis (single or multiple), and 8 had metastases to both the liver and the peritoneum, as determined by frozen section and histological analysis. Conclusion: The number of needless laparotomies that appear resectable on radiography but are discovered to be irresectable on laparoscopy can be decreased with diagnostic laparoscopy. It can help with the diagnosis of unclear cancers for which image guided biopsy is not advised in radiologically treatable illness (e.g. gall bladder malignancy). By collecting a sample from peritoneal nodules or liver nodules and avoiding a morbidly unneeded laparotomy, it also helps to demonstrate metastatic illness.

138. Quantitative C-reactive Protein Levels in Children with Bacterial and Other Meningitis in Cerebrospinal Fluid at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar
Rajesh Kumar Sah, Abhay Kumar, Atul Shekhar, Bankey Behari Singh
Abstract
Background: In both industrialised and developing nations, bacterial meningitis is a substantial cause of morbidity and mortality in children. Individuals with suspected bacterial meningitis require immediate medical attention, however there is a substantial risk of poor outcome due to delayed and inadequate diagnosis. It is possible to enhance the prognosis of an illness with an early and accurate diagnosis of the ailment. Methods: From September 2021 to August 2022, the current study was carried out in the pediatrics department of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar. To confirm the diagnosis, a total of 242 children who were admitted during the research period and had a clinical suspicion of meningitis underwent clinical, biochemical, cytological, and bacterial testing. Also, a quantitative amount of CSF was sent for C-reactive protein measurement using an immuno-turbidimetric latex agglutination test. Results: Only 20 of the 242 meningitis cases brought to the hospital had a positive culture. The quantitative amount of CSF CRP differed significantly between bacterial and non-bacterial meningitis. Conclusion: A useful test to distinguish pyogenic meningitis from tubercular meningitis, viral meningoencephalitis, and other non-meningitis CNS illnesses is the quantitative quantification of CRP in CSF by immunoturbidimetry. It is a simple, quick, accurate, and quick diagnostic test for prompt treatment action. The determination of CRP in CSF also influences the selection of the right antibiotic and the course of treatment.

139. Early Isomerization of Bilirubin in Phototherapy of Neonatal Jaundice at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar
Atul Shekhar, Rajesh Kumar Sah, Abhay Kumar, Bankey Behari Singh
Abstract
Background: Typically, phototherapy is used to treat neonatal jaundice by changing bilirubin into more polar stereoisomers. The blood-brain barrier should allow less of these to pass through. The likelihood of developing kernicterus may be influenced by the rates of photoisomer production and concentrations building up in the circulation. The main 4Z,15E photoisomer of bilirubin’s significant rate of emergence during phototherapy’s initial stages was the focus of this investigation. Methods: Blood samples were taken before, 15, 30, 60, and 120 minutes for 10 infants or at 15, 60, 120, and 240 minutes for 10 infants after the start of phototherapy in 20 jaundiced neonates. Total serum bilirubin (TSB) and the 4Z,15E photoisomer of bilirubin were measured in blood samples. Results: Within 15 minutes, it was possible to observe the significant (p<0.0001) production of the 4Z,15E photoisomer. At 120 minutes, the change in TSB from time 0 was not significant, but it became significant at 240 minutes (p< 0.001). At 2 hours, the 4Z, 15E bilirubin made up to 20-25% of TSB, and it might not have peaked by 4 hours. Conclusion: To find out whether this early change in the equilibrium of bilirubin isomers with different polarity may affect the risk of bilirubin encephalopathy even before TSB starts to diminish, more research is required.

140. Study of Clinical Categorization of Under Five Wheezers at SKMCH, Muzaffarpur, Bihar
Jayprakash Kushwaha, Gopal Shankar Sahni
Abstract
Background: Children are more likely than adults to wheeze; by the time they are 3 years old, 40% of children will have experienced a wheeze episode, and by the time they are 6 years old, 50% of children will have experienced at least one wheeze episode. The study objective was to classify several wheeze kinds among children aged 6 months to 5 years based on their history, clinical profile, aetiology, and risk factors. Methods: All children between the ages of 6 months and 5 years who were admitted to the pediatrics unit at the SKMCH, Muzaffarpur, Bihar, had a known history of wheezing and respiratory distress along with the usual clinical signs. Results: In the age range of 6 months to 5 years, 105 children with recurrent wheeze were examined. In the age range of 0 to 5 years, several children are hospitalised with recurrent wheezing. This research may aid in determining the causes of wheezing, how to classify wheezers, and the risk factors that make these children more likely to wheeze than other children. Conclusion: According to clinical phenotypes, there are several groups for recurrent wheezing in our study, including episodic wheezing (40%) and multitrigger wheezing (42.8%), asthma (12.3%), and gastroesophageal reflux syndrome (4.7%).

141. Assess the Efficacy of Increasing the Metformin Dosage Instead of Adding Empagliflozin to Uncontrolled Type 2 Diabetes Patients
Md. Dilawez Shamim
Abstract
Objective: This prospective observational study’s main aim was to determine whether increasing the dose of metformin rather than adding empagliflozin to individuals with type 2 diabetes who were uncontrolled on it was more beneficial. Method: This was a prospective observational study carried out in Prasad Institute of Medical Science (PIMS) & Hospital, Lucknow that included 100 patients who met the inclusion and exclusion requirements. Upon inclusion, patients were split into two groups, one of which received 1000 mg of metformin OD along with 10 mg of empagliflozin OD (N = 50), and the other of which had metformin up-titrated to the maximum tolerated dose of 1000 mg (N = 50). Results: In the Empa + Met group, there was a considerable weight loss of up to 2 kg over a period of 23 weeks. Despite effective anti-hypertensive therapy in both groups, a statistically significant drop in SBP and DBP (10.1±3.4 mmHg and 7.1±2.1, respectively) was seen in the Empa+Met group, which was not seen in the Met group. Despite the group receiving the recommended amount of lipid-lowering treatment, there was a further statistically significant decrease in total cholesterol, triglycerides, and LDL cholesterol. Conclusion: Instead of increasing the dose of metformin, patients who were initially uncontrolled with metformin monotherapy should be added to empagliflozin 10 mg. If metformin is used with empagliflozin as a second-line treatment, the pleiotropic benefits are improved.

142. A Descriptive Study of Neonatal Vascular Skin Lesions in a Tertiary Care Hospital in Pune
Avdhut B Deshpande, Madiha Mehvish, Sunil Tolat, Anupriya Deshpande
Abstract
The appearance of the skin can provide clues regarding the health status of the neonate such as gestational age or nutritional status. Being aware of common skin lesions found in the neonatal period will alert us to symptoms of systemic or cutaneous disorders. The main aim and objective of our study was to find the vascular skin lesions in neonates and correlate it with their gender and maturity at time of birth.  Our study was conducted on 120 neonates attending the dermatology OPD and neonates admitted in NICU, Pediatric and Postnatal ward of tertiary teaching hospital in Pune. Data was collected and expressed as percentage. We found in our study that Hemangiomas were seen in only 2 female neonates (1.7%), comprising 1 preterm and another full term neonate. In both cases hemangiomas were present over face. A female predominance (3:1) and an increased incidence in premature infants have been documented. We also observed that Port wine stain was seen in 4 neonates (3.3%), 3 preterm and 1 mature neonate. vascular lesions if present at birth should be considered and managed promptly and not just considered it as mere birthmark.

143. To Measure Patients (Consumers) Knowledge and Awareness of Pharmacovigilance, as well as their Involvement in Reporting Adverse Drug Reactions
Shaikh Faseehuddin, Prabodh A. Wankhade, Mahendra M. Gaikwad
Abstract
Background: The purpose of the current study was to conduct drug safety monitoring in tertiary care hospitals with established patient education programmes for adverse drug reactions (ADRs) and to evaluate the role of patients (consumers) in ADR reporting. Methods: Total  300 patients were  enrolled in this study. The subject was chosen using the simple random sampling procedure. The study, which was 6 months long, followed patients from the departments of paediatrics and medicine at Dr. Ulhas Patil Medical College and Hospital in Jalgaon. The study staff has direct contact with the participants. Information was gathered using a Case Recorded Form that Involves an ADR Reporting Form, and then Causality Analysis was used to analyse it (WHO and Naranjos Scale). Consumer data is collected for the test arm (Patients). Information gathered from healthcare professionals makes up the control arm. Data from Consumers and Healthcare Professionals were Converted into Generic Names on ATC (Anatomical Therapeutic Chemical Classification system). Results: More women than men have information about diseases. More educated people than uneducated people knew about diseases. Consumer reports of reactions revealed that 50% were moderate, 25% were mild, and the remaining 25% were severe. Only 12.33% of patients are aware of their drug regimen. 1.10% was reported the ADR. 4.33% of patients told their doctor about their ADR. 2% of patients reported having an ADR. Fifteen ADRS were determined to be Probable, seven to be Possible, and one to be a Definite Type by the causality assessment. Five patients sent us serious ADRs. More serious ADRs are reported by healthcare professionals than by patients. According to the finding, consumer reporting of dermatological ADR was simpler. Conclusion: Reporting an adverse drug reaction (ADR) involves both the prescribing physician, Patients (consumer) and the delivery pharmacist. It is collaborative.

144. Comparative Analysis between I-Gel and Baska Mask in Elective Short Duration Surgeries
Lakshmi Kanta Panigrahy, Girija Shankar Prasad Patro, Malaya Kumar Patel, Ajit Kumar Mishra
Abstract
Background and Aim: The newer spraglottic airway devices (SADs) are designed to decrease the risk of aspirations and to improve the airway seal, at higher airway pressures during intermittent positive pressure ventilation. This study was done to evaluate the efficacy of supraglottic airway devices BASKA MASK and I-GEL by comparing ease of insertion, first time insertion success rate, number of insertion attempts, insertion time and possible complications in elective short procedures under general anaesthesia. Methods: After obtaining Institutional Ethical committee approval, 90 adult female patients of ASA physical status I and II, aged 18-50 yrs. were randomly assigned into two groups: Group B: BASKA MASK and Group I: I GEL. The technique of anaesthesia was standardised in both the groups. The following parameters were compared. Ease of insertion, first time insertion success rate, number of insertion attempts, time taken for device insertion, Ease of gastric tube placement, EtCO2, manipulation, Occurrence of complications like laryngospasm, cough, hoarseness, sore throat, blood staining on the device, soft tissue damage. Results: Ease of insertion was significantly(p=0.006) less ease in Baska group 65.8%,4.8%,29.2% than I‑gel group 81.3%,13.9%,4.65%. The mean insertion time for Baska group (24.58±4.15s) was significantly(p<0.001) longer than I-Gel group( 14.16±2.55s). The first-time insertion success rate of Baska group was only 29/41 (70.73%), compared to I-gel group which was 41/43 (95.34%)(p=.002). The number of attempts required for the placement of the device in Baska mask is more than I gel (p=0.009). Complications like hoarseness, blood stained device, sore throat, were high in Baska mask group. Conclusion: Based on the results of our study, we conclude that I-Gel aids easy and rapid insertion with an acceptable airway seal pressure.

145. Assessing Indications of Caesarean Section among High Risk Pregnant Women by Robsons Classification: A Way of Monitoring Obstetric Practice
Gautami Dhar, Hem Kanta Dev Sarma, Rajesh Das, Rumen Chandra Boro
Abstract
Background: There has been rapid increase in caesarean section (CS) rates in the past decade, leading to increased complications. World Health Organization (WHO) has recommended Robson ten group classification system which have been used in this study to analyse CS at Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Assam. The indications, rate of CS is scrutinised so that only obstetrically indicated CS are carried out. Methods: This hospital based study was carried out for a period of 12 month from 1/1/2021 to 31/12/2021 at FAAMCH. All high risk cases ≥28 weeks who delivered during the said period were taken into account. The data was then regrouped according to Robson’s Ten Group classification. Results: The study reflected overall CS rate being 42.69% with CS rate amongst high risk pregnancies being 53.32%. Most of the women who underwent CS belonged to age group 20-24 years (49%). It was observed that group 1 (24.09%) constituted the largest number of women. However, group CS rate was highest in group 9 (100%). Group 5 made the greatest relative (32.38%) as well as absolute contribution (17.26%). Fetal compromise seems to be the leading cause for primary CS. Conclusions: Robson classification helps in analysing the population catered by a centre to develop strategies for betterment of services. It has limitations in qualitative assessment of the data for comorbidities and severity of the disease.

146. Study of Association of Serum Magnesium Level with the Glycemic Status of Type 2 Diabetes Mellitus Patients
Subrata Bhowmik, Sagar Saha, Kalyan Debnath, Manasi Bhowmik
Abstract
Introduction: Diabetes Increases the excretion of minerals and other nutrients like most of other chronic diseases. Magnesium is the second most abundant intracellular cation, and its concentration remains remarkably constant in healthy individuals. It activates enzymes and acts as important cofactor in many biochemical reactions. Magnesium is required for insulin secretion and proper insulin functioning through tyrosine kinase activity at the receptor level.  Current study has been undertaken to evaluate the association of serum levels of magnesium with glycemic status of type 2 DM patients. Materials and Methods: Sample size calculated to be 100. 100 eligible patients are selected from diabetic OPD from July 2021 to December 2021. It is a cross sectional study.  Our aim is to evaluate the association of hypomagnesemia with HbA1c level in type 2 DM patients. Patients were subjected to history and examination, investigations and analyzed using simple statistical methods. In this study HbA1c>7% was taken as poor glycaemic control. The mean level of magnesium is to be determined in both the groups of HbA1c > 7 and HbA1c< 7 and their statistical association. Observation: The present study included 100 numbers of type 2 diabetes patients. Out of these 56% were male and 44% were female. The maximum number of patients were from >60 years age group. HbA1c>7% was taken as poor glycemic control and the mean magnesium level in the group was 1.6±0.25. HbA1c<7% was taken as good glycemic control and the mean magnesium level was 1.8±0.22. The P value was found to be significant (0.047%). Conclusion: The level of magnesium was lower in patients with poor glycemic status. Hypomagnesaemia was more in high HbA1c group of patients. Therefore, it can be said that magnesium level can act as an indicator of the glycemic status of diabetic patients.

147. Adolescents with Severe Primary Dysmenorrhea Have A Unique Biomarker Called Mean Platelet Volume
Kamlesh Tiwari, Sadhna Singh, Rashmi Singh, Neha Savarna
Abstract
Objective:  To determine whether mean platelet volume (MPV) is a reliable indicator of disease severity in young people with severe primary dysmenorrhea (PD). Method: The study comprised 30 healthy teenagers with regular menstrual cycles and a total of 60 patients with PD. As part of the automated complete blood examination, hemoglobin, MPV, white blood cell (WBC), platelet, lymphocyte, and neutrophil counts were determined. The absolute neutrophil or platelet count was divided by the absolute lymphocyte count to generate the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), respectively. The intensity of the pain was measured using the visual analog scale (VAS), which classified it as mild (30 mm), moderate (30–50 mm), and severe (>50 mm) PD. Results: The combined severity PD and control groups’ MPV levels were comparable. When compared to the control group, the MPV in the severe PD group was, however, considerably lower (p = 0.03). The remaining hematological parameters did not significantly differ between the groups. The mean VAS scores for the control and PD participants were, respectively, 7.34±2.24 and 1.06±1.95 (p < 0.02). Between MPV and WBC, there was a weak negative connection that was statistically insignificant. Conclusion: The results of the current investigation showed that adolescents with severe PD have lower MPV. To better understand the involvement of platelets in the pathophysiology of severe PD and assess the changes in MPV value in response to treatment, additional research with larger subject populations is required.

148. Prepubertal Girls with Vulvovaginitis Clinical and Microbiological Results
Kamlesh Tiwari, Sadhna Singh, Rashmi Singh, Neha Savarna
Abstract
Purpose: To compare genital microbiological results between healthy controls and prepubertal girls who have vulvovaginitis. Method: 50 prepubescent females with vulvovaginitis, ages 1 to 9, and 40 age-matched healthy controls. From November 2021 to May 2022, all study participants in Patna Medical College & Hospital had samples for microbiological culture taken from the introitus and the lower third of the vagina using sterile cotton swabs. Analysis of microbiological findings was done based on the type of bacteria and growth rate. Results: The majority of vaginal microbiological swab results showed bacterial growth: 45 (90.3%) and 33 (80.8%) were comparable in the study and control groups, respectively (P=0.23). According to the results of the microbiological features in the case and control groups, respectively, 15 (30.7%) and 7 (21.4%) were thought to be probable causal factors (P=0.26). Streptococcus pyogenes was the most common pathogen in the study group (P=0.2); all other microorganisms discovered in the control group as either a pure or dominant growth were regarded as opportunistic. Conclusion: Both healthy controls and prepubescent girls with vulvovaginitis had positive vaginal bacterial culture results. There was a higher prevalence of non-specific vulvovaginitis without a dominant/isolated pathogen than vulvovaginitis with a putative causal agent. Girls experienced higher clinical symptoms when the probable infectious agent was discovered.

