International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

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1. Prevalence of Anaesthesia Complications in Orthopaedic Surgeries and its Related Factors
Debasis Sahoo, Santosh Kumar Mishra, T. Suresh Kumar Gupta, Saroj Kumar Parida, Amit Das, Sambit Kumar Panda, Rabi Narayan Dhar
Abstract
Background: The use of anaesthesia is helpful for managing the stress and pain of the patients and influences the body response. Cortisol, catecholamine, cytokines, and glucagon are among the hormones that the body releases in response to stress and surgical injury. Essential physiological processes become unbalanced as a result of the body’s reaction to surgery. Moreover, the aftereffect of the body’s inherent ability to re-establish physiological equilibrium and preserve health is undermined by anaesthetics and muscle relaxants. There are various complications that occurred after the surgeries using the anaesthesia that involve the vomiting, hypoxia, hypothermia, shivering, nausea, and cardiovascular instability. The most frequent side effects were, in that order, respiratory issues, hypotension, bradycardia and tachycardia, neurological issues, delirium, and delayed awakening. Aim: The study aims to determine the prevalence of anaesthesia complications in orthopaedic surgeries and its related factors. Method: This was a descriptive and cross-sectional study. The study population consisted of patients who underwent orthopaedic surgery in the operating rooms of BB MCH, Balangir, Odisha, FM MCH, Balasore, Odisha and SCB MCH, Cuttack, Odisha from December 2019 to December 2022 and met the inclusion criteria. The following formula was used to calculate the required sample size. Based on Miller’s anaesthesia procedure, general anaesthesia was administered to all study participants. The operating room’s temperature was set to 21°C during procedures. The patient was taken to the PACU after surgery. The patients had their hearts monitored by a recovery nurse at the time of their admittance to the recovery room. Results: The results of the logistic regression analysis showed a positive and significant relationship between the kind of surgery (hemiarthroplasty) and the time of surgery (evening). Link between trembling and pain (β=0.652, t=38.31, P<0.05) and shivering (β =0.437, t=18.19, P<0.05). Moreover, gender, age, and the kind of operation limb fractures and intra-medullary nail were all significantly linked with nausea (β =0.777, t=52.08, P<0.05). Moreover, the duration of anaesthesia and the kind of anaesthesia (full venous anaesthesia) were substantially and favourably correlated with vomiting (β =-2.40, t=175.68, P<0.05). Moreover, smoking, gender, and the length of anaesthesia were all positively and substantially linked with tachycardia (β =-3.89, t=118.74, P<0.05). Conclusion: The relatively high frequency of post-anaesthesia problems in orthopaedic procedures highlights the value of PACU staffing that is skilled and using the right monitoring tools. Such actions reduce patient mortality and morbidity while reducing hospital expenses.

2. Drawing Association between Thyroid Function and Auto Immune Status in Female Patients with Polycystic Ovarian Syndrome
Montey Naruka, Victoria Kshetrimayum, Vijaylakshmi P., SMR Usha Manohar, Rupesh Kumar
Abstract
Background: Thyroid disorder and PCOS are considered as two of the most common endocrine disorder among general population and share many common features. As per the clinical analysis, increase in ovarian volume and cystic changes in ovaries have been reported in primary hypothyroidism. Only small numbers of genes are responsible for the endocrine and metabolic symptoms. Apart from this, the environmental risk factors during the prenatal or postnatal period convert PCOS into a clinically manifest syndrome. Aim: The study aims to draw an association between thyroid function and auto immune status in female patients with polycystic ovarian syndrome. Method: The samples were collected from PCOS patients diagnosed according to Rotterdam criteria, ascertained by ultrasonography, attending the OPD in the department of Obstetrics and Gynecology, Rajarajeshwari Medical college and Hospital, Bangalore from December 2014 to May 2016. Seventy-five cases of PCOS patients in the age group of 20-40 years, and seventy-five age-matched healthy women (control) with regular menstrual cycle were selected. Results: The mean age for case was 30.13 years (SD=5.32) and control was 28.54 years (SD=6.78). Pearson’s correlation coefficient for the relationships between anti TPO and T3, T4, TSH, FBS, WT, HT, BMI and WC for cases was determined. Serum T4 and TSH had significant positive correlation with anti TPO in cases. However, there was no significant correlation between anti TPO and T3, FBS, WT, HT, BMI and WC in cases. Conclusion: Positivity for Anti TPO antibodies is more common in PCOS subjects. Euthyroid PCOS cases with anti TPO positivity should be considered as at risk for hypothyroid disorders. Moreover, thyroid disorder is more common among patients with PCOS as compared to normal population.

3. To Compare Perioperative Outcomes Between Anaesthetic Types for Patients Undergoing Primary Elective Total Hip Arthroplasty
Santosh Kumar Mishra, T. Suresh Kumar Gupta, Debasis Sahoo, Saroj Kumar Parida, Amit Das, Sambit Kumar Panda
Abstract
Background: Total hip arthroplasty is being used for offering the orthopaedic procedures. There are more than one million operations are done using this procedure to perform the hip surgery. To perform such surgery, general anaesthesia is considered as the gold standard for major hip surgery. There are many clinical studies have conducted and showing the relative benefits of applying the spinal anaesthesia beyond the general anaesthesia. This kind of anaesthesia is helping to decreased blood loss and required the transfusion to decrease the rate of thromboembolic events. This study’s main hypothesis was that, even after accounting for patient characteristics, there would still be disparities in the rates of adverse events between patients who had primary elective total hip arthroplasty under general anaesthesia and those who had it done under spinal anaesthetic. Aim: The study aims to compare perioperative outcomes between anaesthetic types for patients undergoing primary elective total hip arthroplasty. Method: An exemption for this study was granted by our institutional review board. A retrospective cohort study was conducted with use of the database, which collects data of 234 for general anaesthesia and 372 spinal anaesthesia patients participating in BB MCH, Balangir, Odisha,  FM MCH, Balasore, Odisha  and SCB MCH, Cuttack, Odisha. The database considered from December 2019 to December 2022 was queried to identify patients who had undergone total hip arthroplasty. We identified all patients who had undergone primary total hip arthroplasty.  Bivariate logistic regression was used to compare age, sex, BMI, and modified Charlson Comorbidity Index between patients who had undergone total hip arthroplasty with general anaesthesia and those who had undergone total hip arthroplasty with spinal anaesthesia. Results: surgical approach of the general anaesthesia group for posterior and lateral was 91.9% and 8.1%. Operative side of these patients involves 40.9% left and 59.1% right. Fixation methods involve 4.7% cemented, 46.2% hybrid and 49.1% uncommented respectively. Apart from this, surgical approach of the spinal anaesthesia group for posterior and lateral was also 91.9% and 8.1%. Operative side of these patients involves 46.5% left and 53.5% right. Fixation methods involve 7% cemented, 64.2% hybrid and 28.8% uncommented respectively.  GA patients’ mean preoperative Hb level, 12.5 g/dL (SD, 1.6 g/dL), dropped to a mean immediate postoperative Hb level of 11.2g/dL (SD, 1.3 g/dL). SA patients’ mean preoperative Hb level, 12.6 g/dL (SD, 1.6 g/dL), dropped to a mean immediate postoperative Hb level of 11.1 g/dL (SD, 1.5 g/dL). Conclusion: General anaesthesia was associated with an increased rate of adverse events and mildly increased operating room times.

4. A Study on Menstrual Hygiene and its Association with Perceived Reproductive Morbidity in Adolescent Girls of Slum of Patna District, Bihar, India
Khalid Anwar, Shikha, Pragya Sinha, Amita Sinha
Abstract
Objectives: This study was to assess the knowledge, attitude and practice of menstrual hygiene and evaluate the relation between menstrual hygiene and reproductive morbidities in adolescent girls of slum area of Patna district, Bihar, India. Methods: Data was collected by house‑to‑house survey in the community and girls were asked questions using a predesigned questionnaire. The questionnaire consisted of sociodemographic details, knowledge about menstruation, menstrual patterns and practices, hygiene followed, and associated serious ill-health ranging from Dysmenorrhea, genital tract infections, urinary tract infections, and bad odour etc. Results: We were interviewed 200 adolescent girls with age group 11 to 19 years in slum of Patna district of Bihar. Most of the adolescent girls 143(71.5%) were in age 14 to 16 years. Mean age of age of girls included in this study was 15.1 years. Mean menarche age was 12.9 years.72.5% family were belonged in below poverty line. Majorities of girls 108(54%) were using non-disposable linen (household non-disposable, non-adsorbent cloth materials) during menstrual flow.  out of 200 adolescent girls, prevalence of reproductive morbidity was found to be 143(71.5%). 73(36.5%) girls had dysmenorrhea, menstrual irregularities were in 41(20.5%) girls, burning micturition was seen in 8(4%) girls, 6(3%) girls had white discharge and 4(2%) girls had menorrhagia. 11(5.5%) girls had itching in genitalia. Only 64(32%) girls were utilised health care services for menstruation related problem. Among them 48(75%) were visited public Government hospital and 11(17.18%) visited private hospital for menstrual related problem. And 05(35.71%) girls has taken traditional treatment in menstrual difficulties. Conclusions: Prevalence of dysmenorrhea was not less common and the menstrual hygiene practices were poor among girls, they had to face restrictions and social taboos related to menstruation. So, education to girls about the facts of menstruation, physiological implications, significance and proper hygienic practices during menstruation is the need of the hour. It is also required to bring them out of traditional beliefs, taboos, misconceptions and restrictions. Focus group discussions, mass media campaigns, and inclusion of sex education in schools are required to overcome taboo aspect of menstruation. As well as, we should organise health check-up camp in slum area for awareness of menstrual hygiene and prevention and treatment of reproductive morbidity in adolescent girls.

5. Evaluation of Comparative Efficacy of Dexamethasone, Dexmedetomidine and Fentanyl as Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Block
Shashi Kumari, Ayushi Soni, Pooja
Abstract
Background: An ideal nerve block adjuvant should extend the duration of analgesia, have fewer side effects and expedite the onset of sensory and motor blockade. Aims and Objectives: To evaluate and compare the efficacy of dexamethasone, dexmedetomidine, and fentanyl as an adjuvant to ropivacaine in the ultrasound-guided supraclavicular block. Materials and Methods: A prospective observational hospital-based study was performed on 60 patients after randomly dividing them into Group D (n=20; Inj. dexmedetomidine1mcg/kg added with 0.5% 29ml ropivacaine), Group F (n=20; Inj. fentanyl 1mcg/kg added with 0.5% 29 ml ropivacaine) and Group DM (n=20; Inj. dexamethasone 8mg added with 0.5% 29ml ropivacaine) administered in the supraclavicular block. The duration of post-operative analgesia, sensory and motor blockade onset, time of rescue analgesia demand and adverse effects were observed. The pain was assessed by a visual analog scale (VAS). Results: The duration of post-operative analgesia was significantly longer in the dexmedetomidine group than in dexamethasone and fentanyl. The onset of sensory and motor blockade was quicker with fentanyl than with dexmedetomidine, and it was prolonged in dexamethasone than in the other two groups. Nausea and vomiting occurred in 3 patients in the fentanyl group, and bradycardia was encountered in one patient in the dexmedetomidine group. There were no other side effects postoperatively for 24 hours. Conclusion: Dexmedetomidine is an ideal adjuvant to ropivacaine in the supraclavicular block with prolonged analgesia, relatively faster onset of sensory and motor blockade, and devoid of adverse effects to dexamethasone and fentanyl.

6. A Comparative Study of Post Operative Pain Relief by Continuous Epidural Infusion of Bupivacaine with Fentanyl vs Ropivacaine with Fentanyl by Using Portable Elastomeric Infusion Pump
Raman Kumar, Priyesh Kumar, Harshwardhan, Smriti Kumari
Abstract
Background: Therefore anaesthetic and analgesic techniques should aim not only to provide optimal condition for surgery, but also reduce post operative morbidity and mortality thus improving the outcome. The stress response to surgery results in disturbances in body homeostasis. Many beneficial effects of continuous epidural analgesia during post operative period includes effective pain relief, fast recovery of gut functions, reduction in postoperative thrombo-embolic and cardio respiratory complications. Material and Methods: The study was conducted on 50 patients of either sex aged between 30- 60 years with American society of Anaesthesia physical status grade I who were undergoing upper and middle abdominal surgery. Age of the patients ranged from 20 – 60years and weight between 40-70 kg and height ranging from 150 – 180 cm. All patients were thoroughly examined preoperatively. Conclusion: By using portable, elastomeric epidural infusion pump for the purpose of post operative analgesia by continuous epidural infusion of Bupivacaine with Fentanyl provides superior analgesia compared to Ropivacaine with Fentanyl.

7. A Prospective Randomised Study Comparing Postoperative Outcome after Regional or General Anesthesia for Incisional Hernia Surgery in Obese Patients
Priyesh Kumar, Raman Kumar, Harshwardhan, Smriti Kumari
Abstract
Background and Objectives: Incisional hernia is the most frequent postoperative complication following abdominal surgery. The cumulative incidence has remained constant despite several attempts to improve laparotomy closure. Surgical closure technique, individual, biological and patient dependent risk factors play a key role. To test the efficacy and evaluate the impact of epidural anesthesia and postoperative epidural analgesia on postoperative outcomes in obese patients undergoing incisional  hernia surgery. Material and Methods: The aim of the study was to test the efficacy and evaluate the impact of epidural anesthesia and analgesia on postoperative outcomes in obese patients undergoing incisional hernia surgery. After obtaining institutional review board approval and written informed consent, an open randomized controlled trial was conducted on 60 patients scheduled for elective incisional hernia surgery. Conclusion: Combined spinal epidural is a superior alternative technique to general anesthesia with parenteral opioids in the post operative management of incisional hernia surgery for obese patients. Combined spinal epidural technique provides better pain relief, early bowel recovery, less incidence of hypoxia and nausea and better patient satisfaction in postoperative period in obese patients.

8. A Study of the Effect of Caudal Epidural Neostigmine for Relief of Post Operative Pain in Children Undergoing Lower Abdominal General Surgical Procedures
Raman Kumar, Priyesh Kumar, Harshwardhan, Smriti Kumari
Abstract
Background: Pain has become the fifth vital sign and is now a critical focus of the patient. The relief of pain has always been part of anaesthesiologist’s role. In the immediate postoperative period and extending beyond post anaesthesia care unit. Materials and methods: The study population consisted of 60ASA I and II Children in the age group of 2 years to 8 years admitted to undergoing elective lower abdominal general surgical procedure at our hospital. Conclusion: We conclude that caudal epidural analgesia using a combination of 0.25% bupivacaine 0.5ml/kg and neostigmine (2µg/kg) significantly prolong the postoperative analgesia when compared to 0.25% bupivacaine alone in children undergoing lower abdominal general surgical procedures without any significant increase in side effects.

9. Assessment of Adequacy of Postoperative Analgesia in a Tertiary Care Centre
Priyesh Kumar, Raman Kumar, Harshwardhan, Smriti Kumari
Abstract
Background: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain as the 5th vital sign, has been proposed by the Joint Commission on Accreditation Of Healthcare Organizations Illustration as depicted in Rene’ Descartes Traite de l’homme (Treatise of Man)1664.  The proposition of a link between peripheral sensation and the brain was put forth as early as the 17th century, by Rene Descartes. His cartesian model (5) of a hard – wired system suggested that pain is transmitted by very fixed pathways. Methods: This observational study includes all Gynecology in patients undergoing any open abdominal procedure, with normal mental health and hospitalized for at least 48hrs postoperatively. Our exclusion criteria includes all patients transferred directly to an intensive care unit, those who had emergency procedure or discharged in less than 48hrs. Conclusion: Assessment of adequacy of current analgesic protocols. According to this audit, the analgesic protocols being followed are inadequate and non-uniform.

10. Phenotypic Methods Used for Detection of Carbapenemase Producing Klebsiella Species and Escherichia coli in a Teaching Hospital in the Eastern Part of Bihar, India
Rudrani Das, Sangeeta Dey, Priyanka Paul Biswas, Kahkashan Akhter, Aninda Sen
Abstract
Introduction: Clinical significance of carbapenemases in routine culture is underestimated, since most of the laboratories do not even perform the routine phenotypic tests for detection of carbapenemases. The present study had focused on isolates of carbapenemase producing Escherichia coli and Klebsiella species. Material & Methods: The study was conducted in the Department of Microbiology, Katihar Medical College and Hospital, Bihar, India. 209 consecutive E. coli and Klebsiella species were selected for the study. Of these 55 strains were screening test positive, which were taken up for further testing for detection of carbapenemase production by various phenotypic test methods. Result: Klebsiella pneumoniae carbapenemase (KPC) -producing E. coli was 3.4% (7/209) and Metallo-β-lactamase (MBL) producing E. coli was 9.6% (20/209) and KPC-producing Klebsiella species were 0.48% (1/209) and MBL -producing Klebsiella species were 7.2% (15/209). Some E. coli 2.4% (5/209) was found to produce both types of carbapenemases KPC and MBL. Conclusion: This observation appears to be a warning sign against carbapenemase producing pathogenic profile of most commonly found Enterobacteriaceae E. coli and Klebsiella species and their constantly changing resistance pattern.

11. Evaluation of MAP upon Intubation and Laryngoscopy among ASA I and II Patients
Abaji Parab, Jadhav Sachin
Abstract
Background: Pulse pressure, which represents the difference between blood pressure systolic and diastolic is the only reliable indication of major artery stiffness. Both hypertensive and normotensive individuals have shown it to predict cardiovascular mortality significantly. Traditional studies on Laryngoscopy and tracheal intubation for anaesthesia have focused exclusively on systolic, diastolic, and mean blood pressure changes. Aims and Objectives: To determine the effect of MAP due to intubation and Laryngoscopy with Dexmedetomidine among the patients with ASA I and II. Materials and Methods: A comparative prospective randomized, single-blind, placebo-controlled study was conducted in the operating room of a private teaching hospital offering multispecialty tertiary care. The patients were divided into Group D or Patients in this group received Dexmedetomidine intravenously over 10 minutes at a dose of 0.6 µg/kg body weight diluted to 20 ml of normal saline. Group C or Patients in this group received 20 ml of sterile water intravenously over 10 minutes. From the time the research drug was injected until 10 minutes after intubation, the heart rate and blood pressure (systolic, diastolic, and mean) were monitored every 1 minute, and any difficulties caused by the study drug were reported. Results: The patients were divided into groups D and C, with 30 patients in each group. The mean age of patients is 42.03 and 43 in group D and group C, respectively. There are 43% males and 57% females in group C, 53% males and 47% females in group D. The mean BMI is 25.23 and 25.5 in group C and D, respectively. 56.67% of patients show ASA grade I and 43.33% show ASA grade II in group D, 50% of patients were seen in each grade I and II in group C. Conclusion: The study concluded that pulse pressure is a reliable indicator of arterial stiffness. No significant differences were seen among the patients of both groups upon intubation and Laryngoscopy.

12. Evaluation of Comparative Efficacy of Dexamethasone, Dexmedetomidine and Fentanyl as Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Block
Shashi Kumari, Ayushi Soni, Pooja
Abstract
Background: An ideal nerve block adjuvant should extend the duration of analgesia, have fewer side effects and expedite the onset of sensory and motor blockade. Aims and objectives: To evaluate and compare the efficacy of dexamethasone, dexmedetomidine, and fentanyl as an adjuvant to ropivacaine in the ultrasound-guided supraclavicular block. Materials and Methods: A prospective observational hospital-based study was performed on 60 patients after randomly dividing them into Group D (n=20; Inj. dexmedetomidine1mcg/kg added with 0.5% 29ml ropivacaine), Group F (n=20; Inj. fentanyl 1mcg/kg added with 0.5% 29 ml ropivacaine) and Group DM (n=20; Inj. dexamethasone 8mg added with 0.5% 29ml ropivacaine) administered in the supraclavicular block. The duration of post-operative analgesia, sensory and motor blockade onset, time of rescue analgesia demand and adverse effects were observed. The pain was assessed by a visual analog scale (VAS). Results: The duration of post-operative analgesia was significantly longer in the dexmedetomidine group than in dexamethasone and fentanyl. The onset of sensory and motor blockade was quicker with fentanyl than with dexmedetomidine, and it was prolonged in dexamethasone than in the other two groups. Nausea and vomiting occurred in 3 patients in the fentanyl group, and bradycardia was encountered in one patient in the dexmedetomidine group. There were no other side effects postoperatively for 24 hours. Conclusion: Dexmedetomidine is an ideal adjuvant to ropivacaine in the supraclavicular block with prolonged analgesia, relatively faster onset of sensory and motor blockade, and devoid of adverse effects to dexamethasone and fentanyl.

13. A Study to Assess Maternal and Fetal Outcome of Obesity in Pregnancy
Vatika Tiwari, Deepty Sinha, Anup Pradhan, Saumya Narang
Abstract
Introduction: India is dealing with a twin nutritional burden of undernutrition and a growing problem of overweight and obesity. Significant prenatal, intrapartum, postpartum, and neonatal problems are recognized to be a danger for mothers who are overweight or obese during pregnancy and childbirth, as determined by rising maternal body mass index (BMI).
Aim and Objectives: To evaluate the effect of obesity on the maternal and perinatal outcome in pregnancies complicated by obesity. Material and Methods: This is a Prospective cohort study conducted at Antenatal outpatient department& Antenatal Ward and Labour ward, Dept. of Obstetrics & Gynaecology Sikkim Manipal Medical College and Hospital, during March 2022 to March 2023. 50 Obese, 50 normal women in first trimester. Sikkim Manipal Hospital has on an average 1st trimester AN Registrations of 60 / week. From this I had collected consecutive cases of obese and normal pregnancies till required sample size is reached. Result: The gestational diabetes was 8.0% and 4.0 % respectively in obese and control group. The pre-eclampsia was 14.0% and 6.0% in obese and control group. The incidence of gestational hypertension was 8.0% and 6.0% in obese and control group. The results were statistically significant. Obstetric complications like Multiple pregnancy, Placenta previa, Abruptio placenta and Malpresentation existed in both groups, but the difference was not statistically significant. Conclusions: Our study highlights the multiple maternal and perinatal hazards associated with obese pregnancies, which present a significant challenge to the obstetrician. Significant obesity is also linked to a variety of health problems later in life in women of childbearing age. This underlines the need of focusing efforts on attempting to lower the rising prevalence of obesity in reproductive women.

14. The Bethesda System of Reporting Thyroid Cytopathology: A Hospital Based Study of Eastern UP
Ankit Singh, Vatsala Kishore, Usha
Abstract
Background: Fine needle aspiration cytology is a well-established first line diagnostic tool for the evaluation of palpable thyroid swellings. It is one of the diagnostic investigations for the Evaluation of solitary thyroid nodule (distinguish neoplastic from non -neoplastic), Evaluation of diffuse thyroid lesions (distinguish inflammatory/ autoimmune from nodular goiter), Confirmation and categorisation of clinically obvious thyroid malignancy. Thyroid FNAC is the most accurate and cost-effective tool for guiding the clinical management of patients with thyroid nodules. The role of cytology in thyroid swellings is important for the pre-operative diagnosis of benign or malignant lesions. Aims: To assess the thyroid swelling by fine needle aspiration cytology and classify the FNAC findings according to the Bethesda system of reporting thyroid cytopathology 2017 at a tertiary care hospital. Materials & Methods: It is an observational study done from January 2019 to November 2022. FNAC was performed in 92 cases. Smears stained with Giemsa, Haematoxylin and Eosin and Papanicolaou stain. Result: In present study commonest indication of FNAC was swelling in neck. Among 92 cases, non-neoplastic category II lesions were the major proportion constituting 78.26%%, category I unsatisfactory smears were 4.34%%, category III 3.26%%, next highest percentage of cases were in category IV with 8.69%, category V 4.34% and category VI had 1.08% of cases. Majority of the patients (78.26%) presented with Category II lesions. Among the benign lesion goiter was the most common lesion (64.12%). Nodular goiter formed maximum cases (57.60%) rest were of (6.52%). Next common lesions was thyroiditis in which lymphocytic thyroiditis was common (8.69%) followed by Hashimoto thyroiditis (3.26%) and Dequervain’s thyroiditis (2.17%). Conclusion: In conclusion the present study shows that TBSRTC helps standardize cytology reports thereby improving the quality of reporting, reducing the diagnostic in accuracies and bringing about an interlaboratory agreement on an objective basis. Furthermore it improves the communication between cytopathologists and clinicians, helping them to triage the patient for the appropriate line of management.

15. Observing Likely Outcomes of Different Closure Techniques in Lichtenstein Hernioplasty at Tertiary Care Institute: A Comparative Study
Mayur Bandawar, Sarita Durge, Vikrant Dhawande, Nilesh Mangam
Abstract
Introduction: A total of 80% of groin Hernias goes unnoticed in rural India due to social stigma landing into complications and finally into an emergency. With more than 25% of males having this common but complicated disease. Hence in present study we have focused on closure techniques after meshplasty to observe its various aspects. Methodology: The present study was carried out in the Department of Surgery, at tertiary care institute. Ethical committee approval was taken. In present hospital-based study a sum of 63 individuals were considered, of which 13 patients were drop-outs hence final count was 50. These patients were grouped upon way of hernial closure in which group A was having closure with glue N-butyl-2 cyanoacrylate and group B underwent procedure with traditional suturing. For present study 39 males and 11 females were considered. Observations: After successful pre-anesthetic medical check up Lichtenstein hernioplasty was performed in patients with hernial closure which were grouped as group A was having closure with glue N-butyl-2 cyanoacrylate and group B underwent procedure with traditional suturing. In results considering mean duration of surgery, outcome after surgery, pain relief and its duration, analgesics requirement and sensation of foreign body glue techniques used patients were found have more relief as compared to traditionally sutured patients. Conclusion: Lichtenstein repair for inguinal hernia using glue mesh fixation as compared with conventional method definitely has added advantages and edge above it in terms of outcome and recovery.A benefit of glue mesh fixation is that it is quicker and less uncomfortable. Before the glue approach becomes the accepted standard of care for inguinal hernia repair and longer follow-up times are needed to validate the process. Hence the present study could a stepping stone towards making outcomes of hernial repairs more stress-free and beneficial for patients.

16. Analysis of Preterm Labour and Associated Risk Factors
Rabindra Naik, Avilas Das, Anima Sethy, Madhusmita Hembram, Madhumita Nayak
Abstract
Background: Preterm birth is a poorly understood field, making it one of the most severe issues pregnant women encounter. Due to the incomplete understanding of the biochemical and molecular causes of preterm birth, numerous authors have shown interest in various risk factors. Aims: This study was conducted to learn the risk factors for preterm birth and to look into the matter for identifying high-risk mothers. Methods: In the present study, 50 cases of preterm labour were admitted to Hi-Tech Medical College over two years, and the perinatal mortality and morbidity associated with preterm births were examined. Results: The majority of patients (62%) were aged 20–24 yrs, and the incidence of PPROM was higher among multigravida (54%) than among primigravida (44%). The most prevalent cause of premature labour was an infection of the lower genital tract or UTI. In 36 cases, a positive vaginal culture was obtained. Positive urine cultures were obtained in 14% of 38 cases, with E. coli being the most common (26%). There were significantly more male infants than female infants. The proportion was 1.57 to 1. RDS was the most prevalent complication among newborns (27.8%). The subsequent conditions were septicemia (9.3%), ICH (7.4%), and birth asphyxia (5.5). Conclusion: Therefore, we can conclude that such risk factors are causing premature births. Planning public education initiatives and considering suitable perinatal care alternatives for women at higher risk for preterm deliveries require understanding these risk factors.

17. Study of Arches of Foot in North Indian Population: A Non-Randomized, Cross-Sectional, Single-Center Study
Chhaya Rani, Nilesh Kumar, Sanjay Kumar Sinha
Abstract
Background: Arches of foot represent a serious public health problem which is related to working life because these deformities negatively influence the human productivity and the quality of life of affected patients. There is insufficient evidence over prevalence of arches of foot in North Indian population. Objective: Objectives of this non-randomized, cross-sectional, single-center study was to assess prevalence of arches of foot in North Indian population. Materials and Methods: This single-center study was carried out within the anatomy department, Katihar medical College, Katihar, Bihar, India from December 2021 to March 2023. The study participants were asked to sign a consent form to participate in the study. The baropodometric analysis was performed to diagnose flatfoot and hollow foot, and additional information such as gender and the age were recorded. We calculated percentages, means and standard deviation. The Chi-square test, and the calculation of Odds Ratio were used to identify differences due to these variables (sex and age). The collected data were organized and processed by software Epi info. The level of significance was set at p < 0.05. Results: 125 cases of hollow feet and 125 of flat feet were diagnosed. Maximum study population of either gender belonged to age group >20 years. Patients with hollow feet had an average age of 42.4 years (SD 17.6); patients with flat feet an average age of 29.88 years (SD 20.4). The most numerous cases were in the age group of >20 years old for both flat feet and hollow feet. Conclusion: This study has provided the prevalence of pes planus and pes cavus among the individuals belonging to Katihar Medical College, Katihar, Bihar, Northern region of India as a baseline data and for the comparison to other regions of the country.

18. To Study Prevalence of Types of Anaemia in Pregnancy by Clinical Examination and Peripheral Smear
Vandana Agarwal, Sarika Gupta, Neetu Kumar, Varsha Rani Choudhary, Mudita Jain
Abstract
Objective: To classify the types of anaemia using clinical findings and peripheral smear in pregnant female. Peripheral smear examination reveals the morphological features of RBC’s and help in determining the underlying etiology of anaemia. Methods: Observational cross-sectional study was conducted. 392 women of antenatal clinic were screened for features of anemia. Sociodemographic variables including age, address, socioeconomic status was obtained from the study participants using preformed and peer reviewed proforma. Clinical history regarding presenting complaints, obstetrics history and relevant history was obtained and documented. All the study participants were then subjected to thorough clinical examination. They were investigated by Hb%. TLC, peripheral smear examination. The sample was analyzed to identify different types of anemia by peripheral smear according to pathological classification. Results: Females with anaemia usually present with non-specific features such as pallor, fatigue, weakness, and giddiness. Specific features of iron deficiency anaemia include angular stomatitis and koilonychias, whereas hepatosplenomegaly is specifically observed in haemolytic anaemia. The demographic data examined revealed the mean age to be 25.96+ 4.2. 52% of women overall had a maximum age under 25. 75% of women had low socioeconomic status. Maximum 58% of the remainder were multipara, while 42% were nulliparous. Conclusion: Anaemia is one of the most common clinical conditions observed during pregnancy. Hemoglobin estimation help in quantification of anaemia, and classifying anaemia according to severity and types. Iron deficiency anaemia is most common type of anaemia during pregnancy, other types of anaemia are also observed in few pregnant females and females may not respond to iron therapy.

19. Assessment of Clinical Features on Exposure to Air Pollutants in Elderly Patients with COPD
Sumitra Soren, Madhumita Nayak, Partha Sarathi Mohanty
Abstract
Introduction: COPD, lung tissue deterioration, is caused by tobacco smoking. It is the third leading cause of death and commonly coincides with heart disease, muscle atrophy, and bone loss. Nutritional deficits, anxiety, and depression in older COPD patients can lower quality of life and medication adherence. COPD sufferers require aid with diet, mental health, and pulmonary rehabilitation, but quitting smoking is most critical. Aims and objectives: The purpose is to assess the clinical features of tobacco smoking in elderly patients with COPD and identify appropriate treatment interventions. Methods: Participants were recruited from an academic medical centre’s outpatient clinic using predetermined inclusion and exclusion criteria. All participants had a whole battery of tests run on them, including measures of their lung function. Descriptive statistics and tests are used to make sense of the information gathered. Ethical guidelines for medical research involving human individuals, such as informed permission and privacy, were adhered to throughout this investigation. Results: The peak incidence of COPD occurs between the ages of 70 and 79 for both sexes, with males being more likely to be affected than women. The risk of getting chronic obstructive pulmonary disease (COPD) is significantly increased by Exposure to air pollution and smoking. Table 2 displays COPD cases grouped by air pollution exposure, with the most prevalent symptoms being dyspnea, wheezing, and frequent respiratory infections. Conclusion: In conclusion, air pollution continues to seriously threaten human health, damaging the respiratory system irreparably and leading to enormous suffering. The severity and consequences of respiratory disorders, especially chronic obstructive pulmonary disease (COPD), have been shown to increase in proportion to the length of time people are exposed to air pollution.

20. Study of Clinical Profile and Outcome among COVID-19 Patients during Hospitalization in a Tertiary Care Hospital in Central India
Rahul Soni, Pushpak Goyal, Ashish Dubey, Vinod Kumar Kurmi, Pranav Kumar Dave, Animesh Dubey, Reshu Sharma, Shivani Chaturvedi
Abstract
Background: The COVID-19 outbreak in 2019 has presented in the form of pneumonia of unknown etiology in Wuhan. The complete clinical profile including the prevalence of different clinical symptoms of COVID-19 infection among Indian patients who develop a severe disease is largely unknown. This study is aimed to provide a detailed clinical characterization of the cohort of patients who visited our institute with signs and symptoms of COVID-19. Material and Methods: This was for inpatient hospital (inpatient) based prospective cohort study involving 520 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. Results: Total 520 participants enrolled in the study, (6.9%) participants died, (8.3%) participants required ICU and (5.5%) participants required mechanical ventilation. only signs and symptoms suggestive of severe respiratory system involvement or widespread infection were associated with adverse outcomes, T presence of dyspnoea, cyanosis and hypoxia. The most common chronic disease among patients with adverse outcomes were diabetes, hypertension and pre-existing respiratory disease, personal habit both smoking, and alcoholism was also associated with adverse clinical outcome. Conclusions: The adverse clinical outcome among COVID-19 patients is determined by several factors including advanced age, multi-morbidities, and the presence of severe respiratory symptoms.

