International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Compare the Efficacy of Intravenous Magnesium Sulphate and Dexmedetomidine in Reducing the Hemodynamic Stress Response during Laryngoscopy and Endotracheal Intubation
Syed Saif Ahmad, Rahul Gupta, Vivek Badada, Yamini Gupta
Objective: This study aimed to compare the efficacy of intravenous Magnesium Sulphate and Dexmedetomidine in reducing the hemodynamic stress response during laryngoscopy and endotracheal intubation. Methods: The present study included a total of 60 patients of either sex aged between 18 to 60 years who underwent surgery under general anaesthesia. The patients were randomly allocated into two groups, Group M (Magnesium Sulphate) and Group D (Dexmedetomidine) of 30 patients each. Group M patients were administered intravenous 25 mg/kg of 50 % Magnesium Sulphate in normal saline (10ml total) and Group D patients were received intravenous Dexmedetomidine 1 mcg/kg in normal saline (10ml total), 10 minutes before intubation. In the present study demographic variables, anthropometric variables, ASA physical status and duration of surgery was comparable between two groups. Results: Mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean MAP in Magnesium Sulphate (M) group was significantly higher as compared to that of Dexmedetomidine (D) group throughout the study period except at baseline. Hence Dexmedetomidine (D) group is better than Magnesium Sulphate (M) group Both the drugs had minimal side effects with no significant difference between the groups. Overall, Dexmedetomidine provided a better Hemodynamic study and was found to be superior when compared to Magnesium sulphate. Conclusion: The sympathetic reactions to laryngoscopy and intubation have been suppressed using a variety of medication combinations with varying degrees of efficacy. Overall, Dexmedetomidine provided a better Hemodynamic study and was found to be superior when compared to Magnesium sulphate.

2. A Clinical Study of Extra-Cranial Complications of Chronic Suppurative Otitis Media
Gopal Kumar Jha, Prashant Kumar
Background and Objective: The Objective is to study the risk of extra-cranial complications in treated and untreated cases of CSOM and to study the common extra-cranial complications of CSOM with respect to age, sex and socio-economic status. Methods: The present study comprises of 60 patients with extra-cranial complications secondary to chronic suppurative otitis media in ENT at GMCH Purnea. Results: In this study of 60 cases, the extra-cranial complications were associated with 16.66% of intra-cranial complications. The commonly encountered extra-cranial complications of CSOM were post-aural abscess (50%), mastoiditis (41.7%), facial nerve paralysis (23.3%), post-aural fistula (16.7%), labyrinthine fistula (15%), zygomatic abscess (6.7%), Bezold’s abscess (1.7%) and petrositis (1.7%). Complications were commonly found in squamosal type of CSOM. Conclusion: The extra-cranial complications of CSOM pose a great challenge to the developing countries despite its declining incidence. This can be attributed to the lack of public health awareness and inadequate health care delivery system. It is in this situation that early diagnosis and prompt surgical intervention are most important for the decreased morbidity and mortality of these patients.

3. Study of Septoplasty and Reduction of Blood Pressure in Patients with Hypertension
Prashant Kumar, Gopal Kumar Jha
Background: Nasal septum is the bone and cartilage of the nose that separates the nasal cavity into two passages the space between the septum and the lateral walls of the nasal cavity regulates airflow and respiration. Nasal septum deviation is one of the most frequent reasons for nasal obstruction presented with a reduction in nasal airflow and chronic mucosal irritation. Abnormal upper airway resistance can play a role in the development of hypertension. Effective management of hypertension decreases the risk of, myocardial infarction, stroke, chronic kidney disease and heart failure. Material and Methods: Adults of both sexes with age range from 20–40 years, suffering from symptomatic nasal septal deviation and newly detected hypertension (mean BP ≥140/90 mm Hg), undergoing submucosal resection (SMR) of the deviated septum, were included in the study. Preoperative evaluation was done and detailed history was taken. asal septal deformities were classified according to the Dreher scale (0 = none i.e. no deviation, 1 = mild deviation i.e. deviation less than half of the total distance to the lateral wall, 2 = moderate deviation i.e. deviation greater than half of the total distance to the lateral wall but not touching it, 3 = severe deviation i.e. deviation touching the lateral wall). Compensatory inferior turbinate hypertrophy, when present, was noted. Hypertension was considered as controlled in patients who had a mean SBP <140 mm Hg and mean DBP <90 mm Hg on follow up, Patients in whom SBP was ≥140 mm Hg and/or DBP ≥90 mm Hg, were considered as uncontrolled hypertensive and they were started on medical treatment for hypertension. Postoperatively, patients were followed up after 1 month, 3 months and at the end of 1 year. Results: Of the 50 patients included in the study 40 (80%) were male and 10(20%) were female. Mean age was 34 ± 4.56. Mild septal deviation was seen in 10(20%), moderate septal deviation was observed in 31 (62%) and severe septal deviation was seen in 9 (18%). Compensatory hypertrophy was observed in 11(22%) of cases. Mean preoperative SBP was 143.76 ± 2.78 mm Hg and mean DBP was 93 ± 1.55 mm Hg. Hypertension was controlled in 70 % of patients who showed a strongly significant (P < 0.001) decrease in BP about 10–12 mm Hg decrease in SBP and 4–5 mm Hg decrease in DBP. Conclusion: Patients with hypertension and deviated nasal septum, surgical correction is always indicated as it helps in reducing the blood pressure and thereby prevent cardio-pulmonary and cardio vascular complications secondary to hypertension.

4. Efficacy of HRCT in Detection of Tracheobronchial Foreign Body
Dhananjay Kumar, Manoj Kumar
Background: Aspirated foreign bodies in the airway continue to present challenges to the otorhinolaryngologist and interventional pulmonologists. To established the role of HRCT in diagnosis of foreign bodies in suspected cases. Methods: 30 patients with suspected FB inhalation on the basis of clinical history and symptoms like respiratory distress, stridor, and history of chocking were recruited for study in department of Otorhinolaryngology in DMCH, Darbhanga. Results: 29 patients (96.67%) with foreign bodies were identified on chest CT. For the patients with tracheobronchial foreign bodies, the occurrence of unilateral hyperlucent lung and post-obstructive lobar or segmental infiltrates on plain chest X-ray was 43.33%. 17 patients (56.67%) had no abnormalities on plain X-ray. The difference between multidetector CT and plain X-ray results was statistically significant. Conclusion: Foreign bodies are missed by clinical and X-ray examination in many cases and that is only picked up by HRCT. Thus it is the ideal modality in diagnosis of foreign bodies to avoid the morbidity and mortality associated with missing foreign body.

5. Study on Clinical Profile of Neonatal Seizures with Special Reference to Biochemical Abnormalities in NICU
Sonu Kumar, Tarun Kumar
Background: Neonatal seizures are clinically significant because very few are idiopathic. Biochemical disturbances occur frequently in neonatal seizures either as an underlying cause or as associated abnormalities. In their presence it is difficult to control seizures and there is a risk of further brain damage. Methodology: The present study included 110 neonates presenting with seizures admitted to NICU at BMIMS, Pawapuri.  Study duration of Two years. Detailed antenatal, natal and postnatal history were taken and examination of baby was done and HIE staged according to modified Sarnat’s staging. Relevant investigations including biochemical parameters were done and etiology of neonatal seizures and their associated biochemical abnormalities were diagnosed. Conclusion: Biochemical abnormalities are common in neonatal seizures. Isolated biochemical abnormalities without other co morbid states were seen in 13 (11.8%) cases. 33 (30%) cases of neonatal seizures with identifiable etiology had associated biochemical abnormalities.

6. Comparative Study of Vaginal Delivery and Caesarean Section in Antepartum Eclampsia after 32 Weeks of Gestation
Simmanjit Kaur, Dandamudi Taranya Chowdary, Suroju Kavya, Tanisha, Priyanka Bansal
Background and Objective: To assess the mode of pregnancy termination in patients with antepartum eclampsia after 32 weeks of gestation. To compare the maternal and perinatal morbidity and mortality between vaginal delivery and caesarean section in antepartum eclampsia after 32 weeks of gestation. Material & Methods:  This comparative study was conducted in 100 IPD Patients by dividing   into two groups for comparative analysis. The first group   consisted of patients whom conservative obstetric management & delivery per vagina was carried and called the “VD group”. The second group consisted of patients in whom lower segment cesarean section was conducted due to eclampsia & varied associated indications are called “CD group”.  Results: Most common mode of delivery was vaginal delivery of 57% and caesarean delivery of 43%. Most common age group was 21 -24 years in both caesarean group (49%) and >24 years are common in vaginal group(45%). Mean age was 22. 51 in caesarean group and 23. 19 in vaginal group. Most of patients 72% in vaginal group and 72% in caesarean group were of lower socioeconomic status, 16% cases in caesarean group and 26% cases in vaginal group were of middle socioeconomic class, 12% and 2% cases in caesarean group and vaginal group were of  upper socioeconomic class. The incidence of antepartum eclampsia was most common in primigravida of 72%, multigravida of 28% in caesarean delivery group and primigravida of 63%, multigravida of 37% in vaginal delivery group. Conclusion: Eclampsia is one of the major causes of maternal and perinatal mortality, particularly in developing countries. In our study most common mode of delivery was vaginal delivery than caesarean delivery.

7. The Utility of CSF GeneXpert in Diagnosis of Tubercular Meningitis in Children Aged 2 Months to 12 Years
Tarun Kumar, Sonu Kumar
Background: CNS tuberculosis is the most devastating form of extra pulmonary tuberculosis in which TB meningitis is the most common form affecting 1-2 percent of untreated tuberculosis. Early treatment is critical to reduce TBM related mortality and morbidity. Diagnosing TBM based on smear microscopy has very low sensitivity and using CSF culture and sensitivity takes long time. Hence rapid and accurate detection methods are essential for initiation of early treatment especially in vulnerable pediatric age group. Methods: It is a hospital based observational study conducted in Department of Paediatrics BMIMS, Pawapuri. All children with clinically suspected tuberculous meningitis were enrolled into the study and underwent detailed history taking, clinical examination, blood investigation, CT scan brain and Lumbar Puncture. CSF samples were sent for CSF Xpert MTB/RIF. Conclusion: CSF gen expert was considered superior to smear for AFB in isolating TB bacilli in case of suspected TB meningitis. The sensitivity of CSF gen expert against clinical scoring was 46.15% and specificity was 100%.

8. A Randomised Controlled Trial to Compare the Efficacy of Levobupivacaine 0.5% and Ropivacaine 0.5% in USG Guided Supraclavicular Brachial Plexus Block for Upper Limb Orthopedic Surgery at Tertiary Care Centre
Pinal Vasani, Keta Patel, Hetal Sonawane, Jayendra C Makwana, Hina Shah, Shreya Popatiya
Background and Aim: Clinical guidelines state that controlling postoperative pain requires long-term postoperative pain management. The best local anaesthetics are selected for peripheral nerve block. Levobupivacaine has been demonstrated to be safer, more effective, and more time-effective than ropivacaine for peripheral and neuraxial nerve blocks. The objective of the study was to compare the effects of 0.5% Ropivacaine and 0.5% Levobupivacaine in supraclavicular brachial plexus block in patients undergoing upper limb procedures. Material and Methods: Present Prospective 1.5 year long randomise double blind comparison study was carried out in the Department of Anaesthesia, Tertiary Care Institute of India. The 70 patients were split into two groups of 35 each at random. 30 ml of intravenously administered 0.5% levobupivacaine were given to group L patients. Participants in group R got 30 ml of intravenous 0.5% ropivacaine. The length of the procedure, the length of post-operative analgesia based on the VAS score, and any side effects or issues were all monitored after the block was administered. Results: The Onset Time of Sensory and Motor Inhibition in Group L Was Significantly Earlier Than in Group R. In contrast to Group R, which had analgesia for an average of 11.6 1.80 hours, Group L experienced analgesia for an average of 15.37 2.00 hours. The length of analgesia in Group L was substantially greater than in Group R. Conclusion: Levobupivacaine 0.5% outperforms Ropivacaine 0.5% in terms of early commencement of sensory blockade, early beginning of motor blockade, extended duration of sensory blockade, and prolonged duration of motor blockade for supraclavicular brachial plexus block. Longer Period of Analgesia.

9. Evaluation of Serum Amylase and Serum Lipase in Type- 2 Diabetes Mellitus
Indira, Ch. Sudhakar Babu, I Vasundhara Devi
Background: Subclinical chronic pancreatitis may be increased in subjects with type 2 diabetes mellitus. The present study was undertaken to evaluate the levels of serum amylase and serum lipase in cases of type 2 Diabetes Mellitus. Materials and Methods: This study was conducted in the institute of RMC Kakinada at GGH. A total of 75 peoples were included in the study. It was divided into two groups. Group1 (n=30) was considered as control group. Group II (n=45) had diabetes mellitus type II. All the patients demographic data was collected. Blood was collected from all the patients and used for estimation of blood glucose, serum amylase and serum lipase.  The data was expressed in mean standard deviation. Students ‘t’ test was applied to find the statistical significant between the groups. Results: There was no significant difference observed in the age and gender between the groups. Significant difference was observed in serum amylase and serum lipase compared to group I with group II. Conclusion: It was observed that significant changes in Serum amylase and lipase in patients with type II Diabetes Mellitus   compared to control group. Knowledge about these changes is useful in prevention and treatment of type 2 diabetes mellitus patients suffering from sub clinical pancreatic diseases.

10. A Cross Sectional Study to Assess the Utility, Acceptance and Operational Challenges in Delivering Services at Gram Arogya Kendra in Bhopal District, Madhya Pradesh
Pradeep Dohre, Anand Kumar Patidar, Anurag Jain, Lokendra S. Kot, Preeti Gupta, Mahesh Gupta
Introduction: The villages are the main roots of Indian civilization and about 83.3 crore population of India lives in villages (Census 2011).Even today, health services are out of reach for the vast majority of rural residents, despite the fact that the country’s doctor-to-population ratio has reached 1:2545 (Census -2011). On October 2nd, 1975, the Government of India launched the ‘Integrated Child Development Services’ (ICDS) scheme in 33 pilot projects in accordance with the National Policy for Children. It is also an initiative to improve village-level convergence of health and ICDS services. Objective: To assess the utility and acceptance of these Gram Arogya Kendra in village residents and health workers and to Understand operational Challenges in Delivering services of these Gram Arogya Kendra. Methodology: This community based cross sectional study was conducted among 50 selected (i.e. 22 in rural and 28 in urban areas) Gram Arogya Kendra of Bhopal district. Results: 58% of the ASHA have work experience of 5-10 years. about 98% ASHA responded that they are satisfied with the services being provided at GAKs. 76% of the ANM were educated up to graduate. Fig. 2 showed 96% of the ANM said that village resident were aware about various services provided by GAK in his/her village. Fig .3 showed,84.8% of the beneficiaries responded that they or their family members take medicines from GA. Fig. 4 showed 100% of MO said that GAKs were help in early primary treatment /early referral at village level. Conclusion: The Gram Arogya Kendra is a unique concept to promote village based health and nutrition activities, and for involving the community in their own health.

11. A Randomized Control Study to Compare Ultrasound Guided Femoral Nerve Block versus Intravenous Fentanyl to Provide Analgesia for Positioning Patients with Femur Fracture before Spinal Anaesthesia at Tertiary Care Centre, Ahmedabad
Keta Patel, Pinal Vasani, Ila Prajapati, Ila B. Patel, Gaurav R. Barad, Jaspreet Singh Bagga
Background and Aim: Nerve fibres have been located and blocked using a variety of methods. In recent years, ultrasound has grown in significance and given anesthesiologists a useful alternate tool for locating and safely blocking nerve fibres. This study compares intravenous fentanyl for positioning during spinal anaesthesia in femur fractures to femoral nerve block under ultrasound guidance. Material and Methods: Present Prospective, Randomized, single-blind, Controlled study was conducted in 60 Patients admitted to the Department of Orthopedics, GMERS Medical College and Civil Hospital, Sola, Ahmedabad. The trial was random, single-blind, and controlled. Patients were divided into two groups of 30 each at random. Preoperative ultrasonography guidance was used to provide a femoral nerve block to group FNB. Fentanyl was preoperatively given intravenously to Group FENT. After the block/IV fentanyl, hemodynamic measurements including heart rate, noninvasive blood pressure, oxygen saturation, and respiratory rate were taken at intervals of five minutes until positioning. Visual analogue scale scores obtained 15 minutes after the block and intravenous fentanyl were used to evaluate the analgesia offered by either of the techniques. Moreover, patient satisfaction was noted. Results: There was a statistically significant difference between the FNB group (mean=2.43, SD=0.63) and the FENT group in terms of the effectiveness of patient positioning among the patients undergoing spinal anaesthesia in fracture femur surgery. In terms of VAS score during positioning, there was a statistically significant difference between the FNB group (mean=1.13, SD=1.25) and the FENT group (mean=2.27, SD=1.55). Femoral Nerve Block took shorter time to complete subarachnoid block than I.V. fentanyl. Compared to intravenous fentanyl, femoral nerve block produced greater postoperative analgesia. Conclusion: In the case of femur fracture surgery, femoral nerve block is more effective than intravenous fentanyl for placement during spinal anaesthesia. When compared to IV fentanyl in femur fracture surgery, femoral nerve block offers higher analgesia, better patient posture, and greater patient satisfaction, all of which shorten the time required for spinal anaesthesia in the sitting position.

12. A Prospective Case Control Study of Maternal-Fetal Outcomes in Pregnant Women with Hyperemesis Gravidarum at Tertiary Care Hospital Tirupati
Gangurajula Bhargavi, Salicheemala Bhuvaneswari, Thalisetty Bharathi
Background: One of the most common symptoms seen in pregnant women before the 20th week of pregnancy is nausea and vomiting; an exaggeration of these symptoms, known as hyperemesis gravidarum (HG), can lead to maternal and foetal catastrophes, as well as death. Aim: To investigate certain risk factors and maternal and foetal outcomes of Hyperemesis Gravidarum at Tirupati Tertiary Care Hospital. Methods: A prospective hospital-based case control observational study was conducted on 60 pregnant women with diagnosed HG and 60 pregnant women without HG as a control group. The prevalence of HG was found to be 2.8% among pregnant women in our study. The majority of these women (53.3%) were between the ages of 21 and 25. There is a strong association between hyperemesis gravidarum and preterm labour. There is an association between hyperemesis gravidarum and birth weight. There is a significant association between hyperemesis gravidarum and birth weight. Upper Lower & Lower socioeconomic status (66.6%), primigravida (71.7%), and BMI:18.5 (58.3%) were identified as important risk factors for developing HG. However, gestational age of less than 10 weeks (51.7%) was found to be less likely to be a risk for HG. Low birth weight (p=0.002), small for gestational age (p=0.02), IUGR (p=0.05), anaemia (p=0.04), maternal weight loss (p=0.002), ketonuria (p=0.01), and electrolyte imbalance (p=0.001) were all significantly associated with hyperemesis gravidarum. Conclusion: Hyperemesis gravidarum has a significant impact on maternal health. Multiparity and a history of HG are risk factors for developing the condition, which should be monitored in at-risk pregnant women so that early intervention can be implemented to avoid any negative outcomes.

13. Outcome of Bi-Columnar Plating in Tibial Plateau Fractures
Ravi Kumar A S, Surya Kiran Killi, Anmol Kshirsagar, Anuj Dixit
Background: The tibial plateau, a significant component of the knee joint, is crucial for both mobility and the transfer of weight. 1.2% of all fractures are proximal tibial fractures, whose incidence is more in 3rd& 5th decade & increasing because of high velocity road traffic accidents followed by fall from height, sport injuries etc. Tibial plateau fractures alter the knee kinematics, joint stability, and result in joint incongruity. Complex joint biomechanics, ligamentous stability, and articular congruency all have an impact on treatment results and long-term impairment. Open reduction and stable internal fixation helps in maintaining the articular congruity and restoration of the mechanical alignment which allows early mobilization of knee. Result: The study by using MODIFIED RASMUSSEN SCORE reported the functional outcome to be 70% Excellent, 23.33% Good, 3.33% Fair and 3.33% Poor results. The Radiological outcome showed 73.33% Excellent, 20% Good, 3.33% Fair and 3.33% Poor results. Conclusion: These fractures involving more than one column have excellent to good functional and radiological outcomes if articular reconstruction and stabilization with bicolumnar plating is done which allows for early mobilization of joint. Stabilization of postero-medial fragments by plating prevents subsequent varus collapse.

14. Obstetric Night Mare-Neonatal Mortality Audit in a Tertiary Care Center
Durga Devi, Ajeetha Banu, Thennarasi, Mahalakshmi, Subhashini
Background: The neontal mortality is defined as the death within 28 days of life. However two thirds of the newborn death happens within one week of life. It’s an index of antenatal and intrapartum care and also of the socioeconomic condition of the community. Institutional deliveries have resulted in the expected reduction in neontal mortality. This study has been conducted to primarily identify the cause of neonatal deaths and to evaluate factors affecting mortality. Methods: It’s a 3 year retrospective study conducted in a tertiary care center in Tamil Nadu among 46993 deliveries from January 2020 to December 2022. A convenience sampling technique was used and data were collected from medical record section and entered and analysed in statistical package analysis of version 16. Results: Out of total 46993 births, there were 959 neonatal deaths which accounts to 20.4 per 1000 live births. The most important causes observed were birth asphyxia, respiratory distress syndrome and septicaemia. Among the 959 neonatal deaths,677 deaths happened to preterm delivery accounting to 70.6%. Rest of the neonatal deaths were due to unavoidable causes like anomalous babies, maternal comorbidities like hypertensive disorders of pregnancy leading to preterm pregnancies. Prevention of premature delivery, intensive care of the very low birth weight babies, early diagnosis and control of the hypertensive disorders of pregnancy have become important strategies in reducing early neonatal deaths. Conclusion: The neonatal death can be prevented by strengthening the primary health care to the antenatal mothers, educating them the complication, timely access to health care and monitoring of pregnancy. A proper coordination between Antenatal mothers, Obstetrician and the neonatologists is required for reduction of neonatal mortality. Hence studies are required to diagnose the etiology for preterm delivery of unknown causes and to predict and prevent preterm death.

15. Anti-Microbial Utilization in Surgical Wards: A Systematic Review
Tamil Selvan M, Lavanya K, Nileshraj G, Jayanthi MK
Antimicrobial resistance has become one of the most serious problems in the world and problems in the management of infected critically unwell individuals. This is partly owing to the rising prevalence of pathogenic microbes that are resistant to currently available antimicrobial medicines, resulting in the use of ineffective treatments. Measures to avoid antimicrobial resistance in ICU’s are obtained and should be used as soon as possible. For the near future, the restricted availability of new antimicrobial treatment classes emphasises the importance of preventing antibiotic, antiviral, and antifungal resistance.

16. A Clinical Study on Primary Open Angle Glaucoma in a Tertiary Hospital in South Assam, India
Prasanna Jit Das, Nilanjan Kaushik Thakur, Zakir Hussain Laskar, Rajiv Kumar Das, Ruma Das, Soma Paul, Choudhury Tufail Ahmed Saki, Ankur Baruah
Glaucoma is a group of disorders characterized by a progressive optic neuropathy resulting in a characteristic appearance of the optic disc and a specific pattern of irreversible visual field defects that are associated frequently but not invariably with raised intraocular pressure. It is a potentially blinding disease of global importance and is the second leading cause of blindness after cataract. Aim: The aims and objectives of the study are to find the prevalence and incidence of primary open angle glaucoma, its ocular morbidity and the various risk factors associated with it. Methods: A prospective observational study of 50 patients of age 40 years and above with diagnosed Primary open angle glaucoma were taken for the study and followed up for a year. After due informed consent, detail eye examination was done and results statistically analyzed. The correlation of POAG with age, sex, hypertension and T2DM were noted at the initial presentation. Visual acuity, IOP, RNFL thinning, visual field defects and CDR were noted at each follow-up period and analyzed separately and with each other. Awareness of POAG by the individuals under study was also noted at initial time of study. Conclusions: The prevalence of POAG is found to be 2.8% with a higher prevalence in males (62%). Increased age, family history (24%), hypertension (32%), Diabetes Mellitus (30%) were found to be as risk factors for the disease. There is a positive association between higher IOP (mean 28.4 mm Hg), CDR (mean 0.74), RNFL thinning (frequency-64%) and Visual field defects (frequency-54%) with greater progression and morbidity of the disease

17. Evaluation of Serum Uric Acid and Magnesium Levels in Cases of Myocardial Infarction
Indira, Ch. Sudhakar Babu, V. Bhagya Laxmi
Background: Coronary artery disease is currently the leading cause of mortality and morbidity. The current study was designed to assess the causes of myocardial infarction by measuring serum uric acid and magnesium levels. Materials and Methods: This research was carried out at the Institute of Rangaraya Medical College, GGH, Kakinada. A total of 80 people were included and divided into two groups. Group I (n=40) served as the control group. Group II (n=40) had a myocardial infarction. All of the patients’ demographic information was gathered. Blood was drawn from all patients and used to calculate serum uric acid and magnesium levels. The data was presented in mean standard deviation. The unpaired “t” test was used to determine the statistical significance between groups. Results: There was significant difference was absorbed in serum uric acid and magnesium levels when compared to group I with group II. Conclusion: There were significant differences in myocardial infarction cases when compared to the control group. Knowledge of these changes can help in the prevention and treatment of myocardial infarction patients with cardiovascular disorders.

18. Diagnostic Validation of Trivandrum Autism Behavior Checklist (TABC) a Screening Checklist for Autism Spectrum Disorder (ASD) Against Childhood Autism Rating Scale-2-Standard Version (CARS-2-ST)
MKC Nair, Shyamal Kumar, Riya Lukose, Ashwathy LA, Avinash Kumar
Autism Spectrum Disorder (ASD), a neurodevelopmental disorder is of growing concern because of its progressively increasing prevalence. The current prevalence of 1 in 100 as per WHO data seems largely undermined as a large chunk of population is still not evaluated. There is often a lack of adequate skilled healthcare personnel to evaluate such children in community in LMIC countries. Trivandrum Autism Behavior Checklist (TABC) is a simple tool with ease of administration by Developmental Therapists and Developmental Nurse Counsellors. This study aims at criterion validation of TABC against Childhood Autism Rating Scale – 2 Standard Version (CARS-2ST) a diagnostic tool.

19. Role of High Resolution Ultrasonography Evaluation of Thyroid Nodules and Pathological Correlation
Mohan Kumar B. Nagane, Dr Gondkar Sodhan Ramarao, Chandrasing T Pawar, Nirmalkumar R Chaudhari
Aims and Objectives: To identify morphologic patterns on High Resolution Sonography (HRS) those are predictive of benign and malignant nodules and to evaluate the efficacy of histopathology and HRS in differentiating benign and malignant nodules. Materials and Methods: The study included 50 patients referred for USG of the thyroid to ACPM Medical College, Dhule, Maharashtra who were diagnosed clinically with solitary thyroid nodule. Thyroid sonographic findings relevant to benign or malignant nodules were recorded and these findings were compared with histopathology reports of the thyroidectomy specimen. Results: Out of 50 cases of solitary thyroid nodules, 35(70%) cases were benign and 15(30%) were malignant. Among benign lesions, adenomas were the most commonest group comprising 45.8%, followed by nodular goiter 22.9%. Among malignant, papillary carcinomas were the most commonest group 86.7%, followed by follicular carcinoma 13.3%. Majority of the patients are in the age group of 31-40 years. Among malignant lesions, papillary carcinoma was the most common and medullary was the least common type. Follicular carcinoma was seen in 2(13.3%) cases among malignant lesions. Out of 50 cases of solitary thyroid nodules evaluated at USG, 33 were diagnosed to be benign, 17 were malignant, after histopathological evaluation, 35 out of 50 cases were found to be benign and 15 were malignant. Conclusion: Ultrasound is a safe, fairly accurate investigation to differentiate benign from malignant etiology with sensitivity of 85.7 % and specificity of 80 %. USG proved to be a more sensitive modality to differentiate benign from malignant lesions.

20. To Study the Impact of Residency on Physical Health of Residents during the Period of Post-Graduation
Shilpi Singh, Shashi Kumari, Palak Sharma, Pooja
Background: Medical post-graduation period constitute health risk for resident doctors. The learning curve is improved at the cost of resident’s own health. Not only physical but mental and social health of residents get compromised. This also impacts the interpersonal relationship with friends and family. The repercussions of all these factors are faced by patients as their treatment and care might get compromised in the form working errors due to excessive wear and tear of resident’s health. Aim: To study the impact of residency on physical health and lifestyle of residents. Method: A questionnaire which included 15 questions was given to residents of various departments of Gandhi medical college during the month of November 2022. The first 100 responders during the study duration (November 2022-january 2023) were included under the study. Questionnaire included sociodemographic characteristics like age, sex, weight, height (in m), BMI, marital status, branch of post-graduation. It also included information regarding certain parameters like sleep, meal, water intake, addiction, new medication, new disease diagnosed, weight loss and comparison was done on some of these parameters before and after joining residency. Data was compiled using MS excel. All the data analysis was performed using IBM SPSS version 20 software and appropriate statistical tests were applied. Results: Study revealed that sleep was affected 1 year after joining residency as revealed by the significant p value of 0.027. Breakfast intake was  also affected after joining residency as revealed by the significant p value of <0.001. Study showed that out of 91 residents who were having 2litres of water intake per day before joining, in 58 (63.7%) of them it has reduced post 1 year of joining residency. There was a statistically significant increase in the pack of cigarettes smoked per day, mean alcohol intake per week and amount of sweetened beverages intake per day by the residents after joining residency. After 23.12 hours of continuous duty working error occurred and mean weight loss after joining residency was 5.04kgs in 6.09 months. Conclusion: Post graduation is highly stressful and results in several changes in the lifestyle of the residents, which has serious impact on their physical and mental health.

21. Clinico-Radiological Profile of Joint Involvement in Hyperuricemia Patients
Pramod, Jainender Kumar Deshwal, M.S.Siddiqi, Zia-Ul-Islam, Kumari M, Singh U.K, Bashir Ahmad Mir
Introduction: Hyperuricemia is a condition characterized by abnormally elevated levels of serum uric acid. Symptoms are those of gout and nephrolithiasis. The gold standard for diagnosis of gout is identification of monosodium urate crystals in the synovial fluid, that is painful and leads to complications like joint effusion. In recent years with advancement of ultrasonography and dual energy computed tomography (DECT) new clinical picture and staging has been identified. The present study had been designed to study the clinical profile of hyperuricemia patients with regards to joint involvement as assessed by DECT and USG and comorbidities. Aim: To study the clinical profile of hyperuricemia patients with regards to joint involvement  as assessed by DECT and USG  and comorbidities. Material and Method: This was a cross sectional study which was done in Era’s Lucknow Medical College & Hospital, Lucknow. The study was carried out on diagnosed hyperuricemia patients attending the medicine OPD and indoor patients of Era’s Lucknow Medical College & Hospital in the last 18 months were included in the study till the required sample size was achieved. The overall sample size consisted of 66 cases of hyperuricemia. Results: The age of patients ranged from 36 to 87 years. Majority of the cases were aged more than 60 years. Further, majority of patients were females (56.1%). Only 19 (28.8%) patients were symptomatic with symptoms of pain, swelling and tenderness at joints were reported. Six patients had no comorbidities while rest 60 patients reported comorbidities. Diabetes alone (15.2%) was most common comorbidity. The radiological evidence of abnormalities which were indicative of involvement of joint by USG were DCS or HAG which were observed in 45.5% patients. MSU crystals were observed in 39.1% cases by DECT. So overall radiological evidence of joint involvement was found in 56.1% cases. No significant association of joint involvement was found with no of comorbidities, CAD, hypertension, T2DM and dyslipidemia. Significant association of S. uricemic acid was found only with joint involvement indicated by radiological findings. Conclusion: On the basis of these findings, it can be inferred that that asymptomatic patients (especially females and older) of hyperuricemia are at risk of developing joint involvement who should be radiologically examined. The overall prevalence of joint involvement in hyperuricemia patients was lying in the range (44.13 – 68.07) with 95% confidence. A confirmed relationship of Sr Uric Acid Levels (mg/dl) with Joint Involvement was found.

22. Histological Grading, Histochemical (Agnors) and Immunohistochemical (P53) Profile of Oral Squamous Cell Cancer
Neelima Verma, Saumya Singh Rajput
Background: A significant contributor to cancer morbidity and mortality globally, oral cancer is the sixth most prevalent malignancy. Studies using the immunohistochemical technique (IHC) have examined OSCC to learn more about its biology, prognosis, and therapeutic options. The proliferation potential of a specific tumour can be quantitatively assessed through the immunohistochemical detection of p53. So, the present study was conducted with an aim to analyse the correlation of the histo-morphological grading using Anneroth’s grading with the nuclear proliferative markers (AgNORs and p53 protein) in oral squamous cell carcinoma. Methods: The present hospital based cross-sectional study was carried out under the department of Pathology, among biopsy samples of 53 patients of Oral squamous cell carcinoma of GSVM Medical College, for a duration of one year. Hematoxylin and eosin (H&E) stain was used to perform histopathology on sections of specimens that had been embedded in paraffin. Using Anneroth’s multifactorial grading approach for SCC, the tumor’s histological grade was established. Smears and sections were stained with AgNOR silver and the AgNOR score was expressed as the mean AgNOR count (mAgNOR) One-Way Analysis of Variance (ANOVA) was used to find out the significant correlations and a p-value of <0.05 was considered significant. Results: Most of patients were males (69.8%) and most commonly affected age group were 41-50 years (34.0%) and 51-60 years        (37.7%). The most affected site of OCSS was buccal mucosa (41.5%) and gingivo-buccal sulcus (32.1%). Anneroth’s multifactorial grading system for OSCC showed that 32.1% of patients belonged to Grade I, 37.7% were having Grade II, and Grade III was seen in 30.2% of patients. The ANOVA analysis was used to find the difference of mean AgNOR score (per nucleus) and mean p53 score (% of cells stained) in different grades of Anneroth grading for OSCC and it was found that difference was statistically significant mean AgNOR score (F=126.234, df=2, p=0.000) and mean p53 score (F=12.343, df=2, p=0.000). Conclusion: To improve treatment outcomes for patients with OSCC, pathologists and clinicians should make it normal procedure to determine the histochemical and immunohistochemical profile and its relationship to the histo-pathological grade and clinical features.

23. Response Assessment of Post Operated Carcinoma Breast Patients Treated by Volumetric Modulated ARC Therapy (VMAT): A Prospective Clinical Study
Upasna Sinha, Hemu Tandon, Rahul Singh, Vikram Bali Rathore, Chandrahas Dhruw
Background: Breast cancer is the most common cancer and the leading cause of cancer-related deaths among women worldwide. The annual global incidence of breast cancer is estimated to be >1.3 million cases and approximately 465,000 women die of this disease every year. Postoperative radiotherapy plays an important role in the management of breast cancer and reduces the local and regional recurrence, thereby improving outcomes. Objective: Response assessment of post operated carcinoma breast patients treated by volumetric modulated arc therapy (VMAT). Method: This prospective clinical study involves 40 histopathologically proven cases of carcinoma breast patients conducted during October 2020 to October 2021 in Department of Radiation Oncology at Regional Cancer Centre of Pt JNM Medical College Raipur, Chhattisgarh. Response was assessed and analyzed on every month post radiation. Result: In this study the mean age of patients was 47.8 years with standard deviation of 7.63 years. Our most of the cases (57.5%) belongs to age group 41 – 50 years. 7 (17%) patients were premenopausal, 12 (30%) patients were perimenopausal and 21(52%) were postmenopausal. distribution of the site of tumor among patients were reported as 16 (40.0%) patients had UOQ, 5 (12.5%) patients had UIQ, 12 (30.0%) patients had central quadrant, Further 4 (10%) and 3 (7.5%) patients had LOQ and LIQ respectively, among patients were reported as IA were 0 (0.0%), IB were 7 (17.5%), IIA were 5 (12.5%), IIB were 7 (17.5%), IIIA were 6 (15.0%), IIIB were 11(27.5%) and IIIC were 4 (10.0%), ipsilateral lung dose data analysis was reported as the average total volume of I/L lung is 922.18 ±218.21cc, D min 448.83 ± 489.83c Gy, D max 4192.1 ±116.94c Gy, D mean 1871.70 ±523.92c Gy, V5 90.28 ± 7.96%, V10 62.5 ±12.49 %, V20 25.28 ±3.28 %. Conclusion: In our study we recorded 95% of complete response at the end of 3 months clinically and radiologically while in 5% of cases progressive disease were observed. An ipsilateral lung dose volume constraint of V20≤30% reduced rate of radiation pneumonitis was observed.

24. Study of Thyroid Profile in Chronic Kidney Disorders Middle Aged Individuals
Mohammad Aminuddin, Shreya Nigoska, K. Kalyan Kumar, V. Sunanda
The prevalence of decreased renal function among those with chronic kidney disease (CKD) is rising quickly. Many co morbidities, such as thyroid dysfunction, dyslipidemia, and cardiovascular illnesses, are linked to the progression of CKD. An investigation into thyroid function in CKD patients was done. Methodology: 90 individuals with chronic renal disease were separated into two groups based on their ages for a cross-sectional study. Serum urea, creatinine, glucose, free triiodothyronine (T3), free thyroxine (T4), thyroid stimulating hormone (TSH), and total cholesterol were all measured in blood samples (5 mL). Each patient’s demographic information (age and gender), medical history, hypertension, and cardiovascular diseases were also recorded. Results: The major significant changes were found in urea (P <0.001), creatinine (P <0.001), eGFR( P <0.001) by the correlation of 2 groups. The prevalence of thyroid dysfunction among the sexes and different age group was tabulated. The probability of low T3 syndrome was 54% (27 cases), while the prevalence of low T4 syndrome was 22% (11 cases). TSH levels in the hypothyroid category were 4% (2 cases). Low T3 syndrome was found in 48.6% of male cases. And it was 62.2% among females. P>0.05, the change was not statistically significant. Conclusion: The severity of renal failure was correlated with total T3 and free T4. To distinguish between hypothyroidism and non-thyroidal illnesses brought on by CKD, TSH readings will be helpful. Just 6% of the participants in the research experienced goitre. T3 and T4 readings change as a result of the body’s energy-saving adaption process.

25. Assessment of Influencing Risk Factors of Deep Venous Thrombosis in Cases Undergoing Surgery at Tertiary Care Hospital
Sashikalyan, Bal Singh
Introduction: Deep venous thrombosis (DVT) is a considerable reason of morbidity and mortality in surgical cases. There is lack of evident information on the incidence of DVT and standard guidelines for facilitating thromboprophylaxis in Indian populations. The present study was designed to assess the risk factors favoring the deep venous thrombosis in surgical cases. Materials and Methods: A total of 168 patients undergoing surgery at surgery department were assessed for risk factors favoring deep vein thrombosis. The risk factors such as sociodemographic including age and smoking, clinical profile factors including history of DVT, family history, history of varicose veins, medical illness, connective tissue disorders, cancers and its treatment, and Surgical factors including type of anaesthesia technique, duration of surgery, immobilization period and risk assessment score were assessed. Results: The duration of surgery was up to 60 min in 31.49%, between 61-180 min in 68.62% and above 180 min in 3.70% of DVT cases. The duration of immobilization was 70.37%, 22.22% and 7.40% in ≤7, 8-14, and >14 days respectively. The risk score was low (1-6) in 18.52%, moderate (7-12) in 33.33% and high (>12) in 48.14% of cases. Conclusion: Health care professional should be trained on standardized diagnostic tools in DVT risk assessment and prophylaxis. Preoperatively, thromboprophylaxis is must in moderate and high-risk category of DVT patients undergoing surgery with postoperative follow-up.

26. Comparative Study of Fetal Color Doppler versus Modified Biophysical Profile as Predictor of Perinatal Outcome
Mandowara Naisargy, Hada Anupama, Verma Anjana, Pargee Ankita
Aim: To study the sensitivity and specificity, Positive and Negative Predictive value of Modified BPP and Color Doppler. Comparative analysis of Modified BPP and Color Doppler as a predictor of perinatal outcome. Material and Methods: This comparative prospective observational study was carried out on 189 antenatal patients of > 32 weeks pregnancy in department of obstetrics and gynaecology, Geetanjali medical college hospital, Udaipur, Rajasthan during period of 18 months from February 2021 to July 2022. All patients have been subjected to colour Doppler and modified BPP after  routine examination and investigations and divided into four groups. The sensitivity, specificity, PPV and NPV  of Modified biophysical profile and color Doppler in predicting the neonatal outcome were calculated. Results: Among 189 cases, MBPP and Doppler was normal in 164 patients, 6 cases had abnormal Doppler, MBPP were abnormal in 10 cases and both Doppler and MBPP was abnormal in 9 cases. Those with normal MBPP and Doppler have better neonatal outcome and it was statistically significant. The sensitivity of Doppler and MBPP was 40% and 57.1% respectively. The results of combination of MBPP and Doppler showed higher sensitivity of 70%. Conclusion: Modified biophysical profile and color Doppler both combined together are excellent and cost effective antepartum screening methods for fetal wellbeing and are widely available in most centers in India.

27. Evaluating Efficacy of Fascia Iliaca Compartment Block Preoperatively for Alleviating Pain of Positioning for Subarachnoid Block in Patients with Proximal Femur Fracture: A Prospective Randomized Clinical Study
Sandip Kumar S. Prajapati, Kumud Ganvit, Pinal Raj Bumiya, Nidhi Maru, Urviben Pravinbhai Patel
Background: Femur fracture exhibits extreme pain doesn’t allow ideal positioning for subarachnoid block. Adequate analgesia before administrating subarachnoid block will increase patient’s cooperation. The aim of our study was to assess analgesic efficacy of fascia iliaca compartment block (FICB) for positioning for subarachnoid block in patients with proximal femur fracture. Material and Methods: A Prospective randomized clinical study was carried out in 60 patients of 18-70 years of age, with ASA Ⅰ – Ⅲ surgery for proximal femur fracture and randomized into 2 groups of 30 patients each using sealed envelope method. Group FICB received the block with 40ml (15ml 0.5% Bupivacaine+ 15ml 2% Lignocaine with adrenaline (1:200,000) + 8ml sterile water+ 2ml Dexamethasone) using classical landmark technique, 20 minutes before positioning. Group IVP received injection paracetamol 1 gm IV 20 minutes before positioning. We observed visual analogue scale score (VAS) during positioning, time to perform spinal and postoperatively patient satisfaction, Time to first rescue analgesia, total number of rescue analgesics doses required in 1st 24 hrs post-operatively. Results: VAS during positioning in group FICB: 2.1 ± 0.60 versus IVP 3.53 ± 0.57 (P<0.0001) resulting in lesser time to perform spinal anaesthesia & patient satisfaction was better in group FICB. Total number of rescue analgesics required in 1st 24 hrs in group FICB ;1.66±0.66 compared to group IVP; 2.56± 0.50(P<0.0001). Conclusion: Fascia iliaca compartment block alleviates pain of positioning for subarachnoid block in patients with proximal femur surgeries. It also provides adequate analgesia in postoperative period with lesser requirement of rescue analgesics.

28. Study of Lipid Profile in Stress Induced Type 2 Diabetic Nephropathy Patients
Mohammad Aminuddin, Shreya Nigoska, K. Kalyan Kumar, N Vani
Stress-induced type 2 diabetes is associated with dyslipidemia, a recognised risk factor for diabetic kidney disease (DKD). There is mounting evidence that some lipid ratios may offer extra insight into lipid metabolism when compared to established lipid measures. Therefore, the purpose of the current investigation was to determine which lipid index was most closely connected to stress-induced DKD. Methodology: Diabetes stress questionnaire used to diagnose patients with stress-induced T2D while ruling out other kidney disorders and urinary tract infections. Urinary creatinine was assessed along with lipid profiles, and lipid ratios were computed using the associated lipid parameters. The immunoturbidimetry method was used to assess the level of urinary albumin. Results: Compared to T2D patients without nephropathy, these individuals had greater prevalences of hypertension, use of insulin and statins, higher blood urea nitrogen (BUN) levels, creatinine (Cr) levels, uric acid (UA) levels, cystatin C levels, poorer eGFRs, and lower LDL-C/Apo B ratios (P < 0.05). Other than the LDL-C/Apo B ratio between patients with and without nephropathy, there were no differences in the percentage of male patients, BMI, diastolic blood pressures, s, or lipid indices (p > 0.05). Conclusion: Among the many lipid indices, the LDL-c/Apo B ratio in patients with stress-induced T2D was most closely associated with nephropathy (DNP), and a lower LDL-C/Apo B ratio was linked to a higher risk of DNP in T2D patients.

29. A Study on Usefulness of Ultrasound Guided FNAC in Diagnosing Intra-Abdominal Mass Lesions
Divya K N, Shubha Biradar, Shadaksri
Introduction: Ultrasound guided FNAC of intra-abdominal masses is a safe, simple, reliable and quick procedure.  It avoids invasive diagnostic laparotomy and helps to choose appropriate management procedures. This study aims to assess the utility of ultrasound guided FNAC in diagnosing intra-abdominal mass lesions. The objective of the study is to evaluate the cytomorphology of different lesions of different intra-abdominal organs and to classify them as inflammatory, benign and malignant lesions. Material and Methods: This study involved eighty patients of clinically or sonologically diagnosed intra-abdominal mass lesions. Under the ultrasound guidance FNAC was performed and slides were stained with H and E, MGG and Papanicolaou stains. Results: Majority of the intra-abdominal masses were malignant (75%). Liver was the commonest site (60%). Hepatocellular carcinoma was the commonest tumour. The ultrasound guidance helped to procure adequate material, the diagnostic yield being 94.6%. Conclusion: USG guided FNAC of intra-abdominal lesions is a rapid, cost effective, accurate, non-invasive and a safe diagnostic procedure. It is a valuable tool in differentiating inflammatory, benign and malignant lesions and also assists in categorizing different malignant lesions.