149. Management of Fracture Midshaft Clavicle with Plating versus Titanium Elastic Nail System: A Comparative Study
Anuj Dixit, Nishanth VP, Ashish Dubey, Surya Kiran Killi
Abstract
Introduction: One of the most frequent injuries in the body as a result of a direct trauma or fall on an extended arm is a fracture of the clavicle. Clavicle fractures, which constitute 2.6% to 10% of all fractures, are frequent injuries. Because more than 50% of clavicle fractures are displaced, recent studies have found that surgical intervention produces better functional outcomes than conservative treatment. The two surgical techniques that are most frequently used to treat midshaft clavicle fractures are plating and the Titanium Elastic Nail System. In the management of midshaft clavicle fractures, this study compares the functional outcome and complications of plating and titanium elastic nail systems. Aims and Objectives: To compare the functional outcome of plating and intramedullary titanium elastic nail system in patients with displaced midshaft clavicle fracture, evaluate radiological union in both the groups and analyze complications associated with surgical procedure. Methodology: This prospective study conducted on 56 patients in South Indian population between September-2019 to September-2021 with displaced mid shaft clavicle fracture. Results and Observation: In our study as per Constant and Murley scoring system, out of the 28 patients who were treated with TENS, 25patients showed excellent, 3 of them showed good functional outcome. Out of the 28 patients who were treated with open reduction and internal fixation (ORIF),21 patients showed excellent,7 of them showed good functional outcome. As per DASH scoring system, of the 28 patients who were treated with TENS, 26 patients showed excellent,2 of them showed good functional outcome. Out of 28 patients who were treated with open reduction and internal fixation (ORIF), 21 patients showed excellent,7 of them showed good functional outcome. We came across complications like shoulder stiffness for 3patients in TENS group,4 patients in plate group. superficial wound infection in 1 patient and hypertrophic scar in 2 patients in plate group. Conclusion: TENS nailing has better functional outcome, fewer complications, lesser hospital stay & cosmetically more acceptable than plating. TENS nailing has advantages over plating in terms of lesser blood loss and duration of surgery in our study. Patients treated with TENS nailing were better in terms of Constant & DASH scoring than comparing with plating group. Hence TENS is a promising minimally invasive treatment for displaced midshaft clavicular fracture which may be an alternative to ORIF or even non operative treatment.

150. Multiparametric Prostate MRI and Histopathological Correlation
Ashu Dixit, Ashish Dubey, Priti Rameshwar Komatwar, Akshit Dinesh Gangwal, Sonam Dubey, Anuj Dixit
Abstract
Background and Objectives: The selection of one of the many potential treatments is made easier by early identification of prostatic lesions and malignancies, which can also result in improved treatment outcomes. Historically, transrectal ultrasonography (TRUS) guided biopsy, prostate-specific antigen assay (PSA), and digital rectal examination (DRE) have all been used to diagnose them. Only a biopsy can be used to confirm a prostate cancer diagnosis, however even this procedure has several drawbacks and restrictions. Due to these drawbacks of the currently available techniques, researchers have begun to consider the use of radiological imaging techniques, particularly multiparametric MRI (MP-MRI), which has additional benefits over standard MRI. The radiological diagnosis of prostate cancer is aided by multiparametric MRI, which also provides biopsy guidance. Also, it aids in the assessment of the disease’s degree of involvement. Additionally, it helps in determining which of the many treatment options to choose from and predicting the results of the treatment. This study aims to assess the effectiveness of multiparametric MRI as a non-invasive inquiry in prostate lesion detection and characterization. Methodology: All patients undergone MRI prostate and subsequently TRUS guided biopsy at dept. of radiology, Bansal Hospital, Shahpura, Bhopal were included in study. All patients were subjected to inclusion and exclusion criteria, recruited to study. PIRADS score, that we got from MP-MRI was compared with histopathological score i.e., Gleason’s score. Data was compiled and Association of PI-RADS and Gleason score with age was observed using ANOVA test. Assessment of relationship of PI-RADS & Gleason’s score was done by Spearman correlation coefficient. Results and Conclusion: As observed, in patients with raised PSA level multiparametric MRI PIRADS scoring is beneficial, being non-invasive and convenient for diagnosis for prostatic lesions. It found to have high sensitivity and specificity along with high predictive value and can recognise patients needing biopsy, it also helps in targeted biopsy as well as identifying extent and aggressiveness of malignancy.

151. A Prospective Study of Fenestration Discectomy of Lumbar Intervertebral Disc Prolapse
Surya Kiran, Satyajeeth R, Anuj Dixit, Ashish Dubey, Nishanth VP, Appu G Pillai
Abstract
The 30 cases of lumbar disc prolapse treated with fenestration discectomy were included in the current investigation. with a six-month follow-up. Incidence was higher among male patients (70%) than female patients (30%). Affectation is more prevalent in the 31 to 50 age group, with a mean age of 39.7±8.82 years. Pain in the radicle was the most frequent symptom. The most typical indicator was a positive SLRT. Pre-operative JOA scores for each case ranged from 6 to 10. The most frequent disc level to herniate was L4-5. A post-op JOA score between 11 and 15 was present in 86.67% of patients. 77% of cases ended well. There is a statistically significant improvement in motor deficit correlation with JOA score with P value of 0.053. The sensory improvement in correlation with JOA score is statistically significant with P value of 0.034. Complications were superficial infection in 2 (6.66%) and dural rupture in 2 (6.66%) cases.

152. ACL Deficient Knee with High Grade Pivoting: A Comparative Study of Combined Anterior Cruciate Ligament with Antero Lateral Ligament versus Isolated ACL Reconstruction
DK Sridhar, DJ Ramesh, G Pillai Appu, Surya Kiran Killi, Anuj Dixit
Abstract
Introduction: Among orthopaedic injuries, ACL injuries are found to be the commonly seen. Compared with nonoperative treatment, patients undergoing reconstruction of ACL were associated with improved knee functions and related symptoms. This study intends to compare the clinical efficacy of combined reconstruction of ACL with Antero lateral Ligament versus Isolated reconstruction of ACL. Objective: To compare the functional outcome of combined reconstruction of ACL with Antero lateral ligament to isolated reconstruction of ACL in knee. Material and Methods: There were 62 patients selected for the study of which 31 patients (Group A) were managed by Combined ACL with Antero lateral Ligament reconstruction and 31 patients (Group B) with isolated reconstruction of ACL and were followed up. Result: In this study the preoperative IKDC score was 41.83±9.28 and 37.72±7.54 for ACL group and Combined ACL with Antero lateral ligament groups, respectively. The post-operative IKDC score of patients in ACL group was 87.78±2.65 while the post-operative IKDC score of those patients in Combined ACL with ALL group was 94.29±2.58 (P <0.001). Conclusion: This1study demonstrates improvement in functional outcome following combined ACL along with Antero lateral ligament reconstruction when compared with isolated reconstruction of ACL.

153. Assessment of Mandibular Fractures Treated with Locking Plates versus Three-Dimensional Plates
Ambedhkar, Manish Kumar, Anand Bhatnagar, Anurag Jain
Abstract
Objectives: The goal was to evaluate postoperative complications and compare the effectiveness of 2.00 mm unicortical locking plates and 3D plates in the surgical correction of uncomplicated mandibular fractures. Materials and Procedures: A prospective cohort study of forty patients with uncomplicated mandibular fractures that were treated either with a noncompression unicortical 2 mm locking mini plate or with a noncompression unicortical 2 mm 3D mini plate was enrolled, and the patients were then monitored for the study’s outcomes, including the length of the operation, any postoperative infections, and any postoperative occlusion. Results: Male patients made up 90% of those who had road traffic accidents. Parasymphysis was the location of the mandibular fracture in 92.5% of cases. All cases operated with 3D plates did not require intermaxillary fixation, compared to 60% of cases performed with locking mini plates, P = 0.020. In comparison to 25% in another group, 95% of patients operated with 3D plates did not require postoperative occlusion correction (P = 0.016). There were no statistically significant variations between the two groups for other parameters like postoperative sensory disturbance, postoperative infection, incidence tooth damage, vertical displacement of the mandible, sensation of a plate after plating, and chewing efficiency after a week. Conclusions: The 2.0mm 3D mini-plate has superior results in terms of operating time, the need for intermaxillary fixation after surgery, and occlusal correction. While the results in terms of metrics like infection rate and incidence of tooth damage etc. are comparable to using non-compression unicortical 2.00mm locking miniplate.

154. 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
Abstract
Introduction: 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.

155. A Hospital Based Observational Study to Evaluate the Prescription Pattern of Antiepileptic Drugs
Nuzhat Perween, Asha Kumari, Veena Kumari
Abstract
Aim: The objective was to evaluate the prescription pattern of Antiepileptic drugs in a tertiary care hospital. Methods: The present study was conducted by the Department of Pharmacology, Darbhanga Medical College, Darbhanga, Bihar, India. Adult outpatients who have been diagnosed to have epilepsy were identified and prescribing pattern was studied. Totally 120 prescriptions were collected randomly over a period of 4 months. Patient’s demographic details, clinical diagnosis, type of epilepsy, type of AED used, drug dose and frequency were recorded. Average number of drugs per prescriptions was calculated. Prescription of all patients was entered in a preformed proforma and was analyzed using descriptive statistics. Results: In the present study, out of 120 patients 70 patients were male and 50 patients were females. Epilepsy was more commonly seen in the patients of age group of 20-40 years. The analysis of the type of seizure showed that the most common type was partial seizures (60%) and the least common type was absence seizures (3.34%). Conclusion: Older antiepileptic agents like carbamazepine, valproate, phenytoin are still the most commonly agents as monotherapy whereas newer ones like levetiracetam are mostly used as add on drug in cases of treatment failure with older drugs. Antiepileptic prescribing in this study population is in accordance to the standard treatment guidelines for epilepsy.

156. Identification of Sex from Right Humerus in Maharashtra Population: Retrospective Study
Utkarsh Gopal Shrivastav, Makandar UK
Abstract
Background: Identification of sex from bone is of vital importance to medico-legal expert and anthropologists because the skeleton of a particular individual is able to adopt to its owner’s way of life. Method: 30 male and 30 female right side non-pathological macerated humerus were studied. Each bone was put in anatomical position and metrical parameters were carried out by vernier calliper and weight of the bones by digital weighing machine. Results: Various parameters like transverse diameter of surgical neck of humerus, transverse diameter of superior articular surface, length of humerus, weight of humerus in both sexes were measured and compared and all values were highly significant (p<0.001). Conclusion: The metrical study of humerus of both sexes will be quite helpful to medico-legal experts, anthropologists and Anatomists, because morpho-metric value of mesodermal derivties are un-certain.

157. A Studying the Etiological and Clinico-Epidemiological Variables in Melasma Patients at Tertiary Care Hospital of Middle Gujarat, India
Rutu Harsh Oza, Pratik Makwana, Krunal Tralsawala,  Arti Bhabhor
Abstract
Background: Melasma, previously known as chloasma, is an acquired pigmentary condition, occurs most commonly on the face. It is more prevalent in females and darker skin type. It occurs due to increased melanogenesis. Objectives: The objective is to study clinico-epidemiological and etiological factors in responsible for causation of melasma. Methodology: This cross-sectional investigation was carried out over the course of a year. A total of 70 individuals with melasma who were clinically diagnosed included in the research. A thorough history was gathered, including information on the patient’s demographics, prior medical history, family history, and a number of contributing variables. This cross-sectional investigation was carried out over the course of a year. Results: Most common age group affected was 31-40 years (45.6%). The duration of disease ranged from 4 months to 8 years with a mean duration of 2.1 years. Of the 70 patients, 35 (50%) of females and 55(79%) of males gave history of their melasma exacerbation during sun exposure. Out of 20 female patients,8 (40%) of them reported their onset of melasma during pregnancy. Only 10% of the female patients took oral contraceptive pills during the disease process in our study. 4 patients (20%) used make-up on a regular basis. History of use of mustard oil in cooking/body massage was present in 11(55.07%) of females and 21 (42.14%) of male patients. 06 (52.05%) of female patients and 16 (32.0%) of males reported use of over the counter (OTC) products in the past. Conclusion: Melasma’s precise origin is uncertain. However, other variables have been linked to this disorder’s etiopathogenesis. In our study, we discovered that melasma has a number of key risk factors, including sun exposure, pregnancy, oral contraceptives, cosmetics, Thyroid disorder variables, and family history.

158. A Comparative Study on the Effectiveness of Budesonide Nasal Irrigation vs. Saline Nasal irrigation in Post-Operative Patients following Functional Endoscopic Sinus Surgery in Cases of Chronic Rhinosinusitis
Riddhi Nayak, Bidhan Das, Biswajit Sukla, Arup Chakraborty
Abstract
Aim: To determine the effectiveness of Budesonide nasal irrigation compared to saline irrigation alone in post-operative patients who underwent Functional Endoscopic Sinus Surgery (FESS) in cases of Chronic Rhinosinusitis. Materials & Methods: A total of 50 patients who underwent FESS surgery were randomly allocated into two groups. Group 1 (Budesonide group) comprised of 25 patients who received Normal Saline + Budesonide respule nasal irrigation twice daily continuously starting from 48 hours after surgery. Group 2 (Normal saline group) comprised of 25 patients who received Normal Saline + Similar amount respule of distilled water nasal irrigation twice daily continuously starting from 48 hours after surgery. Pre-operative and post-operative evaluation of all patients were done using 22-item SNOT-22 score and Lund-Kennedy Endoscopic score at 10th Post-operative day, 1 month and 3 month Post-operative day. Result: Post-operative overall SNOT-22 scores and Total Lund-Kennedy scores improved significantly compared to pre-operative scores in all patients at 10th post-operative day, 1 month post-operative period and 3 month post-operative period. But improvement of Total SNOT-22 score was higher among Group 1 compared to Group 2 patients (p=0.00) at 10th post-operative day, 1 month and 3 month post-operative periods respectively. When individual parameters of SNOT-22 was compared among two groups, there was statistically significant difference for 11 parameters at 10th post-operative day, 19 parameters on 1 month post-operative period & 17 parameters at 3 month post-operative period. Improvement of Total Lund-Kennedy Endoscopic score was also higher among Group-1 than Group 2 patients (p=0.00) at 10th post-operative day, 1 month and 3 month post-operative periods respectively. When individual parameters of LKE score was compared among two groups, it was found that there was statistically significant difference for 4 out of 5 parameters at 10th post-operative, 1 month and 3 month post-operative periods. Conclusion: Budesonide nasal irrigation is a good option in post-operative FESS patients. The difference of reduction in overall SNOT-22 score and Total Lund-Kennedy Endoscopic score among two groups was found to be statistically highly significant

159. Study of Clinical and Microbiological Profile of Febrile Neutropenia in Adult Patients in Hematolymphoid Malignancies in Tertiary Care Centre
Krishna P. Londay, Darpan P. Jakkal, Kailas N. Chintale, P. S. Jirvankar
Abstract
Introduction: Febrile neutropenia is a haematological emergency which develops as a result of treatment of haematological malignancies. The literature shows that life threatening infection is observed in 48 to 60% of patients with febrile Neutropenia. Cancer patients receiving antineoplastic therapy are susceptible to be adversely affected by chemotherapy-induced side effects such as myelosuppression or mucositis, which make them at risk for bacterial and fungal infections. Material and Methods: This was cross sectional, observational, Descriptive study conducted in tertiary care centre & teaching institute. The study period was from March 2019 to March 2021. The present study included 100 patients with adult hemato-lymphoid malignancies who were receiving chemotherapy and who had developed febrile neutropenia. Results: In this study majority of the patients were middle aged. Males were seen to be affected more than female. Fever and weakness was the common presentation of febrile neutropenic patients. A large number of patients were presented with clinical signs and symptoms suggestive of respiratory system involvement. Duration of neutropenia and fever were significantly associated with outcome. Gram negative infections especially pseudomonas aeruginosa species was a common cause of febrile neutropenia. The cases of AML and Hodgkin’s lymphoma were common in the present study. In our study 16% patients died during the course of treatment. Conclusion: Since inflammatory response is muted in neutropenic patients, a fever may be the earliest and the only sign of infection. It is, therefore, critical to recognize fever early in neutropenic patients and to initiate Empirical antibacterial therapy promptly to avoid progression to sepsis syndrome and possibly death.