21. Impact of COPD on the Final Outcome of Patients undergoing Emergency General Surgery and Orthopaedic Procedures in a Tertiary Care Hospital
Surender, Sunil Dath Sodha, Malothu Ravinder, Ramachandram Kuncham
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is considered as an independent risk factor of the lung with high mortality and morbidity especially in patients undergoing Emergency Surgical or Orthopedic procedures. COPD is a common disease in India but its effect on the final outcome of emergency surgical procedures was found to be underreported. Aim of the Study: To diagnose, evaluate and study the impact of COPD on various Emergency procedures of General Surgery and Orthopedics on patients in terms of morbidity and mortality. Materials: 84 patients with COPD undergoing emergency surgeries of General surgery and orthopedics were included. 27 (64.28%) were males and 15 (35.71%) were females with a male to female ratio of 1.8:1 in the General surgery group. There were 31 (73.80%) male patients and 11 (26.19%) female patients with a male to female ratio of 2.8:1 in the orthopedics’ group. The mean age among the General surgery group was 44.25±4.50 years and 42.35±5.15 years in the orthopedics group. Results: Among the 84 patients with COPD undergoing emergency surgeries of General surgery and orthopedics there were 27 (64.28%) males and 15 (35.71%) females. male to female ratio was 1.8:1. There were 31 (73.80%) male patients and 11 (26.19%) female patients with a male to female ratio of 2.8:1 in the orthopedics’ group. The mean age among the General surgery group was 44.25±4.50 years and 42.35±5.15 years in the orthopedics group. 03/42 patients developed stroke; (02- General surgery and 01- orthopaedics). UTI, septicemias and deep wound infections were also encountered in patients (02, 08 and 09 patients in General surgery and 03, 02 and 06 patients in orthopaedics surgeries respectively). There was a statistical significant correlation between the incidences of complications and the pulmonary function values in these patients with COPD. Conclusions: Patients with COPD showed higher adverse events, with a risk of in-hospital morbidity and mortality after emergency General surgery and orthopaedics surgeries. Peri-operative latest controlled protocols, optimization are a must to prevent impact of COPD on postoperative outcomes in the emergency surgeries.

22. Evaluation of Various Incisions on the Post-Operative Astigmatism in Cataract Surgery
Minal Patel, Neha Parmar, Hasti Lo
Abstract
Background and Aim: Instrumentation and surgical methods have been improved in order to reduce postoperative astigmatism. The most recent one is cataract surgery without sutures. The current study sought to ascertain whether a steeper meridian incision would be more effective in lowering preoperative astigmatism during manual small incision cataract surgery with IOL implantation. Material and Methods: The current study took two years to complete. The ophthalmology department of the medical college and hospital conducted the study. The study involved 50 eyeballs from 50 participants in total. The thorough history was noted during the preoperative assessment. Slit lamp examination was used to examine the eyes, record the intraocular pressure, and perform a thorough fundus examination. Following surgery, a follow-up was performed on day one and at regular intervals every week for the following six months. Each follow-up included refraction, keratometry, and Slit lamp biomicroscopy to evaluate the wound site. Results: In the current study, preoperative astigmatism was present in 22 patients who were against the rule, 10 patients who were oblique, and 18 patients who were with the rule. In the case of the superior incision, it decreased the pre by 0.78 D, which had a wide range of fluctuations from one week to six weeks before stabilising after six months. Because the temporal incision is farther from the visual axis than the superior incision, any flattening brought on by the wound is less likely to alter the corneal curvature at the visual axis during early rehabilitation of vision. Conclusion: To correct mild to moderate preoperative astigmatism at the time of cataract surgery, an incision at a steeper meridian is a straightforward, safe, and efficient treatment. In the superotemporal and temporal groups, postoperative eyesight and astigmatism remained stable throughout a period of six months of follow-up, whereas in the superior incision group, astigmatism fluctuated in the first six weeks after surgery before stabilising over the course of six months.

23. Radiological Features on HRCT Associated with Poor Outcomes among COVID-19 Patients
Pushpak Goyal, Rahul Soni, Ashish Dubey, Pranav Kumar Dave, Animesh Dubey, Reshu Sharma, Vinod Kumar Kurmi, Shivani Chaturvedi
Abstract
Background: Ever since the beginning of the COVID-19 pandemic, physicians started investigating the clinical features and lab markers that can assist in predicting the outcome among hospitalized COVID-19 patients. Aim: This study aimed to investigate the association between initial chest CT scan findings and adverse outcomes of COVID-19. Material and Methods: This was a single centre; hospital (inpatient) based prospective cohort study involving 497 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. We collected data about 14 identifiable parameters available for the HRCT scan. Result: Among 14 studied parameters, only 8 features differed significantly among the patients who had favourable and unfavourable outcomes. These features included number of lobes of lungs involved (3 versus 5, p = 0.008), CT Severity score (16 versus 20, p = 0.004), air bronchogram (p=0.003), crazy paving (p=0.029), consolidation (p=0.021), and pleural effusion (p=0.026). We observed that high CT scores coupled with the diffuse distribution of lung lesions were responsible for poor prognosis in most patients. Conclusion: Several features of HRCT when combined can accurately predict adverse outcomes among participants and help in triaging the patient for admission in ICU.

24. Spectrum of Female Breast Lesions with Cytological and Histomorphological Correlation in a Tertiary Care Centre of Tripura
Sourabh Das, Nabaneet Majumder, Jayanta Debnath, Maharshi Debnath
Abstract
Background: Breast lesions are heterogeneous diseases that consist of several distinct entities with remarkably different characteristic features. Majority of the breast lesions initially present with a lump in the breast. Incidence of breast malignancy is increasing in India which can be attributed mostly to changing lifestyle and increased hormone usage, and partly to increasing awareness. Breast cancer is the second most common cancer in Indian women. Breast cancer has bad prognosis if detected in late stages. But, its morbidity and mortality can be reduced if it is detected at earliest stages. A timely and accurate diagnosis of a breast lump is crucial and early intervention reduces the anxiety and can be lifesaving. Fine needle aspiration cytology (FNAC) which is highly sensitive, specific, rapid & easy to perform, is a valuable tool for all breast lesions. It plays an important role in pre-operative assessment of breast lesions. The main purpose of FNAC is to differentiate from benign and malignant lesions and helps in appropriate management. Histopathology plays an important role in the diagnosis of breast lesions. It is the main criteria that assess the adequacy of treatment and is a necessary component in the diagnosis, treatment, and prognosis of breast diseases. Materials & Methods: The study was conducted in the Department of Pathology of TMC and Dr BRAM Teaching Hospital for a period of 2 years. A total of 192 female patients with palpable breast lump were included in the study. All cases presented with breast lump were evaluated with FNAC. Cytological and histomorphological correlation was done and diagnostic accuracy of FNAC was determined. Suppurative lesions with purulent material were sent to microbiology department for culture sensitivity testing and Ziehl-Neelsen staining to rule out Acid Fast Bacilli. Results: A total of 192 patients with palpable breast lumps were included in the study. Among them majority of the patients were in the age group of 21–30 years of age, followed by 31–40 years. Majority of the lesions were in benign category. Fibroadenoma was the most common benign breast lesion and Invasive Ductal carcinoma was found to be the most common malignant breast lesion. Conclusion: Fine-needle aspiration cytology (FNAC) is a rapid and effective diagnostic tool for workup of various breast lesions. It also helps in differentiation and categorization of palpable breast lumps into benign and malignant lesions. Benign breast lesions are common than malignant lesions.

25. Effect on Ovulation Induction by Letrozole Alone or in Combination with Clomiphene
Vinay Mirajkar
Abstract
Introduction: Infertility caused by anovulatory cycles is often due to polycystic ovarian syndrome (PCOS), a hormonal problem that affects people during their reproductive years. PCOS can lead to pregnancy issues, birth defects, and other problems. PCOS is characterized by ovulation disorders, with anovulation and hyperandrogenism having a complex relationship. PCOS can also result in high levels of luteinizing hormone (LH) compared to follicle-stimulating hormone (FSH), which affects follicle development and maturation. Obesity and being overweight are often associated with PCOS. Treatments for infertility include ovarian stimulation and ovulation induction using oral medications such as clomiphene citrate and letrozole. Aims and Objectives: The intention of this research is to figure out the effect on ovulation induction by letrozole alone or in combination with clomiphene citrate in PCOS. Methods: The prospective study included infertile couples with women experiencing either oligomenorrhea or normal menstrual periods without ovulation. PCOS criteria were confirmed through high levels of luteinizing hormone, LH to FSH ratio of more than 5, and ultrasound evidence of multicystic ovaries, while prolactin and thyroid hormone levels were normal. Letrozole was given after clomiphene for at least 6 months, and if patients failed to ovulate, a combination of letrozole and clomiphene was administered. Over a three-year period, 70 PCOS patients with resistance to clomiphene and letrozole were treated with 100 mg of clomiphene and 5 mg of letrozole daily for 5 days, timed according to menstrual cycle regularity. Results: To collect the relevant information the researcher used different kinds of software tools and techniques for experimental analysis. The following tables show patient demographic information. In addition, 70 participants with PCOS participated in the research. The mean age of the patients was between 19 and 37. The average duration of infertility was 4.984.0 years. There were 56 occurrences of primary infertility and 14 occurrences of secondary infertility. Dominant follicles were seen in 20 patients with secondary infertility and 63 cases with primary infertility. Conclusion: The   has concluded that  combination of clomiphene citrate and letrozole as a first-line therapy for severe PCOS which would maximize the pharmacotherapeutic effect.

26. Study on the Management of Heavy Menstrual Bleeding by Low Dose Dexamethasone
Vinay Mirajkar
Abstract
Introduction: Menstruation that is so severe it interferes with a woman’s physical, emotional, social, and material well-being is referred to as heavy menstrual bleeding (HMB). Estimates place the prevalence of excessive menstrual bleeding in impoverished countries at 4-9%. It has figured out the causes of HMB and around 48% of patients that are sent to secondary care do not have any evident pathology. Aims and objectives: The purpose of this research study has been explored to the management of heavy menstrual bleeding by low dose dexamethasone. Methods: This prospective Randomized Controlled Trial enrolled 100 female patients with heavy menstrual bleeding (HMB) from May 2022 to April 2023. Patients were randomly assigned to receive either placebo or dexamethasone, a synthetic glucocorticoid, in different dosages (0.4 mg, 0.8 mg, 1 mg, 1.2 mg, 1.5 mg, or 1.8 mg) during the luteal phase of three menstrual cycles. Menstrual blood loss was evaluated using a lab-validated method. Inclusion and exclusion criteria were applied, and statistical analysis was performed using SPSS 25 software, including Chi-square and ANOVA tests. Significance level was set at p<0.05. Results: The researcher was divided into two different groups of patients such as placebo and dexamethasone with 20 and 80 patients respectively. Furthermore, the age categories of patients are from 22 to 56 years old. Again, the mean blood loss during menstruation is high around 136.5 mL of dexamethasone. The greatest impact was seen at a 25 mL reduction in menstrual blood loss with the 1/8 mg total daily dose, with a 95% credible interval of 1 to 49 mL. The posterior odds for any benefit over placebo, or at least a 10 mL benefit, for this dose, were 0.98 and 0.89, respectively. Conclusion: The study has concluded that 0.8mg of dexamethasone taken twice daily for 5 days during the luteal phase of the menstrual cycle would reduce menstrual blood does volume.

27. A Study on Association of Hypothyroidism and Vitamin D Deficiency
Soma Saha, Mukut Roy, Kaushik Tripura
Abstract
Background and Aim: Hypothyroidism is an important endocrine disorder due to the deficiency of thyroid hormones. Vitamin D (Vit D) a steroid pro-hormone (Cholecalciferol). Both the hormone Thyroxin and Vitamin D shares a common steroid receptor. Vitamin D deficiency is prevalent globally nowadays. Various autoimmune disease also associated with Vitamin D deficiency and Hypothyroidism may be one of them. Objective: The purpose of this present study was to examine the association of hypothyroidism and vitamin D deficiency or insufficiency in the local population and to find out the relation of Vitamin D level deficiency or insufficiency in relation with Thyroid stimulating hormone (TSH), free T3 (FT3) and free T4(FT4) level. Method: A one year cross sectional prospective observational study was conducted from June 2021 to May 2022 at Tripura Medical College, Tripura. A total of 100 previously diagnosed adult hypothyroid patients between the age group of 18 to 65 years were included in the study. Serum FT3, FT4, TSH l and serum Vitamin D level were assayed. Results were documented and statistically analyzed. Result: A statistically significant no of elderly females were found to had Vitamin D deficiency or insufficiency in hypothyroid individual. There is a positive correlation with FT3 and FT4 level with vitamin D and a negative correlation was found between Vitamin D and serum TSH level. Conclusion: The etiology of hypothyroidism is multi-factorial where vitamin D deficiency may be one of the causes which may be picked up easily and can be corrected.

28. Evaluation of Uroflowmetric Parameters in Patients of Benign Prostatic Hyperplasia before and after Transurethral Resection of the Prostate in a Tertiary Care Teaching Hospital of Rajasthan, India
Anuj Jindal, Mahakshit Bhat, Nisar Ahmed, Dheeraj Godara, Lokesh Sharma, Rajeev Mathur, Vinay Tomar
Abstract
Introduction: Benign Prostatic Hyperplasia commonly known as BPH is a widespread disorder of men affecting mostly the elderly which further significantly affects the quality of life due to Lower Urinary Tract Symptoms. Aim: The present study objective was to find out the role of uroflometry in Lower Urinary Tract Symptom evaluation due to BPH and to assess the Uroflowmetry findings before and after transurethral resection of prostate. Materials and Methods: This prospective study was conducted from August 2021 to July 2022 at the study site. Eligibility criteria included patients over the age of 40 that reported experiencing lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and were advised for transurethral resection of the prostate (TURP). International Prostate Symptom Score (IPSS) was calculated and uroflowmetry data was obtained both before and after the procedure. A variety of statistical tests were conducted, such as chi-square, crosstabs, paired tests to gather the results. Results: A total of 14 patients (or 40%) were between the ages of 61 and 70, and the mean (SD) age was 67.91 years. 31 (88.5%) patients had an IPSS score of >20 preoperatively, while none did so postoperatively. In the IPSS score 4 (11.4%) patients with values between 9 and 19, a substantial (p0.0001) improvement was seen. Conclusion: Uroflowmetry can be used as a diagnostic technique that can serve as an accurate evaluation of the signs, symptoms, and outcomes associated with transurethral resection of the prostate (TURP). It can be a valuable tool in informing decisions related to treatment.

29. Efficacy of Intraperitoneal Instillation of 0.125% Levobupivacaine versus 0.2% Ropivacaine for Postoperative Analgesia after Laparoscopic Gynecological Surgeries: A Comparative Study
Midhu V Nadh, Silpa A. R, Arun Aravind
Abstract
Background and Aim: Most of the gynecological surgeries are now performed under laparoscopy guidance and though minimally invasive majority of patients experience moderate to severe pain in the post operative period. Intraperitoneal instillations of local anaesthetic ropivacaine or levobupivacaine with buprenorphine as adjuvant were compared in this study to find out the efficacy in providing postoperative analgesia. Method: 80 patients belonging to ASA 1 and 2 were divided to two groups of 40 each to receive intraperitoneal instillation of 25 ml of either 0.125% Levobupivacaine (Group B) or 0.2% Ropivacaine (Group R) with 0.3 mg of buprenorphine as adjuvant. Heart rate, blood pressure, respiratory rate, oxygen saturation, numerical rating scale for pain, time to first analgesic request and total analgesic requirement were assessed in the postoperative period. Results: There was no statistically significant difference in mean heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, oxygen saturation, pain scores, time to first analgesic request and total analgesic requirement with all p values more than 0.05. Conclusion: Intraperitoneal instillation of Levobupivacaine and Ropivacaine with buprenorphine as adjuvant is effective and have comparable postoperative analgesia after laparoscopic gynecological surgeries.

30. Ultrasonographic Breast Imaging-Reporting and Data System (BI-RADS): Radiologic-Pathological Correlation
Om Prakash Rathore, Dinesh Solanki, Manish Choudhary, Tarun Sharma, H. P Toshniwal
Abstract
Background: Breast cancer is the leading cause of cancer deaths among women worldwide. Breast cancer clinically presents as breast lump. Biopsy/Fine needle aspiration cytology (FNAC) and breast ultrasound is pivotal in characterization of a breast lump as benign and malignant lesion. Despite advances in modern investigations, accurate diagnosis is challenge. Delay in diagnosis may leads to Morbidity and mortality. Early diagnosis of breast lump reducing health care costs and also morbidity and mortality of patients. BI-RADS (Breast Imaging-Reporting and Data System) are a risk assessment and quality assurance tool developed by American College of Radiology that provides a widely accepted lexicon and reporting schema for imaging of the breast. Aim: To assess the accuracy of categorization of breast ultrasound findings based on scoring for malignancy using the Sonographic Breast Imaging-Reporting and Data System (BI-RADS) and its correlation with Pathological finding. To assess the prevalence of common breast lesions in general population. Materials and Methods: This prospective study was conducted on all patients who presented to the department of Surgery, Radiodiagnosis and Pathology of Government Medical College and Bangur Hospital, Pali (Rajasthan) for ultrasonography breast from November 2021 to October 2022 with breast lump and willing to undergo ultrasonography biopsy of the breast lesions. The various features of breast lesions were noted. Results: Most commonly affected age group was 42±11.69 yrs. In our study out of 560, 180 breasts were classified as BI-RADS 3-5. Calcification was present 42.22% breasts. BI-RADS 4A showed the highest sensitivity (72.8%). BI-RADS 3 and 5 showed 100% positive predictive value (PPV) and BI-RADS 5 had highest accuracy 84.5 among these categories. Conclusion: High accuracy can be achieved when evaluating breast ultrasound findings for malignancy using the BI-RADS breast ultrasound criteria.

31. Prevalence of Diffuse Hair Loss in Females Attending the Dermatology OPD at Tertiary Care Center in Western India: Etiology and Epidemiology
Apeksha Merja, Jaydipkumar Tank, Rima Joshi, Akshay Ambasana
Abstract
Introduction: In our society scalp hairs are associated with attractiveness and physical wellbeing, lack of hairs can have negative psychological consequences, especially in women. Here is a study of 300 female patients having nonscarring diffuse hair loss attending the outpatient department of Dermatology at a tertiary care centre in western India. Methodology: A cross sectional study was done at the dermatology OPD at tertiary care centre from the female patients attending the OPD for the duration of 2 years. Female patients older than 15 years, complaining diffuse hair fall or visible hair loss were included in the study. Results: Total 300 patients were included in the study. Most of the cases (64%) were observed in between 20–40-year of age. Maximum, around half (54%) number of patients were having female pattern hair loss. Chronic diffuse telogen hair loss (CDTHL) and acute telogen effluvium comprise another 30% of patients. Male pattern hair loss (MPHL), alopecia areata (AA), chronic telogen effluvium, anagen effluvium (AE), trichotillomania and seborrheic dermatitis together comprised of another 16% cases. Conclusion: Being a benign complain, such cases are often overlooked in government hospitals. Some simple measures and a proper counselling will reduce the psychological burden of the condition. Furthermore, various systemic conditions can be identified with appropriate history taking and with the help of noninvasive methods like trichoscopy.

32. Study of Prevalence of Lower Backache and its Risk Factors in Young Doctors as an Occupational Hazard
Renu Dhamnani, Jaya Sinha, Irfan Ahmad Siddiqui, Suruchi Richhariya
Abstract
Background: Lower backache is one of the most common health problems seen worldwide in general population as well as among health care professionals. Working conditions for health care professionals have been considered major risk factor for the development of musculoskeletal disorders. Occupational hazards associated in medical community are least studied in the developing region. Aim: The aim of study was to investigate the prevalence of lower backache and associated risk factors among residents of clinical and paraclinical departments of AIIMS Bhopal.  Materials and Methodology: All the resident doctors of clinical and paraclinical branches of our institute were mailed self-reporting questionnaire, designed using google form to be filled over one-month time. Questionnaire was divided into five parts. Residents who fulfilled the inclusion and exclusion criteria and who gave consent were considered for the study. Each resident was informed about the aims, objectives, procedure. Results: Of the total 100 resident doctors, 81filled google form, 48(59.26%) were male and 33(40.74%) were female, 43(53.08%) complaint of pain and 38(46.1%) did not, of those who had pain 67% develop after joining residency and 32.55% had pain before joining residency. 68 (83.95%) residents exercised for variable duration, 51.47% out of them develop pain and 48.52% did not. 13(16.04%) Residents never exercised, of them, 61% develop pain and 38.46% did not. BMI was calculated and out of 81 residents, 4(4.93%) were underweight, 21(25.92%) were having normal BMI, 24(29.62%) were overweight, 32(39.50%) were obese. Out of 81 resident doctors, 56 worked for >8 hours and of them 32(55.17%) complaint of pain and 26 (44.82%) did not, whereas 25 residents worked for <8 hours, 11 (47.82%) developed pain and 12(42.85%) did not. Severity of lower backache was assessed by VAS score categorized as mild (1(1-3), moderate (4-7) and severe (8-10),31% had mild pain and 24% had moderate pain. Conclusion: Lower backache is common health problem faced by general population as well as health care professionals, which is one of reasons of decreased performance at work and one of cause for absenteeism from work. It is one of occupational hazard amongst health care professionals, if recognized early can be prevented from getting chronic condition affecting the functional ability of individual.

33. Clinical Presentation & Predictors of Outcome in Patients with Chronic Obstructive Pulmonary Disease with Acute Exacerbation: A Cross Sectional Study
Gaurav Dubey, Dipika Koli, Pankaj Wagh, Samadhan Mitkari
Abstract
Background: Prevention of exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. There are patients with COPD that are prone to suffer from recurrent exacerbations and they experience a more severe impairment in health status. Objective: to study clinical Presentation & Predictors of outcome in patients with Chronic Obstructive Pulmonary Disease with Acute Exacerbation. Materials & Methods: The present cross-sectional study was conducted on 50 study subjects having COPD with acute exacerbation during period January 2020 to June 2021. Results: 68 % of the patients studied were more than 60 years of age suggesting that COPD is a disease of the aged. 82% of the patients were males, and all had a history of smoking. This male preponderance was due to greater prevalence of smoking in the male population. Conclusion: Altered sensorium, Hypotension, Cyanosis, raised JVP, pedal edema, Acidemia, invasive mechanical ventilation, Infection, history of >1 episode of exacerbation, GOLD stage C&D and duration of COPD > 10 years were the predictors of mortality.

34. The Importance of Venous Doppler for Evaluation of Intrauterine Growth Restriction
Poonam Muhal, Garima, Asha Verma, Anjuman Sayyed
Abstract
Aim: The aim of this study was to determine the role of venous Doppler Ultrasonography for the prediction of adverse perinatal outcome in “intrauterine growth restricted fetus”, providing the obstetrician with additional information about the time frame and significance of the IUGR to help determine the optimal time of delivery. Patients and Methods: Ninty females with IUGR affected pregnancies, gestational age between 28 and 38 weeks of gestation were enrolled in the study. All patients in the study were subjected to Doppler examination of the umbilical vein (UV), Ductus venosus (DV) and umbilical artery (UA). Results: Abnormal UA Doppler was found in 60 patients. Abnormal DV Doppler was found in 27 patients. Abnormal UV Doppler was found in 20 patients. All parameters studied were strongly related to perinatal mortality, however, none had 100% sensitivity, the pulsatility index in DV and UV pulsations were the best single indices to use in the prediction of perinatal mortality. Conclusion: Venous Doppler is superior to arterial Doppler in predicting poor perinatal outcome.

35. A Descriptive Study of Maternal Near Miss Mortality in the Department of Obstetrics and Gynaecology at SMS Medical College
Anjuman Sayyed, Garima, Asha Verma, Poonam Muhal
Abstract
Introduction: Complications during pregnancy and childbirth remain a leading cause of illness and death among women of reproductive age in India. In the recent years, the concept of the maternal near miss has been adopted by the tertiary level hospitals, as it has an added advantage of offering a large number of cases for intervention and for the evaluation of the maternal healthcare being provided by the health care system. Material and Method: This prospective observational study was conducted at SMS medical college Jaipur to identify the MNM cases based on near miss criterion based on- maternal near miss review operational guidelines near miss approach (2014). Aims and Objective: to evaluate the cause, adverse events, complications, sociodemographic profile, contributing factors, mode of interventions done in cases of Maternal Near Miss. Result: The total number of live births of the hospital was 12127. 208 Severe maternal outcome cases were noted, out of which 170 were of MNM cases and 38 were of MD. MNM mortality ratio was found to be 4.47%. The most common cause for maternal near miss was found to be haemorrhage (51.17%), followed by hypertensive disorders of pregnancy (28%). Conclusion: Systematic review of such cases can help to bring forth various contributory factors. whether it is medical, social, economical and other factors for necessary corrective actions which could be taken at community, district or at state level for reduction in maternal mortality and morbidity.

36. Studying the Lower End of the Ulna Cross-Sectionally using Morphometric Measurements
Shalini Gupta, Sarajuddin Ansari
Abstract
Objective: The anatomy of the distal end of the ulna is important for reconstructive surgeries. The distal end houses the fovea, head, and styloid process. The pole and the seat are the two parts that make up the ulnar head. A severe kind of ulna fracture is coupled with a fracture of the distal end of the radius because the distal ulnar metaphysis does not heal. This is comparable to Baldwin’s procedure, which involves extra periosteal excision of a piece of the ulna’s metaphysis in order to produce pseudo arthrosis in the lower end of the ulna. Method: For one year, 102 completely ossified, dry adult ulnae (51 right and 51 left), regardless of age, gender, etc., were subjected to this study at the Department of General Medicine, Maharshi Devraha Baba Autonomous State Medical College, Deoria. All measurements were made with Vernier digital calipers. Results: The maximum pole width was 4.10 mm on average on both sides. The maximum seat height was 3.83 mm on average on both sides. The largest fovea width measured 3.83 mm on average on both sides. The greatest styloid process length averaged 6.172 mm on both sides. Conclusion: Anatomists, forensic experts, orthopedic surgeons, prosthetics, and researchers undertaking medico-legal investigations, those designing appropriate prostheses, and those caring for patients with lower ulna fractures must all use the information from this study clinically.

37. Treatment Outcome Analysis of Multi Drug Resistant Tuberculosis [MDR-TB] Patients at a District TB Centre: A Retrospective Cohort Study
Y Roja Ramani, Benu Panigrahy, Shivang Raj, Bright Simon Sahoo
Abstract
Introduction: MDR-TB is one of the most difficult challenges today the country is facing to achieve TB free status by 2025. For a better understanding of the local causal relationship, periodic assessment of various risk factors is needed to track public health responses. Accurate diagnosis with appropriate drug regimen as per the resistance pattern is the key to success in managing DR-TB. Aim: In this context this study was conducted to assess the treatment outcomes and evaluate the treatment adherence among the MDR-TB cases. Materials and Method:  The study cohort was presumptive MDR-TB cases registered in the District TB Centre. Relevant clinical and laboratory data was extracted from PMDT records documented in the Nikshay Portal from January 2019 to December 2021. Approval from Institutional Ethics Committee and Office of the District TB Officer was obtained before the study procedures. The association between adherence to treatment as risk factor and treatment outcome were compared using Chi-square test / Fisher’s exact test. Results: Among the presumptive MDR-TB patients, 281 cases were pulmonary TB ,45.73% were on MDR Short Course TB Regimen. Among Pulmonary TB cases 42.70% had completed the given treatment regimen of which 16.37 % were cured, 18.51% died & 13.17% were lost to follow up. 58% patients adhered to the given regimen but 42% were non adherent. Conclusion: To conclude treatment outcome in terms of completion of the given course regimen or cure was favorable in our study cohort with no significant association between treatment adherence and outcome.

38. Cilnidipine and Azelnidipine Effects on Albuminuria, Blood Pressure, and Heart Rate in Type 2 Diabetics with Hypertension
Kamran Khan
Abstract
Objective: According to earlier research, cilnidipine and azelnidipine both show a renoprotective effect in comparison to amlodipine. This study compared how cilnidipine and azelnidipine affected albuminuria, blood pressure, and heart rate. A prospective open-label crossover experiment was conducted. Method: 120 people with type 2 diabetes who were taking amlodipine (5 mg/day) for at least 11 weeks were included. Amlodipine was switched to either cilnidipine (10 mg/day) or azelnidipine (16 mg/day) at trial entry, and each was given for 16 weeks. After that, the medications were changed, and the course of treatment was extended by 15 weeks. Results: Cilnidipine treatment led to a higher decrease in urine albumin:creatinine ratio than azelnidipine treatment, despite no differences between the two drugs in 25-hour blood pressure and heart rate. Conclusion: In type 2 diabetes individuals with hypertension, cilnidipine is more effective at lowering albuminuria than azelnidipine, regardless of its blood pressure-lowering impact.

39. Platelet Indices in the Diagnosis of Acute Appendicitis
Lalhruaitluanga, C. Vanlalhlua
Abstract
Background: The aim of this study was to evaluate the diagnostic value of platelet indices (mean platelet volume and platelet distribution width) and its predictive value in determining the complication/severity of acute appendicitis. Method: This study comprised of 126 adult patients of Acute Appendicitis who were operated in the department of Surgery, Zoram Medical College, Falkawn during the period of two years starting from March 2021 to February 2023. Patients below 12 years, pregnant female, patients on steroid/chemotherapy, immuno-compromised patients and those who are not willing to participate were excluded. Results: The Mean Platelet Volume (MVP) of less than 7.6 was found in 73 (57.9%). The mean MPV was 7.98+/-1.29. Platelet Distribution Width (PDW) was more than 18 patients (23.7%). Out of which 16 and 14 were females and males respectively. The mean PDW was 16.99+/-2.30. Total Leucocyte Count (TLC) was raised (taking 1100 as cut-off value) in 82 patients (65.1%). 11 patients were associated with perforated appendix and 10 patients had intraoperative finding of peri appendiceal collection. Gangrenous appendix was found in 16 (12.7%) patients. Conclusion: MVP did not have higher sensitivity compared with TLC in the diagnosis of acute appendicitis but PDW have higher sensitivity than TLC and is found higher in complicated appendicitis. Therefore, PDW may be used in the diagnosis of acute appendicitis and has a significant role in predicting complicated appendicitis.

40. A Study of Clinicopathological Profile and Management of Change in Voice
Megha Prabhakar, Shrikant Sharma, Yogendra Narwariya, Dhirendra Tripathi
Abstract
Background: One of the most frequent complaints in ENT practise is a change in voice quality, and hoarseness is the most noticeable indication of this change. The first sign of any conditions that affect the vocal apparatus directly or indirectly is always hoarseness. Even though vocal abuse is the most prevalent among the benign causes of hoarseness, we should always look for more serious pathology, such as malignancy. Aims and objectives: To study the clinicopathological profile of change in voice and to study the management of change in voice. Materials and Methods: This study was conducted on 100 patients of age 10 years to more than 70 years for duration of one and a half year. Indirect laryngoscopy and video laryngoscopy under local anesthesia was carried out for local examination. Direct laryngoscopic examination with or without biopsy was performed. The biopsy was sent for histopathological examination. The data collected was entered in excel sheet and analysed using Epi data /SPSS software. Results: Most of the patients were in the age group of 31 to 40 years. Males were affected more than females (2.4:1). Labourers formed the predominant group. Majority of patients were from low socioeconomic class. Smoking, vocal abuse, smoking plus alcohol were the common predisposing factors. Maximum number of cases among etiology of change of voice was due to laryngeal malignancy (33%). The most common duration of hoarseness of voice was seen in less than 1 month. Conclusion: The causes of hoarseness of voice are many and varied. Every case should be carefully and thoroughly investigated to determine the diagnosis and underlying pathology for early and prompt management because the etiological data differs depending on the geographic region and among treatment centres.