30. To Study the Ultrasound Guided Fine Needle Aspiration Cytology of Intra-Abdominal Liver Masses
Shubha Biradar, Divya K N, Shadaksri, Arun Kumar
FNAC being a safe OPD procedure can be used as an important diagnostic tool for any abdominal mass. The basic principle of an ultrasound guided FNAC is that, the rather complicated three-dimensional problem of hitting a small target is converted to a much simpler two dimensional imaging technique. Samples may be obtained from the deeper structures as the first step in the laboratory investigation, thereby, quickly satisfying the avidity of clinicians for a rapid diagnosis.
Material and Methods: This study involved eighty patients of clinically or sonologically diagnosed intra-abdominal mass lesions. Under the ultrasound guidance FNAC was performed and slides were stained with H and E, MGG and Papanicolaou stains. Results: Majority of the intra-abdominal masses were malignant (75%). Liver was the commonest site (60%). Hepatocellular carcinoma was the commonest tumour. The ultrasound guidance helped to procure adequate material, the diagnostic yield being 94.6%. Conclusion: USG guided FNAC of intra-abdominal lesions is a rapid, cost effective, accurate, non-invasive and a safe diagnostic procedure. It is a valuable tool in differentiating inflammatory, benign and malignant lesions and also assists in categorizing different malignant lesions.

31. A Prospective Study of Effectiveness of ESWL versus PCNL in Patients with Kidney Stone Size 1-2 cm
Satyajit Samal, Suryakanta Parida, Amalendu Jena, Samantaray Satya Prasad
Aim: The aim of our study was to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy with that of percutaneous nephrolithotomy for managing kidney stones measuring between 1 to 2 cm. Methods: This study, conducted at a tertiary care hospital in Odisha, included 100 patients with kidney stones (range: 1–2 cm) who were posted for surgery by either PCNL (n=50) or by ESWL (n=50). Success rate and complications were recorded and analyzed. Results: Fifty patients underwent ESWL and 30 patients had stone clearance in 1-3 months. Fifty patients underwent PCNL, out of which 40 patients had stone clearance. Complications were minor in nature and were found in 12% of patients undergoing ESWL while 30% of patients undergoing PCNL had minor complications.

32. Analysis of Papilloedema in ICU Patients
Sujata Priyambada, Divya Mohindru, Pragnya Paramita Mishra
Objective: The term “papilloedema” refers to an almost usually bilateral, non-inflammatory edema of the optic nerve head caused by increased intracranial pressure. One of the true neuro-ophthalmic emergencies is papilloedema. Papilledema, or swelling of the optic nerve head, is one of the few physical examination-accessible objective symptoms that might validate a suspicion of elevated ICP. Method: From January 2021 to December 2022, 100 patients with disc edema/papilledema who were sent from different departments to the Department of Ophthalmology, Hi-Tech Medical College and Hospital, Rourkela are the subjects of the current study, which is a non-randomized prospective case series. All patients had thorough history-taking, ocular examination, complete blood count, blood sugar, urea, creatinine, serum lipid profile, thyroid, and, in certain cases, a chest x-ray. A comparison was made between the follow-up examination and CSF analysis (including opening pressure). Results: Of 100 patients in this study, the age group with the highest incidence of cases—31%—was between 20 and 30 years; 41% of those affected were men, and 59% were women. 31% of patients with papilledema had a local aetiology, including 21% cases of optic neuropathy, 5% cases of AION in the 50–60 year age range, and 3% cases of BRAO in the 40–50 year range. Among systemic causes, ICSOL accounted for 23% of cases, followed by meningitis (11%), malignant hypertension (9%), medication usage (7%), malaria (5%) and each of diabetes, pseudotumor cerebri, anaemia, encephalopathy, and head injury (1%). Conclusion: In order to improve clinical decision-making regarding the diagnosis and treatment of papilledema, ophthalmic evaluation and subjective grading of papilledema by FUNDAL examination have the potential to be low cost objectively and quantitatively, and to assess progression and efficacy of treatment directed towards lowering ICP.

33. Retinopathy  in Chronic Kidney Disease: A Hospital Based Study
Sujata Priyambada, Divya Mohindru, Srabana Kumar Pradhan, Pragnya Paramita Mishra
Introduction: Eye and kidney have structural, developmental and organizational and pathogenic similarities and retinal vessels may reflect renal disease. In our present hospital-based study, we find out the prevalence of retinopathy, the relation of fundus changes with grades of retinopathy and factors associated with retinopathy. Materials and Methods: It was a retrospective study conducted at Hi-tech Medical College and hospital where data of 152 consecutive patients diagnosed as chronic kidney disease was collected and analyzed. The parameters included their ocular examination details and biochemical parameters. Relation was established between the grades of kidney disease and severity of retinopathy. Results: After accounting for both conventional and unconventional risk factors, lower estimated glomerular filtration rate (eGFR) was linked to more severe retinopathy. Lower eGFR was also related to a higher incidence of vascular anomalies often linked to hypertension. No significant correlation between average arteriolar or venular calibres and eGFR was discovered. Conclusion: After adjusting for both conventional and unconventional risk factors for CKD, the results reveal a significant correlation between the severity of retinopathy, its characteristics, and kidney function, indicating that retinovascular pathology mirrors renal illness.

34. A Comparative Study of Dexamethasone and Magnesium Sulphate as an Adjuvant to 0.5% Bupivacaine in Supraclavicular Brachial Plexus Block
Nazia Shaikh, Rajesh Subhedar, Yogesh Borse
Introduction: Upper extremity fractures are usually associated with marked postoperative pain. The goal of postoperative pain management is to reduce pain to a tolerable level with minimal or no associated suffering or distress. Brachial plexus block provides us with an alternative anaesthesia technique for upper limb surgeries that provides excellent surgical conditions and a prolonged duration of postoperative analgesia.  The addition of an adjuvant to a local anaesthetic solution has helped in the early onset of blockade with a prolonged duration of anaesthesia and analgesia in the postoperative period. In our study, we evaluated the analgesic efficacy of the addition of dexamethasone and magnesium sulphate as an adjunct to 0.5% bupivacaine in Brachial plexus block. Methods: The present prospective randomized comparative study was carried out in a tertiary care hospital from Jan.2021 to June 2022 amongst 50 patients in the age group of 18-55 years of either gender undergoing surgery below the lower 1/3rd humerus categorized under ASA physical status I & II. Patients were divided into two groups using simple randomization as follows: 1. Group I (N=25) = Patients receiving 0.5% bupivacaine (28 ml) +Dexamethasone 8 mg (2 ml). 2. Group II (N=25) = Patients receiving 0.5% bupivacaine (28 ml) + Magnesium Sulphate 500 mg (2ml). Results: The onset of sensory block was earlier in group I than in group II. It was observed that the mean onset time of motor block is significantly lower in Group I as compared to group II. It was proved that the mean duration of the motor block is significantly higher in Group I as compared to group II. (p<0.001). It was observed that there is a prolonged duration of analgesia in Group I as compared to Group II which is statistically significant. (p<0.001). the analgesic requirement was higher in group II (2 times) as compared to Group I (1 time). Conclusion: The onset and duration of sensory and motor blockade were faster with dexamethasone as compared to magnesium sulphate. The duration of postoperative analgesia was also significantly longer in the dexamethasone group with a reduced requirement for rescue analgesics for up to 24 hours. Both the additives did not alter the hemodynamics of the patients.

35. Comparation of Waist Circumference-Length Ratio and Ponderal Index in Preterm Infants of Higher and Lower Gestational Ages at Birth
Shailendra Kumar, Prem Kumar, Nand Kishor Singh, Rakesh Kumar
Introduction: Preterm infants are more likely than full-term babies to acquire obesity, hypertension, insulin resistance, type 2 diabetes, and cardiovascular disease later in life. Preterm babies have higher total fat mass or adiposity compared to term babies, in addition to higher visceral fat as a percentage of total body fat storage. Adipose tissue is metabolically active, and the fat cells that make up this tissue secrete a class of bioactive substances known as adipokines. Methodology: For 100 infants born preterm and 100 infants born full-term, a chart review was done. We measured the baby’s weight at birth, length, waist size, and hospital discharge weight (WC). The body mass index (BMI), ponderal index, and width to length ratio (WLR) were calculated. According to birth weight (BW), preterm newborns were divided into quartiles (Q1-Q4). Result: As comparison to preterm infants in higher BW quartiles or full-term infants, preterm neonatal 2 in the lowest BW quartile (Q1) had considerably shorter mean length, WC, WLR, BMI, and ponderal index at birth. Although their weight, length, and BMI remained significantly below term infants, preterm infants in Q1 experienced a disproportionate increase in WLR and ponderal index. As a result, at discharge, their WLR and ponderal index were higher than infants in Q2–3, similar to infants in Q4, and greater than full-term newborns. Discharge WLR and ponderal index increased in Q1 in addition to a decrease in postmenstrual age at delivery. Conclusion: We describe normative birth data for WLR and PI in preterm and full-term neonates according to gestational age and gender. WLR and ponderal index grow disproportionately in premature infants with lower birth postmenstrual ages.

36. Paediatric Encephalopathy and Complex Febrile Seizures
Prabudh Paritosh Mishra, Arvind Kumar, Bheemarao Kamble
Objective:  The most prevalent neurologic condition in children is febrile seizures. Medical professionals need to be knowledgeable about how to diagnose and treat this prevalent illness. Method: A case study consisting of 2 children admitted in Patna Medical College and Hospital, Patna was carried out from November 2021 to October 2022. Results: According to the findings, both of the children exhibited febrile status epilepticus related to acute encephalopathy, which was characterised by biphasic seizures and delayed diffusion restriction (AESD). Conclusion: Children of any descent who exhibit febrile seizures followed by a protracted period before awakening coupled with transaminitis and an irregular EEG should be suspected of having AESD.

37. A Prospective Cohort Study of Cervical Phosphorylated Insulin-Like Growth Factor Binding Protein-1 Test to Predict Preterm Labor
Shubhangi Jain, Shraddha Chouhan, Anupama Dave, Akanksha Thora
Background: Preterm delivery (PTD) is a multifactorial phenomenon with significant medical, health, economic, and human impacts. Despite identifying numerous risk factors, preterm birth is still difficult to predict. Aims & Objectives:  The purpose of this study is to determine whether phIGFBP-1, a phosphorylated form of insulin-like growth factor binding protein-1, can be used to predict Preterm labour. Materials and Methods: A prospective cohort study was conducted, which included all pregnant women coming to the Emergency Room associated with MGM medical college, M.Y.H. and M.T.H Hospital, Indore, India with symptoms and signs suggestive of preterm labour who gave consent to be tested for the presence of phosphorylated IGFBP-1 in the cervical secretions; from June 2021 to June 2022. Observation & Results: It was found that the NPV of the test was consistently higher than the PPV of the test at 48 hours, seven days as well as two weeks (95.8 % NPV and 60.7 % PPV at 48hours, 93.8 % NPV and 64.3 % PPV at seven days and 89.6 % NPV & 67.90 % PPV at two weeks). Discussion: In the present study, we found out that the detection of phosphorylated insulin-like growth factor binding protein -1 in cervical secretions reliably predicts imminent risk of preterm delivery in pregnant women in the next 48 hours, seven days and two weeks after doing the test. Further studies need to be done to compare the role of the cervical phIGFBP-1 test with a combination of the test and other ways to predict the risk of preterm labour, like cervical fibronectin assay and cervical length measurement.

38. Serum Calcium Levels in Hypertensive Disorders in Pregnancy and it’s effect on Fetal Outcome in a Tertiary Care Center in Central India
Shraddha Chouhan, Shubhangi Jain, Anupama Dave, Akanksha Thora
Background: Calcium requirement increases during pregnancy, thereby increasing the chances of developing hypocalcaemia. Hypocalcaemia may be associated with pregnancy-related complications. Therefore, this study aim to estimate the prevalence of hypocalcaemia among Normotensive and Hypertensive pregnant women, and to study association between hypocalcaemia and fetal outcomes. Aim & Objective: To study levels of calcium in hypertensive and Normotensive antenatal patients and it’s affect on fetal outcome. Methods: It is a case control study. Data about hypertensive and Normotensive antenatal patients is being collected from their admission at hospital, their serum calcium levels done .Their fetal outcome have been studied on basis of their follow-up. Settings and Design: This study was done in a medical college hospital in Madhya Pradesh. Results: 240 antenatal patients were labelled as Normotensive and Hypertensive, they were followed up till delivery. Prevalence of hypocalcemia in hypertensive pregnant patient was slightly Higher than in Normotensive antenatal patients. Also serum calcium level among pregnant women who delivered LBW baby was lower than those who delivered baby with birth weight >2500 grams. Conclusion: It has been concluded in this study that serum calcium levels were reduced in hypertensive as compared to normotensive antenatal patients. LBW was associated with low serum calcium level. The actual role of calcium supplements needs further investigation.

39. Comparative Study between Use of Sutures Versus Cyanoacrylate Tissue Adhesive for Split Thickness Skin Graft Fixation
Manish Bariya, Gunjan Kishori, Akshay Parmar, Radha Sidhpuriya
Introduction:  Split-thickness grafts, in which the epidermis and a part of the dermis are virtually taken, are one of two forms of skin transplants. The second type of graft involves harvesting the complete dermis and epidermis for full-thickness grafts. Cyanoacrylate (CA) adhesive usage has grown significantly in recent years. In the presence of moisture, liquids called CAs polymerase create adhesives. Split skin graft fixation has been accomplished using a variety of methods and supplies. Each has advantages and disadvantages. An investigation compared the efficacy of Cyanoacrylate tissue glue versus sutures for fixing skin grafts. Aims and Objectives: To compare the outcomes between Sutures Versus Cyanoacrylate Tissue Adhesive in Split Thickness Skin Graft Fixation. Methods: A sample of 212 patients who were admitted and treated with STSG in the departments of surgery and plastic surgery were separated into two groups, with 105 patients in group A and 107 patients in group B. The envelope approach was used to randomize the patients. Tokens identifying the tokens’ groups, i.e. Group-A or Group-B, were placed inside unmarked identical envelopes holding the numbers 1 and 2. The split-thickness skin grafts were harvested in the usual manner with humby’s knife or mechanical dermatome and meshed and spread over gauze on a moist wooden board. Results: It was found that all patients’ VAS scores varied between 3 and 5 (moderate discomfort). On the third day, individuals reported mild to moderate pain. Patients in Groups A and B experienced different levels of pain, however, this difference was not thought to be statistically significant (p>0.05). Conclusion: It is to be concluded that cyanoacrylate is a better-emerging option for recipient graft fixation than alternate methods.

40. A Clinical Study of Risk Factors for Duodenal Ulcer Perforation and its Outcomes in a Tertiary Care Hospital
Shoaibuddin Mohammad, P Bhaskar Rao
Background: Gastroduodenal perforation can occur spontaneously or as a result of trauma, with peptic ulcer disease accounting for the majority of spontaneous perforations. Peptic ulcers are still a prevalent cause of peritonitis despite improved medical care that has decreased the frequency of perforation. The current study was done to determine the risk factors and surgical management of duodenal ulcers. Methods: Patients diagnosed with duodenal ulcer perforation with relevant investigations. The selected cases were examined thoroughly and demographic profiles which included the age, sex, and occupation of the patients were noted. The location of the ulcer, symptoms, and signs of perforation was also noted in a proforma. Investigations included Complete blood picture, Blood urea, Blood sugar, serum creatinine, blood grouping, serum electrolytes estimation, plain X-ray abdomen in the erect posture, abdominal paracentesis, peritoneal fluid culture, and sensitivity. H. Pylori demonstration in the biopsy from the site of perforation. Results: A total of n=50 cases of duodenal perforation were included in the study based on the inclusion and exclusion criteria. The most important risk factor was NSAID use which was found in 28% of cases in the present study. In most of the cases, 40% presented to our hospital in 12 – 24 hours followed by presentation between 6 – 12 hours in 22% of patients. The range of presentation was from 2 hours to 72 hours. The mean duration of the presentation was 10.5 hours. Radiological Signs: Out of n=50 cases plain X-ray abdomen revealed air under the diaphragm in 46% of cases and absent in 4% of cases. Conclusion: we found that the duodenum is the common site of peptic ulcer. Most commonly affected are males aged between 31 – 50 years. An important predisposing factor is the use of NSAIDs. The common presentation in radiographs is pneumoperitoneum. Mostly occurs at late night or early in the morning. The size of perforation in the majority of cases was 0.5 to 1.0 cm simple closure with a live omental patch was done in all cases.

41. Growth in Infancy Following Extremely Premature Birth: Associations with Later Neurodevelopmental and Health Outcomes
Gurdeep Singh, Aakanksha Tripti, Venkata Sai G., Abhay Kumar
Objective: The only information available on the long-term outcomes of preterm infants is frequently a cross-sectional assessment of neurodevelopmental impairment (NDI) at the corrected age of 23–35 months. However, individual trajectories in result over time may differ and impairments may not become obvious until infancy or disappear over time. This study’s main objective was to describe NDI in very preterm newborns at the ages of 1, 4, and 7 years old. The individual longitudinal trajectories in NDI from 1 to 7 years of age were subjected to a longitudinal analysis as a secondary goal. Method: This was a single-center prospective cohort research that tracked children through 2023 who were born between 2020 and 2021 at less than 31 weeks’ gestation. NDI evaluations at ages 1, 2, and 7 served as the outcome measurement. In regard to the cognitive, neurological, visual, and auditory components of the NDI composite score, issues were classified as none, mild, moderate, or severe. Standardized psychometric tests were used to evaluate cognitive function, which was expressed as a total DQ/IQ score. The neonatologist evaluated the neonate’s neurological, visual, and auditory abilities. Results: 240 kids in total were eligible for follow-up, and 170 (78% of them) were evaluated. 53, 53, and 61% of the children at 1, 4, and 7 years old had no NDI; 30, 35, and 31% showed mild NDI; and 14, 9.1, and 8.5% of the children at 1, 4, and 7 years old showed moderate-to-severe NDI. 62% of the kids stayed in the same NDI category from 1 to 7 years old, 21% got better and moved into a better NDI category, and 16% became worse and moved into a worse NDI group. There were no differences between infants whose baseline traits improved or worsened. There were no differences between infants whose baseline traits improved or worsened. At all-time points, extreme prematurity, male gender, and low parental education were linked to worse NDI status. Despite the fact that there was significant individual heterogeneity in NDI status across time, gestation, gender, and parental education did not affect the trajectory of NDI. Conclusion: In order to offer the best and most individualized recommendations and care when necessary, continued follow-up until the start of the school year is crucial.

42. A Hospital Based Cross Sectional on Management and Outcome of Fractures of Both Bones of the Forearm by Intra Medullary Nailing
Puneeth, Abrar
Background: The upper-extremity injury and fracture is commonly seen in orthopaedic practice which accounted for around 8–15% of all the skeletal injuries. The management of the injury by Micronail, one of the modified intramedullary devices allows facilitating the sub-chondral bone in the form of fixed-angle along with development of stability by combined fixation as well as only minimal soft tissue dissection. This study was taken up to assess the clinical outcomes in patients of fracture forearm and treated by flexible intramedullary nailing. Methods: It is a hospital based prospective interventional study done on 30 patients admitted to Khaja Bandanawaz Teaching and General Hospital attached to Khaja Bandanawaz University, Kalaburagi in the Department of Orthopaedics. Results: The present study found that 14 (46.7%) of patients had radiological union by 6-8 weeks, none of the patients had 9-11 weeks and 12 weeks of union time. 1(6.7%) of the patients had delayed union and did not show callous upto 12 weeks. When comapred with plating group, nailing showed significantly earlier union rates. Average supination range was found to be 81.67±6.17 degrees, pronation of 67 ±5.61 degrees, flexion at wrist was 72.67±3.72 degrees and extension at wrist was found to be 67.67±3.72 degrees. Our study observes that, 12 (86.7 %) didn’t have any infection , 2(13.3%) patients had superficial infection and 2(13 %) developed elbow stiffness and non of the patients showed delayed union. The current study shows that mean-time for union was 7.4±2.47 days, 3.8±1.57 days was the mean-time of surgery and 7.4±2.47 weeks was the union time in weeks, whereas 5.20±1.01 was mean hospital stay in days. Conclusion: The intra medullary nailing is less invasive technique allowing the quicker restoration of the function with minimal pain and reduction of complication risks.

43. Clinical Correlates of Metabolic Parameters in Bipolar Disorder: A Cross Sectional Study
Vidushi, Rajvardhan Narayan
Background: People with bipolar disorder develop a host of physical problems which affect its course and outcome in an unfavorable manner. Many of the physical symptoms observed in bipolar disorder are components of the metabolic syndrome. Metabolic derangements like obesity, abnormal glucose levels, abnormal lipid profile, and thyroid dysfunction, are highly prevalent in these patients due to shared etiological factors. Methods: A cross-sectional study was conducted in the psychiatry department of PMCH Patna. for a period of about one an half year. All patients fulfilling the ICD-10 criteria for bipolar disorder attending the clinical services of the department of psychiatry were included in the study. A total of 67 consenting patient were assessed by using a pretested structured proforma, life chart was drawn to assess course of illness, the severity of present episode was assessed by Young Mania rating Scale (YMRS) for mania and Hamilton Depression Rating Scale (HAMD) for depression. Conclusion: This study aimed to explore the relationship of metabolic syndrome and bipolar disorder. The prevalence of metabolic syndrome found to be 53.7%. Patients with metabolic syndrome were found to have greater numbers of lifetime depressive episodes. Considering the high prevalence of metabolic syndrome in the patients of bipolar disorder; strategies have to be developed for prevention, early detection and treatment of the same.

44. Comparative Study of the Degree of Insight in Patients with Schizophrenia and Bipolar Affective Disorder
Rajvardhan Narayan, Vidushi
Background and Objectives: Poor insight in psychosis has been described as a lack of awareness of having an illness, of the deficits caused by the illness, the consequences of the disorder, and the need for treatment. Evidence suggests that poor insight is a manifestation of the illness itself, rather than a coping strategy. This symptom predisposes the individual to noncompliance with treatment and has been found to be predictive of an increased number of involuntary hospital admissions, poorer psychosocial functioning, and a poorer course of illness. The objective of the current study is to evaluate and compare the degree of insight in patients with schizophrenia and bipolar affective disorder mania during their hospitalisation. Methods: Sixty patients, 30 each belonged to the schizophrenia and bipolar affective disorder mania group respectively. The diagnosis was made according to the ICD-10 classification of mental and behavioural disorders, Diagnostic Criteria for Research [ DCR -10]. The various socio demographic and clinical variables between the two groups were compared. Conclusion: Our study showed that there was a significant improvement in insight during hospitalisation in both schizophrenia and mania groups. The mania group had a significantly higher improvement in insight than the schizophrenia group.

45. Fetal Meconium Peritonitis- Antenatal Diagnosis of a Rare of Rarest Clinical Entity and its Postnatal Outcome
Ruby Bhatia, Manisha Kumari, Sukhbir Pal Kaur, Kiran Pandey, Tanisha
Objective: To present a rare case of fetal meconium peritonitis diagnosed during antenatal period and its postnatal outcome. Background: Fetal meconium peritonitis (FMP) is a rare of rarest fetal complication with the incidence of 1 in 30,000 newborns. It is defined as sterile chemical peritonitis caused due to extravasation of meconium into the peritoneal cavity secondary to bowel perforation. Few causes which might result in perforation include ileal atresia, intussusception, Hirschsprung’s disease, volvulus, Meckel diverticulitis and vascular insufficiency. Sonography with high precision is an effective tool for antenatal diagnosis of FMP. Management and the need for surgery depends on the clinical presentation and the overall condition and the gestational age at birth of the newborn. Timing and mode of delivery relies on combined decision of gynecologists, neonatologists, and neonatal pediatric surgeons. Favorable outcome have been seen when the condition was detected in antenatal period rather than when the neonatal diagnosis is made. Surgery performed within first 24 hours of life may improve perinatal outcome.

46. Quality of Life among Postmenopausal Women with Osteoporosis in North Maharashtra: A Cross-Sectional Study
Deepak Dinkar Patil, Gondkar Shodhan Ramrao, Mohan Kumar B. Nagane, Jagdish N. Gindodia
Introduction: Osteoporosis is characterised by reduced bone mass and structural destruction of bone tissue which increases the brittleness of bone that leads to increased fracture risk. It is very common among postmenopausal women. Aim: To assess the quality of life of among the postmenopausal osteoporotic women without fracture and to find out the association of quality of life with selected demographic variables. Materials and Methods: The present cross-sectional was conducted at Hospital of ACPM Medical College, Dhule, after obtaining the permission from concerned authorities. The sample was 120 postmenopausal osteoporotic women   who   belong   to the age group 45-65 years. After obtaining the informed consent, the participants were interviewed using Short Form-36 (SF-36) quality of life questionnaire. The questionnaire consisted of 36 items and eight subscales which are summarised in two domains: Physical Component Summary (PCS) and Mental Component Summary (MCS). The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: The results of this study showed that participants scored less (29.99±9.56) in role limitations due to emotional problems. Also, the participants scored less (43.39±4.57) in   the domain of MCS in comparison to PCS (47.78±4.53). Further, association of PCS and MCS scores of quality of life were tested (p-value<0.05) with selected demographic variables such as age, religion, education, occupation and BMD. The results showed that there was no significant association found between PCS scores and age (p-value=0.84), religion (p-value=0.94),    occupation    (p-value=0.805)     and     BMD (r= -0.058, p-value >0.05). Also, there was no significant association between MCS scores and age (p-value=0.69), religion (p-value=0.86), occupation (p-value=0.70) and BMD (r-value=-0.0604, p-value >0.05). Conclusion: The participants scored less in the subscale of role limitations due to emotional problems of the SF- 36 questionnaire. The quality of life was less in the mental component subscore. This indicated that osteoporosis make the postmenopausal women anxious and affects their daily activities.

47. Prevalence of Spontaneous Bacterial Peritonitis in Cases of Ascites in a Tertiary Hospital
Sanjeev Johri, Sabyasachi Gupta, Surjeet Singh Rajpoot, Rita Singh Saxena
Objective: To study etiopathogenesis, prevalence, signs & symptoms, lab parameters of Spontaneous bacterial peritonitis (SBP) in cases of patients presenting with ascites of varied etiology. Methods: The present study was conducted in 60 patients of ascites. Patients were selected randomly without any bias for age, sex or type of ascites. A detailed history was recorded with particular emphasis on symptoms of SBP like fever, pain in abdomen, sudden increase in abdominal distension, altered consciousness, hematemesis, malena, etc. Duration of ascites, alcoholism, past history of hematemesis, encephalopathy, jaundice was also noted. Bed side inoculation of ascitic fluid in blood culture bottles was done and growth noted. Results: Fever (63.6%) and abdominal pain (45.45%) were common presenting symptoms Patients with severe liver disease expressed by presence of hepatic stigmata, hepatic encephalopathy, and abnormal liver function tests, had higher occurrence of SBP. Patients with ascitic fluid total protein less than 1 gm/dl had higher occurrence of SBP. Bed side inoculation of ascitic fluid in blood culture broth demonstrated organism in seven patients. In six patients E. Coli and in one patient Klebsiella was responsible for SBP. Conclusion: Any patient of ascites, admitted with fever and abdominal pain. SBP should be considered. SBP is a common cause of hepatic encephalopathy. Thus all patients who are admitted with hepatic encephalopathy should be screened for SBP and treatment should be started as early as possible as their condition can be treated successfully with timely intervention.

48. A Study on Diabetic Foot and its Follow-Up Post-Surgical Interventions
Rajiv Kumar Shahi, Shivam Jaiswal, Rakesh Singh, Veena Rai
Background: Diabetic foot is a common complication of diabetes mellitus and can lead to serious morbidity and mortality if not treated appropriately. Aim and Objectives: The purpose of this study was to evaluate the outcomes of surgical interventions for diabetic foot and to assess the follow-up care provided to patients post-surgery. Materials and Methods: A retrospective study was conducted on 142 patients with diabetic foot who underwent surgical interventions at a tertiary care hospital between January 2018 and December 2020. Data were collected from electronic medical records, including demographic information, comorbidities, type of surgery performed, length of hospital stay, and post-operative complications. Follow-up data were collected up to six months post-surgery. Descriptive statistics were used to summarize the data, and logistic regression analysis was used to identify predictors of post-operative complications. Results: A total of 142 patients were included in the study, with a mean age of 59.8 years and a male-to-female ratio of 1.7:1. The most common comorbidity was hypertension (69.7%), followed by hyperlipidemia (38%) and ischemic heart disease (24.6%). The most common type of surgery performed was debridement (69.0%), followed by reconstruction (18.3%) and amputation (12.7%). The overall post-operative complication rate was 26.8%. The most common post-operative complications were wound infection (12.7%), re-ulceration (7.0%), and persistent non-healing wounds (5.6%). The mean time to the first follow-up visit was 5.2 days, and 84.5% of patients attended all scheduled follow-up appointments. Logistic regression analysis showed that longer hospital stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.07-1.63, p = 0.009) and uncontrolled diabetes (OR 2.63, 95% CI 1.15-6.00, p = 0.022) were significant predictors of post-operative complications. Conclusion: Our study highlights the importance of appropriate follow-up care for patients with diabetic foot after surgical interventions. The high rate of post-operative complications emphasizes the need for careful patient selection and close monitoring post-surgery. Early detection and management of post-operative complications can improve patient outcomes and reduce morbidity and mortality associated with diabetic foot. Our findings can inform clinical practice and public health policies aimed at improving the care of patients with diabetic foot.

49. A Comparative Study on Topical Sucralfate Dressing versus Conventional Dressing in the Management of Chronic Diabetic Foot Ulcers
Pradeep Kumar J, Sathya Seelan, Pramod D, Chinthala Pradeep Reddy
Background: The incidence of diabetes and its complications are increasing day by day. Lifetime risk of developing a foot ulcer is up to 25% in diabetic patients. The course of healing in chronic diabetic foot ulcers is unpredictable and resistant to treatment. Various modalities of treatment have been developed to aid the faster healing of diabetic foot ulcers however none proved to be gold standard. Sucralfate is a drug primarily used to treat GIT ulcers, has proved to be effective in reducing the size of wound and aids in complete healing of wounds in various studies. Our study intends to compare the efficacy of sucralfate with conventional dressing in treating diabetic ulcers. Materials and methods: This randomised comparative study was done in the Department of General Surgery. 100 patients with chronic diabetic foot ulcers, divided into two groups of 50 each were studied. One group received topical sucralfate dressing and the other group received treatment in the form of conventional therapy. Comparison between two groups was made regarding the percentage decrease in wound area, duration taken for complete healing, effect when associated with varicose veins and effect on bacterial load of ulcer. Results: The majority of patients were aged more than 50 years, Females (58%) were more affected than males (42%). The plantar aspect (46%) was the most common site. The sucralfate group mean area of reduction after 21 days was 42.3% (S.D;7,5) and in the conventional group was 17.9 (S.D;12.7). which is observed to be statistically significant. The ulcer’s mean duration for complete healing was 2.7 weeks in the topical sucralfate group and 5.9 weeks in the conventional dressing group.46 patients in the study group, whereas 49 patients in the control group still had a positive culture at the end of 21st day of dressing. Conclusion: In this study, it was perceived that the category receiving topical sucralfate dressing had better wound contraction as compared to the category receiving only conventional treatment Sucralfate helps in wound healing better than conventional dressing for chronic diabetic ulcers and is better even if it is associated with varicose veins.

50. A Study of Causes of Chronic Cough in Children
Kiran HT, Vinaykumar S, Amrutha A M, Tejasvi HT, Meghana MN
Introduction: Chronic cough is a common condition that affects many children and can significantly impact their quality of life. The study aims to identify the different causes of chronic cough in children and their prevalence, and to evaluate the effectiveness of diagnostic tests and treatments. Materials and Methods: The study involved a comprehensive review of medical records of children diagnosed with chronic cough in a large pediatric hospital over a one-year period. Results: The results of the study suggest that the most common causes of chronic cough in children are asthma, upper airway cough syndrome, and gastroesophageal reflux disease. The study also found that diagnostic tests such as chest X-rays, spirometry, and bronchoscopy are useful in identifying the underlying cause of chronic cough. Treatment options for chronic cough include medications, lifestyle modifications, and behavioral interventions. Conclusion: The findings of this study have important implications for the management of chronic cough in children and highlight the need for a multidisciplinary approach to diagnosis and treatment.

51. Correlation of Lipoprotein Phospholipase A2 (Lppla2) Levels With Severity of Coronary Artery Disease: An Observational Study
Mahamine Kaustubh, Patil Nahush, Manohar Ketkar, Kodilkar Jitendra, Hire Devyani, Singh Jeetendra
Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a predictor biomarker for incident atherosclerotic disease. Lp-PLA2 has been recognized in atherosclerotic plaques; however, its role in atherosclerosis is still a matter of exploration. Lp-PLA2 belongs to the superfamily of phospholipase A2 enzymes. It is produced by macrophage that appears to play a role in the atherosclerotic vessel wall. Evolving data appear to suggest that Lp-PLA2 may be pro-atherogenic, which is thought to be mediated by lypo-phosphatidylcholine and oxidized non-esterified fatty acids, two mediators generated by Lp-PLA2. Phospholipase A2 plays an essential role in metabolism of membrane phospholipids, it is related to inflammatory reactions, secretion of amyloid precursor protein. Several studies have documented association of Lp-PLA2 with coronary heart disease in the general population. The present original research article focuses particularly on whether LP-PLA2 activity is positively associated with the severity of Coronary artery disease (CAD). Methods: It was a prospective observational study where fifty consecutive proven cases of coronary artery disease and 50 consecutive cases with normal coronary angiography were enrolled in the study. We classified the cases as mild moderate and severe according to SYNTAX score. There were 19 cases of Mild CAD, 18 and 13 cases belonged to moderate and severe disease respectively. LpPLA2 mass levels were measured for all controls and cases. at LpPLA2 levels correlate significantly with LDL levels. Results: Analysis of data failed to establish any correlation between LpPLA2 and Severity of CAD. Rather we found the LpPLA2 levels correlate with LDL levels. Levels of LpPLA2 also show reduction after statin treatment along with LDL levels. LpPLA2 levels do not correlate with severity of CAD especially in patients on statin treatment. Recommendation and conclusion: Based on our study we can recommend that LpPLA2 level may not be measured to assess severity of Coronary artery disease especially in patients on statin treatment.

52. To study Risk Factors and Clinical Correlates of Spontaneous Bacterial Peritonitis in Patients with Ascites
Sanjeev Johri, Sabyasachi Gupta, Surjeet Singh Rajpoot, Rita Singh Saxena
Objective: To study the risk factors and clinical correlates of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. Methods: The present study was conducted in 60 patients of ascites. Patients were selected randomly without any bias for age, sex or type of ascites. A detailed history was recorded with particular emphasis on symptoms of SBP like fever, pain in abdomen, sudden increase in abdominal distension, altered consciousness, hematemesis, malena, etc. Duration of ascites, alcoholism, past history of hematemesis, encephalopathy, jaundice was also noted. Bed side inoculation of ascitic fluid in blood culture bottles was done and growth noted. Results: The study investigated the risk factors and clinical correlates of spontaneous bacterial peritonitis (SBP) in patients with ascites. The researchers analyzed data from 60 cases and found that a low serum albumin level, advanced age, and a high Model for End-Stage Liver Disease (MELD) score were associated with an increased risk of SBP. Additionally, the study found that patients with SBP had a higher incidence of encephalopathy and renal failure, as well as a higher mortality rate. The findings suggest that monitoring for SBP in patients with ascites and addressing these risk factors may help improve patient outcomes. Conclusion: Any patient of ascites, admitted with fever and abdominal pain. SBP should be considered. SBP is a common cause of hepatic encephalopathy. Thus all patients who are admitted with hepatic encephalopathy should be screened for SBP and treatment should be started as early as possible as their condition can be treated successfully with timely intervention.

53. Epidemiology and Etiological Study of Adult Acute Encephalitis Syndrome in the Rural Setup of Purwanchal, India
Rakesh Kumar Shahi, Kshitij Shahi, Manvi Shahi
Background: Acute encephalitis syndrome (AES), known as Chamki Bukhara, is a major public health problem, claiming hundreds of lives yearly. AES has various etiologies and causes, making it difficult for clinicians to manage. The current study is conducted to describe the incidence, manifestations, etiology, and prognosticators of morbidity and mortality. Aims and Objectives: To evaluate the Epidemiology and Etiology of Adult Acute Encephalitis Syndrome in the rural setup of Purwanchal (eastern UP), India. Materials and Methods:  This study enrolled 300 patients for AESs to study viral etiologic causative agents and their epidemiology. Cerebrospinal fluid (CSF) samples of the AESs were tested for IgM antibodies using Commercial enzyme immunoassays were used to test for Japanese encephalitis virus (JEV), dengue virus (DV), herpes simplex virus (HSV), measles virus (MV), mumps virus, varicella zoster virus (VZV), and enterovirus. Results: Of the 300 subjects, 50% have confirmed AES; the main etiologies were JEV (20%) is the most common, followed by DV (10%) and HSV (7%). Co-positivity with more than one virus was observed in 22 (7%) patients out of 150 confirmed cases. Conclusion: JEV infection resulted in the most significant mortality, whereas HSV infection resulted in the greatest residual neuropsychiatric disability. The main AES-causing agents are JEV and DV, in Central India, mainly during monsoon season.

54. Association of Cigarette Smoking and Raised Blood Cholesterol Levels in Young Population Attending Outpatient Department of a Tertiary Care Hospital
Rashmi Gour, Sangeeta B Chinchole, Priyanka Verma
Background and Objectives: According to the WHO, India is home to 12% of the world’s smokers. More than 1 million die each year due to tobacco in India. Cigarette smoking is one of the most extensively used potentially hazardous social habits throughout the world. The study was aimed to determine the deleterious effects of smoking on lipid profile and to study association between lipid profile and smoking. Material and Method: The study was conducted on 150 normal asymptomatic healthy males. Out of which 75 were controls and 75 were cigarette smokers with age-group between 17-35 years. The association of cigarette smoking and raised blood cholesterol levels was studied. Smokers and non-smokers who attended the outpatient clinic as a patient, attendant, volunteer and staff were recruited in the study. The subjects enrolled for the study were informed about the study and procedural details and an informed consent was obtained. In order to exclude conditions that might influence the results, the recruitment of subject was done on the basis of following criteria. They were all vegetarians, belonged to the age group of 17 to 35 years, indulged in equivalent physical exercise and did not consume alcohol. Patient suffering from chronic diseases or taking medications for lipid lowering were excluded. Results: The study showed, cigarette had raised concentration of serum total cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol and had reduced levels of HDL cholesterol. Mean cholesterol, LDL, Triglycerides levels were increased with the severity of smoking which was found to be significant while level of HDL decreases with severity which was also statistically significant. (p<0.05) Conclusion: We observed a dose response relationship between the number of cigarettes smoked and cardiovascular morbidity and mortality.

55. A Study on Diabetic Foot and its Follow-Up Post-Surgical Interventions
Rajiv Kumar Shahi, Shivam Jaiswal, Rakesh Singh, Veena Rai
Background: Diabetic foot is a common complication of diabetes mellitus and can lead to serious morbidity and mortality if not treated appropriately. Aim and objectives: The purpose of this study was to evaluate the outcomes of surgical interventions for diabetic foot and to assess the follow-up care provided to patients post-surgery. Materials and Methods: A retrospective study was conducted on 142 patients with diabetic foot who underwent surgical interventions at a tertiary care hospital between January 2016 and December 2018. Data were collected from electronic medical records, including demographic information, comorbidities, type of surgery performed, length of hospital stay, and post-operative complications. Follow-up data were collected up to six months post-surgery. Descriptive statistics were used to summarize the data, and logistic regression analysis was used to identify predictors of post-operative complications. Results: A total of 142 patients were included in the study, with a mean age of 59.8 years and a male-to-female ratio of 1.7:1. The most common comorbidity was hypertension (69.7%), followed by hyperlipidemia (38%) and ischemic heart disease (24.6%). The most common type of surgery performed was debridement (69.0%), followed by reconstruction (18.3%) and amputation (12.7%). The overall post-operative complication rate was 26.8%. The most common post-operative complications were wound infection (12.7%), re-ulceration (7.0%), and persistent non-healing wounds (5.6%). The mean time to the first follow-up visit was 5.2 days, and 84.5% of patients attended all scheduled follow-up appointments. Logistic regression analysis showed that longer hospital stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.07-1.63, p = 0.009) and uncontrolled diabetes (OR 2.63, 95% CI 1.15-6.00, p = 0.022) were significant predictors of post-operative complications. Conclusion: Our study highlights the importance of appropriate follow-up care for patients with diabetic foot after surgical interventions. The high rate of post-operative complications emphasizes the need for careful patient selection and close monitoring post-surgery. Early detection and management of post-operative complications can improve patient outcomes and reduce morbidity and mortality associated with diabetic foot. Our findings can inform clinical practice and public health policies aimed at improving the care of patients with diabetic foot.

56. Prevalence of Metabolic Syndrome in Women with Polycystic Ovary Syndrome
Girija C Bellad, Vasant Kabbur, Sunita Kittali
Background and Aim: Cardiovascular disease and type 2 diabetes risk are both elevated by two and five times, respectively, by metabolic syndrome. This demonstrates the significance of early identification of metabolic syndrome and insulin resistance in women with polycystic ovarian syndrome and the subsequent implementation of preventive therapies. Our study’s objective is to assess the prevalence of metabolic syndrome in women with polycystic ovarian syndrome who are in the reproductive age range. Material and Methods: The present study is the cross sectional analysis done in the department of Obstetrics and Gynaecology in Medical College & Hospital. For the analysis, total of 238 women in the reproductive age group were included in the study. The detailed menstrual history in relation to the age of menarche, menstrual cycle was recorded. The history of diabetes, hypertension drug intake, childhood obesity and hypertensive drugs were recorded. The anthropological examination and clinical examination was done. Hirsutusim was graded as per Ferriman-Gallway scoring system. Results: In the study population, metabolic syndrome was found to be 38.5% prevalent. Patients with metabolic syndrome on average were 30.91 + 7.9 years old, while those without it were 29.4 + 6.5 years old. According to the results of the current study, the metabolic syndrome is more prevalent in the PCOS group as BMI rises. 35% of people had hirsutism or other clinical signs of hyperandrogenism with a Ferriman and Gallway score of 8 or above. Those who experienced hirsutism (35% vs 8%) and acanthosis (35% vs 16%) were substantially more prevalent. Conclusion: The current study emphasises the necessity of thorough screening for metabolic syndrome in PCO-positive women visiting OPD. One in four patients visiting a gynaecologist have PCOS, a common illness that affects women in the reproductive age group.

57. Neutrophil Lymphocyte Ratio (NLR) as a Predictor of Disease Severity and Mortality in Geriatric Patients with COVID-19
Shailaja. V. Rao, Kehkashan Farooqui, Mangala Sonavani-Borkar, Sadhana Jaybhaye, Shaikh Zeba Firdous, Smita Andurkar
Introduction: COVID-19 pandemic affected 44,696,984 people in India Geriatric (age 60 years and above) population is increasing globally. Older adults have been affected badly with COVID-19 Neutrophil lymphocyte ratio (NLR) is used in several diseases as an inflammatory marker in predicting prognosis. According to a recent study patients with severe COVID-19 are reported to have higher Neutrophil lymphocyte ratio ( NLR). In this study we aimed to assess the accuracy of Neutrophil lymphocyte ratio (NLR) as a predictor of disease severity and mortality in geriatric patients with COVID-19. Materials and Methods: 200 geriatric inpatients infected with COVID-19 were included in the study. Neutrophil lymphocyte ratio (NLR) at admission was recorded. Neutrophil lymphocyte ratio (NLR) cutoff was taken 3.5. Patients were categorized into mild, moderate, severe and critical cases according to criteria given by Maharashtra Task Force. Relationship between Neutrophil lymphocyte ratio (NLR) and disease outcome was assessed. A p value < 0.05 was taken as statistically significant. Results: The mean age of study sample was 69.00 ±7.09 years. A significant association was found between Neutrophil lymphocyte ratio (NLR) and disease severity (p -0.048) as well as mortality (p-0.041).

58. Prognostic Accuracy of News 2 in Geriatric Patients with COVID-19 in a Tertiary Care Hospital
Shailaja. V. Rao, Momin Aaisha Heena, Mangala Sonavani-Borkar, Mahesh Patil, Shaikh Zeba Firdous, Smita Andurkar
Introduction: COVID-19 is a widespread disease having more impact on elderly as compared to younger age group. [2] Although many parameters have emerged as predictors of prognosis of COVID-19, a simple clinical score at baseline can be used for early risk stratification. NEWS2 (National Early Warning Score) is one such scoring system which was originally developed to improve detection of deterioration in acutely ill patients.[8] Therefore, the present study has been conducted to assess the effectiveness of NEWS2 in predicting critical outcomes and mortality in geriatric patients with COVID-19. Materials and Methods: A cross sectional Observational study was done on 200 Geriatric patients hospitalised with confirmed COVID-19 between December 2020 to November 2022. Baseline NEWS2 score was calculated . The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value were established for NEWS2 score of 5 or above. Results: In critical group, all 109 (100%) patients’ deterioration was predicted, and in non-critical group, in 14 (15.4%) patients non deterioration was predicted while 77 (84.6%) patients’ deterioration was predicted. Statistically significant association has been observed between the critical, non-critical groups and NEWS2 scale (P=0.001). Deterioration was predicted by NEWS2 scale in all the critical patients. Conclusion: NEWS2 score of 5 or more on admission predicts poor prognosis in geriatric patients with COVID-19 with good sensitivity and it can easily be applied for risk stratification at baseline. We recommend further studies in the Indian setting to validate this simple score and use it further in Geriatric patients with COVID-19.