160. Assessment of the Clinico-Etiologic Profile of Hospital-Acquired Diarrhea in Subjects of Age Less than 15 Years: A Clinical Study
Vaibhav Gode, Sunil Bule, Tushar Liladhar Sonawane
Abstract
Introduction: HAD (hospital-acquired diarrhea) is seen in nearly 2-32% of children admitted to hospital which increases the increased stay, cost, increased mortality, and mortality. Each HAD episode deprives the children of nutrients necessary for growth by their loss. More risk is seen in pediatric subjects in hospitals owing to their exposure to subjects having communicable diseases, healthcare workers, and contaminated surfaces with a higher risk in low-income hospitals due to poor infection control. Aim: The present clinical study was conducted to assess the prevalence and etiology of hospital-acquired diarrhea in pediatric subjects. Methods: The present study included 120 subjects admitted to the hospital and in the age range of 1-15 years with hospital stay duration of more than 3 days and admission was for reasons other than diarrhea. In all the study subjects, stool samples were collected and assessed for the presence of fungal, parasitic, bacterial, or viral agents. Latex agglutination test was done to detect human rotavirus antigen and ELISA for Clostridium difficile. Results: In 108 subjects with hospital-acquired diarrhea, Enteropathogenic Escherichia coli was seen in the majority of subjects with 19.16% (n=23) subjects followed by rotavirus in 14.16% (n=17) subjects, C. difficile in 11.66% (n=14) subjects, E. histolytica in 10% (n=12) subjects, Pseudomonas aeruginosa in 6.66% (n=8) subjects, Shigella flexneri in 5% (n=6) study subjects, C. Albicans, Giardia lambia, Cryptosporidium parvum, Proteus mirabilis, and Salmonella enteritidis in 5 subjects each, and Klebsiella oxytoca was seen in the least (n=3) study subjects. Conclusions: The present study concludes that hospital-acquired diarrhea is highly prevalent in pediatric subjects and the infectious etiology was more common in these subjects compared to the non-infectious etiology. Most commonly associated was a bacterial infection.

161. Conduction Block in Acute Myocardial Infarction: A Prospective Observational Study at JLNMCH, Bhagalpur, Bihar
Amrendra Kumar Singh, Kumar Sourav, Rajeev Kumar, Rajkamal Choudhary
Abstract
Background: After an acute MI, several conduction blockages manifest. Several significant electrical anomalies, such as heart blocks including atrioventricular and interventricular blocks, are brought on by acute myocardial infarction. Increased vagal tone or a pathogenic mechanism, with differing occurrence rates in various populations, can both produce delayed conduction. Acute myocardial infarction continues to be a major source of morbidity and mortality in both industrialised and developing nations. It may happen at either the atrioventricular or interventricular levels of the conduction system. It could be temporary or ongoing. Methods: From September 2021 to August 2022, patients who were diagnosed with ST segment elevation myocardial infarction and acquired conduction blocks were admitted to the wards and ICU at the JLNMCH, Bhagalpur, Bihar. This prospective observational study was conducted there. The present study included a total of 140 patients who were admitted to wards and ICU. Results: The current study included a total of 140 patients with ST segment elevation myocardial infarction. Men made up 98 (70%) and women made up 42 (30%) of the ST segment elevation myocardial infarction patients. Men had significantly more infarctions with elevated ST segments than women (p=0.001). Conclusion: Individuals with ST segment elevation myocardial infarction may experience a variety of consequences, including ventricular arrhythmias, conduction blocks, ventricular dysfunction, and cardiogenic shock. Patients with ST segment elevation myocardial infarction have a poor prognosis for developing these consequences.

162. Abdominal Sacrohysteropexy in Young Women with Uterovaginal Prolapse: A Descriptive Study at JLNMCH, Bhagalpur, Bihar
Madhavi, Anupama Sinha
Abstract
Background: The uterus may protrude into or from outside the vagina, which results in uterovaginal prolapse. Failure of the interplay between the ligaments, fascial supports, and levator ani muscles causes it to happen. Other organs, such as the vaginal walls, bladder, or rectum, are also affected by prolapse. The uterovaginal prolapse might manifest itself in several ways. In order to treat uterovaginal prolapse in young women who want to keep their uterus, the goal of this study is to assess the outcomes of sacrohysteropexy with synthetic prolene mesh as a conservative strategy. Methods: From May 20th, 2019, to 20th March 2020, the current descriptive study was carried out in the Obstetrics and Gynecology Department of JLNMCH, Bhagalpur, Bihar. There were 120 women overall with uterovaginal prolapse. The anterior longitudinal ligament of the first or second sacral vertebra and the uterine isthmus was connected by synthetic prolene mesh posteriorly with no strain on the mesh, according to the surgical procedure employed in abdominal sacrohysteropexy. The patients’ subjective and objective symptom relief for uterovaginal prolapse was questioned. They also had surgical and postoperative problems. Results: There were identified 120 patients. The majority of the ladies were between the ages of 31 and 40. In terms of marital status and parity, 8 women were single, while the other women were all married. 86 patients were in the P1–P4 parity range, while 22 patients were in the P5–P9 range. 42 patients had third-degree prolapse, compared to 78 patients with second-degree prolapse in the uterus. Prolene mesh was used to conduct abdominal sacrohysteropexy on each patient without applying strain. With the aforementioned surgery, there were no intraoperative or postoperative problems seen. None of the patients reported any symptoms of uterovaginal prolapse at the time of discharge, when patients were asked if their uterovaginal symptoms had improved. 32 individuals out of 120 experienced spontaneous pregnancy following abdominal sacrohysteropexy. Conclusion: For young women who desire to keep their uteri, abdominal sacrohysteropexy with synthetic prolene mesh is thought to be the best and safest conservative treatment option for uterovaginal prolapse. This conservative technique has no adverse effects on sexual function and aids in maintaining the anatomy and proper axis of the female reproductive canal. Abdominal sacrohysteropexy has the best success rate and fewest problems of any treatment.

163. Induction of Labour – Foley’s Catheter versus Prostaglandin E2 Gel at JLNMCH, Bhagalpur, Bihar
Madhavi, Anupama Sinha
Abstract
Background: The clinical definition of labour is the onset and continuation of uterine contraction with the intent of resulting in increasing cervical effacement and dilation. Prostaglandins are a great replacement for the Foley’s catheter in the treatment of cervical ripening and labour induction. The aim of the study was to explore the outcomes for the mother and foetus in terms of delivery technique and Apgar score, as well as to evaluate the efficacy of the intracervical Foley’s catheter and PGE2 gel as cervical ripening agents. Methods: The Obstetrics and Gynecology Department at the Jawaharlal Nehru Medical College and Hospital in Bhagalpur, Bihar, was the site of this randomised controlled study. In order to compare the effectiveness of inducing labour using an intracervical Foley’s catheter and PGE2 gel, 400 women with signs that they should be induced into labour were participated in the trial. Results: Group A mean age was 24.59±3.42 and group B was 24.28± 3.21 years. 95% of the women in group A and 97% of the women in group B were effectively induced. The two conditions that led to induction the most frequently in both groups were preeclampsia and postdatism. In groups A and B, the mean induction delivery interval was respectively 15.30±4.63 hours and 15.96±4.89 hours. In group A, 4.21% of cases required NICU admission, whereas 5.15% of cases did so in group B. Conclusions: According to the results of our study, both the intracervical Foley’s catheter and the intracervical PGE2 gel are equally effective for inducing labour, and they can be used in conjunction with one another.

164. Ultrasound-Guided Fine Needle Aspiration Cytology Study of Intra-Abdominal Masses in a Tertiary Center
Namita Kumari, Prakash Chandra Jha, N. K. Bariar
Abstract
Background: USG-guided FNAC has become an indispensable component of the diagnosis of abdominal masses. The objective of this study was to adopt USG-guided FNAC in the diagnosis of abdominal masses, assess its efficacy, and describe the cytological features of abdominal masses. Methods: 50 patients with clinically or sonographically diagnosed abdominal masses were taken up for the study. The FNAC has performed under real-time USG guidance. The aspirate was smeared onto a minimum of 3 slides and they were routinely stained with H & E, MGG, and Papanicolaou stains. Observation: In our study, we were able to diagnose 88% (44) of cases as either benign or malignant (Benign-40% and malignant- 48%) and 12% of cases were inconclusive. The percentage of inconclusive cases was quite high. Proper discussion and input from both radiologists and pathologists can reduce this. In the case of malignant cases samples taken from primary organ/visceral organ were more diagnostic. Conclusion: USG-guided FNAC is a rapid, economical, less-invasive, highly accurate, and safe diagnostic procedure.

165. Evaluation of Phenotypic and Genotypic Test Methods to Detect Methicillin Resistant Staphylococcus Aureus
Nazia Anwar, Gautam Sanjay Kumar, Tarannum Yasmin, R. S. Prasad
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent cause of nosocomial and community-acquired infections. Because of this, accurate MRSA detection is essential for both implementing control measures and lowering MRSA endemicity. The current study set out to evaluate the performance of various phenotypic methods with mecA-based PCR for MRSA detection. Methods: This investigation includes a total of 2000 S. aureus isolates. Oxacillin disc diffusion, oxacillin MIC, cefoxitin disc diffusion, and the oxacillin screen agar test were used to assess methicillin resistance, and they were compared to mecA-based PCR. Results: According to Cefoxitin and Oxacillin susceptibility tests, 530 (26.50%) and 302 (30.1%) of the 2000 isolates from our hospital were determined to be MRSA. The Cefoxitin disc diffusion test for MRSA identification has a better correlation with the gold standard PCR approach than any other phenotypic method. Conclusion: Our study demonstrated that the cefoxitin disc diffusion method has a high sensitivity and specificity when compared to other phenotypic methodologies for MRSA detection. As an alternative to PCR for the detection of MRSA, cefoxitin disc diffusion test results for MRSA prevalence are compatible with PCR results for the mecA gene.

166. Virulence Factors Analysis and Antibiogram of Uropathogenic and Commensal Escherichia Coli: New Emerging Pattern of the Common Pathogen
Swanyakar Kaushalendra, Anita Kumari, Sonal Jindal, Shambhavi Singh, Pragya Tripathi
Abstract
Background: The most prevalent infectious disorders in children are urinary tract infections (UTIs), which include cystitis and pyelonephritis. 50% of nosocomial UTIs and up to 90% of community-acquired UTIs are caused by Escherichia coli (E. coli). Consequently, for both clinical and epidemiological consequences, it is crucial to identify E. coli strains and patterns of antibiotic resistance. Methods: We examined 100 strains of E. coli that were found in stool samples from healthy children and urine samples from children under the age of 7 who had UTIs that were acquired in the community. Results: We assessed the isolated E. coli’s virulence factors (VFs) and drug sensitivity. The isolates’ medication sensitivity levels for amikacin were 94%, nitrofurantoin was 90%, gentamicin was 66%, cefixime was 56%, nalidixic acid was 40%, and gentamicin was 28%. (cotrimoxazole). The prevalence of virulence factors varied between 2% for type 1 fimbriae and 18% for hemolysin and P fimbriae, according to laboratory investigations. Drug resistance was lowest for amikacin and highest for cotrimoxazole. Comparatively to non-pathogenic E. coli, uropathogenic E. coli were more likely to produce hemolysin and P-fimbriae. Conclusion: Even though amikacin initially thought to be the preferred option for UTI in children, nitrofurantoin now seems to be practical and can be considered as the chosen choice for simple lower UTIs.

167. Efficacy of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation by Using Oral Ivabradine and Oral Gabapentin
Bonasi Devender, Lokesh Walvekar, Rishindra Babu
Abstract
Background: Laryngoscopy and endotracheal intubation are fundamental skills that an anaesthesiologist is supposed to achieve in order to administer anesthesia safely. Some studies have been reported in literature suggesting the role of Ivabradine and Gabapentin in inhibiting the hemodynamic responses to laryngoscopy and endotracheal intubation separately, but none of them have compared their efficacy. Aim and Objective: To evaluate the efficacy of oral Ivabradine and oral Gabapentin in attenuating the hemodynamic response occurring due to Laryngoscopy and Endotracheal intubation. Material and Method: This was the Hospital based prospective, randomized double blind clinical trial, conducted on Patients undergoing elective surgical procedure under general anesthesia, in which 120 patients were included in Group I (Patient has received Ivabradine 5 mg.) Group G (Patients has received Gabapentin 800mg)  for the duration of one year, in one of the tertiary care center Government medical college, Siddipet, after getting informed consent and followed inclusion and exclusion criteria. Results: There was no statistically significant difference in gender between the groups, and also we found age between the groups was comparable. Mean heart rate, SBP, DBP and MAP  at pre op was higher in Group I compared to Group G, only at induction it was increased and higher compared to group G and at intubation and later on it was lower compared to Group G and mean difference in of these parameters were statistically highly significant between the groups. Conclusion: we can conclude that both the drugs provides good degree of hemodynamic stability during the surgeries, but ivabradine is maintaining the vital at all points and providing good hypotensive effects also by using ivabradine was more effective in addition to the avoidance of some side effects.

168. Clinical Indications and Outcomes of Bilioenteric Bypass at a Single Tertiary Care Centre in India
Kapil Gothwal, Asma Khalife, Solai Muthu Rajagopal S, Natasha Menon, Abhi H Kothari, Pravin Goykar, Rajeev Joshi
Abstract
Introduction: Bilioenteric bypass procedures are commonly done for extra hepatic biliary tree pathologies. Different procedures like Roux–en-Y hepatico-jejunostomy, choledochojejunostomy, choledochoduodenostomy or cholecysto-jejunostomy, by either conventional open or minimally invasive techniques can be considered depending on the diagnosis.
Materials and Methods:  30 patients operated for bilioenteric bypass in our institute from December 2018 to December 2020 were retrospectively studied. The study analyzed clinical presentations, diagnosis, treatment, and postoperative outcomes. Results: We observed male predominance with ratio of 1.5:1, commonest age being 41 to 60 years. Most common symptom overserved was abdominal pain (74%) followed by jaundice. Malignant etiology was found in 30% and iatrogenic biliary injuries was found in 26% of patients. Roux en Y Hepaticojejunostomy was the commonest (70%) procedure done followed by Cholecystojejunostomy (16%).  13% of patients had early post-operative complications and 10% developed recurrence of symptoms. They were managed conservatively. Conclusion: Bilioenteric bypass is the procedure of choice in patients with obstructive jaundice with either benign or malignant cause. Despite the technological advances, outcome of bilioenteric bypass surgeries depend mainly on surgeons’ skills and experience, pre operative optimization and post operative care. 90% of our patients had good postoperative outcome with only 10% with complications.

169. A Comparative Study between Anatomical Landmark and Ultrasound Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgery
Madhulika Kumari, K. H. Raghwendra, Kumar Saurabh, Bibha Kumari
Abstract
Background: Brachial plexus blockade is a time-tested technique for upper limb surgeries. Ultrasound for supraclavicular brachial plexus block has improved the success rate with excellent localization as well as improved margin of safety.[8] Hence, this study was planned for comparing the efficacy of supraclavicular brachial plexus block using anatomical landmark with ultrasound guided technique. Methods: The present prospective, randomized, comparative study was conducted among 60 patients undergoing elective upper limb surgery under the Department of Anaesthesiology and Critical Care. The study was approved by the Institutional ethical committee. Blood investigations, Urine routine (Albumin, sugar) and microscopy, ECG and Chest x-ray PA view was done in all patients. All the patients underwent thorough pre anaesthetic evaluation on the day prior to surgery. The 60 patients were randomly divided into two groups of 30 patients each, Group AS and Group US. The time taken for the procedure, the onset of sensory blockade and motor blockade were noted. Data were coded and recorded in MS Excel spreadsheet program. SPSS V 23.0 (IBM Corp.) was used for data analysis. Descriptive statistics were used elaborated in the form of means/ standard deviations and medians/ IQRs for continuous variables, and frequencies and percentages for categorical variables. Results: In our study the block execution time was lower in group AS (5.37+1.45 minutes) and higher in group US (9.97+2.44 minutes) and it was statistically significant (p<0.05). The block effectiveness in group AS was total in 70.0%, partial in 10.0% and failure in 20.0%, whereas block effectiveness in group AS was total in 90.0%, partial in 6.7% and failure in 3.3%. Vessel puncture as complication was seen in 20.0% of patients in group AS and no vessel puncture was seen in group US. Conclusion: From our study it was concluded that time taken to perform block by ultrasound was longer than the anatomical landmark technique. Onset and duration of both sensory and motor blockade were similar in both groups.

170. Fistula in Ano: MRI and Post-Operatve Findings Correlation
Palak Gandhi, Arun Kumar Gaur, Bhoomi Modi
Abstract
Objective: To asses role of MRI in perianal fissure and fistula and to evaluate complications. Materials and Methods: Total 50 patients, who were clinically diagnosed as suffering from perianal fissure/fistula, were recruited. Each patient was studied in detail with relevant clinical history and Examination. MRI was performed on 1.5 T Philips scanner with patient in prone position using body coil, no special bowel preparation was used. Results: A total of 50 cases of perianal fissure/fistula, most patients were in age group of 31 to 50 years, 43 patients were males (86%) & 7 patients were females (14%). 3 cases (6%) had previous operative history for perianal fistula and shows recurrence. 36(72%) tracts were trans-sphincteric type followed by inter-sphincteric type (13, 26%) & 1 (2%) fistula was of supra-sphincteric type. grade IV fistulas were found in 19 cases (38%), grade III fistulas found in 17 cases (34%), grade I & grade II fistulas were found in 7 cases (14%) & 6 cases (12%) respectively & grade V fistulas in 1 patient (2%). 41 patients had single external opening while 7 patient had multiple external openings. One patient had sub mucosal fissure and one patient had only internal opening(sinus) disease. 44 patients had single internal opening while 4 patients had multiple internal openings. 3 patients had multiple(two) perianal fistula, 9 patients had complex fistula in form either multiple internal openings or multiple external openings. 38 patients had simple fistula. 40 tracts were low anal fistula while 10 tracts were high anal fistula-involving puborectalis sling and levator plate, about 17 fistulas showed abscess formation. Conclusion: MRI is imaging modality of choice in preoperative evaluation of perianal fistulae, especially in complex and recurrent cases. MRI Fistulogram is recommended in recurrent and complex cases as a method of pre-operative evaluation, for surgical outcome and planning and hence to reduce recurrences.