41. Breast Feeding Practices among the Mothers of Rural Field Practice Area of Department of Community Medicine, Osmania Medical College, Hyderabad
Manchu Kalyani, Sravanthi Gilla, Veereswara Rao Kurma, Sujatha Pambi, M. L. Surya Prabha
Abstract
Introduction: Breastfeeding has nutritional, immunological, behavioural and economic benefits and also provide desirable mother-infant bonding. The beneficial effects of breastfeeding depend upon appropriate breastfeeding practices (early initiation of breastfeeding as early as possible, no pre lacteal feeds, feeding colostrum, and giving exclusive breastfeeding till 6 months of age). Aim and Objectives: (1) To enumerate the socio-demographic profile of the mothers with children in the age group 0-12 months of rural field practice area of Department of Community Medicine, Osmania Medical College, Hyderabad. (2) To assess breastfeeding practices among study population. (3) To determine the factors influencing breastfeeding practices. Materials and Methods: A community based cross sectional study was conducted in Patancheru, a Rural Field Practice area of Department of Community Medicine, Osmania Medical College, Hyderabad from November 2013 to October 2014 after obtaining prior permission from the ethics committee. Mothers with children in the age group 0-12 months with a willingness to participate are included in the study. Results: In the present study,37.6% of mothers had initiated breastfeeding within 1 hour of delivery. About 85.2% of mothers had given colostrum to their babies and Prelacteal feeds were given by 91(36.4%) mothers. Among 130(52%) mothers with children in the age group of 6-12 months, exclusive breastfeeding was practiced by 51(39.2%) mothers. Feeding on demand was seen in 92.8% of mothers. Conclusion: Continuous vigilance over infant feeding practices in the community is necessary for timely interventions, to ensure optimal growth and development.. The women who practiced breastfeeding practices according to norms should be made as role models and such women should be grouped as Mother Support Group at the community level.

42. Evaluation of Risk Factors & Maternal and Perinatal Outcome in Puerperal Pyrexia: A Prospective Study
Pooja Jain, Rekha Vimal Gupta, Geetanjali Sanodia
Abstract
Background & Method: The present study is conducted with an aim to Evaluate risk factors & maternal and perinatal outcome in Puerperal Pyrexia – A Prospective Observational Study carried out in the department of Obstetrics and Gynaecology at Government Medical College Ratlam. Prolonged labour, caesarean section, wound infection, septicemia, UTI, endometritis are the most common etiology and risk factors of puerperal pyrexia globally and Indian studies which ranged between 4 to 80%. Therefore, we considered 20% probability of risk factors with 6.4% marginal error (precision). At 95% confidence limit, 5% alpha (type I error) and 80% power (Beta), this accumulate 300 number required. Finally we planned to enroll 300 women with puerperal pyrexia in the study. Result: Age wise distribution of puerperal pyrexia among women which revealed that about two third (71%) of the subjects were age between 20 to 30 years followed by >30 years and least under 20 years of age. majority of the women were unbooked (74.3%) and rest 25.3% were booked. majority of the cases (76.2%) were no growth in culture report and 14.6% cases were E. coli, 4.6% cases were Klebsilla species, 2.6% cases were multiple gram negative bacilli, 2% were Staphylococcus aureus. majority of newborn (83.3%) were live born and discharge home, 11.3% were early neonatal death and 5.3% were still birth and the difference was statistically significant (P<0.0001). Conclusion: Most common cause of puerperal pyrexia in our study is urinary tract infection (this may be attributed to improper asepsis during catheterization), followed by pain in breast or breast engorgement, endometritis, wound infection, Risk factor for women who developed bacteriuria were primiparity, cesarean delivery, perineal laceration, oxytocin induced or augmented labour, operative vaginal delivery, catheterization and prolonged labour. Difficulties in breastfeeding, cracked nipples were also contributory factors into developing fever in Puerperium period. The route of delivery is significant risk factor for development of uterine infection. Risk increases with prolong membrane rupture, prolong labor and multiple vaginal examination.

43. Significance of Echogenic Intracardiac Foci in Predicting Fetal Aneuploidy: A Prospective Observational Study in Rural Tertiary Care Hospital
Ramesh Babu S, Priyanka J P, Mahendra G, Ravindra S Pukale
Abstract
Background: Echogenic intracardiac foci (EIF) are described as hyperechoic regions on papillary muscles or Chordae tendineae in the fetal cardia. The incidence ranges form 4-30% in euploid and aneuploidy respectively. The positive likely-hood ratio between Trisomy 21 and EIFs is 1.4 to 1.8. Objective: This study was done to understand the association between EIF and aneuploidy and congenital anomalies. Methodology: Out of all the cases undergoing obstetric scan after 14 weeks of gestation in Adichunchanagiri Institute of Medical sciences, showing Echogenic Intracardiac Foci were included in our study. All the cases were examined in detail and followed up till 3 months postpartum to look for aneuploidy. Results: 842 cases underwent scan after 14 weeks in our hospital and out of that 30 (3.5%) had isolated EIF whereas 5 had EIF associated with other soft markers. Out of this 30 cases with isolated EIF only 2 had congenital anomalies. Conclusion: Isolated EIFs are not markers of aneuploidy and hence are not an indication for invasive testing for the same.

44. Assess the Utility of Minimally Invasive Technique Fine Needle Aspiration Cytology for Early Diagnosis of Cases of Rosai Dorfman Disease
Vandana Mishra, Lubna Khan, Anita Omhare, Divya Shukla
Abstract
Aims: The objective here is to assess the utility of minimally invasive technique fine needle aspiration cytology for early diagnosis of cases of rosai dorfman disease. Material and Methods: The cytology of 10 cases of Rosai dorfman disease. Results: Our study included 10 cases out of which 6 where of nodal Rosai Dorfman whereas 4 of them showed extranodal disease. Conclusions: FNAC is a simple, primary, minimally invasive technique which is a reliable first line investigation in the diagnosis of Rosai Dorfman disease and very useful in prevention of overdiagnosis and overtreatment of a self-resolving disease.

45. Management of the Surgical Patient during the First and Second Wave of COVID-19 Pandemic: Experience of a Tertiary Care Centre
Tapan Kumar Behera, Jyotirmaya Nayak, Chandan Das
Abstract
Objective: Due to the COVID 19 pandemic healthcare providers all over the world had brought some changes in the management of surgical patients. This study is aimed to estimate the impact of pandemic on surgical practices. Material and Method: We conducted a retrospective review of the medical records of all patients admitted to the department of general surgery (both elective &amp; emergency), SCB Medical College and Hospital, Odisha, India from April 1 to July 31, 2020, and 2021 and the records were those of patients who were admitted in the same period in 2019. Data collection includes the number of admissions, the reason for admission, the age &amp; gender of the patients admitted patients and type of management. Result: There was a 57.5% reduction in total admission during first COVID in pandemic 2020 and 58.7% reduction during second wave of pandemic in 2021. The proportion of patient presenting to emergency department was more in 2020 and 2021 than 2019. Number of emergency admission decreased by 46.54% in 2020 and 46% in 2021.There was a 79.5% drop in the number of out- patients admission in 2020 and 84% in 2021. Furthermore a 79.8% reduction in elective surgical intervention noticed in 2020 and 80% in 2021.Conservative management was preferred over surgical management during the COVID era. Conclusion: COVID-19 has led to a drastic reduction in outpatient and elective surgical practices. Hence creating a major concern for all surgeons about the critical situation.

46. Study of Greater Sciatic Notch of Hip Bone in Sex Determination by Metric Method in South Indian Population
R Deepa
Abstract
Background: The estimation of sex from skeletal remains is of great medico legal and anthropological importance. The bony pelvis is sexually dimorphic and it is affected by parturition and reproduction. So the hip bone is considered as an ideal bone for sex determination and it provides the highest accuracy level. Materials and Methods: 48 Adult dry hip bones (28 Male&20 Female) of known sex were collected for the study. All the bones were fully ossified and free from defect. Data were tabulated according to gender and sides are statistically analysed using unpaired student t-test and measurements are measured using triflanged stainless steel calliper. The following parameters of Greater sciatic notch were considered and measured in millimetre. The parameters are Maximum width (AB), Maximum depth (OC), Posterior segment width (OB), Index I and Index II. Results: A significant difference is noted both in maximum width and maximum depth of Greater sciatic notch of male and female on right (P<.01) while difference in posterior segment width was significant on right side (P<.01). A significant difference were found in indices of I & II of Greater sciatic notch of right and left sides. Conclusion: The Greater sciatic notch was found to be wider in female on the right side and also on left side as compared to male.

47. Modified Triple Assessment in the Diagnosis of Breast Lump
Khyati Shah, Pranav Rambhai Patel, Kunal Chinubhai Modi, Mehulkumar K Vasaiya
Abstract
Background and Aim: Doctors commonly hear from women who have breast lumps. Since the majority of them are benign, excluding cancer necessitates a thorough examination, precise diagnosis, and effective treatment. Breast cancer is suggested as the diagnosis following a clinical examination. The current study’s objectives were to analyse the modified triple assessment’s sensitivity and specificity for detecting breast lumps as well as to assess the modified triple test’s diagnostic effectiveness. Material and Methods: The current study involved 130 randomly selected female patients with breast lumps who were admitted to the female surgical unit at a tertiary care centre during the study period. Using a complete patient history, a targeted clinical examination, radiological imaging (mammography, ultrasonography (USG), and fine-needle aspiration cytology (FNAC)), the patients were tested for probable malignant disease at its onset (early stage). Results: During their clinical breast exams, 69 people had lumps that ranged in size from more than 2 cm to 5 cm in diameter, and 21 of those patients had lumps that were larger than 5 cm in diameter. Three people had soft consistency, and the rest 38 patients had firm consistency, according to the majority of patients who underwent clinical breast examinations, which included 79 patients in total. Conclusion: The modified triple evaluation, which has a 98% overall accuracy rate for diagnosing breast cancer in women with breast lumps, is a very useful diagnostic tool. The modified triple assessment, which assisted in the earlier diagnosis of breast tumours, led to the majority of cases being found at stage I or stage II. (T1 or T2, N0 or N1, M0).

48. Evaluation of the Role of Imprint Cytology and Frozen Section in Soft Tissue Lesions with Histopathological Correlation
Neetu Vanapalli, S. Brindha, Shashikala C
Abstract
Introduction: Frozen section and imprint cytology are important intraoperative diagnostic procedures. Performance of frozen section is useful in determining the type of neoplasm, degree of malignancy and the adequacy of surgical margins. Imprint cytology has also been shown to be quite reliable in diagnosis of various soft tissue tumours. The tissue architecture seen in frozen section is close to the sections made in histopathology while imprint cytology provides a better cellular detail of tissue. Both the procedures show high degree of accuracy, in this study we have planned to compare the accuracy of imprint cytology and frozen section using histopathology sections as gold standard for soft tissue lesions. Materials and Methods: This was a prospective study of 60 cases of soft tissue lesions which were submitted to department of Pathology at a tertiary care teaching hospital for a period of 18 months. Frozen section (FS) and Imprint smears (I) were performed on fresh, unfixed specimens along with macroscopic evaluation. The results of frozen section and imprint cytology were analyzed by comparing to the results of gold standard histopathological section results. Results: Out of 60 cases, 59 were benign and only 1 case was of intermediate grade. Among all the lesions, lipoma was the commonest of all the soft tissues lesions (61.7%). The male: female ratio was found to be 1.5:1. Frozen section and imprint smears were performed on all the soft tissue lesions and showed a diagnostic accuracy of 98.33% and 91.67% respectively. When both these procedures were used in combination, the overall diagnostic accuracy was 98.33%. Kappa statistics calculated was 0.964 which showed an almost perfect agreement between imprint, frozen section and histopathology diagnoses on lipoma lesions. Conclusion: In our study, it was observed that diagnosis of soft tissue tumors can be best appreciated on imprint smears and frozen sections when performed in conjunction.

49. Psychiatric Morbidity in Infertile Couples
Leenakshi, Monica Soni, Nisha Meena
Abstract
Introduction: Having children is a social responsibility for a family. Inability to fulfil this responsibility adversely affects the social life, emotional status, marital relations, future plans, self-esteem and body image of the couple. Aim: To estimate prevalence and determine correlates of psychiatric morbidity in infertile couples in tertiary care hospital. Methods: Hospital based cross-sectional study entitled “To study the prevalence and determinants of psychiatric morbidity in infertile couples in tertiary care hospital”. Infertile couples attending infertility clinic and outpatient department of Obstetrics and Gynaecology Department, PBM Hospital within a defined period of one year were screened. Those fulfilling the inclusion and exclusion criteria were enrolled after proper counselling and written consent. 112 couples i.e. 112 males partners and 112 female partners were enlisted making a total of 224 subjects. Selected participants were interviewed using a pretested semi-structured interviewer administered questionnaire which consisted of two sections. One section included question related to socio-demographic background and possible determinants of psychiatric morbidity and second section included questions based on Depression Anxiety and Stress Scale (DASS-21) for estimation of depression, anxiety and stress. Data was collected and systematically analyzed. Results: 70.5% subjects presented with primary infertility and 29.5% subjects with secondary infertility. Prevalence of depression is 72.3% and anxiety is 74.6% and stress is 71.9%. Depression (67.1%), anxiety (73.4%) and stress level (71.8%) was comparatively seen more in primary infertile patients than in secondary infertile patients. Conclusion: Assessment of mental health status of the couples should be integrated with infertility management, so that counselling and treatment can be initiated as early as possible, achieving psychosocial wellbeing as well as improved infertility results.

50. Observational Study of Suspected Cases of the Abdominal Tuberculosis on the Basis of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) Compared with Histopathology Examination
Pramod Rawal, Ummed Singh Parihar, Kalpana Agarwal, Rajveer Kuldeep, Pallavi Chaubisa, Hansraj, Priyanka
Abstract
Background: Tuberculosis is a chronic granulomatous infectious disease, primarily affecting the lungs. However, it is a systemic infection and may involve any organ. Most of the abdominal tuberculosis cases are either missed or diagnosed late, both this late and missed diagnosis contributes to high mortality and morbidity. Aim: Comparison of diagnostic accuracy of CBNAAT and Histopathological examination in suspected case of abdominal tuberculosis. Methods: This is a prospective observational study on 37 operative cases with sub-acute intestinal obstruction, intestinal stricture, intestinal adhesion, appendicular lump, intestinal perforation and mesenteric lymphadenopathy with consecutive sampling during the period of 2 years (January 2021– December 2022) conducted in the department of surgery, JLN Hospital Ajmer. Results: Mean age of study population was 41.58±22.01 yrs. (age range of 7 month -76 yrs.). Adhesion (35.14 %) was found to be the most common intra operative finding followed by Intestinal perforation (32.43%), SAIO, or RIF mass (32.43%). About 73% patients were found to be tuberculosis positive in histopathology examination whereas only 24 % of the patients were found to be microbiologically confirmed for mycobacterium tuberculosis on CBNAAT. For CBNAAT sensitivity was 88.88% and specificity was 32.14%. Positive predictive value was 29.62% and negative predictive value was 90%. Mean length of hospital stay was 15.43±5.96 days. 2.70% had recurrence after discharge from hospital. Conclusion: In abdominal tuberculosis, CBNAAT had high sensitivity and low specificity, making it more a screening tool than a diagnostic tool.

51. To Evaluate the Sensitivity, Specificity of Real Time PCR (TrueNAT) Assay in Case Detection of Mycobacterium Tuberculosis in Presumptive Pulmonary Tuberculosis Cases
Kapil Singh Meena, Ravindra Kumar Tiwari, Sourabh Soni, Harsh Kumar Veshar, Anil Samaria, Amit Kant
Abstract
Aim of Study: To evaluate the Sensitivity, Specificity of Real-time PCR (TrueNAT) assay in case detection of Mycobacterium Tuberculosis in Presumptive Pulmonary Tuberculosis Cases(Culture Positive). Material And Methods: This was a prospective, hospital based cross sectional study carried out in SCB Medical College and Hospital, Cuttack, Odisha for a period of one year, i.e from Sept 2019 –August 2020, on 50 Presumptive Pulmonary tuberculosis patients visiting inpatient and out-patient department of Pulmonary Medicine. Statical analysis of the data was conducted with Statistical Package for the Social Sciences (SPSS) VERSION 20.0. Results: Considering culture as the gold standard test the results of TrueNAT (RT PCR ) was compared for Pulmonary tuberculosis specimens in present study. Performance of Real-time PCR (TrueNAT ) assessed against Culture in this study, Sensitivity was 92.11%, Specificity was 91.67%. Conclusion: Our study concludes that Real Time PCR (TrueNAT) has shown good results and has high sensitivity and specificity for detection of Mycobacterium tuberculosis in Presumptive Pulmonary tuberculosis patients.

52. Maternal and Perinatal Outcomes in Second Stage versus First Stage Caesarean Section: A Comparative Study at a Tertiary Care Hospital
Nisha Meena, Monica Soni, Leenakshi
Abstract
Introduction: Caesarean Section (CS) is the most performed intra peritoneal peritoneal surgical procedure in women all over the world. At the same time delay and avoidance in decision of caesarean may also lead to increase in second stage caesarean sections. Aim: To compare maternal and perinatal outcome in second stage vs first stage caesarean section. Methods: hospital based prospective study, comprised of 300 women enrolled by convenient sampling, after fulfilling the inclusion and exclusion criteria and written consent. Pregnant adult women aged ≥ 18 years with POG ≥ 37 weeks with singleton fetus in vertex presentation admitted in the labour room of obstetrics and gynaecology department, S.P. medical college and associated group of hospitals, Bikaner, Rajasthan and undergoing caesarean delivery in first or second stage of labour were screened. Women with Caesarean delivery in second stage of labour were enrolled in group A and those with Cesarean delivery in first stage of labour into group B. Both groups were closely followed, observed data collected and systematically analysed. Results: Mean age in group A was 23.56 ± 3.11 yrs and 24.12 ± 3.51 years in group B. 69.33% subjects in group A were unbooked whereas in group B 56.67% were unbooked. Mean operating time was 30.56 ± 7.81 minutes in group A and 22.14 ± 3.24 minutes in group B. The incidence of uterine atonia, PPH, prolong catheterization and post op complications and neonatal complications was significantly higher in group A. Conclusion: Caesarean section in second stage of labour is associated with higher maternal and perinatal morbidity along with increased neonatal mortality. Hance casual procrastination in decision making should be avoided and surgical expertise in 2nd stage caesarean should be ensured.

53. Exploring Homocysteine, Antioxidant Defences, and Oxidative levels in Acute Myocardial Infarction
Dharmveer Sharma, Vidyanand Pandit, Kshatrapal Prajapati, Vijay Prasad Sangishetti
Abstract
Acute myocardial infarction (AMI) is a significant contributor to morbidity and mortality worldwide. Homocysteine, an intermediate in methionine metabolism, has been identified as a potential risk factor for a variety of diseases, including cardiovascular diseases. The aim of this study was to evaluate the role of homocysteine and investigate oxidative stress, antioxidants, and inflammatory molecules in patients with AMI. The study was included 200 subjects, 100 of whom had AMI (70 males and 30 females) and 100 healthy, age-matched controls (80 males and 20 females). Various blood parameters, including body mass index, fasting blood glucose, lipid profile, antioxidants, and homocysteine, were measured.  The results showed that total cholesterol, LDL, and malondialdehyde levels were significantly higher, and antioxidants such as vitamin E, catalase, glutathione peroxidase, and superoxide dismutase were significantly lower in AMI patients compared to controls (p<0.0001). The findings suggest that oxidative stress and inflammation are elevated in patients with AMI, with a depression of the antioxidant system. Furthermore, the study revealed that AMI patients had elevated levels of homocysteine as compared to healthy subjects, indicating that high serum homocysteine levels are strongly associated with AMI risk. Our results suggest that increased serum homocysteine levels may be a possible cause of AMI and that it is an important biomarker for risk stratification for AMI, along with lipid profile parameters. This study sheds light on the role of homocysteine and oxidative stress in AMI patients. The results underscore the importance of monitoring homocysteine levels in individuals at risk of AMI and highlight the potential of antioxidant therapies in reducing AMI risk. Further research is needed to understand the underlying mechanisms and to develop effective prevention and treatment strategies for AMI.

54. Assessment of Risk Stratification and Prognosis among Patients of AMI by Lipoprotein (A), Lipid Profile and Antioxidant Biomarkers
Dharmveer Sharma, Kshatrapal Prajapati, Vijay Prasad Sangishetti
Abstract
Introduction: Acute myocardial infarction (AMI) is one of the important reasons for morbidity and mortality in the world. Indians are more prone to coronary artery disease (CAD) at a much younger age. Lipoprotein (a) [Lp (a)] levels have revealed wide ethnic variations. Lp(a) levels show link with clinical variables and severity of AMI in Gwalior region of India population needed further studies. The aim is to study and evaluate the alteration of lipid profile and lipoprotein (a) in AMI and compare it with that of a healthy population mainly in Gwalior region in India. Methodology: Case control studies involving 100 patients of AMI were taken as cases and 100healthy persons were used as controls almost same age and sex matched. They were analysed by measurement of various parameters like BP, biochemical parameters such as FBS, lipid profile, MDA, GPx, SOD and catalase enzymes and Lipoprotein (a). Serum Lp(a) estimation was performed by immunoturbidimetric method. Results: Our findings and evaluation demonstrated that elevated values of FBS, total cholesterol, triglycerides, LDL-c, VLDL-c and Lp(a) level and decreased level of HDL-c and antioxidant enzymes (GPx, SOD and catalase) were observed in AMI subjects. Concentration of Lp(a) was significantly higher in AMI subjects (43.66±8.20) in comparison to control subjects (22.9±03.46).The values of all biochemical markers were found increased in AMI patients and the difference were found to be statically significant. The level of Lp (a) and Lipid profile were found positive correlation in AMI. Conclusion: Our study showed the patients of acute myocardial infarction have increased levels of serum Lp(a) as compared to healthy individuals. The increased level of serum lipoprotein(a) is strongly linked with the risk of coronary heart disease.

55. Wound Complication Outcome of Absorbable Suture Polydioxanone and Non-Absorbable Suture Polypropylene in Midline Laparotomy Wound Closure: Analytical Study
Vijay Kumar Goel, Neharika, Arun Kumar Singh, Ankit Abhishek
Abstract
Introduction: Wound closure techniques have progressed tremendously, ranging from simple sutures to adhesive compounds. Thus, we aimed to compare the wound complication rates of absorbable suture polydioxanone vs nonabsorbable suture polypropylene in midline laparotomy wound closure. Methodology: Eighty patients with emergency and elective laparotomies were enrolled. All the patients were equally divided into two groups, i.e., Group A had patients with even numbers in whom abdominal incisions were closed with absorbable suture material polydioxanone, and Group B had patients with odd numbers in whom abdominal incisions were closed with nonabsorbable suture material polypropylene. Data was collected based on postoperative wound complications and compared. Postoperative pain was recorded by using a VAS score. Results: In this analytical study, in group A, most patients had no pain (90.00%) and mild pain (10.00%). On the contrary, patients in group B experienced moderate pain (5.00%). A significant difference was noted in immediate and late postoperative outcomes among groups. Conclusion: Based on the observations of this study, the continuous mass closure technique employing no.1 Polydioxanone (PDS) suture material is superior to no.1 Polypropylene (PPL) suture material in preventing wound complications.

56. Effect of Storage Time on Pleural Fluid Adenosine Deaminase Level
Sanjay Tandon, Chandan Singh Kushwaha, Anil Kapoor
Abstract
Background: It is essential to investigate why some clinicians are reporting low level of ADA (< 40 IU/L) in TB pleural fluid. We studied the effect of storage time at room temperature on pleural fluid ADA level. Methodology: This study was a cross-sectional observational study conducted at a tertiary care hospital on patients with pleural effusion over a period of 18 months. ADA estimation in the fluid was done within one hour of collection as well as after 24 hours of storage at room temperature. Results: The mean ADA level within 1 hour of collection was 43.19±19.47 IU/L which increased to 45.32±18.80 IU/L after 24 hours of storage at room temperature (p<0.05). In non-tuberculous pleural effusions, the mean ADA level within 1 hour of collection was 32.75±14.97 IU/L, which increased to 35.44±14.19 IU/L after 24 hours of storage at room temperature (p<0.05). In neutrophilic predominant exudative pleural fluid the mean ADA level within 1 hour was 34.25±20.71 IU/L, which increased to 38.50±21.61 IU/L after 24 hours (p<0.05). The mean ADA level increased after 24 hours only in rainy season from 40.27±14.56 IU/L to 43.50±16.13 IU/L (p<0.05). Conclusion: Twenty-four hours of storage of pleural fluid at room temperature increased the ADA level but not enough to change the diagnosis from a non-TB pleural effusion to a TB pleural effusion. The factors affecting the increase in ADA level upon storage included the type of fluid (exudate), predominant cells (neutrophils), aetiology (non-tuberculous), and season (rainy).

57. Phenotypes in Acute Exacerbation of COPD
Sanjay Tandon, Harshit Agarwal
Abstract
Background: We studied the severity of exacerbations, response to standard therapy and length of hospital stay in patients with eosinophilic and non-eosinophilic phenotypes of acute exacerbations of COPD. Methodology: The study was conducted as an observational cohort study on patients with AECOPD admitted at our centre over a period of 18 months. Blood and sputum counts were done based on which exacerbations were either classified as eosinophilic or non-eosinophilic. Results: 82 patients with AECOPD presented during the study period. The mean age was 65.38±9.91 years. Based on sputum and absolute blood eosinophil count, 32.9% and 58.5% cases had eosinophilic AECOPD respectively. We found a significant association of severe to life-threatening AECOPD with sputum eosinophilia. 18 patients out of 27 eosinophilic AECOPD had severe to life threatening exacerbations while 14 patients out of 55 non-eosinophilic AECOPD had severe to life threatening exacerbations (p<0.05). We did not find any association of sputum and blood eosinophilia with LOHS [ sputum (eos vs non-eos,9.22 and 8.84 days, p = 0.77), AEC (eos vs non-eos, 8.40 and 9.76 days, p = 0.27] and relief of symptoms to standard therapy at day 5 (p>0.05). We found a weak positive correlation of peripheral blood eosinophilia with sputum eosinophilia in acute exacerbation of COPD (r=0.423; p<0.05). Conclusion: Non-eosinophilic exacerbations were twice as common as eosinophilic exacerbations. No difference in LOHS was seen in eosinophilic and non-eosinophilic phenotypes. Although, sputum eosinophilia was associated with more severe exacerbations, there was no difference in response to standard therapy between the two phenotypes.

58. Acceptability & Safety of Thermal Ablation in VIA Positive Women to Prevent Cervical Cancer
Shaily Sengar,  Anil Kushwanshi, Raman Ohary
Abstract
Cervical cancer is a significant contributor to the incidence and mortality of cancer in women globally, ranking fourth worldwide. However, the establishment of screening programs has led to a significant decrease in cervical cancer rates. Thermal ablation, a novel ablative procedure for precancerous cervical lesions (CIN), also known as cold coagulation or thermocoagulation, aims to reduce the incidence of cervical cancer. This study evaluated the safety and acceptability of thermal ablation as a treatment for precancerous cervical lesions in women who tested positive on visual inspection with acetic acid (VIA) and Lugol’s iodine (VILI). The study enrolled 50 VIA/VILI positive women, who underwent visual evaluation and thermal ablation therapy at a tertiary care hospital’s Department of Obstetrics and Gynecology. Interviews were conducted after treatment and 4-6 weeks later to assess the participants’ experiences with anxiety, discomfort, and pain during thermal ablation. The results showed that thermal ablation is a safe and widely accepted procedure among women. 90% of the patients did not experience any pain during the treatment, while 10% reported high pain. The most common mild side effect was vaginal watery discharge, and none of the participants experienced any severe adverse effects requiring hospitalization or urgent care. Additionally, 62% of the women were willing to repeat the procedure if necessary. These findings suggest that thermal ablation is a safe and minor surgical procedure that can improve screening and treatment in a single visit, thus optimizing cervical cancer control, particularly in low-resource settings. As a result, thermal ablation has the potential to be a valuable supplement to current cervical cancer screening and treatment options.

59. Evaluation of Abnormal Uterine Bleeding Based on Palm-Coein Classification
M Bhagyasri, Nekkalapu Sahithi
Abstract
Background:  Any deviation from the typical menstrual cycle that affects the regularity and frequency of menses, as well as the length of the flow or the volume of blood lost, is known as abnormal uterine bleeding (AUB). The goal of this study was to examine the various etiopathological causes of abnormal uterine bleeding in women between the ages of 20 and 55, as well as to assess the contributing aetiologies, frequent manifestations, diagnosis, assessment, and treatment of AUB using the PALMCOEIN approach. Methods: This prospective study was carried out at Department of Obstetrics and Gynaecology in a tertiary care hospital, within two years. 100  hundred patients in reproductive age group who presented with abnormal uterine bleeding were enrolled. The demographic information was documented, and then a general, physical, systemic, and gynaecological examination was followed by a structured history of the patient’s past and present menstrual history, history of using contraception, and medical/surgical history. Ovulatory dysfunction was characterized as unpredictable timing and a variable amount of bleeding for the sake of evaluating the COEIN component, whereas endometrial diseases referred to situations where AUB occurred in accordance with predictable/cyclical patterns. Results: Twenty-one percent of the 100 cases in the research group had obesity as a risk factor, as did twelve percent of cases with thyroid problems, seven percent with hypertension, five percent with diabetes mellitus, and two percent of cases with a history of PCOS or a family history of endometrial cancer. In 61% of cases, there was heavy menstrual bleeding, and in 11% of cases, there was dysmenorrhea with menorrhagia. Intermenstrual haemorrhage occurred in 10% of the cases, while AUB occurred in the remaining instances. For instance, abdominal masses occurred in 7% of cases, vaginal masses in 4%, and urine retention in 4%. Proliferative phase was the most frequent pathology seen in 58 (58%) of the individuals. Conclusion: The diagnosis and management of abnormal uterine bleeding are significantly easier and more objective when done with the PALM-COEIN technique. Additionally, it facilitates diagnosis.

60. Reticulocyte Study in Different Neoplastic and Non- Neoplastic Conditions of Haematology
Aarushi Anupriya, Poonam Kumari, Hari Shankar Mishr, Ravi Reshav
Abstract
Introduction: Reticulocytes are immature red blood cells. Reticulocytes occupy an intermediate position between nucleated RBC and mature RBC. They are called reticulocytes because of reticular network of ribosomal RNA. Reticulocytes undergo removal of RNA on passing through spleen on 1st day and are important indicator of RBC production. Aims: To study the significance of reticulocyte count in preliminary evaluation of various haematological conditions in patients who underwent bone marrow examination. Material and Methods: The present study was a descriptive study. This Study was conducted 18 months (from March 2021 to September 2022) at department of Pathology for haematological evaluation in D.M.C.H. Total 100 patients were included in this study. Result: In our study, 9 (9.0%) patients had ALL Diagnosis, 7 (7.0%) patients had AML, 6 (6.0%) patients had Drug Induced hemolytic anemia, 1 (1.0%) patients had Essential Thrombocythemia, 30 (30.0%) patients had IDA, 2 (2.0%) patients had IDA on Treatment, 3 (3.0%) patients had MAHA, 8 (8.0%) patients had Malaria, 18 (18.0%) patients had Megaloblastic Anemia, 2 (2.0%) patients had Megaloblastic Anemia on treatment, 5 (5.0%) patients had Thalassemia and 9 (9.0%) patients had Visceral Leishmaniasis. The value of z is 5.6662. The value of p is < 0.00001. The result is significant at p < 0.05. Conclusion: We conclude that, higher number of patients had IDA which was statistically significant. All these clinical and histo-morphological parameters and advanced newer diagnostic modalities like immunohistochemistry, morphometric analysis can help to early diagnosis and to plan the line of treatment and also have prognostic significance.

61. Detectability of Spinal Metastasis in known Malignancies: A Comparative Study between 1Tesla MRI and F18 Sodium Fluoride PET- CT
Tasdiqul Islam, Chiranjib Murmu
Abstract
Background:  The development of spinal metastasis is a seminal event in the progression of common malignancies and their early detection plays a critical role in deciding the treatment protocol and assessing prognosis. There is no consensus in the literature regarding the preferred imaging modality. The study was undertaken with the objective to compare the efficacy of Magnetic Resonance Imaging (MRI) as against 18F Sodium Fluoride (Positron Emission Tomography- Computed Tomography) PET-CT in detection of spinal metastatic lesions. Methods: A total of 32 patients with biopsy-proven malignancy and clinical and laboratory suspicion of metastases were taken up for this study. All patients underwent spinal MRI and whole body 18F Sodium Fluoride PET-CT scan using standard techniques. The MR images and 18-F Sodium Fluoride PET-CT scans was read independently by an experienced Radiologist and an experienced Nuclear Physician respectively, who were blind to the results of the other study. Results: A total of 1056 vertebrae of 32 patients were examined by both PET CT and MRI. On MRI 148 total lesions were detected whereas on PET CT scan 199 lesions were found. Analyzing the data by using Mc Nemar’s chi square statistics assuming 18F NaF as case and MRI as control, it is found that p value is 0.000. That means statistically ‘highly significant difference’ were seen in detection of vertebral metastasis by PET CT than MRI as PET CT picked up more number of lesions. Conclusion: Combined 18F NaF PET CT scan showed superior to MRI in the detection of spinal metastatic lesions. Consequently18F NaF PET CT has a better impact on clinical management compared to MRI, which will help in staging and reducing the morbidity associated with advanced malignancy.