59. The Comparison of Cardiac Autonomic Functions in Patients with Polycystic Ovarian Syndrome and Healthy Controls
Sharma Vanshika, Shukla Jyotsna, Mittal Premlata, Amita
Introduction: Polycystic ovarian syndrome (PCOS) is a prevalent heterogeneous endocrine condition that affects 5-10% of women of reproductive age. It is one of the most prevalent reasons for female infertility. Autonomic function testing (AFT) is a non-invasive technique used to assess cardiac autonomic dysfunction. AFT might assist us in identifying PCOS women who are more likely to suffer cardiovascular issues. Aim and Objectives: To evaluate and compare cardiac autonomic function tests in polycystic ovarian syndrome patients and age-matched healthy women. Material and Methods: 60 women between the ages of 18 and 35 were recruited for this research. The research group was divided into two groups. Women with PCOS who had a BMI of 23 were classified cases (n = 30), while healthy women with the same BMI were labelled controls (n = 30). They were tested for autonomic function. Results: When compared to healthy controls, women with PCOS had an autonomic imbalance with higher sympathetic discharge (p < 0.05). When compared to healthy controls, there was less vagal drive. Conclusion: Autonomic dysfunction was seen in women with PCOS, with increased resting sympathetic and reduced parasympathetic activity.

60. A Case of Complete Second Arch Branchial Fistula in a 11-Year-Old Child
Sunil Pawara, Sayed Faiyaz Ali, Sarojini Jadhav
Introduction: Branchial cleft anomalies are formed due to failure of embryonic structures to obliterate during development. Anomalies in the development of branchial clefts can lead to cysts, external sinuses, internal sinuses, and complete fistulas. The branchial fistula arising from each arch can be identified from the position of the internal and external openings. In majority of cases, the tracts end blindly, leading on to the formation of branchial sinuses. Patients with fistulae often present with mucoid drainage from a lateral neck opening that may become infected over time. Definitive management consists of complete surgical excision of the fistula tract. We report a rare case of complete second arch branchial fistula in a 11 year‑old child, which was successfully treated by excision. Case Scenario: A 11 years old male presented to Surgery OPD with, chief complaints of opening over right side of neck since childhood with intermittent discharge from the opening. Opening of size 0.1×0.1cm over right side neck at the skin over middle third of anterior border of sternocleidomastoid. Patient was investigated by Conventional X-ray Fistulogram. Patient was further investigated by MRI Fistulogram showing- second branchial cleft cyst with fistula. Treatment: Patient was operated by brachial fistulectomy by Elliptical skin incision taken around the opening, incision deepened, underlying tract identified and dissected from surrounding structures till just above the level of submandibular gland almost in the area around the tonsillar fossa, the tract ligated at the base and around 6 cm length of tract excised. Postoperatively, patient was kept under surveillance for recurrence. Conclusion: We reported a rare case of radiologically demonstrable complete second arch branchial fistulae, diagnosed by Fistulogram and treated by complete excision.

61. Hepatogastric Fistula – A Grave Complication of Liver Abscess
Pushkar Chaudhari, Suresh Harbade, Sarojini Jadhav
Introduction:  Liver abscess may rupture into adjacent thoracic, pericardial, and peritoneal cavities however fistulization into gastrointestinal tract is extremely rare; only a few cases of hepatogastric fistula have been reported. A majority of abscesses respond to medical management with complete resolution. Rupture into the thoracic or peritoneal cavity is a common complication of ALA. There are no established guidelines for diagnosis and management of this complication. Case: A 36 years old patient, chronic alcoholic presented with lump and pain in epigastric region for 8 days. Pain was localized in epigastric region with intermittent episodes of high-grade fever. On general examination- febrile (100 F), Pulse rate -120/min, bp-100/60mmhg, spo2-98% on room air. On per abdomen examination- ill-defined lump seen over epigastric region. On palpation there was localized tenderness and guarding in epigastric region, liver was palpable 4cm below right costal margin in midclavicular line. USG (A+P) s/o 2 abscesses in left lobe of liver of volume 557cc(tappable) and 275cc(non-tappable) with suspicious breach into peritoneal cavity. Abscess was drained by USG guided pigtail catheter insertion- 600cc pus drained. Discussion: Gastroduodenoscopy and CECT(A+P) are investigations of choice. Direct communication between abscess and gastric lumen can be demonstrated and presence of air along with oral contrast in abscess is confirmatory. Management includes broad spectrum antibiotics, drainage of abscess. Surgical management includes en bloc removal of involved portions of stomach and liver., endoscopic retrograde papillotomy with stenting of common bile duct. Conclusion: Hepatogastric fistula because of pyogenic liver abscess is a rare complication still we need to have high degree of suspicion to diagnose it in early stage.  Management can either be surgical, endoscopic or conservative, we have managed this patient conservatively.

62. Evaluation of Incidence and Risk factors of Hypocalcemia after Parathyroid Preservation total Thyroidectomy in Patients of Thyrotoxic Goiter
Anil Kumar Dash, Dayanidhi Meher, Jyoti Prava Sahoo
Introduction: Thyrotoxic nodules usually present with diffuse goiter, exopthalmos and rarely pretibial edema. Thyroidectomy is considered to be safe with morbidity of less than 5% as described in literature. The associated complications following thyroidectomy are injury to recurrent laryngeal nerve, postoperative haemorrhage and hypocalcaemia; among which hypocalcemia is the most common, with an incidence of 7-51%. The quality of life is affected significantly by hypocalcemia following thyroidectomy. Study Design: Prospective clinical study. Methodology: Thirty-two patients had undergone total thyrodectomy for thyrotoxicosis. Preoperatively, patients were treated with Methimazole and β-blockers for 4-6 weeks until the T3 and T4 levels were reduced to near normal and were subsequently admitted in ENT ward. Lugal’s iodine was administrated for 5-7 days as a preoperative preparation before the planned total thyroidectomy with parathyroid preservation. Results: All the patients developed hypothyroidism and were treated with Levothyroxine. 93.6% cases with preserved parathyroid developed temporary hypocalcaemia and needed calcium supplementation for 3 to 8 weeks. Only 6.4% cases had permanent hypocalcemia after six months of surgery and needed lifelong calcium and calcitriol replacement. Conclusion: In conclusion, the most important factor for predicting postoperative hypocalcemia is the number of preserved parathyroid glands and it was found that, to avoid permanent hypocalcemia only two functional parathyroid glands are required. Thus it is imperative for the surgeon to make every attempt at identifying and preserving parathyroid glands and its blood supply.

63. Caesarean Section: Rate & Determinants in a Teaching Institute in Eastern U.P, India
Babita Kapoor, Neetu Verma, Sadanand, Reena Shrivastava
Objectives: (1) To evaluate the total caesarean section rate (CSR) along with Primary and repeat caesarean rate. (2) To explore and analyse the indications of caesarean section (CS) along with their sociodemographic and obstetric determinants in our institution to reduce the caesarean section rate in future. Methods: The present study was conducted retrospectively in the department of Obstetrics and Gynaecology, in a tertiary care institute in eastern UP. Hospital records of women who delivered between January 2016-Dec2016 were reviewed and information regarding number of caesarean sections performed during the time period, sociodemographic factors, Obstetric characteristics and indication of caesarean section among the pregnant women delivered by caesarean section were noted and analysed. Results: Out of 3740 deliveries conducted during the study period,1788 were via caesarean section( Total CS rate 47.8%).Primary caesarean section rate was 64.4%. whereas 35.6% were via repeat caesarean section. In our study majority of CS(1568/1788) were performed in emergency(87.7%). In emergency CS group majority (58%)were primary caesareans  whereas 29.7% were repeat emergency caesareans. Fetal distress was the main indication (28%) of primary caesareans performed in emergency. Scar tenderness was the main indication(45.8%) for repeat emergency caesareans. Conclusions: In Present study high caesarean section rate is because of emergency caesarean sections performed in unbooked pregnant women referred from rural areas. Better health care infrastructure in rural areas and thorough evaluation of maternal and fetal conditions during labour can reduce the caesarean section rate and determine the possibility for more vaginal deliveries.

64. Prevalence of Refractive Error among the Anaemic and Non Anaemic First Year MBBS Students
Ayushi, Gitanjali, Ajeet Kumar, Amit Kumar
Background: Medical students determine their visual acuity (VA) as well as haemoglobin (Hb) level as part of the curriculum. We observed, frequently those who had refractive error were also anaemic observation that medical students who had refractive error were also anaemic, coupled with lack of published literature on such an association, led us to determine if this was merely a chance occurrence The students were screened for anaemia and refractive error. Material and Methods:  This cross sectional, analytical study was conducted on 148 first MBBS students. Department of Physiology, at DMCH,  Darbhanga. The study duration of Two years. After clearance from the institutional ethics committee and informed consent, the recruited students were screened for the presence of anaemia and assigned to anaemic group  or non-anaemic group. Conclusion: Observation of frequent co-occurrence of anaemia and refractive error amongst medical students is not just a chance occurrence. This pioneering study points to a real association between anaemia and refractive error in the study group.

65. A Study of Peripheral Nervous System Alterations in Hypothyroid Patients in North Indians
Ajeet Kumar, Ayushi, Gitanjali, Vijay Kumar Singh
Background: The thyroid gland is the one of the largest endocrine glands. The Greek word ‘thyreos’ means ‘shield’ and ‘eidos’ means ‘form’. So it yields its name as it is shield shape in nature. It consists of two lobes connected by an isthmus and located anterior to the trachea between the cricoids cartilage and the suprasternal notch. Methods: It included 30 cases of hypothyroid patients, of both sexes between the age group of 20 to 60 years. The controls were selected from patients who do not have the thyroid hormone deficiency and attending the medicine and neurology OPD of both sexes of the same age group as cases 20 – 60 years. Study duration of Two years. At DMCH  Darbhanga. Conclusion: Estimation of the nerves conduction values can be considered as a useful parameter in the diagnosis and evaluation of the neuropathy in hypothyroid patients. The presence of carpal tunnel syndrome without clinical neuropathy, suggests that nerve conduction study can be carried out as a routine investigation to find out the electrophysiological alterations without clinical presentation in hypothyroid patients.

66. Study of Auditory and Visual Reaction Time in Premenstrual and Post Menstrual Phase
Gitanjali, Ajeet Kumar, Ayushi, Santosh Kumar
Background: Menstrual cycle is caused due to cyclical secretion of gonadotropins from pituitary glands which further causes cyclicity of estrogen and progesterone secretion from the ovaries. Materials and Methods: VRT was assessed in pre- and post-menstrual phase with portable instrument. Results were analyzed using Student’s paired t test. Prior approval of the Medical Ethics Committee was obtained for conducting this study in the Department of  Physiology of DMCH, Darbhanga. Study duration of Two years. Conclusion: Prolongation of VRT in premenstrual phase is predominantly due to high levels of progesterone. It exerts its action centrally through inhibitory neurotransmitter gamma-aminobutyric acid. It delays neuronal conduction time. Effects of progesterone locally acting on the ocular tissue and the intraocular fluid also contribute to prolonging VRT in premenstrual phase.

67. Intranasal In-Situ Gelling Systems: An Approach for Enhanced CNS Delivery of Drugs
Damagundam Srilakshmi, Jupally Pooja, Prasanthi D.
The oral route is the one that is most frequently used for drug administration. Unfortunately, this oral route is not the best for the delivery of several medications because of gastrointestinal breakdown and substantial hepatic first-pass metabolism. As an alternative, the nasal route can be chosen to deliver drugs via the olfactory and trigeminal neurons directly to the brain bypassing the blood-brain barrier (BBB). The advantages of the nasal route are its non-invasiveness, and self-medication. The main drawback of this route is the quick mucociliary clearance, which leads to low absorption and consequently poor bioavailability. This drawback can be overcome by adopting in situ mucoadhesive gelling systems. The in-situ gelling systems are liquids that upon administration turn into gel as a result of various physiological stimuli, such as temperature or pH or ionic. In addition to discussing the polymers employed in the formulation of in situ gels, approaches of in situ gelation, mechanism of gelation, and their evaluation, the current review critically assesses the significance of in situ gelling systems for the delivery of medications from the nose to the brain.

68. To Evaluate the Relationship between the Platelet Count and their Indices MPV, PCT, PDW, PLCC and P-LCR for Diagnosis and Prognosis in Patients with Sepsis. A Prospective Observational Study in Tertiary Care Center
Priyanka Prajapati, Radhika Rajesh Nandwani, Geeta Devi, Santosh Kumar Gond
Background: Platelets Count, Mean corpuscular volume (MCV), platelet crit (PCT), platelet distribution width (PDW), PLCC, and platelet-large cell ratio (P-LCR) are commonly used laboratory parameters to assess platelet function in sepsis, a life-threatening condition caused by an overwhelming immune response to infection. Materials and Methods: The platelet count amongst non-survivors and survivors and the MPV, PDW, P-LCR, PLCC and PCT values were among non-survivals and survivals on admission day 1,2 and last day were compared with control group. The platelet indices were obtained from automated haematology analysers, and the results were compared with the reference ranges provided by the manufacturer and to compare platelet indices of cases of sepsis and non-septic patients, platelet indices of control group were also included in our study. Results: A total of 90 patients were included in the study, with a mean age of 44 years (range: 18 to >65 years). The majority of the patients were males (60%) and female is (30%). The platelet count(*109/L) amongst non-survivors and survivors and the MPV (Fl), PDW (%), P-LCR (%), PCT (%), PLCC(*109/L) values were among non-survivals and survivals on day 1,2-4rth and final sample platelets count (231.23±115,254±141.9), (202±114,250.89±185.26), (104±51.9, 197±97.9). MPV (10.75±1.33, 10.54±1.46), (11.20±1.22,10.78±1.20), (11.84±1.17,10.88±1.20), PDW (16.60±0.82, 16.22±0.49), (16.52±0.74, 16.31±0.75), (16.62±0.89,16.30±0.87), P-LCR (41.4±12.47, 40.52±12.17), (47.32±12.79, 43.17±10.06), (53.22±13.77,42.72±9.72), PCT (2.09±1.2, 2.55±1.5), (2.17±1.25,2.66±1.91), (1.50±1.25, 2.46±1.71), PLCC (98±56.9, 83.15±41.7), (89.88±47,101.19±69.62), (71.58±40,101.72±79.62) respectively . Conclusion: Thrombocytopenia is common in sepsis and associated with higher risk of mortality in sepsis. Higher MPV and PDW are associated with poor prognosis. Higher PLCR correlates with increased risk of mortality in sepsis. Lower PCT in sepsis is associated with poor prognosis. Platelet count inversely related to MPV and directly related to plateletcrit. MPV has a strong positive correlation with PLCR as larger platelets contribute to increase in mean platelet volume. MPV has a strong positive correlation with PDW, when MPV increases the PDW tends to be higher. Platelets and its indices are helpful in diagnosis and prognosis of sepsis.

69. Role of Neutrophil to Lymphocyte Ratio to Predict Acute Appendicitis and to Distinguish between Complicated and Uncomplicated Appendicitis: A Cross-Sectional Study
Limar Angu, Debopam Sanyal, Chabungbam Gyan Singh, Keisham Lokendra Singh, M. Athai Phom, Shubhamoy Jana
Introduction: Acute appendicitis (AA) is the most common surgical presentation requiring emergency operative treatment. The symptoms in many of the patients with acute appendicitis may be very non-specific, mimicking other acute abdominal conditions. Accurate and prompt diagnosis of acute appendicitis reduces the risk of perforation and negative appendectomy rate. Objectives: To assess the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) in predicting acute appendicitis and to determine a cut off value of neutrophil-to-lymphocyte ratio to distinguish between complicated and uncomplicated acute appendicitis. Methods: A cross sectional study was conducted from April, 2019 to July, 2021 in the Department of Surgery, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur. Patient with acute abdomen who underwent appendectomy during the study period were included in the study. Age, gender, occupation, religion and family history were the independent variable. Neutrophil to lymphocyte ratio and TLC were the dependent variable. Data collected were analyzed using SPSS-version-21. Chi-square test and Fisher’s exact test were used for proportions. ANOVA and independent t test were used for comparing means. A p-value of <0.05 was taken as significant. Results: 100 patients were recruited for the study and 66% were males. Histopathological Examination (HPE) reported 84 cases of uncomplicated acute appendicitis, 13 cases of complicated acute appendicitis (abscess and perforation) and 3 cases with normal appendix. NLR >3.5 had a sensitivity of 92.7% and specificity of 66.7% for diagnosing acute appendicitis. Sensitivity and specificity of NLR taking 8 as the cut-off point to distinguish between complicated and uncomplicated Acute Appendicitis was 92.3% and 100% respectively. Conclusion: A NLR greater than 3.5 may be considered as a simple and sensitive indicator for the diagnosis of acute appendicitis. A NLR of 8 can be used as a cut-off value to distinguish between complicated and uncomplicated appendicitis.

70. Imaging Evaluation of Malignant Breast Lesions by Digital Mammography, USG and DCE-MRI
Puja Bhuyan, Pranjit Thapa, Mohini Patir, Imdadul Islam
Introduction: Breast cancer is in a rising trend in India with breast cancer accounting for 40-60% of cancers in women, next to which is the cervical cancer. Aim: The aim of this article was to evaluate the characteristic features of malignant breast lesions and to compare the sensitivity, specificity and accuracy of digital mammography, sonography and MRI with histopathology correlation. Classification of all breast lesions according to the breast imaging reporting and data system final assessment categories (BI-RADS) was done. Materials and Methods: This was a prospective diagnostic study conducted on 52 female patients from 1st June 2021 to 31st May 2022 in the Department of Radiodiagnosis, Silchar Medical College and Hospital, Silchar. Results: Out of 52 patients, 19 cases were found to be malignant of which 18 cases were intraductal carcinoma and 1 case of malignant phylloides. Most commonly encountered characterstics were spiculated margin, irregular shape and pleomorphic calcifications in mammography, posterior acoustic shadowing and internal vascularity in USG, and inhomogenous enhancement pattern with type II or III kinetic curve in DCE-MRI. The sensitivity, specificity and accuracy of MRI was found to be highest as 94.74%, 96.97%, 96.15% respectively. Conclusion: Thus the study concluded that MRI appears to be more sensitive than mammography or USG in detecting malignantlesions in women with palpable breast lumps. Classification of the lesions according to BI-RADS helps to improve the management of lesions.

71. Management of Intertrochanteric Fractures with Cemented Bipolar Arthroplasty: A Prospective Study
Pravin P Patel, Ajay Ramkaran Yadav, Ashif Suthar, Harsh Patel
Background and Aim: A successful hip operation should result in a stable, pain-free hip with a wide range of motion. However, none of the approved treatments for intertrochantric fractures has been able to fully meet this objective. The study’s goal was to examine how cemented bipolar arthroplasty might be used to treat older individuals with unstable intertrochanteric fractures. Material and Methods: The current study was carried out over a period of two years in the Department of Orthopedics at the tertiary care teaching institute in India on senior patients with intertrochanteric fractures treated by cemented Bipolar hemiarthroplasty. A total of 40 patients were chosen for the trial, including 16 men and 24 women. The fractures were categorised using a method developed by Boyd & Griffin. At the conclusion of the trial, the functional result of each patient was evaluated using the Harris hip score. (HHS). Results: In the current study, cemented bipolar arthroplasty was used to treat 40 patients with intertrochanteric femur fractures. The following observations were made after a follow-up using the Harris Hip Score. 60% of patients reported no pain at all. Six patients (15%) experienced minor pain, while six (15%) experienced mild pain. Four individuals (10%) reported moderate pain. Out of 40 patients, 12 had Harris hip scores of excellent, 12 of good, 10 of fair, and 6 had Harris hip scores of poor. Harris hip score on average was 81.25. 70% of individuals had no complications at all. Six of them had knee stiffness, four had an infection of the skin just above the surgical site, and two had foot drop as a post-operative consequence. Conclusion: The morbidity associated with prolonged bed rest, such as pressure sores, lung infections, and atlectasis, is significantly reduced in older patients with unstable intertrochanteric fractures treated with cemented bipolar arthroplasty. Early mobilisation, generally consistent pain management, and a return to almost normal daily activities are all undeniable benefits.

72. Assessment of Speech and Language Delay among 0-3 Year Old Children Attending Well Baby Clinics Using Language Evaluation Scale Trivandrum (LEST 0-3)
Janani D, Priyanka Bansal, Sheela Aglecha, Deepak Dwivedi
Objective: To assess the prevalence of speech delay among 0–3-year-old children using Language Evaluation Scale Trivandrum and to study the modifiable risk factors in speech and language delay among 0–3-year-old children. Study design: Cross-sectional prevalence study. Setting: Children attending Well Baby Clinic of Tertiary Care Hospital, Central India, aged 0-3 years from March 2014 to September 2014. Participants: The cross-sectional study in central India involved assessment of speech delay among 200 children attending Well Baby Clinic of Tertiary Care Hospital, Central India, who were 0-3 years of age using Language Evaluation Scale Trivandrum (LEST) and simultaneously assessing the risk factors based on Risk Factor assessment Questionnaire and Home Screening Questionnaire (HSQ). Results: The prevalence of speech delay among 0-3 years was found to be 28%. There was inverse relation between educational status of mother and prevalence of speech delay (χ2 17.458 p-Value 0.008). Language delay was higher in families with income less than 7322 and lower in high income families with highest speech delay was seen in income group 982-2935 rupees (28.6%) (χ2 17.53 p-Value 0.014). Speech delay was higher in children of Lower socioeconomic status according to kuppuswami scale (64.7% lower; 44.7% upper lower) and lower prevalence in higher socioeconomic status (16.7% upper; 16.3% upper middle class) (χ218.04 p-Value 0.012). As the birth order increased in family, incidence of speech delay also increased with 23.9% delay in 1st child, 23.3% delay in 2nd child and 37% incidence in children born beyond 2nd order (χ215.10 p-Value 0.010). Based on HSQ, Families with positive home environment had a lesser prevalence of speech delay (12.3%) than those with negative home environment (5.5%) (χ2 11.762 p-Value 0.001). Conclusion: The prevalence of speech delay among this population is 28% and the significant risk factors contributing to it are lower socio-economic scale, higher order of birth, low educational status of parents, presence of television in home and negative home environment.

73. Effective Evaluation of Male Infertility by Semen Analysis in Tertiary Care Center
Hemlata Bamoriya, Geeta Devi, Gautam Chandrakoshi, Prachi Mantri (Maheshwari)
Background: Semen analysis (SA) represents the most basic evaluation of male infertility. The evaluation of semen parameters is currently based on the standards defined in the laboratory manual for the examination and processing of human semen created by the World Health Organization (WHO). Studies showed 30% of men with a normal semen analysis actually have abnormal sperm function. Careful evaluation of different parameter in on semen analysis may suggest the possible causes of infertility. Method: semen samples were analyzed by manual method. An analysis done for volume, viscosity, sperm concentration, motility, and morphology, according to WHO guidelines on semen analysis was done. Results: According to WHO criteria 118 sample was assessed, 74 sample shows abnormality. In which 36.48% males had volume < 2 ml, 67% males had oligospermia (< 15million/ml sperm count), 6.7% Azoospermia and 78.37% had abnormal morphology. Conclusion: semen analysis is the diagnostic tool to find out male infertility. Sperm concentration, motility and morphology are related to each other, factors that cause deterioration of one of them usually also have negative impact on the other two as well. Males contribute towards infertility in couples significantly.

74. Liver Cysts! A Diagnostic Dilemma
Shraddha Kalyane, Sarojini Jadhav, Suresh Harbade, Vishakha Iyer, Gaurav Bhavsar
Introduction: Cystic lesions within the liver are reported to occur in up to 5% of the population. Most of them are common and benign, but the possibility of a rarer cystic liver lesion should not be overlooked. They can present with general or specific symptoms. Most are found incidentally on imaging studies. None of the haematological and biochemical parameters were suggestive of liver cyst. We report this case because of its unusual presentation and associated findings. Case scenario: A 66 years old lady presented to general surgery OPD with complaints of mass per abdomen for 3-4 months and pain in abdomen for 2 months. On Examination: A 10X10cm bulge was visible in hypogastric, left hypochondriac and umbilical region. Lump was moving with respiration and was reducing in size on leg raising test. Cystic in consistency, swelling was moving in horizontal direction and dull on percussion. Investigations: CBC, LFT, KFTS, Serum amylase and lipase, chest and abdominal X-ray showed no major abnormality. Upper GI scopy showed bulging posterior wall of stomach suggestive of lump arising behind the stomach. Ultrasound of abdomen was suggestive of two cystic lesions possibly a simple biliary cyst and a pseudocyst of pancreas. Management: Patient underwent exploratory laparotomy with marsupialization and drain placement in both the cysts with left hepatic lobe contained hemorrhagic fluid and the right hepatic lobe contained straw colored fluid. Conclusion: Cystic liver lesions require accurate pre-treatment diagnosis in order to select the appropriate therapy for each patient, as they can represent benign or malignant formations.

75. Correlation of the Clinical and Radiological Profile in Outcomes of Patients with Chest Trauma
Krantiraj Pawar, Sarojini Jadhav, Rahul Mundhe
Introduction: Trauma is one of the leading causes of morbidity and mortality Worldwide. According to the national trauma database (NTDB) of India, chest injuries are present in 13.8% of all blunt trauma patients. The overall mortality rate of the chest trauma patient is 8.4%.  Most chest injuries can be treated non-surgically with relatively simple methods including tube thoracostomy, adequate analgesic management, and good pulmonary toilet. For the best patient outcome, aggressive management of the chest trauma, as well as timely care of related injuries, is needed. Hence, the present study was carried out to study the correlation between the clinical features and radiological findings in the outcomes of patients with chest trauma. Methods: The present Prospective observational study was conducted in Government Medical College amongst 377 patients diagnosed with chest trauma, admitted, and managed during May. 2018 – Nov. 2020. All patients received in the Emergency Room (ER/Casualty) were immediately attended and history, primary survey and resuscitation were done simultaneously. A chest X-ray in the erect position and an NCCT chest with USG was taken, followed by operative or non-operative management based on the clinic-radiological findings. Results: Vehicular accident was the commonest 257(68.2%) cause of injury followed by fall from height 69(18.3%). The commonest clinical and radiological finding was rib fracture seen clinically in 51.45%, on x-ray in 63.66% and on CT scan in 80.63% of patients, which was followed by pneumothorax clinically in 50.92 %, on x-ray in 60.47% and in 76.9% on the CT scan. CT Scan was the best modality which effectively predicted chest injury. Out of 377 patients, 86 (22.81%) needed only conservative management whereas in 291(77 %) patients’ operative treatment was needed. Conclusion: For patients with pneumothorax, haemothorax, and hemopneum -othorax Intercostal tube drainage with under seal is an acceptable and safe method. Analgesics and, in some cases, strapping and intercostal nerve block are the best remedies for basic rib fractures. CT scan thorax is superior to traditional chest radiographs in our research, with a positive predictive value of <0.001. In chest trauma patients, prompt diagnosis and care, judicious use of radiological investigations, and effective surgical intervention increase the final outcome.

76. Morphological Study of Bone Marrow in Visceral Leishmaniasis at SKMCH, Muzaffarpur, Bihar
Shweta Kumari, Anita Kumari, Mahesh Prasad
Background: In Muzaffarpur district of Bihar, Visceral Leishmaniasis (Kala Azar), a parasitic illness spread by vectors, is widespread. global persistent febrile illness brought on with Leishmania Donovani (LD). More than 300 million residents of endemic regions are at high risk, and 14 million are afflicted with the illness. Methods: This prospective study, which examined the morphology of bone marrow aspirates taken from patients, was carried out on 75 patients over the course of nine months, from November 2020 to July 2021, at the pathology department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. On glass slides, the aspirate was spread, fixed with alcohol, and stained with Giemsa. Results: The ratio of male to female participants was 1.02:1, with 38 male participants to 37 female individuals being the only significant difference. Most of the patients were between the ages of 1 and 15. Up to 45.2% of patients were between 1 and 5 years old. With a male to female ratio of 1.4:1, men in this age range were more affected than women. The majority of the patients came from the Muzaffarpur district. Bone marrow aspiration was simple, and the majority of patients had marrow fragments in the aspirate upon visual inspection. 100% of patients had extrahistiocytic LD bodies alone, 80% had extra and intrahistiocytic LD bodies, and 33.3% had intrahistiocytic LD bodies alone. In 53.4% and 26.6% of patients, the parasite index ranged from 1 to 10, respectively. Conclusion: The research area has an endemic case of visceral leishmaniasis. Despite being invasive, bone marrow analysis provides a direct microscopic diagnosis of visceral leishmaniasis and may be used as necessary.

77. Study of Different Types of Liver Pathology by Ultrasound Guided Fine Needle Aspiration Cytology at JNKTMC, Madhepura, Bihar
Shweta Kumari, Md. Ghulam Tabraiz
The evaluation of mass lesions of the liver. Most FNAC of hepatic masses could be accurately diagnosed by using only the cytomorphological characteristics. However, in some circumstances, auxiliary tests could be very useful in establishing the exact diagnosis. The cytopathologist may obtain important information to incorporate into the final diagnosis through discussions with radiologists and doctors on site. Evaluation of a hepatic mass is the primary reason for FNA of the liver. The evaluation of non-neoplastic and particularly malignant mass lesions of the liver benefits greatly from FNA cytology. Methods: This study was conducted at JNKTMC, Madhepura, Bihar from October 2021 to September 2022. A total of 88 individuals were taken with hepatic masses, already screened by USG due to suspected liver disorder were evaluated through aspiration and microscopic cytosmear examination method: 65 male and 23 female. Results: On 88 patients USG guided liver aspirations with fine needles were done. There were 23 women and 65 men. The people’s ages ranged from 9 to 92. In the majority of patients, an ultrasound examination that revealed further abnormalities like cirrhosis, not looking like benign and was viewed as indicative of malignancy came before the FNAC. A handful of the patients may have had some space occupying lesion comprising of chronic non-specific inflammation, regenerating nodule and Hemangioma. On the 88 patients, 52 non-neoplastic lesions and 36 malignant lesions were diagnosed. Conclusion: Although FNA is not useful in identifying diffuse liver diseases like hepatitis and cirrhosis, it works so wonderfully in differentiating non neoplastic from neoplastic lesion which appear to be non-homogenous or mimic mass-like lesion on radiology. Aspiration Using Fine Needles through radiological guidance, the diagnosis of liver lesions by cytology seems to be a reliable, secure, rapid and reasonably priced procedure.

78. Risk Factor and Outcome Analysis for Neonatal Sepsis in Tertiary Care Neonatal Unit: A Cross Sectional Study
Mithun Kumar, Anshu Kumari, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Background: The main issue in our nation is under-five mortality. The newborn period, which accounts for more than half of under-five child deaths, is the most vulnerable demographic in terms of under-five mortality. The goal of the current study was to look at the risk factor and outcome for neonatal sepsis in tertiary care neonatal unit. Methods: The study was conducted on newborn infants who had the typical sepsis signs and symptoms after obtaining parental permission. The study took place from January 2022 until December 2022. After receiving sufficient parental consent, venous blood was taken from the newborns and tested for sepsis. A predesigned and typical questionnaire was utilised to gather information regarding the risk factors, and these newborns were treated in accordance with hospital protocol. Results: Out of total 957 sepsis screen positive cases, 101(10.6%) were culture proven sepsis and 10(1.0%) died. Klebsiella (36.9%) was the most typical organism recovered from blood cultures. Maternal Fever and outcome have p value of 0.01. PROM and outcome have p value of 0.0005. Meconium-stained liquor and outcome have p value of 0.0005. Birth asphyxia and outcome have p value of 0.0005. Conclusion: Birth asphyxia and neonatal sepsis mortality are significantly correlated with maternal fever, PROM, maturity, and birth asphyxia. Klebsiella was the most typical organism isolated from blood cultures. Maternal and family education, maternal nutrition, proper antenatal checkups, delivery at health facility, proper newborn care and proper hygiene are important steps to reduce the neonatal sepsis and thus under-five mortality. It is advised to conduct additional in-depth studies to better comprehend the risk factors and create management strategies.

79. Comparative Evaluation of Maturation of Mid Palatal Suture in Adolescents and Young Adults Using Cone-Beam Computed Tomography (CBCT)
Pramod Kumar, Padmaja Katiyar, Richa Angik
Background and Aim: This study evaluated the midpalatal suture maturation stages in adolescents and young adults using cone-beam computed tomography (CBCT). Methods: 200 CBCT scans of individuals between the ages of 10 and 25 were included in the sample. (95 men and 105 females). Young adults (n = 100), post-adolescents (n = 52), and adolescents (n = 48) were divided into these three groups. Using Planmeca ProMax 3D software, a cross-sectional axial slice was used to assess the midpalatal suture maturation stage in accordance with Angieleri’s technique. Two previously calibrated examiners analysed the images and divided them into five unique maturational stages. Stages D and E were not taken into account with an open midpalatal suture, but phases A, B, and C were. Association tests were conducted using chi-square tests, and a binary logistic regression was evaluated (P< 0.05). Results: In subjects aged 10 to 15 years, the likelihood of finding an open midpalatal suture was 70.8%; in subjects aged 16 to 20 and 21 to 25 years, the odds were 21.2% and 17%, respectively. Furthermore, males were more likely than females to experience this possibility at the older age of 16 years. Conclusion: Postadolescents and young adults have a higher chance of having an open midpalatal suture than orthodontists did decades ago. Men are also more likely to discover the midpalatal suture opening. When maxillary expansion is required, the orthodontists may take these consequences into account. Additionally, the middle palatal suture’s ossification is highly variable, hence CBCT may be advised to rule out this possibility.

80. To Assess the Efficacy of Mometasone and Hydroxypropyl methylcellulose Nasal Spray to Control Symptoms of Allergic Rhinitis: A Comparative Study
Arup Chakraborty, Biswajit Sukla, Bidhan Das, Riddhi Nayak
Introduction: Allergic Rhinitis is a debilitating disease that affects the quality of life. Treatment of allergic rhinitis includes prevention of exposure to allergens and pharmacological therapy. Pharmacological therapy in the form of nasal sprays play a major role. This study aims at comparing the efficacy of mometasone nasal spray and hydroxypropyl methylcellulose nasal spray in controlling the symptoms of allergic rhinitis. Methodology: 120 patients who presented with symptoms of allergic rhinitis and fulfilled the inclusion and exclusion criteria were selected as study subjects. They were randomly allocated into two groups. Group A patients received Mometasone nasal spray while Group B patients received Hydroxypropyl methylcellulose nasal spray. Follow up was carried out on 14th and 28th day from the starting of treatment. Efficacy was measured based on a 5 point scale. Result: Hydroxypropyl methylcellulose nasal spray was superior in controlling symptoms than Mometasone nasal spray on 28th day of treatment. Conclusion: Both Mometasone and Hydroxypropyl methylcellulose nasal spray are effective in controlling the symptoms of allergic rhinitis. Hydroxypropyl methylcellulose nasal spray is found to be more effective in comparison to Mometasone, on day 28th of treatment in this study.

81. Prevalence of Metabolic Syndrome among Medical Students at Tertiary Health Care Center
Prathibabharathi K., N. Sivaranjani, Deepa Molluru, J. Praveen Kumar4, K. Nikhila
Introduction: The term “metabolic syndrome” refers to a cluster of cardiometabolic risk factors that, when combined, increase an individual’s likelihood of developing type 2 diabetes and atherosclerotic cardiovascular disease. The purpose of this study was to assess the prevalence of metabolic syndrome among first year MBBS students. Materials and Methods: This cross sectional study involved 150 first year MBBS students at Sri Balaji Medical College & Research Institute. Renugunta. Anthropometric parameters, including weight, height, body mass index (BMI) and waist circumference (WC) were measured. Fasting blood samples were collected from all participants and assayed for fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Result: The total prevalence of Metabolic syndrome among the first year MBBS students was 10.7%. The prevalence of MS, was higher in females, and it was statistically not significant. The BMI of patients with MS was significantly higher from that of non-MS subjects. Conclusion: In conclusion, there is a relatively high frequency of metabolic syndrome among first-year MBBS students. There is a direct correlation between BMI and MS prevalence among students.

82. Comparative Study Between Application of Neomycin Ointment at External Meatus to Foleys Catheter and the Conventional Catheter Care in Prevention of Catheter Associated Urinary Tract Infection
Latpate Drushti, Joshi Dinesh, Gangurde Anita, Singh Jeetendra
The study was conducted in a tertiary healthcare centre, on the patients who had urinary catheter. Criteria for the selection of the patients were prerecorded and accordingly the participants for the study were selected. The patients whose baseline urine analysis came out to be normal were selected. The participants were clearly told about the research and informed written consent was cordially taken. They were allotted either a conventional (group A ) or interventional(group B) method by block randomization. Patients were informed about their role and the procedure they need to follow. Patients of both the groups A and B respectively were subjected to urine analysis and the routine vitals checkup, every 7 days. The data obtained was systematically recorded. The patients who had a positive urine analysis test result were then subjected to urine culture to determine the presence of catheter associated urinary tract infection. Urine culture was selected as confirmatory test as it is gold standard. The patients whose urine culture came out to be positive were labelled as positive for CAUTI presence. The severity of the manifestations was also checked simultaneously. The data obtained was cordially put to the Z test and chi square test. The observations were recorded. Among the 120 patients participated in the study, 60 were under the CONVENTIONAL ( group A)and 60 were under the INTERVENTIONAL (group B). 8 of 60 belonging to the conventional group and 2 of 60 belonging to the interventional group were found positive for the presence of CAUTI. This suggests that there is significant decrease in the rates of the presence of urinary tract infection by doing a simple intervention of neomycin ointment at the junction of urethral meatus and Foleys catheter. The null hypothesis is thus rejected. The results of the z test and the chi square test came out to be significant. The primary objective was thus fulfilled. We were successfully able to compare between the conventional and interventional methods for prevention of CAUTI. The duration of sustainment of catheter is increased in the patient receiving intervention. Thus, from the above results it is seen that, the intervention of the application of neomycin ointment at the junction of urethral meatus and Foleys catheter, is a good option to reduce the rates of CAUTI. It is a simple, cheap and effective method to reduce CAUTI and improve patient compliance. The some exceptional cases who acquired infection inspite of the intervention, acquired a milder form of infection having reduced severity of manifestations. Majority of the latter cases belonged to a age group>40 years, this presents to us an opportunity for further research on the topic of reducing the rates of CAUTI in the older age group.

83. Seroconversion and Seroprotection after Hepatitis B Vaccination using Recombinant Vaccine via Subcutaneous Route in Patients with Bleeding Diathesis
Mahamine Kaustubh, More Asmita, Gangurde Nita, Sharma Svasti, Vasa Manav, Singh Jeetendra
Patients of bleeding disorders are repeatedly exposed to blood and blood products and are thus at an increased risk of acquiring transfusion associated infection which like HIV, Hepatitis B and Hepatitis C. It is recommended that all patients of bleeding disorders should be vaccinated against hepatitis B virus as early as possible. Hepatitis B vaccine is conventionally administered via intramuscular route. Intramuscular injections are to be avoided in patients of bleeding disorders for the risk of bleeding and hematoma formation. It is advised to vaccinate them via subcutaneous route. Few studies have been done to study the efficacy of subcutaneous route. The aim of this study was to measure the seroconversion and seroprotection after primary immunization with recombinant hepatitis B vaccine by subcutaneous route in patient with bleeding diathesis. Cases and controls were screened for HBsAg, anti HBc (total) and anti HBs and ALT. 30 patients of bleeding disorders and 30 patients of were vaccinated against hepatitis B using recombinant vaccine via subcutaneous route and intramuscular route respectively at 0, 1, 6 month interval. HBsAg, anti HBc (total), ALT and anti HBs titre were estimated one month after every dose of vaccine that is at 1, 2 and 7 month interval. . The dose (10µg in age <10, 20µg for>10yrs age) and schedule (0,1,6 months) was same in both the arms of study.
A total of 24 cases received all three doses of the vaccine and the remaining 6 received only 2 doses. All 30 controls received 3 doses. Seroconversion was defined as anti-HBs titre≥1mIU/ml and seroprotection as anti HBs titre≥10mIU/ml. Seroconversion (anti HBs ≥1mIU/ml) was observed one month after first dose of hepatitis B vaccine in 19 out of 25 cases (76%) and all 30 controls (100%). The ‘p’ value obtained using 2 tailed Fischer exact test is significant at 0.0061. Seroprotection (anti HBs≥10mIU/ml) was observed one month after first dose of Hepatitis B vaccine in 14 out of 25 cases (56%) and 12 out of 30 controls (40%) and the difference is statistically insignificant (p=0.285). Geometric Mean Titre (GMT) at 1 month were 11.48 and 12.39 mIU/ml in s.c. and i.m. arm respectively. 100% seroconversion was achieved at 2 month after first dose of hepatitis B vaccine in both the study groups. Seroprotection was achieved in 18 of 19 (94.73%) cases and 29 of 30 (96.66) controls at 2 months after second dose of hepatitis B vaccine. GMT at second month were 217.38 and 196.12 mIU/ml in s.c. and i.m. arm respectively. 100% seroconversion was achieved after third dose of hepatitis B vaccine. GMT at 7 months after first dose of vaccine was 706 and 650 mIU/ml for cases and controls respectively. None of the cases or controls reported any side effects.
Thus, this study demonstrate that (1) Subcutaneous route of hepatitis B vaccination using the conventional dose (10µg in age <10yrs and 20µg in >10yrs) of recombinant vaccine achieves seroconversion and seroprotection rates similar to that of intramuscular route. (2) Subcutaneous route is safe in patients of bleeding disorders. Based on these findings we recommend that all patients of bleeding disorders should be vaccinated against hepatitis B using a recombinant vaccine in the dose of 10µg for age <10 years and 20µg in age>10 years via subcutaneous route.

84. Effectiveness of Structured Group Discussion over Problem based Learning in teaching Interns Basic Concepts of Physical Medicine and Rehabilitation
Santhosh Kothirappallil Raghavan, Charvakan Suthan, Roy Rama Chandran
Background: According to Graduate Medical Education 2012 regulations, Physical Medicine and Rehabilitation is an optional subject for MBBS course; thus, the concept of Medical Rehabilitation among young graduates is relatively low. The Objective of the study is to assess the effectiveness of Structured Group Discussion over Problem-based Learning in teaching fundamental concepts of Physical Medicine and Rehabilitation to MBBS Graduates. Materials & Methods: The present Interventional study was conducted in 60 Interns of the Department of Physical Medicine and Rehabilitation, Government Medical College, Alappuzha from June 2018 to Aug 2018. After obtaining IRC and IEC clearance, 60 Interns were identified; and after taking Informed consent, they were divided in to two groups of 30 each. Results: Structured Group Discussion is more effective than  Problem based Learning in teaching Medical Graduates (Interns) the basic concepts of Physical Medicine and Rehabilitation and it has been found  to be statistically highly significant. Structured Discussion is preferred to Problem based Learning as a Teaching Method, proven with Statistical significance. Structured Discussion not only augments the learning process, but also, helps improve the communication skills of students. Conclusion: Structured Group Discussion is more effective than Problem based Learning in teaching Interns/ Medical Graduates, the basic concepts of Physical Medicine and Rehabilitation.

85. Visual and Auditory Reaction Time in the Hands of Individuals with Endocrine Disorders like Hyperthyroidism
Kedar S. Kulkarni
Background: In this study, we wanted to assess the visual and auditory reaction time in the hands of individuals with an endocrine disorder like hyperthyroidism. Methods: The present study was conducted on 50 male hypothyroid patients, 50 male hyperthyroid and 50 male healthy subjects who were attending the OPD of Dr. M. H. Patwardhan’s Endocrine Research Centre, Miraj. Results: Reaction time in hypothyroid patients was increased and it was statistically highly significant. Reaction time in hyperthyroid patients was also increased and statistically highly significant. Conclusions: Reaction time can be used for mass screening of patients with thyroid disease, and for follow-up of thyroid patients.

86. Comparison of Sitting and Lateral Position for Spinal Anesthesia for Orthopaedic Lower Limb Surgeries: An Observational Study
Anzer Shah M., Aneesh K.V., Antony K.A.
Background: Spinal anesthesia is a frequently used technique for lower limb surgeries. Spinal anesthesia gives a faster onset of analgesia and relaxation of the lower limb muscles. Lower limb surgery especially for treating fractures poses a challenge to the anesthesiologist during the centri-neuraxial block. The primary problem is difficult positioning due to pain. There are two main types of positioning for spinal anesthesia, lateral and sitting. Lateral can be left lateral or right lateral depending on the affected side with the affected side usually kept above to decrease pain. Sitting position can be with the legs kept straight on the table or sitting to one side of the table with the legs hanging down freely. After giving spinal anesthesia the patient is positioned supine or lateral depending on the type of surgery.  There are a lot of studies about the effects of different position on spinal anesthesia is abundant especially those for cesarean section. But the effect of position on spinal anesthesia for orthopedic patients is practically nil. Hence the present study is expected to give conclusions that may trigger further research. Methods and Material:  After obtaining institutional ethical committee clearance, a prospective observational study among 62 participants were recruited for this study.  The patients undergoing spinal anesthesia for lower limb orthopedic surgery were recruited in this study.  Statistical Analysis: Data collected was entered in a Microsoft excel data sheet and was analysed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions. Chi-square was the test of significance. Continuous data will be represented as mean standard deviation. Independent t test was the test of significance to identify the mean difference between the two groups. p value <0.05 was considered statistically significant. All statistical and analyses were carried out using the software Statistical Package for the Social Sciences (SPSS) Statistics version 19.0.0 with the help of a professional statistician.  Data was expressed in its frequency and percentage as well as mean and standard deviation. Results: Analysis of the monitored data shows that time taken for attaining adequate sensory block i.e. T10 level, height achieved in each position defined as the dermatome level blocked at the end of five minutes after the procedure assessed by response to cold spirit cotton stimulus, incidence of hypotension in each position defined as more than 20% fall in pre procedural mean arterial pressure, were not significantly different in both the positions of spinal anesthesia. But the time taken for the procedure defined as the time from start of positioning to the end of the spinal procedure, and the number of attempts for spinal was significantly less for sitting position. Conclusion: Sitting position for spinal anaesthesia takes less time, and a smaller number of attempts for the procedure, compared to lateral position.