171. Traditional Clinical Examination vs Objective Structured Practical Examination in Physiology of 1st Year MBBS Students: Examiner’s Bias
Aparna Debbarma, Debina Sarkar, Soma Choudhuri
Abstract
Objective: The competency-based medical curriculum put in place in 2019 places a strong emphasis on assessment frameworks that are in line with the teaching-learning process. The learning process is driven by evaluation, hence assessment methods must be impartial, consistent, dependable, and valid. Conventional practical testing is less objective, more susceptible to examiner bias, and less valid and reliable. OSPE has been recommended as a tool for CBME use because it meets the requirements for the optimal assessment tool. Nevertheless, OSPE is not commonly utilized in our nation. Method: The performance of one MBBS student in the regular practical exam and the OSPE was compared in this study, and the students’ attitudes regarding it were assessed. There were 100 1st year MBBS students from the 2021–22 class. The topic of “Blood sugar Estimation” was evaluated using standard and OSPE methods. Two observer stations and three response stations were used for OSPE. MS Excel was used to determine the mean and analyze it for statistical significance. The same students were given a well-designed questionnaire, and responses to the OSPE method were received. Results: The mean ratings for the standard format and OSPE differed statistically significantly (P <0.002). According to an analysis of student comments, more students thought that OSPE was better in terms of scoring, passing, and accommodating psychomotor domain evaluation. Many students said OSPE was more practical and comfortable than the standard exam format. The majority of students said OSPE should be preserved as a form of assessment in internal and university exams because they did not find it to be intimidating. Conclusion: This study found that OSPE scores were superior to those from the conventional format. By integrating the cognitive, psychomotor, and affective domains, OSPE decreased examiner bias. So, it is concluded that OSPE, albeit being labor- and time-intensive, should be used as an assessment tool.

172. A Community-Based Study Evaluated Drug Compliance among Children by Employing Home Medication Reviews
Samragnee Mondal, Roshan Kumar, Syed Mohammed Shahid, Nandita Chattopadhayay
Abstract
Objective: Drug compliance is a key factor in determining a treatment’s safety and effectiveness. Medication compliance is the question of whether a patient is taking their medications as prescribed by a doctor and in the appropriate quantity and timing. Failure to comply can result in therapy failure or have long-term effects. Due to their unique pharmacokinetic characteristics, the pediatric population is a particularly vulnerable segment of society and needs to be handled with the utmost caution. The information regarding pediatric compliance was gathered for this community-based prospective trial by reviewing each study subject’s home medication regimen. Method: At Department of Pediatric, MGM Medical College and LSK Hospital, Kishanganj from April 2021 to May 2022, 155 children participated in the study and had their drug compliance evaluated. Results: 52% of the population had low adherence, 31% had medium adherence, and 17% had strong adherence, according to the findings. The study population’s noncompliance with therapy was about 81%. Conclusion: As the majority of the participants in this study were noncompliant, it is essential to raise public awareness about pediatric drug adherence.

173. The Effects of BMI, Socioeconomic Status, and Bedtime Technology Use on Sleep Duration in Adolescents
Sagarika Baidh, Ravi Pratap Singh, Qutub Rahi, Abhay Kumar
Abstract
Objective: Adolescents and sleep-related factors are poorly understood. In 8th graders (N = 200) involved in a school-based wellness initiative, the associations between bedtime technology usage (TU), TV in the bedroom, weight, and socioeconomic status were assessed. Method: This was a cross-sectional study carried out in Department of Paediatric, MGM Medical College and LSK Hospital, Kishanganj from January 2021 To February 2022. High TU before sleep was determined by use “a few evenings each week” or “every, or practically every night.” Sleep duration was dichotomized as inadequate (<7 hours) or sufficient (≥7 hours). Result: The most often mentioned issues were insufficient sleep (38.6%), TV in the bedroom (72.8%), and high TU (83.0%). Students with high TU had a decreased chance of getting enough sleep (odds ratio [OR] = 0.528 [0.462-0.604]), as did obese students (OR = 0.814 [0.701-0.948]) and those who watched TV in bed (OR = 0.816 [0.702-0.951]). Moreover, attending a school with a higher percentage of pupils from low socioeconomic backgrounds was linked to insufficient sleep (P =.025). Conclusion: Treatments to lower TU may be crucial for increasing the amount of sleep, particularly for some susceptible populations.

174. Adolescents with Severe Primary Dysmenorrhea Have A Unique Biomarker Called Mean Platelet Volume
Kamlesh Tiwari, Sadhna Singh, Rashmi Singh, Neha Savarna
Abstract
Objective:  To determine whether mean platelet volume (MPV) is a reliable indicator of disease severity in young people with severe primary dysmenorrhea (PD). Method: The study comprised 30 healthy teenagers with regular menstrual cycles and a total of 60 patients with PD. As part of the automated complete blood examination, hemoglobin, MPV, white blood cell (WBC), platelet, lymphocyte, and neutrophil counts were determined. The absolute neutrophil or platelet count was divided by the absolute lymphocyte count to generate the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), respectively. The intensity of the pain was measured using the visual analog scale (VAS), which classified it as mild (30 mm), moderate (30–50 mm), and severe (>50 mm) PD. Results: The combined severity PD and control groups’ MPV levels were comparable. When compared to the control group, the MPV in the severe PD group was, however, considerably lower (p = 0.03). The remaining hematological parameters did not significantly differ between the groups. The mean VAS scores for the control and PD participants were, respectively, 7.34±2.24 and 1.06±1.95 (p < 0.02). Between MPV and WBC, there was a weak negative connection that was statistically insignificant. Conclusion: The results of the current investigation showed that adolescents with severe PD have lower MPV. To better understand the involvement of platelets in the pathophysiology of severe PD and assess the changes in MPV value in response to treatment, additional research with larger subject populations is required.

175. Prepubertal Girls with Vulvovaginitis Clinical and Microbiological Results
Kamlesh Tiwari, Sadhna Singh, Rashmi Singh, Neha Savarna
Abstract
Purpose: To compare genital microbiological results between healthy controls and prepubertal girls who have vulvovaginitis. Method: 50 prepubescent females with vulvovaginitis, ages 1 to 9, and 40 age-matched healthy controls. From November 2021 to May 2022, all study participants in Patna Medical College & Hospital had samples for microbiological culture taken from the introitus and the lower third of the vagina using sterile cotton swabs. Analysis of microbiological findings was done based on the type of bacteria and growth rate. Results: The majority of vaginal microbiological swab results showed bacterial growth: 45 (90.3%) and 33 (80.8%) were comparable in the study and control groups, respectively (P=0.23). According to the results of the microbiological features in the case and control groups, respectively, 15 (30.7%) and 7 (21.4%) were thought to be probable causal factors (P=0.26). Streptococcus pyogenes was the most common pathogen in the study group (P=0.2); all other microorganisms discovered in the control group as either a pure or dominant growth were regarded as opportunistic. Conclusion: Both healthy controls and prepubescent girls with vulvovaginitis had positive vaginal bacterial culture results. There was a higher prevalence of non-specific vulvovaginitis without a dominant/isolated pathogen than vulvovaginitis with a putative causal agent. Girls experienced higher clinical symptoms when the probable infectious agent was discovered.

176. Psoriasis Patient in Bihar with Elevated Serum Lipid and Lipoprotein Levels
Naresh Kumar Suman, Sarika Swaraj, Suday Kumar Singh
Abstract
Introduction: Psoriasis is a chronic, inflammatory, and proliferative skin condition characterized by improper lipid metabolism. Genetic, environmental, viral, infectious, immunological, biochemical, hormonal, and psychological variables, as well as alcohol and drug misuse, all influence its prevalence in the community. The frequency of cardiovascular problems in these patients is significantly greater than in the general population, which appears to be related to hyperlipidemia. The purpose of this study was to examine the blood lipid and lipoprotein profile levels in psoriatic patients to determine their relationship with disease severity. Methodology: The study was conducted on 200 people with psoriasis who were over the age of 18. Total cholesterol, Triglyceride, HDL, and LDL lipid levels were measured. The Psoriasis Area Severity Index was used to determine the severity of the psoriasis (PASI). The relationship between Psoriasis severity and lipid levels was investigated. SPSS 21.0 was used to examine the data. To compare the results, ANOVA and Pearson correlation coefficients were employed. Result: The average age of the patients was 39.4 ±16.6 years. The majority of patients (66.7%) were men. The mean total cholesterol, triglyceride, LDL, and HDL values were correspondingly 151.52 ±39.39, 152.53 ±85.43, 77.46 ±34.34, and 43.98 ±16.43 mg/dl. According to PASI, 9 (15%) people had mild psoriasis, 35 (58.3%) had moderate psoriasis, and 16 (26.7%) had severe psoriasis. Mean total cholesterol, triglyceride, and LDL levels increased with increasing PASI severity grade; however, the correlation was statistically significant only for total cholesterol and triglyceride levels. Conclusion: The current study’s results indicated that psoriasis affects lipid levels and that severity is associated with higher lipid levels, meaning that those with higher grades of psoriasis have a higher chance of developing cardiovascular disease.

177. Evaluating IUGR with Color Doppler Along with a Clinical Correlate
Shalini Sahu, Subrat Prasad
Abstract
Objective: The perinatal fate of newborns with IUGR can be considerably improved by early detection and prompt care. Common methods for monitoring fetuses include biophysical profiles and non-stress tests, although neither one is reliable for identifying preterm births. Doppler has made it considerably simpler to identify cases of IUGR early and with good consistency and efficacy for the perinatal outcome. 1) To link clinical findings in IUGR with color Doppler and the perinatal outcome was the study’s primary goal. 2) To investigate the Doppler parameters’ predictive effectiveness in the early identification of fetal compromise. Method: Between May 2021 and June 2022, this research was done at MGM Medical College LSK Hospital, Kishanganj. The study comprised 70 singleton pregnancies with IUGR detected after 31 weeks of gestation, and these pregnancies were investigated and monitored clinically as well as using Doppler results until delivery. We used percentage to examine the prognostic efficacy (sensitivity, specificity, positive and negative predictive values) of waveforms from the middle cerebral artery and umbilical artery. Results: MCA PI had the best sensitivity and specificity (77%, 92%) as a marker for the degree of fetal impairment in IUGR, however other ratios, such as MCA PI/UA PI and UA SD (>2), were also highly specific predictors of a poor perinatal outcome. A certain bad prenatal result in terms of mortality is linked to absent and reverse end diastolic flow in the umbilical artery. The accuracy of clinical evaluation and ultrasound biometry in identifying the ideal window for intervention in growth-restricted fetuses is limited. The positive predictive value for non-reactive non-stress testing was found to be just 23%, with a false positive rate of 74%. Conclusion: Multiple vascular studies, one of the tests for antepartum fetal surveillance, has good accuracy compared to the other tests, and the color doppler study is a straightforward, rapid, non-invasive process.

178. Assessment of Lipoprotein (A) in Acute Coronary Syndrome Patients Admitted Intensive Cardiac Care Unit of Tripura Medical College: A Clinical Study to Compare with Lipoprotein (A) Level in Normal Healthy Persons of Tripura
Tapan Debnath, Arpita Das, Aparna Debbarma, Debina Sarkar, Sankar Roy
Abstract
Lipoprotein (a) is a low-density lipoprotein containing apolipoprotein(a) and identified as a risk factor for  and its related diseases, such as  and stroke. Lipoprotein(a)was discovered in 1963 by by Kåre Berg. It is a thrombogenic and atherogenic molecule. Due to lack of data from the north eastern part of the country, a case control study was done with the aim of finding an association and to estimate the serum levels of lipoprotein (a) in patients with Coronary artery disease patients admitted in Intensive Cardiac Care Unit. Lp(a) was quantified by immunoturbidiometric method. The serum lipoprotein (a) levels were significantly elevated (p< 0.0001) in cases (80±30 mg/dl) as compared to controls (30±20 mg//dl). Lipoprotein(a) levels with routine lipid profile testing were assessed. So it is suggested to make LP(a) serum level determination test as a routine laboratory test for identification of risk factor for AMI.

179. Cadaveric Examination of Renal Artery Anatomical Variations
Ranjan Kumar Das, Charulata Sarangi
Abstract
Objective: In the era of widespread MRD, cadaveric research on renal artery abnormalities can alert the doctor and help them avoid endangering vital nephrons. The purpose of the study was to document if adult human cadaveric kidneys have Extra Renal Arteries (ERA). Method: Throughout July 2021 and July 2022, this study was conducted on embalmed cadavers at Department of Anatomy, DRIEMS Institute of Health Science & Hospital, Cuttack. Results: EBRA was discovered in 11% of the cadavers examined, along with auxiliary renal arteries in 31% and aberrant renal arteries in 21%. Conclusion: It was thought that this study of ERA would be very helpful in the development of laparoscopic renal operations and renovascular treatments.

180. A Cross-Sectional Study of Morphometric Measurements of the Lower end of the Ulna
Ranjan Kumar Das, Charulata Sarangi
Abstract
Objective: In reconstructive procedures, the distal end of the ulna’s anatomy is crucial. Head, styloid process, and fovea are located at the distal end. The Ulnar head is made up of two components, the pole and the seat. Due to non-union of the distal ulnar metaphysis, a fracture of the distal end of the radius is associated with a severe form of ulna fracture. This is similar to Baldwin’s operation, which aims to create pseudo arthrosis in the lower end of the ulna by extra periosteal resection of a segment of the ulna’s metaphysis. Method: This study was conducted on 104 totally ossified, dry adult ulnae (52 right and 52 left), regardless of age, gender, etc. at Department of Anatomy, DRIEMS Institute of Health Science & Hospital, Cuttack from August 2021 to September 2022. Vernier digital calipers were used to take all of the measurements. Results: The maximum pole width was 4.12 mm on average on both sides. The maximum seat height was 3.86 mm on average on both sides. The largest fovea width measured 3.85 mm on average on both sides. The greatest styloid process length averaged 6.174 mm on both sides. Conclusion: Clinically, this study is crucial for anatomists, forensic experts, orthopedic surgeons, prosthetists, and researchers conducting medicolegal investigations, as well as for those creating appropriate prostheses and treating patients with lower ulna fractures.

181. Morphometric and Topographic Investigation of Nutrient Foramen in the Human Clavicle in North India
Ranjan Kumar Das, Charulata Sarangi
Abstract
Objective: The main blood supply to a long bone comes from the nutrient artery, which enters the bone shaft through the nutrient foramen. This is especially true throughout a long bone’s growth phase in the embryo and fetus as well as during the early stages of ossification in childhood. Recent research has demonstrated that the blood supply of bone has a significant impact on the lifespan of vascularized bone and joint allografts. The objective of this research was to examine the nutritional foramen in 102 adult humans of North Indian origin. Method: At Department of Anatomy, DRIEMS Institute of Health Science & Hospital, Cuttack from June 2021 to July 2022, the study was conducted. Foramina Index was used to calculate how many and where each nutrient foramen was distributed along the length of each bone. It was also noted the nutrient canal’s direction. Results: The study revealed that 71% of clavicles had a single nutrition foramen, 21% had double foramen, and 8% had more than two foramen. 31% of clavicles had foramen on the posterior surface, compared to 69.7% that had foramen across the inferior surface. With 61.0% of dominant foramen situated in the middle third of the bone length, the foramina index range for dominant foramen was between 31% and 76.3%. Conclusion: The acromial end was the target of the nutrition channel.