62. A Community-based Study on the Incidence and Risk factors of Unintentional Fall Related Injuries Among Children in Patna District, Bihar, India
Shikha, Khalid Anwar, Pragya Sinha, Amita Sinha
Abstract
Objectives: This study was to assess the incidence and risk factors of unintentional fall related injury among children residing in Patna district, Bihar. Methods: Data was collected by house‑to‑house survey in the community, If the first one was not met the criteria the next house was utilized for the study. And parents/guardians of child were asked questions using a predesigned questionnaire specially designed for this purpose. At the end of the interview, the parents/guardians of child were educated about the safety and prevention from unintentional fall injury in children. Results: Incidence of unintentional fall related injury was 9.8%. A total of 19(35.18%) fall injuries got first aid and 29(53.70%) falls injuries children were admitted in hospital admissions. Unintentional fall injury was mostly seen in 31(57.41%) children who belonged in nuclear family as compared to joint family children 23(42.6%). 30(55.56%) unintentional fall injury was found in age 5-10 years and 14(25.92%) injury was found in age 11-14 years of children. 34(62.96%) were males and 20(37.03%) were female children. The commonest place for unintentional fall injury occurred at 39(72.22%) home followed by 10(18.52%) road and 5(9.26%) school. Commonest unintentional fall injury was 24(44.44%) fracture, 14(25.92%) cut injuries and 9(16.67%) dislocation. Conclusions: Male children are more preponderance for unintentional fall injury as compared to female. It was commonly occurred in home and school. Lower socioeconomic status, lower literacy of mother, children belong from nuclear family, leisure/play activity of children and child falls from stair, falls from arms of the person, falls from height less than 2 meter are the major risk factors for unintentional fall injury in children. Upper limb and head are the major anatomical site for injury. Fracture, abrasion/cut/open wound and dislocation are the common unintentional fall injuries in children. Thus, the educational status of mother, type of family, gender and age of the children had a great influence on unintentional injuries. The lack of attention and proper care, transport facilities also make the children more prone to unintentional fall injuries. So that, this study suggests in modifying the home environment to reduce injuries, teaching people about home safety, and providing safe equipment to prevent injuries.

63. Assessment of Drug Use Pattern and Adverse Drug Reactions in Patients with Bipolar Mood Disorder in Tertiary Care Teaching Hospital
Kotadia RB, Kubavat AR
Abstract
Background: Prescription pattern of drugs plays a important role in helping the health care system to understand, interpret and improve the prescribing administration and using medications. Bipolar Mood Disorder is a chronic or episodic (which means occurring occasionally and at irregular intervals) mental disorder. It is characterized by recurrent episodes of mania, hypomania, depression, and mixed states separated by periods of relative euthymia. In past for bipolar mood disorder most of the drug utilization study was done in OPD bases. Present study is undertaken to evaluate the drug usage pattern and its safety profile in indoor patient at tertiary care teaching hospital. Aims and Objectives: Assessment of drug use pattern and adverse drug reaction in patients with Bipolar Mood Disorder in tertiary care teaching hospital. Methodology: This was a prospective, observational, single center study conducted at Psychiatry department of tertiary care teaching hospital in Gujarat from January 2019 to December 2019. Prescriptions of patients attending inpatients department were collected prospectively. Before collection of the data informed written consent of the patients was taken. The particulars of the participants were collected at the time of enrolment comprised of baseline demographics data, clinical data and therapeutic data.  All data were recorded on case record forms and analyzed using descriptive statistics. Results: A total of 1134 prescriptions were collected from 100 patients over a period of 12 months. More than half of the sample size comprised of patients between the age group of 21-40 years, out of 100 patients 70:30 being male female ratio, 73 were literate, 73 were married and 82 were unemployed. An average no. of hospital stay admitted in tertiary care teaching hospital was 11 days with ± 7.66 SD. 98 patients were prescribed mood stabilizer (Lithium turned out to be the most frequently prescribed mood stabilizer and sodium valproate ranked second). 98 patients were prescribed anti-psychotics, 2 patients were prescribed antidepressants, 99 patients were prescribed benzodiazepines. 29 different types of ADRs were noted in our study. Most of the reactions were classified as ‘possible’ according to WHO-UMC causality assessment scale, mild severity and found to be preventable. Conclusion: In the present study, most frequently prescribed drugs were mood stabilizers (Lithium & Sodium Valproate). Most concomitantly prescribed drugs were Sedatives and Antipsychotic. ADR can be minimized by Therapeutic Drug Monitoring.

64. A Study on the Incidence and Frequency of Extracranial Complications of Chronic Suppurative Otitis Media
Jairam Prasad, Kameshwar Prasad Singh
Abstract
Objectives: The present study was to evaluate the incidence and frequency of extracranial complications of chronic suppurative otitis media in various age group patients. Methods: A total of 4987 subject of chronic suppurative otitis media were included in this study. A detail clinical history and clinical examinations were conducted to all subjects. The incidence and significance of the complications and detailed type of complication was noted and reported. Results: Out of 4987 patients of chronic suppurative otitis media, 100 patients had extracranial complications, that is, the rate of incidence of extracranial complication in CSOM was 2%. Out of 100 extracranial complication patients, 64% patients were belonged from rural area. Primary and below primary educated patients were 54(54%). Majorities of patients were females 61(61%). Majorities of patient 54(54%) were in age 11-20 years. 19(19%) cases were in age group of 0-10 years. 16(16%) patients of extracranial complications were in age group of 21-30 years.  Most of the patients were belonged from low (52%) and below low socioeconomic class (32%). Most common complication was 33(33%) post aural abscess. 27(27%) had mastoiditis, 19(19%) patients had facial nerve paralysis, 12(12%) had petrositis and 9(9%) had post aural fistula. Conclusions: The highest incidence of extracranial cranial complication of CSOM was seen in younger age patients. Females were more preponderance than males. Low socioeconomic status, low hygiene and lower literacy were the common risk factors of extracranial complications in CSOM patients. Post aural abscess and mastoiditis were the more common extracranial complications of chronic suppurative otitis media. Thus, lack of knowledge regarding the disease process and its complications in illiterate and under educated population lead to complications. So that, educations of the peoples are essential for the prevention from complication and morbidity due to CSOM. For this, we should organise the health check-up camp in rural as well as urban area for awareness and treatment of CSOM and its complications.

65. Association of Glycosylated Hemoglobin (HBA1C) Level with Diabetic Retinopathy in Type 2 Diabetes Patients at Tertiary Care Hospital
Vikas Gupta, Amit Gupta
Abstract
Introduction: Diabetic retinopathy (DR) is a chronic progressive, potentially sight-threatening disease of the retinal microvasculature associated with the prolonged hyperglycemia and associated with other condition. HbA1C is an important predictor for early identification of diabetic retinopathy cases. Materials and Method: It is a hospital based prospective observational study conducted in the Department of Ophthalmology, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India to assess association of HbA1C levels with Diabetic retinopathy in type 2 Diabetes. Study duration was from March-2021 to Feb-2022. The study included 160 DR cases. All calculations were performed using SPSS® version 15 (Statistical Packages for the Social Sciences, Chicago). Results: Maximum cases 88(55%) were developed diabetic retinopathy after 10 year. Mean duration of diabetes in (years) study population was 12.28± 6.05 years. 77.27% of mild NPDR (non- proliferative diabetic retinopathy) cases were in range of 6.5-8.5% range of HbA1C. 60.72% moderate NPDR were in range 8.6-10.5% of HbA1C. 80% severe NPDR were in range 10.6-12.5% of HbA1C, whereas 80% PDR (proliferative diabetic retinopathy) cases were in 12.6-14.5% range of HbA1C. Hb1Ac range was statistically significantly associated with progression of diabetic retinopathy (P=.001). Conclusion: Maximum number of patients 84 (52.5% ) were developed diabetic retinopathy after 60 years of life and maximum patients 88(55%) were developed diabetic retinopathy after 10 years duration of disease. Glycosylated hemoglobin value (HbA1C %) showed increasing trend according to severity of diabetic retinopathy cases hence prevalence and severity of diabetic retinopathy increased with increasing level of HbA1C.

66. A Hospital Based Prospective Observational Study to Observe Correlation between Preoperative Anxiety and Arterial Pressure Change after Spinal Anaesthesia for Lower Segment Caesarean Section
Amit Yadav, Nihar Sharma, Subhrat Agarwal, Pankag Garg, Kavita M
Abstract
Background: The most common complication of spinal anaesthesia is hypotension. Preoperative worry is one of the many reasons of hypotension after spinal anaesthetic. We investigated the relationship between preoperative anxiety and changes in arterial pressure after spinal anaesthesia for caesarean delivery. Material and Methods: A hospital-based prospective observational study with 90 pregnant women separated into three groups (Group A n=30, Group B n=30, and Group C n=30) was carried out. Patients in Group A had mild anxiety, Group B had moderate anxiety, and Group C had severe anxiety. We performed one-way analysis of variance (ONE -WAY ANOVA) to assess preoperative mother anxiety and post spinal hypotension in low, medium, and high preoperative anxiety groups, and the differences between the groups were analysed using an unpaired T-Test. Conclusion: We concluded that the preoperative anxiety had a significant effect on hypotension after spinal anaesthesia for caesarean delivery.

67. To Study Cord Blood Vitamin D Levels in Term v/s Preterm Neonates at Birth
Pandey Animesh, Aggarwal Arjun, Singh Ayush
Abstract
Background: The vitamin D play important role in neonatal period and prevention of sepsis and morbidities in neonatal period. The Indian population is increasingly being discovered to be vitamin D deficient. Present study aimed to assess the cord blood Vitamin D levels in term and preterm neonates at birth. Material and Method: This prospective observational study was conducted among the neonates born in the hospital and the cord blood sample was obtained for estimation of the cord blood vitamin D. Vitamin D levels as estimated by the chemiluminescence immunoassay (CLIA) method. Serum levels of Vitamin D was classified according to severity: Sufficient->30ng/ml; Insufficiency-20-30ng/ml; Deficiency-<20ng/ml. All the data was entered in excel sheet and analysed using SPSS v21 operating on windows 10. A p-value of <0.05 was considered statistically significant. Results: In present study total of 100 neonates are include among them 50 were term and 50 were preterm neonates in the study. The mean vitamin D level was found to be significantly lower among the preterm neonates compared to the term neonates.(p<0.05) The vitamin D deficiency was seen in 32% of preterm in comparison to 4% in term pregnancy, this was statistically significant finding. (p<0.05). Conclusion: Present study documented a significant lower mean vitamin D level among the preterm neonates at birth compared to the term neonates. The study highlights the requirement of the vitamin D among the preterm neonates compared to term neonates.

68. Study of Hospitalized Cases of Fractured Neck Femur for Risk Factors that May Affect Recovery
Sadhana Narayan Jaybhaye, Mangala Sonavani-Borkar, Shailaja V. Rao, Mahesh Patil, Shaikh Zeba Firdous, Mangala Sonavani-Borkar
Abstract
Hip fracture is a major public health problem with significant consequences. Recent worldwide estimates are in the order of 1.7 million hip fractures annually and are expected to reach 6 million by the middle of this century. More than one-third of elderly fall annually, with an estimated 1% of those who fall sustain a hip fracture. Because of high levels of frailty, multimorbidity, polypharmacy, and coexisting cognitive impairment, people with hip fractures are at particularly high risk of developing delirium. Therefore, present study has been conducted to study hospitalized cases of fractured neck femur to look for risk factors that may affect recovery of the patient. Materials and Methods: A cross sectional Observational study was done on 100 Geriatric patients hospitalised with fractured neck femur admitted in the orthopedics ward who fulfilled the eligibility criteria from Dec. 2019 to Dec.2021 have been included in the study, with the approval of the institutional ethic committee and informed written consent. They were seen daily. A detailed history was taken, comorbidities recorded, and patients examined thoroughly, including the use of the following assessment tools: (1) Mini Mental Status Examination. (2) Geriatric Depression Scale-4. (3) Barthel’s Index. (4) H. Fall Risk Assessment Tool. (5) Delirium Observation Screening Scale (DOSS). (6) Confusion Assessment Method-4 (CAM-4). Parameters for Delirium and Barthel Index were studied at the time of the end of hospitalization. Three or more points on the DOSS were considered highly indicative of delirium. The diagnosis was confirmed based on the CAM-4 criteria. Results & Conclusion: Age, history of comorbidities, time of surgery after fall, hyponatremia, and polypharmacy were statistically significant risk factors associated with the post operative delirium that may affect the recovery of fracture neck femur in geriatric patients. Patients of age ≥ 75 years were 25.06 times at risk for delirium as compared to those of the age group 60-75 years. Patients who were operated on≥ 7 days after the fall were 13.35 times at higher risk of developing delirium as compared to those operated on within 7 days. Patients having hyponatremia were 57.84 times at risk as compared to their counterparts. The association between delirium and mortality is statistically significant. The greatest service a geriatrician can do for his patients is to counsel them for preventing falls.

69. Epidemiological and Demographic Profile of COVID-19 Suspects in a Tertiary Care Hospital at Jaipur, Rajasthan
Anupma, Gaurav Dalela, Kriti Goyal, Nilofar Khayyam, Jitendra Panda, Pooja Gupta
Abstract
Background: The coronavirus disease (COVID-19) was a pandemic which spread to various countries and originated in Wuhan, China. For appropriate response, planning, and allocation of resources demographic data play an important role in understanding the impact of COVID-19 across the country. Aim: To estimate epidemiological and demographic parameters like age, sex, area, sample type etc. of samples reported in COVID-19 diagnostic laboratory of RUHS College of Medical Sciences, Jaipur, Rajasthan. Material and Method: The study was conducted retrospectively in a tertiary care hospital at Jaipur. Data like age, gender, urban or rural, IPD/ICU or OPD etc. were collected between January 1, 2021 to June 30, 2021. The collected data were expressed in number, counts and percentage. The data of six months were analysed using Microsoft Excel. Results: From January to June 2021, April and May 2021 showed highest positivity 13084 (27.42%) and 10968 (23.06%) respectively. February 2021 and June 2021 showed least positivity 156 (2.39%) and 163 (0.8%) respectively. Total COVID-19 positive cases during 6 months were 25134 and deaths were 357 with highest deaths were during May 2021 (n=270). Males (64.28% to 72.20%) were affected most. In April and May 2021 positivity in urban area was 6053 (46.26%) and 5712 (52.07%) respectively, while in rural area 7031 (53.74%) and 5256 (47.93%) respectively. The positivity in OPD patient during April and May was 93.58% (12245) and 95.26 % (10449) respectively. Nineteen to forty years was most affected age group. Conclusion: During second wave both urban and rural population was affected. Males and working age group were affected more. Among COVID-19 suspects’ positivity rate was low in IPD patients as compared to OPD patients. Critical factors for an effective public health response are surveillance and contact tracing.

70. Evaluation of Clinical Profile and Outcome of Empyema Gallbladder in Anugrah Narayan Magadh Medical College and Hospital, Gaya (Bihar)
Dinesh Chauhan, Anupam Ranjan, Sweta Rani, Mahesh Chaudhary
Abstract
Introduction: Empyema gall bladder derived from greek word Empyema meaning suppuration, it is most prevalent worldwide. Presentation of patients varies from mild tenderness in upper abdomen to features of sepsis. Patients having comorbidities especially immunocompromised patients have very few or relatively asymptomatic at the time of presentation, it requires high degree of clinical suspicion and expertise to early detect the disease and act accordingly. Methods: A Prospective study of total 90 patients of Empyema Gall Bladder were enrolled in Department of General surgery either from OPD or from Emergency, Anmmch gaya from December 2019 to October 2021.Clinical profile and outcome data were recorded and was analysed for evaluation of better management protocol. Result: In our study we found majority of patients were in age group between 40-50 yrs. Male to Female ratios was 1:1.8. Chief complaint of pain abdomen, epigastric fullness nearly 100%. Laboratory investigations revealed altered Liver function test in almost all patients. Conclusion: Younger females were most commonly affected than male having maximum incidence in 4th-5th decade. A high index of suspicion is warranted for the diagnosis of empyema GB as presentation are mostly like acute cholecystitis. All acute cholecystitis patients who are immunocompromised or having comorbidity are to be evaluated aggressively in order to reduce morbidity.

71. Analysis of Heart Rate Variability Using Frequency Domain Parameters in Patients with Allergic Rhinitis
Himanshu Gupta, Jyotsna Shukla, Varsha Gupta, Abhishek Saini
Abstract
Introduction: Allergic rhinitis (AR) is an inflammatory disease of nasal membranes characterized by symptoms like nasal congestion, itching, rhinorrhea, and sneezing. AR constituting almost 55% of all allergies. AR incidence in India lies somewhere between 20% to 30%. One of the primary factors towards development of AR symptomatology happens to be neurological. The objective of the present study was to assess such associations of cardiac autonomic functions in AR patients and their subsequent comparison with healthy controls subjects via frequency domain parameters of heart rate variability analysis. Methodology: The present study was conducted in the Department of Physiology, SMS Medical College, Jaipur wherein forty AR patients (both males and females) were recruited from the ENT Department and forty age- and gender-matched healthy subjects were taken for comparison. HF (ms2) and HF (n.u.) used for Parasympathetic function; LF (ms2) and LF (n.u.) used for sympathetic function and LF/HF ratio used for sympathovagal balance. Results: Values of LF (ms2) and LF (n.u.) significantly lower in AR patients (P < 0.05) whereas, values of HF (ms2) and HF (n.u.) was Significantly higher in AR group (P < 0.05). The LF/HF ratio was significantly lower (P < 0.05) in AR patients as compared to the healthy controls. Statistical Analysis: Unpaired ‘t’ test was applied for statistical analysis of data of both groups where P valve <0.05 considered as statistically significant. Conclusions: Our study indicated that patients with allergic rhinitis have escalated Parasympathetic reactivity and blunted sympathetic reactivity along with diminished Sympathovagal balance which represent as hypervagal activity as compared to the apparently healthy normal individual.

72. Oral Candidiasis among Cancer Patients Attending a Tertiary Care Hospital in Bihar, North India: An Evaluation of Clinic Mycological Association and Antifungal Susceptibility Pattern
Nushrat Jahan, Sarita Kumari, Nidhi Nandan, Kumari Simpi Rani
Abstract
Objective: The purpose of this study was to examine the prevalence and associated risk factors for oral candidiasis among cancer patients seeking treatment at a tertiary care hospital Bihar, and to determine the antifungal susceptibility pattern among these patients. Methodology: A cross-sectional study was conducted on 100 cancer patients who presented with clinical features of oral candidiasis at a tertiary care hospital in Bihar from January 2023 to April 2023. Clinical and mycological evaluations were performed to identify Candida species and determine antifungal susceptibility patterns. Statistical analysis was performed to evaluate the clinicomycological association and antifungal susceptibility pattern. Results: The prevalence of oral candidiasis among cancer patients in this study was found to be 52%. Candida albicans was the most commonly isolated species, followed by Candida tropicalis. Antifungal susceptibility testing revealed that most isolates were susceptible to fluconazole, while resistance to amphotericin B was observed in a small percentage of isolates. Significant clinic mycological associations were found between the severity of oral candidiasis and the use of broad-spectrum antibiotics. Conclusion: This study highlights the importance of appropriate use of broad-spectrum antibiotics to prevent the development of oral candidiasis among cancer patients. The findings of this study can inform the development of effective treatment guidelines for the management of oral candidiasis among cancer patients in Bihar. The study’s contributions to the existing literature on oral candidiasis among cancer patients underscore the significance of understanding the prevalence, etiology, and management of this condition in developing countries such as India.

73. To Study the Incidence, Types, Mode of Treatment of Ovarian Masses in Unmarried Women
Juhi, Afreen Nabi, Indu Kumari
Abstract
Background: Ovarian mass is common gynaecological masses in unmarried woman. This study was done to evaluate the incidence, types and mode of treatment of ovarian masses in unmarried women. Objective: To study the incidence, types, mode of treatment of ovarian masses in unmarried women. Materials & Methods: It is prospective study of all cases of ovarian cyst in unmarried girls in department of obstetrics and gynaecology of tertiary centre of Patna, Bihar from January 2022 to April 2023. Inclusion criteria: unmarried women with ovarian mass. Exclusion criteria: pregnant females, PCOD, girls taking drugs like clomiphene, tamoxifen. Result: To study types, demographic relation and method of intervention in different types of ovarian mass, 65 girls with diagnosed ovarian mass in hospital were enrolled in study. It was found that 47% patient was in 21-25 years. 40% had simple cyst. 24% presented with endometrioma and chocolate cyst. 18% had size greater than 12cm and few presented with torsion and malignancy. Proper diagnosis, management and follow up surveillance of ovarian cyst is required for better outcomes and few adverse effects.

74. A New Pathogenicity Model of Leprosy: Mutilation of Toes in Mice Experimentally Infected with M. leprae CAN Bacteria
Aninda Sen, Priyanka Paul Biswas, Mohammad Hassan, Zobia Khan, Anamika Singh
Abstract
Introduction: We describe an animal mutilation model of leprosy, comparable to the human disease, in infant mouse. Materials & Methods: Infant mouse (6-10 day) inoculated in the mouse footpads (MFP) with 107 /108 / 109 colony forming units (CFU) of M. leprae or CAN bacteria adjuvanted with 40 mg sterile collagenase in each MFP; controls consisted of; (i) uninoculated mice of same litters; (ii) mice inoculated with collagenase alone (without M. leprae / CAN bacteria); (iii) inoculated with killed bacteria adjuvanted with collagenase, and (iv) those inoculated with Nocardia brasiliensis (instead of M. leprae / CAN bacteria) with comparable inoculum size. Results: Earliest suggestive deformities developed around 12 weeks, which manifested clearly and developed progressively giving rise to contractures and mutilations. Studies on these lesions showed significant bacillary proliferation coupled with disintegration / dissolution of the connective tissue and replacement with fibrous tissue. The control uninfected animals did not show such changes, although N. brasiliensis could easily multiply in the MFP. Conclusion: The leprosy bacillus seems to share the capability of producing collagenase and gelatinase, with many members of the Actinomycetes e.g. Nocardiae, nocardioform bacteria, Streptomycetes etc. enabling them to utilise gelatin as a substrate in the human, animal, as well as in the environmental systems, as evidences suggest.

75. Implications of Radiological Parameters in Round Window Approach in Cochlear Implantation
Safa Abdussalam N K, Sunil Kumar, Swatilal S A
Abstract
Background: Cochlear implantation (CI) has revolutionized the treatment of severe to profound SNHL. Promontory cochleostomy and RW insertion are two common methods for implanting the intracochlear electrode, of which RW insertion is the preferred one due to its atraumatic character. Residual hearing can be preserved by this means. But the major setback is uncertainty regarding RW accessibility prior to surgery and consequently the need to shift the surgical approach. Only way to tackle this is to make use of available imaging modalities to derive maximum information possible prior to surgery, including cochlear orientation, RW accessibility, and major anatomical landmarks, thus guiding surgeon’s approach to CI. Aim and Objectives: (1) To find out the probability of round window rotation by looking into various radiological parameters (2) To compare the findings of preoperative radiological assessment with those obtained during surgery (3) To measure the surgical outcome using intra operative NRT assessment and comparing it with aided audiogram at 3 months and 6 months postoperatively (4) To find out whether early identification of hearing loss, use of hearing aid or early surgery, longer cochlear duct and thicker cochlear nerve will affect hearing outcome (5) To know if congenital / acquired abnormalities in inner ear and incomplete electrode insertion result in poor outcome. Methods: It was a prospective cohort study done in the department of ENT, GMC Kozhikode on the Cochlear Implant candidates under Sruthitharangam Program from 1st January 2019 to 31st May 2021 with minimum follow up period of 6 months. Data was entered in MS Excel and analyzed using SPSS 20. Results: Our study included subjects within the age group of 1 to 5 years- 57.5% at 3 years, 27.5% below 3 years and 15% above 3yrs. 70% of study population were males and 30% females. According to our study, the outcome of cochlear implant surgery had no significant relation with age at which the hearing loss was identified, use of hearing aid, age at which surgery was performed, thickness of Cochlear nerve and length of cochlear duct. HRCT was more than 90% accurate in predicting the anatomic landmarks like mastoid cellularity, Korners septum, position of Jugular bulb, sinus plate and Tegmen plate. All 12 cases with RW rotation were accurately predicted from HRCT findings like orientation of cochlear basal turn, angle between lines drawn along the anterior margin of internal auditory canals and plane of incudo-malleal joint and cochlear basal turn. Significant positive correlation was obtained between the thickness of facial nerve and cochlear nerve in IAC. Comparison of aided audiogram at 3 months and 6 months after surgery showed significant improvement in hearing outcome. Mean hearing level changed from the preoperative value of 77dB to 43 dB at 3 months and 38dB at 6 months. Conclusion: Preoperative radiological evaluation has great implications in round window approach in cochlear implantation. Having an overview of anatomical landmarks and round window accessibility before surgery will guide the surgeon towards proper surgical approach.

76. Bupivacaine versus 2 Chloroprocaine Spinal Anesthesia Comparison Study at a Tertiary Hospital
Shankar D.A., Baskaran Rajendran, Vimal Kumar Kuppusamy, Shanmugappriya Vijayarajan
Abstract
Introduction: Anesthesiologists are increasingly in need of a quick-acting, predictable anaesthesia and a quick discharge to deal with the rise in day care surgery. Due to the introduction of new pencil-point spinal needles, spinal anaesthesia has grown in popularity in nursery settings today. The purpose of the study is to compare 1% 2-Chloroprocaine with 0.5% Bupivacaine in spinal anesthesia with respect to effectiveness and time taken to attain discharge. Methods: Hospital based Randomized, Double Blind, Interventional study conducted on patients undergoing for ambulatory surgery under subarachnoid block. One of two intrathecal injections of 2-Chloroprocaine or hyperbaric bupivacaine was given to 60 patients with ASA I-II. Chloroprocaine 40 mg 1% (4 ml) was given to Group C (n=30). Bupivacaine 7.5mg 0.5% (1.5 ml) was administered to Group B (n=30). Comparisons were made between the two drugs’ side effects, recovery characteristics, and the onset and duration of sensory and motor blockage. Results: When compared to Group B (4.46 ±1.58 sec), Group C’s time of sensory block onset was faster (4.18 ± 1.43 sec). When compared to Group B (5.45 ± 0.37 sec), Group C’s motor block began sooner (5.24 ± 0.52 sec). When compared to group C (154.28 ±18.35 minutes), the duration of the sensory block was longer in group B (196.27 ± 20.12 minutes). When compared to group C (168.48±18.93 minutes), group B’s duration of the motor block was longer (196.48 ±20.48 minutes). When compared to Group C (154.04 ±2.49 minutes), Group B’s time to ambulation was longer (166.40 ±4.50 minutes). When compared to Group C (1.32±0.51 days), Group B’s length of stay was longer (1.53±0.45 days). Conclusion: 2-Chloroprocaine has a quicker onset of action than bupivacaine, which aids patients having day surgery in recovering more quickly and leaving the hospital earlier.

77. Neutrophil Lymphocyte Ratio: A Marker of Glycemic Status and Proinflammatory State in Patients with Type 2 Diabetes Mellitus
Deepak D, Veer Bahadur Singh, Harsh Tak, Siddharth Bharatiya, Vartika Saini, Maniram Kumhar
Abstract
Background: The aim of present study was establishing NLR levels of type 2 diabetic subjects. We also aimed to find out possible correlation between NLR and HbA1c in type 2 DM. Methods: In this Hospital based observational study, we studied 140 patients with type 2 diabetes mellitus, aged above 30 years presenting to the Medicine out-patient service and those admitted to the medical wards, between September 2021 and September 2022 at the JLN Hospital, a part of the Medical College in Ajmer, conducted with the aim of establishing subclinical inflammation as indicated by neutrophil lymphocyte ratio, and it’s association with glycemic control in type 2 diabetes mellitus. Results: In the present study mean ± SD of the neutrophil count was 82.78 ± 6.95 where 97.14% cases had high neutrophil count; the mean ± SD of lymphocytes count was 13.53 ± 5.43, with 88.57 % having low, 7.14% having normal, and 4.28% having high counts. The mean ± SD of the neutrophil lymphocyte ratio was 4.80 ± 2.02. The mean ± SD of fasting plasma glucose was 187.35 ± 58.01 mg/dL. The mean ± SD of HbA1c was 8.39 ± 1.87 %. A statistically significant positive correlation was found between NLR and fasting blood sugar (r = 0.425, p value <0.001) as well as HbA1c (r = 0.516, p value <0.001). Conclusion: NLR is a marker a systemic inflammation. Elevated NLR in otherwise healthy subjects with type 2 diabetes mellitus may be indicative of underlying impaired glucose metabolism and moreover, NLR should be used as a marker of diabetic control level in addition to HbA1c in type 2 diabetic subjects.

78. A Prospective Comparison of Fistulectomy and Ligation of Intersphincteric Fistula Tract (LIFT) in Fistula in Ano
Inuganti Gopal, Ambuja Satapathy, Nishirekha Behera, Sumita Tripathy, Soumya Ranjan Jena
Abstract
Background and Objectives: The most typical benign anal disease seen in routine surgical practise is fistula in Ano. The only available therapy for anal fistula is surgery. Numerous surgical procedures have been documented, such as the use of collagen plugs, seton, fibrin glue, rectal advancement flap, fistulotomy combined with sphincter reconstruction and rerouting the fistula tract. For optimal treatment and to lower the risk of relapse or incontinence, the correct method of choosing must be adjusted among the available surgical techniques. A straightforward, risk-free, and affordable therapeutic option was discovered to be ligation of the intersphincteric fistula tract. Due to the possibility of anal incontinence and the resulting morbidity, treating peri-anal fistulas is still difficult. A novel sphincter-saving treatment called LIFT has produced positive results in the therapy of anal fistulas. Aims and Objectives: In cases of diagnosed fistula in Ano as well as admitted to our hospital for surgery in the previous two years, to compare the sphincter-saving surgery LIFT with fistulectomy with regard to of surgery time, post-operative wound healing time, post-operative wound-related infection rates, and faecal incontinence on follow-up. Material and Methods: This prospective comparative study was carried out at the Government Medical College and Hospital of Northeastern India’s General Surgery Department. After receiving approval from the institutional ethical committee and informed written consent, 80 patients who had been diagnosed with Fistula in Ano and been admitted for surgical treatment were evaluated. They were then split evenly and randomly into two groups: Group I, which consisted of 40 patients, underwent fistulectomy, and Group II, which consisted of 40 patients, underwent the LIFT procedure. Both Groups were then monitored for six months. Results: 90% of the 40 patients in Group I who underwent a fistulectomy for a fistula in Ano were over 20 and under 50, with 57% of the patients being men and 43% being women. In Group II (LIFT), 88% of the participants were between the ages of 20 and 50, with 53% of men and 47% of women. In Group I, 77% of procedures take between 30 and 50 minutes on average, but in Group II (LIFT), the average operation time was closer to 30 minutes. Fistulectomy recovery took an average of 7 weeks, whereas LIFT recovery took an average of 5 weeks. In the LIFT technique, the post-operative hospital stay was shorter. Wound infections affected 18 individuals in group I and 8 patients from group II. Incontinence was a complication that affected 4 individuals in Group I, while there were none in Group II. Conclusion: In terms of maintaining sphincter function and preventing anal incontinence, LIFT is superior to fistulectomy. The likelihood of postoperative infection of the surgical site and recurrence is lower. Overall, LIFT delivers a higher quality of life and has superior post-operative results.

79. To Evaluate the Outcome of Second Line Anti-Retroviral Therapy in HIV Positive Patients at Tertiary Care Centre
Jatin Jain, Munesh Kumar, Harsh Kumar Veshar, Sunil Kumar Jangid, Chandra Kant, Ravindra Tiwari
Abstract
Background: Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. Methods: This prospective study was carried out at a tertiary care hospital among HIV-infected patients who was failed on first-line treatment and started on second-line HAART during October 2020 to September 2021 and formed the cases of the study and registered at ART centre, Ajmer. Ethical approval was obtained from the Institutional Ethics Committee of this institution. Result: In our study at baseline of 2nd line ART initiation mean CD4 cell count was 299.04 cells/ul ; at 6 months of 2nd line ART therapy mean CD4 cell count was 334.24 cells/ul and at 12 months mean CD4 cell count was 396.82 cells/ul. Change in CD 4 count from 6 months to baseline was 35.20 (P value 0.001) and change in CD 4 count from 12 months to baseline was 97.78(P value 0.001). The mean CD4 cell count is found to be increased from baseline to successive follow-ups. The increase in CD4 count is statistically significant (P value <0.05) at 6 and 12 months from baseline. Conclusion: Second line ART was found to achieve statistically significant (P value <0.05) clinical effectiveness (weight increase), virological effectiveness (viral load decrease), immunological effectiveness (CD4 count increase) at 6 and 12 months from baseline.