87. Comparing Clinical and Hematologic Outcomes in Hypertensive and Non-Hypertensive Patients Suffering from COVID-19.
Bhaskar Das, Puran Mal Parihar, Mahesh Kumar Choudary, Mamta, Amit Tak
Introduction: Hypertension is the most common co-morbidity associated with COVID-19  patients. Many patients take angiotensin-converting enzyme (ACE) inhibitors for the management of hypertension.  The study aimed to compare the clinical and hematologic features in hypertensive and non-hypertensive patients suffering from COVID-19. Material and Methods: This observational study compared clinical and hematologic features in hypertensive and non-hypertensive patients suffering from COVID-19. The study enrolled patients from SMS Medical College, Jaipur (Rajasthan, India) after approval from the institutional Ethics Committee. The comparison of quantitative variables was performed using the Mann-Whitney test, and qualitative attributes were compared using the chi-squared test. The level of confidence is considered at 5%. Results: There were no significant differences found in clinical and hematologic features between hypertensives and non-hypertensives suffering from COVID-19. Conclusion: The present study concludes that there is no evidence that either use of ACE inhibitors is useful or harmful in patients with hypertension. Therefore, it is endorsed to use these agents in the management of hypertensives in patients suffering from COVID-19, till further evidence is found.

88. Efficacy and Effectiveness Of Lumbar Sympathetic Block in Buergers Disease (Peripheral Vascular Disease): An Observational Study
Amitesh Pathak, Nidhi Shukla, Quamaruzzma Khan, Kapil Rastogi, Faisal Moin Ansari
Introduction: High incidences of Buerger’s disease (43-62%) in India draw our attention towards available treatment modalities in such patients. Patients with this disease are in severe pain and agony. Pain relief by any means remains first and foremost priority in such patients and if patient is able to sleep even one pain free night it is a boon for the patients. The purpose of study was to test the hypothesis that lumber sympathetic block relieves the pain of ischemic limb in Buerger’s disease. Materials and Methods: All the patients, thirty-eight male patients of TAO not responding to conservative mode of treatment and regularly visiting our pain clinic were enrolled in our study for a period of 6 months Diagnosis of TAO was made on clinical history, local and general examination and Colour Doppler study. Results: Visual analog scale(VAS) and claudication distance were improved significantly after 3-4 blocks but no significant difference was observed between third and fourth block. Healing of ulcer, reduction of pedal swelling was seen after each block. Conclusion: Despite advances in treatment modalities in such patients, lumber sympathetic block is still very cost-effective, safe, and least-invasive technique in treating painful ischemic legs.

89. Correlation of Serum Anti Tissue Transglutaminase Immunoglobulin-A Levels with Weight, Height and Haemoglobin in Cases of Celiac Disease
Vikrant Singh Raghuvanshi, Ankit Dashore, Jiteendra Kumar Piple, Swati Saral
Objective: Correlation of serum anti tissue transglutaminase immunoglobulin-A levels with weight, height and haemoglobin. Correlation of staging with weight, height and haemoglobin. Abdominal ultrasonography finding in cases of celiac disease. Methods: This was a prospective analytical study conducted in Department of Pediatrics, Umaid Hospital, Dr. S.N. Medical College, Jodhpur in children attending outpatient department and patients admitted in wards. Patients of with age less than 18 years were included in the study. The study was conducted over period of one year from January 2014 to December 2014. Total 52 patients were enrolled in study. Results: The most common finding on abdominal ultrasound was distended bowel loops which were present in fifteen (28.84%) cases on upper gastrointestinal endoscopy villous atrophy was seen in 33 (63.46%) cases. There was no correlation between serum tissue transglutaminase IgA levels and clinical parameters like weight, height, hemoglobin .There was no correlation between serum tissue transglutaminase IgA levels and abdominal ultrasonography finding. Conclusion: There is significant correlation between serum anti tissue transglutaminase immunoglobulin A levels. Endoscopy and biopsy may not be necessary for diagnosis of celiac disease. Whenever levels of serum anti tissue transglutaminase immunoglobulin levels are inconclusive then endoscopy and biopsy is helpful in diagnosis. This will avoid an invasive procedure and lead to a more rapid diagnosis and earlier treatment of celiac disease.

90. A Prospective Observational Study on Outcomes of Patients Undergoing Emergency Large Bowel Resection at a Tertiary Care Hospital
Zubin Parekh, Meenu Singh, Nitin Borle, Asma Khalife, Anirudh Chaphekar, Solaimuthu Rajagopal S, Rajendra Habib
Background: Outcomes vary within the heterogeneous general surgical group of patients. However, it has been well established that emergency surgery has a high risk of postoperative complications other than death. The present study was undertaken to evaluate the outcomes of emergency large bowel  surgery at a tertiary care hospital. Methods: This prospective, observational study was conducted in 30 patients of age 18 years and above with large bowel resection. The study parameters included post-operative outcome, duration of ICU and ward stay, incidence of sepsis and septic shock, incidence of acute respiratory distress syndrome (ARDS), post-operative morbidity and mortality. Data thus collected was entered in excel sheets and analyzed using appropriate statistical test. Results: Majority of patients were in their 6th decade of life with male predominance. 43.33% were hypertensive and 26.67% were diabetic. Mean duration of ICU stay was 3.37±2.37 days and ward stay was 8.04±3.17 days. Most common post-operative complication was Sepsis (26.67%) followed by septic shock (20%) and ARDS (16.67%). Conclusion: Patients should be  assessed and post-operatively closely monitored, since it is likely that post-operative complications might be detected earlier, and so treated in time which might increase survival.

91. To Observe the Appearance of Amblyopia in 6 to 10 Years of School Going Children during and Post COVID Era.
Padmini Warkhede, Priyanka Bansal, Kiran Thorat, Chandrashekhar Waghmare
Introduction: As a part of prophecy by WHO nearly half of the population of Globe will be facing problem of refractive errors by 2050. In India by the mid of this century these diseases will flourish in Indian continent with frightening velocity. Amblyopia is one of the basic reason for refractive errors in childhood with maximum global prevalence of 4.7% averaging 2% school going children. “Amblyopia” is a disorder in retinal image foundation because of decline in the value of central, adjusted vision which most commonly happens during first decade of life.  Hence we have undertaken the present study to know the status of amblyopic status in school going children during and in Post Covid sessions. Methodology: In this hospital-based observational cross-sectional study we examined (optometry, retinoscopy along with Auto-refractometer) 639 school going students from our tertiary care institutes who were facing problem in their vision. Results and discussion: Amongst the participants during COVID period 331 (52.73%) were girls and 308 (48.2%) were boys learning in different classes having refractive errors. Out of these total participants 27 students were found to have amblyopia.  Affecting a greater number of females that is 16 (4.8%) and 11 boys (3.5%) of the total participating population. While in post covid period out of 437 boys students 3.4% were having amblyopia with statistical significant difference between the two groups depicting more number of boys having amblyopia during COVID period.  Refractive errors are mostly caused by prolonged focusing on the screen, that children should take a break from the screen every half an hour to avoid possible eye problems. Conclusion:  We conclude that if detection of amblyopia is possible in earlier phases of life then nationwide campaign or programme should be initiated and implemented for prevention of mortality of vision.

92. Cataract Following Mechanical Trauma: A Single Centre Experience.
Deepak Choudhury, Rajendra Kumar Behera
Aim: To know the incidence, modes of presentation of traumatic cataract, its intraoperative and postoperative complications and visual outcome following management in a tertiary care centre. Type of study: Prospective interventional case series. Material & Methods: It’s a prospective study of 87 eyes of 87 patients of all ages and both sex diagnosed with traumatic cataract following mechanical trauma who have attended the ophthalmology outdoor of a tertiary care hospital of Western Odisha from 1st December 2013 to 30th November 2015. The study involved: 1) Preoperative evaluation of the patients that includes complete ophthalmic examination, 2) Various modalities of treatment like Phacoemulsification, small incision cataract surgery (SICS), capsular tension ring (CTR), scleral fixated intraocular lens (SFIOL), Pars Plana Lensectomy (PPL), 3) Postoperative evaluation at the end of 1 week, 4 week, 6 week and 3 month. Result: Incidence of traumatic cataract was 0.3% of total outdoor patients and 3.3% of all cataract cases. Male: Female ratio is 3.4:1. 69% of total cases belong to ≤ 40 year age group. Penetrating type of injury was 46% and rest due to blunt trauma. Most common cause was injury by stick (34.5%) followed by stone (31%). 29.9% occurred at work place followed by violence (26.4%). 41.4% of patients presented within 48 hours of the injury. Cataract was total in 55.2% followed by cataract with ruptured lens capsule (35.6%). There were 13 cases (14.9%) with subluxated lens and 15 cases (17.2%) of dislocation. 80 out of 87 patients (92%) had vision less than 6/60 preoperatively. SICS with posterior chamber intraocular lens (PCIOL) was done in 20 patients (23%). Bandage contact lens (BCL) was given in 2 patients having small corneal perforation following penetrating trauma. The most common problem encountered intra operatively was undilated and distorted pupil due to posterior synechiae (25.3%) followed by posterior capsular tear (24.1%). Uveitis and Striate Keratitis were the common post operative complications within 1 week. Post operative best corrected visual acuity (BCVA) at the end of 3 months shows 27.7% of total patients had a good vision (6/12 — 6/9), while 55.2% had a moderate vision (6/60 — 6/18). Conclusion: Traumatic cataract is a common cause of ocular morbidity, especially in younger individuals with higher incidence in males. Stone & stick are the common agents causing injury. Several different surgical techniques can be employed to restore vision. Postoperative astigmatism, Corneal Opacity, posterior capsular opacity (PCO) and pupillary capture etc are some of the major problems associated with management of this entity.

93. Clinical Evaluation of Uveitis in a Tertiary Care Hospital of Southern Odisha
Rajendra Kumar Behera, Deepak Choudhury
Aim: To determine the etiopathogenesis of uveitis as well as to compare and correlate the demographic profile of the study population. Materials and Methods: 195 patients with signs and symptoms of uveitis attending the Ophthalmology department of a tertiary care health centre in southern Odisha from October 2018 to September 2020 were prospectively studied. Detail history was taken. Complete ophthalmic examination was done with slit lamp, gonioscopy and indirect ophthalmoscopy. Detail blood investigations were done. Radiological investigations were done whenever required. Results:- The female to male ratio was 1.26:1. Most affected age group was 21-40 years (47.2%). Bilateral involvement was seen in 33.8% of cases. Anterior uveitis was more common, found in 122 cases (62.6%) followed by posterior uveitis, found in 57 cases (29.2%). Acute uveitis was found in 106 cases (54.4%). Most cases (49.8%) had best corrected visual acuity of 6/12 or more. Non-granulomatous keratic precipitates were seen in 112 cases (57.4%). 57.6% cases had anterior chamber cells and 62.1% cases had anterior chamber flare. In 79 cases (40.5%), uveitis was idiopathic. Second most common etiology was herpetic i.e. 38 cases (19.5%). In posterior uveitis patients, tuberculosis was the leading cause (59.6%). Cataract was the most common complication (12.3%). Conclusion: For a sizable proportion of patients, the cause of uveitis remains unknown despite the appropriate investigations. A thorough clinical evaluation and tailored investigation are needed for finding out the etiopathogenesis of uveitis.

94. A Randomised Prospective Study of Hyoscine-N Butyl Bromide Rectal Suppository and IV Drotaverine on Cervical Dilatation in Labourz
Hemamalini J., Priyadharshini P., Ajeetha Banu M, Vigneswari
Background: Whenever labor is prolonged, the mother suffers from Exhaustion, postpartum hemorrhage, and sepsis. Also, the fetus morbidity is increased due to fetal distress and birth asphyxia. So, use of pharmacological agents to reduce the duration of labor is justified. Objective: To compare the rate of cervical dilatation and duration of the active phase of labor with rectal bucopan and injection of Drotaverine. Methods:  The study was conducted in Government Rajaji Hospital, Madurai in 195 pregnant women who were admitted with term pregnancies in the active phase of labor. The women were randomized into three groups. Group A patients were the control group, who were not given any drug for cervical dilatation, Group B patients were given, 40 mg of intravenous Drotaverine, and Group C patients were put on Buscopan rectal suppository 10 mg. Result: It was seen that in Primigravida, the mean rate of cervical dilatation was 2.47 cms/hr. in Group A compared to 3.12 cms./hr. in Group B and 3.92 cms/hr. in Group C. With both Drotaverine and Hyoscine, the rate of cervical dilatation was faster than control group[.[p value<0.001]. With Hyoscine, the rate of cervical dilatation was faster than Drotaverine [p value -0.0151]. In primigravida, the duration of active phase was 188.4 minutes in the control group, 130 minutes in Drotaverine group and 103 minutes in the Hyoscine group. Duration of the active phase was reduced both in patients who received Drotaverine as well as Hyoscine when compared to the control group[p-value < 0.001]. Hyoscine was more effective in reducing the duration of the active phase in primigravida compared to Drotaverine. [p value 0.0219]. In multigravida, there was no reduction in the duration of the active phase with use of both Hyoscine and Drotaverine. In multigravida, there was no difference in the rate of cervical dilatation with both drugs. Most of the subjects delivered vaginally. No serious side effects were noted in both the drug groups. Conclusion: With use of Hyoscine butyl bromide in Primigravida, the rate of cervical dialalation was significantly increased when compared to Drotaverine. Also, the duration of active phase of labor was shortened in primigravida with use of Hyoscine, when compared to Drotaverine. Whereas in multigravida, there was no significant difference between both the groups in rate of cervical dialation and duration of active phase of labor.

95. Cord Blood Albumin as a Marker for Predicting Neonatal Jaundice in Healthy Term Newborns
Aishwarya Kawalkar, Puneet Jain, Savita Shekhawat
Background: Neonatal jaundice is a commonly witnessed condition in the first week of neonatal life. Because of the medical, social and economic constraints, healthy term neonates are increasingly being discharged prior to 48 hrs of life, thereby increasing number of readmissions due to hyperbilirubinemia. Early discharge of healthy term neonates raises a concern of delayed recognition of hyperbilirubinemia that can induce brain damage resulting in sequelae like chronic bilirubin encephalopathy. Therefore, it is important to identify markers to predict hyperbilirubinemia early in the neonates. Methods and Materials: A prospective study was conducted on 1000 healthy term neonates (gestational age ³37 weeks) with an Apgar score of ≥7 at first and fifth minutes of life; irrespective of mode of delivery, birth weight and gender. Neonates with ABO and/or Rh incompatibility, those with congenital malformations (e.g. CDH, TEF, ARM etc), conjugated hyperbilirubinemia or any significant illness (like sepsis, perinatal asphyxia etc) were excluded from the study. Based on cord blood albumin levels, 3 groups were formed; namely Group A (<2.8 gm/dl), Group B (2.8 – 3.3 gm/dl) and Group C (>3.3 gm/dL). These groups were then assessed for development of clinically significant jaundice until they reach day of life 5 or until discharge, whichever is later. Results: Group A, B, and C had 240, 350, and 410 neonates respectively. In group A, 199 (82.9%) neonates developed significant jaundice (Kramer’s Zone ³3), of which 178 (74.2%) neonates required phototherapy and 3 (1.25%) neonates needed exchange transfusion; whereas 127 (36.3%) neonates in group B developed significant jaundice (Kramer’s Zone ³3), of which 88 (25.1%) neonates needed phototherapy and 2 (0.5%) neonates required exchange transfusion. In group C, 112 (27.3%) neonates developed significant jaundice (Kramer’s Zone ³3), of which 22 (5.4%) neonates required phototherapy while none of them required exchange transfusion (p value £0.0001). Conclusion: The risk of developing subsequent neonatal jaundice can be predicted early using umbilical cord blood albumin levels. Neonates with cord blood albumin levels >3.3 gm/dl can be safely discharged early. However, if cord blood albumin level is £3.3 gm/dl, neonates will need a closer follow-up to look for development of jaundice.

96. Multislice CT in Maxillofacial Injuries: A Hospital-Based Study
Samir Khan, Mohini Patir, Pranjit Thapa, Dibyajyoti Nath, Rituparna Dhar, Imdadul Islam
Introduction: Worldwide, cranial cerebral injuries are a cause of death and disability due impairment of brain function and as such most centres will use all resources at their disposal to diagnose and treat these injuries. In recent advances of CT scan, 3D CT is one such which is advantageous because of clear preoperative localization of fracture lines involving the facial buttresses. It was found that the 3D CT images provided information regarding depth perception, contours, volumes, and extent of an abnormality. Aim: The aim of this study was to determine the causative factors of maxillofacial injuries and as well as to assess, the number of fractures, fracture extent, and displacement of fractures by comparing axial and 3D reformatted images of the computed tomography scan of the trauma patients at Silchar Medical College and Hospital. Methods: All the patients of age >12 years presenting to the emergency department who sustained polytrauma with facial injury on clinical examination over 1-year period of the study. Patients were checked for CT imaging contraindications. The pregnancy in female patients was ruled out. The patient’s primary complaint, the location of the injury, the nature of the damage, the patient’s overall state both immediately and afterward, and the period between the injury and reporting to the hospital was noted down. Results: A total 100 of patients with faciomaxillary injuries on CT scan were studied over the one year study period. The median age of the patients with maxillofacial fractures was 30.9 years and 23-32 age group was most common at 47.5%. Road traffic accidents constituted 38% of fractures. The single most affected isolated bone was the zygomatic bone (51%) followed by maxillary bone (45%). Conclusions: The craniofacial region is one of the most complicated parts of the human body. Clinical conditions of traumatised patients and lack of their cooperation make radiographic imaging of this area even more challenging. 3D images can provide the clinician with an overall spatial concept that allows a simpler understanding of the complexity of multiple two-dimensional axial CT images. However, 3D CT was found to be less useful in minor trauma.

97. Use of Prostaglandin E1 in Chronic Vascular Insufficiency
Paramhans, Ishant Chaurasia, Sourabh Mishra
Background & Method: The aim of present study is to study use of prostaglandin e1 in chronic vascular insufficiency. Patients of both gender and older than 20 years, with a clinical and instrumental diagnosis of mixed ulcer were eligible for this study. In accordance with our previous study (5), presence of venous reflux flow Patients were excluded if they had diabetes mellitus; rheumatoid arthritis; malignancy; blood disorders; systemic disease; no current episode of ulceration; wound infection; ABPI <0⋅5 (patients with severe arterial disease at presentation were considered for arterial imaging with a view to revascularisation) or >0⋅8; systolic ankle pressure<60 mmHg; presence of necrotic tissue on the wound bed; medications that might impair wound healing; pain at rest; sensory loss (neuropathy); cardiac insufficiency; and medial calcinosis. Result: Average reduction in area at in Group I is 92% & in Group II 60 %. Conclusion: The future of PG infusion therapies depends on the progression of scientific research in understanding the mechanism of action of PGs in the arterial ischemia patients.

98. A Case Report of Gastrointestinal Stromal Tumor
Satish B Dharap, Sushma Dinesh, Sudarshan Shejwal
Sarcoma(STS). These tumors are believed to originate from the interstitial cells of Cajal within the gastrointestinal myenteric plexus and emanate from nearly any part of the alimentary tract, from esophagus to anus. Although these tumors were previously described as leiomyoma or leiomyosarcoma, GISTs are differentiated on the basis of CD34, CD117, and DOG1 expression and the lack of smooth muscle staining. This report presents a case of gastric gastrointestinal stromal tumor with a large dimension and high malignant potential operated recently in a 63-year-old male patient and the outcome, as well as literature review of the pathological identification, sites of origin, and factors predicting it’s behavior, prognosis and treatment. Conclusions: According to review of literature, this is a rare case of GIST with high risk of recurrence according to the National institutes of health consensus criteria with tumor dimension being more than 10 cm which could benefit from Adjuvant therapy with a tyrosine kinase inhibitor.

99. A Case Presentation of an Infant with Enteric Duplication Cyst and Mesenteric Cyst
Yogesh Moghe, Ansari Mohammed Abdul Muqtadir, Shreyanka Suresh, Sarojini Jadhav
Introduction: Enteric duplication cysts are rare congenital malformations of the gastrointestinal tract formed during embryonic development. The incidence is 1 in 4500 live births with a slight male predominance. Multiple duplication cysts are rather uncommon. Mesenteric cysts are rare surgical conditions occurring approximately in 1/200,000 – 350,000 hospital admissions. A mesenteric cyst can occur anywhere in the mesentery of the gastrointestinal tract, most common in the mesentery of the small bowel. Case Scenario: An 8 months old male child was brought with complaints of intermittent irritability, abdominal distension, and constipation since birth with multiple previous hospital admissions in view of subacute intestinal obstruction managed conservatively. Computed tomography was suggestive of multiple cystic lesions in the left lumbar region likely enteric cysts. The patient was posted for elective exploratory laparotomy with intraoperative evidence of a mesenteric cyst and two enteric duplication cysts with no communication with each other. Excision of the mesenteric cyst along with resection of the enteric cysts and the adjacent bowel was done with jejunoileal anastomosis. The post-operative recovery and follow-up period were uneventful. Conclusion: These cysts are rare and can either be symptomatic or asymptomatic. In symptomatic patients, surgical resection is often the choice for symptom relief. However, in asymptomatic patients, surgical resection is controversial, though they have to be resected to avoid late complications like malignant transformation.

100. To Evaluate the Stricture of Posterior Urethra before & after ‘U’ Shape Urethroplasty by Uroflowmetry, RCU/MCU, Patient Satisfaction and Urethroscopy
Ishant Chaurasia, Sourabh Mishra, Ajay Sharma, D. Paramhans
Background & Method: The aim of present study is to evaluate the stricture of posterior urethra before& after ‘U’ shape urethroplasty by uroflowmetry, RCU/MCU, patient satisfaction and Urethroscopy. The detailed history and physical examination will be carried out. Dye studies will be done both pre and postoperatively. Then patient satisfaction will be noted both objectively and subjectively and patient will be counselled for urethroscopic examination postoperatively. Result: The youngest patient was 10 years old and the oldest was 68 years. From the above table it is seen that maximum no. of cases (33.6 %) belong to 21-30 years age groups i.e. 18. Mostly catheter was removed on 21 to 30 day as keeping catheter for long duration would increase the chances of infection. Thus, it can be seen that stricture in membranous urethral is the most common site in the stricture involving the posterior urethra. Conclusion: Various modalities of treatment have evolved over the years, primary suturing, endoscopic realignment and initial SPC followed by delayed anastomosis for posterior urethral stricture which is considered as gold standard. 33.6 % of posterior urethral stricture was in the age group of 21-30 yrs.  Pelvic injuries were responsible for 67.27% of posterior urethral stricture. Perineal approach has been proven to be the best approach since it preserves the neurovascular bundles hence there are lower chances of impotence, restenosis.

101. Neonatal Hypoglycemia: A Problem Not Well Addressed in Postnatal Wards
Anjali Jatav, Yogendra Singh Verma, Ajay Gaur
Background: Neonatal hypoglycemia is a common metabolic problem, which is due to abrupt cessation of maternal glucose after birth and inability to maintain a normal glucose homeostasis but many a proportion of them do not manifest symptoms and may develop complications and sequele of hypoglycemia.Objective: (1) To estimate blood glucose level in newborns at different intervals in first 48 hour in postnatal ward. (2) To correlate blood glucose level in newborns to gestational age, birth weight and initiation of feeding. Method: This is a cross sectional observational study on 196 neonates in postnatal wards of a government medical college hospital. The blood glucose level was assessed at birth, 30 min, 3hr, 6hr, 12hr, 24hr and 48hr independent of feeding time. Hypoglycemia was assessed by Glucometer using capillary blood against age of onset, birth weight, sex of baby, mode of delivery and time of initiation of breast feeding. Data was recorded on a pre-designed proforma. Results: This study revealed that Incidence of Hypoglycemia was 23% in neonates in postnatal ward. High incidence of hypoglycemia was found in low birth weight babies (33.3%), preterm neonates (57.1%) and neonates with delayed breast feeding (32.3%). All 45 neonates with hypoglycemia had correction of Blood glucose level after 30 minutes of feeding. Conclusion: Healthy, low birth weight & preterm neonates in postnatal wards have a very high possibility of Hypoglycemia need close monitoring for hypoglycemia in first 48 hrs of life.

102. Efficacy of the Ultrasound in Unsuccessful Landmark Guided Internal Jugular Vein Cannulation
Divas Sinha, Ramees Ahamad Anchukandan, Thomas Francis, Ankit Kumar Shah
Background: Internal jugular vein cannulation is a commonly performed procedure for administering medication, fluid, and nutrition, monitoring central venous pressure, or obtaining blood samples. In the past, using the traditional landmark technique to assess the internal jugular vein for central venous procedures was associated with a lower rate of success and higher rate of complications compared to using ultrasound. Aim and objectives: To study the efficacy of ultrasound in unsuccessful cannulation by the landmark technique. Material and Method: This single-center prospective longitudinal observational study was conducted in the Department of Anaesthesiology at All India Institute of Medical Science, Bhopal. Thirty patients aged above 18 years, undergoing elective/emergency surgical intervention under general anesthesia, and requiring central venous cannulation as determined by the in-charge anesthesiologist of the theatre, were included. All cannulation attempts were taken by a single candidate, as decided by the in-charge anesthesiologist. Observations for attempts and causes of failure were assessed after two failed attempts of a landmark technique of cannulation. Result: The success rate of ultrasound-guided cannulation after two failed landmark-guided attempts was 96.6%. The most commonly associated cause of failure was improper identification of landmarks. Conclusion: The overall success rate of ultrasound-guided cannulation was 96.6% after two failed attempts of landmark-guided cannulation in difficult cases. The most common cause of failure for landmark-guided cannulation was improper identification of the landmark in patients.

103. Assessment of Depression, Anxiety and Stress among Computer Aided Design Engineers Working in a Multinational Company in Chennai, Tamilnadu
K. Subhashchandra, Balaji Selvaraju, Ra. Vaanathi, Gomathy Parasuraman
Depression, anxiety and stress play a significant role in mental wellbeing of an individual. People with depression tend to suffer with anxiety, where as it can in-turn lead to more stress and dysfunction in working environment. This study aims to find out the prevalence of Depression, Anxiety and Stress among the Computer aided design engineers and to assess the factors affecting them. A cross sectional study was conducted using Depression Anxiety Stress Scale (DASS) to assess the level of Depression and Anxiety among the computer aided design engineers in a multinational private software company in Chennai, Tamil Nadu. A total of 309 engineers participated in the study. A pre-tested questionnaire consisting of socio-demographic variables and questions related to depression, anxiety and stress was administered. Data obtained were collected and analyzed statistically by simple proportions and chi-square test. The Prevalence of Depression, Anxiety and Stress among the study participants were 42.7%, 48.2% and 19.1% respectively. The factors associated with them were number of working days in a week, not spending enough time with the family and absence of savings or investments. Highly significant association was noted between Depression levels, anxiety and stress. The Prevalence of Depression and Anxiety was high among the Computer aided design engineers. This study is an early attempt at exploring the various factors which can affect the morbidity conditions among them.

104. Evaluation of Palpable Head and Neck Swellings with Fine Needle Aspiration Cytology (FNAC): A Clinicopathological Study
Shailaja Koppula, Meghana Akula
Introduction: Head and neck swellings exhibit mystifying diagnostic uncertainity and have diverse pathology ranging from benign inflammatory lesions to neoplasms. Fine needle aspiration cytology (FNAC) is considered as first line diagnostic method with high specificity for the diagnosis of palpable head and neck lesions thus eliminating the need of surgical intervention. The present study was designed to evaluate the efficacy of FNAC as a diagnostic tool for head and neck lesions. Material and methods: A source of 152 cases with palpable head and neck lesions above 6 years of age attending department of pathology for FNAC were included. All palpable swellings at head and neck region were aspirated for the examination. The outcome of histopathological examination was compared with FNAC findings. Results: Thyroid gland swellings (42.76%) were common, followed by lymph node swellings (27.63%), salivary gland swellings (16.44%) and soft tissue swellings (13.16%). Out of the swellings, 1.31% are normal, 16.44% are malignant, 31.57% are benign, 21.71% are autoimmune, 25% are inflammatory and 3.94% are inconclusive in FNAC examination. The diagnostic sensitivity, specificity, PPV, NPV and accuracy was 87.4%, 91.1%, 92%, 83% and 90.5% respectively for FNAC. Conclusion: FNAC is an effective diagnostic modality for head and neck swellings with remarkable diagnostic accuracy and proved to be a remarkable diagnostic adjunct in preoperative assessment of the swellings.

105. Dinoprostone Followed by Prostaglandin Compared to Prostaglandin Alone in Second Trimester MTP
Sudharani M, Spandana JC, Bhagyalaxmi Sidenur, Amrutha AM, Vijayalaxmi M
Introduction: Worldwide, 10%–15% of all induced abortions occur during the second trimester. Overall, two thirds of all major complications of abortions are attributable to those performed in the second trimester. Materials and methods: This was a comparative study in which women pregnant women advised mid trimester abortion were divided into two groups randomly. Group A were induced with intra-cervical insertion of dinoprostone gel [PGE2 gel] 0.5mg. The patient was made to remain supine for least 30 minutes. Six hours later vaginal examination was done to check for progress of abortion, if uterine action was inadequate or failed to occur, tab misoprostol 400microgram was inserted vaginally every 4th hourly for maximum of 4 doses, failure of expulsion of products of conception inspite of 4 doses of misoprostol was considered as failure of procedure. Whereas second group had group (B) received one tab of multivitamin (placebo) and after 24 hours followed by Misoprostol (50mg) maximum 6 doses vaginally. Results: Intracervical dinoprostone (PGE2) gel plus misoprostol is a safe and effective protocol with less induction to abortion interval method for second trimester medical termination. Conclusion: Intracervical dinoprostone gel followed by serial insertion of misoprostol is found to be effective in second trimester medical termination of pregnancy with minimal side effects and shorter induction to abortion interval.

106. Procalcitonin as a Marker for Early Diagnosis of Sepsis
Pradeep Jain, Sandeep Jain, Adil Aziz, Mohd Shakeel
Background: Procalcitonin (PCT) has been newly proposed indicator of presence of infection and as a useful marker of the severity of sepsis. Methods: This hospital based cross sectional study was conducted at Department of Medicine, JNUIMSRC, Jaipur, Rajasthan. The study was conducted on 50 ICU  patients of suspected or established sepsis who were admitted in the hospital. The study samples included all patients aged above 15 years presenting with acute sepsis as diagnosed by clinical presentation. Results: The study included 50 ICU patients with suspected sepsis. Patients age ranged 15 to 75 years. Out of 50, 32 patients were male & 18 were female. Among these, patients PCT above 30 ng/ml were seen in 3 patients, 10-30 ng/ml in 3 patients, 2-10 ng/ml in 19 patients, 0.5-2 ng/ml in 1 patients & less than 0.5 ng/ml in 24 patients. There was a statistically significant correlation with the presence of sepsis determined using either PCT ≥05 ng/ml or ≥2 ng/ml. Conclusions: PCT is among the most promising sepsis markers capable of completing clinical signs and routine lab parameters suggestive of severe infection.

107. Serum Albumin as a Prognostic Marker in Critically Ill Patients in Intensive Care Unit in a Tertiary Care Centre
Sagar Saha, Atul Debbarma, Saru Kumar Debbarma, Sandipan Debbarma, Subrata Bhowmik
Introduction: Albumin is the most abundant plasma protein and contributes to 50-60% of total protein of the body. Serum albumin is a useful marker of nutritional status of an individual. Besides maintaining colloidal osmotic pressure, it has important anti-inflammatory, anti-oxidant, ligand binding and anticoagulation properties. Serum albumin can be used as a good independent prognostic marker in critically ill patients in comparison with APACHE 2. Materials and Methods: This study is a single centre observational study conducted in the ICU, Agartala Government Medical College, GB Pant Hospital for 1- and 1/2-years study periods. 322 patients are studied Serial albumin levels were estimated on admission, 24hrs, 48hrs and 72hrs. All the patient were be followed up till discharge or death and these 2 groups were termed as ‘survivors’ and ‘nonsurvivors’. APACHE 2 scoring was done in all patients and compared with mean albumin level. Results: Receiver operating characteristics curve was plotted using S Albumin at admission, S Albumin at 24 hrs, S Albumin at 48 hrs, S Albumin at 72 hrs and APACHE II scores to predict the mortality. The area under the curve was 0.64, 95% CI (0.56-0.72) for APACHE II scores, 0.94, 95% CI (0.87-0.97) for S Albumin at admission, 0.91, (0.87-0.95) for S Albumin at 24 hrs, 0.90, 95% CI (0.86-0.93) for S Albumin at 48hrs and, S Albumin at 72 hours. All these AUCs were significant with the p value of <0.001 for predicting mortality. Among the survivors, no one had serum albumin level of <2.5 g/dL at 72 hours, 21 (8.4%) had (2.5- 3.0) g/dL, 112 (44.8%) had a level of (3.0-3.5) g/dL and 117 (46.8%) had >3.5g/dL. Among non-survivors, nearly half (51.4%) had a serum albumin level of( 3.0-3.5)g/dL and 27 (37.5%) had albumin level in the range of (2.5-3.0)g/dL and only one patient had >3.5g/dL, 7(9.7%) had albumin <2.5g/dL. There was a significant difference in serum albumin level at 72 hours and the status of survival with the p value of <0.001. Conclusion: Serum albumin on 72 hrs correlated directly with higher mortality in Critically ill patients. Serum albumin on 72hrs and the level of change, during the hospital stay, had an impact on morbidity. At 72hrs serum albumin <2.5 mg/dl served as a poor prognostic marker. Serum albumin measured after 72 hrs was as accurate as the admission APACHE II score in correctly classifying patients according to outcome. Serial assessment of serum albumin provides useful prognostic information in critically ill patients. Serum albumin thus serves as a simple but powerful prognostic tool for critically ill patients.

108. Study on Prevalence of Anaemia and Various Risk Factors among Pregnant Women Attending Rural Health Training Centre of Katihar Medical College, Katihar
Pritha Ganguly, Shahid Iqbal, Purnendu Kumar Singh, Arun Kumar Pandey
Background: Anaemia during pregnancy is a public health problem affecting developing countries and it is associated with adverse outcomes in pregnancy. Aims and Objectives: (1) To evaluate the prevalence of anaemia among pregnant women attending rural health training centre of Katihar Medical College, Katihar. (2) To assess the various risk factors associated with anaemia among pregnant women. Attending the rural health training centre of Katihar Medical College, Katihar. Materials and Methods:   The present study was a cross sectional observational study.    Data collection involved 180 pregnant women of any trimester of pregnancy irrespective of Iron and Folic Acid (IFA) consumption. Pregnant women who attended the antenatal clinic of the Rural Health Training Centre for three months were taken as study sample. Written informed consent was taken. The study was conducted at Rural Health Training Centre of Katihar Medical College, Katihar. Participants were interviewed by using a predesigned and pretested questionnaire after taking consent. Results: The prevalence of anaemia among pregnant women was 65.55%. majority of anaemic pregnant women 62 (51.69%) belonged to age group 21-25 years. Majority of study participants belonged to joint family 117 (65%). In this present study, most anaemic pregnant women were commonly found in lower socio-economic status 64 (54.24%). Conclusions: The present study concluded that anaemia in pregnancy was commonly seen in age group 21 to 25 years and most pregnant women had mild anaemia. Parity >3, illiteracy, lower socioeconomic status was major predictors of anaemia in pregnancy. Anaemia continues to be a major public health problem in rural area. To reduce its prevalence there is a need for public health education on reproductive health. There is a need to improve the dietary level and to strengthen the healthcare seeking behaviour of women. Therefore, anemia continues to be a major public health problem in rural area of India.

109. A Study of Tobacco Consumption among Male in Urban Field Practice Area of Katihar Medical College, Katihar
Gulshan Imroz, Purnendu Kumar Singh, Mukesh Nandan
Introduction: Tobacco use is the major cause of morbidity and premature death, but it is preventable. In some parts of the society, it is socially accepted. To assess the prevalence of Tobacco consumption among male in urban field practice area of Katihar Medical College, Katihar. Methods: A Community based cross- sectional study was conducted between August 2021 to October 2021 among 384 male of age 15 and above years in urban field practice area of Katihar. A pre-tested and predesigned questionnaire taking after consent and was done by using MS- Excel. Results: This study shows that 173 (45%) males out of 384 consumed tobaccos in one or other form. Smokeless tobacco like (zarda, gutkha, khaini) are commonly used by male 60.7%. The most common reasons found for tobacco consumption were parents 34.3%. The most common age group of tobacco consumption was 15-19 years 22.5%. Majority of nuclear family consumed tobacco. Conclusion: In my study, the prevalence of tobacco consumption was higher in male so we have to formulate prevention strategies like anti- tobacco education should be initiated right from the early age.

110. Ultrasound Elastography in Evaluation of Cervical Lymphadenopathy with FNAC Correlation
Mohini Patir, Pranjit Thapa, Puja Bhuyan, Samir Khan, Imdadul Islam, Mirazul Haque
Introduction:  When ultrasonography and elastography are used together, it is more accurate to distinguish benign from malignant cervical lymph nodes. This helps with treatment planning and reduces the need for fine needle aspiration cytology and biopsy. The purpose of this study was to evaluate the sensitivity, specificity, and diagnostic accuracy of B-mode ultrasonography, colour Doppler imaging, and elastography, as well as to correlate these results with pathological findings. Aims and objectives: (1) To determine the role and diagnostic value of ultrasound elastography in differentiating benign from malignant cervical lymph nodes. (2) To evaluate the accuracy and efficacy of ultrasound elastography in discriminating benign from malignant cervical lymph nodes by comparing the results of the two techniques with pathological (FNAC) confirmation. Materials and Methods: B-mode and colour Doppler ultrasonography were used to examine patients first, followed by elastography. Short axis diameter, short-to-long axis ratio, fatty hilum, and margin were all examined on B-mode USG imaging. Color Doppler imaging was used to identify five patterns of lymph node vascularity. Lymph nodes were examined using elastography based on the strain ratio and elastography pattern. Results: The fatty hilum and vascularity patterns were observed to have the highest diagnostic accuracy of 84%, followed by the short-to-long axis ratio (82%). B-Mode USG’s overall sensitivity, specificity, and diagnostic accuracy were 88.1%, 66.6%, and 85.0% respectively. The current study found that using a strain ratio cut-off of 1.5 resulted in 87.2% sensitivity, 93.3% specificity, and 90% diagnostic accuracy. Ultrasonography and elastography were performed together to achieve a sensitivity of 96.3%, specificity of 80.8%, and diagnostic accuracy of 81.0%. Conclusions: To correctly diagnose cervical lymphadenopathy, elastography can be a helpful adjunct to ultrasonography. The cut-off strain index of 1.5 and the elastography pattern can successfully distinguish between benign and malignant.

111. A Comparative Study on Supraglottic Airway Devices Classic LMA, Proseal LMA, Blockbuster LMA in Adult Patients Undergoing Short Surgical Procedures
Premkumar K G, Vijayalakshmi H, Shanthini S
Introduction: The invention of supraglottic devices changed the focus of airway management during general anaesthesia (GA) from intubation to oxygenation and ventilation. There were many improvements in LMA with regard to intubation facility, anatomical similarity and increase in cuff volume. Hence comparative studies with various types of LMA is essential for its proper selection as per the need. Aim: The aim was to compare the utility of three different supraglottic airway devices namely Classic LMA, Proseal LMA and Blockbuster LMA. Materials and Methods: This was a randomized single blind triple arm study involving 30 patients in each three groups. (Group C: classic LMA, Group P: proseal LMA and Group B: block buster LMA). The number of attempts, time and ease for insertion, sealing pressure, hemodynamic changes and complications were studied. SPSS software was used for statistical analysis. One-way ANOVA, Tukey HDS and chi-square test were used. The p value of < 0.05 was statistically significant. Results: The time needed for insertion was significantly less with Proseal group and it was easy to insert than others. It also has less incidence of sore throat, blood staining and displacement. There was no significant difference with regards to attempt on first insertion, airway sealing pressure or hemodynamic changes between three groups. The block buster type was easy to insert and had less rate of complications than the classical type. Conclusion: All the three supraglottic airway devices (classic, proseal, blockbuster LMA) can be safely used during GA and Positive Pressure Ventilation. Proseal LMA was quickly inserted than other types in this study with less complications than blockbuster type.

112. Abdominal Sinus – Pandora’s Box
Meenu Singh, Nitin Borle, Zubin Parekh, Durgesh Bhat
Sinus tract is a blind tract lined by granulation tissue leading from an epithelial surface into the surrounding tissue. Retained foreign body is one of the cause which can also lead to sepsis, intra-abdominal abscess and fistula. The sinus tract can involve the intestine as well as other hollow organs to form fistula if untreated, therefore early diagnosis and treatments important. Chronic sinuses are more commonly seen in head and neck, sinus tract formation following pelvic surgeries for uterine prolapse are rare. A 40 year old female presented with discharge from sinus opening in right iliac fossa since 2 yrs, with a past history of 4 times surgeries for uterine prolapse via abdominal and vaginal approach 16yrs back. Sinogram suggestive of linear blind ending sinus tract of length 2cm and CECT of abdomen and pelvis revealed the linear sinus tract arising from anterior abdominal wall in right iliac fossa showing intraperitoneal extension encircling the rectus abdominis muscles. Patient underwent sinus tract excision with finding been a 6cm long sinus tract extending up to the rectus with mersilene tape as its content. It is crucial to accurately assess the depth and extent of sinus invasion and fistula formation before treatment for personalized treatment plans.

113. Study of COVID-19 Impact on Medico Legal Cases Registered at Mediciti Hospital, Ghanpur Village, Medchal Mandal, Telangana.
Rathod Vinayak, Sanjana Goud Teegala, Sandeep Battilu
Background and Objectives: In every tertiary care hospital, casualty deals with the emergency cases of which the majority are Medico legal cases. The knowledge about the incidence of Medico legal cases is important to recognise the socioeconomic burden. The present study was conducted to scrutinize different Medicolegal cases at the emergency department of Mediciti Hospital, Medchal. The idea of the study was to find out frequency of several types of medico legal cases at casualty of Mediciti Hospital, Medchal. Materials and methods: It was a record based cross sectional study in which all the MLC cases registered in MLC record book from March 2020-March 2021 were analyzed. The data was collected on age, sex, type of Medico legal cases, road traffic accidents, mode of occurrence, month-wise distribution of medico legal cases and the time of occurrence. Results were expressed in numbers and percentages. Results: Out of all 355 registered medico legal cases, of which 258(73.2%) were males and 94(26.76%) were females. Maximum cases were from the age group of 20-29 years i.e., 127(43.09%). Majority of the MLC’s registered we are due to road traffic accidents 144(39.7%) followed by Assault 49(13.8%), falls-43(12.7%), poisoning-43(12.1%), and injury at workplace-43(12.1%), accidental-14(3.9%), snake bite-8(2.2%) and others (7.4%). Conclusion: The present study shows RTAs account for a major part of MLCs. By proper education and training of safety measures among public decreases the cases. Enforcement of strict laws reduces the incidence of road traffic accidents. And also, strict laws should be amended to reduce the incidence of Assault.

114. Assessment of Right Heart Function and Dimensions following Device Closure of Atrial Septal Defect in Tertiary Medical Centre
Vinit Kumar, Dhananjay Kumar, Siddarth Samrat
Introduction: ASD closure causes electrical and mechanical reverse remodelling after shunt closure. There haven’t been many studies to determine whether surgical closure or device closure is better for regressing right heart volumes. In comparison to secundum ASD closure, transcatheter ASD closure has shown to be more affordable while eliminating the common risks of surgical closure, such as cardiac trauma and wound problems. Aim and Objective: To assess right heart function, right atrial and right ventricular dimensions pre and post transcatheter closure of atrial septal defect (ASD). Materials and Methods: From August 2021 to December 2022, 50 research participants participated in this descriptive longitudinal study at the LPS Institute of Cardiology in Kanpur, Uttar Pradesh. All ostium secundum ASD patients who were referred for closure were examined. Patients of both sexes are chosen for the investigation. For each patient, pertinent history, a clinical examination, pulse oximetry, a chest X-ray, and an ECG were performed. Each patient had a thorough transthoracic and transoesophageal echocardiogram performed. Results: At immediate post-closure, one week, and three months after closure, the mean RV longitudinal measurement was 6.31 cm, 6.07 cm, and 5.96 cm, respectively. F=359.324, P < 0.001, indicates that there is a significant difference between the 4 occurrences. Further numerous comparisons of the occasions reveal that every pair differs considerably. The mean MPI was 4.173, however, it fell to 3.93, 3.592, and 3.199 at the immediate, 1-week, and 3-month post-closure times. Further numerous comparisons of the occasions reveal that every pair differs considerably. F=444.425, P< 0.001 indicates that there is a significant difference between the 4 occurrences. Conclusions: Comparable positive effects are shown on hemodynamics, right heart dimensions, and functional capacity. Immediately upon device closure, the highest favourable effects on right cardiac functions, remodelling, of heart functions and the advantage is still there three months later.