182. Role of VEGF in Prediction and Diagnosis of Severe Dengue Viral Illness
Rohit Jagar, Ankita Singh, Champa Kumari Saini, Prakash Keswani
Abstract
Detectable VEGF levels in plasma before, during, and after the identification of severe dengue, could potentially offer various clinical usage. This protein can serve as predictive markers for determining patient’s need for admission, as a diagnostic marker or as a prognostic marker to determine the likelihood of death. Method: The present study is a hospital-based cross-sectional study conducted at for the period of 15 months. A convenient sample size of 80 cases and 10 controls was chosen by using simple random sampling. Confirmed cases of dengue were taken for study as per the inclusion and exclusion criteria. Patients were evaluated by taking complete history of the present febrile illness, patient demographics, presence of WHO warning signs for severe dengue, associated co-morbidities, and length of hospital stay. Complete blood count, hematocrit, platelet count and platelet volume were noted at the time of admission and at 48 hours along with ferritin and triglyceride levels at admission were noted. Serum VEGF level was measured in cases at day 5 of hospitalization after the diagnosis. Results: The mean age of cases was 39.86 ± 14.83 years, while that of controls was 40.25 ± 13.30 years with male : female ratio of 1.14:1 while that of controls was 1.1. 3.42% patients had non-severe dengue, while the remaining 26.58% patients had severe dengue. The most common complication in our patients included bleeding manifestations. There was an insignificant difference in over hematocrit of our patients from day 1 to day 3 and day 5. The mean VEGF level was 863.301 ± 316.673 ng/ml. While the mean VEGF level in controls was 287.830 ± 187.612 ng/ml and the difference between cases and controls was significant (p value=0.0001). The mean VEGF of non-severe cases was 658.373 ± 146.166 ng/ml, while that of severe cases was 1053.087 ± 458.384 ng/ml. Similarly, cases with severe illness had significantly higher VEGF than non-severe cases (p value<0.0001). Overall, the sensitivity and specificity of serum VEGF in predicting the severity of dengue was is 95.24% and 77.58%, respectively. The positive and negative predictive value of VEGF was 66.66% and 97.8%, respectively. The accuracy was 76.76%. There was a negative correlation between platelet count and serum VEGF in patients, the correlation coefficient being R= -0.29 (p value=0.001). Conclusion: In conclusion, plasma leakage is a cardinal hallmark of severe dengue. We demonstrated that plasma VEGF levels in cases with severe dengue were significantly higher than values from a mild illness. The increased plasma levels of VEGF in patients with dengue illness were correlated positively with haematocrit levels, and negatively with low platelet count. These findings suggest that VEGF, as a contributory factor of increasing vascular permeability, contributes to the pathogenesis of dengue. VEGF may serve as an adjunct investigation to support the diagnosis.

183. Study on Polytrauma in the Emergency Department: A Retrospective Analysis of its Character and Prognosis
Jayesh Dhake, Chetan A. Patil, Akhilesh Somani
Abstract
Background: In both industrialized and developing nations, polytrauma is a leading cause of morbidity and mortality. In a tertiary care hospital, this study aims to evaluate the prevalence and prognosis of polytrauma patients.
Method: In a sizable emergency department, this observational study was undertaken retrospectively (ED). The analysis included all patients >15 years old who presented to the ED with polytrauma. Results: The majority (85%) of the 70 polytrauma patients were men. Age was 40.1 years on average (standard deviation: 10.05 years). Fewer than one-third of the patients visited the emergency room within three hours of their injuries. A fifth of the patients suffers severe traumatic brain injury. 75 percent of the patients needed orthopedic testing and treatment. The mortality rate in the ED was 12%. Fewer than one-third of the patients visited the emergency department (ED) within three hours of the accident, underscoring the urgency of enhancing prehospital treatment and transportation in our nation. In treating polytrauma sufferers, aggressive resuscitation with crystalloids and blood products is crucial.

184. Effects of Post COVID-19 Pneumonia on the Prognosis of Trauma Patients undergoing Treatment in a Tertiary Care Hospital
Sunil Dath Sodha, Ramachandram Kuncham, Krishna Kanth Vankdoth, Avunoori Pushpalatha
Abstract
Background: In the light of post severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) Pneumonias playing a role in the long-term respiratory complications in patients subsequently involved in trauma, a study was conducted to assess the post COVID-19 Pneumonias on the prognosis of trauma patients in a Tertiary care Hospital of Telangana. Aim of the Study: To identify the post COVID-19 pneumonia and respiratory complications, their severity, factors affecting the management of trauma patients and the long-term sequelae. Materials: 42 patients categorized on American Association for the Surgery of Trauma (AAST) injury scoring scales were included. Patients aged between 18 and 70 years were included. Patients with previous history of post COVID-19 lung disease for 09 months or above were included. Pulmonary function tests like FEV1, FVC, TLC and DLCO were performed and analyzed. The CT scan signs were based on the involvement of the lung parenchyma as: Normal CT (no lesion), minimal (0–10%), moderate (11–25%), important (26–50%), severe (51–75%), and critical (>75%). Results: 42 patients with trauma with either COVID-19 disease affecting the lungs or RTPCR positive were included. There were 29 (69.04%) male patients and 13 (30.95%) female patients with a male to female ratio of 2.23:1. The mean age among the men was 41.55±3.25 years and 38.15±4.10 years in female patients. There were 33/42 patients with positive RTPCR test and 09/42 were negative for RTPCR test for COVID-19. Conclusions: Recovery from COVID-19 disease especially with lung parenchyma changes during the active state have shown to affect adversely the morbidity of post trauma surgeries. Preoperative assessment of Lung function tests such as FEV1, FVC, TLC and DLCO would guide the surgeon and the anesthetist in the surgical management of such patients.

185. Clinico Hematological Profile and Phase Distribution of Chronic Myeloid Leukemia
Soumya B. M, Darpan P. Jakkal, Kailas N. Chintale, P. S. Jivankar
Abstract
Chronic myeloid leukemia is a clonal hematopoietic stem cell disorder. CML is caused by the BCR-ABL1 chimeric gene product, which results from a reciprocal balanced translocation between the long arms of chromosomes 9 and 22, t (9; 22) (q34.1; q11.2), known as the Philadelphia chromosome (Ph) and its codes for a constitutively active tyrosine kinase. CML is a common hematological malignancy in adults and accounts for 15% of all hematological malignancies. Worldwide incidence of CML is 1-2 cases per 1 lakh population per year. Material and Methods: This was a cross sectional, observational and Descriptive study conducted in tertiary care centre & teaching institute during the period from November 2018 to December 2020. Total 100 patients of Chronic Myeloid Leukemia irrespective of etiology were included in this study. Results: In our study most of the patients were aged between 31-40 years. Majority of the patients were males (62%) and male to female ratio was1.6:1. Generalized weakness was the most common symptom (52%) followed by fatigue (35%), pain in abdomen (22%), Anemia (46%) and splenomegaly (58%) & 16% of the patients were Asymptomatic. Among 100 CML cases, Chronic phase (CP) cases were 95%, Accelerated phase (AP) cases were 3%, Blast crisis (BC) cases were 2%. But majority of patients were in chronic phase (95%) which is a good sign as the disease is completely treatable in the modern era. Conclusion: CML accounts for one of the most common leukemia which is treatable with oral medications when presented at an early stage. TKIs have revolutionized the treatment of CML.

186. Assessment of Pattern of Usage of Digital Screen and Associated Health Problems among Children <15 Years during COVID-19 Pandemic
Atul Rajpoot, Anand Kumar Patidar, Anurag Jain, Lokendra S. Kot, Preeti Gupta, Mahesh Gupta
Abstract
Background: The covid-19 pandemic came with the lockdown which enforced people stay at home. During COVID-19, screen time increase significantly for the psychological needs and social requirements. Excessive ST is associated with sedentary behavior in children and teenagers and contribute to the development of non-communicable diseases. Objectives: (1) To assess the pattern of digital screen time. (2) To assess health problems associated with screen time. Methodology: A cross-sectional study was conducted for one year among the children between age group 5-15 years in a tertiary level of health care centre. Sample size calculated was 278. Those attending OPD/IPD and gave consent were included in the study. Results & Conclusion: Independent variables like gender, types of family, education of the parents, types of residence and family income is significantly associated with the screening time. Male and female distribution was 61.2% and 38.8%. Significant large difference for the screen time was observed between pre- covid-19 (mean= 13, SD= 5.7) and during covid-19(mean= 20.6, SD=7.5). Health problems were significantly increased during Covid-19 as compared to pre-covid era among children due to excessive screen time.

187. A Study to Assess and Evaluate Parental Attitude and Practice of Pediatric Oral Health Care
Chetanaben Bharatbhai Patel
Abstract
Background: Children’s oral health is a vital aspect of their overall well-being, but many parents do not have adequate attitudes or practices towards pediatric oral health care. Aim: Thus, this study aimed to evaluate the attitudes and practices of 300 parents with children aged 1-5 years who visited a pediatric dental clinic in India. Methods: Using a self-administered questionnaire, data was collected on the parents’ knowledge and behaviors related to pediatric oral health care. Results: The results indicated that parents had some understanding of oral health care, but their practices were often inadequate. Conclusions: As such, the study suggests that parents should receive education on proper tooth brushing frequency, regular dental checkups, and supervision of children’s tooth brushing.

188. A Comparative Study between Push and Pull Method and Patwardhan’s Method in Second Stage Cesarean Section -Maternal and Fetal Outcome
Anusha S R, Rashmi S, Amrutha A M
Abstract
Objective: To compare the maternal and neonatal outcomes between Patwardhan’s method and push/pull method for delivery of fetus in second stage cesarean section. Methods: This comparative study was carried out for a period of 1 year, from October 2020 to September 2021, at the PES Medical College in Kuppam, Andhra Pradesh. The study included 180 patients in total. Two groups of patients were created: group 1 was the Patwardhan’s groupand group 2 was the traditional push/pull group, where the baby was delivered as breech or cephalic. We evaluated the two groups in incidences of maternal complications like uterine extensions, excessive blood loss, the requirement for blood transfusions, and newborn morbidity. Results: When compared to the push/pull group, it was found in our study that Patwardhan’s group had a much lower number of cases involving uterine extensions, excessive blood loss, and blood transfusions, which reduced maternal morbidity. Neonatal results in both groups were, however, very similar. Conclusion: Patwardhan’s method is a unique method which is found to be superior and a safe for delivery of fetus in second stage caesarean sections as compared to “Push” and “Pull” methods. Whileneonatal complications in both the methods are almost identical maternal complications are extremely less in Patwardhan’s method.

189. Prevalence of Thyroid Disorders in Pregnancy: A Prospective Study in a Tertiary Care Centre
Anusha S R, Amrutha A V, Vijayalaxmi Mangasuli
Abstract
Background: One of the most prevalent endocrinopathies in pregnancy is thyroid disease. It’s essential to keep in mind that pregnant women have increased thyroxine needs due to the intricate hormonal and metabolic changes that occur during pregnancy. Untreated hypothyroidism during pregnancy is harmful to the mother and the foetus. According to global data, thyroid dysfunction affects at least 2%–3% of expectant mothers. 0.2% to 0.4% of pregnant women get hyperthyroidism, which is most frequently linked to Grave’s disease. Instances of hypothyroidism during pregnancy range from 0.5% to 3.5%. According to reports, 11.07% of pregnant women have hypothyroidism. This research was done to find out how prevalent thyroid problems are among pregnant women attending the antenatal clinic of our tertiary care facility. Materials and Methods: This prospective study was conducted in the Obstetrics and Gynaecology Department at the PES Medical College Kuppam, Andhra Pradesh. 200 first-trimester pregnant women who visited our antenatal clinic were taken into the study. Together with the usual antenatal tests, a thyroid profile including TSH, FT3, and FT4 was sent. Results: In our study, 81% of the mothers had normal thyroid function. Having subclinical hypothyroidism at 10%, overt hypothyroidism at 6%, subclinical hyperthyroidism at 3%, and overt hyperthyroidism at 0%in our study hypothyroidism was significantly prevalent among pregnant women in their first trimester. Conclusion: In our study, subclinical hypothyroidism predominated and thyroid problems were more frequent in first trimester pregnant women. The need for timely thyroid disease identification and prompt treatment initiation is because of the detrimental effects that maternal thyroid diseases have on maternal and foetal outcomes. Thereby, early thyroid testing should be performed on all pregnant women.

190. Efficacy of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation by Using Oral Ivabradine and Oral Gabapentin
Bonasi Devender, Lokesh Walvekar, Rishindra Babu
Abstract
Background: Laryngoscopy and endotracheal intubation are fundamental skills that an anaesthesiologist is supposed to achieve in order to administer anesthesia safely. Some studies have been reported in literature suggesting the role of Ivabradine and Gabapentin in inhibiting the hemodynamic responses to laryngoscopy and endotracheal intubation separately, but none of them have compared their efficacy. Aim and Objective: To evaluate the efficacy of oral Ivabradine and oral Gabapentin in attenuating the hemodynamic response occurring due to Laryngoscopy and Endotracheal intubation. Material and Method: This was the Hospital based prospective, randomized double blind clinical trial, conducted on Patients undergoing elective surgical procedure under general anesthesia, in which 120 patients were included in Group I (Patient has received Ivabradine 5 mg.) Group G (Patients has received Gabapentin 800mg)  for the duration of one year, in one of the tertiary care center Government medical college, Siddipet, after getting informed consent and followed inclusion and exclusion criteria. Results: There was no statistically significant difference in gender between the groups, and also we found age between the groups was comparable. Mean heart rate, SBP, DBP and MAP  at pre op was higher in Group I compared to Group G, only at induction it was increased and higher compared to group G and at intubation and later on it was lower compared to Group G and mean difference in of these parameters were statistically highly significant between the groups. Conclusion: we can conclude that both the drugs provides good degree of hemodynamic stability during the surgeries, but ivabradine is maintaining the vital at all points and providing good hypotensive effects also by using ivabradine was more effective in addition to the avoidance of some side effects.

191. N-Terminal Pro B Type Natriuretic Peptide as Marker of Severity of Bronchiolitis in Children (3 months to 2 Years of Age)
Jitendra, Satnam Kaur, Rani Gera, Sunita
Abstract
Aim: The aim of the present study was to evaluate the utility of NT- pro BNP as a marker for assessing disease severity and outcome in previously healthy children between 3 months -2 years of age with bronchiolitis. Methods: The proposed study was conducted in Paediatrics OPD, wards and emergency room of Vardhaman Mahavir Medical College and Safdarjung Hospital after clearance from Institutional ethics committee for the period of 18 months. 99 patients were included in the study. Results: Approximately 50% of the enrolled children were between 6-12 months of age. Out of 99 children enrolled, 60.6% were males and 39.4% were females. Out of 73 children that were admitted, 7 had mild bronchiolitis, 33 had moderate bronchiolitis and 33 had severe bronchiolitis. All children with moderate bronchiolitis and 14/33(42.42%) with severe bronchiolitis had SpO2 90-94%. 19 children with severe bronchiolitis had SPO2 < 90%. Two children presented with shock and required admission in paediatric intensive care unit and mechanical ventilation. Median duration of hospital stay was 5 days (IQR 3-6 days, range 1-18 days). Corresponding values for children with mild, moderate and severe bronchiolitis were 1 day (IQR1-1 day, range 1-2 days), 3 days (IQR 3-4 days, range 1-7 days), 6 days (IQR 5-7 days, range 1-18 days) respectively and this difference between duration of stay in 3 severity groups was statistically significant (Kruskal Wallis test X2 = 44.5, p value < 0.001). Conclusion: Our study showed that levels of NT pro BNP increased progressively with increasing severity of bronchiolitis. Median values in control, mild, moderate and severe groups of bronchiolitis were significantly different. There was a strong correlation between NT pro BNP levels and duration of hospital stay. Children hospitalised for > 7 days had significantly higher NT pro BNP levels as compared to those requiring hospitalization for ≤ 7 days.

192. Association of Electrocardiographic Changes and its Role in Predicting Outcome in CKD Patients on Maintenance Hemodialysis
Sakhare Akshata, Manohar Ketkar, Pingale Amruta, Kodilkar Jitendra, Swami Shruti, Singh Jeetendra
Abstract
Background: Chronic kidney disease is associated with markedly increased risk for cardiovascular accidents and mortality. Cardiovascular disease is the most common cause of death in CKD. Cardiovascular mortality is very high in chronic and end- stage kidney disease (ESKD). However, risk stratification data is lacking to certain extent. The echocardiogram has been a useful instrument with remarkable accuracy in assessing ventricular mass and volume, systolic function measurement, hypertrophy detection, and determination of its geometric pattern (concentric or eccentric). So, the present study focuses on impact of routine electrocardiography for predicting prognosis in patients of CKD on maintenance haemodialysis and need for early intervention in best patient interest. Aims and Objectives: To study ECG changes in patients with CKD on maintenance haemodialysis. To classify ECG changes for predicting outcome in patients of CKD in Maintenance hemodialysis. Methodology: Study type/design: Prospective observational clinical study. Study setting: The study was done in department of medicine in a tertiary care centre.  In this study ECG changes diagnosed to have chronic kidney disease was studied. Patient evaluation was done on day of admission, during each dialysis and at time of discharge. Informed consent was taken from every patient. Result and Discussion: This study suggests a significant association was seen between the CKD stage and the presence of ECG changes. The heart rate was almost normal in all the CKD patients in 24 months of ECG. 85% of cases had a P-wave of more than 0.25 mV initially the number of percentage p-wave after 24 months was reduced to 35.53%. QRS complex of more than 100 ms was in 35.05 % of patients at initial. There was a fluctuation in the changes in the T- wave in 24 months of. 83 % of patients had QTc interval between 401- 450 ms initially. ST segment was elevated in 14.87 % of cases initially and after 24 months the number of patients with elevated ST segment was 1.65%. 09 % reported LVH at an initial screening at the end of 24 months the number of patients with LVH was 21.48%. Conclusion: Electrocardiography is a non-invasive tool that can be used to identify cardiovascular disease early in the course of CKD. ECG abnormality observed in CKD patients was left ventricular hypertrophy followed by ST depression. The ECG changes observed after the 3 month of intervals for 24 months in the CKD patient with maintenance on hemodialysis showed   varied changes at each interval. The present study observed a high prevalence of ECG abnormalities in CKD patients. In view of the above findings, the present study recommends periodic electrocardiographic examination for diagnosis and early treatment of cardiac abnormalities in patients with CKD at regular intervals to prevent complications in the longer run. It is crucial to periodically check on CKD patients to evaluate any changes to their ECG. The probability of abnormal ECG readings increases as the CKD stage progresses, especially in the later stages.