80. Detection of Colistin Resistance Among Multi-Drug Resistant Gram-Negative Bacterial Isolates Isolated from Clinical Specimens of ICU Patients
Praveen Kumar, G. Sowjanya, A.R.K. Archana, G. Swetha
Abstract
Introduction: Hospital‑associated infections caused by multidrug‑resistant (MDR) Gram negative bacteria (GNB), especially Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, represent a growing problem worldwide Colistin is considered to be one of the last resort antibiotic of multi-drug resistant (MDR) gram-negative bacilli (GNB). The increase in colistin usage has resulted in the emergence of colistin resistance in GNB.
Materials and Methods: The study included clinical specimens received from intensive Care Units (ICUs), of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from June 2021 to August 2022 in the Department of Microbiology. The objective of this study was to estimate the prevalence of colistin-resistance (CLR) in MDR isolates collected from different intensive care units (ICUs). The Gram-negative isolates showing colistin resistance by Kirby- Bauer’s disc diffusion method was included and further subjected to broth microdilution method for confirmation of colistin resistance.
Results: A total of 336 (8.02%) Gram negative bacilli isolated from intensive care units. K. pneumoniae 136 (40.47%) was the predominant isolate, followed by Escherichia coli (33.33%), Pseudomonas aeruginosa (23.51%), Acinetobacter baumannii (2.67%). 58(17.26%) of the 336 isolates, were found to be resistant to colistin by Kirby Bauer’s disc diffusion, which were subjected to broth-microdilution method, for confirmation of colistin resistance, following which only 11 (18.96%) isolates showed colistin resistance. The predominant resistant isolate was Klebsiella pneumoniae isolate followed by P.aeruginosa, A.baumannii and E.coli. The Colistin resistant Gram-negative isolates showed high sensitivity to Tigecycline and meropenem. Conclusion: It is recommended to reduce the colistin usage as it has been considered a last resort drug. Microbiologist, consultant and hospital infection control committee should work together to prevent further rise of resistance. In our study Tigecycline is found sensitive against colistin resistant Gram-negative bacilli.

81. A Clinicomycological Study of Suspected Mucormycosis in Post COVID Patients Attending a Tertiary Care Hospital
Kiran, V. Rastogi, Vikas, Mansi, Digvijay, Bhawana
Abstract
Background: Most of the studies done on this emerging disease in India, as well as investigations throughout the world, are retrospective. Due to increase in number of cases within a short duration, diverse risk factors and inclusion of immunocompetent and immunocompromised patients, there is need of prospective study so that suspected cases can be diagnosed in a timely manner, various risk factors can be analyzed and accordingly patients appropriately treated, which should result in the increase of patient survival. Methods: A prospective observational study was undertaken  over a period of ten months from March  to December 2021. A total of 175 biopsy samples were collected from 150 suspected cases of post covid mucormycosis  patients in sterile normal saline at the ENT department and received in the department of microbiology. MRI of brain, orbital and paranasal sinus was done in all patients. Results: The prevalence of mucormycosis laboratory confirmed was found to be  42.66% . Out of 150 Patients, 47 were KOH positive while 33 culture positive. The most common isolate was  Rhizopus arrhizus (84.85%) followed by R.microsporus var. rhizopodiformis (9.09%) , Rhizomucor pusillus (3.03%) and Saksenaea vasiformis (3.03%). Rhino-orbital-cerebral mycormycosis was the most common clinical form (33 cases). Diabetes mellitus was the most common predisposing factor n=112, (74.66%) . Many patients had multiple symptoms like periorbital swelling (52%) , headache (44.7%), fever (41.3%), loss of vision (16%), facial swelling (27.3%) and nasal pain (8.7%). Invasive fungal sinusitis was seen in MRI in 116 (77.33%) cases.  Tissue debridement was done in all positive patients  along with treatment with liposomal amphotericin B (1.5- 5.0 mg/kg/d ) and  then switched over to oral posaconazole 300 mg BD on first day then 300 mg OD for several weeks. Inspite of rigorous treatment in 4.6% cases the prognosis was not good resulting in mortality. Also in 40 % of the patients who recovered, long-term morbidity related to vision was observed. Conclusion: Present study determined the fungal etiology of post covid mucormycosis with Rhizopus arrhizus being the most common cause in our region comparable to other studies from India. The identification of risk factors, clinical features and laboratory  findings helped in  early diagnosis, leading to prompt treatment and favourable outcome. With diabetes mellitus being the most common predisposing factor seen, it is suggested that holistic approach to prevent, revert and treat this condition need to be strengthened.

82. Characterization of Non Fermenting Gram Negative Bacilli and Determination of Their Antimicrobial Susceptibility Pattern
Anjum Afsana, Sangeeta Dey, Kahkashan Akhter
Abstract
Background: Non-fermenting Gram negative bacilli (NFGNB) are capable of causing a variety of infections like bloodstream infections, skin and soft tissue infections including burn and surgical wound infections, endocarditis, meningitis and urinary tract infections. Furthermore, infections caused by NFGNB are not limited to hospital settings and cases involving otherwise healthy individuals of all age groups, occurring in community settings, following natural disasters and wars has been reported. Material and Methods: This prospective observational study was conducted from January 2021 to June 2022 in the Microbiology laboratory in Katihar Medical College, Katihar. 120 consecutive isolates of NFGNB were identified by VITEK 2 Gram Negative identification card and susceptibility testing was performed using the same instrument. Results: Out of 120 NFGNB 41.7% was Pseudomonas aeruginosa, 25.0% was Acinetobacter baumannii, 15.8% was Burkholderia cepacia, 6.7% was Pseudomonas putida, 3.3% was Pseudomonas oleovorans and Alkaligenes spp, S. maltophillia and Sphingomonas paucimobili were2.5% each. P. aeruginosa showed maximum susceptibility to levofloxacin 66% and maximum resistance to ceftazidime 62%, Acinetobacter baumannii showed maximum susceptibility to minocycline and maximum resistance to piperacillin/tazobactam whereas Burkholderia cepacia showed maximum sensitivity to trimethoprim/ sulfamethaxazole. Conclusion: The present study gives us indication regarding the occurrence of NFGNB in Eastern Bihar. Isolation of non-fermenters and their antibiotic susceptibility pattern should be regarded with seriousness by Microbiology laboratories, in clinical practice and in clinical epidemiology because being resistant to multiple antibiotics, their prevalence not only limits treatment options but they also act as reservoir of drug resistance genes.

83. Predicting Factors of Interstitial Lung Disease in Dermatomyositis and Polymyositis
Ashish Kumar Jaiswal, Vidushi Jain
Abstract
The aim of this study was to define the predicting factors and evaluate the prognosis of interstitial lung disease in dermatomyositis/polymyositis. For the period 2018–2022, we retrospectively reviewed the clinical information and laboratory data of 56 patients who were diagnosed as definite and probable dermatomyositis and polymyositis. Interstitial lung disease is common (41.9%) in these patients. Dyspnoea and cough were the two most common initial presentations. Anti-Jo1 antibody was more common in those with interstitial lung disease. Univariate and multivariate analyses identified primary idiopathic dermatomyositis subtype, cough and dyspnoea at onset to be the three independent clinical predicting factors of interstitial lung disease. High serum lactate dehydrogenase level (>400 U/l) was inversely associated with development of interstitial lung disease (OR 0.088, p=0.031). Serum lactate dehydrogenase level and presence of anti- Jo1 antibody can serve as laboratory indicators of lung complications. Patients with malignancy and older age at onset (more than 60 years) had poorer prognosis for dermatomyositis/polymyositis (p=0.047 and p=0.035, respectively). Interstitial lung disease did not affect the survival of dermatomyositis/polymyositis patients.

84. Cutaneous Tuberculosis – Where Children Are Placed
Ashish Kumar Jaiswal, Vidushi Jain
Abstract
Cutaneous tuberculosis continues to be a significant medical problem even with the advent of highly effective antituberculous drugs. It constitutes about 1.5% of all extrapulmonary tuberculosis. The prevalence in children varies from 18 to 54% in India. There is no gender predilection and the infection occurs with increased frequency in 10-14 year age group. Intrafamilial source of TB has been observed very frequently. A concomitant TB lymphadenitis is most common while involvement of other Systemic organs like lung, bone and abdomen has also been served. Protective efficacy of BCG is debatable and not yet fully defined. Of all the clinical types, scrofuloderma (SFD) is the most commonly encountered variant followed by lupus vulgaris(LV) and tuberculosis verrucosa cutis(TBVC). Lichen scrofulosorum (LS) is generally found to be associated with systemic TB focus in about 72% of cases. The impact of HIV on childhood cutaneous TB seems to be minimal. Similar to adults, the diagnosis of cutaneous tuberculosis relies mainly on histopathology, culture on LJ medium or radiometric BACTEC 460 TB culture system and PCR. In addition Mantoux positivity and a positive therapeutic trial with anti-tubercular drugs may be a good pointer to tubercular infection. A thorough clinical evaluation and exhaustive investigations to pinpoint associated systemic focus is advocated as the latter has an impact on the duration of treatment. Cutaneous TB in children is treated as per the recommendations of therapy for extrapulmonary TB.

85. Clinical and Radiological Findings of Patients with Screw-Fixed Dorso-Lumbar Spine Fractures in a Tertiary Center
Rajnish Kumar, Mahesh Prasad
Abstract
Background: Screw fixation is a surgical procedure which is commonly used to treat fractures in the dorso-lumbar spine region. A thorough comprehension of the distinct radiological and clinical symptoms of these patients may facilitate their identification and management. Materials and Methods: This retrospective analysis included fifty patients who were treated at a tertiary center for screw-fixed dorso-lumbar spine fractures from April 2022 to March 2023. Since the patients were included in the study, the radiological and clinical information of the patients were compared and contrasted. Results: From 2% to 8% of individuals did not experience any postoperative complications. The most frequent problem was wound infection, which occurred 4% of the time. After surgical intervention, clinical symptoms and radiological data improved for the vast majority of patients (86%). Conclusion: In conclusion, patients with dorso-lumbar spine fractures benefit greatly from the surgical procedure which is screw fixation.

86. Antibiotic Susceptibility Patterns of Bacterial Isolates from Pus Samples in a Tertiary Care Centre of Patna, India
Kumari Simpi Rani, Nidhi Nandan, Sarita Kumari, Nushrat Jahan
Abstract
Background: The development of antibiotic resistance is a problem that affects people all across the world, including India. This study’s objective was to determine the antibiotic resistance profiles of bacterial isolates obtained from pus samples gathered at a tertiary care centre in Patna, India. Methodology: Between April 2022 and March 2023, pus samples were taken from 250 patients for this cross-sectional investigation. The Kirby-Bauer disc diffusion method was used to determine antibiotic susceptibility after bacterial isolates were identified using normal microbiological procedures. Results: The most commonly found bacteria were Staphylococcus aureus, Klebsiella pneumoniae, and E. coli. Most bacterial isolates tested positive for resistance to at least one antibiotic, with ampicillin, ciprofloxacin, and cotrimoxazole showing the highest rates of resistance. Antibiotic susceptibility profiles varied greatly amongst bacterial species. Conclusion: Bacterial isolates from pus samples were shown to have a significant prevalence of antibiotic resistance in this investigation from a tertiary care centre in Patna, India. To enhance patient outcomes and forestall the formation and spread of antibiotic-resistant organisms, these results highlight the importance of robust antimicrobial stewardship programmes and focused treatment guidelines. Antibiotic resistance is a serious problem, and more study is needed to determine its causes and provide viable solutions.

87. Serum Vitamin D Levels in Acne Vulgaris and its Relation to Acne Severity: A Case–Control Study
Sadhika Ganni, Sathvika Gogineni, Rama Mani P, Satya Saka, Ramya Kakumani, Dhriti Chugh
Abstract
Background: Vitamin D plays an important role in acne vulgaris through its anti-inflammatory, comedolytic, anti-proliferative and antioxidant action. There is paucity of studies about vitamin D status in acne. Hence, we studied serum vitamin D levels in acne and also its association with acne severity and compared them with healthy age, sex, skin phototype matched controls. Methods: Patients attending our outpatient department with acne vulgaris were included and graded according to Global acne grading system(GAGS). All cases and controls were investigated for serum vitamin D levels using Chemi luminescent Immuno Assay ( CLIA ). Results: Forty cases and controls were taken after following inclusion and exclusion criteria. Vitamin D deficiency was observed in 42.5% of patients with acne, but only in 27.5% of the healthy controls and difference was significant. Moreover, an inverse correlation was found between serum vitamin D level and the GAGS score of acne. Pearson’s correlation analysis value was -0.362 and the P value = 0.022. Limitations: The study sample was small. Conclusions: Serum vitamin D levels were lower in acne patients than in controls, and the levels were inversely correlated with acne severity.

88. Analysis of Histopathological Findings in Hysterectomy Specimens of Women with Menorrhagia across Various Age Groups
Hemlata Bamoriya, Geeta Devi, Priyanka Prajapati, Santosh Kumar Gond
Abstract
Background: Heavy menstrual bleeding significantly impairs the quality of life of many healthy women. Sixty percent of these patients develop Anemia. Perception of heavy menstrual bleeding is subjective, and management usually depends upon what symptoms. Surgical options include conservative surgery (uterine resection or ablation) and hysterectomy. Menorrhagia is usually associated with benign pathologies and only rarely with malignancy. Aim: Aim of this study to identify the different pathological condition in hysterectomy specimen of patients that present with history of menorrhagia. Material and Method: Descriptive study was done on 73 hysterectomy specimens in pathology department of tertiary care center of histology section. Patents with history of menorrhagia and abnormal uterine bleeding included in study. The specimens were grossed by the pathologists in pathology and processed, stained with H &E and examined microscopically. Result: In this study the age group of patients was 31 to 70 years of age. 47.9% (n=35) presented with complaints of menorrhagia between 41-50 years of age group. 41% (n=30) were from 31-40 years age group. Out of 73 cases, 38% cases (n=28) showed leiomyomas, followed by adenomyosis in 13.6% cases (n=10), 20% cases (n=15) showed dual pathology consisting of both leiomyomas and adenomyosis. Maximum no. of lesion showed was leiomyomas (n=12) in 41-50 years of age group then (n=12) in 31-40 years of age group. Conclusion: In conclusion, the analysis of histological patterns in menorrhagia cases revealed leiomyomas as the most common pathology, followed by adenomyosis. Coexistence of both leiomyomas and adenomyosis was also observed. These findings highlight the significance of a comprehensive histopathological evaluation in the management of menorrhagia, enabling tailored treatment approaches based on individual patient needs. Further research is required to expand our knowledge of the underlying mechanisms and refine diagnostic and therapeutic strategies for this common gynecological concern.

89. Unfolding the Socio-Demographic Determinants and Risk Factors for Polycystic Ovarian Syndrome among Adolescent Girls to Design Social Vaccine in a Tertiary Care Hospital
Sadhika Ganni, Ramamani Poluri, V.V. Jagadeesh Settem, Jayasree Palla, Ravi Babu K, Satya Saka
Abstract
Background: PCOS is a complex endocrine disorder, most common in women of reproductive age. It may first present in adolescence, and there could be more than one predisposing factor that can contribute for development of PCOS. The aim of the study is to assess the factors associated with PCOS, and relevant risk factors of PCOS among adolescent girls. Methods: A hospital based cross-sectional study was conducted between March 2022 to May 2022, among adolescent girls, aged 15 to 19 years, attending out-patient departments (OPDs) of Dermatology, Obstetrics and Gynaecology, and Psychiatry, GSL Medical college & General hospital, Rajamahendravaram. An open and closed ended questionnaire was used for the collection of data. Statistical analysis was done by applying Chi-square test and Odds ratio. Results: The prevalence of PCOS in this study was 10.87 %. Urban residents, undergraduates, youngest born and those belonging to upper socio-economic status, family history of PCOS, childhood overweight or obesity, fast food consumption, less physical exercise and those with waist: hip ratio > 0.85 were significantly associated to PCOS. The odds of exposure to these factors among PCOS group is greater than Non-PCOS group. Conclusions: PCOS is increasingly encountered during adolescence. Socio-demographic factors associated with PCOS and the risk factors identified should be utilized in designing a social vaccine for modification in diet and life style, to prevent long term metabolic and reproductive complications.

90. Role of Interleukins IL-2, IL-8 and IL-10 in Preeclampsia Patients at Tertiary Care Hospital from North West Rajasthan
Swati Kochar, Manisha Kumawat, Dniranjana, Mohammad Rizwan, Sanjay Kochar
Abstract
Introduction: Pre-eclampsia is a multisystemic disorder of pregnancy, with the clinical diagnostic features of hypertension and proteinuria. Aim: To study the role of interleukins IL-2, IL-8 and IL-10 in the etiology of pre-eclampsia. Methods: This prospective hospital-based study was conducted on 60 cases including 30 patients with Pre-eclampsia and 30 healthy patients who were admitted in hospital from 1st Oct 2021 to 31 august 2022 at Department of Obstetrics and Gynaecology, Sardar Patel Medical College & AGH, Bikaner (Rajasthan). Results: Mean age in group A was 26.23 ±3.19 year and in group B mean age was 25.53 ±3.37 year. Both groups were comparable in terms of area, education, socioeconomic status.7 (23.33%) cases in group A and in group B 4(13.33%) cases had family history of hypertension. BMI in group A was 24.44 ±2.09 kg/m2 whereas 22.98 ±1.64 kg/m2 in group B. Mean values of IL-2, IL-8, IL-10 in group A were 322.09 ± 125.36 pg/ml, 806.14 ± 450.86 pg/ml, 271.21±158.50 pg/ml whereas in group B, 312.46 ± 22.79 pg/ml, 285.38±106.43, 174.42±60.79 pg/ml respectively which were significantly different in both the groups. Mean Systolic blood pressure and uric acid were statistically significantly associated with higher level of IL-8and IL-10 (p<0.05). Conclusion: Interleukins can be used as biomarkers for the prediction of pre-eclampsia in the initial stages which can add in better clinical management.

91. Evaluation of Thyroid Function in Premenopausal and Postmenopausal Women: A Hospital Based Comparative Study
Kanchan Kumari, Rajnish Kumar, Yogesh Krishna Sahay
Abstract
Objectives: This present study was to compare the thyroid profile (serum TSH, T4 and T3 level) in premenopausal and postmenopausal women.  Methods: All the data like age, health status and thyroid hormone values of all selected premenopausal and postmenopausal females were collected from clinical laboratory of Department of Biochemistry and Medical record department. All the values were recorded. Female with history of major illness, Diabetes mellitus, Hypertension, endocrinal disorders, altered serum T3, TSH, and T4, operational patient with hysterectomy, women not attaining puberty and pregnancy were excluded from this study. Results: Mean serum TSH (uIU/ml) level of premenopausal and postmenopausal women was 2.54± 1.43 and 2.97±1.74 respectively. And P value was 0.180. Mean serum T3 (ng/ml) of premenopausal and postmenopausal women was 1.32±0.12 and 1.12±0.09 respectively. And p value was <0.0001. similarly, mean Serum T4 (ug/dl) level of premenopausal and postmenopausal women was 9.72±1.87 and 9.23±0.74 respectively. And P-value was 0.088. Conclusions: T3 level significantly decreases in postmenopausal women as compared to premenopausal women. Serum TSH level increases and T4 level decreases in postmenopausal women as compared to premenopausal but it is not statistically significant. Hence, changes occur in thyroid function of the premenopausal and postmenopausal women. This pattern of changes may influence due to physiological and some pathological factors.

92. To Observe and Study the Clinical Features, Radiological Findings of Traumatic Temporal Contusion in Brain Injury
I. D. Chaurasia, Nitin Patta, Sourabh Mishra
Abstract
Background &Method: The aim of the study is to observe and study the clinical features, radiological findings of Traumatic Temporal contusion in brain injury. A detailed history about the patients diagnosed to have temporal contusion following head injury and admitted at Gandhi Medical College, Hamidia Hospital, Bhopal were taken. The variable factors like age, sex, mode of injury, time interval between injury and admission, LOC, Seizures, vomiting, ENT bleed were noted. Then a detailed clinical including Neurological examination was done and the status of the pupillary reaction to light, size, extra ocular movements/Doll’s eye movement and GCS were noted. Speech assessment was not included in this observational study. Result: In our study there was deformity in x ray skull – FRACTURE in- 30.0% and NORMAL in – 70%. In our study there was following other findings in CT- DEPRESSED FRACTURE OF Lt parietal region 4.0%, displaced fracture Rt temporal 3.0%, linear undisplaced fracture 9.5%, undisplaced fracture 7.0%, NAD 76.5%. Conclusion: Temporal lobe contusion occur usually in RTA. Severe contusion with low GCS resultant mortality in such patient. Contusion associated with TBI are the most commonly seen in frontal and temporal lobes as a result of impact with head .but may be seen all over the brain . Patient with head injury presenting with seizure, abnormal pupillary response to light, abnormal occulocephalic reflex, bradycardia must need intensive neurosurgical care.

93. Evaluation of Clinical Profile, Anthropometric Measurements and Biochemical Parameters in Obesity Associated Type 2 Diabetes: A Hospital Based Study
Hussain E, Choudhury RB
Abstract
Background: Obesity associated Diabetes Mellitus (DM), also known as Diabesity, refers to the coexistence of obesity with DM. Aim: The aim of the present study is to evaluate the various clinical profile, anthropometric measurements and biochemical parameters of obesity associated type 2 diabetes mellitus vis-à-vis obese non-diabetes mellitus and healthy controls. Materials and Methods: This is a case control study conducted among the patients of Obese DM and Obese non-DM patients of Barpeta and surrounding areas and attending the Medicine Department of Fakhruddin Ali Ahmed Medical College and Hospital and study was conducted for a period of one year w.e.f 10th September, 2021 to 9th September 2022. Total number of 20 cases of Obese type2 Diabetic of 18 to 40 years age attending the Department of Medicine were screened and that fulfil the inclusion and exclusion criteria were included. 20 number of age-matched, unrelated, healthy controls (n=20) were also included in the study. The investigations done were: Fasting blood glucose, HbA1C, Fasting Insulin, Fasting lipid profile including Total Cholesterol, HDL-cholesterol, LDL-Cholesterol, Triglycerides, complete hemogram, serum creatinine and TSH. The statistical analysis was carried out in SPSS software (IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Results & Discussion: In the current study, the mean age of Obese-Non Diabetes was found to be 29.38±4.47 while the mean age of Obese- Diabetes subjects was found to be 37.60±4.808 which suggested that the prevalence of the disease in middle adulthood period of life. Further, sedentary life style, frequent consumption of food and lack of exercise are the most important risk factors contributing to the development of Obese-diabetes. The HOMA-IR values were higher in obese-diabetes mellitus (4.495±2.324) as compared to obese-non-diabetic patients (2.49±0.621) and healthy controls (1.65±0.513). It was found that in the HOMA-IR values were significant in obese-diabetic subjects compared to healthy controls (p=0.078). An increased serum total cholesterol and triglyceride level and decreased HDL cholesterol level in Obese-diabetic compared to healthy control vis-a-vis Obese non-diabetic although not statistically significant. The serum cholesterol levels in healthy controls, Obese-NDM and Obese-DM was found to be 194.05±53.141, 197.2±35.952 and 201.00±46.004 mg/dl respectively. The serum LDL-C levels in healthy controls, Obese-NDM and Obese-DM was found to be 108.55±22.97, 121.80±26.49 and 103.20±24.40 mg/dl. Further, the serum HDL-C level of healthy controls, Obese-NDM and Obese-DM was found to be 40.55±7.776, 38.45±9.659 and 36.85±7.256 mg/dl respectively. Lastly, the serum TG level of healthy controls, Obese-NDM and Obese-DM was found to be 181.35±83.42, 197.65±76.50 and 210.95±83.84 mg/dl respectively. Conclusion: Various biochemical alterations depicts the picture of underlying metabolic derangements which has been linked with the pathogenesis of obesity associated T2DM. Further studies with larger sample size are required to confirm whether this association is actually prevalent in the population of Barpeta district of Assam.

94. Complications and Mortality Patterns in Burn Patients: A Study of Open and Closed Dressings in General Ward and Burn Unit
Raman Ohary, Anil Kushwanshi, Shaily Sengar
Abstract
Background: Burns caused by various sources such as friction, cold, heat, radiation, chemical, or electric sources. However, the majority of burn injuries are caused by heat from hot liquids, solids, or fire. Burn injuries are significant injuries that can result in substantial morbidity and mortality. Objective: The aim of this study was to investigate the complications and mortality patterns of burn patients with respect to open and closed dressing methods in a general ward or burn unit. Method: The study was conducted on 764 patients who were admitted to the surgical ward and burn unit of the Department of General Surgery. General and systemic examinations were performed to identify any associated problems. Patients were then categorized into four groups based on the percentage and depth of burn, the body surface involved, and the age of the patient for systemic therapy and local dressing. Selection of patients was done for open or closed dressing. Resuscitation of the patient was done, and the burn wound was treated using open or closed dressing based on specific criteria. Dressing was changed every 3rd or 4th day, and the wound was examined, debrided, and managed accordingly. Results: The study found that 32.72% of patients had tachycardia, 30.49% had hypotension, and a significant number of patients (17.14%) had cold extremities. Mortality was higher in females than males, with an overall mortality rate of 34.81%. Mortality was higher in the 15-30 years age group (40.80%). Pain persisted for a longer duration (10 days) in patients treated with the exposure method, while it was shorter (8 days) in the group treated with closed dressing. More cases of epithelization (10%) were found in open dressing compared to closed dressing (8.38%). Majority of patients recovered, but a significant number of cases (19.39%) died. Conclusion: In conclusion, the study found that the open method was superior to the closed dressing method, especially in patients with less extensive burns of extremities. The open method had less pus discharge, less problem of foul odours, early epithelisation, and shorter hospital stay.

95. Expression of E-Cadherin in Colorectal Carcinoma: An Immunohistochemical & Histological Correlation
Swagatika Agrawal, Sunil Agarwal, Debi Prasad Mishra, Kamlesh lenka, G Punyatoya
Abstract
Background: Usually cancer in colon or rectum which arises from benign polyps, show variable clinicopathological features. Aim: To evaluate the E cadherin expression in colorectal carcinoma. Material and Method: A hospital based prospective study was conducted in eastern India. All the cases of colorectal carcinoma undergone colonoscopy and surgery were included. Result and data were analyzing in the department of pathology of Hi-Tech Medical College Bhubaneswar between 2018-2020 for diagnostic accuracy by using data. Results: Out of 59 cases mostly elderly age group and males were more affected. E cadherin expression decrease with increasing grade. Conclusion: E cadherin expression can be used for investigate the tumor invasion, metastasis, better treatment and more comprehensive management of patients.

96. Bacterial Coinfection and Evaluation of Serum Procalcitonin Level as Biomarker for Disease Severity among Admitted COVID Patients
Mohsin Ali Khan, Shadma Yaqoob
Abstract
Background: Bacterial coinfections often present in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is an important diagnostic criterion. One important diagnostic criterion is PCT values that may be the indication of increased risk of coinfection, thus increasing the mortality rate in critical COVID-19 patients. Methods: We performed the culture of the Tip of Oxygen pipe, catheter tip, endotracheal tube tip, sputum and blood collected from the confirmed covid positive patients to know the prevalence of acute bacterial coinfection. PCT value were also taken as specific diagnostic criteria in suspected cases of bacterial co-infection. Result: Microbiological investigations were recorded for 1740 patients and the bacterial Coinfection rate was 5.5%. out of 93 coinfected patient’s samples, 37 samples were of blood, 26 of sputum and 30 samples of catheter tip, endotracheal tube tip, pus. most common pathogens were Klebsiella followed by Pseudomonas, E. coli, Acinetobacter and Staphylococcus aureus. we also observed that increased PCT values for the coinfection higher pct values had high risk of coinfection thus high mortality rate in critical covid19 patients.

97. Clinical and Biochemical Profile of Chronic Kidney Disease Patients on Maintenance Haemodialysis in a Tertiary Care Hospital
Bhavyaa Ranawat, Nupur Dhande, Neha Dash, Digvi Pandit, Akshata Sakhare, Nita Gangurde
Abstract
Background: Chronic kidney disease is associated with markedly increased risk for morbidity and mortality. If kidney dysfunctions for more than three months or long , it is identified by structural or functional disorders of the kidney that reduces glomerular filtration rate to less than 60 mL/min/1.73 m². It presents as either clinical abnormalities or indicators of kidney injury, such as changes in the blood or urine composition or abnormalities in imaging studies.
Nearly every system in the body is impacted by CKD, which leads to a number of structural and functional problems. Since CKD leads to disturbances in vital functioning of every organ system of the body including disorders of fluid electrolyte, acid base balance, hematologic, gastrointestinal and metabolic abnormalities, it was planned to assess the demographic and other biochemical parameters in cases of CKD patients to appreciate various clinical presentations along with biochemical investigation reports of CKD patients in a tertiary care hospital and to study various biochemical parameters which are associated with the course of CKD. Aims and Objectives: To study various demographic patterns and other biochemical clinical parameters in patients with CKD on maintenance hemodialysis. Methodology: It was a prospective observational clinical study. The study was done in the department of medicine in a tertiary care centre. Sample Size: 121 patients. Inclusion Criteria: Both sexes and all age groups on haemodialysis. Exclusion Criteria: Patients not willing to give informed consent.
In the present study, clinical profile, biochemical parameters such as Complete blood count, Serum electrolytes, Renal function test, Liver function test, C reactive protein level, Lipid profile, S proteins, Serum calcium and phosphorus and Serum uric acid was done. Patient evaluation was done on the day of admission, during each dialysis and at time of discharge. Discussion and Conclusion: Higher age patients with male predominance were observed in CKD patients. Weight, height, and BMI are the important demographic parameters in CKD patients. Hypertension was the common comorbidity in the current study of CKD patients. Creatinine level, urea level and urea protein parameters were abnormal in the CKD patients. The present study observed a high prevalence of biochemical abnormalities in CKD patients. In view of the above findings, the present study recommends periodic biochemical examination for diagnosis and early treatment of abnormalities in patients with CKD at regular intervals, which may prevent renal complications in the longer run.

98. Characteristics of Quality of Life, Burden and Expressed Emotions in Primary Care Givers of Patients Having Alcohol Dependence Syndrome and Schizophrenia: A Descriptive Study
Anudeep Joshi, S. K. Tandon, Manish Borasi, Richa Priyamvada, Prerana Agrawal
Abstract
Objective: To access the quality of life, burden, and expressed emotions of primary caregivers of patients diagnosed with alcohol dependence syndrome and schizophrenia. Methods: This study is a cross sectional study on primary caregivers of all patients with Alcohol Dependence Syndrome and Schizophrenia attending the Outpatient Department of Psychiatry in CMCH, Bhopal fulfilling the inclusion and exclusion criteria were included in study. Calculated sample size for this study was 40 in in each group. A semi structured questionnaire was used. For assessing burden, burden assessment scale (BAS) was used, for assessing quality of life of care giver (WHO-QOL BREF) was used and FEICS was applied and expressed emotions were assessed. Results: The mean for BAS scores in schizophrenia cases has found to be 48.46 in case of wife was caregiver, 47.67 in case of husband was caregiver and 42.52 in case of parents were caregiver. WHO QOL Domain 1 scores was found across the caregiver (p =0.396) while in case of ADS in the ADS group the WHO QOL Domain 1 scores was 63.10. Domain 2 scores was found across the caregiver (p=0.396), while for ADS group the WHO QOL Domain2 scores was 58.03. Domain 3 scores was found across the caregiver (p =0.313), for ADS group the WHO QOL Domain 3 scores was 50.58. Domain 4 scores was found across the caregiver (p = 0.912), for ADS WHO QOL Domain 4 scores was 64.2. The mean for BAS scores in ADS cases is 46.68 in the case of the wife being a caregiver and 36.67 in the case of parents being caregivers. The mean for perceived criticism scores in ADS cases is 18.90 in the case of the wife being a caregiver and 16.67 in the case of the parents being a caregiver. The mean for perceived criticism scores in ADS cases is 18.90 in the case of the wife being a caregiver and 16.67 in the case of the parents being a caregiver. Conclusion: There is impairment in the quality of life of both groups of caregivers. Regarding burden among caregivers of schizophrenia patients husband suffered the maximum burden while in the case of ADS wife suffered the maximum burden. Caregivers with a high burden of care are more likely to have depression, anxiety, and poor quality of life. Among domains of quality of life, the social relationship domain has the lowest mean score for the caregiver of ADS patients while it is lowest in physical health for caregiver of schizophrenic patients. Therefore, priority interventions to improve social deficits, physical health, and comprehensive interventions that could address psychiatric symptoms among people with schizophrenia and ADS are essential to improve the quality of life of caregivers, also decreases burden on caregiver.

99. A Comparative Study of Obstetric Outcome in Women with Previous Spontaneous Abortion versus Women with Previous Normal Delivery
Santosh Khajotia, Pooja Bishnoi, Anita Sharma, Dinesh Bishnoi
Abstract
Introduction: A pregnancy that fails to proceed, resulting in the death and ejection of the embryo or foetus, is referred to as a miscarriage (abortion). Each individual’s miscarriage has a unique aetiology, which is frequently unknown. Aim: The purpose of our study is to compare women who have a history of previous spontaneous abortion to women who have a history of prior normal delivery in order to estimate the risk of preterm delivery, low birth weight, IUGR, recurrence of abortion, stillbirth, IUD, and PROM use, among other unfavourable outcomes. Methods: This prospective comparative study was conducted. By using a systemic random selection process, we enrolled 200 patients who were OPD/IPD/ANC patients at the obstetrics and gynaecology department of the S.P. medical college and related network of hospitals in Bikaner starting in November 2021. According to the study population, each subject was split into two groups. Group 1: The trial group consists of 100 patients with a history of one or more spontaneous abortions. Group 2: Control group consists of 100 patients with a history of no more than one full-term normal delivery that resulted in a live birth. All patients underwent thorough examinations, had thorough histories involving prior abortions obtained, and were monitored up until delivery with a focus on this information. Results: In study group, 32.55% neonates had NICU admission whereas in control group, 4.08% had NICU admission (p=0.0001*). In study group, 12% cases had abortion and 2% cases had IUD whereas in Control group, 2% cases had abortion. (p=0.007). In study group, 20% had PROM, 10% had IUGR, 3% placenta previa and preeclampsia each, and 2% had breech delivery whereas in control group, 10% had PROM, 6% had IUGR, 1% preeclampsia and placenta previa each, and 2% had breech delivery. Conclusion: Every pregnancy that has experienced spontaneous abortion in the past should be regarded as a high risk pregnancy, and evaluation along with antenatal checkups should be carried out carefully and routinely.