115. Introduction of Objective Structured Clinical Examination as an Assessment tool for learning in Surgery
Manmeet Kaur, Satish Parihar, Monika Sharma, Pamela Alice K
Background: The curriculum tells the teacher what to teach and assessment tells the students what to learn. With the introduction of CBME, innovations in both teaching and assessment are needed to catch up with the learning. Competencies in CBME are a mix of all domains of learning, so we felt the need to introduce Objective Structured Clinical Examination (OSCE), as a method of assessment which can be aligned with the learning objectives. OSCE serve as an efficient and potent learning opportunity, nevertheless there are a variety of challenges with conduct and implementation of OSCEs regularly. Aim and Objectives: To introduce OSCE as assessment method in 2nd phase MBBS students in surgery, to assess its feasibility, and to assess perception of students and faculty for OSCE as an assessment tool for learning in surgery. Methodology: After the clearance from IEC, Surgery faculty was sensitized to the process of implementation of OSCE. Stations and Feedback questionnaire were designed (peer reviewed and validated). The MBBS PhaseII students were sensitized to OSCE and assessment was conducted. Feedback from students and faculty was collected as anonymous questionnaire form scored with a 5point Likert response scale and analyzed. Results: 93.5% students and 95.5% faculty were satisfied with the OSCE as assessment and its feasibility. 96.5% students and 100% faculty wanted that OSCE should be followed as the method of assessment of practical/ clinical skills in surgery. Conclusions: (1) Faculty found it feasible and worth implementing regularly in surgery. (2) Student appreciated this form of learning through assessment and feedback.

116. A Prospective Comparative Study of 50 Cases of Intestinal Anastomosis by Stapler versus Hand Sewn Method
Parth Patel, Samir Shah, Jekee Patel, Pranav Parthasarthi
Background: Intestinal anastomosis in General Surgery is a very commonly performed procedure for various indications by various methods and for ancient times. Various evolvements occurred in the field of various aspects of intestinal anastomosis with recent advancement is the use of stapler as a device for GI anastomosis. Because of the use of staplers, technical failure is a rarity, anastomosis is more consistent and can be used at difficult locations. Method: A total of 50 cases which met the inclusion and exclusion criteria were included in this hospital based prospective comparative study. Than after taking informed and written consent of the patients, they have been operated by either hand-sewn or stapler methods of intestinal anastomosis randomly (25/25 cases). The subjects were allocated into two groups according to the type of anastomosis, hand sewn and stapler. Both the group of patients have been compared for various outcome measures: hospital stay, operation time, post-operative pain, post-op wound discharge, post-op anastomotic leakage, post-op resumption of day-to-day activity. Result: The patients, operated by stapler method of intestinal anastomosis have required less operation time and less hospital stay with significantly low rate of postoperative pain, wound discharge, anastomotic leakage and early resumption of routine daily activity. Conclusion: In our present study, we found that stapling technique can significantly reduce the time for anastomotic procedure, less tissue trauma due to less tissue handling, there is early restoration of gastrointestinal function, less post-operative complications including those of anastomotic site and reduced duration of hospital stay which helps ultimately in early return to routine work, importantly staplers can be used at places were hand sewn anastomosis is technically difficult.

117. Cervical Cancer Screening: A Cross-Sectional Study Conducted in Tertiary Care Center in Indore
Sonali Dutt, Akanksha Thora, Anupama Dave, Jyoti Praseeth
Background: Cervical cancer is a potentially preventable disease if appropriate screening and prophylactic strategies are employed. Low awareness of cervical cancer, in combination with low health care seeking behavior, is a key challenge for cervical cancer prevention.  Adequate knowledge play a huge role in influencing the beliefs and practices of the general public in a positive way. We assessed the knowledge, attitudes, and practices of cervical cancer and screening amongst female came to our patient department of MTH hospital Indore. Methods: We conducted a facility-based cross-sectional study on females  from February 2020- October 2022   between 21 and 49 years of age. Data were collected and analysis was done using descriptive statistics. Results: A total of 12994 women screened, about  503 are VIA positive out of which 339 are true positive and 164 are false positive, All VIA positive women consider for colposcopy. Conclusion: This study revealed that knowledge about cervical cancer was generally low, in particular for health care seeking behavior and treatment of cervical cancer. Health awareness programs should be strengthened at both community and health facility levels with emphasis highlighting the causes, risk factors, care seeking behaviors, and treatment options for cervical cancer.

118. A Study of Knowledge, Attitude and Practices (KAP) of College Students Regarding HIV Infection and its Prevention in Patna District
Puja, Shiv Shankar Kumar, Rehana Anjum, Amita Sinha
Background and objectives: HIV infection is a newly emerged, globally spread infection. Though all ages and both sexes are equally affected, 50% of HIV infections occurred in the age group of 15-24 years of age group. This vulnerable age group is of adolescent and young adulthood, mostly available in schools and colleges. It is well proved that creating awareness can act like ‘social vaccine. Accordingly as a part of global consensus School Aids Education(SAEP) and College AIDS Education Programmes (CAEP) were conducted through NACO (National AIDS Control Organization) and SAPS (State AIDS Prevention Society). Methods: A cross-sectional study conducted in Patna district, i.e Stratified random technique was used  to select required sample from each strata. Pre-tested questionnaire was used to collect data. To study the levels of awareness regarding infection and prevention among college students, Study duration of Nine months.  Conclusion: Student population had better knowledge levels regarding HIV infection and prevention in all seven strata. There appear to be gaps in awareness regarding services concerned. Reinforcement activities are need at times to keep awareness levels at higher level.  More emphasis should be given to degree and PU students.

119. Study of Physical Health Profile of Adolescents in Rural Field Practice Area NMCH Patna
Shiv Shankar Kumar, Rehana Anjum, Puja, Amita Sinha
Background and Objectives: Adolescent period is characterized by exceptionally rapid growth. Because of which nutritional requirements are increased in different proportions for boys and girls. If these are not met then it results in short stature and lean body mass affecting their working capacity in later life. Hence, there is a need to study the health profile of adolescents. To assess physical health profile of adolescent boys and girls, to determine factors affecting physical health profile and to impart health education. Methods: A community based, cross-sectional study was conducted in rural field practice area, Department of Community Medicine, at Nalanda Medical College and Hospital Patna. Study duration of Nine Months. The study subjects were adolescents between 10 and 19 years of age. Estimated sample was 600 and by simple random method houses were visited till sample size was achieved. Conclusion: In our study more boys (42.2%) were stunted than girls (34.8%). Factors associated with stunting were parent’s education and occupation. More girls (30.6%) were underweight than boys (24.9%). Type of family, socio-economic status, parent’s education and parent’s occupation were associated with underweight among adolescents. Dental caries (8.5%) was most common morbidity.

120. Needs Assessment of Persons with Physical Disability for Community Based Rehabilitation in Rural Field Practice Area Patna
Rehana Anjum, Puja, Shiv Shankar Kumar, Amita Sinha
Background and Objectives: Disability has been defined as “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being”. It is estimated by WHO that 15% of the world’s population has some form of disability and 5% of the population in developing countries has one or the other kind of disability. To determine the needs of Adults and Children with physical disability with respect to Health, Education, Social, Livelihood and Empowerment. Methodology: This was a Mixed method study (quantitative through cross sectional and qualitative research technique through focus group discussion) carried out in 22 villages with a total population of 12669, under Rural Health Training Center Patna, attached to department of Community Medicine, PMCH and NMCH Patna. Study Duration of Nine Months. Conclusion: Most of the persons with physical disability had unmet needs in health, education, livelihood, empowerment and social component under CBR matrix and the resources available in the study area are adequate for starting CBR programme.

121. Retrospective Study of Malpresentation in Tertiary Care Institute
Shivani Badal, Babli Yadav, Priti Verma, Jaya Patel
Objective: Malpresentation is a common complication encountered during pregnancy causing undue stress to the mother, the baby and the obstetrician. We conducted this study to observe the incidence of various malpresentation and their association with fetal and maternal outcomes. Methods: This is a retrospective study where we analyzed the age, parity, period of gestation, associated high risk, type of malpresentation, mode of delivery, fetal weight, fetal gender and fetal outcome for three years. Results: In our study 755 cases of malpresentation were included of which 52.1% were primigravida patients, 52.7% were delivered at term with 82.7% having no obstetric risk factor associated with them. Breech (90%) was the most common malpresentation and 63% were delivered by cesarean section with 84.6% babies born alive and healthy. The breech presentation was more commonly seen in primigravida patients, and a statistically significant association was seen between gestational age and type of malpresentation (p<0.05). Conclusion: Adequate perinatal care can significantly reduce maternal and fetal mortality and morbidity. Malpresentation if managed properly in the hospital can significantly reduce maternal and fetal outcomes.

122. Prevalence of Non-alcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus and its Association with Ischemic Heart Disease
Sourabh Soni, Anil Samaria, Monika Chowdhary, Meenakshi Samaria, Amit Kant, Deepak Dewat, Harsh Kumar Veshar, Trivendar Jangir, Sahil Khan,Vinita Yadav, Pearl Samaria
Introduction: NAFLD disease entity comprises of Fatty Liver, Steatohepatitis, Cirrhosis as the disease progresses. NAFLD is the outcome of imbalance between mechanisms of triglyceride synthesis and triglyceride disposal. Diabetes Mellitus is an important risk factor for development of NAFLD, which enhance the lifetime risk of developing NAFLD by production of Cytokines that lead to insulin resistance and oxidative stress. Association of NAFLD with TYPE-2 DIABETES MELLITUS and Metabolic Syndrome makes the patient more prone to develop Ischemic Heart Disease. Hence it is important to establish the prevalence of NAFLD in Diabetics and to find out its association with Ischemic Heart Disease. Objectives: (1) To find out prevalence of NAFLD in patients with TYPE-2 Diabetes Mellitus. (2) To find out association of IHD with NAFLD. Methodology: A cross sectional study involving 300 patients was conducted in JLN Hospital Ajmer. It Included patients fulfilling inclusion criteria after ruling out the exclusion criteria. An initial screening in the form of detailed history taking and clinical examination was carried out to include/exclude the patients in the study. The Investigations used such as HbA1c, USG, 2D Echocardiography. Results: among 300 patients studied NAFLD was present in 166 patients, it was absent in 134 patients, hence the prevalence of NAFLD was 55.3%. In our study, the prevalence of IHD was found 36.7% in total study participants. Statistically significant (P value <0.001) higher prevalence (51.8%) in NAFLD group than Non-NAFLD group (17.9%) was found in our study. Conclusion: In our study it was observed that there is high prevalence of NAFLD in diabetic population. And being a state of ectopic fat deposition, NAFLD itself works as an independent risk factor for developing IHD.

123. Diagnostic Value of Typhidot Rapid IgM Assay for Rapid Diagnosis of Enteric Fever in a Pediatric Population
Subhradeep Majumder, Jugal Kishor Agarwal, Yasmeen Naushi
Background: Enteric fever is an extensive public health concern in developing countries. A rapid, simple and cost-effective diagnostic test is needed for early and accurate diagnosis. This proposed study was done to evaluate sensitivity and specificity of Typhidot rapid IgM assay to find out detection of enteric fever using blood culture as gold standard. Methods: Febrile children complain with fever of >3 days were enrolled. Blood culture by BacT/ALERT™, Widal test and Typhidot rapid IgM test were performed. Patients in whom diagnosis other than typhoid was made served as controls. Results: Of 300 children enrolled, 134 were diagnosed clinically as enteric fever with blood cultures positive in 38% children for S. Typhi. Sensitivity, specificity, positive predictive value and negative predictive value of Typhidot rapid IgM test were higher than for Widal test among blood culture confirmed typhoid cases (76.9%, 87.3%, 65.5%, 92.4% and 90.3%, 97.5%, 92.1%, 97% respectively). Compared to Widal test, Typhidot rapid IgM showed better diagnostic sensitivity (67.6% vs 85.3%) and predictive values in first week of illness (52.2% vs 87.8%). Conclusions: Typhidot rapid IgM assay is simple to perform with superior diagnostic parameters for rapid diagnosis of enteric fever in endemic areas.

124. A Study to Assess Newborn Care Practices among Mothers in Bhopal so as to Determine Risk Factors for Unsafe Practices and to Assess the Knowledge and Skills of ASHA during Their Home Visits to Those Newborns and Mothers
Sadaf Ikram, Navneet Khandelwal, Shiv RK Dubey
Aim: This study aimed to assess the newborn care practices among mothers in Bhopal and to determine the risk factors for unsafe practices. The study also evaluated the knowledge and skills of Accredited Social Health Activists (ASHAs) during their home visits to the newborns and mothers. Methods: A cross-sectional survey was conducted, and data were collected from 200 mothers and 20 ASHAs through a structured questionnaire. Results: The majority of the mothers (80%) exclusively breastfed their newborns, and only 20% reported giving prelacteal feeds. However, only 45% of mothers-initiated breastfeeding within the first hour of birth. Regarding sleeping practices, 40% of mothers reported placing their newborns prone to sleep, which is a risk factor for sudden infant death syndrome (SIDS). Only 60% of mothers reported using a clean and dry cloth to wipe their newborn’s face after feeding. Only 30% of mothers reported washing their hands before handling their newborns. Regarding illness management, only 40% of mothers knew how to recognize signs of illness in their newborns, and only 20% knew what to do if their newborns developed a fever. Conclusions: The ASHAs demonstrated good knowledge and skills regarding newborn care practices, including feeding, sleeping, hygiene, and illness management. However, they reported facing challenges in accessing and providing timely care to newborns and mothers due to inadequate resources and infrastructure. This study highlights the need for interventions to improve the knowledge and practices of mothers regarding newborn care and for strengthening the infrastructure and resources for effective delivery of newborn care services.

125. Study and Compare the Efficacy of Rapid Emergency Medicine Score (REMS) and National Early Warning Score (NEWS) in Prediction of Hospital Outcomes in Patients of Sepsis
Shreyansh Bardiya, Himanshu Bansal, Shatakshi Singh, Mini Bhatnagar
Background: Sepsis is the leading cause of death worldwide in critically ill patients. To predict the outcome, an early diagnosis and stratification of the severity of sepsis is important. Efficient scoring methods for early diagnosis, stratification of severity and prognostication of sepsis are critical specially in resource limited settings. Clinical scoring systems are cost effective methods which can ensure rapid identification of patients requiring critical care. Aim: The present study was done to compare the efficacy of two clinical scoring system, REMS, and NEWS in prediction of hospital outcomes in sepsis patients. Materials & Methods: 100 patients of sepsis who were diagnosed on basis of qSOFA score, who fulfilled inclusion and exclusion criteria were selected for the study after taking informed consent. After admission in ER, detailed clinical history and examination was done. NEWS and REMS was calculated within 30 mins of admission in ER. All Collected data was analyzed and studied accordingly. Results: Among 100 patients of sepsis mean age of patients was found to be 55 years and among them 40% were female and 60% were male. Most common focus of sepsis was respiratory infections and most common isolated organism was Escherichia coli. On comparing, REMS and NEWS score in prognostication of hospital outcomes of the patients, it was documented that the p value was significant for both the scores to assess the outcome in patients of sepsis (p<0.05). However, ROC was plotted and REMS was found to be superior to NEWS. Conclusion: The study concludes that there is significant association between the outcome of sepsis patients with the REMS and NEWS scores. The study found REMS and NEWS scoring as important predictors for the mortality among the patients admitted with sepsis. REMS was found to be superior to NEWS scoring in predicting the worst outcome among the study subjects.

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

127. The Effect of Myocardial Scars on Left Ventricular Deformation in Type 2 Diabetes Mellitus following a Myocardial Infarction was Studied using Contrast-Enhanced Cardiac Magnetic Resonance
Shubham Bhaskar, Vikram Aditya, Ahraz Ali Imam, S.K. Astik
Objective: Myocardial infarction (MI) and coronary artery disease are both greatly increased by type 2 diabetic mellitus (T2DM). Uncertainty exists on how diabetic cardiomyopathy and MI scars affect myocardium deformation in T2DM patients. The objective was to assess myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients who had previously experienced a MI and to find out how myocardial scar affected left ventricular (LV) deformation. Method: At Nalanda Medical College and Hospital, Patna, 200 T2DM patients, comprising 45 with MI (T2DM(MI+)) and 155 without MI (T2DM(MI), as well as 58 normal controls who received CMR scans, were included for one year. Late gadolinium enhancement was used to evaluate myocardial scarring. The LV function and deformation, including the peak systolic strain rate (PSSR), peak diastolic strain rate (PDSR), and LV global peak strain (PS), were compared between these groups. The correlation between myocardial scars and LV distortion was examined using multivariate linear regression and correlation analysis. Results: When compared to the other groups, the T2DM (MI+) group’s LV function and LV global PS, PSSR, and PDSR showed declines. In the T2DM (MI+) group with anterior wall infarction, there was lessened LV deformation (p<0.016). Reduced LV global PS (radial, circumferential, and longitudinal directions; p<0.02) and LV global PSSR (radial and circumferential directions; p<0.01) were associated with increased total LV infarct size and LV infarct mass. LV anterior wall infarction was independently associated with LV global longitudinal PS (β=0.397, p=0.005), and NYHA functional class was independently associated with LV global radial PS (β=0.401 and β=0.445, respectively, all p<0.02; model R2=0.36) and circumferential PS (β=0.338 and β=0.531, respectively, all p<0.02; model R2=0.40). Conclusion: In T2DM individuals who have had a MI, the amount of myocardial scarring is inversely linked with the LV global PS and PSSR, especially in the circumferential direction. Additionally, specific clinical evaluations should be reinforced because different MI areas have different effects on reducing LV distortion.

128. Clinical and Etiological Characteristics of Patients with Bicytopenia
Sonu Kumar, Ankit Karan
Background: Erythrocytes, leukocytes, or platelets are only a few of the two types of blood cells that are reduced in bicytopenia. There are numerous studies on pancytopenia, however, there are very few that examine the range of etiologies for bicytopenia. The objective was to examine the clinical-hematological characteristics of patients with bicytopenia and to look into the various causes of bicytopenia. Method: 200 patients with bicytopenia were selected for the study using systematic random sampling from those admitted to Indira Gandhi Institute of Medical Sciences, Patna between March 2022 and February 2023. Their hematological markers and clinical characteristics were assessed. Results: All ages were found to have bicytopenia, with a mean age of 30.6 years. Bicytopenia was present in 5% of newborns, 6% of infants, 24% of children, 16% of teenagers, 84% of adults, and 10% of the elderly across various age groups. Anemia with leukopenia (25%) and leukopenia with thrombocytopenia (12%) were the two bicytopenias that were seen most frequently. There were 1.5 times as many men as women. Bicytopenia was shown to have non-malignant (55%) as its most frequent aetiology, followed by infectious (31.6%), malignant (8.2%), and drug-induced (3%). In the non-malignant group, immune thrombocytopenic purpura, alcoholic liver disease, and megaloblastic anemia were the most common aetiologies. Dengue (11% of all infectious diseases) was the most prevalent. The hematological malignancies were most substantially linked with symptoms such lymphadenopathy, splenomegaly, and hepatomegaly (P≤ 0.002). The most prevalent non-malignant symptoms were pallor, hemorrhage, hepatomegaly, and splenomegaly (p < 0.002). In the infectious category, fever and lymphadenopathy were most prevalent (p < 0.002). Lymphadenopathy, hepatomegaly, and splenomegaly were the most prominent symptoms in drug-induced aetiology (P < 0.002). Conclusion: Many benign and malignant disorders can be detected by bicytopenia, a reliable hematological sign. Understanding its causes can aid in the diagnosis and effective treatment of patients.

129. A Retrospective Cohort Study on Changes in Proteinuria and Myocardial Infarction in Diabetic or Pre-Diabetic Patients
Vikram Aditya, Shubham Bhaskar, Ahraz Ali Imam, Swarnim Swarn
Introduction: Proteinuria, a frequent and significant sign of chronic kidney disease, is widely acknowledged as an independent predictor of cardiovascular disease in a variety of groups. In persons with diabetes or pre-diabetes, the association between changes in proteinuria and myocardial infarction (MI) is unknown. In this study, we intend to see if changes in proteinuria over a year may predict the occurrence of MI in persons with diabetes or pre-diabetes. We also investigate all patient data who had been first hospitalised for acute myocardial infarction and assessed the prevalence of non-diabetics, prediabetics, and diabetics among them. Methodology: The patients with an acute myocardial infarction were included in this study. Several physiological (such as heart rate, pulse, blood pressure and respiratory rate) and biochemical (such as HbA1c, lipid profile, plasma glucose, and cardiac markers) indicators were investigated. The study looked at the proportion of diabetics, pre-diabetics, and non-diabetics who experienced myocardial infarction as well as the relationship between aberrant blood glucose levels and the severity of myocardial infarction. SSPE 21.0 was used to do the statistical analysis. P values less than 0.05 were deemed statistically significant. Result: Among the 200 patients, 76 (38%) had no diabetes, compared to 74 (37%) and 50 (25%) who had pre-diabetes and diabetes, respectively. There was no statistically significant difference in the mean age of patients with diabetes, pre-diabetes, and those without diabetes (P>0.05). The gender distribution revealed a M:F ratio of 1:0.26, with 71 (79.78%) men and 18 (20.50%) females. Diabetes patients were shown to have greater heart rates, systolic and diastolic blood pressure, and total cholesterol levels than pre-diabetic and non-diabetic individuals. Myocardial enzyme levels (CK-MB and Troponin I) analysis revealed that diabetes patients also had greater levels than pre-diabetic and non-diabetic individuals. Diabetes patients’ mortality was shown to be statistically substantially higher (P <0.05). Conclusion: Diabetic patients with AMI had higher diastolic blood pressure, total cholesterol, triglycerides, LDL cholesterol, CK-MB, and Troponin I levels. Although the average age of myocardial infarction across diabetic, pre-diabetic, and non-diabetic patients was found to be similar, diabetic patients with myocardial infarction had statistically significantly higher fatality rates.


130. Relationship between Depression and Quality of Life with Disease Severity in Patients with Vitiligo
Vikash Chandra Mishra, Md. Shahnwaz, Manish Kumar, Arati Shivhare
Objective: An autoimmune pigmentary condition called vitiligo causes localized or widespread skin depigmentation. It has a negative effect on patients’ quality of life (QoL) and psychological health and is strongly stigmatized. Studying the prevalence of depression in vitiligo patients, determining the association between the severity of the condition and major depressive disorder, and evaluating patients’ quality of life were among the objectives. Method: The research consisted of 60 Vitiligo patients aged ≥18 years who attended the OPD at the Out-patient department of Dermatology and Psychiatry at Katihar Medical College from February 2022 to June 2022. The Vitiligo area severity index (VASI) was used to assess the disease severity and then Quality of Life was measured using Dermatology Life Quality Index Questionnaire (DLQI) and diagnosis of depression was made as per ICD10 and was rated on Hamilton rating scale of depression (HAM-D). Results: 60 patients were included in this study. The 18-30 age range was the most prevalent. Mean DLQI scores were 7.4 in VASI ≤5 and 9.3 in VASI ≥5. The DLQI indicated that QoL was somewhat impacted. 76% of people had only mild depression. Conclusion: Younger patients had higher degrees of depression and QoL impairment. Offering psychiatric consultation and counselling in addition to particular treatment might be beneficial.

131. Assessment of the Cervical Length by Transvaginal Sonography in Predicting the Success of Labor Induction
Gupteswar Mishra, Sambit Kumar Mohanty, Prabir Kumar Biswal
Objective: The objectives of the research were to evaluate the Bishop Score in women undergoing labor induction procedures followed by transvaginal sonography measurements of cervical length and to examine the contribution of transvaginal sonographic cervical assessment to the prediction of induction of labor outcomes. Method: For one year, 200 pregnant women who were having inductions at Hi-Tech Medical College & Hospital, Bhubaneswar participated in this prospective observational study. Prior to labor induction, all the women had transvaginal ultrasounds done to measure the cervical length and calculate the Bishop score. Results: This study has shown that 66.7% of singleton pregnancies with labor inductions at 36–40 weeks of gestation resulted in a successful vaginal delivery within 24 hours of the induction. The study also showed that the pre-induction Bishop score and sonographically measured cervical length are significantly related to the time from induction to delivery; the higher the Bishop score and lower the cervical length, the greater the likelihood of vaginal delivery within 24 hours of induction. The ROC curve revealed that the best cutoff points for effective induction were ≥4 for Bishop score and 2.0 cm for cervical length. Conclusion: The success of labor induction was better predicted by transvaginal ultrasonography measurement of cervical length.

132. A Simple and Effective Alternative to Antibiotic Beads in the Treatment of Open Fractures is Prophylactic Vancomycin-PMMA Strips
Bijay Kumar Lamay, Pradip Kumar Merli, Derga Kanta Sahoo
Objective: Even in the best-case scenario, infection is still a possibility during surgery and can be extremely dangerous after a compound fracture treatment. This study evaluated the effectiveness and practicality of locally applied antibiotic-impregnated polymethyl methacrylate (PMMA) strips to prevent infection and achieve functional union within a predetermined period of time following primary definitive stabilization of compound fractures. Method: A study was conducted from January 2021 to February 2022 at Department of Orthopaedic, Veer Surendra Sai Institute of Medical Sciences and Research, Burla on patients who got PMMA-vancomycin strips during orthopedic surgery repair of open fractures. There were 105 patients in all (ages 25 to 60) with open fractures of types I through IIIC. In-depth wound cleaning, meticulous debridement, and final stabilization with PMMA-vancomycin strips were all performed on the patients. Measurements were made on the frequency of wound healing, fracture union, and infection rate. Radiographs and infection markers were used to monitor patients over the course of a year. The effectiveness of the PMMA strips used in this investigation was compared to that of PMMA beads used in techniques identical to those in published studies. Results: 4 (4.6%) of 105 individuals developed a subclinical infection up until the implant was removed. There was no evidence of osteomyelitis or non-union in any patient. Comparable results in terms of infection rates were found between the PMMA strips used in this investigation and the antibiotic beads utilized in earlier experiments, according to a literature review. Vancomycin PMMA strips can be removed more easily than vancomycin beads in most cases. Conclusion: PMMA vancomycin strips provide surgeons a simple, effective solution to the contentious problem of deciding how long to keep antibiotic beads in place.

133. A Retrospective Cohort Study of the Short- and Long-Term Prognosis of Admission Hyperglycemia in Patients with and without Diabetes after an Acute Myocardial Infarction
Ahraz Ali Imam, Shubham Bhaskar, Vikram Aditya, Ajay Kumar Sinha
Objective: Acute myocardial infarction (AMI) patients with admission hyperglycemia had a worse prognosis; however, the effects of baseline diabetes status on this connection are yet unknown. The goal was to examine how admission hyperglycemia affected both short- and long-term outcomes in AMI patients with and without diabetes. Method: 300 individuals who experienced their first AMI between March 2022 and February 2023 at Nalanda Medical College and Hospital, Patna were identified in this retrospective cohort analysis. 150 patients with diabetes and 150 patients without diabetes were separated into two groups among the participants. Following that, they were split into four groups based on a cut of fasting blood glucose (FBG) levels that was specific to a person’s diabetes status and was identified via a limited cubic spline. Cardiac problems and in-hospital death were among the short-term results. All-cause mortality and serious adverse cardiovascular events were the long-term results (MACE). To account for baseline differences between the groups, inverse probability of treatment weighting (IPTW) was used. This was followed by a weighted Cox proportional hazards regression analysis to determine the hazard ratios and 95% confidence intervals for all-cause mortality associated with each FBG category. To assess the robustness of the findings, subgroup analysis, and sensitivity analysis were carried out. Results: 113 patients passed away over a median follow-up of 1.2 years. During long-term follow-up, there was a significant (p <0.002) interaction between diabetes status and FBG levels for all-cause mortality. Furthermore, among patients with diabetes, restricted cubic spline curves for the relationship between FBG and all-cause mortality had a J shape, while in patients without diabetes, they had a non-linear form. In both the diabetic and non-diabetic patient groups, the Kaplan-Meier analysis showed that non-hyperglycemic patients had a higher survival rate than hyperglycemic patients. Those with hyperglycemia who do not have diabetes have a higher survival rate than those who do. Admission hyperglycemia predicted increased short- and long-term mortality in the weighted Multivariable Cox analysis. The robustness of the findings was demonstrated by subgroup analysis and sensitivity analysis. Conclusion: For patients without diabetes and those with diabetes, the infection points of FBG level indicating a bad prognosis were 5.50 mmol/L and 10.50 mmol/L, respectively. Hyperglycemia during admission was identified as an independent predictor.

134. A Research on the Clinical Outcome of Diaphyseal Orthopaedic Forearm Fractures in Children undergoing Conservative Treatment with a Plaster Cast
Bijay Kumar Lamay, Pradip Kumar Merli, Derga Kanta Sahoo
Objective: Conservative treatment, including closed reduction and immobilization with an above-elbow plaster cast, is still the most prevalent method of treating forearm fractures in children. However, side effects of conservative treatment with a plaster cast include malunion, joint stiffness, and compartment syndrome. The therapeutic environment has changed thanks to the titanium elastic nailing system (TENS). The care of pediatric forearm fractures was the focus of the comparison of titanium elastic nailing versus conservative treatment using a plaster cast. Method: This study was carried out at Department of Orthopaedic, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, from June 2021 to July 2022. 50 patients with diaphyseal forearm fractures in the age range of 4 to 16 years were treated with internal fixation utilizing TENS, while another 50 patients were treated conservatively with a plaster cast. 12 months of prospective follow-up were conducted, and the results were examined. Results: Among patients treated with TENS, 44 (87.4%) cases had outstanding functional outcomes, 3 (11%) had acceptable outcomes, and 2 (1.6%) had fair outcomes. 22 (77.4%) of patients who received conservative treatment with a POP cast had outstanding functional outcomes, 13 (17.4%) had acceptable outcomes, and 5 (5.2%) had fair outcomes. Conclusion: In terms of a functional output with little difficulties, TENS provides numerous advantages over a more conventionally conservative treatment strategy.

135. Evaluation of Fine Needle Aspiration Cytology in Diagnosis of Lymph Node Lesions
Kavita Thakkar, Hiren Vaghela, Ashish Jawarkar, Premnath Hiryur
Introduction: Fine Needle Aspiration Cytology (FNAC) is a simple and rapid diagnostic technique because of rapid availability of results, simplicity, minimal trauma and complications, the aspiration cytology is now considered a valuable diagnostic procedure. Lymph node swellings are one of the commonest clinical presentation of patients and it encompasses a wide spectrum ranging from inflammation to a metastatic malignancy. Aim: The aim of this study is to evaluate the results of FNAC of lymph node lesions in our institution. Material and Methods: This is a retrospective study of all the cases of lymph node lesions that were referred to pathology department for FNAC. Results: In this 1-year study lymph node lesions were found in patients between ages of 1 to 80 years with male predominance. Overall, six lesions of lymph nodes were identified, namely: Reactive hyperplasia, Metastatic carcinoma, Granulomatous lymphadenitis, Suppurative lymphadenitis, Tubercular lymphadenitis and Lymphoma. All these lymph node lesions occurred at three sites, namely: Cervical, Inguinal and Axillary group of lymph nodes. Cervical group of lymph nodes were the most commonly affected site for lymphadenopathies and the most common lesion was reactive hyperplasia. Conclusion: FNAC has significant diagnostic value in differentiating lymph node lesions and offers valuable information for planning and subsequent disease management. It is most suitable for use on outpatient basis as it is quick, safe, minimally invasive, reliable and cost effective. The statistics and pathological features encountered in present study can be compared with studies reported from India and outside. The findings should contribute in better understanding of the disease.

136. Utility of the Biomedical Waste (BMW) Mobile App for Auditing BMW Segregation Practices in a Surgical Discipline of a Tertiary Care Hospital
Kuyare Sunil, Ginodia Saumitra, Warke Himangi, Kasar Smita, Bhosle Vaibhav, Nataraj Gita
Background: Appropriate segregation of biomedical waste is necessary not only legally but also for safer environment and health care worker protection. Presently, BMW Management Rules 2016 has been notified in India. Inappropriate waste segregation is the biggest challenge. Audits are known to help identify lacunae and improve practices. However, conventional audits require paper documentation and communication to different departments and are time consuming which makes it difficult to implement/sustain. The present study was planned to assess the utility of newly conceptualized(copyrighted) mobile app as an audit tool to improve waste segregation practices. Methodology: The mobile app captures practices while maintaining strict confidentiality and works on android based application ensuring restricted and password protected access. After approval from Institutional Ethics Committee, a prospective study was planned in a surgical discipline using the mobile app which included observation of the waste segregation practices in two phases i.e. pre intervention and post intervention for a period of one month each(intervention being training on appropriate waste segregation practices). Waste segregation practices were analyzed. Results: During pre-training audit, 93.4%(1032/1105 observations) of biomedical waste segregation practices were found to be appropriate. Inappropriate segregation was found with reference to waste in yellow category(63%) followed by red category(17.8%). The items that were inappropriately segregated included gloves(52.5%), plastic apron(7.5%), blood bags(7.5%) and non-infectious waste(8.8%). Post training, appropriate segregation improved to 99.7%(1490/1495 observations) which was statistically significant(p<0.05). Conclusion: Mobile app was found to be useful in reducing inappropriate segregation practices. It is easy to use and will support implementation process.

137. Exploring Parents’ Perspectives on Children’s Screen Time: Knowledge, Attitude and Practices
Priyanka Bansal, Aswin Raveendran KU, Aayush Aggarwal, Shiv Singh Manjhi
Background: In recent years, screen time has become a pervasive aspect of children’s lives, with children spending an increasing amount of time on various digital devices. Despite various recommendations, many parents struggle to limit their children’s screen time. Aims and objectives: To estimate the exposure of media and its influence among school going children. Materials and Methods: A school based cross-sectional study was performed on parents of children between 3 years and 13 years in three different schools in Shivpuri district of Madhya Pradesh. Their knowledge, exposure and attitude regarding screen time of children were extensively analyzed with the help of a predesigned and detailed questionnaire. Results: Many parents have limited knowledge about the appropriate amount of screen time for their children and the potential negative effects of excessive screen time. Parents have positive attitudes towards the educational benefits of screen time but express concerns about its potential negative effects on their children’s health and well-being. Parents’ screen time practices are influenced by various socio-demographic factors such as their age, education, income, and employment status. Conclusion: Overall, the study suggests that there is a gap between parental knowledge, attitude, and practice on children’s screen time. There is a need for parental education programs to improve parents’ knowledge about the appropriate amount of screen time for their children and strategies to mitigate the negative effects of excessive screen time.

138. Bacteriological Profile of Acute Exacerbation of IPF
Parag Sharma, Soniya Saxena, Payasvi Baweja, Nishant Srivastava, Lokendra Dave, Ratan Kumar
Introduction: Idiopathic pulmonary fibrosis (IPF) is a fatal disease with unknown or idiopathic aetiology, characterized by a radiographic and pathologic pattern of usual interstitial pneumonia (UIP)[1,2]. Patients with IPF have either a progressive course of worsening respiratory function, or a more rapid decline described as acute exacerbation (AE-IPF). Out of the infectious agents, bacterial exacerbation and the possible alteration of alveolar healing by bacteria are the least explored [6-8]. A recent study by Jonathan J Smith et al [13], has pointed to a disordered host defense and thus susceptibility to infection, as an important contributor to disease progression in IPF. Aim: This study analyses the sputum for bacterial isolates in patients with acute exacerbation of IPF and aims to find the significance of such association. Materials and Methods: Sputum samples of 120 patients who came with acute exacerbation of IPF to a Tertiary Medical College and Hospital between January 2021 to January 2022 were analyzed. Patients who were unable to produce sputum and who had received antibiotics for the present exacerbation prior to admission were excluded. Expectorated sputum samples were subjected to gram staining and after assessing the sputum quality. Chi-Square tests were used to find the significant association between the bacterial isolates in the sputum samples. Results: Among the 120 patients, there were isolates in 78.3% (n=94 ) and rest had no isolates. Streptococcus pneumoniae was isolated in 24 patients and Escherichia Coli in 26 patients and these were found to have significant association statistically in patients presenting with acute exacerbation of IPF. Whereas the rest of the isolates like Klebsiella (n=18), Haemophillus influenza (n=16), Enterococcus (n=4) and Moraxella catarrhalis (n=6) were found to have insignificant association. Conclusion: Preserving the lung functions in patients with IPF is the main aim of treatment. Whether infectious causes play a role in decreasing lung function and treating these with prophylactic antibiotics needs to be seen with larger studies in different geographic areas.

139. Evaluation of Hazards of Ionizing Radiation on Nerve Conduction in Superior Extremity with Duration of Exposure at Tertiary Care Institute: A Comparative Study
Kiran Thorat, Manish Goyal, Priyanka Bansal, Shefali Singhal
Introduction: Peripheral neuropathies are unfavorable consequences of radiation treatment. Tissue changes due to Radiation Exposure result in inflammation and fibrosis that affect the peripheral nerve and lead to peripheral neuropathies. Since the introduction of numerous new radiologic procedures, uses of radiation are increasing in modern medicine. Radiation exposure of Radiologic Technologists (RTs) is about two times higher than that of other occupation groups in the fields , such as physicians, dentists, dental hygienists, and nurses. For better understanding peripheral nerves functioning Nerve Conduction Study (NCS) are most frequently used in neurophysiological laboratories. . we tried to study the effect of chronic radiation exposure on peripheral nerve conduction study parameters in RTs. Material and Methods: The Present study is a cross-sectional analytic prospective hospital-based study. In present hospital-based study a sum of 60 individuals were selected, of which all of them were Radiologic Technologists (study group/cases), were grouped upon duration of occupational radiation exposure. Group I-RTs with duration of exposure <10 years averaging 6.27 ± 2.05 years. Group II – RTs with duration of occupational radiation exposure 11-25 years averaging 14.44 ± 3.35 years and Group III – RTs with duration of occupational radiation exposure >20 years averaging 23.60±5.21. The Nerve conduction study parameters were recorded with the help of computerized RMS EMG EP Mark –II, made 2015 machine, Panchkula, Haryana, using conducting jelly and recording electrodes. Results & Discussion: We found changes in both sensory and motor nerve conduction study parameters in RTs of different duration of occupational exposure. With increase in duration of exposure nerve distal latencies were increased and, Amplitudes (CMAP/SNAP) and NCV were reduced among group I and III. Group II showed variable results. Nerve Conduction velocity showed a reducing trend with the increasing duration of radiation exposure, this may be due to the reason that Nerve Conduction velocity excludes the individual anthropometric variations. Conclusion: Conclusion of our study is that ionizing radiations are harmful to all the body tissues including the peripheral nerves. Radiations appear to cause both demyelination and axonal loss.

140. Comparison of Handholding and Conversation alone or with Midazolam Premedication on Preoperative Anxiety in Adult Patients undergoing Lumbar Spine Surgeries: A Three Arm Parallel Randomized Controlled Trial
Girdhari Lal, Shobha Purohit, Neelu Sharma, Sonal Mishra, Rekha Kumawat
Introduction: Preoperative anxiety is associated with hemodynamic instability and poor post operative outcome like increased pain, analgesic consumption, recovery time and length of hospital stay. Present study aimed to compare effect of hand holding with conversation or IV midazolam and combination of these for relieving anxiety among patients undergoing lumbar spine surgery. Material and Methods: This Hospital based three-arm parallel-group randomized controlled trial included 108 patients aged 18 to 45 years undergoing elective lumbar spine surgery. Randomization and sequentially numbered opaque sealed envelope were used allocate subjects to one of the three groups – Group-A: 0.05 mg/kg of midazolam diluted in 5ml normal saline intravenously; Group-B: hand-holding and conversation with 5ml normal saline intravenously; Group-C: hand-holding and conversation with 0.05 mg/kg of midazolam diluted in 5ml normal saline intravenously. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to evaluate anxiety. Results: The change in APAIS score post intervention was highest in Group C (5.42 ± 3.09), followed by Group B (4.33 ± 2.87) and minimum in Group A (1.80 ± 1.61); {p<0.001}. Change in Ramsay sedation score was highest in Group C (1.06 ± 0.41), followed by Group A (0.91 ± 0.43) and minimum in Group B (0.16 ± 0.42), {p<0.001}. The mean heart rate was significantly higher in Group B at 5 min (p=0.030), 10 min (p=0.036, 15 min (p=0.031) and 20 min (p=0.028). Mean SBP was significantly lower in Group B at 15 minute (p=0.008) and 20 minute (p=0.004). No significant difference was seen in DBP or MAP at any time intervels among the study groups (Figure 2). Conclusion: Combination of hand-holding and conversation with injection midazolam in preoperative period is more effective in reducing anxiety in terms of lower SBP, HR and APAIS.

141. Prevalence and Predictors of Chronic Genitourinary Conditions in Older Women in India: Longitudinal Ageing Study in India Findings
Bhagirathi Pradhan, Smrutirekha Behera, Sibasis Acharya, Madhushree Naik
Introduction: When it comes to longevity, women outlive males. This does not ensure a healthy existence, either, as women are typically marginalised in society. Furthermore, a number of normal physiological changes that occur in women during midlife are accompanied with chronic illnesses, such as genitourinary disorders. This study set out to determine the prevalence and correlates of chronic renal failure, incontinence, and kidney stones in Indian women over the age of 45. Methods: Data from the Longitudinal Ageing Study in India (LASI) wave-1, which took place between 2017 and 2018, was used. The study comprised 32,097 women in total who were 45 years old. Descriptive statistics and a 95 percent confidence interval as a measure of uncertainty were employed to report prevalence. To examine the link between several sociodemographic and behavioural predictors and the outcome, which included chronic renal failure, incontinence, and kidney stones, a separate multivariable regression analysis was carried out. Results: Incontinence was present in 2.9 percent (95% CI: 2.72-3.09), chronic renal failure was present in 0.53 percent (95% CI: 0.45-0.62), and diabetes was present in 2.28 percent (95 percent CI: 2.11-2.45). Those over the age of 75 had a greater risk of incontinence, according to the multivariable regression analysis [AOR: 1.81 (95 percent CI: 1.34-2.44)]. Those who were obese had a significantly increased risk of kidney stones (AOR: 1.98; 95% CI: 1.53-2.55). Conclusion: We found that chronic genitourinary diseases were significantly more common in elderly women, which is important to note. It is important to improve the recently established Health and Wellness Centers (HWCs), which have the potential to be a window of opportunity for equitable and timely care.

142. Reliability Indices of Biometric Values Compared to Goniscopy in the Diagnosis of Primary Angle Closure Suspects
Harsha S Das, Dalia S, Sija S, Dhanya R S
Glaucoma is one of the leading causes of irreversible blindness. Glaucoma affects 2-3 % of people of age more than 40 years, of which 50% are undiagnosed. Angle-closure glaucoma is the predominant cause of morbidity from glaucoma in Asian populations. Hence screening programs have a large role in preventing angle-closure glaucoma.
According to estimates from the WHO from 1995, glaucoma is responsible for 51 lac blindness cases, or 13.5 percent of all cases of blindness worldwide. Since glaucoma more frequently strikes the elderly, it impacts all societal groups and has serious physical and financial ramifications, making it a major public health issue. For the purpose of making a primary angle closure suspicious assessment, we examined the central anterior chamber depth, lens thickness, and axial length in the current investigation (PACS).

143. A Study on the Effect of Intranasal Steroids on Intra Ocular Pressure in Allergic Rhinitis Patients Attending a Tertiary Teaching Hospital
Kosoori Sreenivas, Porika Ram Mohan Lal, Salvadi Ramesh Kumar
Background: Allergic Rhinitis is a worldwide burden of disease and in India the prevalence is 25 to 30% of the population. Oral and Intranasal steroids are used as a mode of treatment in 10% of these patients. The effect of intranasal steroids on intra-ocular pressure was reported in the literature and in this study an attempt was made to review its incidence and effects on the vision over a period of 16 months. Aim of the Study: To study the effects of intra nasal steroids used in Allergic Rhinitis patients on the intraocular pressure and vision. Materials: 109 patients aged between 15 and 65 years who were using Intra nasal steroids belonging to both genders were included. The Allergic Rhinitis response score was used and graded as Allergic Rhinitis score: Good- 45 to 60, Moderate- 30 to 45, Average- 20 to 30 and Poor- Less than 20. Parameters used were decrease in rhinorrhea, nasal obstruction, sneezing, time taken for relief and improved quality of life. All the subjects were assessed with visual acuity and intraocular pressure using Goldmann applanation tonometry. The Goldmann tonometer was calibrated. Results: The mean age was 32.35±4.15 years in males and 28.45±2.15 years in females. There were 69/109 (63.30%) male patients and 40/109 (36.69%) female patients. Pearson coefficient correlations showed significant statistical significance between tonometry results and steroid usage in both the eyes (p value was 0.021; p significant at less than 0.05). Conclusions: This cross-sectional study showed that Intra nasal steroids were safer in patients with Allergic Rhinitis without any Intra ocular pressure changes. The study showed a statistical significant data in favour of INS. However the Ophthalmologists should be aware of INS causing IOP in patients using INS. The ENT surgeons should cautious of occurrence of IOP in Allergic Rhinitis patients treated with INS. Such awareness remains significant in patients with glaucoma risk. Large sample cohort study would be welcome to evaluate the long-term results.

144. Diagnostic Accuracy of Van Herick Technique Compared to Goniscopy in Detecting Primary Angle Closure Suspects among Eclipse Sign Positive Cases
Harsha S Das, Dalia S, Dhanya R S, Sija S
One of the main causes of permanent blindness is glaucoma. Primary angle closure glaucoma affects 0.75 percent of adult Asians and 0.46 percent of adult Indians. The optic nerve head and the patient’s vision are in danger since many angle closure glaucoma patients present at the stage of acute congestive glaucoma. Prophylactic laser peripheral iridotomy, an outpatient technique, can stop angle closure glaucoma from developing once an occludable angle has been found. So it’s critical to check candidates for occludable angles.