193. A Study to Find the Bacterial Colonization in Central Venous Catheters among the Critically Ill Patients
Suresh Kumar Chodavarapu, PSM Rama Ganesh, Uma Maheswara Rao
Abstract
Introduction: Placement of central venous catheters (CVC) is most common procedures in ICU. In spite of the proper sterile practices, one of our previous studies reported that CRBSIs were common in subclavian vein (SCV) group. With this we conducted a study to find the commonly associated bacteria catheter related blood stream infection (CRBSI). Methods: It was a prospective study, conducted in NRI institute of Medical Sciences. Study protocol was approved by the Institutional Ethics committee. Informed consent was taken from the participants. The study members was divided to internal jugular vein (IJV) and SCV groups. Standard 7 Fr size CVCs of same brand were used. Strict aseptic precautions were followed for placement as well maintenance; as per the guidelines, catheters were placed. The catheter was removed after one week, under strict aseptic precautions. Upon withdrawal, distal 5 cm was cut with sterile surgical blade and transported immediately to the department of Microbiology by placing in a sterile tube. Chi-square test was used for statistical analysis; P>0.05 was considered to be statistically significant. Results: In this study 60 patients were included, 30 in each group respectively.  Maximum number of participants were in 18 – 30 years group and minimum in 41 – 50 years group; statistically there was no significant difference. Gram negative rods (GNRs) are the predominant pathogens, more number of pathogens were isolated in IJV. Non fermenters are the leading isolates. Conclusion: Bacterial colonization is common in the CVCs despite of through sterilization protocol. Non fermenting GNRs are the leading isolates followed by Klebsiella.

194. A Prospective Study on Effect of Exercise on Pulse Rate and Respiratory Rate among Normal Individuals in a Tertiary Healthcare Setup
Rajesh Potti, P Satyanarayana Raju, P Usha Rani
Abstract
Introduction: Regular exercise as well as physical activity throughout the life can improve life expectancy.  Data related to pulse rate (PR) and its effect on exercise is limited in this area. Hence a study was conducted to find the effect of exercise on Pulse Rate among the active adults. Methods: It was a prospective study. Study protocol was approved by the institutional Ethics committee. Informed written consent was taken from all the participants. Individuals of both gender, aged > 18 years, regularly attend gym were included. After recruiting the PR and respiratory rate were measured as per the protocol. Under resting condition radial arterial pulse was recorded. First the participant was allowed to laydown comfortably in supine position. At post exercise, PR was recorded 10 min, 30 min and 60 minutes. The difference between the post exercise value and resting value were used to evaluate the PR changes with exercise. Simultaneously, respiratory rate (RR) was also recorded. Chi-square test was used to find the statistical analysis and P>0.05 was statistically significant. Results: Statistically there was significant difference in the mean PR values 10 and 30 minutes after the exercise. After cycling for 5 minutes, statistically there was significant difference in PR 10 and 30 minutes after the exercise. Similar results were detected 15 minutes after cycling also. Conclusion: As per the study findings, during exercise, the PR and RR are increased. But cycling was only considered in this research. Long term studies with different exercises are recommended.

195. A Study to Characterise the Intrathoracic Lesions By Contrast Enhanced Computed Tomography and its Histopathological Correlation by CT Guided Biopsy
Lavu Srikanth, Indra Neil Mekala, Anusha Rani Sambangi, Potla Srilakshmi
Abstract
Introduction: Lung carcinoma is the commonest cause of cancer deaths. CT guided interventional procedures are commonly used with high diagnostic accuracy. A study was conducted to correlate the radiological findings of contrast enhanced computed tomography (CECT) with histopathological findings obtained from CT guided biopsy. Methods: It was a prospective study carried in the department of Radiodiagnosis, GSL Medical College, Rajahmundry. Individuals > 18 years, both gender with intrathoracic lesions who were referred for CT guided biopsy were included; coagulation abnormalities, those with contraindication for contrast media, risky for biopsy and noncooperative members were not included. After 4 hrs fasting the patient was positioned in the CT gantry and the percutaneous access site was prepared. Immediate preprocedural topogram and CT of the chest was done from the neck base up to the diaphragm. The area was cleaned with antiseptic solutions, anaesthetised locally using 2% lignocaine; 18 gauge automated biopsy guns were used for biopsy and sent for histopathology in 10% formalin. Compression was given for 5 minutes at the site. Histopathological examination was carried as per the guidelines. P≤0.05 was considered as statistically significant. Results: The male female ratio was 1.2. Maximum (35.7%) were in in 51 – 60 years. Lung parenchyma is the commonest (89.2%; 50) site for the lesions. Histopathological examination showed that 92.8% (52) were malignant. Whereas CT findings revealed that 51 (91%) were malignant cases. The sensitivity, specificity, positive and negative predictive values for the CT were 98.08%, 75%, 98.0% and 75%. Conclusion: The diagnostic accuracy of CECT was to be at par with histopathological findings. But long-term studies on different age with different clinical conditions is recommended.

196. Factors Affecting Readmissions of Term and Late Preterm Infants in the Neonatal Period
Supriya N, CVS Lakshmi, A Akshay Reddy, Radha Reddy
Abstract
Objective: To determine the incidence of hospital readmissions, the etiologies, and to analyze the risk factors for readmissions of Late Preterm infants (LPI) and term infants (TI) in the neonatal period. Methods: It was a retrospective cohort study conducted at Nice Hospital for Women and Children, Hyderabad, India. The study protocol was approved by the institutional ethics committee. Late preterm and TIs > 34 weeks of gestational age (GA), discharged alive either from the post-natal ward or NICU were included in the study. Neonates with congenital anomalies, who died before discharge, and who were readmitted >28 days of age were excluded from this study. The relevant demographic, antenatal, perinatal and neonatal data of the study infants as well as their mothers were recorded in the pre-designed proforma. Mann Whitney U test and Chi square tests were used for statistical analysis. A p value < 0.05 was considered statistically significant. Results: A total of 1396 (100%) neonates were included in this study. Thirty-eight (2.72%) of the LPIs were readmitted and 3.87% (54) were in the TI category. When neonatal characteristics were compared, statistically significant difference was seen in both categories in birth weight, jaundice requiring phototherapy, sepsis and time to full feeding respectively. Poor weight gain was the leading cause of readmission in both categories; though not statistically significant. Maximum LPIs (23) and TIs (36) were admitted in the monsoon; though statistically no significant difference was observed. Conclusion: Poor weight gain, respiratory infection, jaundice, poor feeding/lethargy and feeding difficulty/vomiting were identified as reasons for readmission. Metacentric studies with a large sample size are recommended.

197. Serum Lactate Dehydrogenase: A Biochemical Marker for the Prediction of Adverse Outcome in Pre-Eclampsia
Chaitanya Gadhavi, Vidya Manoj Jadhav, Sneha Yadav
Abstract
Aims & Objectives: To find out the role of serum LDH levels in prediction of adverse outcome of pre- eclampsia” Objectives: 1) To estimate the level of serum LDH in preeclampsia. 2) To study the correlation of LDH level and severity of the disease.3) To study the correlation of LDH level and occurrence of complications. 4) To identify the better severity indicator in maternal and perinatal outcomes. Materials & Methods: A study was conducted over a period of 6 months in the department of Obstetrics and Gynaecology, Bharati Vidyapeeth medical college and hospital, Sangli. Women with pre-eclampsia were studied who satisfied the inclusion and exclusion criteria of the study. Demographic, hemodynamic, laboratory data were compared among 2 groups. The symptoms and complications of severe pre-eclampsia along with the fetal outcome were analysed according to serum LDH levels. Results: Severely pre eclamptic women patients were significantly younger, with low gravidity and parity. Higher LDH levels have significant correlation with high BP. The symptoms and complications of pre-eclampsia along with perinatal mortality were increased significantly in pt with LDH>800IU/L compared with those who had lower levels. Conclusion: Serum LDH is useful biomarker and can be considered as a supportive prognostic tool that reflects the severity of disease and complications of pre-eclampsia. Identification of high-risk patient with increased level of LDH mandate their close monitoring and correct management may prevent these complications.

198. Tranexamic acid to Reduce Blood Loss in Women at High Risk for Postpartum Hemorrhage undergoing Cesarean Section: A Randomized Controlled Trial
Priyanka, Minakshi Bajpayee, Abha Rani Sinha
Abstract
Background: One of the leading causes of maternal death worldwide is postpartum haemorrhage. Significant blood loss raises the risks associated with blood transfusions and, as a result, raises the possibility of needing urgent surgical operations like artery ligation or hysterectomy. In low- or middle-income nations in particular, it can also result in prolonged anaemia. This study goal was to find out whether tranexamic acid effectively and safely reduces blood loss during and after lower segment caesarean sections. Method: From January 2022 to December 2022, 200 women who were having lower segment caesarean sections (LSCS) at the Obstetrics and Gynecology Department at SKMCH, Muzaffarpur, Bihar, participated in a randomised, controlled trial. One gramme of tranexamic acid was administered intravenously to 100 of them 20 minutes prior to making a skin cut so that they could be compared to 100 additional individuals who did not receive it. During two sessions, blood loss was measured and collected. The first period covered the time from placental delivery to the end of LSCS, while the second covered 2 hours after delivery. Results: Tranexamic acid significantly decreased blood loss from the conclusion of LSCS to two hours after delivery; it went from 128.57±23.72 ml in the control group to 79.0±14.18 ml in the experimental group (p=0.0001). The amount of blood loss from placental delivery to end of LSCS was also considerably less in the study group than in the control group (308.80±43.60 ml versus 349.18±42.17 ml) (P=0.0001). In neither group were there any complications or negative effects noted. Conclusion: The use of tranexamic acid significantly reduces the amount of blood loss during and after the lower segment caesarean section and has no adverse side effects or problems, such as thrombosis. Tranexamic acid can be used effectively and safely in women having LSCS.

199. Thoracic Epidural Anaesthesia for Breast Surgery using Dexmedetomidine and Ropivacaine: A Clinical Comparison to General Anaesthesia
Satyendra Kumar, Shashi Shekhar, Bijoy Kumar
Abstract
Background: Although thoracic epidural anaesthesia has advantages such as better hemodynamics, quicker recovery, fewer postoperative respiratory problems, and effective analgesia, general anaesthesia remains the old standard method for many breast surgeries. In this research, the effectiveness of traditional general anaesthesia and thoracic epidural anaesthesia using dexmedetomidine and ropivacaine (0.5%) for breast surgery will be compared. (MRM). Methods: From February 2022 to January 2023 at Nalanda Medical College and Hospital, Patna, Bihar, two groups of 40 consenting ASA Grades I and II patients who were posted for MRM were created. In Group (TEA), a 5 cm epidural catheter was threaded during a thoracic epidural in the T4–T8 intervertebral region. To reach the necessary height, injections of ropivacaine 0.5% and dexmedetomidine 1 microgram/kg were administered via the catheter. Patients in Group (GA) received Glycopyrrolate (0.2 mg), Fentanyl (2 microgram/kg), and Midazolam (0.05 mg/kg) as premedications before being administered Inj. Propofol (2 mg/kg). Vecuronium was used for the intubation and thereafter to keep the patient relaxed. Isoflurane 0.4–0.6% in IPPV and N20:O2 at a 60:40 ratio are used to maintain anaesthesia. At the end of the operation, the patients received an infusion of ondansetron (4 mg) and diclofenac (75 mg), followed by a reversal with neostigmine (0.5 mg/kg) and 20 micrograms of glycopyrrolate. Both groups utilised Ringer’s Lactate as a maintenance fluid. During surgery, both groups had their pulse, NIBP, ECG, SpO2, and respiration monitored. Results: Anaesthesia suitability, surgical condition, bleeding, post-anesthesia recovery, adverse effects during the perioperative phase, and general patient satisfaction were all evaluated. Conclusion: A thoracic epidural with 0.5% ropivacaine in addition to dexmedetomidine produced a positive postoperative outcome. There were no serious negative effects recorded.

200. Postpartum Blood Loss in Induced Verses Spontaneous Vaginal Delivery: A Descriptive Observational Study
Minakshi Bajpayee, Priyanka, Abha Rani Sinha
Abstract
Background: The most severe and potentially fatal complication of vaginal birth is postpartum haemorrhage (PPH). Blood loss of more than 500ml during vaginal birth is referred to as PPH. Primary PPH is what it is called if it happens within 24 hours of delivery. Secondary PPH is the term used when it arises after 24 hours and within 6 weeks following delivery. The aim of this study is to compare third stage blood loss during induced vs. spontaneous vaginal deliveries and to determine whether the volume of blood loss correlates with the subsequent drop in hemoglobin. Methods: From January 2022 to December 2022, the current descriptive observational study was carried out in the Obstetrics and Gynecology Department at SKMCH in Muzaffarpur, Bihar. When 300 pregnant women underwent vaginal deliveries through labour induction, blood loss after placental deliveries was assessed using special collection bags, and it was compared to blood loss in another 100 women who underwent spontaneous vaginal deliveries. Each patient’s haemoglobin levels were noted both before and after the child was delivered. Results: The difference in mean blood loss between the induced and spontaneous groups was 30 mL (202±117 vs. 172±114 mL), although this difference was not statistically significant (p=0.12). However, when various induction techniques were evaluated, it was discovered that the oxytocin group had much more blood loss (327±140 mL) than both other labour induction techniques and spontaneous deliveries. When compared to spontaneous deliveries, the blood loss caused by prostaglandin-assisted labour induction was not greater. Post-delivery haemoglobin values in both the induced and spontaneous delivery groups showed statistically significant drops, but the induced group’s drop was relatively greater than that of the spontaneous vaginal delivery group (0.96gm/dL vs. 0.56gm/dL), which appeared to be statistically significant (p=0.001). Conclusion: Using prostaglandins to induce labour is safer than using oxytocin. All deliveries require an accurate calculation of blood loss in order to identify postpartum haemorrhage early and take the necessary precautions.

201. Efficacy and Safety of Nd: YAG Laser in Tattoo Removal: An Interventional Study
Chittla Sravan, Donakonda Swetha, Sathaiahgari Dheeraj, Pathipati Vengamamba Ravali
Abstract
Background: Tattoos are intentionally made on skin by an artist or cosmetologist which may be temporary or permanent. Most of them are permanent. Because of various reasons patient intends for tattoo removal, in that situation various procedures like dermabrasion, cryo-surgery, excision are available but with limited satisfaction. Newer techniques like lasers such as Q-switched lasers are now being tried. Objective: Present study was done to know the efficacy and safety of neodymium-doped yttrium aluminium garnet (Nd: YAG) laser in eliminating tattoos. Materials and Methods: Present study was done at a tertiary care teaching institute in the Department of DVL at MNR Medical College, Sangareddy, Telangana from January 2021 to June 2022. 50 patients were included as per the eligibility criteria. Age, gender, the motive for tattoo removal, wavelength of Nd: YAG laser, number of sittings undergone by study patients, clearance rate and adverse effects were assessed. Results: Most common age group of patients involved in study was 21 to 30 years. Males are predominant with 56% and most of the patients were managed with 1064 nm wavelength for tattoo removal. The most consistent motive for tattoo removal was to get new employment. The mean number of sittings was 7.2±1.3. There is no statistical significance in the clearance rate between amateur and professional tattoos. There is no statistical significance in the clearance rate between lasers of various wavelengths. Adverse effects were mild and self-limiting. Conclusion: Q switched Nd: YAG laser is considered a good choice for treating amateur and professional tattoos, as it enables complete removal with acceptable minor side effects.

202. Effect of H1N1 Infection on Capacity of Long Term Exercise Tolerance
Manoj Saluja, Chetan Prakash Suman, Mohammed Shadab Gouri, Savita Saini
Abstract
Introduction: Swine influenza is an acute, highly contagious respiratory disease that results from infection with type-A influenza virus (H1N1). It not only causes an immediate adverse morbidity and mortality but also has been reported to have adverse impact on long term health outcome. This study was planned to assess long term consequences of H1N1 in respect of long term exercise tolerance. Material: This was a cross sectional study conducted at tertiary care centre, Sixty patients were included, All diagnosed cases of influenza H1N1. Each patient was evaluated after around one year of illness by pulmonary function test (PFT) using standard protocol by single operator. Results: Out of Sixty patients Group 1 included 38 patients without any chest disease and non-smoker,  group-2 included 13 patients with smoking habits ), and Group-3 included  9 patients with h/o asthma or with chest disease. Patient of group-1 (63.33%) were observed to have mild decrease in exercise capacity and mild restriction in PFT, Patients of group-2(21.66%) showed decrease in exercise capacity more than the patients of group-1 and mixed pattern in PFT, Patients of group-3(15%) showed marked decrease in exercise capacity as compared to pre illness exercise capacity and showed predominantly obstructive pattern in PFT, requirement of bronchodilator was significantly increased in group-3 patients. Conclusions: H1N1 infection is associated with significant long term respiratory morbidity. Exercise tolerance is significantly reduced as evident from symptoms profile, obstructive pattern in PFT and increased need of bronchodilator.