100. Prevalence of Anaemia and Its Determinants in Rural and Tribal Pregnant Women in India: A Cross Sectional Study
Akanksha Agrawal, Rama Singh Chundawat, Priyanka Sekhsaria, Rajrani Sharma
Abstract
Introduction: Anemia is a worldwide public health problem mainly affecting developing countries. Anemia in pregnancy can have serious consequences on social, health and economic development. The etiology of anemia is multifactorial in pregnancy. Many cases of anemia are easily preventable and treatable if detected on time. The aim of the present study was to estimate the prevalence of anaemia and its determinant factors like socio demographic factors, obstetrical and dietary factors in the pregnant women from rural and tribal area.
Methods: This was a cross sectional analytical study conducted at Pacific Medical College and Hospital, Udaipur, Rajasthan from January 2022 to April 2023. Total 398 pregnant women from rural and tribal area were included in the study. Data collection was done using pre tested interviewer administered structured questionnaire. The primary outcome of the study was to estimate the prevalence of anaemia in rural and tribal pregnant women. Secondary outcome measures were to find the association of potential determinants of anaemia.
Results: The prevalence of anaemia was found to be 72% (n = 398). Mild anaemia (Haemoglobin = 10-11.9 gm%) was found to be 55%. While moderate anaemia (Hb 7-9.9 gm%) and severe anaemia (< 7 gm%) was found in 25% and 20% respectively. The mean haemoglobin of the study group was 7.7(2.6) gm/dL. The results of bivariate analyses showed that anemia was significantly associated with socio demographic parameters like lower socio-economic status and lower education level. This study revealed that multigravida status (OR 2.20, 95% CI (1.4051 to 3.4497) and inappropriate birth interval OR 41.42, 95% CI (22.505 to 76.239) were the independent predictors of anaemia among pregnant women. Conclusion: The study confirmed that anemia in women of reproductive age group is a major health problem. The findings revealed increased prevalence of anemia in rural and tribal pregnant women. There are various sociodemographic, obstetrical, and dietary factors associated with prevalence of anaemia.

101. A Study of Haematological Abnormalities in Patients of Alcohol Liver Disease and its Clinical Significance
Ashok Mosalpuri, Sandeep Kumar, Rajesh Kumar Saini, Amit Kant, Geetika Roat, Subhash Chand Jain, Laxmikant Tank
Abstract
Background: The liver is the body’s largest organ, accounting for 1.5-2.5% of lean body mass and weighing 1-1.5 kg. Liver diseases are fast emerging as global health priorities. Alcohol is a commonly used medicine with hematopoiesis suppression as one of its adverse effects. Alcohol consumption is known for morbidity and mortality, being a serious health hazard of the world. Methods: The study was conducted in the patients admitted in Department of General Medicine, Jhalawar Medical College, Jhalawar, Rajasthan, after taking informed consent eligible patients were enrolled according to the inclusion and exclusion criteria. Result: According to hematological indices (RBC and MCV), 20% of cases have normal RBC, while 80% have low RBC (with 3.41±0.95).MCV revealed that 17% of cases had a low MCV of 95.10±13.42, whereas 40% of cases had a high MCV. The mean HB was 12±32.39(4.1±13.3), with a median of 9.2 gm% and 23% of cases had leukopenia, 13% had leukocytosis, and 64% had a normal total leucocyte count. 47.72% of cases have thrombocytopenia, and 28% of cases have a normal platelet count of 1.14± 0.73 while in 17% of patients, pancytopenia was noted. According to P.B.F. Smear, 54% of cases are macrocytic anemia, 28% are normochromic normocytic, 13% are microcytic hypochromic and 5% are dimorphic anemia.PT and BT results showed that 89% of cases had high PT, 11% had normal PT, 29% had high BT, and 5% had low BT. Conclusion: Cirrhosis of the liver is caused by long-term, excessive alcohol intake and affects a number of physiological, biochemical, and metabolic processes, including the maturation and generation of blood cells. These negative effects can have substantial medical consequences, such as anaemia, a higher chance of developing life-threatening bacterial infections, leucopenia, leukocytosis, thrombocytopenia, pancytopenia, prolonged PT and BT.

102. Topical Silver Dressing versus Conventional Saline Dressing in the Management of Non-Healing Ulcers: A Prospective Randomized Interventional Study
Kanneedi Naresh Kumar, G. Sashikalyan
Abstract
Introduction: Understanding and addressing obstacles in the management of non-healing ulcers steer to favorable outcome, which can reduce economic burden and improve quality of life of the patient. Topical silver dressings are effective in the management of non-healing ulcers. However, their safety and efficacy is always debatable. This study was designed to assess the efficacy topical silver preparations versus conventional saline dressing in the management of non-healing ulcers. Material and Methods: This prospective randomized interventional study consist of a source of 124 cases with non-healing ulcers of different etiological background approached Department of General Surgery at MNR Medical College and Hospital was recruited. Participants were randomly allotted to group 1 (topical silver dressing) and group 2 (conventional saline dressing). The recovery of wound size and rate of granulation tissue were recorded at the end of first, second and third week of treatment. Results: At the end of 3rd week, cases managed with topical silver dressing (82.81%) had effective recovery of granulation tissue than conventional saline dressing (32.37%). There was a decreased incidence of microbial flora from first week to third week of treatment in silver dressing. The overall ulcer size was significantly reduced in group 1 than group 2. The mean difference between both study groups was statistically significant (p<0.05). Conclusion: Topical silver dressing has superior efficacy in terms of wound discharge reduction, early recovery of granulation tissue, diminishing the microbial isolates and reduction of ulcer size than conventional saline dressing.

103. A Clinical Study of Very Low Birth Weight Babies
Ramesh Babu S, Prakruthi N, Mahendra G, Ravindra S Pukale
Abstract
Background: Low birth weight is a valuable public health indicator of maternal health ,nutrition, health care delivery &poverty. WHO defines Very Low Birth Weight (VLBW) as birth weight <1500 gms. VLBW babies have serious long term complications like neurological disability, impaired language development, impaired academic achievement . The study of maternal factors influencing VLBW, use of antenatal corticosteroids &their influence on fetal outcome in terms of NICU admission, duration of stay in NICU &further neurodevelopment of babies is essential to reduce the morbidity & mortality among VLBW babies. Materials And Methods: This was a prospective study conducted on all live newborn infants with birth weight in range of 500 – 1500 gms who required immediate NICU admission after birth from October 2021 to September 2022 at Adichunchanagiri Institute Of Medical Sciences. Results: Out of total cases, most pregnant women age ranged between 22 to 27 years,63% were primiparous, 37% were multiparous, 73% were singleton pregnancies while 27% were twin pregnancies, 20% had preeclampsia, 6%had abruption, risk of gestational diabetes and hypothyroidism was 1% each, 64% mothers had received antenatal corticosteroids, 46% delivered vaginally and 54% by cesarean delivery. All babies were admitted to NICU immediately after birth, 83% babies survived to discharge, 6% died, 11% got discharged against advice. Among NICU admission 12% babies stayed for <10 days,48% for 10-20 days & remaining 40% needed prolonged stay for >30 days. Conclusion: Proper antenatal care reduces risk of VLBW babies along with improving the survival chances and also reduces morbidity & mortality among VLBW babies.

104. Risk Factors for Unconjugated Hyperbilirubinemia and Readmission for Jaundice in Neonates: A Case-Control Study
Aparna Kadambari, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Abstract
Background: About 60% of term and 85% of preterm neonates experience hospital readmission due to hyperbilirubinemia, which is a common condition in newborns. Although it is frequently a benign condition, it can have neurological consequences like bilirubin induced encephalopathy and the kernicterus spectrum of disorders. We sought to assess the neonatal and maternal risk factors for hyperbilirubinemia as well as to pinpoint those that may be changed. Methods: From September 2021 to February 2022, an observational case-control study was conducted in the paediatrics department of the SKMCH in Muzaffarpur, Bihar. Neonates without hyperbilirubinemia were used as controls, while neonates with hyperbilirubinemia levels within the phototherapy range as defined by age and gestation by the American Academy of Paediatrics were used as cases. All neonates included in the study underwent thorough prenatal, perinatal, family history, and physical examinations. Risk factors such as the presence of maternal illness, intrauterine growth retardation (IUGR), premature rupture of the membranes (PROM), prematurity, ABO and Rh incompatibility, prior phototherapy use in siblings, breastfeeding issues, and birth asphyxia were also assessed. Results: Neonatal hyperbilirubinemia has been associated significantly with IUGR (P value 0.01), prematurity (P value 0.002), ABO incompatibility (P value 0.009), breastfeeding difficulties (P value 0.001), birth asphyxia (P value 0.05), and the presence of PROM (P value 0.05) in multivariate logistic regression studies of collected data.  Conclusion: Rapid care and early detection of neonatal hyperbilirubinemia minimise the morbidity and death linked to this widespread illness.

105. Risk Factors and Clinical Profile of Severe Acute Malnutrition in Infants below 6 Months of Age: A Prospective Observational Study
Aparna Kadambari, Vivek Prakash, Jiteshwar Prasad Mandal
Abstract
Background: A public health issue of epidemic proportions is acute malnutrition. Prioritising effective exclusive breastfeeding by the mother or another carer should be a priority for feeding infants under 6 months old who have severe acute malnutrition. The purpose of this study is to investigate the numerous risk factors and determinants of severe acute malnutrition in infants below 6 months of age as defined by WHO growth reference standards. Methods: At SKMCH, Muzaffarpur, Bihar, a prospective observational study was conducted. 44 infants under the age of six months in total visited the pediatrics department inpatient and outpatient OPD the six-month period from March 2022 to August 2022. A study was conducted to determine clinical characteristics and risk variables. Results: In our study of 44 children, we found that 17 (38.63%) of the infants were between the ages of 2-3 months, followed by 15 (34.09%) who were under 2 months, and the remaining 12 (27.28%) were between the ages of more than 3 and less than 6 months. 28(63.40%) were females. 40 (90.90%) were born to young, uneducated housewives (21-23 years old) who gave birth to them. Conclusion: Young maternal age, low maternal education levels, and low family socioeconomic position all contributed to risk. But other elements, such as the size of the family, the baby’s birth order, the length of breastfeeding, the consumption of top milk, such as cow or buffalo milk, mixed feeding, the mode of feeding, and the impact of NRC registration, also have a significant impact on severe malnutrition in young children under the age of six months. Furthermore, one of the perceived risk factors for severe malnutrition in infants younger than six months old is the absence of exclusive breastfeeding. Maternal education and knowledge of newborn feeding procedures must be a top priority for concerned health programmes.

106. A Cross-Sectional Observational Study on Adolescents Disordered Eating Behaviour
Deepak Kumar, Tejendra Kumar Jha, Kafeel Akhtar Ansari
Abstract
Background: Adolescence is a moment when people are more influenced by fitness ideals and therefore more susceptible to eating problems. Eating disorders are characterised by serious abnormalities in eating behaviour. For both men and women, eating disorders are serious mental and physical issues that can have fatal outcomes. The current cross-sectional study looked at adolescent eating disorder behaviour and gender differences in eating disorder. Methods: From July 2022 to January 2023, 150 adolescents (75 males and 75 females) enrolled in 11th and 12th grade and between the ages of 15 and 18 were randomly chosen from a variety of intermediate colleges in the Sitamarhi district of Bihar. A general demographic survey and the short version of the Eating Attitudes Test (EAT-26) were both given to respondents to gauge their attitudes towards and preoccupations with food, dieting, eating, physical appearance, and personal control over food. Results: Respondents were divided into low risk (0–19) and high risk (20 or more) groups based on the scoring. The results showed that 14.67% of male and 23.67% of female had eating disorders and had EAT-26 scores that were greater than the recommended cutoff point. Female also had higher EAT-26 scores than male. Conclusion: Adolescents problems with eating disorders are on the rise, and the findings show that many of them have disrupted eating habits.

107. Acute Watery Diarrhoea in Children Aged 2 Months to 5 Years: The Role of Saccharomyces Boularii
Tejendra Kumar Jha, Deepak Kumar, Rajnish Chandra Mishra
Abstract
Background: Globally, acute diarrhoea is the second most common cause of mortality in children under the age of five, killing more than 1.5 million of them each year. The objective of the current study was to evaluate the contribution of Saccharomyces boularii to acute watery diarrhoea in children between the ages of 2 months and 5 years. Methods: 140 children between the ages of 2 months and 5 years who had acute watery diarrhoea were split into two groups. Oral rehydration solution (ORS), zinc, and the active ingredient (S. boulardii) were given to group I twice daily for five days, while group II only received ORS and zinc. The length of the diarrhoea, as well as the nature and frequency of the faeces, were noted.  Results: 40 males and 30 females made up Group I, while 36 males and 34 females made up Group II. Stool frequency >3 was seen in group I in 70 individuals on day 1, 60 individuals on day 2, 50 individuals on day 3, and 20 individuals on day 4, as well as in 70, 64, 56, 48, and 12 individuals in group II, respectively. The distinction was appreciable (P <0.05). In group I and II, respectively, 70 people had liquid-like stools on day 1, 64 on day 2, 8 on day 4, and 70 on day 1, 66 on day 2, 40 on day 3, 24 on day 4, 16 on day 5, and 2 on day 6. The distinction was appreciable (P <0.05). Conclusion: The bacteria Saccharomyces boulardii reduces the length of diarrhoea and restores normal bowel movements.

108. Rectal Misoprostol versus Intramuscular Oxytocin: A Comparative Study to Prevent Postpartum Haemorrhage
Kumari Snehalata, Nirmala Kumari, Abha Rani Sinha
Abstract
Background: Worldwide, postpartum haemorrhage (PPH) is the most frequent reason for maternal mortality. The majority of PPH-related morbidity and death instances occur in the first 24 hours after delivery and are classified as primary PPH, whereas any abnormal or excessive birth canal bleeding that takes place between 24 hours and 12 weeks after birth is classified as secondary PPH. The study’s objectives are to evaluate the safety of both medicines and compare the effectiveness of 800 mcg of rectal misoprostol and 10U of intramuscular oxytocin in preventing postpartum haemorrhage. Methods: A prospective, double-blind study was conducted from January 2022 to June 2022 at Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar. For the study, 120 cases were collected, and each group of 60 cases received either Group B (800 mg of misoprostol rectally administered immediately after delivery of the infant) or Group A (10 IU of oxytocin given intramuscularly soon after delivery). The chosen cases’ personal information and medical information were gathered using a standardised proforma. Results: Mean blood loss for Groups A and B was 219.5 ml and 230.93 ml, respectively, with a statistically insignificant difference (p=0.138). Although the mean blood loss in the Oxytocin injection group was less than that in the Misoprostol tablet group, the difference was not statistically significant. In Group A, the incidence of PPH was 6.66%, whereas in Group B, it was 10.0%. Statistics did not support the difference. When compared to the oxytocin group, the incidence of shivering and pyrexia was higher in the misoprostol group (13.33 versus 6.67% and 8.3 versus 3.33%, respectively). The statistical analysis was carried out with SPSS 19.0. Conclusion: When administered during the active management of the third stage of labour for the prevention of postpartum haemorrhage, it has been found that misoprostol 800g rectally is just as effective as injectable oxytocin 10 IU.

109. A Prospective Analysis of the Acceptability, Safety, and Effectiveness of Intrauterine Device Insertion during the Postpartum Period
Nirmala Kumari, Kumari Snehalata, Abha Rani Sinha
Abstract
Background: Utilising the best possible hospital resources, the post-partum intrauterine contraceptive device offers a secure and perfect method of contraception. Promoting post-partum contraception proactively provides numerous health benefits and prevents difficulties from unintended births. The purpose of this study is to assess and contrast the acceptability, safety, and effectiveness of Post-partum IUCD implantation during vaginal and intra-caesarean delivery. Methods: In this prospective study, which carried out from January 2022 to December 2022 at the Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar. Total 145 mothers had PPIUCD implanted during the course of the 12-month study period. In 145 mothers we selected 100 mothers for PPIUCD implanted, first 50 vaginal birthing women and another 50 caesarean mothers were selected for the study. Results: Both PPIUCD insertion techniques were proven to be extremely successful methods of birth control with very low rates of expulsion, vaginal bleeding, abdominal pain, infection, and missing thread. Conclusion: After a vaginal or caesarean delivery, PPIUCD is a reliable and effective technique of family planning.

110. Clinical Study on Evaluation of Protein Tolerance Test as Marker for Early Renal Dysfunction in Type 2 Diabetes Mellitus
Sanjay Nath Jha, Rajesh Kumar Jha, Vinayanand Jha
Abstract
Background: A protein tolerance test can be highly helpful in selecting individuals who are most likely to benefit from an aggressive intervention by detecting incipient renal failure in those with normal GFR and serum creatinine values. This is crucial when assessing high-risk individuals including diabetics, people who have just undergone a kidney transplant, and people with polycystic kidney disease. PTT can be used to accurately predict the prognosis of a progressing renal disease and to evaluate the borderline renal donor. To demonstrate the value of the tubular stress test, standardisation and additional research are still needed. The purpose of this study was to examine the evolution of renal dysfunction with age and the duration of Type 2 Diabetes mellitus, as well as to assess the protein tolerance test as a marker for early renal impairment in Type 2 Diabetes mellitus. Method: From March 2022 to February 2023, participants in this clinical trial were outpatients at the DMCH in Laheriasarai, Bihar. 208 instances altogether were split into two groups. In this study period, 108 cases in the study group and the remaining 100 cases in the control group were included. The study included people with Type 2 diabetes mellitus. For comparative purposes, 100 healthy, age- and sex-matched controls free of diabetes or its consequences were also included in the study. Results: The prevalence of renal failure was found to be higher in individuals older than 60 years, at 179 (86.05%), compared to 33 (15.86%) in the group of patients who were 51–60 years old and 17 (8.17%) in the 41–50-year group. In contrast, in patients with renal dysfunction, 35 (16.8%) were found to have renal risk, and 43 (20.7%) had renal failure. It was discovered that normal working kidney would be able to lower urine protein after protein tolerance. In contrast to cases of renal failure, where eGFR decreased following protein tolerance, it was shown that kidneys with normal function responded to protein tolerance by increasing eGFR. In contrast to cases of renal failure, blood creatinine levels increased after protein tolerance good working kidney increased GFR. Renal failure risk is increased by Type II diabetes mellitus for an extended period of time. Conclusion: Compared to patients with normal renal function or mild renal dysfunction, patients with renal failure exhibited more persistently elevated blood creatinine and sustained decreases in GFR.

111. Chronic Abdominal Pain: Etiology and Clinical Features in a Laparoscopic Surgery Study
Surabhi Tomar, Raman Ohary, Shaily Sengar
Abstract
Background: Chronic abdominal pain is a persistent or intermittent discomfort in the abdominal region lasting for more than three months. It may be caused by various pathologies in different systems, including gastrointestinal, genitourinary, or gynecological, and can have either organic or functional origins. Despite the availability of advanced medical and surgical techniques, the role of diagnostic laparoscopy in evaluating chronic abdominal pain remains controversial. Method: A study was conducted to evaluate the sociodemographic profile, clinical features, and etiology of chronic abdominal pain in patients undergoing diagnostic laparoscopy. A pretested questionnaire was used to collect data on the patients’ age, gender, occupation, residence, socioeconomic status, and other relevant information. A detailed history and physical examination were performed, along with systemic examination to identify signs indicating an underlying etiology of abdominal pain. All patients underwent preoperative evaluations, including ultrasonography, erect abdominal X-ray, CT scan, MRI, and routine blood investigation, to identify the cause of their abdominal pain. Diagnostic laparoscopy was performed when the diagnosis was uncertain. Results: The study found that the mean age of patients with chronic abdominal pain was 38.99 ± 18.61 years, with the highest number of cases occurring in the 21 to 30 years age group, followed by those in the less than 20 and 31 to 40 years age groups. A small percentage of cases were found in patients aged over 70 years. Females accounted for 52.8% of cases, indicating a slight female predominance. The most commonly observed features in patients with chronic abdominal pain were free fluid, abdominal pain, weight loss, and anorexia. Vomiting and a doughy abdomen were less frequently observed. The study found that tuberculosis was the most common cause of chronic abdominal pain, accounting for 62.5% of cases, while malignancy was found in 30.6% of cases. A diagnosis could not be made in 6.9% of cases. The mean age of patients with tuberculosis was 29.93 ± 12.82 years, while those with malignancy had a mean age of 56.73 ± 14.02 years. The majority of cases of chronic abdominal pain associated with tuberculosis occurred in younger age groups, whereas a higher proportion of cases with malignancy were in elderly age groups. Conclusion: The study emphasizes the importance of diagnostic laparoscopy in managing chronic abdominal pain and reducing the financial burden on patients. It highlights the association of abdominal distension with malignancy and a doughy abdomen with tuberculosis. With advancements in surgical techniques and instrumentation, diagnostic laparoscopy has become an integral part of surgical procedures and can improve patient outcomes by avoiding expensive, time-consuming, and potentially complicated surgical procedures. Overall, this study provides valuable insights into the etiology and management of chronic abdominal pain.

112. KAP Study Regarding COVID-19 Amongst Pregnant Women, in Central India
Smita Batni, Pooja Patil, Shesha Sinha, Kalpana Mishra
Abstract
Objectives: To assess the knowledge, attitude and practices of preventive measures against COVID-19 infection among pregnant women. It is our understanding that assessing healthcare needs and healthcare education form the pillars for better healthcare thereby this study was conducted. Methodology: An observational cross-sectional study was conducted in which 150 antenatal women were included. Face–to–face interview was conducted by using a self-developed internally validated semi-structured questionnaire based on 3 major domains, Knowledge (10), Attitude (10) and Practice (4), with close ended questions. Each response -correct was allotted score 1 & incorrect allotted score of 0. The responses were described as frequencies and percentages. Scoring system- Poor score<60%, Fair score 60-75%, Good score > 75% of total score in each domain. Results: 103(68.7%) had good knowledge and 121(80.7%) had poor attitude, regarding COVID affecting their pregnancy, antenatal visits and unborn baby. 113(75.3%) were practicing preventive habits. Conclusion: Our study showed the anxiety and fear related to Covid-19 affected mental health of women and their adherence to antenatal care which needs to be addressed in providing antenatal care services.

113. Radiological Study of Secondary Ossification Centers around the Elbow Joint in North Bihar
Chhaya Rani, Nilesh Kumar, Sanjay Kumar Sinha
Abstract
Background: The bones of human skeletons develop from separate Ossification centers. From these centers ossification progresses till the bone is completely formed. These Changes can be studied by means of x-rays. It is therefore possible to determine the approximate age of an individual by radiological examination of bones till ossification is complete. Materials & Methods: This radiological study was carried out with the objective to assess the skeletal maturity round elbow joint, of subjects in North Bihar region, 168 Males and 132 Females between age group of 10-19 years and size of dwelling in North Bihar more than 10 years. Subjects representing the heterogenous population of Bihar were included from first year MBBS students of Katihar Medical College, Katihar of different districts of this state, schools as well as patients attending outpatients Department of Radiology, Katihar. Medical College, Katihar Anteroposterior and lateral view of Right elbow joint was taken, appearance and fusion of ossification centers around this joint studied. Data was tabulated and statistically analysed by using STATA 12.0 TX, USA. Results: From the analysis, it is found that in males at the age of 16 years, ossification centers around the elbow joint is fused except medial epicondyle and in females, it is completely fused. Conclusion: From this radiological study, when findings are compared with the other authors from different states of India and in addition with other nations and observed to Fluctuate substantially.

114. Study of Functional Outcome of Radial Head Fractures Treated with Primary Replacement
Maddineni Vamsi Krishna, K Rajavel, Sabari Vaasan L, S Deviprasad
Abstract
Introduction: Radial head fractures are common in adults and the elderly, with 85% occurring between 30-60. Falling forcefully on an outstretched hand during trauma is the usual mode of injury but osteopenia and osteoporosis can make even a little fall dangerous. Aim: This study aims to assess the functional outcome of fractures of the radial head treated with a primary replacement. Methods: This prospective, single-arm, observational study was conducted at the Department of Orthopaedics, SRM Medical College Hospital and Research Centre, between November 2020 to August 2022. In this study, 21 patients with radial head fractures fulfilling the inclusion criteria were treated using Kocher’s approach with a radial head prosthesis and evaluated functionally. In addition, functional outcome was assessed with Mayo and Oxford elbow scores. Results: Of the 21 patients included in the study, 13 were male (61.9%), and eight were female (38.1%). 61.9% had Mason Type 3 fractures, 38.1% had Mason Type 4 fractures, and 47.6% had mild chronic pain as a complication of radial head replacement. We had excellent results in 14 (66. 7%) patients, and 7 (33.33%) had good results. It was observed that postoperative pain was the major complication. There was a significant improvement in the functional outcome scores within six months of the postoperative period. Conclusion: Radial head replacement with radial head prosthesis has given excellent results and can be the implant of choice for complex radial head fractures.

115. Study of Obstetric and Foetal Outcome in Women with Short Interpregnancy Interval after Previous Caesarean Delivery
Surabhi Kuhikar, Shrishty Shrivastava, Kavita Chandel, Sona Soni
Abstract
Objective: To study the effect study of obstetric and foetal outcome in women with short interpregnancy interval after previous caesarean delivery. Methods: All patients admitted for MTP, abortion, and delivery after short inter pregnancy interval with previous caesarean delivery will be included with consideration of inclusion and exclusion criteria. Anemia, scar dehiscence, uterine rupture, PPH, PROM, and premature delivery were all associated to mothers’ short IPI. Low birth weight, preterm, IUFD, stillbirth and neonatal death were foetal problems associated to short IPI. Results: This study emphasizes the gloomy attitude of family spacing among couples. It was directly correlated with several demographic characteristics, including low levels of literacy, rural residents, and lower socioeconomic class. The most frequent causes of short IPI included poor antecedent birth outcomes, child sex preference, unintended pregnancies, non-use of family planning methods, contraceptive failure, lack of understanding regarding recommended birth intervals, and female gender of antecedent birth. Anemia, scar dehiscence, uterine rupture, PPH, PROM, and premature delivery were all associated to mothers’ short IPI. Low birth weight, preterm, IUFD, stillbirth and neonatal death were foetal problems associated to short IPI. Conclusion: Social initiatives like raising the educational level of the population and expanding access to contraception will support appropriate IPI and enhance mother outcomes. It will be possible to attain the best maternal health by further enhancing the education campaigns on contraception and encouraging couples to adopt sufficient spacing with the support of primary care physicians. The study’s findings will help policymakers further educate healthcare professionals at all levels about the need of promoting the ideal inter-pregnancy interval, as stressed by the WHO.

116. Ageing and Quality of Life among Elderly Population in Field Practice Area of Department of Community Medicine
Vinay Godara, Chetan Kumar Sharma, Rajaat Vohra
Abstract
Background: The global population is ageing, with implications for public health, including community medicine. The field practice area of the Department of Community Medicine provides a unique setting to study ageing and quality of life among elderly individuals. Understanding this relationship is crucial for developing effective interventions to promote healthy ageing and improve the well-being of elderly populations in the field practice area. Methods: The study was conducted as a cross-sectional study among elderly individuals (aged 60 years and above) residing in the field practice area of the Department of Community Medicine. A structured questionnaire was used to collect data on socio-demographic characteristics, health status, functional ability, social support, and quality of life among the elderly participants. Data was analyzed using appropriate statistical methods, including descriptive statistics and inferential statistics. Results: The findings revealed that a significant proportion of the elderly population in the field practice area of the Department of Community Medicine reported poor quality of life. Factors such as advanced age, female gender, low socio-economic status, presence of chronic health conditions, functional limitations, and lack of social support were found to be associated with lower quality of life among the elderly population. Conclusion: Ageing is a complex phenomenon that has significant implications for the quality of life of elderly individuals in the community. The Department of Community Medicine has a crucial role to play in addressing the challenges associated with ageing populations and promoting healthy ageing practices. Further research and interventions are needed to better understand and address the diverse needs of the elderly population in the field practice area of the Department of Community Medicine and to improve their quality of life.

117. A Study to Assess the Prevalence and Clinical Profile of Psychosis in Chronic Alcoholism among Alcohol-Dependence Patients
H. Ahamadu Nisha, M. Mangayarkarasi, A. Ramesh Babu, S. Renganathan
Abstract
Introduction: Alcohol use disorders (AUDs) are having special relevance to psychiatry. Alcohol is a potent drug which causes both acute and chronic changes in almost all neurochemical systems and with the result of heavy drinking can produce serious psychological symptoms which are temporary including anxiety, depression and psychosis. Our study has been framed to explore the clinical profile associated with alcoholism and to find out the association between the severity of alcohol dependence and psychiatric co morbidity among alcohol dependence patients. Methodology: The study was conducted at Government Medical College, Ariyalur, a tertiary care center for a period of 6 months. This study got approval from institutional ethical committee. Consecutive patients above 18 years of age and consuming alcohol for more than 2 consecutive years, attending de-addiction clinic were evaluated. AUDIT- Alcohol Use Disorder Identification Test, SADQ- Severity of Alcohol Dependence Questionnaire, PSLES- Presumptive Stressful Life events Scale. All 66 patients were assessed similarly and statistical analysis of the data was made. Results: In our study shows that total number of people who got psychosis is 8.The people who got other psychiatric co-morbidity are 15. Out of which 8 (12.1%) were suffering from psychosis, 7 of them (10.6%) have Adjustment disorder with attempted suicide, 5 of them (7.6 %) are suffering from major depressive illness, and 3 of them (4.5%) are reported as Anxiety disorder cases. In our study severity of alcohol dependence increase the risk and prevalence of psychosis. But there is no statistically significance between stressfull life events experienced and types of psychiatric comorbidity. Conclusion: Based on the findings in our study, it is understood that Alcohol Dependence patients have a variable clinical presentation and high risk of co morbid Psychiatric illness. Early recognition and treatment of Alcohol Dependence and co morbid Psychiatric illness may lead to a better outcome.

118. Comparative & Prospective Analysis of Unstable Trochanteric Fractures Fixed with PFN vs PFN AII: A Prospective Observational Study
Avinash Manoharan, Muthu Vignesh, Maheswaran Jawaharlal Nehru
Abstract
Introduction: Intertrochanteric fractures (IT) also referred to as peri trochanteric fractures, possess a huge burden on elderly individuals, due to their increased prevalence. Several modalities of operative procedures are in place, with varying results. Aims and Objectives: To assess the functional outcome such as intraoperative time, intraoperative blood loss, fracture Union duration, hip range of motion, Harris hip score and complications of unstable trochanteric fractures managed by Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN). Methods: Design: Prospective observational type. Study duration: Two years. Study tool: using a semi-structured pre-tested that included Hip Harris Score. Data analysis: Data was analysed using SPSS version 20. The comparison of Hip Harris Score was compared between the PFN and PFN A-II across the follow-up months, while the comparison of other parameters was done between PFN and PFN A-II groups. A p-value of less than <0.05 was considered statistically significant. Results: We included around 20 patients who had Boyd and Griffin types II-1V closed fractures. We observed that there was a significant difference in time taken for operation, amount of operative blood loss and time taken for union between the groups with PFN A-II having better results. (p value<0.05) We did not observe any difference with respect to HHS distribution, while thigh pain was more commonly seen in the PFN group (p-value 0.02). Conclusion: Thus, PFN A-II can be considered as a vital option for IT fractures among elderly individuals who need surgical correction when compared to PFN.

119. Clinico-Etiological Profile and Outcome of Children with Status Epilepticus Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital
Prabudh Paritosh Mishra, Arvind Kumar, Bheemarao Kamble
Abstract
Background: Status epilepticus (SE) is a life-threatening medical emergency that accounts for a disproportionate share of pediatric mortality and morbidity. Effective therapy of SE requires knowledge of the disease’s clinical- etiologic characteristics and consequences in children.
Methodology: These results came from a retrospective study of 124 SE patients hospitalized in the Children’s Intensive Care Unit, Major University Hospital. The cause and progression of SE were investigated by evaluating clinical and analytical data.
Results: The majority of patients (69%), with acute symptomatic SE due to CNS illnesses. The median number of days someone lived was 29 and the overall mortality rate was 16%. Compared to the survivors, the non- survivors had considerably lower Glasgow Coma Scale scores, longer SE durations, higher blood glucose levels, lower pH, and lower bicarbonate levels upon admission. Those who did not make it required mechanical ventilation at a higher rate than those who did. The prognosis for patients with acute symptomatic SE was markedly worse than that of those with cryptogenic or distant symptomatic SE.
Conclusions: This research emphasizes the need for early diagnosis and treatment of SE in youngsters. Early commencement of proper antibiotic therapy is critical for a better outcome in the treatment of acute symptomatic SE in children, with CNS infections being the most common cause. There is an increased risk of death when patients are younger, have SE for a longer period, have a lower Glasgow Coma Scale score, have higher blood glucose levels, lower pH levels, lower bicarbonate levels, or require mechanical ventilation.