145. The Use of Fine Needle Aspiration Cytology (FNAC) for the Identification of Soft Tissue Cancers and Lesions that Resemble Malignancies
Ashok Kumar, Sandip Kumar
Background: Soft tissue tumors are a diverse category of lesions that develop from the body’s extraskeletal non-epithelial tissue. In a hospital population, benign tumors outnumber malignant ones by a factor of ten. Due to their incredibly diverse shape, it is questionable whether or not soft tissue tumors should be evaluated with fine needle aspiration cytology (FNAC). The primary objective was to assess the value of FNAC as a standard method for identifying soft tissue cancer, and, 2. To assess the diagnostic precision and relationship between cytomorphological and histomorphological traits. Methods: The cytological examination of FNAC conducted on soft tissue cancers reported to Jannayak Karpoori Thakur Medical College and Hospital, Madhepura in over a 1-year period is the subject of this retrospective study. Evaluation and correlation of the histomorphological characteristics of the biopsies taken with FNAC results. The patient records contained pertinent clinical information that was collected. Results: 172 (91.5%) of the 200 cases of soft tissue tumors examined were benign, 25 (8.1%) were malignant, and 3 (0.4%) were inconclusive. Lipoma and its variations made up the majority of benign tumors (82%), while Pleomorphic sarcoma made up 19.4% of malignant cases. In malignant patients, cytohistomorphological correlation was 99% concordant, and one case that had been initially diagnosed as benign turned out to be malignant after the biopsy. Conclusion: A safe and affordable diagnostic method called FNAC can pretty accurately correlate the histomorphology of soft tissue cancers.

146. A Study of the Socio-Demographic Profile and Treatment Outcome of Paediatric Tuberculosis Patients
Pragya Sinha, Khalid Anwar, Shikha, Amita Sinha
Background: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the 9 million annual tuberculosis cases, about 1 million (11%) occur in children (under 15 years of age). In countries worldwide, the reported percentage of all tuberculosis cases occurring in children varies from 3% to more than 25%. Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. Methodology: There are nine Tuberculosis units in Patna. Five Tuberculosis units from the nine tuberculosis units were selected by simple random sampling method. The study was conducted from Jan 2022 to Oct 2022. The paediatric patients diagnosed as TB and registered under RNTCP were included in the study till the sample size of 209 was reached. Data regarding sociodemographic profile, type of TB was collected, and the patients were followed for treatment outcome. Conclusion: Paediatric tuberculosis still continues to be a major problem in 1-5 years of age who are undernourished and belonging to low socioeconomic status. Thus, improving the socioeconomic conditions and proper treatment of adult TB who are the source of infection to children will go a long way in preventing paediatric TB.

147. Histomorphological Analysis of Gastric Polyps: A Retrospective Study
Raja Gopal, Lavanya Narasingamoorthy
Introduction: A polyp is a tumorous mass that projects above the surrounding mucosa and protrudes into the lumen of the gut. Polyps are common in 6th and 7th decade, though they may occur in any age. Majority of polyps are sporadic in nature and familial polyposis syndromes are rare. Aim of the Study: To study the incidence and morphology of different types of gastric polyp and to analyze the incidence and morphological features of malignancies associated with polyps. Methods: It is a retrospective study done at our institute between January 2014 and December 2015. This study includes all lesions identified as polyps and polypoidal lesion in stomach. The specimen includes both endoscopic biopsies and resected specimens. Nodules and ulcerated mass lesions were excluded. Results: Prevalence of gastric polyp among the gastrointestinal (GI) specimens was 4.4%. common age group is among 5th and 6th decades. Men have higher incidence with 1.4:1 ratio. Common site of occurrence was antrum and commonest morphological type was hyperplastic polyps. Hyperplastic polyp more than 1.5 cm and adenomatous polyps are associated with dysplasia. Malignant polyps occurrence rate was 3% in our study. Conclusion: Hyperplastic polyps are more common in our region and larger size polyps warrant excision and should be subjected to histopathological examination to rule out dysplasia or malignancy.

148. A Study on Asymptomatic Bacteriuria in Women with Diabetes Mellitus
Veeranna Addanki, Kummamuru Ravi, Srikanth Dubbaka, Rajiv Kumar Bandaru, T Jaya Chandra
Introduction: Urinary tract infections (UTIs) are clinically relevant problem for patients with diabetes mellitus (DM). Many UTIs are asymptomatic especially in women. Hence a study was conducted to estimate the prevalence of asymptomatic bacteriuria among women with DM and also to identify the causative organisms with its antibiogram. Methods: It was a prospective research conducted in the department of general medicine, ESIC medical college, Hyderabad. Study was conducted between Women with DM were included in this research. Women with symptoms of UTI, those catheterised 2 months before the study, those proceeded for urogenital instrumentation 2 months before the study, pregnant women, those used antibiotics 14 days prior to the study, those with gynecological infections, non-cooperative women were not considered in this research. The participants were thoroughly explained about the collection of mid-stream urine (MSU). Nursing assistance was also provided for elders. Urine was collected in a sterile wide mouthed screw cap bottle for culture as well as microscopy. Culture of urine specimen, identification of the pathogens along with antimicrobial sensitivity were carried as per the guidelines. Results: Total 200 members were included in the test and 75 in control group; mean age was 52.2 ± 11.5 and 51.7 ± 11.9 years, respectively. The rate of significant bacteriuria (SB) was 68 and 6, respectively in the groups (Table 1). In the test group, Escherichia coli (56; 82%) was the leading causative agent followed by Klebsiella pneumoniae (6), coagulase negative staphylococcus (CoNS). Majority isolates from diabetic women were susceptible to conventional antimicrobial drugs. Conclusion: This study showed that the prevalence of asymptomatic bacteriuria is higher in diabetic women, age is an important risk factor. Longer duration of diabetes has increased risk of asymptomatic bacteriuria.

149. Biochemical Insights into Chronic Alcoholism: A Prospective Observational Study on Liver Function and Oxidative Stress Markers
Prem Kumar Gera, Lakshmi Narasamma Vellanki, Bharathi Madaka, Sandhya Saripalli
Chronic alcoholism, defined by the World Health Organization as habitual consumption of around 75ml of pure ethanol or 200ml or more of 40-60% alcohol, is a pressing public health issue worldwide. Biochemical tests have been instrumental in uncovering the complexities of chronic alcoholism, providing valuable prognostic insights. In this study, we investigated the levels of total bilirubin, direct bilirubin, indirect bilirubin, liver enzymes (SGPT, SGOT, ALP, GGT), serum calcium, serum magnesium, and malondialdehyde (MDA) in chronic alcoholics compared to healthy controls.
A prospective observational case-control study was conducted in the Department of Biochemistry with a total of 100 male subjects, 50 of whom were chronic alcoholics (Group 1), and 50 age and sex-matched healthy controls (Group 2). Our findings indicated that chronic alcoholics had a mean age of 45.06± 8.83 years, while the mean age of controls was 42.44 ± 8.91 years.
Our analysis revealed that chronic alcoholics had significantly higher levels of total bilirubin and direct bilirubin compared to healthy controls. Indirect bilirubin levels were also higher in the chronic alcoholics, but the difference was not statistically significant. Furthermore, chronic alcoholics had significantly higher levels of SGPT, SGOT, ALP, and GGT enzymes compared to healthy controls. Conversely, the mean value of serum calcium was significantly lower in the chronic alcoholics. Finally, our study demonstrated that malondialdehyde (MDA) levels were significantly higher in the chronic alcoholics compared to the healthy controls.
In conclusion, our study provides compelling evidence of the detrimental effects of chronic alcoholism on liver function and oxidative stress markers. These findings underscore the importance of early diagnosis and intervention in the management of chronic alcoholism, which is critical for improving patient outcomes and reducing the burden of this debilitating disease.

150. Awareness about Complications of Diabetes among Diabetic Patients Attending Urban Health Training Centre, Katihar Medical College, Katihar
Faraze Ahmad, Prawin Chandra, Purnendu Kumar Singh
Background: Diabetes is a chronic disease, and a group of metabolic disorders which manifests as hyperglycemia for prolonged period that occurs either when the pancreas does not synthesize sufficient amount of insulin. Diabetes is an important public health issue and a priority non-communicable disease (NCDs) targeted for action. Objectives: To assess the awareness levels of the diabetic patients attending the Urban Health Training Centre of Katihar Medical College regarding the complications of Diabetes Mellitus. Materials and Methods: This is a cross sectional study which was conducted at Sharifganj, which is Urban Health Training Centre of Katihar Medical College, Katihar. The duration of this study was three months from August to October of 2021. This study was carried out among diabetic patients who were 30 years and above and were visiting UHTC, Sharifganj. Results: This study was conducted among 107 diabetic patients aged 30 years & above and 52.33 % were males & 47.66 % were females. The maximum burden of the disease was in the age group above 45 years i.e. 77.58 %. 81.30 % patients believed that diabetes cases were on the rise these days, 63.4% patients believed that Diabetes could be prevented.75.6% subjects knew that Diabetes affects other organs. Conclusions: It is a well-known fact that prolonged duration of Diabetes leads to various associated complications, lack of awareness & poor disease control contribute to disease related morbidity. Simple lifestyle modifications like regular exercise & diet control can go long way in dealing with Diabetes & its complications.

151. Effect of Glycemic Control on Urinary Tract Infections in Type 2 Diabetic Mellitus
Ritesh Kumar, Ujwal Kumar, Sameer Trivedi, Lalit Agarwal, Yashasvi Singh, Sridhar Reddy
Background: Type 2 Diabetes Mellitus (DM) is frequently associated with increased risk of Urinary Tract Infection (UTI). Bacterial UTI are common in diabetics and need aggressive treatment. In this study we aim to evaluate the effect of glycemic control on UTI in Type 2 diabetic patients. Materials and Methods: This is a retrospective study that included patients reporting to the outdoor with type 2 diabetes mellitus and symptomatic UTI from January 2021 to October 2022. Patients were divided into two groups based on glycemic control, Group 1: good glycemic control (HbA1C <7%), Group 2: suboptimal glycemic control (HbA1C 7%). Quantitative variables were expressed as mean ± standard deviation and analyzed using independent sample t-test. Qualitative variables were expressed as percentage and was analyzed using Fischer Exact test. Results: We retrospectively collected and evaluated the data of 156 Type 2 DM patients with urinary tract infection. Prevalence of good glycemic control & suboptimal glycemic control was 33.7%& 67.3 % respectively. Prevalence of Gram negative, Gram positive and Candida were 71.8, 19.9%& 14.1% respectively. Acute pyelonephritis was significantly more in suboptimal glycemic control group in comparison to good glycemic control group [24.7% vs. 9.8%, p value 0.0325]. Cystitis was more common in good versus suboptimal glycemic control but was not statistically significant [78.4% vs 67.6%, p=0.19]. Conclusion: In type 2 diabetes mellitus, acute pyelonephritis was more common in suboptimal glycemic control group in comparison to good glycemic control. Age & WBC (White Blood Cell) count was significantly higher while Hemoglobin and GFR was significantly lower in suboptimal glycemic control group in comparison to good glycemic control group.

152. Comparison between Fentanyl and Nalbuphine Pretreatment in Prevention of Etomidate Induced Myoclonus
Irfan Ahmad Siddiqui, Renu Dhamnani, Jaya Sinha, Prayank Mandloi
Background: Etomidate is a cardio stable intra vascular induction agent associated with myoclonus, a frequent and dangerous side effect of etomidate induction, and many opioids have been studied for effectively attenuating etomidate induced myoclonus. But there is no evident literature comparing the efficacy of nalbuphine and fentanyl pretreatment on Etomidate induced myoclonus, this study was engineered to compare efficacy of 0.2mg/kg nalbuphine and 2mcg/kg fentanyl intravenous pretreatment for myoclonus prevention caused by Etomidate. Aims: Aim of this study is to compare the efficacy fentanyl with nalbuphine in prevention of etomidate induced myoclonus. Material and Methods: This prospective randomized double blind placebo controlled study was conducted in a tertiary hospital associated with a medical college, 60 patients undergoing elective surgeries under general anaesthesia were randomly allocated to one of the two groups 2mcg/kg of fentanyl in 10ml of normal saline(group I) or 0.2mg/kg of nalbuphine in 10ml of normal saline(group II) 150 seconds before injecting iv Etomidate 0.3mg/kg administered over 20 seconds, patients were assessed for severity of myoclonus associated with etomidate induction over next two minutes. Students t test, chi-square test were used as per the requirement and a P value of <0.05 was considered statistically significant. Result: Out of 60 patients 30 were pretreated with fentanyl and 30 were pretreated with nalbuphine prior to etomidate induction. In our study 14(46.62%) patients from fentanyl group developed myoclonus whereas only 6(20%) patients from nalbuphine group developed myoclonus, 4(13.32%) patients from fentanyl group had pain on injection whereas only 2(6.66%) patients from nalbuphine group had pain on injection, 6(19.98%) patients from fentanyl group developed minor side effects like bradycardia 2(6.66%), hypotension 2(6.66%), nausea vomiting 1(3.33%), sedation 1(3.33%) whereas in nalbuphine group 8(26.64%) patients developed minor side effects like bradycardia 3(9.99%), hypotension 2(6.66%), nausea vomiting 2(6.66%), sedation 1(3.33%). Conclusion: Both groups were comparable with respect to demographic characteristics, the incidence(46.62% in group I vs. 20% in group II) and severity(0.4 in group I vs 0.8 in group II), of myoclonus was significantly reduced in nalbuphine pretreatment group compared to fentanyl group, whereas the safety profile of both the groups was comparable with no significant side effects; (95% confidence interval, P < 0.05).

153. A Study on the Clininico-Haematological and Biochemical Profile of Anaemia in Pediatrics
Rakesh Kumar Kalra, Tripti Srivastava
Objectives: This present study was to evaluate the clinico-haematological and biochemical profile and associated factors of anaemia in various age group of children. Methods: Parents /guardians of children were interviewed for the demographic, socioeconomic status, medical history and previous history of taking any medications and supplements. Venous blood specimens were collected and was transferred to a tube containing ethylenediaminetetraacetic acid (EDTA), and within 4 hours a whole blood count was performed using an automated cell counter. Notation was made. Haemoglobin estimation was done by automated hematology analyzer and peripheral blood smear was prepared simultaneously by a trained lab technician. Estimation of serum B12, folate and ferritin were performed by the Chemiluminescence method and estimation of TIBC was done by Ferene method in a semi-automatic machine. Results: A total of 100 children with age 1 to 15 years were enrolled in this study. Most of the children 46(46%) were in age of 01-05 years and 56(56%) males. Most of the children 49(49%) had microcytic hypochromic anaemia. 33(33%) had normocytic normochromic anaemia. Dimorphic anaemia was 12(12%). 87 patients out of 100 cases were found to have significant correlation between red cell indices and peripheral blood smear. Out of 49 microcytic hypochromic anaemia, 42(85.71%) cases had reduced red cell indices. Conclusions: Iron deficiency anaemia is the most common in young children. Males were preponderance than females. Microcytic hypochromic and normocytic normochromic anaemia are the most common in paediatric age group. Hence, for the prevention from the anaemia, paediatric health check-up camp should be organise in rural as well as urban area for the awareness and counselling of the parents/guardians for child feeding practices, immunization and sickness recognition from the first year of life and also for the proper screening/assessment of anaemic children.

154. A Study of Vestibular Dysfunction in Patients with Chronic Kidney Disease
Mahima Singh, Rajkumar Bhati, Navneet Prasad Mathur
Introduction: Chronic kidney disease is a slowly progressive disease that causes irrevocable loss of renal function and is considered a public health problem worldwide. CKD patients can be treated by peritoneal dialysis, haemodialysis and kidney transplantation. These may result in electrolyte, biochemical, osmotic, vascular and immunological abnormalities in the inner ear causing vestibular and cochlear manifestations like tinnitus, vertigo and decreased hearing. Therefore the aim of this study was to determine association of chronic kidney disease (CKD) with vestibular dysfunction in a general population. Methods: 60 CKD patients were evaluated in this study. The data collected from the participants included age, gender, an estimated glomerular filtration rate (eGFR), CKD stage, CKD etiology, whether on ototoxic drugs or not, whether on dialysis or not. Video Head Impulse Test (vHIT) performed on these patients. Results: The number of participants with vestibular dysfunction was 2 out of 60, that is 3.3%. These participants were found to have reduced VOR Gain i.e. abnormal vHIT. Both of them showed the presence of corrective saccades. Conclusions: CKD was not found to be associated with vestibular dysfunction in our study. Considering the limitations of this study, further studies are required to evaluate the relation of CKD with vestibular dysfunction.

155. A Study to Assess Cardiovascular Risk Factors in Subclinical Hypothyroidism in Tertiary Medical Centre
Bipul Kalita, Gagan Garg, Sushil Kumar, Ujjwal Sourav
Introduction: The TSH increase in SCH is typically between more than 5 and within 10 Iu/ml, while individuals with a TSH over 10 Iu/ml tend to have lower free T4 levels and may exhibit typical hypothyroid symptoms. According to several research and current therapeutic recommendations, individuals with subclinical hypothyroidism have a greater risk of cardiovascular disease (CVD) and all-cause death than those with euthyroidism. Aim and Objective: To evaluate patients with subclinical hypothyroidism’s cardiovascular risk by looking at their lipid profiles, homocysteine levels, C-reactive protein levels, and platelet counts. Materials and Methods: From June 2021 to June 2022, this descriptive longitudinal study was carried out at the government medical college in Saharanpur. 40 newly diagnosed subclinical hypothyroid female patients between the ages of 30 and 60, with 40 like aged and gender patients. Study subjects were recruited as per inclusion and exclusion criteria. The key factor used to diagnose SCH was a somewhat elevated TSH level (10 IU/ml) with a normal free T4 level. Result: The mean total cholesterol was 194.71±58.34, their mean LDL was 119.42±24.01, their mean HDL was 46.06.14, their mean TGL was 135.6937.99, their mean homocystine level was 13.818.05, and their mean CRP level was 6.924.40. The research subjects’ mean TSH was 5.143.11, whereas the mean free T3 was 0.340.29 and the mean free T4 was 1.030.14. Conclusions: Based on the study’s findings, we can say that people with subclinical thyroid abnormalities are more likely to be overweight, have pre-hypertension, have dyslipidemia, and have higher CRP. Due to these changed parameters in the subclinically hypothyroid female participants, it may result in the development of cardiovascular risk.

156. Serial Serum Albumin and C-Reactive Protein Levels as Predictors of Mortality in Critically Ill Patients
Suhena Patel, Rahul Gambhir, Hiren Makwana, Pankaj Patil
Background: It’s important to identify those ICU admitted patients at the time of admission who are likely to have a poor outcome for their better management. Serum Albumin (SA) & CRP (C-reactive protein) levels can act as potential predictor of prognosis. Objectives of the study are: (1) to evaluate the CRP and albumin as prognostic markers in critically ill patients (2) to assess for correlation of S. Albumin & CRP levels with mortality (3) the association between duration of stay and mortality in critically ill patients. Patients & Methods: Prospective observational study involved 100 critical admitted patients. Results: SA (<3.5 g/dl) on Day 1, Day 3 & Day 5 or CRP levels (>11 g/dl) on Day 1, Day 3 & Day 10 is a suggestive of bad prognosis (in terms of survival). Decrease in albumin level >0.9 g/dl from day 1 to day 10 or rise of mean CRP level to >12 on days 1,3 & day 10 is a suggestive of bad prognosis. Equation obtained in study correctly predicts survival with 82% accuracy. A steady increase in CRP / albumin ratio or a higher score in APACHE-II indicates a poor prognosis. Conclusion: Equation obtained in study can predict survival with accuracy of 82%. CRP level (>11g/dl) on Day 1, Day 3 and Day 10 or decrease in albumin level of more than 0.9 g/dl from day 1 to day 10 is a suggestive of bad prognosis. Average duration of ICU stay was higher in non-survivors than survivors. Highlights: Serial serum albumin and c-reactive protein levels can act as predictors of mortality in critically ill patients. Equation obtained from this study can determine prognosis accurately using both these predictors in 82% of cases.

157. The Efficacy and Safety of Extraamniotic Mannitol along with Carboprost (PGF2α) and Intracervical Misoprostol (PGE1) in Second Trimester Termination of Pregnancy: A Prospective Comparative Clinical Study
Jakhetiya Bhamini, Chaudhary Divya, Upadhyay Shradha, Gupta Arun, Chaudhary Vaani, Sharma Aditi
Introduction: Second trimester termination of pregnancy accounts for around 10 to 15% of all abortions annually. These can be performed either medically or surgically. The aim of this study is to compare the efficacy and safety of extraamniotic mannitol along with carboprost (PGF2α) and intracervical misoprostol in second trimester termination of pregnancy. Result: The most common indication for termination of pregnancy was intrauterine fetal demise (41.7% in mannitol group and 45.8% in misoprostol group). Second trimester termination of pregnancy success rate was significantly higher in the extra-amniotic mannitol along with PGF2α group as compared to intracervical misoprostol group (95.8% v/s 75%, p<0.05).A significantly shorter duration from induction to delivery was observed in the extra-amniotic mannitol along with PGF2α group as compared to intracervical misoprostol group (19.3 ± 4.2 v/s 22.3 ± 2.1 hours, p<0.01).Incidence of side effects like pyrexia, diarrhea, abdominal pain and headache were significantly lower in the mannitol group as compared to misoprostol group. Conclusion: Extra-amniotic mannitol along with carboprost (PGF2α) is an effective and safe method for second trimester termination of pregnancy. The success rate of extra amniotic mannitol along with PGF2α was significantly higher with notably shorter induction-abortion interval. A remarkable lower hospital stay and fewer side effects were seen in patients induced by mannitol along with PGF2α.

158. Estimation of Prevalence of Asymptomatic Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites
Jitendra Jajoria, Hardayal Meena, Monika Chowdhary, Narendra Kumar Prajapat, Mohammed Riyaz Bhati, Pinki Tak, Rajesh Jain
Spontaneous bacterial peritonitis (SBP) is a serious and potentially life-threatening complication in patients with decompensated liver cirrhosis. The prognosis is generally improved if antibiotics are begun before the onset of shock and renal failure. Because of significant morbidity and mortality related to SBP, identifying predisposing factors is of great interest. The Model for End-Stage Liver Disease (MELD) score is a measure of mortality risk in patients with end-stage liver disease. Method: This is a prospective study conducted for the period of 1 year. Patients with ultrasound proven ascites & cirrhosis were selected for the study. After taking informed consent 10 ml of ascitic fluid is collected and sent for various biochemical analyses like proteins and sugar along with cell count. Results: Most of the cases were reported in the age group 41-60 years (N=28, 56%). 7 (14%) of cases were more than 60 years. The mean age of study participants was found 48.06± 13.03 years of age ranged from 14 to 85 years. Majority of cases were Male. Male female ratio was 1.94:1. Prevalence of asymptomatic spontaneous bacterial peritonitis in cirrhotic patients with ascites was found 16% (8 out of 50 cases). We found 12% (6 out of 50 cases) culture positive cases in cirrhotic patients with ascites, in which E. Coli was found in 50% of culture positive cases then Klebsiella (33.3%) and least number of cases show Streptococcus Viridans (16.7%). SBP was defined by Cell Count (PML) in Ascitic Fluid of cirrhotic patients with ascites, PML count of > 250/mm3, was found in 5 (10%) patients from 50, and in 45 (95 %) patients were reported cell count ≤250/mm3. Higher alcohol intake proportion was observed in SBP group which was statistically non- significant. In SBP group Statistically insignificant (P value >0.05) lower mean duration of cirrhosis was observed. Significant difference (P value <0.05) in the mean values of S. Bilirubin and INR between the presence and absence of SBP in patients. In the presence of SBP group, mean MELD was 29.88 compared to MELD of 21.81 in the absence of SBP group. All 8 patients with SBP had Meld score greater than 24. No patients with MELD score from 11-24 also had SBP, Whereas the patients in which SBP was absent, 10 patients have MELD score from 11 to 18 and 21 patients have MELD score from 19 to 24. This distribution was found statistically significant (P value <0.001) when compared the absence and presence of SBP in patients. By ROC analysis MELD Score is a good predictor of SBP in cirrhotic patients in our study (High values of MELD predict SBP). Conclusion: there is a low prevalence of SBP in asymptomatic individuals with ascites and liver cirrhosis. In the patient population under study, serum Bilirubin and INR concentration was found to be the accurate predictor of SBP episodes. We saw a tendency for the infection to develop more frequently in individuals with severe liver disease (higher MELD score).

159. Evaluation of Clinical Outcomes in Non-Surgical Management of Fistula: A Comparative Study
Hitender Suri, Deepika Suri, Sauvik Suri, Virendera Ghodke, Kamalpreet Bansal
Background: An anal fistula connects the anorectal area with the skin; a fistula is an abnormal route joining two epithelialized surfaces. Such a fistula often has an external orifice in the perianal skin and an internal orifice mostly in the anal canal, which frequently results in a chronic suppurative disease. Theoretically, surgical intervention for an anal fistula will eliminate sepsis, encourage tract repair, protect the sphincter system, and eliminate sepsis. Complex perianal fistulas have been treated using a number of methods, which is indicative of the fact that no one strategy has yet been fully successful. Conventional anal fistula surgery frequently results in continence issues, which is why innovative methods intended to achieve significant integrity of the apparatus of surgical intercention. Aim: This study was carried out to analyze the clinical outcomes of non surgical therapy of fistula using CIDCI technique. Methods and Materials: The examination of 84 individuals who received perianal fistula treatment at our institution served as the basis for this comparative study. The included individuals had been identified as having single-tract transsphincteric fistulas and suprasphincteric anal fistulas. Patients who had intersphincteric fistulas and sphincter impairment were also included All participants with history of Crohn’s disease, history of acute inflammatory changes, history of complex anal fistulas with many tracts and cavities, and other conditions were disqualified. The study participants were divided into two categories. Category A:Patients undergoing surgical management (n=42). Category B: Patients undergoing non-surgical management using CIDCI technique. (n=42). Results: In this study, infection was observed in 2 patients in group A patients while no mobility was was observed in 40 patients in group B patients. Infection was observed in 1 patients in group B patients while no mobility was observed in 41 patients in group B patients.(p˂0.05). It was observed that there was reduced infection and mobility in both technique of management of fistula. However the difference was not observed when comparison was made between two the groups. (p˃0.05).Healing of fistula was observed in 36 patients in group A patients while healing of fistulas was observed in 37 patients in group B. There was significant healing in both groups. However the difference was not observed when comparison was made between two the groups. (p˃0.05). Conclusion: It can be inferred from these findings that there was no difference between between surgical and CIDCI clinical outcomes like suppuration or infection in one or two patients and cellular or epithelial healing progress which is not different and which is similar in both procedures.

160. Efficiency of Diagnosis of Ureteral and Renal Stones by Diagnosis of  Sonographic Diagnostic Signs
Ekta Gupta, Namrata Jaiswal
Introduction: Kidney stones or urolithiasis is a prevalent form of health disorder affecting nearly 10 to 12% of men and 5 to 6% of women in the western world. The biological procedures of crystal anchorage within urothelium are still unclear. However, the development of calcium oxalate stones on “Randall’s plaques” erodes the urothelium forming a nucleus for the deposition of calcium oxalate. The passage of kidney stones through the ureter to bladder is painful. However timely diagnosis of kidney stones prevents any form of permanent damage. Patients are either advised to take medication and drink water or are advised to go for surgery after consulting medical expertise depending upon the situation. Aims and Objectives: To determine the diagnosis ureteral and renal stones using sonography and its associated signs that are found. Methodology: To collect information the research was conducted on 100 participants who came to the patient unit of our hospital during the period of six months. This research included patients with urinary stones (renal or ureteral) also. Even, unenhanced spiral “computed tomography” (CT), the “gold standard” for the proof of identity of urinary stones, were used to evaluate all people for the presence of urinary stones. Furthermore, all people were surveyed with plain abdominal radiography. Results: The researcher conducted this survey among 100 outpatients with urinary stones. To understand this research the research examined the sone with size ≤ 0.4 and > 0.4 is seen as high in renal stones compared to ureteral stones. 58.3% of ≤ 0.4 saw in grayscale US and 95% in twinkling artifact. 100% of >0.4 size stones saw in the twinkling artifact. The overall 67% and 97% of stones saw in grayscale and twinkling artifact respectively. Conclusion: the study concluded that there was no significant improvement in the results obtained from computed tomography compared to ultrasonography.

161. To the Study the Incidence and Severity of Atazanavir Induced Hyperbilirubinemia in HIV Patients Receiving Second Line Antiretroviral Therapy (ART)
Sunil Kumar Jangid, Ravindra Tiwari, Harsh Kumar Veshar, Jatin Jain, Chandra Kant, Munesh Kumar
Background: To the study the incidence and severity of atazanavir induced hyperbilirubinemia in HIV patients receiving second line antiretroviral therapy (ART). Methods: This study was a longitudinal observational study conducted at a tertiary care hospital. The study was approved by the Institutional Ethical Committee and written informed consent was obtained from all patients who was included in the study. All patients in the study population was initiated on second-line ART containing tenofovir, lamivudine, and ATV/r at a dose of 300/100 mg/day during October 2020 to September 2021 and followed up for at least 12 months. Results: A continuous increasing trend of mean serum bilirubin levels was seen during the study. In the case of total bilirubin 0.79 mg/dl, 1.52 mg/dl and 2.33 mg/dl were observed at the time of baseline, 6 months and 12 months respectively. In the case of Direct bilirubin 0.13 mg/dl, 0.26 mg/dl and 0.36 mg/dl were observed at the time of baseline, 6 months and 12 months respectively. In the case of Indirect bilirubin 0.67 mg/dl, 1.27 mg/dl and 1.95 mg/dl were observed at the time of baseline, 6 months and 12 months respectively. In our study, statistically significant (P value<0.05) increased in Serum total, direct and indirect bilirubin level were observed at 6 and 12 months from baseline. Conclusion: It was observed that most of the HIV-positive patients receiving Atazanavir in the ART regimen were found to develop transient hyperbilirubinemia. So, these patients should be regularly investigated and followed up for bilirubin levels and counselled accordingly to avoid discontinuation of the regimen due to cosmetic concerns like sclera icterus and jaundice. No life-threatening hepatic dysfunction has been reported. Discontinuation of ATV/r is advised only when there is a life-threatening complication. Conclusively, it was observed that Atazanavir is an effective 2nd line anti-retroviral drug but causes hyperbilirubinemia frequently.

162. Correlation between Glycemic Indices and Vitamin D in Patients with Type 2 Diabetes Mellitus
Mathur Pooja, Thadani Deepa, Makwana Asha, Mahawar Sarla, Shrivastava Mayank
Introduction: The incidence of type 2 DM is increasing worldwide and results from a lack of insulin or inadequate insulin secretion following increases in insulin resistance. The potential role of vitamin D in insulin resistance and type 2 diabetes mellitus is multifactorial. These effects of vitamin D deficiency, either acting in concert or alone, all serve to increase insulin resistance. Objectives: To estimate and compare the levels of Vitamin-D, HbA1c, fasting blood sugar and 2hour post prandial blood sugar levels in type 2 diabetes mellitus patients and healthy controls and to find any correlation between Vitamin D level and glycemic variables. Methodology: It is an observational descriptive, case control, hospital-based study conducted on 160 T2 DM patients and 50 healthy controls. Results: Glycemic variables, body weight and BMI were significantly high in diabetic group. Most of the study population was Vitamin D deficient. Conclusions: A significant inverse correlation was found between glycemic variables and vitamin D level. Most of the Indian population was Vitamin D deficient.

163. Association of Serum Butyrylcholinesterase Activity Level and 25 (Oh) D Level in Outcome of Organophosphorus Poisoning
Deepak Kumar Dewat, Anil Samaria, Anil Kumar Ranwa, Meenakshi Samaria, Monika Chowdhary, Sourabh Soni
Background: We do not find any study regarding status of vitamin D3 level and its role in outcome of organophosphorus poisoning in the world literature. Therefore this prospective observational cross-sectional analytic study was planned to evaluate status of vitamin D3 level in organophosphorus poisoning and its correlation with outcome of such patients. Methods: This cross-sectional study was conducted among 340 patients acute organophosphorus poisoning admitted in Casualty ward, MICU and attending the medical ward of JLN hospital, Ajmer during September 2021 to September 2022. Diagnosis of OP poisoning shall be made by history of poisoning including container of the poison brought by patient’s relative, clinical examination and measurement of serum butyrylcholinesterase activity. Results: Mean vitamin D3 in expired patients was 16.4±5.69 ng/ml and in recovered cases it was 52.97±49.97ng/ml and this difference was also found statistically highly significant (p<0.001). Conclusion: We observed that vitamin D3 deficiency is highly prevalent, and it is also associated with suicidal tendency. Vitamin D3 level is having linear correlation with length of hospital stay. Severe D3 deficiency is associated with more requirement for ventilator support, development of serious complication like ARDS, IMS and poor outcome.

164. A Study of Thyroid Dysfunction in Cirrhosis of Liver and Correlation with Severity of Liver Disease
Amit Kant, Anil Samaria, Anil Kumar, Meenakshi Samaria, Monika Chowdhary, Sourabh Soni
Background: Liver plays an important role in the metabolism of thyroid hormones, as it is the most important organ in the peripheral conversion of tetraiodothyronine (T4) to triiodothyronine (T3) by Type 1 deiodinase. Methods: This cross-sectional study was carried out at a tertiary care hospital, in central Rajasthan among 360 cases of cirrhosis of liver from all causes getting admitted in Medicine & Gastroenterology wards of JLN Medical college & Associated Hospitals, Ajmer after prior written and informed consent. Ethical approval was obtained from the Ethical Committee of this institution. Results: The mean FT3 levels were found to decrease (p=0.03) while the TSH levels increased (p=0.002) with increase in MELD score in the present study. This is due to impaired peripheral conversion of T4 to T3 by Type I deiodinase in cirrhotic liver. The sensitivity of FT3 in detecting the cirrhosis of liver at cut off of 1.05 MELD score was 91.8% and specificity 88.5%. The sensitivity of FT4 in detecting the cirrhosis of liver at cut off of 0.32 MELD score was 95.9% and specificity 84.7%. The sensitivity of TSH in detecting the cirrhosis of liver at cut off of 0.88 was 100% and specificity was 70.9%. Conclusion: The mean FT3 levels were found to be decreasing, while the TSH levels were found to be increasing with increase in MELD score due to impaired peripheral conversion of T4 to T3. The mean portal vein diameter was observed to increase with increase in MELD score because of development of portosystemic collaterals in cirrhotic liver which results in portal hypertension and dilatation of portal vein.

165. To Evaluate the Effect of Second-Line Anti-Retroviral Therapy on Blood Sugar in Patients with Human Immunodeficiency Virus (HIV) – Acquired Immune Deficiency Syndrome (AIDS)
Harsh Kumar Veshar, Munesh Kumar, Jatin Jain, Sunil Jangir, Chandra Kant, Sourabh Soni
Background: To evaluate the effect of second-line anti-retroviral therapy on blood sugar in patients with human immunodeficiency virus (HIV) – acquired immune deficiency syndrome (AIDS). Methods: This prospective study was carried out at a tertiary care hospital among 100 HIV infected patients who had failed on First line and started on Second-line HAART, formed the cases of the study and registered at ART centre. Ethical approval was obtained from the Institutional Ethical Committee of this institution. Results: Average FBS of the study population was 89.95mg/dl at the baseline.  However, it increased with the course of treatment over the time.  It was observed that the mean FBS raised to 103.18mg/dl in 6 months and 115.28mg/dl in 12 months. This difference was statistically significant (P<0.0001). Average HBA1c of the studied subjects was 5.65% at the baseline.  However, it increased with the course of treatment over the time.  It was observed that the mean HBA1c raised to 6.02% in 6 months and 6.46% in 12 months. This difference was found to be statistically significant (P<0.0001). Conclusion: In our study it was found that second line ART along with its duration is a significant risk factor for development of  Hyperglycemia. Hence timely screening should be done for FBS in patient who are on second line ART so that we can prevent and timely manage the Metabolic complications.

166. The Study of Pattern of Injury, Clinical Presentation, Organ Involvement and Associated Injuries in Patients of Penetrating Abdominal Trauma in a Tertiary Care Hospital
Minati Mohapatra, Srikanta Panda, NityaNutan Misra, Lamture Yeshwant R, Ansuman Sarangi
Background: Abdomen is the most frequently involved organ in penetrating injuries. Its anatomical location makes it unprotected and most susceptible for penetrating injuries either homicidal or accidental. Penetrating injuries can be caused by stab either homicidal or accidental, gunshots. This study is being done to evaluate various indications for emergency laparotomy and morbidity in penetrating abdominal injuries. Methods: The prospective observational study was conducted in SCB Medical College, Cuttack from October 2018 to September 2020. The study population included patients with penetrating injury to abdomen admitted to SCB Medical College & Hospital, Inclusion – selected patients with penetrating abdominal trauma who are admitted in emergency department and required some definitive intervention/ monitoring for evident abdominal organ injury or intra-abdominal haemorrhage or haematoma. Results: The study included 74 males and six females.63 patients with peritoneal penetration on local wound exploration, evisceration, those with haemodynamic instability, with  peritoneal signs underwent exploratory laparotomy. Of the 63 patients who underwent exploratory laparotomy, 54 had therapeutic laparotomy. It was negative in 9 cases. The commonest post-operative complications following penetrating abdominal trauma is respiratory complication. There were total five cases of intra-abdominal abscess occurring following trauma involving colon and small bowel. Conclusion: Measures taken for the care of patients at the trauma site and establishing well equipped trauma care centres at least at every district hospital will go a long way in preventing morbidity and mortality in these unfortunate victims.

167. Epithelioid Sarcoma of Retroperitoneum with Distant Metastasis in a Young Male: A Rare Autopsy Case Report
Lalita Yoganand Patil, Vasundhara Singh, Vikas Kavishwar, Sanraksha Mannya, Girish Rajadhyaksha, Charpe Prasad
Epithelioid sarcoma (ES) is a rare, high-grade malignancy of soft tissue, the most common location is in hand. In this case report, a 26-year-old male patient admitted with the history of polysubstance use such as alcohol, tobacco, ganja, and charas. The chief complaints of the patient were loss of appetite since 15 days, abdominal distension since 5 days, and pain in abdomen since 2 days. On enquiry, history of fever with chills and generalized weakness was present since 1 week. History of appendicectomy done 15 days back. Patient condition got deteriorated 3 days later and expired and partial post mortem examination was done, provisional diagnosis was confluent bronchopneumonia with septicemia in a case of disseminated malignancy which on histopathological examination revealed epithelioid sarcoma of extra-intestinal origin.

168. Clinico-Cytomorphological Evaluation of Cervical Lymphadenopathy Supplemented by Cell Block Study
Kasturi Dinesh, Narasimharao Bharadwaz Chennapragada, Karthik Kasireddy, Y. Sushma
Background: Accurate diagnosis of the cause of lymphadenopathy can sometimes be challenging and can lead to delay in diagnosis causing delayed treatment and health issues. Aim: This study evaluate various pathological entities involved in cervical lymphadenopathy and supplemented by cell block preparation. Method: A prospective observational study was carried out on 136 cervical lymphadenopathy patients with age group of 3-83 years who presented to outpatient department of Ear, Nose & Throat (ENT), General surgery, and at admitted wards. Clinical history, fine needle aspiration cytology (FNAC) and other investigations were done. Results: Female to male ratio was 1.4:1. A total 32 cell blocks were prepared in clinically suspected cases of malignancy and compared with FNAC and biopsy findings. Younger age group mostly presents as TB lymphadenopathy and non-specific lymphadenopathy. In elderly people, cervical lymphadenopathy presented mostly as metastatic deposits in cervical lymph nodes. The right side was more involved 54.42% cases, followed by left side in 34.56% cases and bilaterally in 11.03% cases. Majority lymph nodes (64.7%) were less than 3cms in size. Most of the lymph nodes were firm rubbery consistency (84.5%) seen mostly in TB, reactive and non-specific lymphadenitis, followed by hard consistency nodes (11.76%) seen in malignant cases, soft consistency nodes (3.67%) were seen in suppurative. Maximum number of lymph nodes (75.7%) were mobile and fixed lymph nodes were seen in 12.5% cases followed by matted nodes seen in 11.7%. On clinical diagnosis 76.47% cases were benign, out of which 42 cases (30.8%) were TB lymphadenopathy and 62 cases (45.58%) were chronic non-specific lymphadenopathy. Malignant cases accounted for 32 cases (23.52%) out of which Metastatic deposits accounted for 30 cases (22.05%) and Hodgkin’s lymphoma accounted for 2 cases (1.47%). Fixity of underlying structure and skin is primarily seen in malignant cases with metastatic deposits. The commonest cause was due to Reactive lymphadenitis (38 cases), followed by TB lymphadenitis (33 cases), Chronic non-specific lymphadenitis (19 cases), Granulomatous lymphadenitis (18 cases), Metastatic deposits (16 cases), suppurative lymphadenitis (3 cases), Acute lymphadenitis (2 cases), Lymphoma (2 cases), dermatopathic Lymphadenopathy (1 case) and inconclusive (4 cases). 16 cases were metastatic deposits in the neck followed by 2 cases of Hodgkin’s lymphoma. The Ziehl Neelsen stain for acid fast bacteria (AFB) was positive in 10 out of the total of 33 cases of TB lymphadenitis. Out of 32 cell blocks made in clinically suspected malignant cases, 19 cases were showing malignancy, 13 cases were benign. Conclusion: Reactive lymphadenitis was predominant cause for cervical lymphadenopathy in the present study followed by Tuberculosis. FNAC can strongly suggest a preliminary diagnosis, which can be followed up by biopsy for histopathology and immunohistochemistry for confirmation and final classification. The inconclusive diagnosis given in FNAC was diagnosed as Metastatic Squamous cell carcinoma on biopsy as well as in cell block. Use of supplemental cell blocks provide minimally invasive way of obtaining additional architectural information of pathological lesions and it augments the diagnosis of FNAC.

169. A Comparative Study of Air Dried or Rehydrated Cervical Smears and Traditionally Alcohol Fixed Smears
Narasimharao Bharadwaz Chennapragada, Kasturi Dinesh, Karthik Kasireddy, Y. Sushma
Background: Conventional Pap stain requires immediate alcohol fixation of the cervical smears. Delayed alcohol fixation of the Pap smears can lead to poor fixation, air-drying artifacts and unsatisfactory staining resulting in diagnostic difficulties. Rehydration of air-dried cervical smears with normal saline can be an effective alternative to retain the optimal squamous and glandular cells morphology. Aim: The objective of the study is to compare the diagnostic efficacy of normal saline and acetic acid rehydrated dry smears with traditional wet alcohol fixed pap smears in primary screening of cervical lesions especially in high volume and resource limited settings. Material and Methods: Comparative study with a total of 354 subjects of 20-70 years age group who were examined in OPD department of OB&G for routine examination were subjected to study to obtain cervico-vaginal smears. The obtained smears were sent to Department of Cytopathology for further microscopic evaluation. Paired smears were obtained from these 354 patients are divided into wet fixed smears (WFS) and Air-dried Rehydrated smears (ADRS). 354 paired smears obtained were assessed by the Pathologist according to Bethesda system of reporting cervical cytology 2014 for evaluation of cytomorphological parameters such as cell borders, cytoplasmic staining, nuclear borders and chromatin staining in both groups. Results: Background changes like presence of RBCs, air-drying artifacts and presence of organisms in both groups were observed and appropriately recorded. Cellularity and adequacy in our study showed ADRS>WFS, a notable finding, which in turn having better results in cytomorphological parameters in ADRS. Percentage of distinct cell borders in ADRS (96.32%) is more than WFS (90.39%) and cytoplasmic staining in ADRS (96.89%) exhibited superiority over WFS (91.52%) with p value <0.05. In ADRS indistinct cell borders are less (3.94%) in comparison to the WFS (9.04%) with notable significance statistically, whereas intensity and crispness of chromatin staining in ADRS and WFS showed a mere difference of 5.4% which is comparable. ADRS showed prominent clearing of RBCs (97.75%) from the background giving a better picture for smear interpretation than WFS (92.66%). Air drying artifacts are routinely encountered in WFS smears. Out of 354 smears 21 WFS smears showed air drying artifacts whereas 2 smears in ADRS showed the artifacts. Microorganisms like Candida, Trichomonas, Lactobacilli, Coccobacilli was appreciated in both the groups equally. Conclusion: Our study showed that Air-dried and Rehydrated smears had satisfactory cellular preservation and staining quality. ADS (Air-dried smears) were especially useful in markedly haemorrhagic or inflammatory smears. There was no undue hurry for immersion of smears in alcohol for fixation. Another advantage of ADRS includes easy transportation of smears from remote setups to higher centres with no requirement of alcohol and much difficulty. It can be noted that ADS is a simple, feasible, applicable and reliable fixation technique which can be used for the evaluation of cervical smears on a routine basis.