203. Growth in Infancy Following Extremely Premature Birth: Associations with Later Neurodevelopmental and Health Outcomes
Gurdeep Singh, Aakanksha Tripti, Venkata Sai G., Abhay Kumar
Abstract
Objective: Premature birth causes the brain to be prematurely exposed to the extrauterine environment during a crucial time for neurodevelopment. As a result, preterm babies are more likely to experience negative behavioral outcomes in adulthood. The aim was to examine the relationship between postnatal growth and neurodevelopment in very low gestational age infants (ELGAN, 27 weeks’ gestation) at the age of 1 years. Method: Live ELGAN born in June 2021– July 2022, at Department of Paediatric, MGM Medical College and LSK Hospital, Kishanganj, were included in a retrospective population-based cohort study. 250 infants in all made it out of the hospital and were taken into account in the studies. For 150 newborns, FU1 was recorded. Results: At 2FU, the average (±SD) psychomotor and mental development indices were 86.8 (±17.6) and 88.8 (±18.1), respectively. 23.1% of patients had moderate or severe neurodevelopmental impairment identified. Weight z-scores between birth and discharge and between birth and FU1 changed by 1.05 (±0.84) and 0.141 (±1.14), length z-scores changed by 1.35 (±1.33) and 0.41 (±1.32), head circumference z-scores changed by 0.60 (±1.03) and 0.75 (±1.31), and BMI z-scores changed by 0.21 (±3.35) and 0.005 (±1.44). No one of the four growth indicators was significantly correlated with any of the three neurodevelopmental outcome parameters, according to both unadjusted and adjusted analyses. This held true for both time periods. Conclusion: Neither growth between birth and hospital discharge nor growth between birth and FU1 were significantly linked with neurodevelopment at the age of one year in the current population-based cohort of ELGAN.

204. Dermatological Manifestations in COVID-19 and Post COVID-19 Patients: An Observational Study
Bandaru Sougandhika, Chittla Sravan, Donakonda Swetha, Sathaiahgari Dheeraj
Abstract
Background: In December 2019, a new infection termed severe acute respiratory syndrome coronavirus 2 was recognised in Wuhan China. In literature only few studies exist on cutaneous manifestations in COVID-19 and post-COVID-19 phase. Hence the present study is conducted to know the most common cutaneous manifestations. Material & Method: The present study included total of 60 patients presented with skin manifestations during COVID-19 and post COVID-19 phase of both in-patients and out-patients from October 2020 to June 2021. The patients aged more than 18yrs, tested positive for SARS CoV2 with dermatological manifestation during the infection and 3wks after testing negative for SARS CoV2 up to 3 months were included. The dermatological manifestations were recorded during the active COVID-19 infection and during post-COVID-19 period. Result: Among the 60 patients the common pattern was maculopapular rash in 24 patients (40%), urticaria seen in 8 patients (13.3%), chilblain seen in 4 patients (6.66%) and livedo reticularis seen in 2 patient (3.33%), during post COVID-19 were acneiform eruption seen in 16 patients (26.4%), vesicular lesions seen in 4 patients (6.66%) and lichen plan us observed in 2 patients (3.33%). Conclusion: There is significant association of presence of the dermatological manifestations among the patients with COVID-19 and post COVID-19 period. Study of these dermatological manifestations and their pathogenesis and their significance in human health is useful in avoiding misdiagnosis and proper treatment.

205. Nociceptive Analgesic and Anxiolytic Effects of Ondansetron in Wistar Rats: A Prospective Observational Study
Rout Anima, Goutam Siddhartha, Paikray Elisha, Pattanayak Chaitali, Mishra Vedvyas
Abstract
Introduction: Serotonin plays an important role in pathogenesis of many diseases. Ondansetron is a selective 5HT3 antagonist used in patients with nausea and vomiting. It has also shown effectiveness in treatment of epilepsy, severe neuropathic pain, anxiety attacks & CNS-related disorders. The aim of this study was to evaluate the anticonvulsant, anxiolytic & antinociceptive effect of ondansetron in rats. Materials: Rats were treated with different doses of ondansetron intraperitoneally (i.p. – 0.5mg/kg, 1mg/kg and 2mg/kg) , phenytoin 5mg/kg and control group received normal saline 0.1 mg/kg for 3 days. MES induced convulsion model is used to study the anticonvulsant effect. To study the anxiolytic effect of drugs ondansetron(0.16mg/kg), diazepam (1 mg/kg) & distilled water, we used an elevated plus maze test model, in which we recorded number of entries and time spent in open & close arm. Similarly, the nociceptive effect was evaluated by Tail flick test using radiant heat. Ondansetron as 0.5 mg/ kg and 1 mg/ kg; tramadol as 5 & 10 mg/ kg & normal saline were given i.p 30 mins prior to experiment. The efficacy of drugs were tested on basis of increase in pain threshold and suppression of symptoms depicting pain. Results: The percentage protection from seizures in ondansetron 2mg/kg group is 16.7% as compared to control group. The onset and duration of tonic hind limb extension was less in ondansetron 1mg/kg (9.3 sec & 6.7 sec) as compared to other groups. Ondansetron showed dose dependant anti-nociceptive action similar to but less than that of tramadol. Similarly animals receiving ondansetron at dose 0.16 mg/kg showed anxiolytic effects in compared to control group and spent more time in open arms as compared to close arms. Conclusion: Being a potent 5HT3 antagonist, Ondansetron has shown its potential role in modulating various CNS actions at higher dose.

206. A Prospective Study on Incidence of Incidental Gallbladder Carcinoma in Cases of Routine Cholecystectomy on Eastern Indian Population
Parikshita Dalai, Swapnarani Behera, Chandan Das, Jyotirmaya Nayak
Abstract
Background: The most common malignancy of the biliary tract is carcinoma gallbladder and most of these cases are diagnosed incidentally in patients undergoing Cholecystectomy. Objectives: Find the incidence of gallbladder carcinoma in patients undergoing routine cholecystectomy. Methods: A prospective study was carried out in Sri Rama Chandra Bhanja Medical College, Cuttack in the year 2018. The surgical notes hospital records and histopathology reports of 100 patients who underwent routine cholecystectomy were studied. Results: Out of Fifty cases studied, 3 cases for detected to have gallbladder carcinoma. Males preponderance and mean age of occurrence was nearly 50 years. Both were adenocarcinoma of gallbladder. Conclusion: Rate of incidental gallbladder carcinoma is 6% in our tertiary care hospital.

207. Status of Neurocognitive Functions in HIV Patients on HAART at ART Centre of a Tertiary Care Teaching Hospital
Savita Saini, Chetan Prakash Suman, Mohammed Shadab Gouri
Abstract
Background: The Central Nervous System is one of the major targets of HIV infection and is often associated with neurocognitive impairment. Aims & Objectives: The present study is aimed to determine the status of neurocognitive functions among HIV positive patients on Highly Active Antiretroviral Therapy (HAART). Materials & Methods: A cross-sectional study was conducted in 200 HIV positive patients, registered at ART Centre of Government Medical College & AG Hospital, Kota. A test battery comprising two scales was used i.e International HIV Dementia Scale (IHDS) and Activities of Daily Living (ADL) Scale to diagnose cognitive dysfunction and dependence in ADL respectively. Results: The prevalence of HIV associated neurocognitive disorder (HAND) was found to be 36.5% (n=73). Out of these cognitively impaired patients 2.5% (n=5) patients were dependent in > 2 activities of daily living. The lower baseline CD4 count and duration of HAART < 1year, both were found to be significantly associated with cognitive impairment. Conclusion: Asymptomatic and mild neurocognitive impairment is prevalent among HIV patients on HAART. This suggests the need to routinely screen HIV positive patients, to recognize the neurocognitive deficits at an early stage.

208. Assessment of Utilization of ICDS scheme and Impact on nutritional status of beneficiaries in RHTC area under Government Medical College Kota (Rajasthan)
Shirish Gupta, Mohammed Shadab Gouri, Shikha Sharma, Ishrat Jahan, Amit Kumar, Kshitij Gupta, Ankushree Yadav
Abstract
Background: Under-nutrition is one of the major problem which leads to developmental delays as well as poor health requiring frequent visits to health care center in early child hood in India. The aim of this study was to conduct assessment of utilization of ICDS program and its impact on under‐nourished children attending anganwadi center (AWC). Methods: This was a record and interview based analytical study conducted in RHTC area under Government Medical College of Kota district. Total 380 records of beneficiary children registered under the ICDS scheme were observed for present day assessment of these beneficiaries followed by SPSS mediated analysis. Results: A higher weight gain was seen in children of literate mothers. Regular attendance in anganwadi was seen in eighty five percent  of children, however 19 % of children dropped out for more than 1 month. In a period of one year, it was observed that in growth had faltered in 2.6% children and was stagnant in 71.5% of them. Conclusions: Focus on taking regular follow up by the AWWs should be encouraged so that continuity in attendance  and maximum utilisation of services by the eligible and registered beneficiaries under the scheme is ensured. This might prove to be an important step in preventing shifting of children towards red category.

209. A Study of Serum C-Peptide Level in Obese and Non-Obese Type 2 Diabetes Mellitus Patients at SMS Hospital, Jaipur
Kailash Chand Kumawat, Karamveer Singh, Rekha Bagla, Sharwan Kumar, Rati Mathur
Abstract
Background: Diabetes mellitus (DM) is a chronic metabolic and endocrine disorder characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. Obesity is associated with an increased risk of developing insulin resistance, which is a risk factor for Type 2 Diabetes Mellitus. C-peptide has recently been shown to be a biologically active peptide which corrects vascular, neural and renal dysfunction in patients with DM. So we evaluated the serum C-peptide level in obese and Non-Obese Type 2 Diabetes Mellitus Patients in tertiary centre .at SMS Hospital, Jaipur. Materials & Methods: After taking necessary permissions, a cross sectional study was conducted at Department of Biochemistry and Department of Endocrinology / Medicine, SMS Hospital, Jaipur. This study includes 100 obese patients suffering from type 2 diabetes aged 30-80 years compared with 100 non obese cases. Samples were analyzed for the measurement of serum glucose by Colorimetric method, C-peptide by chemiluminescence assay method and HbA1C measured by latex turbidimetric method. Results: Results were analyzed statistically by Student’s t-test and Pearson correlation coefficient test. C-peptide in Non-Obese patients was 3.62 ± 1.63 ng/ml and in obese patients was 8.71 ± 1.59 ng/ml. C-peptide levels were significantly high in obese patients. There was statistically highly significant positive correlation between serum c peptide levels with Fasting blood sugar and HbA1c in diabetic patients. Conclusion: Measurement of C-peptide is a better index of endogenous insulin production and pancreatic beta cell function than insulin measurements; it will also be helpful to alter the treatment modality based on it. This study suggests routine C-peptide testing in patients with poor glycaemic control so that treatment modality can be modified based on C-peptide levels (endogenous insulin reserve).  Moreover, in clinical practice, emphasis should be given to educating patients about lifestyle modifications and to prevent obesity.

210. Etiopathogenesis, Clinico-Biochemical Profile & Surgical Intervention in Patients with Liver Abscess: A Cross Sectional Observational Study
Parikshit Singh Chandawat, Garima Gupta, Sourabh Gaur, Manish Choudhary
Abstract
Background: Liver abscess is a common clinical presentation requiring prompt diagnosis. The clinical symptoms are vague making diagnostic quandary. Imaging modalities are essential to conclude & start early management. Objectives: To describe the etiopathogenesis, clinical & biochemical profile & management in patients with liver abscess. Material & Methods: This cross-sectional observational study was conducted at our tertiary health centre from January 2022 to Dec 2022. 80 patients who were diagnosed with liver abscess were recruited. Inclusion criteria was patients with liver abscess, Hydrated cyst of Liver, and not responding to conservative management at the end of 48 hours. Detailed history recording with complete clinical examination was done. The venous blood samples were taken & sent for laboratory assay. Parameters assessed were alcohol intake frequency, socioeconomic class, Complete blood count, kidney function test, liver function test, PT/INR, ultrasound guided aspiration of liver abscess- percutaneous needle or pigtail catheter. Results: Mean age was 43.3 yrs 12% were females 62% of the patients belonged to low socioeconomic strata with high alcohol intake. In 77%  of the patients liver abscess was amoebic & 23% had pyogenic abscess. Clinical presentation of  pain abdomen (100%), fever (25%) & anorexia (94%), diarrhoea & cough (18%). Clinical signs noted were hepatomegaly, pallor, jaundice, pleural effusion & splenomegaly. Higher values noted for leucocytes, SGOT, SGPT, alkaline phosphatase, bilirubin, ESR. The abscess was drained by percutaneous needle aspiration in 78%, pigtail drainage in 12% and open surgical drainage done in 10%. The mean duration of hospital stay was 7±4.1 days. Conclusion: The clinical profile in liver abscess was of young alcoholic male belonging to low socioeconomic class having right lobe solitary amoebic liver abscess. Early diagnosis & intervention favours successful outcome & reduced duration of hospitalization.

211. Prevalence of Clinically and Biochemically Diagnosed Myopathy in Hypothyroid Patients
Swathy Krishnan A.R., Padmakumar Rajasekhara Pillai, Sajeesh K.
Abstract
Background: In this study, we wanted to estimate the proportion of myopathy among hypothyroid patients, assess the correlation of hypothyroid myopathy with Serum TSH levels, and study the association of anti-TPO antibody with hypothyroid myopathy. Methods: This was a hospital-based cross-sectional study conducted among 100 patients who presented with hypothyroidism to the Thyroid Clinic, Department of Internal Medicine, Government Medical College, Thiruvananthapuram, for one year, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Hypertension has got a statistically significant relation with hypothyroid myopathy (p=0.013). Increased sensitivity to cold (p<0.001) and depression (p=0.004) when compared to other symptoms of hypothyroidism has got significance in hypothyroid myopathy. Proximal “Limb-Girdle” weakness of upper limbs is much more common in hypothyroid myopathy as per the study (p<0.001). Among the serum muscle enzymes studied, there exists a statistically significant relation between S. CPK (p<0.001) and S. LDH (p=0.029) with hypothyroid myopathy. Urine myoglobin has a statistically significant relation with hypothyroid myopathy (p<0.001). There is a statistically significant relation between anti-TPO and hypothyroid myopathy in the study (p<0.001). Anti-TPO and S. CPK have a statistically significant linear relationship (r=0.812, p<0.001) in the study. Conclusion: The prevalence of myopathy in overt hypothyroidism is 69% in the study. Serum TSH levels and serum muscle enzymes CPK, LDH, and urine myoglobin have a significant correlation with hypothyroid myopathy. Anti-TPO has a significant relation with hypothyroid myopathy, and it has a significant positive linear relationship with CPK values.

212. Superficial Cervical Plexus Block with Interscalene Block vs. General Anaesthesia for Clavicle Surgeries: A Randomized Comparative Study
Sourav Dash, Chittranjan Pradhan, Jajnadatta Kar
Abstract
Background: Clavicle fractures are a common injury to the shoulder girdle, with operative management recommended for displaced fractures with greater than 2cm of shortening. Clavicle surgery is typically performed under general anesthesia, with regional anesthesia methods rarely used. However, recent literature suggests that combined interscalene-cervical plexus blocks may be an effective alternative to general anesthesia for clavicle surgeries. Material and Methods: This prospective randomized study aimed to compare the efficacy of anesthesia and postoperative analgesia between combined interscalene-superficial cervical plexus blocks and general anesthesia for clavicle surgeries. Sixty patients between the ages of 18-60 undergoing clavicle surgery were randomly allocated to either Group A (general anesthesia) or Group B (combined interscalene-superficial cervical plexus blocks). Results: The results showed that surgery was completed exclusively under block in 90% of patients in Group B, with a mean duration of surgery of 2 hours. The study found that superficial cervical plexus block with interscalene block can be used as an alternative to general anesthesia for patients undergoing clavicle surgery. Regional anaesthesia provided better analgesia in terms of VRS score and also provided stable intraoperative hemodynamics. Conclusion: The study suggests that combined interscalene-superficial cervical plexus blocks can improve outcomes and maintain the stability of vital functions and providing better analgesia for clavicle surgeries. The results of this study can be useful for clinicians in selecting an optimal nerve block for anesthetizing the clavicle and can inform the development of future research on regional anesthesia for clavicle surgeries.