120. Clinical Study of Growth, Nutrition and Thyroid Dysfunction in Children with Beta Thalassemia
Sonu Kumar, Prashant Gaurav
Abstract
Background: Thalassemia is a hereditary anaemia resulting from defect in haemoglobin production and the most common genetic disorders worldwide. The aim of this case control study was to know the growth patterns and thyroid dysfunction in beta thalassemia major patients. Materials and Methods: This study was conducted in the Department of Paediatrics, BMIMS Pawapuri, over a period of two years. The study included 50 homozygous thalassemia major patients, receiving regular blood transfusion and 50 normal children were taken as controls. Conclusion: Thalassemia major patients with iron overload had decreased weight for age, height for age and increased TSH suggestive of subclinical hypothyroidism. Awareness of these findings is helpful to avoid unnecessary evaluation in patients with beta thalassemia. Better evaluation of iron toxicity can protect patients from complications associated with treatment.

121. Hyponatremia as a Predictor for Bronchiolitis Severity in Children Admitted to Intensive Care Unit: A Prospective Cohort Study
Prashant Gaurav, Sonu Kumar
Abstract
Background and Objective: Bronchiolitis is self-limiting in most children, and hyponatremia is one of the well-known complications of bronchiolitis and its presence at the time of admission is known to have an impact on the adverse outcome. To the best of our knowledge there has been no study has been done in the past in the Indian setting on the relationship between hyponatremia and the severity of bronchiolitis in children. Methods: The study was a prospective cohort study that was conducted for a time period of Two years on sixty children with diagnosis of bronchiolitis in admitted in PICU was based on NICE clinical criteria These two groups were compared for the outcome variables. Outcomes were use of mechanical ventilation and ICU length of stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment. Conclusion: Our findings confirm in bronchiolitis children there is no significant association between the development of hyponatremia and severity of bronchiolitis. Further studies needed to validate about hyponatremia as a prognostic factor.

122. A Hospital Record Based Study Outcome of IV Iron Sucrose in the Treatment of Iron Deficiency in Pregnancy
Parth Suresh Kadam, Sanjivani Ashok Deshpande
Abstract
Introduction: Intravenous iron sucrose is a promising therapy for increasing haemoglobin concentration; however, its effect on clinical outcomes in pregnancy is not yet established. The present study was aimed to assess the outcome of intravenous iron sucrose in the treatment of iron deficiency in pregnancy. Methodology: This prospective observational study was conducted at a tertiary level care hospital. The research included 125 patients who were diagnosed as anaemia (less than 11 gm/dl) and received intravenous iron sucrose while receiving prenatal care at our institution between November 2020 and October 2022. 200 mg of iron sucrose injection was administered intravenously twice a week in 200 ml of normal saline over the course of 15 to 20 minutes. Results: It was observed that mean hemoglobin increased from 8.77 ± 1.32 to 11.74 ± 1.44 gm/dl (p value < 0.01), mean hemtocrit increased from 26.5 ± 4.4 to 44.7 ± 12.7% (p value < 0.01), mean MCV increased from 75.3 ± 10.9 to 78.2 ± 11.5 fl (p value < 0.01) and mean ferritin increased from 19.21 ± 2.4 to 48.7 ± 8.7 ng/ml (p value < 0.01). Before treatment, 77.6% of the patients had moderate anemia and 22.4% had severe anemia. Post-treatment, of those with moderate anemia, 54.6% had mild anemia and 18.5% had no anemia, while of those with severe anemia, post-treatment 64.2% had moderate anemia and rest 35.8% had mild anemia. At the time of delivery, 2% had postpartum hemorrhage, 2% needed blood transfusion and 1% was admitted to the ICU. Low birth weight was present in 22%, 16% were preterm and there was one intrauterine death. Conclusions: Intravenous iron sucrose has a clinically acceptable safety profile, improves haemoglobin and ferritin levels in pregnant women with anemia.

123. Comparison between Sub-Anaesthetic Dose of Propofol and Ondansetron as Pretreatment Options in Prevention of Post Operative Nausea and Vomiting in Pregnant Females after Spinal Anaesthesia
Neelofar Shaikh, Irfan Ahmad Siddiqui, Shruti Rajendra Tiwari3, Prayank Mandloi, Fauzia Siddiqui
Abstract
Background: PONV is a common long-standing post-operative problem in anesthesia and remains a challenge, especially in obstetrics populations, and occurs more often after caesarean operations under regional anesthesia. Many anti-emetics have been studied for effectively attenuating post operative nausea and vomiting in pregnant females but there is no evident literature comparing the efficacy of sub-anaesthetic doses of propofol with ondansetron as pretreatment options on reducing the incidence and severity of post operative nausea and vomiting, this study was designed to compare efficacy of 0.5mg/kg propofol and 0.1mg/kg ondansetron intravenous pretreatment for PONV prevention in pregnant females. Aims: Aim of this study is to compare the efficacy of sub-anaesthetic dose of propofol with ondansetron in prevention of incidence and severity of post operative nausea and vomiting.  Material and Methods: This prospective randomized double blind study was conducted in a tertiary hospital associated with a medical college, 60 patients undergoing elective caesarean section under spinal anaesthesia were randomly allocated to one of the two groups Group I received 0.5mg/kg of propofol and Group II 0.1mg/kg of Ondansetron, 10 minutes before completion of surgery, patients were assessed for incidence and severity of nausea and vomiting over next twenty four hours. 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 propofol and 30 were pretreated with ondansetron 10 minutes before completion of surgery. In our study 8(26.66%) patients from propofol group developed PONV whereas only 2(6.66%) patients from ondansetron group developed PONV. In our study severity of PONV was calculated on a 3 point scale, it was observed to be 0.33 in patients belonging to propofol pretreatment group whereas it was observed to be 0.10 in ondansetron pretreatment group. Conclusion: Both groups were comparable with respect to demographic characteristics, the incidence(26.66% in group I vs. 6.66% in group II) and severity(0.33 in group I vs 0.10 in group II), of PONV was significantly reduced in ondansetron pretreatment group as compared to propofol pretreatment group, (95% confidence interval, P < 0.05).

124. Effect of Polythene Wrapping and Standard SNCU Care vs Standard SNCU Care Alone on Mean Body Temperature of Low Birth Weight Neonate during SNCU Stay
Sapna Thakur, Ravi Ambey, Ajay Gaur
Abstract
Background & Objectives: Maintaining a normal body temperature is a critical function for newborn survival. Newborn who are premature, LBW drop their body temperature suddenly after birth because of disproportionate body mass to surface ratio, decrease subcutaneous fat, poor vasomotor control. Study is done to compare effectiveness of polythene wrap along with standard SNCU care in thermoregulation of preterm, low birth weight babies compared to newborn who are given standard SNCU care alone. Objectives: Comparison of mean body temperature in two neonatal groups. Methods: This randomized controlled trial among low birth weight neonates from SNCU of Kamla Raja Hospital, Gajra Raja Medical College, Gwalior M.P. between January 2021 to June 2022. Neonates weighing>1500gms to <2500gms are included in the study. Total of 100 LBW neonates were taken for the study. Mean temperature over 7 days were compared between polythene wrap group and standard care group. Results: Total of 100 LBW neonates included in study randomized into polythene wrap group (n=50) and to standard care group (n=50) having similar baseline characteristics (birth weight, gestational age, baseline temperature). Neonates in polythene wrap group had lower rate of hypothermia and higher axillary temperature (37.06±0.3oC vs 36.6±0.26oC) with p<0.001 as compared with infants receiving standard care alone. It was also found weight loss is less in experimental group than control group (150 gm vs 180 gm over 7 days) which is statistically not significant. Interpretation & Conclusions: Use of polythene wrap might be simple innovative intervention for maintaining normal body temperature in LBW neonates.

125. Neurological Complications of COVID-19 Infection in Western Rajasthan: An Observational Study
Naveen Seervi, Ramesh Chandra, Veeram Parmar, Ankit Kumar Garg
Abstract
Background: The most common symptoms of COVID-19 infection involve fever, cough, cold and fatigue. However, the major impact of the virus was identified on the respiratory system of the human but some neurological problems were also identified. The neurological problems identified among the patients of COVID-19 were headache, dizziness, and myalgia. The neurological manifestations could be non-specific and influence the mental health of the individual. The changes in health of patients are having a significant impact on the neurological problem and these problems could have a long-term impact on patients. The studies have shown that neurological problem with patient include post-COVID-19 syndrome. Moreover, the young population that was affected from the COVID-19 virus was experiencing a higher chance of neurological issues that lead to major illness or mental disorder. Aim: The study aims to identify neurological complications of COVID-19 infection in western Rajasthan. Material and Methods: It was an observational study that has collected and analyzed the data of neurological patients associated with COVID-19. The study has evaluated the information of patients from Jan 2021 to March 2022 in Hospitals attached with Dr S.N. Medical College, Jodhpur, Rajasthan. The statistical data analysis was performed considering the variables that were presented in percentage. Continuous variables were summarized as median and interquartile range (IQR). All the statistical analyses were performed using SPSS software, version 28. Results: The outcome of the study has suggested that immediate neurological complication among the COVID patients include anosmia, loss of taste (29.5%), anxiety and depression (9.1%), psychosis (4.5%) and acute ischemic stroke (2.3%).  As per the analysis, delayed neurological complications among the patients include acute ischemic stroke (20.4%) followed by the ADEM (11.4%), anosmia, loss of taste (9.1%), GBS (9.1%), and cerebral venous sinus thrombosis (6.8%). Moreover, ADEM patients were treated with corticosteroids (18.2%), GBS patients were treated with IVIG (11.4%), and stroke patients were treated with anticoagulants and antiplatelets (15.9%). Conclusion: The neurological manifestation among COVID-19 patients is highly prevalent and associated with various neurological morbidities. The high impact of virus is having a direct association with the neurological illness of the patients of different age groups. Large vessel stroke is frequently associated in the younger adult population. Immune-mediated neurological disorders including GBS and encephalitis can present later in the course of the disease.

126. Synovial Lipomatosis of the Knee Joint: A Case Report
Ankit Nandkumar Gujarathi, Prakash Ganesan, Leena Jayabackthan
Abstract
Synovial lipomatosis is a rare, benign lipoma like intra-articular lesion commonly affecting the synovial lining of knee joint causing joint pain and swelling with or without movement restriction. Lesion chiefly consists of proliferating mature fat infiltrating the hypertrophic synovial villi. Synovial lipomatosis may be primary or secondary to osteoarthritis of the affected joint. Conclusion: Though most cases of synovial lipomatosis occur de-novo it may be associated with a degenerative process. Possibly it occurs as a secondary process following a chronic joint disease like osteoarthritis.

127. Prevalence and Risk Factors Affecting Speech and Language Delay in Children Aged 3- 6 Years in North Maharashtra
Chandrakant K. Survase
Abstract
Background: There is a large amount of data on the prevalence and risk factors of speech and language delay from the West. As of now an Indian data is more from tertiary care centers and there is a very scanty data from rural parts of the country or at community screening level. Objectives : The aim of this study was to assess the prevalence and risk factors of speech and language delay in children from 3-6 years age group, using the Language Evaluation Scale Trivandrum (LEST 3-6). Methods: A descriptive, cross-sectional study was conducted in the pediatrics department of District Hospital, Nasik, Maharashtra, on a sample of 150 children, three to six years old, who attended pediatric Outpatient Department (OPD) of District Hospital, Nasik, Maharashtra State. Language was assessed using Language Evaluation Scale Trivandrum (LEST 3-6). Various biological and environmental predisposing factors were analyzed. Results: The prevalence of speech and language delay was found to be 21%. There was no significant association of gender difference with speech and language delay. Age group affected more was 4 to 5 years. In this cross sectional study, male predilection was found to be significantly associated with speech and language delay were male gender, educational status of the parents, preterm delivery, history of convulsions, low birth weight, intra uterine growth retardation, down syndrome and positive family history of speech and language delay. Conclusions: Prevalence of speech and language delay is high (21%) in children between 3-6 years of age. Negative home environment, educational status of family members, family history of speech and language disorders were the common risk factors for speech and language delay. There is a strong association of speech and language delay with perinatal risk factors like prematurity, LBW, IUGR, convulsions, neonatal jaundice, birth asphyxia and also early stimulation.

128. A Study of Association of Serum Anti-TPO and TNF-Alpha in Hypothyroid Subjects
Itika Saxena, Shikha Saxena, Mamta Gupta, Basant Kumar Joshi, Ananya Katyal
Abstract
Background: The thyroid is a ductless endocrine gland that performs crucial functions in the body’s metabolism as well as maturation and growth. Thyroid hormones control the metabolism of cells, which is the rate of their activity. Thyroid hormones regulate the rate of oxygen consumption. Although thyroid hormones have a similar effect and affect the proper functioning of all body cells, their effects are particularly noticeable in certain tissues and on certain functions.. Hypothyroidism is brought on by a decreased thyroid hormone production. Thyroperoxidase also known as thyroid peroxidase (TPO) or iodide peroxidase, catalyses the oxidation of iodide to produce iodine atoms, which are then added to tyrosine residues on thyroglobulin to produce thyroxine or triiodothyronine, or thyroid hormones. Tumor necrosis factor alpha (TNF-α) acts as a factor that causes the necrosis of tumors, but it has additional important functions as a pathological component of autoimmune diseases. Method: The present study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine in Rohilkhand Medical College and Hospital, Bareilly among 150 adults between the age group 20-55 years attending the hospital selected by a systematic random sampling method. Laboratory and anthropometric parameters were evaluated using standard protocols. Informed written consent was obtained from the subjects and the ethical approval of the institution was obtained before the start of the study. Taking all aseptic precautions, 5 ml of blood was drawn by venipuncture from a peripheral vein, with a disposable syringe. Samples for thyroid profile (TSH, FT3, FT4), TNF-alpha & Anti- TPO were collected in a plain vial. The blood thus collected in clean dry glass tubes was allowed to stand for 30 minutes at room temperature for the retraction of clots. This was then centrifuged at 3000 r.p.m. to separate the serum for 10 minutes. The serum was stored at 4-8 ̊C in the refrigerator for further analysis. To avoid haemolysis of samples appropriate care was taken. Estimation of levels TSH, FT3, FT4, TNF-alpha & Anti- TPO of both groups was carried out and the data was analysed using SPSS version 23. Descriptive data were given as mean ± standard deviation (SD). Descriptive data were given as mean ± standard deviation (SD). Comparisons between controls and patient’s groups were performed using independent t-test and p values < 0.05 were considered statistically significant. Pearson correlation coefficients (r) were calculated to quantify the relationship between TSH and other variables. Result: ANTI-TPO & TNF-α both have statistically significant association with hypothyroid disorder as p-value is 0.001. We have also observed positive correlation of anti-TPO antibody and negative correlation of TNF-alpha with TSH in hypothyroidism. Conclusion: Out of all the investigations we have concluded the estimation of anti-TPO and TNF-alpha will helpful inflammatory marker to diagnose hypothyroidism and thyroid dysfunctions.

129. The Effect of Preoperative Nebulisations with Ketamine and Magnesium Sulfate on Incidence of Postoperative Sore Throat
Sanchara M Paramesh, Swathi Hegde, Pavithra Chandrappa, Rashmi Parameshwar
Abstract
Introduction: Postoperative sore throat (POST) is a common entity following general anesthesia with endotracheal intubation with incidence ranging from 21%–65%. Variousm non-pharmacological and pharmacological trials have been tried for decreasing the incidence of POST with no proven single modality. Ketamine and magnesium sulfate are NMDA antagonists and available studies suggest that both drugs decrease the incidence of POST. Study Design: A prospective randomised double blind comparative clinical study conducted over a period of 8 months. Materials and Methods: 120 subjects who are between 18–65 years of age, either sex belonging to ASA physical status I-II undergoing elective surgery in supine position requiring General anesthesia with endotracheal intubation with duration of the surgery upto 2 hours were randomised into three groups namely. Group S: received nebulisation of normal saline (NS) 5ml. Group K: received nebulisation of 50mg ketamine diluted to 5ml using NS. Group M: received nebulisation of 250mg of magnesium sulfate diluted to 5ml using NS. Primary aim was to compare the incidence of POST in all three groups and secondary aim was observation of hemodynamic effects. Statistical Analysis: Chi-square and ANOVA were used as test of significance for qualitative and quantitative data respectively. Results: demographic data were similar in all three groups. Incidence of POST in group N – 57.5%, group M – 25% and group K – 10%. Conclusion: Ketamine and magnesium sulfate both decreased the incidence of postoperative sore throat after endotracheal intubation with ketamine 50mg nebulistion being more effective than magnesium sulfate 250mg nebulisation.

130. Role of Admission RDW-CV in Patients with Sepsis as In-Hospital Prognostic Marker
Suyash Anshumali, Abhijit Swami, Karthyayani Prakash, Piyush Kumar Gupta
Abstract
Background: In an effort to find a quick and reliable prognostic marker for sepsis, scientists have done several researches. A simple haematology parameter RDW-CV as a in-hospital prognostic marker in patients with sepsis in a resource limited setting has been widely studied and this present study evaluates the same. Objective: The present study aimed to study the distribution of RDW-CV in patients with sepsis and its role as a prognostic marker in sepsis. Methods: It was a hospital based prospective observational study conducted over a period of one year from June 2021 to May 2022 in Department of Medicine of a tertiary care teaching hospital in Assam, India in which 280 sepsis patients aged 18 year and above were enrolled. Results: Respiratory infections was the most common cause of sepsis (42.8%), followed by intra-abdominal infections (23.9%) and genito-urinary infections. The mean RDW-CV in survivors were 14.23±1.59 and it was 17.66 ±3.81 in those who died. Conclusion: High RDW-CV is an independent prognostic marker in sepsis.

131. Serum Sodium Level as a Short Term Prognostic Indicator in Cases of Acute ST Elevation Myocardial Infarction in Southern Assam
Karthyayani Prakash, Dipankar Deb, Suyash Anshumali
Abstract
Background: The most common electrolyte anomaly in clinical practice is hyponatremia, which has a bad prognosis in ST elevation myocardial infarction (STEMI) and heart failure patients. Objective: The present study aimed to study the Serum sodium level as an indicator of short term prognosis in cases of Acute ST Elevation Myocardial Infarction. Methods: It was a hospital based prospective observational study conducted over a period of one year from June 2021 to May 2022 in Department of Medicine of a tertiary care teaching hospital in Assam, India in which 100 patients having acute ST elevation myocardial infarction based on diagnostic ECG changes were enrolled. Results: Mortality among patients with normal sodium levels was 10.7 % while mortality in hyponatremia group was 27.3%. This association was statistically significant. Conclusion: Serum sodium can be regarded as an inexpensive independent risk factor and prognostic marker of short term mortality in patients with ST elevation myocardial infarction.

132. USG Guided FNAC of Palpable and Non-Palpable Lesions
Indu Choudhary, Bhavana Garg, Rashmi Monteiro, Monica Mittal Kadam
Abstract
Background: Fine needle aspiration cytology (FNAC) has gained tremendous popularity, since it majorly impacts the management of the patients and prevents unnecessary surgical interventions. This study was undertaken to critically analyse the usefulness of USG guided FNAC in the diagnosis of palpable and non-palpable lesions. Methods: This was a prospective study from June 2015-June 2017 on 62 patients who came to the outpatient department or were admitted in a tertiary hospital in western Rajasthan. Out of 62 cases studied, majority of the cases were in the age group of 41-50 years i.e. 5th decade having 21 cases (33.87%), followed by 51-60 years having 12 cases (19.35%). The lesion was categorised into benign, suspicious for malignancy and malignant lesions 2. Results: The mean number of aspirates was aspirated from right hypochondrium (16 cases 25.80%) followed by left iliac fossa (12cases 19.35%), other sites (11cases 17.74%), right hypogastrium (3 cases 4.83%), right lumbar (4 cases 6.45%) and left hypochondroma (3 cases 4.83%) and least cases were from left umbilical region (1 case 1.61%). Sensitivity calculated was 91.49%, specificity was 100%, PPV was 100% and NPV was 73.33%. The disease prevalence was 81.03% and accuracy was 93.10%. Conclusions: Ultrasonography guided FNAC is a relatively simple, safe, quick, economical and reliable procedure in obtaining a pathologic diagnosis of intra-abdominal masses. It can be considered as a standard technique of pre-operative evaluation, which lets the practitioner to tailor appropriate stitches of management for deep seated lesion.

133. A Descriptive Cross-Sectional Study on the Role of Ultrasonic B-Scan in Thyroid Eye Disease
Selvi, R. Saravanan, Sangeetha Selvaraju, Sangeetha Devadoss, Keerthika A., Athula A.S.
Abstract
Background: In this study, we wanted to evaluate the orbital content changes using ultrasonic B-scan in thyroid eye disease due to hyperthyroidism/hyperthyroidism, assist in early detection of thyroid eye disease, assess the response of treatment in TED, and assess the progress of disease. Materials and Methods: This was a hospital-based descriptive cross-sectional study conducted among 45 patients- 90 eyes who presented with clinical signs and symptoms of thyroid eye disease due to hyperthyroidism, to the Department of Ophthalmology, Government Rajaji Hospital, Madurai, for 1 year, after obtaining clearance from the institutional ethics committee, and written informed consent from the study participants. Results: The four recti muscles were significantly thicker. The mean of the sum of all four recti muscles in the mild category was 15.7 mm in BE, the moderate category was 20.5 mm in BE and the severe category was 32 mm in BE. A severe form of TED was found to generally result in a higher exophthalmometric measurement of proptosis and eye muscle thickness (P value < 0.001). In thyroid eye disease, enlargement of the muscle belly with sparing of tendon insertion is the characteristic appearance in B-scan. Our result showed EOM enlargement to be the principal cause of proptosis. Conclusion: It is difficult to distinguish the thickened muscle with high reflectivity from the surrounding orbital soft tissue. This can be avoided by decreasing the gain setting to get a better visualization of the muscle sheath.

134. Role of Intraarticular Steroid Injection with Physiotherapy and Physiotherapy alone in Idiopathic Adhesive Capsulitis of Shoulder (Frozen Shoulder)
Braja Sundar Sahoo, Kumuda Bandhu Sahoo, Laba Kumar Naik, Tarini Prasad Sahoo
Abstract
Background: Frozen Shoulder otherwise termed Adhesive Capsulitis is a common, disabling but self-limiting condition. It presents with progressive pain & limitation of movement and ends in resolution. Management is manifold, non-operative management includes analgesia, physiotherapy, and oral or intraarticular corticosteroid. Operative management includes intraarticular distension, manipulation under anesthesia and arthroscopic capsular release. Methods: This study, spanning over two years included 47 patients, 22 patients were treated with physiotherapy alone and 25 patients were treated with intraarticular steroid injection followed by physiotherapy. Both the groups took NSAIDs for analgesia. Results: The result was compared between the two groups with regard to age, sex, side of affection, duration of symptoms, pain, tenderness, muscle atrophy, range of movement. Overall result was good in 10, fair in 6 and poor in 6 cases of the physiotherapy alone group and good in 20, fair in 5 cases in the physiotherapy following intraarticular steroid injection group. No poor result was seen in this group. Conclusion: Though the study population and the duration of study was small, intraarticular steroid injection followed by physiotherapy gives good result in cases of Adhesive Capsulitis or Frozen Shoulder.

135. Assessment of Postoperative Residual Neuromuscular Blockade with Vecuronium as a Muscle Relaxant using Peak Expiratory Flow and Train of Four Ratios: A Prospective Observational Study
Keshavamurthy G.R., PrasannakumaraV.R., Shashikiran D.S., Naveen H.S.
Abstract
This study was conducted to assess and compare the incidence of post-operative residual neuromuscular blockade in patients who were administered intermediate acting (30-45 min) neuromuscular blocking agents (vecuronium) for maintenance of neuromuscular blockade in the intra-operative period with those in patients who were not administered neuromuscular blocking agents for maintenance of neuromuscular blockade during general anesthesia, with regard to the time required to extubate the patients after reversal of neuromuscular blockade, the Peak Expiratory Flow (PEF) and TOF after extubation and percentage of preoperative PEF at 60 minutes after extubation. Methods: This was a hospital based prospective observational study conducted among 60 patients who underwent elective orthopedic surgery, otorhinolaryngologic surgery, urological surgery and plastic surgery at BGS Global Hospital, Bangalore, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.
Results: Among the intraoperative variables statistically significant difference was observed in the total dose of vecuronium and total dose of fentanyl used among the two groups. Total dose of Fentanyl used was found to be statistically significant. A comparison of R-TOF interval among two groups was found to be statistically significant. Statistically significant difference was observed in PEF values performed 60 min after extubation, expressed as percentage of preoperative PEF values. Statistically significant difference was observed among the two groups in sedation score after extubation. Sedation score was more in group B compared to group A till 15 minutes after extubation. Conclusion: Neuromuscular blocking drugs should be avoided for maintenance of neuromuscular blockade wherever possible, i.e., surgeries that do not require muscular relaxation such as certain peripheral limb surgeries, surgery on the skin (plastic surgery) etc.

136. Incisional Hernia: Incidence, Clinical Profile, Risk Factors, and Prevention
Alkesh Meena, Ashish Pratap Singh, Gautam Tayade, Saddam Singh
Abstract
Background: Incisional hernias are highly prevalent. After inguinal hernias, they are the second most prevalent form of hernia. Aim and Objective: To study the incidence and various risk factors leading to incisional hernia. Materials and Methods: This prospective study was conducted in the Department of Surgery, Shyam Shah Medical College Rewa MP, India, from May 2021 to May 2022. All the cases were analyzed in various aspects like age, sex, parity, relative incidence, clinical presentation, nature of the previous operation, site of the previous scar, and precipitating factors like obesity, wound infection, and abdominal distension. Results: The incidence approximates 6.5%. The maximum incidence of incisional hernia was found in patients aged 30 to 60. The ratio of females to males was four to one. The incisional hernia was more prevalent among patients with a history of gynaecological surgery. Most patients presented with an incisional hernia in the infra umbilical region. Over half of the patients presented with incisional hernias within three years of the operation. Wound infection remains the most prevalent risk factor associated with wound failure. Conclusions: Incisional hernias are caused by medical intervention and can be avoided by avoiding midline incisions, particularly in the infraumbilical region.

137. Incidence of Anemia and Serum Protein Deficiencies in Patients with Acute Traumatic Spinal Cord Injury
Tuglak Nadeem, Goenka Sunil, Sharma Kamlesh, Pandey Nitin
Abstract
Introduction: In the acute phase of traumatic Spinal Cord Injury, many patients suffer from anemia, hypoproteinemia and hypoalbuminemia which can contribute to easy fatiguability and an overall hindrance to the rehabilitation effort. This study was conducted to further investigate the incidence of anemia, hypoproteinemia and hypoalbuminemia in patients with acute traumatic spinal cord injury (SCI). Methods: This prospective study was carried out at department of physical medicine and rehabilitation, SMS Medical College, Jaipur. Adults with acute traumatic spinal cord injury (n=200) were recruited. The enrolled patient’s demographic data, clinical examination, ASIA scale grade, blood reports (hemoglobin, Serum Total protein, Serum Albumin) were analyzed at admission. Result: In 200 recruited patients at initial admission, 53% (n=106) patients were anemic (hemoglobin <13.0 g/dl in males and Hb <12g/dl in female), 24 percent were hypoalbuminemic (s. albumin <3.2 g/dl) and 64 percent were hypoproteinemic (S. total protein <6.5 g/dl). Deficiencies were most commonly observed in complete spinal injury (ASIA A) and statically significant association (p <0.05) with severity of injury with each deficiency was observed. Conclusion Therefore we should concern about the treatment and progression of anemia and protein deficiencies in the spinal cord injured patients.

138. Knowledge, Attitude and Practice towards COVID-19 Vaccination during Pregnancy
Neha Sharma, Seema Mehta, Urmila Mahala
Abstract
Objective: To determine   knowledge, attitude and  practice towards COVID-19 vaccination in pregnant women. Methods: A questionnaire consisting 12 questions was completed for 600 pregnant women who were selected randomly in an OPD of tertiary health care center. Socio demographic characteristic, knowledge about vaccine, vaccine availability at free of cost, vaccine safety in pregnancy, vaccine acceptability, causes for refusal of vaccine and effect of counseling on   vaccine acceptance were evaluated. Results: Among 600 participants 271(45.16%) pregnant women were already immunized with COVID-19 vaccine at the time of study. 157(26.16%) pregnant women took vaccine after counseling while 172(28.66%) women out of 600 wished to take it after delivery. Main causes for lack of vaccine acceptance were- misinformation regarding its safety (25%), patient’s belief   that it’s unsafe for fetus (28.83%) and unavailability of documents in 1%. Socio demographic characteristic were evaluated and compared in terms of knowledge of vaccine, free of cost vaccine availability, vaccine safety, practice in terms of vaccine acceptance, causes for non-acceptance of vaccine and counseling for vaccination safety and need in pregnancy. Conclusion: This study showed that pregnant women had good knowledge about vaccine and availability of vaccine free of cost .A large number of women had doubt about the safety of vaccine during pregnancy.  A good number of patients received vaccine after counseling which reflects need of proper counseling.  In order to protect all pregnant women and their newborns, COVID-19 vaccination should be considered as a part of routine antenatal care.

139. Prescription Analysis and Improvement of Prescription Practices in a Tertiary Care Hospital: A Study on Core Prescribing Indicators
Bhatt Kamalesh Maheshbhai, Butani Noopur Jamnadas, Balat Jayesh Dineshchandra
Abstract
Introduction: This study aimed to analyze prescriptions and generate information on core prescribing indicators proposed by the World Health Organization (WHO). The objectives were to identify frequently prescribed drugs, understand the morbidity pattern, and propose measures to improve prescription practices. The study was conducted in a tertiary care hospital attached to a teaching hospital. Materials and Methods: Prescriptions were collected from the outpatient department (OPD) by photographing them at the dispensing window of the hospital pharmacy. A Case Record Form was used to collect relevant information, including OPD number, department, age, diagnosis, system involved, drugs, dosage, frequency, duration of treatment, and route of administration. The collected data were assessed using WHO core prescribing indicators. Results: The average number of drugs per prescription was found to be 3.54. Approximately 72.95% of the prescribed drugs were prescribed using generic names, indicating a favorable practice. About 3.01% of the prescribed drugs were in combination form, suggesting the use of fixed dose combinations. Around 6.69% of the prescriptions contained at least one injection, and 25.80% of the prescriptions included at least one antibiotic. Notably, in 50.01% of the prescriptions, a vitamin or tonic was prescribed. Additionally, approximately 97.76% of the prescribed drugs were in accordance with the Central Medical Stores Organization Gujarat State Essential Drug List for the year 2021-22. Conclusions: The findings of this study emphasize the importance of prescription audit and continuous evaluation of prescribing practices in order to enhance the quality of care provided by hospitals. The analysis of prescription patterns and adherence to core prescribing indicators provides valuable insights into prescription practices and treatment preferences. The study underscores the need for rational prescribing, including the use of generic names, minimizing polypharmacy, and ensuring appropriate use of antibiotics. These measures can optimize patient outcomes, reduce healthcare costs, and improve patient safety. Efforts to improve prescription practices should be an integral part of healthcare systems to provide high-quality and cost-effective care.

140. A Prospective Study on the Consequences of Blunt Ocular Trauma on Intraocular Pressure in a Tertiary Care Centrex
Goli Sridhar, P. Srinivas, Midhu Mathews, Pasupala Vasudev Anand
Abstract
Background: Ophthalmic injuries are the primary reason for blindness, visual impairment, and loss of vision in one eye among children worldwide. This represents a preventable public health problem. The present study was conducted to evaluate the clinical features, visual acuity, intraocular pressure changes, and visual outcomes following blunt trauma. Methods:  A total of n=100 patients (101 eyes) diagnosed with blunt ocular trauma were evaluated by taking a detailed history, vision by Snellen’s visual acuity chart, slit lamp biomicroscopy, fundus examination under full drug mydriasis by indirect ophthalmoscopy and +90 D lens, gonioscopy with Goldmann four mirror gonio lens and IOP by Goldmann applanation tonometer. In cases with hazy media due to corneal edema or hyphema, gonioscopy was deferred in the first visit and B-Scan was performed to look for the posterior segment. Results: In this study, out of 100 patients, 62% (n=62) patients presented to the hospital within 3 days of trauma. N=53 eyes (52.4%) eyes had angle recession and 44.5% (n=45) eyes had open angles. In this study, at the time of presentation 56.4% (n=57) eyes had normal IOP, 28.7% (n=29) eyes had raised IOP, and 14.8% (n=15) eyes had low IOP. By 12 weeks 98.0% (n=99) eyes had normal IOP and 0.9% (n=1) eyes each had raised and low IOP. Out of 101 eyes, 61.3% (n=62) eyes required only medical management, and 38.6%(n=39) eyes underwent surgical management. The majority 57.4% (n=58) eyes had circumcorneal congestion and 0.9%(n=1) eyes had RAPD. Out of n=29 eyes with raised IOP, 48.27% (n=14) eyes had a vision in the range of 1/60-PL positive, and only 3.4%(n=1) eyes had a vision of more ≥ 6/12. By 12 weeks majority 58.6% (n=17) eyes had ≥6/12 vision and only 3.4%(n=1) eyes had a vision of 1/60-PL positive.