170. Study on the Outcomes and Safety of Day-Care Management of Acute Appendicitis
Jayantkumar Mafatlal Uperia, Mohamad Imran, Bikram Chandra Lenka
Introduction: Severe appendicitis is a significant concern for children, with peak rates occurring in the second or third decade of life. Acute appendectomy has been the standard care for treating appendicitis, but there is ongoing debate about whether it is always necessary. Studies have shown that conservative measures such as antimicrobial therapy can be effective for uncomplicated appendicitis. Laparoscopic appendectomy has become the preferred surgical technique due to its advantages over open surgery. Complication rates vary widely, and ongoing research is focused on finding better treatment options for children with appendicitis. Aims and Objectives: To evaluate the outcome and safety of day-care management in patients with acute appendicitis. Methods: A randomized cohort study was conducted on 60 patients to evaluate the safety of a 10-day total treatment protocol using intravenous antibiotics. Serious adverse events (SAEs), such as death, life-threatening occurrences, major treatment-related disability, or hospitalization unrelated to appendicitis, were the main outcome measured. The study also compared SAE incidence among outpatient and inpatient care, and assessed other outcomes such as appendectomies, subsequent hospitalization, patient-reported treatment dissatisfaction, and EQ-5D score. Inclusion criteria included confirmed appendicitis by imaging in patients aged 15 years and older who continued treatment in the hospital, while exclusion criteria included patients with severe conditions or contraindications for the study. Results: The study sample consisted of mostly patients in the age range of 15-35 years (47.1%), with 21.8% of patients being over 35 years old. Symptom duration was mostly 1-2 days (33.3%), with 13.8% having symptoms for less than 1 day and 21.8% having symptoms for 2 or more days. The mean Charlson Index was 0.2 ± 0.4, and the mean Alvarado score was 6.5 ± 0.8. Adverse effects were experienced by 3.33% of participants by day 7, and hospitalization for 7 days or longer occurred in 5% of participants.  The study found that the number of patients within 15-35 years range is significant more than those above 35 years. Again, the study highlighted that the most number of patients had 1 to 2 days of symptom duration, most of them had fever and did not show Appendicolith. Conclusion: The study has concluded that the day-care treatment (outpatient antibiotic therapy) of mild acute appendicitis is safer and effective as well.

171. Analysis of Chitosan in Terms of its Antimicrobial and Wound-Healing Properties
Jayantkumar Mafatlal Uperia, Navdeep Singh Osahan, Yash Solanki, Bikram Chandra Lenka
Introduction:  Chitosan is a biocompatible and biodegradable polymer derived from chitin, commonly found in the shells of insects and crabs. It has antimicrobial properties and has been shown to effectively kill bacteria, fungi, and viruses due to its cationic charge. Chitosan also has wound-healing properties and can stimulate cell proliferation and tissue remodelling, making it an effective agent in the healing process. Chitosan is a subject of significant research due to its non-toxicity and natural origin. This study focuses on chitosan’s antibacterial and wound-healing properties. Aims and Objectives: To analyze the efficiency of chitosan as an anti-microbial and evaluate its effect on the growth kinetics of S. aureus. Methods: This study involved 60 participants divided into two groups: S.aureus SG511 and SCV. They were exposed to chitosan at concentrations ranging from 10 to 60 g/ml. The experiment measured the effect of chitosan on S. aureus SG511 by analyzing the fluorescence emission magnitude of DiBAC4(3) and the amount of potassium produced. The analytical lipid II assay was performed in the same manner as described in previous studies. Results were compared between the two phenotypes. The cultures were maintained at 37 degrees Celsius, and the sample was discarded after 30-90 minutes. Results:  The study has shown that chitosan has a bacteriostatic effect on the bacteria, with its effectiveness increasing with concentration and exposure time. Figure 2 shows the results of an assay measuring the percentage of potassium release in the presence of chitosan and lantibiotic nisin over time, indicating membrane damage as a potential mechanism of action for antimicrobial agents. Both chitosan and nisin have a concentration-dependent membrane-damaging effect on bacterial cells. Further studies are needed to investigate their mechanism of action and potential toxicity in vivo. Conclusion: The study has concluded that chitosan has a clinically efficient bacteriostatic effect and there is no significant difference in efficacy as compared to other antibiotics. Also, the study has concluded that chitosan has a dose-dependent bacteriostatic effect.

172. Ultra-Sonographic Methods for Preoperative Assessment of the Airway for Anticipation of Difficult Endotracheal Intubation
Alok Singh, Akanksha Agarwal, Hemendra Bhardwaj, Saurabh Trivedi, Seema Gupta, Sudeep Phadke
Background: Predicting difficult intubation (DI) is a significant challenge because no single clinical predictor is sufficiently reliable to predict the result. Ultrasonography is a non-invasive and rapid bedside method for visualisation of neck anatomy and airway assessment. Therefore, this study evaluated the difficulty level during laryngoscopy and intubation using ultrasound-guided airway assessment methods. Aims and Objectives: To assess USG-guided airway assessment methods for preoperative anticipation of difficult airways, its association, and prediction with difficult laryngoscopy in patients undergoing elective surgery under general anaesthesia. Materials and Methods: An observational & single-blinded study was conducted on 45 adult patients on whom USG parameters were studied for airway assessment. Statistical analysis using an appropriate independent t-test/non-parametric test at a P value <0.05. Results: Out of all the USG parameters, the cross-sectional area of the tongue >3 cm (26.57 at P-value of 0.0046), AP thickness of geniohyoid > 4 mm (32.5 at P-value 0.0018), skin to hyoid >1.69 cm (5.9048 at P-value 0.0414) were statistically significant. Therefore, a strong association exists between a cross-sectional area of tongue >3 cm2, AP thickness of geniohyoid > 4 mm, skin to hyoid >1.69 cm, and occurrence of CL≥ 3 during laryngoscopy. Conclusion: USG parameters are better predictor of difficult airway in the present study; therefore may be associated with a higher likelihood of difficult visualization during laryngoscopy, as indicated by a CL grade ≥3.

173. Retracted

174. A Comparative Study of the Effects of Select Yogic Exercises on Cardiovascular Parameters in Patients with Hypertension
Anwar Khan, Dheeraj Jeph, Suresh Kumar Meena, Mrinal Sharma
Hypertension, also known as high or raised blood pressure (BP) is a global public health challenge. Hypertension (HPT) is defined as a condition wherein blood pressure (BP) is persistently elevated with systolic blood pressure (SBP) ≥ 140 mm Hg and/or diastolic blood pressure (DBP) ≥ 90 mm Hg. It is aptly designated as the “silent killer,” because it has no specific sign and symptoms in initial stage. Yoga is an ancient Indian system for integrating mind and body that is claimed to bestow the practitioner with physical, mental, intellectual and spiritual development. Researchers have postulated that yogic relaxation and breathing techniques may reduce BP by inducing slow rhythmic proprioceptive and exteroceptive impulses, reducing peripheral adrenergic activity and facilitating autonomic balance, which reduces chemoreceptor responses and enhances baroreflex sensitivity. Our study focused towards the probable impact non-pharmacological approaches like Practicing Yoga on blood pressure control in patients with Hypertension. Our study was conducted in the Upgraded Department of Physiology, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan. Two sex matched groups (with and without Yoga) of hypertensive patients aged 40-60 years was constructed enrolling 60 hypertensive patients in each group. We found increase in parasympathetic activity in our study after yoga practice. Regarding BP changes, it was observed that the total peripheral resistance and average ambulatory DBP decreased significantly during meditation. The decrease in vasoconstrictor tone during the meditation might be hemodynamic mechanism responsible for reduction in diastolic blood pressure in our study. Enhancement in cardiac functions & reduction in drug doses can be achieved more effectively and rapidly with yoga.

175. CPR is Better Predictor of Intrauterine Growth  Restriction as Compare to Individual Artery Examination
Suresh Chandra Gupta, Sunil Agarwal, Neha Choudhary, Tushar Prabha
Purpose: In clinically suspected cases of intrauterine foetal growth restriction, the study set out to see how well doppler indices measured in the uterine artery, umbilical artery, and middle cerebral artery and which artery is better predictor of of IUGR and might better predict perinatal outcome or neonatal growth. Material and Methods: Doppler ultrasonography of the uterine artery, umbilical artery, and middle cerebral artery was performed on 96 pregnant women who were beyond the 26-weeks’ gestation and suspected of carrying a baby with intrauterine growth restriction. Results: Approximately 96 pregnancies were analyzed when IUGR was suspected based on clinical criteria. The average birth weight was 2.3+_0.519kg. Nearly half of all newborns (n=46) weighed less than 2.5 kilogram at delivery. Of the fetuses studied, 64.58 percent (n=62) had at least one undesirable outcome. The remaining 35.41% (n=34) of the pregnancies were successful. Out of a total of 89 births, 7 women passed away from complications within the womb. There were 89 live births, and 41 of the newborns were hospitalized to a neonatal intensive care unit. At 5 minutes, 42 of the newborns had an APGAR score of less than 7, and 16 of the births were deemed urgent enough to need caesarean section. An examination of the pulsatility index in the uterine artery had a sensitivity of 54.83 percent for predicting a negative perinatal outcome. The sensitivity of umbilical artery Doppler ultrasonography with PI for predicting neonatal outcome was 64.51 percent. Doppler tests of the umbilical and uterine arteries together were more sensitive than studies of either arterial alone. The CPR / cerebro placental ratio (93.54 percent) is a more reliable predictor of intrauterine growth restriction and worse perinatal outcome than either the middle cerebral artery or the umbilical artery alone. Conclusion: The cerebro umbilical ratio (MCA/UA PI) is more indicative of a bad delivery outcome when IUGR is suspected than either an abnormal MCA PI or Umb A PI alone (93.54 percent vs. 64.51 percent, 70.91 percent respectively). However, the MCA/UA PI Ratio generally provides more insightful results than just comparing the two PIs. Diastolic flow in the umbilical artery is connected with a decreased risk of mortality. Monitoring of high-risk pregnancies with intrauterine growth restriction using Doppler ultrasound imaging is beneficial since it has been found to enhance pregnancy outcomes and may provide indirect confirmation of foetal impairment.

176. Effects of Exercise on Blood Glucose Level, Weight Gain and Pregnancy Outcome in Patients with Gestational Diabetes Mellitus
Vijay Kumar, Shrikant Shete, Shashikant Agarwal, Abhishek Verma
Background: The estimated prevalence of gestational diabetes mellitus worldwide is 17.8%. GDM can affect the health of mothers and their offspring due to transient abnormalities in carbohydrate metabolism. Women with GDM are at risk of adverse pregnancy outcomes. Objectives: To find the effects of exercise on blood glucose level, weight gain and pregnancy outcome in patients with gestational diabetes mellitus. Methods: A longitudinal follow-up study was carried out during September 2019 to August 2022 on 224 pregnant women with GDM at SHKBM hospital associated with Jhalawar Medical College, Jhalawar. Women were enrolled between 24 to 30 weeks of gestation. They were separated into two equal groups: exercise and control groups and followed till delivery. Results: Mean age of participants was 28.78 ±4.6 years. Reduction in mean blood glucose level was significant in exercise group in comparison to control group (p<0.05). In exercise group mean weight gain during pregnancy was significantly less in comparison to control group (p=0.02). Conclusion: Exercise is beneficial as a means of achieving better glycaemic control, gestational weight gain in women with GDM and thereby improving maternal and neonatal outcomes.

177. A Study of Clinical Patterns and the Role of Patch Testing in Determining the Etiological Factors in Hand Dermatitis
Namrata C. Manjunath
Background: Hand dermatitis is a distressing and disabling condition of multi-factorial origin. An estimated 2% to 10% of the general population is affected by hand dermatitis. It appears to be the most common occupational skin disease, comprising 9% to 35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. In these contact dermatitis of hands, more than half of patients (58.5%) had Irritant contact dermatitis (ICD) and 41.5% had Allergic contact dermatitis (ACD). Patch testing, at present, is the only scientific method to detect the cause of contact dermatitis. Aims: To assess clinical types of hand dermatitis and to evaluate the role of patch testing in patients with hand dermatitis using Indian Standard Battery, Cosmetic and Fragrance Series, Vegetable Series. Materials and Methods: A total of 100 patients with ACD of hands attending dermatology OPD Kempegowda Institute of Medical Sciences (KIMS), Bengaluru, after clinical diagnosis who consented for the study were included and studied over a period of 18 months. Patch testing was done by using Indian Standard Battery Series, Cosmetic and Fragrance Series, and Vegetable Series. The patches were removed after approximately 48 hours and the sites of contact of allergens were marked with a marking pen. Reading was taken after 30 minutes. Results: A total of 100 patients of ACD of hands were studied. The incidence was 6.3%, of which 45% were males and 55% females. Soaps and detergents were the most common aggravating factor (27%), followed by vegetables (9%). Hyperkeratotic eczema was the most common morphological form (46%). Patch test was positive in 58% and negative in 42% of the study group. The common sensitizers were phenylenediamine(22%), fragrance mix(18%), parthenium hysterophorus (15%), Balsam of Peru (12%), potassium dichromate (6%), Thuiram mix(6%), Nickel sulphate (6%), Colophony and Epoxy resin (4%), wool alcohol(1%). Among the cosmetics and fragrances series common sensitizers were Thiomersal (36%), Cetrimide (13%) while in the vegetables series Garlic, Chilly, Onion, Ginger were 20% each and Brinjal, Potato were 10% each in the study group. Conclusion: In this study patch test was found to be a useful investigative procedure for Allergic contact dermatitis of hands. The Indian standard battery series is useful but insufficient.

178. Histomorphological Findings of Skin Lesions in Leprosy – A Comparative Study between Pretreatment and After Fixed Duration of Treatment
Dilleswari Pradhan, Priyadarshini Biswal, Swapna Jena, Priyanta Meher, Lity Mohanty, Prasenjeet Mohanty
Background: Leprosy, a public health problem often heals after completion of WHO recommended multi-drug therapy for a fixed duration. Irrespective of the complete therapy residual lesions are still there and which made patients not satisfied. A repeat biopsy and re-treatment may be advised. So this study was undertaken to compare the histomorphological features of paucibacillary leprosy before and after MDT for a period of two years from November 2018 to October 2020. Aims and Objectives: To study and compare the histopathological features of skin lesions of leprosy before and after fixed duration of treatment. Materials and Methods: This prospective study was conducted at department of pathology in SCB MCH Cuttack. Duration of study was from Nov 2018 to October 2020 on 60 cases. Pure neuritic cases were excluded from the study. Observation: Total number of cases included in the study is sixty for a period from November 2018 to October 2020. Patients with clinical features of macule, papule, nodule were underwent biopsy and H&E staining and followed up on treatment and again biopsied and different histomorphological features were observed. Conclusion: Awareness of histomorphological changes that occur in skin lesions of leprosy after completion of treatment can aid the pathologists to determine whether the lesions are active or inactive histologically and assist the clinician towards patient care.

179. Effect of Chewing Gum on Recovery of Intestinal Function after Caesarean Section
Shubhra Singh, Radha Agarwal, Priyamvada Singh, Ajay Singh Kalyanwat
Background: Chewing gum may act as non-pharmacological inexpensive measure to help in early postoperative recovery by increasing gut motility and preventing post-operative ileus. Aims: The present study was conducted to find out the role of chewing gum on the recovery of bowel function post caesarean section. Settings and Design: It was a Randomized Controlled Trial conducted in Obstetrics and Gynaecology department in a tertiary care hospital. Methods and Materials: 82 post elective caesarean patients were enrolled including 41 cases and 41 controls. Cases were asked to chew chewing-gum after surgery along with standard routine post-operative care and controls were given only standard postoperative care. Both groups were examined to detect the time of first bowel sound, first passing flatus, first time of feeling hunger, time of first defecation and time of first eating. Statistical Analysis: Data was compiled into Microsoft Office Excel version 2013 and descriptive statistical analysis was carried out. Qualitative variables and quantitative data were compared using (χ2) test and (t) test respectively. Statistical significance was considered at p-value ≤ 0.05. Results: Highly significant difference (p=<0.0001) was seen in time of hearing of first bowel sound and first passage of flatus, significant difference (p=0.022) was seen for first feeling of hunger and first eating and no significant difference (p=0.06) was seen for first defecation among two groups. Conclusion: Chewing gum in patients of CS is well tolerable, feasible and cost effective intervention that positively influences the recovery of bowel function and hence reduces hospital stay and overall cost.

180. Study of FNAC in Breast Lesions
Arvind Chouhan, Fuzail Ahmad
Background: Fine needle aspiration cytology (FNAC) was described and practiced by Martin and Ellis in 1930. All detected breast lesions are not malignant and all the benign masses do not progress to cancer; nevertheless the precision of the final diagnosis can be greatly increased by radiological imaging (mammography, ultrasonography) and pathological diagnosis.6 Breast cancer accounts for the most common cause of cancer related death in women. Method – The study was designed at Department of Pathology, Siddhanta Red Cross Hospital, a tertiary health care center in urban area of central India. The study was carried during August 2018 to July 2020. The study was approved by ethical committee. Informed consent was obtained from the patient. FNAC is an effective modality for the diagnosis of breast lesions. It is a safe, simple, and cost effective outpatient procedure associated with negligible complications. It helps the clinicians for early diagnosis and specific management thus reducing morbidity and mortality.

181. Evaluation for Granulomatous Inflammation on Fine Needle Aspiration Cytology using Special Stains
Arvind Chouhan, Fuzail Ahmad
Background: Tuberculosis is the commonest infectious disease in the developing countries like India. Many diagnostic tests are devised for its detection including direct smear examination. This study was designed to determine the frequency of cases positive for AFB and positive for fungus in patients diagnosed to have granulomatous inflammation on Fine Needle Aspiration Cytology using special stains. Materials and Methods: A descriptive cross-sectional survey was done on 100 cases of granulomatous inflammation consistent with tuberculosis diagnosed on fine needle aspiration cytology at the Department of Pathology, Tertiary care hospital, Bhopal. After reporting granulomatous inflammation on Hematoxylin & Eosinstaining of aspirates from FNAC, some unstained slides were subjected to special stains, like ZN, GMS, and PAS. Cases positive for AFB on ZN stain and fungus on GMS/PAS were noted down along with their frequency and percentages. Results: Forty-four cases(44%)of AFB positive smears were reported in granulomatous inflammation while only 5% cases of fungus were reported down. Cervical lymph nodes were the most commonly involved site(87%), and females were aected more (62%) than males. Most cases of AFB- positive smears were associated with caseation necrosis (93%). Conclusion. Special stains should be done on all granulomatous inflammation cases seen on FNAC for confirmation of TB and ruling out other infectious causes.

182. Impact of CISP II training in CBME Curriculum at Tripura Medical College
Nirmalya Saha, Jayanta Kumar Poddar, Kaushik Tripura
Background: Medical teachers trained in conventional education system were in need to go through new faculty development programme, Curriculum Implementation Support Programme (CISP), for effective implementation and functioning of Competency Based Medical Education (CBME) curriculum. The medical teachers trained with CISP were shown with much better perceptions of CBME Curriculum Implementation comparing to those of the medical teachers who were yet to be trained. For this a well organised educational process for faculty development programme was mandatory. At the same time, evaluation of any educational process also was essential which assessed the impact on educational quality of the faculties as well as reflected on that organized programme. Methods: This cross-sectional study was conducted among twenty-six (26) medical teachers to evaluate impact of Curriculum Implementation Support Programme – CISP II. The faculty trainee had given their pre and post-tests and feedback on a rating scale of 1-5. Results: The average number of test score had been increased pre workshop to post workshop significantly (p = 0.00) by 11.75 (CI 10.70 – 12.80). After workshop the importance of the topics covered in the workshop had increased [39.62 (CI = 2.75 – 5.03)] to participant significantly (p = 0.00). The knowledge level also had increases [39.50 (CI = 2.30 – 4.28)] significantly (p = 0.00). Conclusion: It was observed that, after two days of CISP II training, the participant faculties had given more importance on topics of new curriculum and they had perceived more knowledge about the sessions during post CISP II training period.

183. Fracture Patterns in Type 3 Supracondylar Humerus Fracture and their Functional Outcome after Surgery
Hariharan Selvam, Kumaran Chettiyar, Nithin Karun, Manojkumar CV

Supracondylar humerus fracture in children is one of the most common fractures around elbow. In this study, we followed up all the children (3-12 years) with type 3 supracondylar humerus fracture fixed by CRIF method for the period of 8 months post-surgery. We studied the 6 different patterns of type-III supracondylar humerus fracture (extension type) in children and analysed their fracture patterns and functional outcomes. From the study it found that the Typical transverse type (65.3%) are the most common type in coronal view and Low sagittal type (70.8%) is most common type in sagittal view. Out of 100 % (72), no coronal deformity observed in 61.1 % (44) of cases, Based on Baumann’s angle in AP radiograph of elbow, Varus deformity with 19.4% (14) cases and Valgus deformity with 12.5% (9) cases were observed. 75% of medial oblique fracture, 57.9% of lateral oblique fractures, 57.4% of typical transverse fractures, 50% of high fractures, 58.8% of low sagittal, 57.1% of high sagittal fractures showed excellent functional outcome independently. Since, the Chi-Square value is > 0.05, they are not significantly related. Hence, the fracture type had no influence over the functional outcome.

184. Supracondylar Humerus Fracture Patterns in Children: A Prospective Study
Hariharan Selvam, Kumaran Chettiyar, Nithin Karun
Supracondylar fracture of the humerus is one of the most talked about and often encountered injury (only after clavicle and both bone forearm fracture) in pediatric age group. Immediate complications associated with it are limb threatening (by virtue of involving neurovascular structures) whereas late complications are a serious concern to functional status of the patient. Due to the above reasons, they require a strict vigilance and a proper management protocol. In pediatric age group the more common age of presentation is 5-7 years (90% cases). In this study 6 different patterns of type-III supracondylar humerus fracture (extension type) in children were analyzed. It was found that Loss of carrying angle is observed most commonly in high sagittal fractures (28.6 %) followed by transverse type fracture (27.7%). Clinical varus deformity (loss of carrying angle more than 15%) is most commonly caused by medial oblique type (50%) followed by low sagittal type (11.8%). Clinical valgus deformity is most commonly caused by medial oblique type (25%). Among the coronal fracture types, medial oblique fracture is more prone for varus deformity than others. Among the sagittal fracture types, high sagittal fracture is more prone for extension malunion than others. Most common complication was found to be AIN palsy followed by vascular injury, other associated fracture, PIN palsy.

185. Comparison of the Effects of Phytoestrogen and Conjugated Oestrogen on Vasomotor Symptoms in Surgical Menopause
Kumari Nisha, Renu Jha
Background: Menstruation ceasing permanently is referred to as menopause. Women go through a variety of physical, mental, and emotional changes throughout this trimester. Phytoestrogens, a class of chemicals generated from plants that bind to oestrogen receptors and have structural similarities to oestrogen, are used to treat vasomotor symptoms. The goal of the current study was to investigate how phytoestrogen and conjugated oestrogen affected vasomotor symptoms. The purpose of this study is to compare phytoestrogen and low dose conjugated oestrogen for the reduction of vasomotor symptoms in surgically menopausal women. Method: 128 surgically menopausal women who experienced vasomotor symptoms within six weeks of their recovery were divided evenly into two groups by chance. For 12 weeks, one group received conjugated oestrogen (Premarin) at a dose of 0.625 mg per day, whereas the other received soy isoflavone (70%) at a dose of 100 mg per day (lsoflav CR). Daily self-reports on the episode and intensity of vasomotor symptoms were taken. Up until the end of the 12-week period, evaluations were performed every four weeks. Results: The 12-week treatment cycle was completed by 52 women in the phytoestrogen group (n=52) and 58 women in the conjugated oestrogen group (n=58). After 12 weeks of treatment, 48 (82.75%) of the women (n=58) in the conjugated oestrogen group experienced considerably fewer hot flashes than the 14 (26.92%) of the women (n=52) in the phytooestrogen group. Only in the conjugated oestrogen group, 38 (65.51%) of the women (n=58) reported fewer night sweats. Both groups were deemed to be quite safe and well-accepted, with the exception of a few minor adverse effects in the conjugated oestrogen group such nausea, breast soreness, headache, etc. Conclusion: Contrary to phytooestrogen, conjugated oestrogen significantly decreased the severity and occurrence of vasomotor symptoms in surgical menopause, and both phytooestrogen and conjugated oestrogen were shown to be well tolerated and safe over the course of a 12-week research.

186. Maternal and Fetal Outcome in Fibroid Complicating Pregnancy: A Observational Study
Kumari Nisha, Renu Jha
Background: One of the most frequent benign tumours of the female reproductive system is uterine fibroids. As the majority of uterine fibroids are asymptomatic, their prevalence is generally underreported. Uterine fibroids can occur in pregnant women in a range of 1% to 10.7% of cases. Our study objective was to assess the prevalence, mother health, and foetal development in pregnancies complicated by fibroids. Methods: From July 2020 to December 2021, this observational study was carried out at the Department of Obstetrics and Gynaecology, DMCH, Laheriasarai, Bihar. The study involved 100 pregnant women with fibroid tumours more than 3 cm. The criteria included maternal age, parity, gestational age, previous myomectomy history, problems during pregnancy, mode of birth, and caesarean myomectomy. Results: In our study, the prevalence of fibroid complications during pregnancy was 0.78%. The majority of women (66%) are multiparous, and (38%) are between the ages of 31 and 35. Only 12 (12%) of the cases had a prior history of myomectomy, and the majority of cases were detected in the first trimester. Maternal consequences include abortion 4 (4%), APH 6 (6%), abdominal discomfort 12 (12%), PROM and premature labour 10 (10%), and PPH 20 (20%), even though asymptomatic patients make up the majority of cases. FGR 12(12%) and LBW 12(12%) are examples of foetal problems. The majority of births (58%) took place via caesarean section. Only 17.8% of the women underwent a Caesarean myomectomy. Conclusion: Most uterine fibroids were asymptomatic throughout pregnancy, and risk rose as fibroids grew in size. Combating these problems requires prompt antepartum, intrapartum, and postpartum surveillance and care. In some circumstances, myomectomy leads to a better obstetric outcome.

187. Cilnidipine versus Amlodipine Effectiveness and Tolerability in Patients with Recently Diagnosed Essential Hypertension: A Comparative Analysis
Shashi Prakash Chandra, Navin Kumar, Navin Kishore, Asha Singh
Background: It is suggested that calcium channel blockers (CCBs) will be crucial in managing and controlling hypertension. Calcium channel blockers (CCBs) of the dihydropyridine family, like amlodipine, are extensively utilised due to their potent antihypertensive benefits and lack of significant side effects. However, among the patients, it is frequently linked to the cause of pedal edoema. A novel calcium channel blocker of a new generation called cilnidipine is thought to have fewer adverse effects, lessen pedal edoema, and provide clinically adequate management of hypertension. This research compared the clinical efficacy and tolerability profiles of Amlodipine with Cilnidipine. Methods: At Nalanda Medical College and Hospital, Patna, Bihar conducted this prospective, double-blind, parallel group study from December 2021 to November 2022. 50 patients were randomly divided into two groups of 25 each based on inclusion and exclusion criteria. Cilendipine 10 mg was given to one group, whereas amlodipine 5 mg tablets were given to the other, both once daily for a period of 12 weeks. There were follow-ups at 2, 4, 8, and 12 weeks. Sitting still, blood pressure readings for both the systolic and diastolic were taken. At 4, 8, and 16 weeks, the dose was adjusted if the patient did not reach the goal blood pressure of 140/90 mmHg. By asking about adverse drug reactions during the follow-up visit and abnormalities in standard laboratory test results at the conclusion, tolerability was evaluated. For analysis, the Z test was utilised. Results: No statistically significant difference existed between the antihypertensive efficacies of the two medications. In comparison to amlodipine, the number of patients who experienced side effects was much lower in the cilnidipine group. Although the group on cilnidipine saw fewer unfavourable vasodilator reactions, the only other notable difference was the incidence of pedal edoema. This variation in edoema incidence cannot be attributed to the degree of blood pressure lowering. Conclusion: Comparable in antihypertensive efficacy to amlodipine, cilnidipine is linked to a significantly decreased incidence of vasodilation-related adverse effects, particularly pedal edoema. This superior tolerability profile may improve treatment outcomes by encouraging better medication therapy adherence.

188. An Evaluation of the Effectiveness and Safety of Diclofenac and Lornoxicam as Postoperative Analgesics following Mastoidectomy Surgery
Navin Kishore, Shashi Prakash Chandra, Navin Kumar, Asha Singh
Background: Postoperative discomfort is brought on by the surgical trauma that occurs during the manipulation of tissues. Lornoxicam is a nonselective NSAID with analgesic and anti-inflammatory properties. It acts more quickly than other oxicams and has a shorter half-life. Diclofenac sodium, a cyclooxygenase inhibitor, has long been used to manage postoperative pain. The active metabolite of the drug accumulates in the inflamed tissue and maintains a greater plasma concentration for several hours by acting as an analgesic. The current study compares the effectiveness and safety of diclofenac and lornoxicam for the treatment of postoperative pain following mastoidectomy surgery. Methods: Eighty patients who underwent mastoidectomy surgery and were randomly assigned to two parallel groups participated in this prospective single-blinded trial at Nalanda Medical College and Hospital from December 2021 to November 2022. Group A was given an intramuscular injection of lornoxicam 8 mg three days in a succession, while group B was given an injection of diclofenac 75 mg. The major indicator was postoperative pain, which was measured using the Visual Analogue Scale and Wong Bakers Scale. The rescue medication used was a 300 mg intramuscular injection of paracetamol. The secondary parameters include the frequency and length of usage of rescue medication by the patients in each trial group. During each follow-up appointment, the doctor made a note of any adverse events that the patient had reported or that he or she had personally witnessed. Results: When comparing the lornoxicam group to the diclofenac group, the primary efficacy parameter consistently showed a significant reduction in postoperative pain (p value 0.05). Three (7.5%) patients in the lornoxicam group required rescue medication, compared to 11 (27.5%) in the diclofenac group. In comparison to the lornoxicam group, the diclofenac group had a considerably greater percentage of patients who required rescue medication. The average time spent utilising rescue medication was 7.09±3.36 hours for the diclofenac group and 7.33±2.21 hours for the lornoxicam group. Renal and liver function markers’ preoperative and postoperative levels did not substantially change from one another. There were no noteworthy adverse effects in any of the two groups. Conclusion: Based on the results of our study, we draw the conclusion that lornoxicam 8 mg intramuscular injection is a more potent and well-tolerated analgesic than diclofenac 75 mg intramuscular injection for the management of postoperative pain following mastoidectomy surgery.

189. A Comparison of the Effectiveness and Safety of Glimepiride with Sitagliptin in Patients with Type 2 Diabetes Mellitus
Navin Kumar, Navin Kishore, Shashi Prakash Chandra, Asha Singh
Background: One of the key reasons why treating people with diabetes mellitus (DM) and society at large is expensive. To contrast sitagliptin safety and efficiency with glimepiride in Type 2 DM patients who are also being treated with metformin as a background. Methods: From December 2021 to November 2022, this study was carried out at NMCH, Patna, Bihar. Eligible patients were randomly assigned to receive sitagliptin 100 mg and glimepiride 2 mg once daily as an add-on medication for 12 weeks. A pre-populated proforma was filled up with demographic data. All study participants/patients heard advice to keep up a healthy diet and exercise frequently. At week 0 and again at week 12, which is when the trial came to an end, all patients’ HbA1C, FBS, weight, Alanine Aminotransferase (ALT), serum urea, and serum creatinine measurements were obtained. The primary goal was to reach the target HbA1C upper normal level at the end of the study. Results: A total of 120 patients were enrolled in the experiment, with 60 in each group. There were 36 men and 24 women in group B, compared to 32 men and 28 women in group A. Group A utilising sitagliptin demonstrated a statistically significant decline in HbA1C and BMI when compared to the Glimepiride group. (p<0.05). The two groups’ reductions in FBS were comparable (p>0.05). Hypoglycemia, diarrhoea, and vomiting were the most frequent adverse reactions in both groups. There was no statistically significant difference in the frequency of occurrence between the two groups (p>0.05). Conclusion: The results of the current research show that sitagliptin, when taken in addition to metformin, improves glycemic control just as effectively as glimepiride and is well tolerated with no obvious side effects. Glimepiride fared worse than sitagliptin, which also had a decreased risk of hypoglycemia. In addition, it was well tolerated and caused weight loss when compared to glimepiride.

190. Comparative Study of Dexmedetomidine and Dexamethasone as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Tanweer Uz Zaman, Tabish Javed, Arun Deka
Background: One of the most recommended methods for perioperative anaesthesia and analgesia during upper limb surgical procedures is the supraclavicular brachial plexus block. The inclusion of various adjuvants can lengthen the block’s lifespan. In addition to comparing pain levels and postoperative morphine use, our goal is to examine the effectiveness of dexamethasone and dexmedetomidine as an adjuvant to bupivacaine in extending the duration of supraclavicular brachial plexus block. Methods: In this prospective randomised study, we divided 60 patients who were scheduled for upper limb procedures into three groups, each of which had 20 patients. The three groups of patients each got 25 ml of 0.5% bupivacaine. Patients in Group A also got 8 mg of Dexamethasone and patients in group B also got 1mgkg-1 of Dexmedetomidine respectively. Group C patients received 0.5% bupivacaine only. All patients received morphine by patient-controlled analgesia (PCA) following surgery, and the block characteristics, pain ratings, and overall opioid consumption were recorded. Results: When comparing the dexamethasone group to the dexmedetomidine group, we found that the motor block (1202.63±197.85 min vs 798.65±50.69 min) and the sensory block (1520.58±228.65 vs 1198.28±210.85 min) were considerably extended. Dexamethasone and dexmedetomidine group postoperative pain scores and morphine intake were comparable. Conclusion: In comparison to dexmedetomidine, dexamethasone dramatically prolongs the time that the supraclavicular brachial plexus is blocked when used as an adjuvant to bupivacaine. The two adjuvants mentioned above are both successful in reducing postoperative morphine intake.

191. A Comparative Study on NS1 Antigen Detection in Acute Dengue Infection by Rapid Diagnostic Test and Elisa in a Tertiary Care Hospital
Pothula Madhurima, Ponugoti Muni Lakshmi
Introduction: Early detection of dengue virus (DENV) infection can enhance clinical outcomes by maintaining close monitoring, implementing appropriate supportive medicines, and raising awareness of the risk of haemorrhage or shock. Non-structural glycoprotein-1 (NS1) has been shown to be an effective biomarker for the early detection of dengue. Rapid diagnostic tests (RDTs) and enzyme-linked immunosorbent assays (ELISAs) targeting NS1 antigen (Ag) are now commercially available. The purpose of the study was to improve the early identification of dengue by comparing the immunochromatographic test and ELISA for NS1 antigen. Materials and Methods: This cross-sectional study was done on 100 clinically suspected cases of Dengue at a tertiary care hospital in Nellore, Andhra Pradesh, India. All the sera samples were collected and subjected to NS1 antigen detection test by rapid test and NS1 ELISA. Results: Out of total 100 samples, 76 samples were tested positive by NS1 rapid test & 91 samples were tested positive by NS1 ELISA. The sensitivity, specificity of dengue NS1 antigen rapid test were 82.2% and 87.6% when compared to ELISA. Conclusion: The NS1 ELISA test needs additional procedures and time. RDTs require a one-step procedure that takes 15-30 minutes. Despite the fact that ELISA perform better than RDTs, RDTs are more useful for early diagnosis and treatment of dengue fever in nations with poor infrastructure and in remote locations.

192. Comparison of McGrath Video Laryngoscope versus BPL Video Laryngoscope for Endotracheal Intubation in Children (1-5 years): A Prospective Randomised Comparative Study
Panchal Niyanta A., Lalchandani Kavita S., Syed Afroza N., Kotecha Hetal G., Patel Azarabegum A., Nayani Nimisha L.
Introduction: Pediatric patients, because of their anatomical differences in airway compare to adult pose many challenges during endotracheal intubation. Routinely we perform conventional laryngoscopy in the sniffing position which aligns the 3 axis (oral, pharyngeal, laryngeal). Vocal cord visualization may become difficult with this technique. To overcome this issues, different video laryngoscope are available. They utilize indirect laryngoscopy via a camera to improve glottic visualization eliminating the need of aligning the 3 axis in a straight line possible in neutral position. So, less force is required to visualize the structures, thereby, decreasing the stress response and local tissue injury. Our aim of the study was to compare two different video laryngoscope BPL & McGrath in term of intubation time, POGO grading & hemodynamic parameters. Method: After ethical approval total 60 patients of 1 -5 years age, belonging to ASA grade I&II posted for elective surgery were taken. They were randomly divided into 2 groups, group B (N=30) intubation done by BPL video laryngoscope & Group M (N=30) intubation done by McGrath video laryngoscope. Results: Mean time for intubation in group B 9.67 was sec & group M was 15.93 sec (p < 0.001) which was highly significant. POGO grading was better in group B compared to group M. Conclusion: The BPL VLS provides better glottic view with less intubation time compared to McGrath VLS.

193. First Trimester Screening for Prediction of Preeclampsia with Maternal Characteristics, Uterine Artery Doppler and Mean Arterial Pressure
Kaur Arshdeep, Bhatia Ruby, Khatri Sheena, Kaur Pal Sukhbir
Aim: First trimester screening for prediction of preeclampsia with maternal characteristics, uterine artery doppler and mean arterial pressure. Materials and Methods: The present study was done in pregnant women attending outpatient Department of Obstetrics and Gynaecology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana. This study was conducted from Jan 2020 – June 2021. Women, giving consent for participation in the study; between 11-13+6 weeks; Spontaneous conception were included in the study. Fetal Congenital abnormalities detected any time during pregnancy. Results: 129 pregnant women were included. Majority of pregnant women included were in the age group of 25-29 years. Out of the total 129 women in our study group, 18(13.95%) developed preeclampsia. Incidence of preeclampsia was highest (33.0%) in the age group of 20-24 years and 30-35 years. 7.0% female developing preeclampsia were aged 25-29 years and above 35 years. 3 (16.6%) Women developed early onset pre-eclampsia whilst the rest 83.4 % i.e. 15 females had late onset pre-eclampsia amongst which 5 gestational hypertension followed by proteinuria and eventually late onset pre-eclampsia. In 45% (5/11) women who had past history of pre-eclampsia/ gestational hypertention developed pre-eclampsia in present pregnancy. 4 out of 6 women (66%) with past history of chronic hypertension developed pre-eclampsia. In our study 3 out of 3 women (100%) who were APS positive had pre-eclampsia in present pregnancy. 72% of the women with preeclampsia had a mean arterial pressure of more than 90mmHg. On bilateral uterine artery Doppler, 39% of women had a raised palatability value. Majority of women (89%) with the presence of a diastolic notch developed pre-eclampsia. Past history of pre-eclampsia, advanced maternal age, gestational, raised pulsatility index, presence of diastolic notch showed association with adverse pregnancy outcome. Conclusion: A detailed history for first trimester (11-13+6 weeks) detection of maternal characteristics, MAP along with uterine artery Doppler (PI, RI and diastolic notch) are helpful in early prediction of preeclampsia. There is a statistically significant correlation of presence of diastolic notch on uterine artery doppler with development of preeclampsia. In a low resource country like India prediction of preeclampsia with maternal characteristics, mean arterial pressure and uterine artery doppler is not only cost effective but a non-invasive modality for prediction of pre-eclampsia so that preventive measures can be implemented well in time to avoid catastrophic maternal and fetal outcomes.

194. Comparative Study of Conventional EBRT plus Concurrent Weekly Carboplatin versus Conventional EBRT plus Concurrent Weekly Paclitaxel in Locally Advanced Carcinoma Cervix
Vinay Shivhare, Vikas Pal, Garima Uikey, Abhishek Pratap Singh
Background: For patients with early-stage cancer, radiotherapy (RT) or surgery are the mainstay of treatment. However, multimodality treatment approaches, such as RT combined with cisplatin-based chemotherapy (CT), neoadjuvant chemotherapy, or CT followed by radical surgery, have been shown to improve both disease-free and overall survival. Concurrent chemotherapy and radiation therapy (CCRT) is a recognised kind of treatment for locally advanced cervical cancer. For the treatment of locally advanced cervical cancer, radiation therapy has been combined with carboplatin, an equivalent of cisplatin with a similar mode of action. Aims and Objectives: to compare the effects and side effects of weekly paclitaxel and concurrent chemotherapy with weekly carboplatin in locally advanced cervical cancer. Materials and Methods: This study will cover all histopathologically confirmed patients with locally advanced cervical cancer (FIGO stage IB2-IVA) who registered at Govt. Cancer Hospital, Indore between April 2015 and April 2016. Two groups of randomly chosen patients, each with 30 patients, will be formed. One group received EBRT and concurrent inj. treatment. Second group receiving EBRT and concomitant paclitaxel 80mg/m2 IV weekly in addition to carboplatin 150 mg/m2. For a total of 35 days, EBRT will be administered using the parallel opposed (anterior posterior fields)/four field box approach. Following EBRT, 3 fractions of weekly intracavitary brachytherapy will be administered. Total duration of completion of treatment with EBRT and ICRT should be 56 days. Results: Complete remission was 66.67% in the carboplatin arm and 56.67% in the paclitaxel arm. Compared to paclitaxel arm, carboplatin arm had a partial remission rate of 33.33%. Conclusion: EBRT with concurrent weekly carboplatin has a better response than concurrent weekly paclitaxel and is associated with a more tolerable incidence of nausea and vomiting as well as less diarrhoea and skin sensitivity.

195. To Study Changes in Anterior Segment Morphology after Laser Peripheral Iridotomy (LPI) in Different Stages of Primary Angle Closure Glaucoma Using Gonioscopy and Ultrasound Biomicroscopy (UBM): A Comparative Study in a Tertiary Care Hospital
B K Pattnaik, T Behara, S Mohapatra
Aim: To prospectively evaluate the efficacy and study the anatomical changes in the angle of anterior chamber following Nd- YAG laser Peripheral iridotomy (LPI) in different stages of primary angle closure glaucoma & complications of Nd YAG laser PI. Materials & Methods: Between October 2019 to September 2021, 243 eyes of 243 patients of primary angle closure glaucoma presenting with less than 180 degree peripheral anterior synechiae were selected at the glaucoma clinic of SCBMCH, Cuttack and assement of angles and their comparision were done by Gonioscopy (Shaffer‘s Grading) and UBM imaging, before and 2 weeks after Nd:Yag Laser Iridotomy(LPI). The outcomes measured are Trabecular-iris angle (TIA) and angle-opening distance (AOD 500) and values compared before and after LPI. The present study have evaluated more on the actual effect on the angle as most studies in the past have concentrated on the disease progression or IOP control after LPI. Results: Following the quadrant with LPI among the PAC group, the mean gonioscopy grade increased significantly from 1.33 to 1.84 (0.50 change) and on UBM mean superior TIA increased from 8.252±0.16 to 16.081±0.23 degrees, p <0.001; mean AOD500 increased from 0.106±0.04 to 0.209±0.02 mm . Among the PACG group, change in the goniosopy grading was found to be approximately 0.04 and on UBM the mean superior TIA increased from 4.109±0.86 to 4.385±0.14 degrees, p= 0.113,mean AOD500 increased from 0.0631±0.01 to 0.074±0.0, p =0.074. Conclusion: The benefits of LPI was found to be in the quadrant with LPI resulting in significant widening of the anterior chamber angle and in other quadrant in eyes with PAC which was appreciated both in Gonioscopy and UBM. In Gonioscopy the anterior segment parameters were not markedly improved but changes was best appreciated by UBM in, eyes with PACG.UBM is far more preferred diagnostic modality than gonioscopy for observing the angle changes.

196. A Study of Cardiac Dysfunction and its Association with Outcome in Acute Pancreatitis
Mohan Lal Gurjar, Rajmani, Sourabh Soni, Amit Kant, Anil Samaria, Anil Kumar, Deepak Dewat
Background: Pancreatitis by itself is a disease, which is unique, protean and extrudes into the diagnostic arena. Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable involvement Cardiovascular and pulmonary system. Methods: The study was conduct in the Department of medicine J.L.N. Medical College & Hospitals, Ajmer. After taking informed consent eligible acute pancreatitis patients were enrolled according to the inclusion and exclusion criteria. Result: In our study, maximum patients (96.00%) were male and (80%) were from 31-50 years of age group. Patients with CTSI ≥7 (severe pancreatitis) had significantly higher CRP score of 125.29±6.84 mg/dl. positive S. CRP Value were present with sensitivity 100% and specificity 16.13%. The mean CKMB was found to be 33.52 ± 19.51 IU/L. and in Patients with CTSI ≥7 (severe pancreatitis) was 52.57±26.97 IU/l. In case of severe pancreatitis positive CKMB value were present with sensitivity 85.71% and specificity 51.61%. Abnormal ECG changes were seen in 42% patients (42/100), all patients had Sinus tachycardia. Abnormal ECG finding were present with sensitivity 100% and specificity 62.37%. 20% of the studied patients, were found to be having abnormalities in 2D echo and mostly have diastolic dysfunction. Conclusion: In our study association of high S. CRP and S. CKMB levels with severe Pancreatitis had high sensitivity. Association of 2D ECHO abnormalities with severe pancreatitis was highly specific. Association of ECG changes with Severe pancreatitis had 100% sensitivity. Most common ECG abnormalities was sinus tachycardia.

197. A Study on Correlation of ER, PR Status and Serum Estradiol Levels with Histopathology Type among Women with Dysfunctional Uterine Bleeding
Gowtham Karunanithi, S. Brindha, Shashikala C
Introduction: Dysfunctional uterine bleeding is a clinical term used to describe bleeding not attributable to an underlying organic pathologic condition. Receptor studies in DUB cases show that ER and PR levels in DUB patients were significantly higher. Circulating blood levels of estrogen and progesterone have implications on DUB.A few studies have shown that DUB has high estradiol levels. There is Based on this aim of our study is to evaluate the histopathological features of endometrium in correlation with Serum Estradiol levels and with special emphasis on ER, PR receptors and morphometry in the diagnosis of menorrhagia. Materials and Methods: This study is a prospective study of the histomorphological profile of endometrium in dysfunctional uterine bleeding in patients in age group of 20-75 years. A total of 60 cases were enrolled during our study period. Endometrial curettage from patients of other age groups were excluded. Immunohistochemically scoring for ER and PR receptors were done with Quick score. Also, intensity scoring was done. The above two scores, score for proportion and the score for intensity are summated to a total maximum score of 8. Score of more than 2 is considered positive. Results: The common histopathologic diagnosis was proliferative phase in 45 %. ER mad PR were positive in all type of HPE findings in our study with different ranges. The levels of ER and PR expression was significantly raised in DUB patients compared to normal patients.Serum estradiol levels too were positively correlated. Conclusion: The study of ER and PR expression helps in diagnosing endometrial hyperplasia without atypia, endometrial hyperplasia with atypia and endometrial carcinoma. Measurement of serum estradiol levels in DUB is important because it is markedly increased in case of endometrial hyperplasia and endometrial carcinoma compared to normal proliferative and secretory endometrium.