213. Observational Study of Operative Outcome of Simple Ovarian Cyst in Laparoscopy vs. Laparotomy Method
Mansi Gadhavi, Vijay Gadhavi, Malvee Kela, Bhavesh Airao
Abstract
Background: Ovarian cysts are quite common and involve all age groups, occurring in both symptomatic and non-symptomatic females. Ovarian cyst removal is surgery to remove one or more cysts from one or both ovaries. A laparoscopic surgery uses small incisions and specialized tools. It may offer faster recovery times than open surgery , which uses a larger abdominal incision. Method: It is an observational study conducted in Obstetrics & Gynaecology department, C.U. Shah Medical College with retrospective data of 50 patients review of all cases of ovarian cysts diagnosed and managed between January 2022 and June 2022. All data collected from medical record charts, patients details, clinical presentations, ovarian cysts description, and pathology type were recorded, and management by laparoscopy or laparotomy was identified. Ethical approval was obtained from ethical hospital committee. Result: There were 50 cases of ovarian cysts during the study period. including duration of surgery laproscopic vs. laparotomy group is (98.34 ± 12.83 minutes vs. 75±08.43  minutes), intraoperative blood loss (51.27 ± 4.19 mL vs. 75.12± 2.19 mL), postoperative pain score (5.13 ± 0.43 points. vs. 7.45 ± 0.35 points), length of hospital stay (4.05± 0.2 days vs. 6.25 ±  0.8 days), and time to free activity (22 ± 3.02 hours vs. 32±1.25 hours). The total complication incidence in the laproscopy group was 3.9%, compared with 16% in the laparotomy group. significant differences in direct medical costs were recorded between the two groups. No. of complications in laproscopy vs. laparotomy group are wound site infection( 0 vs. 4 ), bowel injury( 1 vs. 0), nausea and vomiting (6 vs. 11), peritonitis(1 vs. 3), surgical site heamatoma(1 vs. 2). Conclusions: Traditional laparotomy in the treatment of simple ovarian cyst is usually associated with postoperative complications such as wound infection, nausea vomiting, surgical site heamatoma. The incidence of complications decreases sharply when laparoscopic surgery is employed. Patient compliance for Post-operation pain score, Length of hospital stay (days), Time to free activity are better in laparoscopic group than laparotomy group.

214. To Compare the Quality of Life in Newly Diagnosed Patient’s of Epilepsy on Monotherapy with Levetiracetam and Valproic Acid
Sanjay Kumar Verma, Rajit Sahai, Suman Bala, Yashpal Singh, Akanksha Suman
Abstract
Background: Quality of life (QOL) is often neglected while managing epilepsy, as the main goal is to enable a person to live a seizure-free life. Epilepsy and its treatment affect the quality of life of the patient. Methods: The present study was an observational analytical study, comparing QOL in epileptic patients receiving monotherapy with either levetiracetam or valproic acid. It was conducted in the Department of Neurology, Himalayan Institute of Medical Sciences, Dehradun. Over 12 months period, 120 patients satisfying inclusion criteria were enrolled and divided into two groups based on the treating physician’s discretion. They were followed up for a period of 12 weeks. Patients were evaluated based on a QOLIE-10 self-administered questionnaire for quality of life at 0 and 12 weeks. They were also assessed for drug-related adverse effects and seizure control. Results: Significant improvement in quality of life was seen with both drugs. Levetiracetam (18.117 ± 1.967) showed a mean change significantly greater than valproic acid (11.317 ± 2.931) (p<0.05). The most common adverse event in the levetiracetam group was drowsiness; in the valproic acid group, the most common were anorexia and drowsiness. Seizure control was similar in both groups at the end of 12 weeks. Conclusions: Monotherapy with levetiracetam resulted in a better quality of life, with similar seizure control and a lesser number of adverse events as compared to valproic acid.

215. Risk Factors Leading to Lower Extremity Amputation in Diabetic Patients: An Observational Study
Usha Sadasivan, Prathap B, Madhumittha R, Deepak Kanna, Karthika Padmavathy
Abstract
Introduction: Diabetes mellitus is the most common endocrine disorder, currently considered  as  pandemic,  affecting  both  developed  and  developing  countries. Our study aims to find the association between major lower extremity amputation with age, gender, HbA1c, duration of diabetes mellitus, triglycerides, smoking, neuropathy, nephropathy, vasculopathy, osteomyelitis, socio economic status and sepsis in diabetic patients. Material and Methods: Observational cross section study conducted at department of General Surgery, Saveetha Medical College Hospital, Chennai from March 2016 to September 2017. Around 100 diabetic patients who were going for lower extremity amputation were included. All diabetic patients with foot/toe ulceration (Grade 3,4,5 – Wagner classification of diabetic foot) requiring amputation, infection (severe sepsis) of the lower limb requiring amputation gangrene of the lower limb requiring amputation and underlying osteomyelitis of the lower limb requiring amputation were included in our study. Diabetic patient undergoing amputation following road traffic accident crush injury and diabetic patient undergoing amputation following lower limb tumours were excluded from this study. Permission as taken from institutional Ethics Committee of Saveetha Medical College prior to the initiation of the study. Results: Based on the observation and statistical analysis of this study, there is no association between increasing age, gender and duration of diabetes mellitus with major lower extremity amputation.  Based on the observation and statistical analysis of this study, there is significant association between increasing HBA1C, triglycerides, neuropathy,  nephropathy, vasculopathy, osteomyelitis and sepsis with  major lower extremity amputation (P=0.001). Conclusion: Based on the our study observations we conclude that the risk factors elevated HbA1C which indicated uncontrolled diabetes mellitus. Elevated triglycerides, diabetic neuropathy, diabetic nephropathy, osteomyelitis, and sepsis have significant association with major amputation and avoiding these risk factors has profound influence in the prevention of major lower extremity amputations.

216. Anemic and Non-Anemic Adolescent Girls towards Audio-Visual Reaction Time: Case Control Study
Rashmi Gour, Sangeeta B Chinchole, Priyanka Verma
Abstract
Background: Anemia is common problem in adolescent girls in many developing countries including India. Low hemoglobin levels may lead to decreased attentiveness and low neuronal metabolic action. Objectives: To observe and compare the effects of hemoglobin level on auditory and visual reaction time in Non- Anemic and anemic girls of same age group. Material and Methods: Adolescent girls of age group 17-19 years were included in the study. Hemoglobin estimation was done using Saheli’s Hemoglobinometer. Two groups were made. Group I (n= 40) with estimated haemoglobin concentration ≥12 gm%. Group II (n=40) with estimated haemoglobin concentration<12gm%. Auditory and visual reaction time has been measured using Reaction time analyzer. Recorded observations were analysed using Epi-info software. Results: Delayed auditory and visual reaction time was observed in Group II. The mean hemoglobin level was 12.3± 0.48g/dl in group I and was 10±0.52 g/dl in group II. Significant difference (p<0.05) in auditory and visual reaction time was found between two groups. A significant negative correlation of hemoglobin with both Auditory and Visual reaction time was seen with Group -II. Conclusion: Both auditory and visual reaction time were found to be delayed in Group II having hemoglobin < 12gm% as compared to those having hemoglobin ≥ 12gm%. Sensorimotor performance is affected in anemic individuals.

217. Comparative Analysis between Primary and Secondary Dacryocystorhinonstomy in Acute Dacryocystitis
Ritesh Surana, Amit Modwal
Abstract
Introduction: Primary dacryocystorhinostomy is a technique used to relieve epiphora by removing fluid and mucus retention in the lacrimal sac and increasing tear outflow. Secondary dacryocystorhinostomy is a bypass technique that uses a bony ostium to form an anastomosis between the lacrimal sac and the nasal mucosa. Acute dacryocystitis in infants is extremely rare, affecting less than 1% of all babies. Acquired dacryocystitis affects more women than men and is more common in individuals over the age of 40, with a peak in people aged 60-70 years. Acute dacryocystitis is an acute suppurative inflammation of the lacrimal sac characterized by a painful swelling in the sac region. Acute sac inflammation is usually often caused by a blocked lacrimal duct. Aims and Objectives: To conduct comparative analysis between primary Endoscopic dacryocystorhinostomy (EN-DCR) and secondary EN-DCR (post percutaneous drainage of lacrima sac abscess). Methods: This is a prospective trial which has divided the patients into 2 groups, namely, control and intervention group. Patients in the control group had percutaneous lacrimal abscess drainage performed while the patients in the intervention group received early EN-DCR. Baseline characteristics were determined and the outcome variables were statistically analyzed. Results: The study found that significant time was needed (p<0.05) for resolution of symptoms in control group (32.5±27.5 minutes) as compared to the Intervention group (14.9±6.2 minutes). The duration of surgery, functional success and clinical visits among the patients of Intervention group was found to be significantly lower as compared to the control group (p<0.05). Conclusion: The study has concluded that primary early EN-DCR is recommended in acute form of dacryocystitis to obtain an optimum functional and anatomical efficiency as compared to the secondary procedure.

218. A Comparative Study on Auditory Reaction Time among Prolonged Headphone Users and Non-Users
Priyanka Verma, Ajay Bhatt, Sunita Solanki
Abstract
Introduction: There is an increasing public health concern about the effects of recreational noise, especially among young people who listen to music at high volumes at concerts and other events. The prevalence of noise-induced hearing loss among adolescents is rising, affecting 1.7% of the world’s population. Hearing loss can occur from Exposure to loud noises if it lasts too long. Aims and Objectives: This research aims to determine if regular headphones users have slower auditory reaction times than non-headphone users. Methods: Between May 2020 and April 2023, 80 patients who were seen in our hospital’s Physiology Department were surveyed for this study. Participants’ auditory reaction times were measured with the 0.001-second resolution, +1-digit accuracy Reaction Time Machine 653. To establish their baseline auditory reaction time, each participant undertook three trials. The average reaction time (ART) was then calculated and ART of both headphone users and non-users was compared. Results: There was no statistically significant variation in response time to any of the three auditory stimuli tested between the sexes in this study. However, using earphones significantly slowed auditory reaction time to the first stimulus but did not affect the second or third stimuli. Male participants’ reaction times increased significantly with earphone use for both stimuli, while female participants’ reaction times increased significantly with earphone use for both stimuli. Conclusion: The study has concluded a significant difference in auditory reaction time between headphones and non-users.

219. Requirements for Maintenance Vitamin D3 Dosage in Indian Women with Postmenopausal Osteoporosis
Tirpti Verma, Sunita Kuldeep, Kamal Kant Sain, Jyoti Gothwal
Abstract
Objective: There hasn’t been much research on the vitamin D3 (cholecalciferol) dosage needed to maintain adequacy in women with postmenopausal osteoporosis (PMO) in India. While some recommendations call for 700–1100 IU of vitamin D per day, the Endocrine Society (US) recommends 1500–2000 IU per day to keep 25(OH)D concentrations at >75 nmol/L (1ng/ml = 2.5 nmol/L). We wanted to determine the oral cholecalciferol dose necessary to keep 25(OH)D concentration at >75 nmol/L in PMO Indian women, with the hypothesis that lower dose requirements would apply to those with a light complexion in Indian population. Method: Within a year, 100 Indian women with baseline blood 25(OH)D concentrations more than 40 nmol/L were enrolled at Department of PMR, RNT Medical College, Udaipur. Prior vitamin D supplementation were stopped, and patients were randomized to receive either 15,000 IU/3-weekly (Group-A) or 60,000 IU/3-weekly (Group-B) oral cholecalciferol for 15 weeks while being closely monitored. At baseline, week seven, and week fifteen, serum 25(OH)D, PTH, and urine calcium levels were assessed. Results: Osteoporosis severity, sun exposure (2 hours/week), and serum 25(OH)D baseline characteristics did not differ across treatment arms. With mean serum 25(OH)D values of 108.0±20.3 and 114.6±18.3 SD nmol/L, respectively, after 15 weeks, 91% of women who were sufficient at baseline remained sufficient on 15,000 IU/3-weekly compared to 97% on 60,000 IU/3-weekly (p=0.272). At the trial’s conclusion, 38% and 81%, respectively, of the baseline-insufficient women in Groups A and B had acquired sufficiency (p=0.056). No dose was connected to toxicity or hyperparathyroidism. Conclusion: Despite pre-trial vitamin D treatment and adequate sun exposure, 25.5% of women had insufficient levels of vitamin D, showing that in the, sunshine alone cannot provide enough. More than 80% of women can safely maintain vitamin D adequacy with cholecalciferol doses of either 800 or 2700 IU per day.

220. Difficulties Pertaining to the Musculoskeletal System That Occur During Pregnancy, Delivery and the Period Following Childbirth
Jyoti Gothwal, Arun Yadav, Kamal Kant Sain, Himanshu Agarwal
Abstract
Background: Pregnancy-induced hormonal and physiologic changes increase the risk of musculoskeletal problems in pregnancy. The purpose of this report is to provide a comprehensive look at the musculoskeletal pain and symptoms experienced during pregnancy. Methods: A total of 184 women (mean age 30.9 ± 5.0years) who gave birth in the obstetrics clinic of RNT Medical College, Udaipur were included in the study. The participants who had given birth at 37–42weeks of pregnancy (term pregnancy) and aged over 18years were selected for participation. Basic demographic and clinical characteristics of the participants including age, body mass index, weight gained during pregnancy, education level, occupation, parity, sex of baby, and exercise habits were collected from the medical chart and face-to-face interviews. Musculoskeletal pain sites were defined as hand–wrist, elbow, shoulder, neck, back, low back, hip, knee, and ankle–foot in a diagram of the human body. The interviews with participants were performed to assess their musculoskeletal pain separately at each trimester follow-up visit. Results: The most frequent musculoskeletal complaints during pregnancy were low back pain (n = 130, 70.7%), back pain (n = 80, 43.5%), hand–wrist (n = 61, 33.2%) and hip pain (n = 59, 32.1%). The participants experienced musculoskeletal pain most in the third trimester except for elbow, shoulder and neck pain compared with the first and second trimesters (p < 0.05). Conclusions: The results of the study suggest that numerous musculoskeletal problems may complicate pregnancy especially in the third trimester.

221. Screening of Cardiac Status in Asymptomatic Antenatal Mothers to Detect Undiagnosed Heart Disease
Kokila. S, Radha. R, Hemamalini. J
Abstract
Introduction: Heart disease is the leading cause of death during pregnancy in developed countries, and cardiovascular complications may develop in 0.2%–4% of pregnancies, even if no prior cardiac disease is known. Aim and Objective: To determine the prevalence and distribution of CVD and its potential risks among asymptomatic pregnant women. Result: Out of 200 sample that was studied, 8 (4%) had h/o heart disease and remaining 192 cases had (96%) had no h/o of heart disease. Only 45 (22.5%) had heart disease detected by ECHO and remaining 155 cases had (77.5%) no heart disease. Out of the 45 cases of heart disease, 13 cases had CHD, 5 cases each moderate MR and MS and 4 cases each had TR and severe MS. Conclusion: Cardiac screening during pregnancy may seem to be an expensive process. However, the detection of cardiac diseases during pregnancy can be lifesaving, due to the fact that CVD is the major cause of maternal death. Conducting a systematic, accurate and realistic risk assessment for potential maternal and foetal complications and anticipated adverse outcomes, both during pregnancy and postpartum is vital to the success and safety of the pregnancy. Hence it advisable to subject all pregnant women to echocardiographic examination at least one time during pregnancy.

222. To Evaluate the Etiology and Outcome of Pregnancies Affected by Thrombocytopenia
Priyadharshini. P, Kokila. S, Radha. R
Abstract
Background: To investigate the aetiology, obstetric risk factors and outcomes of thrombocytopenia complicating pregnancy. Methods: Study was conducted on 100 pregnant women who had thrombocytopenia from May 2022 to October 2022, in Government Rajaji Hospital, Madurai, Tamilnadu, India. Clinical data including history, physical examination and investigations and outcome of those women were evaluated. Results: Of the hundred women studied, 40% had viral infection, 34% had Gestational thrombocytopenia, Preeclampsia and its complications like HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) accounted for 22% of cases whereas idiopathic thrombocytopenic purpura (ITP) accounted for 4% of cases. IUGR (Intrauterine growth restriction), placental abruption, preterm and Neonatal Intensive Care Unit admission were more commonly observed in cases with moderate to severe thrombocytopenia but not with mild thrombocytopenia. Conclusion: The Commonest cause of thrombocytopenia in pregnancy is viral infections in our study as there was a viral fever outbreak during September and October, followed by gestational thrombocytopenia, preeclampsia and its complications like HELLP syndrome and the last one being ITP. Early detection and treatment of underlying disorder and proper obstetric management depending on the cause is the key factor in management.

223. Peripartum Hysterectomy in a Tertiary Care Centre
R. Anitha, Shameema Begum, Priya Dharshini
Abstract
Peripartum Hysterectomy is performed at the time of delivery or at any time from delivery to discharge. The study was conducted retrospectively for a period of 6 months from July 2022 to December 2022. Abnormal placentation was the most common cause.

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