198. The Study of the Association between Serum Bilirubin Levels and the Risk of Heart Disease in Hospitalised Patients
Jigar Shaherawala, Ketan Mangukiya
Background: When Haemoglobin is broken down, bilirubin is produced ,a metabolic waste product that needs to be metabolized before it can be properly disposed of Low Level of bilirubin are linked to a decreased risk of cardiovascular and coronary heart disease. Objectives: The major objective of the study was to establish a correlation between hospitalised patients’ blood bilirubin levels and risk factors for heart disease. Methodology: This cross sectional study includes total 120 Indian male of age group between 40-60 year who came to our medicine OPD .Among them 60 patients were came for health check up so that is considered in a control group and rest 60 were in Case Group. from all study subjects blood samples were collected for estimation of Lipid profile ,Serum Bilirubin level and blood sugar level. In order to calculate the p value and determine whether there was a significant difference, the acquired findings were statistically evaluated. Results: The difference in HDL level between OPD and IPD individuals (28.50± 4.25, 43.92± 5.23) was statistically significant. Study demonstrated greater levels of FBS (123.23±4.2 mg/dl) and PP2BS (133.2±38.0 mg/dl) in OPD participants as compared to IPD patients, however the difference between them was not statistically significant. When blood LDL levels were compared, they were 165.86±15.29 and 134.43±10.39 in the control and case groups, respectively. The difference among them was highly significant and LDL having atherogenesis property so it leads to increase risk of cardiovascular disease. The level of Direct bilirubin was 0.36±0.21 mg/dl in control group and 2.80±1.72 mg/dl in case group. and difference among them was highly significant. The Level of Total bilirubin was 0.94±0.41 mg/dl in control group and 3.42±2.1 in case Group and difference among them was highly significant. Conclusions: According to my findings, there is a substantial negative link between baseline bilirubin levels and incident CHD and CVD death, and serum bilirubin levels are an important component in determining cardiovascular disease risk.

199. Prevalence of Overweight and Obesity in School Children and their Correlation with Hypothyroidism in District Rohtas, Bihar
Vijay Kumar, Nutan, Mani Kant Kumar
Introduction: Overweight and Obesity is a global health issue and it’s incidence is rising consistently. It is developing as the most important contributor to ill health and mortality and is influencing adults as well as children and adolescents. Aim and Objective: To study the prevalence of overweight and obesity in school children and their correlation with hypothyroidism in the District of Rohtas, Bihar, India. Methodology: The study was concerned with the primary and middle school-going children of Rohtas district. total of 7 schools were selected, Weight was recorded using an electronic weighing scale, to the nearest 100 g. Height was recorded using the stadiometer to the nearest 0.1cm. Result: The total 10 (62.5%) of obese included in this study were hypothyroid out of 16 obese children and the total 6 (37.5%) obese were euthyroid. All the normal controls included were euthyroid. Although all the overweight children and control were euthyroid but mean value of TSH was comparability higher in overweight children than control, the difference was statistically significant (p value = 0.002). The mean levels of T4 were higher in overweight children than controls but was statistically not significant. Conclusion: There is a rising prevalence of overweight and obesity in India, leading to altered TSH and fT4 levels. The mean levels of TSH were significantly higher in obese children than controls. The mean levels of T4 were significantly lower in obese children than controls.

200. Prevalence of Cancer Induced Cachexia in Non-Digestive Tract Malignancies: An Observational Study
Vikas Pal, Abhishek Pratap Singh, Garima Uikey, Vinay Shivhare
Background and Aim: Cancer-related complications can occur throughout any phase of therapy. It could happen before, during, or after the procedure. One such multifactorial, very incapacitating condition is cachexia. Anorexia is the first symptom, which is subsequently followed by weight loss and muscular wasting. It is linked to a lower quality of life, a lesser tolerance for medical procedures like chemotherapy, and lower survival rates. When it comes to non-gastrointestinal tract malignancies, it is more serious. In this study, we assessed the incidence of cancer-induced cachexia in malignancies beyond the gastrointestinal system. Methodology: We included 200 patients who reported with sudden weight loss and had cancer that was determined to have spread to other parts of the body than the gastrointestinal system. Cancer-induced cachexia was evaluated using descriptive statistics. Numbers and percentages were used to present all the facts. Results: Males were more likely to get non-gastrointestinal tract cancer (56%) than females (44%). In this group of 200 patients with non-gastrointestinal tract cancer, head and neck cancer accounted for 70.7% of cases, breast cancer 14.6%, lung cancer 5.7%, ovarian cancer 4.8%, cervical cancer 2.4%, and lymphoma 1.6%. Conclusion: Patients with non-gastrointestinal tract cancer should be informed that they should seek appropriate support as soon as they notice any unfavourable changes before, during, or after their treatment in order to avoid debilitating conditions such cancer-induced cachexia. Preventative approaches contribute to better treatment outcomes and life quality.

201. Study on Diaphyseal Humerus Fracture Treated with Plate Osteosynthesis by Anterolateral and Posterior Approach and Incidence of Iatrogenic Radial Nerve Injury
Gautam Chandra Paul, Shamim Ahmed Barbhuiya, Nagesh C S, Ch Rakesh Singha
Background: Humerus shaft fractures represent 3-5% of all fractures. Several methods have been used to treat diaphyseal humerus fractures. Open reduction and internal fixation by plate osteosynthesis for diaphyseal humerus fractures are alternatives that can be performed anteriorly, posterior, or minimally invasively. There haven’t been many trials or studies to find the most effective treatment for diaphyseal humerus fractures. Objectives: to compare the results of diaphyseal humerus fractures treated with open reduction and internal fixation with a plate using the anterolateral and posterior methods. Methodology: It was a prospective comparison of the two methods for treating diaphyseal humerus fractures. All regular radiological and hematological studies were completed after the first evaluation and stabilization of the patients. Patients were informed about the procedure, given adequate consent, and prepped for surgery. Each patient received a randomly chosen management strategy. Patients were evaluated postoperatively using the American Shoulder and Elbow Surgeon (ASES) rating system at six weeks, three months, and six months. Results: Simple transverse fractures of the AO type accounted for 36% of all fractures, according to Müller, followed by simple oblique fracture (28%), simple spiral fracture (16%), Spiral wedge fractures 6(12%), Bending wedge fracture (4%) and Fragmented wedge fractures (2%) and Complex spiral fracture 1(2%). 94% of patients who underwent anterolateral treatment had good results, compared to 96% of individuals who underwent posterior treatment. Three of the five difficulties included the anterolateral approach, and two involved the posterior approach. Conclusion: For diaphyseal humerus fractures in the upper third and middle third, an anterior approach is a favorable choice; for fractures in the distal third, a posterior approach is preferable. In the posterior technique, iatrogenic radial nerve damage is less frequent.

202. The Study of Biochemical Abnormalities and its Outcome in Neonatal Seizures
G Murali Krishna Yadav, Pasupurekula Laxmi, N J Gokula Kumari, Mrudula Yenepalli, A Thirupathi Reddy
Introduction: Neonatal seizures are a typical neonatal neurological issue and may be the newborn’s earliest clinical indication of CNS problems. The goal is to investigate the biochemical deviations and ascertain how newborn seizures affect neurodevelopment. Aims and Objectives: (1) To research the biochemical deviations in newborn seizures. (2) To determine how newborn convulsions will affect neuro-development. Methods: This is a prospective observational study conducted on 100 consecutive neonates admitted in NICU of the Department of Paediatrics, SVRR Government General Hospital, Tirupati. For each case, full history was recorded on a pretested proforma after the parents gave their informed consent in writing, and after that all cases underwent the necessary investigations. At the time of discharge, Hammersmith Neonatal Neurological examination was done and any disability if present was noted. Developmental evaluation of these infants was carried out by DASII at the age of three months after their discharge. Results: In our study the most common etiological factor for neonatal seizure was Hypoxic- ischemic-encephalopathy (HIE) and hypocalcemia was the most common transient metabolic abnormality in this group and for outcome measurable, neurodevelopmental abnormality was observed most often with Hypoxic ischemic encephalopathy. Conclusion: Neonatal seizures usually involve biochemical changes, either as underlying causes or as co-occurring abnormalities. For effective therapy and a positive long-term outcome, metabolic abnormalities must be identified and treated as soon as possible.

203. Profiling of TOC-Microsatellite Loci at 17q25 in OSCC Patients with Therapeutic Validation
Biswajit Maity, Seema Gupta
Abstract: Treatment strategies for oral cancer are still primarily based on tumor-node-metastasis classification. A variety of prognostic biological markers correlated to survival have been described over the years, but very few of these have been tested for prognostic accuracy. The advent of genome-wide screening methods such as comparative genomic hybridization, Microarray, microsatellites and SNPs have opened up new possibilities to catalogue chromosomal aberrations, point mutation for disease diagnosis as well as therapeutic validation. Aberration of the Tylosis Oesophageal Cancer (TOC ) gene mapped to chromosome 17q25 has been recognized as a genetic marker for the development of Oesophageal, Breast and Ovarian cancer. Material & Methods: A total of 26 Microsatellite markers at 17q25 were examined in 150 OSCC patients treated with cisplatin and capecitabine to establish genetic marker for early detection and therapeutic validation. A total of 150 primary tumor tissues, and corresponding blood samples from patients attending the Chhatrapati Shahuji Mahraj Medical University Lucknow from 2003 to 2006, were collected. The tissue samples were obtained, either at the time of investigative biopsy or during the time of the surgical resection of the lesions. Results: Overall incidence of LOH/MSI was 40%±20.84 with the frequency of LOH and MSI of individual markers ranged from 12-93%. LOH was relatively more frequently detected at five loci, namely D17S1817 (57.33%), D17S1864 (81.33%), D17S1603 (68.66%), D17S1602 (93.33%), D17S929 (64%). Low incidence of LOH and MSI was observed in D17S2238 (20.7%) and D17S926 (12.66%) and D17S2101 (18.7%). Conclusion: To our knowledge, this is the first report suggesting an association between allelic loss at D9S1602 & D17S1864 on TOC loci and recurrence in OSCC from India in patients treated with Cisplatin & Capecitabine.

204. Comparative Study of Efficacy of 0.5% Ropivacaine and 0.25% Levobupivacaine when used in Tranversus Abdominis Plane (TAP) Block for Post-Operative Analgesia in Lower Abdominal Surgeries
Tabish Javed, Tanweer Uz Zaman, Arun Deka
Background: To assess the effectiveness of 0.25% Levobupivacaine and 0.5% Ropivacaine in the Transversus Abdominis Plane Block for Post Operative Analgesia in Lower Abdominal Surgery. Methods: In this prospective, randomised, single-blind, controlled clinical trial, 60 ASA physical status I–II patients of either sex, older than 16 years old, with normal liver and renal functions, were scheduled for unilateral lower abdomen surgery. Using systematic random sampling, patients were assigned to either group L (n = 30) or group R (n = 30) to receive a TAP block with 0.25% levobupivacaine or 0.5% ropivacaine. Results: In group L, the average age was 45.62±16.63 years, while in group R, it was 44.99±12.13 years. As hernias are more common in men, the majority of group L and group R members are men rather than women. The majority of inguinal hernia cases in our study were on the right side, which was more common than on the left in both groups. Open appendicectomy is the least common of the surgical procedures in both categories. In groups L and R, the mean respiratory rates range from 13.99±0.95 beats per minute to 14.63±1.11 beats per minute and 13.96±0.75 beats per minute to 14.18±0.68 beats per minute, respectively. The mean pulse rate varied between 72.64±5.80 beats per minute in group B and 71.2 ±4.26 beats per minute in group R. In groups L and R, the mean arterial pressure ranged from 84.4±11.99 mmHg to 90.01±11.9 mmHg and from 81.98±10.98 mmHg to 89.75±13.01mmHg, respectively. There was no statistically significant change (p>0.05). In group L, the average time was 418.5±48.55 minutes, and in group R, it was 2090±622.21 minutes. Statistics indicated that this difference between the two groups was present (p <0.05). Conclusion: This study found that 0.5% Ropivacaine, when administered in Transversus Abdominis Plane (TAP) Block to give post-operative analgesia after lower abdominal procedures, offered longer duration of analgesia compared to 0.25% Levobupivacaine.

205. Rheumatoid Arthritis Etiology Pathogenesis Investigations Immunology Latest Management and Prognosis
Shelar Vinay Baliram
Introduction: The clinical spectrum of rheumatoid arthritis (RA) presentation is heterogeneous, with wide variation in age of onset, degree of joint involvement and severity. The aim of the present study is to assess the demographic, clinical & seriological features, severity of disease and treatment option used among patients diagnosed with rheumatoid arthritis. Materials & Method: The present observational study was conducted among 162 patients of rheumatoid arthritis visited to department of general medicine of a tertiary care centre during the period of study. The Clinical history and physical examination of all patients were done. Data was recorded and analyzed using SPSS version 23.0. Results: The mean age of patients 51.6 years and females were more as compared to males. 54.3% of patients were suffering from severe stage of RA. The most frequently affected joints were the wrist (94.7%), MCP (92.1%), and PIP (93.7%). The sicca symptom (42.6%) and the carpal tunnel syndrome (32.7%) were the most common extra-articular involvement followed by pulmonary involvement (6.5%), vasculitis (2.8%), and the Raynaud’s phenomenon (1.9%). The medications, including methotrexate, leflunomide, salazopyrine, and low-dose corticosteroid have been used by 86.4%, 12.9%, 75.3%, and 72.2%, respectively. Conclusion: The most prevalent type of inflammatory polyarthritis is RA, however due to its variable presentation, it is not always easy to identify at the outset. The different options present today help in early diagnosis and complete management of disease.

206. A Comparative Study of Partial Uncinectomy Versus Total Uncinectomy in Chronic Rhinosinusitis Cases
Kattula Divya Prasanna, Pentapati Chaitanya, Vegiraju Divya Mani, Pedapati Dharmendra Manohar
Background: In this study, we wanted to compare operative time and healing time in partial and total uncinectomy. We also wanted to compare between total and partial uncinectomy results in terms of patient symptoms improvement and complications in partial and total uncinectomy. Methods: This was a hospital based prospective study conducted among 50 patients who presented with chronic rhinosinusitus to the Department of Otorhinolaryngology in Maharaja institute of medical sciences, Vijayanagaram, from January 2022 to December 2022, and underwent partial uncinectomy on right side and total uncinectomy on left side, after obtaining written informed consent from the study participants. Results: Operative time in partial uncinectomy is 1 – 4 min, and total uncinectomy is 4 – 6 min. Partial uncinectomy has a significantly shorter operative time when compared to total uncinectomy with a p-value < 0.001. Healing time [weeks] ranged from 1 – 3 weeks in partial uncinectomy and 2 – 3 weeks in total uncinectomy, with a significant difference between them with a p-value < 0.001. Conclusion: Compared to total uncinectomy, partial uncinectomy has a shorter operative and healing time. Total and partial uncinectomies are effective in relieving symptoms with slightly better effectiveness in total uncinectomy. All complications were reported in total uncinectomy. No significant difference between partial and total uncinectomy was noted with regard to any of the studied complications.

207. Among COVID- 19 Hospitalized Patients Does D-Dimer Value at the Time of Admission Predict Future Outcome
Areena Hoda Siddiqui, Anju Shukla, Shareh Fatima Naqvi, Surbhi Gupta, Priyanka Jain, Reshma Umair
Background: COVID-19 is still going on with lots of uncertainties. There is a need for early and effective marker for prognostication of COVID-19 patients. Coagulation dysfunction and increased D-dimer levels are seen in this disease. Thus, present study was aimed to compare D-dimer value in relation to disease severity and disease mortality, and to evaluate prognostic significance of D-dimer. Method: All symptomatic SARS-CoV-2 RT-PCR confirmed COVID-19 patients admitted in Hospital from March 31, 2021, to May 31, 2021 were evaluated and clinical, demographical and laboratory findings were collected and analysed. According to disease severity patients were grouped and death events and D-dimer value were assessed. Optimal D-dimer cut off point in all groups were evaluated. Results: 388 patients were included in the study out of which 142 (36.5%) died during hospital stay. Mean D-dimer value in mild disease was 1.17±0.21, moderate disease was 1.47±0.17 and in severe disease was 2.92±0.23 FEUµg/ml. Mean D-dimer value in non-survivors were significantly (P<0.001) different and higher (59.3%) as compared to survivors. ROC curve analysis showed a prognostic value of D-dimer in mild (AUC=0.755, Z=3.30, P=0.001), moderate (AUC=0.762, Z=4.65, P<0.001) and severe (AUC=0.694, Z=5.08, P<0.001) patients. Optimal cut off of D-dimer between survivor and non survivors was >0.78 in mild cases, >1.05 in moderate patients and >2.11 in severe cases. Conclusion: Mean D-dimer value showing increasing trend with increase disease severity and prognostic significance was found highest in moderate patients followed by mild patients and least in severe patients in terms of mortality.

208. A Study on Prevalence of MDR TB Among Pulmonary TB Cases at a Tertiary Care Hospital in Southern Odisha
Debabrata Barik, Priyanka Das, Gopal Krushna Sahu, N. Akshaya, Sushree Swetapadma, Abinash Dandasena
Introduction: Tuberculosis (TB) is a highly infectious disease caused by Mycobacterium tuberculosis. In India, more than 40% of the population is infected, and 1.8 million new cases occur every year, with over 70% affecting the economically productive age group. Multidrug-resistant TB (MDR-TB) refers to TB strains resistant to Isoniazid and Rifampicin. MDR-TB remains a major public health threat, with India accounting for over one-fourth of the global TB burden. Aims and objectives: This study aims to detect TB and determine MDR-TB prevalence using fluorescence staining, culture, and nucleic acid amplification tests. Methods: This prospective study was conducted at the Department of Microbiology and Department of Pulmonary Medicine, MKCG MCH, Berhampur, Odisha and Anti-TB Demonstration Centre, SCB Medical College, Cuttack. Sputum, bronchoalveolar lavage, or pleural fluid samples from suspected pulmonary TB patients were collected and screened for acid-fast bacilli using fluorescence microscopy and ZN staining. Positive samples underwent nucleic acid testing to confirm the presence of Mycobacterium tuberculosis. Results: The analysis of Rifampicin and Isoniazid resistance genes showed that MUT3 (S450L) of the rpoB gene and katG MUT1(S351T) were responsible for 100% of the MDR-TB cases in the study. MDR-TB was more common in previously treated patients, but it could also occur as a primary infection in new patients. Conclusion: MDR TB was a growing threat to global TB control programs, with previous TB treatment as a key risk factor. Early detection of drug resistance was crucial to prevent its rapid spread.

209. A Study of the Role of Endoscopy in the Diagnosis and Management of Dyspepsia
D Guruva Reddy, Sangeetha R
Background: Endoscopy is advised as the initial test in the evaluation of a patient with dyspeptic symptoms and is critical in determining if the patient has organic or functional dyspepsia. Endoscopy will continue to be the first line of study for clinically relevant abnormalities that need accurate detection and biopsy, notwithstanding the difficulty in establishing a link between mucosal changes and symptom patterns. The present study was done to determine various endoscopic findings in dyspeptic patients and to study the usefulness of endoscopy in patients presenting with dyspepsia. Method: Through a predesigned proforma, a thorough clinical history was gathered, including the existence of warning symptoms. An abdominal ultrasonogram is performed to search for gallstones or any other mass lesions. After that, an endoscopy was performed on the patients, and the results were recorded. Before the surgery, cardiology fitness tests were conducted on all patients older than 40 years. Before the operation, the patient went without food for 12 hours. Endoscopy was performed on the majority of patients under just topical anesthesia. Few patients needed sedation. Results: In this study, the endoscopic findings were normal in 18.87% of cases. Gastritis was the most commonly diagnosed condition in 28.30% of cases followed by GERD in 15.09% of cases. In n=2 instances (3.77%), stomach cancer was observed, while n=1 (1.88%) individuals had duodenal ulcers. Barrett’s esophagus and esophageal polyp in n=1(1.88%) cases each. Significant findings were found in the age group of 21–40 years when the endoscopic findings were split based on the age group. GERD mostly affects people between the ages of 31 and 40 years. The inflammatory lesions were more prevalent in those aged 21 to 40 years. Ulcer-related dyspepsia was typical in people between the ages of 41 and 70 years. Conclusion: Males were more likely than females to have dyspepsia, and it was more prevalent in the 31–40 years age range. The most frequent first symptom in people with dyspepsia is epigastric pain or pain. The most frequent endoscopic finding was gastritis.  H pylori prevalence in the studied population was 58.49%. The study population’s incidence of cancer was 3.77%.

210. Perinatal Outcome in Oligohydramnios at Term Pregnancy
Rieona Saha, A. B. Fuzayel Ahmed, Pranoy Nath
Background: In this Modern era, Obstetrics is very conscious with the health and well-being of both the mother and the newborn. Identifying the fetus at risk for intrauterine death, against the various complications of neonates and assessing the perfect time and the way of intervention for delivery of the unborn fetus are the milestones of the modern Obstetrics. Identification of volume of the amniotic fluid is an important characteristics in USG evaluation for well-being of the fetus at term. Objectives: To study the Perinatal outcome in Oligohydramnios (AFI <6) at term pregnancy. METHODS: A Prospective study was done at Silchar Medical College & Hospital with 200 cases of Oligohydramnios with AFI <6. Results: In this study the rate of Oligohydramnios was obtained to be 2%. 35.5% had Caesarean delivery of which 20% was due to liquor having stained meconium. The incidence of Low birth weight was 53%. 39.5% of patients had non-reactive CTG. 71.5% required NICU Admissions. 46.5% had APGAR SCORE lower than 7 at 1 minute and 27% had APGAR SCORE lower than 7 at 5 minutes. Conclusions: Oligohydramnios is related with more maternal and perinatal morbidity. There are high chances of respiratory distress syndrome, meconium stained liquor, birth asphyxia, low birth weight in cases of Oligohydramnios. Amniotic fluid index of <6 has a poor perinatal outcome. Timely interventions, skilled obstetrician and paediatrician can reduce the perinatal morbidity in cases of Oligohydramnios.

211. Prospective Study of Assessment of Proprioception Recovery Post Anatomical Anterior Cruciate Ligament Reconstruction with Remnant Retention
Amit Bansal, Sunil Dachepalli, Saumya Agarwal
Background: Most of proprioception receptors of anterior cruciate ligament (ACL) for somatosensory reflex arc are present in tibial footprint [1-3]. These receptors start disappearing after tear and degenerate by the end of a year. Retaining these receptors can help in early rehabilitation, graft ligamentization and reducing postoperative graft re-ruptures. Objectives: To evaluate proprioception post ACL reconstruction between remnant retaining and remnant non retaining group by Lysholm knee score and clinical propriception assessment. Methods: Participants between age 15-45 years within 6 months of ACL injury presented to our hospital between January 2021 to December 2021 were randomised and divided into two groups of remnant retaining (RR) and non-Remnant retaining surgery (NRR), were evaluated by joint position sense weight bearing (WB) and non-weight bearing (NWB) tests, followed by functional scoring with Lysholm knee score at 6weeks, 3 months, 6 months, 1 year and 2 years. Result: 31 patients (M-18, F-13) were enrolled in RR (n-17) and NRR (n-14) depending upon surgical technique with mean age 34.1±7.6 years and 32.2±4.8 years respectively. Preoperative mean scores were 53±4.4 and 52±5.7 in each group. Mean of preoperative NWB test were 42±2.7 (RR) and 40.7±3 (NRR) respectively. Mean score of the preoperative WB test were 44.3±3.3 (RR) and 44±3.3 (NRR) respectively. At 6 weeks, RR group had score 63±3.4, NWB 40.4±2.8, WB 42.3±3. NRR group had similar picture (Score 66±2.8, NWB 42.5±2.4, and WB 46.3±2.6). There was significant difference in score and proprioception test between groups at the end of 6 months and thereafter till 2 years. In RR group, numbers were following (score- 85±7, NWB -33±3, WB-35±3.7) as compared to NRR group (score 73±4, NWB -39±3, WB-41±3.4). Patients of RR group were followed till end of 2 years had mean score 98. Conclusion: Remnant retaining anatomical ACL reconstruction using hamstring graft have better proprioception recovery compared to non-remnant retaining group in short period of time which can avoid serious complication post-surgery like re-rupture of graft due to frequent falls.

212. To Compare the Maternal and Perinatal Outcome in Pregnant Women with and without Thyroid Disorder
Samudyata, Girish B. L., Indira H.
Background: After diabetes mellitus, thyroid disorders are among the most prevalent endocrine conditions in pregnant women. Several changes in the mother’s thyroid function are seen during pregnancy & thyroid dysfunction occurs from failing to adjust to these physiological changes. It is generally known that subclinical thyroid dysfunction, in addition to overt thyroid dysfunction, also negatively affects the mother and the foetus and can cause preterm birth, abortion, preeclampsia, eclampsia, placental abruption, low birth weight, and neonatal hypothyroidism. Thyroid hormone availability issues may also affect a fetus’s capacity to grow cognitively and neurologically. Aim of the Study: To compare the maternal and perinatal outcome in pregnant women with and without thyroid disorder. Materials and Methods: This is a prospective study conducted in the Department of Obstetrics and Gynecology at Sri Siddhartha Medical College and Hospital, Tumakuru from February 2021 to July 2022 in 160 patients. Results: In this study, among the 80 cases of thyroid disorder, 75% ( 60/80) cases were Hypothyroid and 25% ( 20/80) cases were Hyperthyroid. Anemia (mild-moderate) was most common complication with p value-0.114, which is not significant. 2nd most common complication being preterm labor with p value – 0.710, which is not significant. Conclusion: In this study of thyroid disorder in pregnancy, showed no significant association between the maternal and perinatal complication in patients with thyroid disorder. As our hospital is a referral center and receive many complicated cases, results cannot be generalized to the whole population and it needs further studies.

213. A Comparative Evaluation between 4 ml Intrathecal 1% 2 Chloroprocaine and Intrathecal 0.5% Levobupivacaine for Infraumbilical Short Surgical Procedures under Subarachnoid Block: A Clinical Study
Sonam Shrivas, Jitendra Kushwaha, Urmila Keshari, Rajkumar Ahirwal
Aim: This study aims to assess the anaesthetic effects of intrathecal 1%, 2-chloroprocaine versus intrathecal 0.5%, levo bupivacaine in infraumblical short surgical procedures.
Material and Methodology: After obtaining approval from the Institutional Ethics Committee and written informed consent from patient, the present prospective randomised double blind study entitled was carried out on 60 patients (ASA grade I and II ) age of 18-45 years of either sex scheduled for infraumblical surgeries. The selected patients were randomly divided into two equal groups of 30 patients. GROUP CP patients received 40 mg 1% chloroprocaine and GROUP LB patients received 30 mg 0.5% levobupivacaine. The parameters assessed were duration of sensory & motor blockade, perioperative hemodynamic effects and duration of post operative analgesia. Results: In our study, we observed that, the mean onset time of sensory block was early in CP group ( 3.75±1.5 min in CP and 4.25±0.75 min in LB) but was not significant. The time for two segment regression of sensory block was 49.22±6.52 min versus 78.97±6.17 min in group CP group and LB group respectively with significant p value. It was significantly shorter in group CP. The time for complete regression to S2 in CP group was 112.15±33.45 min and in group LB 252.16±31.43 min which was statistically significant. Onset of motor block was shorter in CP group 4.75±0.55 min than LB group 5.80±0.65 min. Duration of motor block was observed and found that it was shorter in CP group, 108.91±5.15 min versus 222.12±16.60 min in LB group. Duration of analgesia was 118±2.18 min versus 214±4.20 min in group CP and LB respectively with significant p value. Hemodynamic parameters were stable in both the groups. Conclusion: According to the results obtained from the present study it is concluded that chloroprocaine intrathecally in dose of 30 mg provides adequate duration & Surgical anaesthesia for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block, resulting in earlier hospital discharge with stable hemodynamics as compared to 0.5% Levo-bupivacaine 30 mg.

214. Zinner’s Syndrome as a Rare Case Report
Hrishikesh Tovar, Sneha Karhade, Anant Beedkar, Sarojini Jadhav
Introduction: Zinner’s syndrome is a triad of mesonephric (wolffian) duct anomalies comprising of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Maldevelopment of distal part of the mesonephric duct results in atresia of ejaculatory duct (leading to obstruction and dilatation of seminal vesicle), while abnormality in ureteral bud leads to renal agenesis. Method: Here we present a case of 17 years old male child with complain of pain in abdomen on right side. USG & CECT[A+P] was done which confirmed above diagnosis. He was managed by exploratory laparotomy with right abdominal testis and cyst excision and was sent for HPE. Post operative period was eventful. Histopathology report was s/o cryptorchid testis. Results and Conclusion: Seminal vesicle cyst combined with ipsilateral renal agenesis is a rare anomaly in the development of urogenital system. This usually occurs in male in 2nd to 4th decade of life. The usual presentation is pain in abdomen, perineum and scrotal region. The diagnostic workup consists of Transrectal USG, CECT, MRI pelvis. The definite treatment is open surgery.

215. Role of Thyroid Imaging Reporting and Data System (TI-RADS) to Evaluate Thyroid Nodules, Correlation with FNAC
Potla Srilakshmi, Indra Neil Mekala, Anusha Rani Sambangi, Lavu Srikanth
Introduction: The diagnostic techniques play vital role in the diagnosis of thyroid nodules. A study was conducted to assess the diagnostic reliability of TI-RADS classification in differentiating between benign and malignant thyroid nodules. Methods: It was a cross sectional study carried in the department of Radiodiagnosis, GSL Medical College, Rajahmundry. The study was carried for 18 months. Both gender, >18 years, with thyroid swelling history and referred to radiology for ultrsonography (USG) were included in this study. The participant was kept in supine position, scanned with high frequency probe in sagittal, transverse, and oblique sections and the findings were recorded.  It was followed by USG guided FNAC under strict aseptic precautions 23 gauge needle was introduced into the suspicious thyroid nodules under USG guidance, sample was aspirated and transferred to a microscopic slide. Then slides were transferred in coplin jar containing Isopropyl alcohol as fixative. P≤0.05 was considered as statistically significant. Results: Total 93 members were included. Majority (33.5%; 31) were between 31 – 40 years; maximum (6.5%) malignant cases were also diagnosed in this group.   Gender wise maximum (12%) malignant cases were detected in female, no statistical significance. Majority of malignant cases maximum were TI-RADS 5 category. Conclusions: For evaluating thyroid nodules USG is commonly used with lot of variabilities and subjective reporting. USG features such as microcalcification, irregular margins, lobulated margins, width have an increased risk of malignancy. So TIRADS category is useful in stratifying the patient management.

216. Platelet Rich Plasma Intraarticular Injections for Knee Osteoarthritis: A Prospective Study
Pookhraj Choudharay, Harpreet Singh, Yogesh Kumar Gautam
Background: Around 10% of the global population is suffering from osteoarthritis which leads to moderate to severe long-term pain and disability. Tissue regenerative therapy like platelet rich plasma have shown a considerable potential to alleviate the symptoms & improve physical function. Aims & Objectives: This prospective study was designed to evaluate the efficacy and safety of Platelet Rich Plasma intraarticular injections in patients affected by knee osteoarthritis. Material & Methods: The present prospective randomized study was conducted in our tertiary care hospital from September 22 till Jan 2023. The study recruited 60 patients with early bilateral knee OA with Ahlback grade 1 or 2 knees without any significant deformity in patients. The patients were randomized into 3 groups: Group A – patients were given a single injection of PRP, Group B – patients were given a two injections of PRP at an interval of three weeks & Group C – patients were given a single injection of normal saline (placebo). The sociodemographic parameters like age, sex, weight, height, body mass index (BMI) were noted. WOMAC scores & pain on VAS scale at baseline, 6 weeks, 3 months & 6 months were recorded. Results – Intra group comparison showed statistically significant reduction in VAS & WOMAC scores in Group I & Group II at 6 weeks, 3 months & 6 months. Intergroup comparison between Group I & Group II showed no statistically significant reduction in VAS & WOMAC scores. Conclusion: PRP shows a great potential in reduction of pain relief & improving the quality of life of patients with osteoarthritis with benefits extending even at 6 months followup.

217. Perception of First MBBS Students to AETCOM Module on Doctor Patient Relationship
Rufus Rajkumar Peterson, G. Sandeep
Introduction: The Indian Medical Council has proposed Attitude, Ethics, and Communication modules (AETCOM) for undergraduate medical students in the new competency-based curriculum. The purpose of this study was to analyse first-year medical undergraduate students’ attitudes regarding the AETCOM module on doctor-patient relationships. Materials and Methods: The current cross-sectional study was carried out in the Department of Physiology at Mamatha Medical College, Karimnagar, in the second week of March 2023. The study involved a total of 175 first-year undergraduate (MBBS) students. According to MCI’s requirements, the AETCOM Module’s teaching schedule consisted of four sessions. All of the students received a Likert scale-based questionnaire at the conclusion of the lesson, and the answers were compiled. Result: There were a total of 175 students among which 70 were boys and 150 were girls. 88% of students strongly agreed that it is useful for gaining patients confidence and for gaining self-confidence, 85% of students strongly agreed that Understanding and respecting patients are a good part of the patient-doctor relationship and 82% of students strongly agreed that it will help in future patient interaction. Conclusion: Students have realised the significance of establishing a positive doctor-patient relationship and its function in effective patient care.

218. The Outcome of Various Treatment Modalities of Keloid and Hypertrophic Scar
Barun Kumar, Brajesh Pathak, Biswajit Maity, Vijay Kumar Goel, Deepika Agarwal, Sanjiv Bhatia
Several types of skin injury, such as surgery, piercing, burns, lacerations, abrasions, tattoo placement, immunizations, insect bites, and any inflammatory condition, such as acne, varicella, or folliculitis, can cause keloids, which may appear months to years after the initial damage and do not have a tendency for retreat whereas hypertrophic scars often develop immediately after injury (weeks) and may regress over time. The treatment of hypertrophic and keloid scars remains an unresolved issue. Numerous therapeutic techniques have been documented, including intralesional therapy, pressure therapy, cryotherapy, radiation, surgical excision, and even combination treatments. The purpose of this study was to evaluate the efficacy of various keloid and hypertrophic scar treatments. Aim: To study the comparative efficacy and outcome of various modalities of treatment of keloid and hypertrophic scar. Study Area: Hind Institute of Medical Sciences, Safedabad, Barabanki, U.P. Study Design: Analytical study.  Study Groups: Five Groups. Sample size:100 cases during the study period. Results: It was observed that at the baseline in combined therapy, all the scores such as pigmentation [2.95±0.18], pliability [3.03±0.28], height [2.64±0.25], vascularity [2.25±0.24] and itching [2.31±0.19] were noted in patients and found comparable. A gradual decrease was observed in all the scores, and at 18 weeks, the scores were noted as pigmentation [2.03±0.14*], pliability [1.41±0.15*], height [0.24±0.06*], vascularity [0.82±0.04*] and itching [0.71±0.05*] was found. Conclusion: Based on the findings of this study, only 5- Fluorouracil and Verapamil therapies showed side effects in patients. There was a significant mean difference in the scores among all the therapies, which showed combined therapy was best without any side effects.

219. Study on Dietary Intake and Body Mass Index among Pubertal and Post-Menopausal Women: A Comparative Study
A Rachel Vidyullatha, Rajani RV, P. Subhash Babu, D Haseena
Background:  Puberty and Menopause demarcate the beginning and the end of the female reproductive life cycle and are two major transitions in a woman’s life. Despite underlying biological parallels, previous research suggests a weak or non-existent relationship between these reproductive life events. Aim and Objectives: Study to compare body mass index and dietary intake between pubertal and post-menopausal age. Material and Method: A Cross Sectional Study, conducted on 100 patients, attended a tertiary care centre, Guntur Medical College, Guntur, in period of one year, in the Age group of 8 – 10 Years and Age >45 years, after following inclusion and exclusion criteria and approved by institutional ethical committee. Results: We have found that there was significant difference in the mean age, height and weight between the groups also we have observed mean body mass index between the groups was statistically significant. Dietary intervention between the group was statistically significant and it was found more in post-menopausal group compared to pre pubertal group. Conclusion: Body weight, and body mass index among pubertal group was at normal level while among post-menopausal group weight was more and most of the women found obese, and these excess weight was observed because of wrong dietary habits and it’s all because of sedentary life style according to physical activity level assessment.

220. To Study the Pathogenesis, Clinical Presentation and Management of Patients with Colorectal Emergencies Presenting as Intestinal Obstruction
Minati Mohapatra, Srikanta Panda, Nitya Nutan Misra, Lamture Yeshwant R
Background: The recurrent cause is malignancies followed by volvulus, trauma, infection and other mechanical etiologies, in the order of frequency. Over the years, a definite changing trend has been observed in colorectal pathology regarding causes, mode of presentation, treatment and prognosis. This study aims to study clinical features, management, complications and prognostic factors affecting the outcome of colorectal emergencies and to study the nature and biology of disease in future. Methods: This was a prospective observational study in SCB Medical College and Hospital from October 2019 to October 2021. Inclusion criteria: Patients (18 years+) presenting with acute abdominal pain, distension, obstipation, bleeding per rectum, with signs of peritonitis admitted in an emergency. Exclusion criteria: Pathology localised to the small bowel and upper GI tract are excluded. Results: On analysing the comorbid factors, as expected, Diabetes, hypertension and anaemia were the predominant comorbid factor. On the evaluation of patients, most patients predominantly present with obstruction (malignancy contributes 60%, volvulus 36%, paralytic ileus 4%). Elevated total count indicative of peritonitis was seen in almost 70% of patients, while evidence of pre-renal failure, indicated by elevated urea levels, was seen in more than 80% of patients. Around 45 per cent of the patients had electrolyte abnormalities. Malignancy had the highest mortality rate,60 %, and volvulus is the next common cause of death, accounting for 35% each. Conclusion: A good resection of the tumour at the appropriate time and with reduced co-morbidity, there is a good prognosis it is carried out by good extensive early pre-operative care.

221. Association of Serum Visfatin and Oxidative Stress Markers in T2DM Patients
Divya Shukla, Juhi Aggarwal, Krishana Gopal, Arun Nagtilak
Background &Method: The aim of this study is to study the association of Serum Visfatin and Oxidative stress markers in T2DM Patients. Out of 100 subjects selected, 50 were of T2DM, and 50 Normal healthy subjects which served as control group. All subjects with T2DM were diagnosed by the criteria of American Diabetes Association. Each and every participant received prior counselling regarding diabetes, causes, symptoms, complications etc. All the subjects were informed of the objectives of the study prior to registration. Result: In our study we found 71% male whereas 29% female. In our study we found maximum no in age group of 41-50 i.e. 44%.We found mean of Serum Visfatin 22.7794±3.402 in our study & PP Sugar mg/dl 127.4300±14.49922. Conclusion: The present study found an association between visfatin levels, MS and oxidative stress. Authors suggest that serum visfatin could be used as a predictive marker for T2DM Patients and its higher levels are associated with oxidative stress.

222. Analysis of Demographic Pattern of Patients with Disorders of Posterior Segment of Eyeball
Arpita Thamba, Kriti Malhotra
Introduction: The International Agency for the Prevention of Blindness (IAPB) and WHO together created the global program VISION 2020 in 1999 with the goal of eradicating preventable blindness. Three of the nine leading causes indicated are NCDs, which are located in the posterior section. Worldwide, 90.2% of people with VI reside in low-income nations. Because infectious diseases have been successfully controlled, NCDs are the main cause of VI. Aims and Objectives: To analyze the demographic characteristics of the patients with disorders of posterior segment of eyeball. Methods: This cross-sectional study was carried out on 123 patients suspected of having opaque or hazy ocular media clinically or by previously performed ultrasonography, underwent will be evaluated using a standard USG. using this, pathologies were diagnosed and studied based on the gender and age. This was done to analyze the demographic status of the diseases. Results: There were 61.5% in the range of 80 Male patients while 38.5% of 50 were female patients and 100% were total of 130 patients. The study investigated the age distribution of cases. In total, there was 72 males with non-traumatic lesion while 8 males with traumatic lesion. Again, there was 41 females in non-traumatic lesions and 9 females with traumatic lesions. The study has investigated the distribution of pathologies with respect the genders. Vitreous membrane was found in 46 males and 30 females. There was significant number of males with VD, VM and VH as compared to females (p<0.05). Conclusion: The study has concluded that the prevalence of diseases of posterior eyeball was significantly higher in the population and males have much higher incidences than females, specially the pathologies like VD, VM and VH.

223. Study on Disorders of Posterior Segment of Eyeball using B-Scan Ultrasound in Hazy or Opaque Media
Arpita Thamba, Kriti Malhotra
Introduction: Ophthalmologists have historically been the sole practitioners of ocular B- mode ultrasonography (US), frequently employing specialized tools. The morphology and spatial association of lesions in the posterior segment can be better visualized using B-mode. A cross-sectional representation of sick tissues and organs is provided by B-scan. It is useful in identifying posterior segment illness. This technique allows for an accurate assessment of common disorders such as cataracts, retinal detachment, ocular trauma, vitreous degeneration, retinoblastoma, and choroidal melanoma. Cost-effectiveness, which is crucial in a rural area, is a benefit of B-scan USG. Aims and Objective: To determine the pathologies and posterior segment lesions using B-scan ultrasound in hazy or opaque media. Methods: This cross-sectional study was carried out in the Radio-Diagnosis Department, K J Somaiya Medical College and Research Centre, Mumbai and using approval for this study was obtained from the institutional ethical and scientific committee from November 2015 to November 2016. 123 consecutive patients suspected of having opaque or hazy ocular media clinically. All patients who were subjected to B-scan ultrasonography for evaluation the malignant and benign lesion of posterior chamber of eye in hazy ocular media., were evaluated using a standard USG machine (PHILIPS HD 7) equipped with a real-time high-frequency (8-12HZ) probe with the patient in the supine position and contact method. Results: In the present study, majority of the pathologies were benign (82.5%), followed by traumatic (13%). Congenital accounted for 04% of lesions, and vascular (1.5 %). The study found that there are 10 and 13 patients, or 8% and 10%, respectively, with axial lengths of less than 2.2 cm in both the right and left eyes. Of the lesions involving the posterior segment of eye in hazy media, maximum number of lesions were recorded as vitrous membranes (42 & 35%) followed by  acute vitreous haemorrhage (22 &17%) and vitrousdeattachment (20 &14% each). Conclusion: The study concludes that B scan ultrasonography proved to be a very useful noninvasive tool in accurately diagnosing the posterior segment pathologies in hazy media. The quicker and faster investigation, easy availability, less susceptibility to patient motion as well as relatively lower cost are its advantages.

224. Immediate Induction of Labour in Term PROM-Maternal and Neonatal Outcome
R. Anitha, Shameema Begum, Ajeetha Banu
Aim: To study the maternal and neonatal outcome of immediate induction of labour in term pre labour rupture of membranes. Methods: Prospective observational study was conducted in Government Rajaji Hospital, Madurai, over a period of 4 months (August 2022 to November 2022).281 low risk mothers with singleton pregnancy, cephalic presentation, term PROM were included in the study. Various maternal and neonatal outcomes were analysed. Results: 94.6% (266) of cases delivered within 12 hours of induction.82.4% (234) delivered by labour natural,17.6% (47) needed LSCS,7.8% of the babies needed NICU admissions .In our study there was nil maternal sepsis ,nil maternal and neonatal mortality. Conclusion: Immediate induction of labour in term PROM reduces the PROM delivery interval and reduces the incidence of neonatal and maternal sepsis with good maternal satisfaction.

225. A Cross-Sectional Study on Resistivity Index of Renal Vasculature in Patients with Cirrhosis of Liver in a Tertiary Care Centre
C. Arvind Kumar, Rajendra Prasad Saligommula, Velisala Madhuri
Aim of the Study: To study resistivity Index of Renal Vasculature in Patients with Cirrhosis of Liver in A Tertiary Care Centre. Material & Methods: A total of 92 patients in which there were 75 cases which included cirrhosis with ascites, cirrhosis without ascites and 17 controls which included fatty liver and healthy individuals formed the study group. Results: The study group is a total of 92 patients, 49 were cirrhosis with ascites patients, 26 were cirrhosis without ascites patients, 17 healthy which includes fatty liver. In our study, Resistivity index is increased in both cirrhosis with ascites and without ascites. So early phase itself shows increased Resistivity Index. Resistivity Index was significantly higher in ascitic patients compared to non-ascitic patients (0.74 vs. 0.67, p<0.01) and in non-ascitic patients with liver cirrhosis than in control subjects (0.67 vs. 0.62, p<0.01). In our study Resistivity Index was significantly higher in ascitic patients compared to non-ascitic patients (0.87 vs. 0.76, p<0.01) and in non-ascitic patients with liver cirrhosis than in control subjects (0.76 vs. 0.64, p<0.001). Conclusion: Renal vasoconstriction evaluated by these indices is correlated with Child score which quantitatively measures the hepatic function in cirrhosis. The diagnosis of elevated Resistivity Index may be taken into account in the clinical management of these patients.

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