Conclusion: This study highlights the epidemiology, clinical presentations, and consequences of blunt ocular trauma on intraocular pressure. As the angle structures can be severely injured following trauma, it emphasizes regular follow-up of such patients to prevent late-onset glaucoma. The public should be made aware of the risks of ocular trauma, and morbidity with a delayed presentation to the hospital.

141. Tardive Dystonia and its Management: A Case Series
Prashant M Mangla, Aarushi P Mangla
Abstract
Tardive dystonia is characterized by involuntary muscle contractions and its occurrence is more common with typical antipsychotics while it is rare with atypical antipsychotics. In this case series, three patients who were on antipsychotics for long duration developed tardive dystonia. Drugs with low dopamine receptor blocking propensity like clozapine and quetiapine were used. Also, other drugs like tetrabenazine, anticholinergics and benzodiazepines were used. Tardive dystonia is difficult to diagnose and is often underdiagnosed and misdiagnosed. It is difficult to treat, can be disabling involving the activities of daily living and may also lead to social embarrassment. Very few of the treatment possibilities are known to be effective for tardive dystonia. Thus, this side effect should be screened at regular intervals.

142. Study of Serum Uric acid and CRP Levels & its Association in Patints with Type 2 Diabetes Mellitus with Metabolic Syndrome
Sandeep Kumar, Ashok Mosalpuri, Geetika Roat, Amit Kant, Subhash Chand Jain, Laxmikant Tank
Abstract
Background: Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Metabolic syndrome is a term referring to the frequent clustering of the cardiovascular risk factors of hypertension, obesity, insulin resistance, dyslipidemia, and dysglycemia in a single patient. Uric acid and highly sensitive C reactive protein (hs-CRP) each now share a respected inclusion as two of the novel risk markers – risk factors associated with the metabolic syndrome in patients with type 2 diabetes mellitus. Methods: The study was conduct in the Department of medicine Jhalawar Medical College & Hospitals, Jhalawar. After taking informed consent eligible patients were enrolled according to the inclusion and exclusion criteria. Result: In our study, Uric acid levels in males were 7.12 ± 1.74 mg/dl, while those in females were 6.37 ± 1.81 mg/dl. There was a significant difference in uric acid levels between males and females (p = 0.038S) in the study. A significantly higher mean was observed in males as compared to females. The mean FB sugar in groups with low UA and high UA was 160.01 ± 40.11 and 176.94 ± 40.23, respectively. (P value, LS 0.048S). A significant positive correlation was observed between uric acid and fasting blood sugar. Significantly high SBP and DBP were associated with high uric acid. The uric acid level and the lipid profile were found to be significantly related with P = 0.49S, a significantly higher mean value of LDL was observed with uric acid >6. Waist circumference was increased in all patients with 47% having high uric acid and 33% having high CRP. Conclusion: In our study, a significant positive relationship of uric acid and CRP with components of metabolic syndrome was observed, so it is concluded that chronic inflammation exists in patients with DM with metabolic syndrome.

143. Hemodynamic Response of Dexmedetomidine as an Adjuvant to Fentanyl in Patients Undergoing Valvular Heart Surgery: A Comparative Study
Manish Kumar Mourya, Rajbala, Anurag Gill, Roshan Lal Jajoriya, Indu Verma
Abstract
Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) pose significant health risks in developing countries and sporadically in developed economies. Echocardiographic studies highlight the burden of RHD, necessitating updated diagnostic guidelines. RHD, a non-suppurative manifestation of Group A streptococcal pharyngitis, remains a major cause of morbidity and mortality in developing nations, including India with an estimated 2.0 to 2.5 million affected individuals. Methods: This study included adult patients undergoing cardiac surgeries for valve replacement. They were randomized into two groups: one receiving dexmedetomidine infusion and the other saline infusion. Preoperative assessments and baseline data collection were performed. General anesthesia was induced, and intraoperative hemodynamic monitoring was conducted. After surgery, renal function parameters were monitored in the ICU. Results: The study evaluated the hemodynamic response of dexmedetomidine as an adjuvant to fentanyl in patients undergoing valvular heart surgery. Dexmedetomidine demonstrated significant effects on heart rate, blood pressure, and plasma catecholamine concentrations during emergence from general anesthesia. The combination of dexmedetomidine and fentanyl resulted in better hemodynamic stability compared to fentanyl alone. Conclusion: In valvular heart surgery, adding dexmedetomidine to fentanyl improved hemodynamic stability. Dexmedetomidine positively affected heart rate, blood pressure, and plasma catecholamine levels, showing promise for perioperative management. Further research is needed to validate these findings and investigate long-term benefits and safety of dexmedetomidine in this setting.

144. A Clinicoepidemiological Study on Various Mucocutaneous Adverse Reactions of Anti-Cancer Drugs in Cancer Patients
Swapnarani Behera, Sarada Prasad Parija, Dinesh Ranjan Panda, Jayashree Mohanty, Prasenjeet Mohanty, Niharika Panda, Chandan Das
Abstract
Background: Cutaneous adverse reactions are the most commonly associated adverse effects with chemotherapy next to hematological toxicity. Chemotherapy is evolving with a tendency towards increasing the use of newer targeted agents. This has resulted in changing patterns of cutaneous adverse effects. Aims: We aim to study clinicoepidemiological aspect of various mucocutaneous adverse reactions due to anti-cancer drugs in cancer patients. Objectives: 1. Estimate occurrence of mucocutaneous adverse reactions among cancer pts on anticancer drugs. 2. To see the pattern, duration & latency of mucocutaneous reactions due to anticancer agents. 3. Study the association of cutaneous adverse reactions with various chemotherapy drugs or combination regimens. 4. Assess severity of various mucocutaneous adverse reactions using standardised criteria. Methods: This was a cross sectional observational study carried out in dermatology department, SCB Medical college & AHPGIC, Cuttack during June 2020 to November 2021. Inclusion Criteria: We included cancer patients who developed at least one mucocutaneous reactions after starting chemotherapy during our study period & gave consent to participate in our study. Exclusion Criteria: Cancer cases who were on prior or concurrent radiotherapy, those who developed mucocutaneous reactions prior to starting chemotherapy & those who did not consent to participate were excluded. The obtained information was analysed retrospectively using SPSS software & results were represented using tables & statistical diagrams. Results: Out of 200 cases, 131 were female & 69 were male. Overall, Breast cancer(37.5%) was the most common indication for chemotherapy followed by rectal cancer & cervical cancer. However, among males Ca Rectum was most common indication for chemotherapy followed by stomach & lungs cancers. Combination regimens were most frequently used. The dermatological manifestations observed include hair changes (alopecia) in 73% cases, followed by skin changes (acral pigmentation, infusion site reactions, hand foot syndrome, Flagellate dermatitis, Supravenous Pigmentation, skin rash, acneiform eruptions, Xerosis etc) in 72% cases, nail changes (nail Pigmentation, Onycholysis, etc) in 56% & mucosal changes (Mucosal pigmentation, painful mucositis) in 14% cases respectively. Limitations: Since most of chemotherapy consisted of combination regimens, it was difficult to imply specific drug in causal association. Due to the cross-sectional nature of our study with limited study period, cases could not be followed up properly. Conclusion: Mucocutaneous adverse reactions of cancer chemotherapy can be mostly diagnosed by detailed history taking & physical examination. Many of the observed side effects are reversible changes, yet their inappropriate management might sometimes affect quality of treatment such as dose reduction or stoppage of drugs. A multidisciplinary approach including oncologist & dermatologist to prevent its occurrence or else limit its progression with appropriate timely management & proper counselling thereby improving the quality of patient care.

145. Imipramine Genotoxicity Research and the Effect of Vitamin E in Mice
Jyothsna, Ravindra S. Beedimani, Shakira Fathima Syeda
Abstract
Introduction: Evaluation of impiramine’s genotoxicity and the function of vitamin E in mice is the goal. Materials & Procedures Seven groups of forty-two male albino mice were created at random (n=7). Group I served distiller water as the control group. Mice were given imipramine treatment in Groups (II-IV). Specifically, orally for two days in two split doses of 12.9 (¼LD50), 25.8 ( ½LD50) and 38.6 (¾ LD50) mg/kg body weight. Groups (V, VI, and VII) of mice were administered with 100 mg/kg body weight of vitamin E orally every day for six days in order to assess the involvement of vitamin E in genotoxicity. The mice were subsequently given imipramine orally for five days. Animals in all the groups were sacrificed by euthanasia and were dissected and epididymal sperm sample was taken, smear was made and staining done, and screened under the microscope. Results: A chi-square test was performed after the results. Using an assay for sperm head abnormalities, the current study. The protective effect of vitamin E was observed by a decrease in the incidence of abnormal sperms only in the Group V but not in Group VI or VII. Genotoxic effect of imipramine with ¼, ½, ¾LD50 doses were observed by an increase in incidence of abnormal sperms with the increasing dose of imipramine in the Groups II, III, & IV, compared to group I. Conclusion: According to the sperm head abnormalities assay, imipramine had a genotoxic effect at all three of the levels mentioned—namely, ¼, ½, and ¾LD50. Only for lower doses of imipramine does vitamin E have a geno protective effect.

146. Correlation of Severity of Organophosphorus Poisoning as Assessed by Peradeniya Organophosphorus Poisoning Scale with Serum CPK and Random Blood Sugar Levels
Rashmi Nagdeve, Vishwanath Marshivanilar, Baba Yelke
Abstract
Background: Organophosphorus (OP) compounds are a major contributor to poison-associated morbidity and mortality in India. The present study was undertaken to assess severity of OP poisoning according to Peradeniya organophosphorus poisoning (POP) scale and correlate severity with serum CPK and random blood sugar levels (RBSL). Method: A total 104 patients of OP poisoning were enrolled in the study. They were initially subjected to POP severity scale and classified as mild, moderate, and severe. All cases were investigated for serum cholinesterase, serum CPK, and RBSL. These investigations then compared with POP severity scale and outcome of disease as mortality were observed. Results: Most of the patients belonged to age group between 21-30 years (32.69%), males (55.77%), farmers (36.5%), from rural region (77.88%) and illiterate (60.6%). Most common compound consumed was monocrotophos (31%). The commonest symptom was vomiting (85.58%), and commonest sign was miosis (70.19%). Most of the patients were in mild POP severity category (44.23%) followed by moderate (34.62%) and severe (21.15%) category. The relationship between severity of poisoning with serum cholinesterase was statistically significant showing more the severity of poisoning more the depression of serum cholinesterase levels. However, the relationship between severity of poisoning with ventilator requirement and mortality was statistically significant showing that higher the CPK and RBSL levels were associated with more severity, ventilator requirement and more mortality of patients. Conclusion: POP Scale can be used as good prognostic scale for OP poisoning patients. CPK and RBSL may be considered as routine investigation as it is a good prognostic marker for assessing severity of OP poisoning and ventilator requirement and outcome of patients.

147. A Cross Sectional Study of Bone Marrow Examination in Patients with Pancytopenia and with Respect to Iron Stores in the Bone Marrow Shreya Amul Pawaskar, Sagar Chandrakant Mhetre, Meenal Rajesh Patil, Ruchi S. Gandhi
Abstract
Background: Pancytopenia refers to decrease in all three hematologic cell lines in the peripheral blood below the normal reference range. Haematopoietic and non-hematopoietic conditions manifest with features of pancytopenia and hence marrow composition will differ. The severity of pancytopenia and underlying pathology determines the management and prognosis of these patients. Objective: The current study was undertaken to evaluate the common causes of pancytopenia by correlating haematological and bone marrow findings understudying the grading of iron store, with an intent for early diagnosis and appropriate treatment to patients with pancytopenia. Methodology: A prospective study was conducted at a Tertiary Hospital in Maharashtra in 50 patients detected as Pancytopenia, based on peripheral smear examination with haemoglobin <10 mg/dL, total leukocyte count <4000 cells/mm3 and platelet count <150,000 cells/mm3. Bone marrow aspiration was done and Prussian blue stain was used to assess the iron stores in bone marrow aspirates. Results: 48% of patients had haemoglobin<5gm/dl, 78% had leucocyte count of1-3×103/mm3 and 50% had Platelet count of 50-100 x103/mm3. Megaloblastic anaemia was the commonest cause of Pancytopenia (66%) followed by subleukemic leukemia, dry tap, Dimorphic Anaemia, Iron deficiency anaemia and Multiple myeloma. Out of 33 cases of Megaloblastic anaemia,18 showed normal iron stores, while 15 showed increased iron stores. Decreased iron stores were seen in dimorphic anaemia and iron deficiency anaemia. Conclusion: Megaloblastic anaemia is a common cause of Pancytopenia and Bone marrow study is a useful tool in diagnosis of pancytopenia. Prussian blue stain helps to diagnose co-existence of iron deficiency in other anaemias.

148. Comparison between Inj. Fentanyl vs Inj. Dexmedetomidine Infusion to Assess Awareness during General Anaesthesia Using Bis Monitor
Shraddha Mehta, Pavanjit Vadar, Nidhi Pambhar, Rina Gadhvi
Abstract
Background: Awareness during general anaesthesia is very distressing for a patient, particularly if accompanied by recall of the painful nature of surgery. This can result in serious emotional injury and post-traumatic stress disorder. Awareness may have psychological sequelae for the patient and medico-legal consequences for anaesthetist, so it becomes imperative for any anaesthetist to monitor and prevent awareness during intra-operative period. Aims: Aim of the study was to monitor depth of anaesthesia and occurrence of awareness using BIS monitor in patients and to study and compare use of Inj. Dexmedetomidine and Inj. Fentanyl intraoperative to prevent awareness. Material and Methods: Two groups of patients 25 in each undergoing general anaesthesia for elective surgeries were studied after proper informed consent. Group D (Inj. Dexmedetomidine) and Group F (Inj. Fentanyl) were monitored with BIS index for awareness during anaesthesia and compared. Statistical analysis: Chi-square test, unpaired student ‘t’ test. Results: There is a significant difference between SBP and DBP of group D and group F. Systolic and Diastolic blood pressure were significantly lower in Dexmedetomidine group. There is significant difference in BIS score between group D and group F after induction (P value <0.0001), which is lower in Group D and difference remains significant until end of the surgery. Conclusions: We concluded that Dexmedetomidine gives better depth of anaesthesia. Both Dexmedetomidine and Fentanyl reduce the awareness but compared to fentanyl, dexmedetomidine provides a lower BIS score.

149. Prevalence of Retinal Vein Occlusion in Diabetic Patients and its Association with Systemic Illness in a Tertiary Care Teaching Hospital
Soumya Shyam, Sneha B.V, Malhari Bokhani
Abstract
Background and Aim: The likelihood of endothelial damage or irregular blood flow is increased by systemic conditions such hypertension (HTN), dyslipidemia, diabetes mellitus (DM), and cardiac disorders; as a result, they are linked to retinal vein occlusion. The purpose of the current study was to determine the prevalence of retinal vein blockage in diabetic patients and its relationship to systemic illness at a teaching hospital that provides tertiary care. Material and Methods: The current cross-sectional study was carried out over the course of a year at the Tertiary Care Teaching Institute of India. The patient received fundus fluorescein angiography, optical coherence tomography, and direct and indirect ophthalmoscopy. We acquired medical histories that included information on the duration of diabetes, hypertension, hyperlipidemia, and cerebro-vascular accidents. Results: In this investigation, RVO was found in 7% of the patients (n=70), 40 of whom were men (57.7%) and 30 of whom were women (52.85%). Eighty percent (n=56) of the patients had BRVO, with 12 (75%) having bilateral involvement and 44 (81.48%) having unilateral BRVO. 20% (n=14) of the patients had CRVO, of which 10% (or 18.5%) had unilateral involvement and 4% (or 25%) had bilateral CRVO. RVO was substantially related with diabetic patients who had a history of hypertension, hyperlipidemia, and CVA. (p< 0.0001). Conclusion: The multifactorial condition known as retinal vein occlusion. Ageing, hypertension, hyperlipidemia, and CVA are some of the risk factors for RVO in diabetics with poorly regulated blood sugar levels.

150. Comparative Study of Inj. Ropivacaine (0.2%) v/s. Inj. Ropivacaine (0.2%) with Hyaluronidase in Transversus Abdominis Plane Block for Post Operative Analgesia
Kinnari Patel, Aniruddhsinh Gadhvi, Nandan Upadhyay
Abstract
Background and Aim: The nerves of the anterior abdominal wall are employed in the TAP block, a common analgesic method. An enzyme called hyaluronidase aids in the distribution of local anaesthetic throughout the tissue surrounding the eye. In order to compare the effectiveness of injecting ropivacaine (0.2%) against injecting ropivacaine (0.2%) with hyaluronidase in tap block for postoperative analgesia, this study focused on that topic. Materials and Methods: A total of 60 patients with ASA classes I and II who were scheduled for lower abdomen surgery were included in the study. With 30 patients apiece, the research populations were split into two groups. Using a blind approach on each side, 20 ml of 0.2% (preservative-free) ropivacaine was administered to Group R (n=30) together with 2.5 ml of distilled water, and 20 ml of 0.2% ropivacaine was administered to Group H (n=30) along with 750 IU of hyaluronidase diluted in 2.5 ml of distilled water. Results: Between the two groups, there is no statistically significant difference up to 30 minutes and 1 hour postoperatively. (p>0.05) However, following that, Group R continually has a lower mean VAS score than Group H, which was statistically significant after 2, 4, 6, and 12 hours. after surgery. (p≤0.05). In comparison to Group H’s 5.471.48 hrs, Group R’s mean analgesic duration was 8.944.22 hours, which is longer and statistically significant. In both groups, nausea had the highest percentage of problems, followed by vomiting, bradycardia in Group R, and bradycardia, hypotension in Group H. Conclusion: In group H compared to R, the visual analogue scale (VAS) SCORE was lower. Traditional analgesia is less effective than Group H at lowering the pain score. Group H consumes fewer analgesics overall than Group R. The use of 0.2% ropivacaine with hyaluronidase in TAP block offers significant promise as an analgesic regimen following lower abdominal procedures, it can be concluded.

151. The efficiency of Lower Abdominal Analgesia Using 600 Mg Gabapentin as Part of the Management of Post-Operative Pain
Rajesh Jaywant More
Abstract
Introduction: Gabapentin is a medication approved as an anticonvulsant; however also used to treat neuropathic pain and hyperalgesia. It works by reducing the excitability of neurons in the posterior horn of the spinal cord, thereby reducing central sensitization. Gabapentin is effective in reducing postoperative pain, and its use can lead to a decrease in opioid consumption and related side effects. Aims and objectives: To analyse the efficacy of gabapentin given at 600 mg to manage post-operative lower abdominal pain. Methods: The study involved 50 randomly assigned participants receiving either gabapentin or a placebo before surgery. Standard monitoring and anaesthesia were used during the procedure, and postoperative pain was evaluated using the VAS score. Patients were given patient-controlled analgesia with morphine, and the primary outcome was the amount of morphine consumed in the first 24 hours. Secondary outcomes included VAS scores, the timing of analgesia rescue, and adverse events. Results: This randomized experiment with 50 patients in each group indicated that gabapentin was related to significantly reduced pain scores at 0, 2, and 24 hours after surgery compared to a placebo. The trial was conducted on patients who had had surgery. After six and twelve hours following surgery, there was no discernible change in the levels of pain experienced by the patients. The placebo group reported significantly more instances of nausea, but the difference did not reach statistical significance. Conclusion: Pre-emptive administration of gabapentin in the first 24 hours after surgery can effectively reduce postoperative opioid consumption and alleviate discomfort in patients undergoing non-obstetric lower abdominal surgery.

152. A Longitudinal Study on Lymphedema in Patients Undergoing Axillary Dissection for Carcinoma Breast
Najeeb P.M., S. Sreekumar
Abstract
Background: This study was conducted to evaluate the occurrence of lymphedema in patients undergoing axillary dissection and/or irradiation for breast cancer and also to determine the risk factors associated with the occurrence of lymphedema in these patients. Methods: This was a hospital-based prospective study conducted among 198 patients who presented with carcinoma breast to the Department of General Surgery, Government, Medical College, Thrissur over a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Out of 198 patients with a mean age of 53.8 years, a modified radical mastectomy was performed in 193 patients (97.5%), and 5 patients underwent breast conservation surgery (2.5%). 65.2% patients were diagnosed with stage II disease. 18.2 % of participants had post-operative wound infection or seroma. Of the 198 participants, 18 (9.1%) had >/= 10 lymph nodes that tested positive for malignant cells on HPE. The incidence of lymphedema was 8.1 %. Conclusion: Approximately 8% of breast cancer patients in our study developed clinically significant lymphedema. Non-dominant side malignancy, advanced stage of disease, post-operative wound infection, seroma, large nodal burden and systemic therapy are significant risk factors for lymphedema development. Irradiation had no significant effect on the development of lymphedema.

153. Evaluation of Glycemic Parameters in Type 2 Diabetic Shift Workers
Soniya, K. Shivani, S. Hitendra, M. Sonam, V. Amit, B. Kiran
Abstract
Diabetes Mellitus (DM) is associated with several short term and long term complications which has led to adverse impact on overall wellbeing of such patients, in the form of severe morbidity and mortality risk. The subjects so included were subjected to a detailed clinical history with special emphasis on duration of illness and treatment history and a thorough clinical examination was done in each case. Quantitative data was expressed by mean and standard deviation and difference of means was observed by t test and qualitative data was expressed as percentages and difference between proportions was observed using appropriate test. 95% confidence level was used to quantify at risk values and factors. The glycemic parameters were significantly deranged in shift workers as compared to non-shift workers, with a difference of almost 4% in hBA1c levels (p  value ) Similar statistically significant difference was noted in fasting and post prandial blood sugar levels also.

154. A Comparative Evaluation of Hyperbaric Bupivacaine with Clonidine versus Dexmedetomidine as an Adjuvant in Lower Abdominal and Lower Limb Surgeries at a Tertiary Care Centre
Joshi H, Dutt HK, Singh AK, Sharma S
Abstract
Background: Hyperbaric bupivacaine is most commonly used in spinal anaesthesia but cause motor block with late recovery as well as hemodynamic side effects. The use of adjuvant reduces the dose of bupivacaine and thereby the side effects which mandates the search for the better adjuvant. Objective: To evaluate the efficacy and the safety of clonidine and dexmedetomidine as an adjuvant to intrathecal hyperbaric 0.5% bupivacaine. Materials and Methods: Ninety patients in the age group between 20 years and 60 years of either sex belonging to ASA Grade-I and Grade-II posted for elective lower abdominal surgeries and lower limb surgeries were grouped randomly into three groups (n=30) where each group received 12.5 mg of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline (control group), 50µg clonidine (clonidine group) and 5µg dexmedetomidine (dexmedetomidine group). Results: Clonidine and Dexmedetomidine group showed an early onset of both sensory and motor blockade and a higher level of sensory blockade compared to Control group and duration of sensory, motor blockade and duration of analgesia is significantly prolonged in the clonidine and dexmedetomidine group compared to the control group which was found to be statistically significant (p<0.001). Conclusion: Our study concludes that intrathecal dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory and motor blockade, adequate sedation and prolonged postoperative analgesia.

155. Study of Maternal Outcome in Twin Pregnancy Based on Chorionicity
Avani Ahuja, Jesmitha Vijayan, Bharti Parihar, Babli Yadav
Abstract
Objective: To study the maternal morbidity & mortality in twin gestations    according to chorionicity and predict the course of twin pregnancy. Methods: All Women with twin pregnancies attending the antenatal OPD, antenatal ward, labour were included in the study, according to inclusion criteria. All the data were collected with the help of pre structured pre tested proforma. The detailed history and through physical and obstetric examination along with relevant investigation were done, risk factors if any were noted. Determination of chorionicity was done using sonography during pregnancy and by clinical assessment of placenta during delivery and described as dichorionic, monochorionic, diamniotic, monochorionic monoamniotic. Maternal outcome in terms of morbidity and mortality were noted. Results: Among 252 twin pregnancies, 188 (75.2%) were dichorionic, 64(24.8%) was monochorionic out of which 52 (20.4%) were monochorionic diamniotic and 12(4.4%) were monochorionic monoamniotic. Higher maternal age group was noted in dichorionic group (50.5%) as compared to monochorionic group (45.2%). In monochorionic and dichorionic twin pregnancies, primigravida contributed the largest percentage which was 54.8% (139 out of 252). MCMA group was found to be associated with use of ART(16.7%). In present study, significant family history of twinning was seen in MCMA group (50%). Conclusion: All the twins should have their chorionicity assessed via ultrasound, preferably in the first trimester. The practicality of reducing multifetal pregnancies, invasive diagnosis and therapy of discordant abnormalities, and counselling parents about their risk of prenatal morbidity and death all depend on the chorionicity of the mother. If unfavourable results are to be avoided, every effort should be taken to identify any foetal abnormalities as early as feasible and to perform the necessary interventions.

156. Comparative Diagnostic Accuracy of Tran-Vaginal Sonography and Hysteroscopy to Identify Intrauterine Pathology among Perimenopausal Women with Abnormal Uterine Bleeding
Vandana Gupta, Archana Gautam, Kranti Chandrajai, Rina Sharma, Vani Gupta, P.V. Saraschandrika, M. Usha Suresh
Abstract
Background: Abnormal uterine bleeding (AUB) is any departure from a normal menstruation cycle pattern i.e., regularity, frequency, heaviness, and duration of flow. Aim: To determine the diagnostic accuracy of transvaginal sonographic (TVS) and hysteroscopic in identifying the intrauterine pathologies among perimenopausal women presenting with abnormal uterine bleeding. Material and Methods: This was a single-centre, hospital-based, cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology, CARE Hospital, Hyderabad. A total of 100 perimenopausal women with AUB were enrolled. Thereafter, participants underwent clinical evaluation, transvaginal sonography, hysteroscopy, and histopathological examination of endometrial samples to evaluate intrauterine pathology. The following diagnostic characteristics viz. sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: The sensitivity, specificity, Positive Predictive Value, and Negative Predictive Value of Hysteroscopy for evaluation of endometrial pathology was greater than Trans-Vaginal Sonography. In addition, hysteroscopy had a good diagnostics agreement with histopathology for the evaluation of intrauterine pathologies. Individually, hysteroscopy has a substantial agreement with histopathology for endometrial hyperplasia [kappa=0.66 (95% CI- 0.49-0.84)] and almost perfect agreement [k=0.85 (95% CI- 0.70-0.99)] for detecting endometrial polyp. Conclusion: In comparison to Trans vaginal sonography, Hysteroscopy is a more sensitive, specific, and accurate diagnostic investigation to evaluate intrauterine pathology associated with AUB among perimenopausal women. Hysteroscopy with guided biopsy enhances the accuracy of endometrial sampling, thus providing an adequate diagnosis.

157. Etiological Profile of Meningitis in a Tertiary Care Hospital of West India
Ritapa Ghosh, Suvorit Subhas Bhowmick, Rakesh Shah
Abstract
Background and Objectives: There are few studies on meningitis in the adult population from the West India. Our objective was to study the etiological profile of community-acquired and health-care associated meningitis in a tertiary care hospital from West India. Additionally, we looked at laboratory profile which may help in recognizing subtypes of meningitis. Methods: We carried out a retrospective study in a tertiary care neuroscience hospital in Gujarat. Case records of patients admitted from January, 2013 to December, 2017 were reviewed. We included patients who had clinical features and cerebrospinal fluid (CSF) analysis consistent with meningitis. We classified the patients as community-acquired and healthcare-associated meningitis. Further analysis was carried out by grouping patients with community-acquired meningitis into acute, subacute, and chronic meningitis. Results: During the study period, 71 patients were diagnosed with meningitis. The causative agent was isolated in 21.4% of the patients with acute meningitis, 21.7% of the patients with subacute or chronic meningitis, and 44.4% of the patients with healthcare-associated meningitis. The patients with pyogenic meningitis had higher white blood cell counts, CSF cells, and CSF protein, compared to those with aseptic meningitis. Majority of the patients with subacute or chronic meningitis were presumed tuberculous meningitis based on clinicopathological features. Conclusions: The yield of cerebrospinal fluid culture was low. Clinicians relied on clinical, laboratory, and radiological profile for treatment of meningitis. Leukocytosis and marked pleocytosis distinguished pyogenic meningitis, when there was overlap of clinical features with tuberculous meningitis.

158. Outcome Analysis of Pulmonary Tuberculosis Patients on Daily Drug Regimen with Fixed Dose Combination during COVID-19 Pandemic: A Cross Sectional Study at Rajendra Institute of Medical Sciences, Ranchi
Sahil Nayan Rajnish, Vidya Sagar, Shalini Sunderam, Shashi Bhushan Singh, Venkatesh N, Prerna Anand, Tanya Tanu, Jeseena K
Abstract
Background: In the tribal predominant state of Jharkhand, daily drug regimen in FDC was introduced during 2015-16. There are not many studies done to assess the outcome of TB treatment after the initiation of daily regimen under NTEP. Hence, we formed our study to identify the socio-demographic profile and factors influencing outcome of daily drug regimen in FDC which will provide the scientific intuition on tuberculosis management. Design: A cross sectional study was conducted at DOTS center of Rajendra institute of medical sciences Ranchi. All drug sensitive pulmonary TB patients in the age group of 16-80 years who were enrolled in the DOTS center between 12th April 2021 till 12th October 2021 were selected by consecutive sampling technique and followed up for 9 months. A total of 355 patients were included in the study for outcome and socio demographic profile during the course of anti-TB treatment. The protocol of the study strictly followed the Strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. Data were analyzed using SPSS V.20.0 software, Results: Patients having urban residence (12.398, p<0.001), nuclear family type (15.543, p<0.001), less than four persons in the family (16.728, p<0.001), less than two rooms in house (15.597, p<0.001), DOTS center distance less than 6km (9.943, p<0.002), drug availability on daily visit(10.925, p<0.001), Follow up with sputum examination (130.72, p<0.001) and follow up visit by Health care workers (107.52, p<0.001), Daily taking the drug (67.001, p<0.001) and knowledge of treatment duration (5.844, p=0.02), have significant association with better treatment outcome. Taking alcohol daily(37.492, p<0.001), Forgot taking pills (136.08, p<0.001), stopped without informing treatment provider (144.88, p<0.001), Stopped drug when feeling good (153.03, p<0.001), Inconvenience in taking daily (20.483, p<0.001) and Not receiving initial 750rs by tribal people (26.331, p<0.001)are having significant association with undesired treatment outcome during TB management. Conclusions: From this study, we can understand that, knowledge about the disease and treatment, easy accessibility and availability of the drug, motivations like incentives and follow up of the patients, deaddiction from alcohol, reminders calls, adherence counselling and drugs with lesser side effects will pave the way for better results while managing tuberculosis using the current regimen.

159. Study of Serum Adenosine Deaminase (ADA) Level in FNAC Confirmed Cases of Tubercular Lymphadenitis
Dhimoyee Ghatak, Babai Halder, Nirvana Rasaily Halder
Abstract
Background: Tuberculosis is a chronic pulmonary and systemic disease that predominantly occurs due to Mycobacterium tuberculosis infection. TB is a leading health hazard globally. Tubercular lymphadenitis is the commonest type of presentation of extrapulmonary TB. The Present study was done to assess correlation between FNAC and serum ADA level in diagnosing tubercular lymphadenitis and to rule out early tuberculosis in cases reported as reactive lymphadenitis by FNAC. Materials and Methods: A two-year prospective study of 54 cases of clinically suspected tubercular lymphadenitis from December 2020 to November 2022 was done. The study subjects were first confirmed by FNAC along with AFB staining. This was followed by measurement of serum ADA levels. Results: The mean age of the patients in this study was 29 years with slight predilection for female sex. Only 24%, 13 cases present with constitutional symptoms. In cytomorphology 22 cases (40.74%) diagnosed as granulomatous lymphadenitis, while 2 cases diagnosed as reactive lymphadenitis only. Most of cases (39 cases, 72.2%) show significant increase in serum ADA level. Conclusions: FNAC along with raised serum ADA level can be considered as a reliable indicator of tubercular lymphadenitis and is fairly significant though demonstration of AFB Ziehl-Neelsen stain is gold standard.

160. Evaluation of Pap Smear Examination in Patients with Complaint of Vaginal Discharge in a Tertiary Care Hospital
Avinash Priyadarshi, Nirvana Rasaily Halder, Babai Halder, Nupur Singh, Ayushi Sinha
Abstract
Background: Cervical infections of the female genital tract are usually asymptomatic in their presentation and are a major health issue for women in developing world. Cervical infections with vaginal discharge are a common problem among reproductive age group of females. A cervical pap smear is a good screening test for early detection of premalignant lesions of cervix and associated pathogens causing vaginal discharge. Materials and Methods: It was a retrospective study carried out on 100 patients attending an obstetrics and gynaecology clinic in a tertiary care hospital with the chief complaint of vaginal discharge. Cervical smear samples were collected in the outpatient department of obstetrics and gynaecology. Conventional smears were prepared by technical staff, and smears were stained with Papanicolaou (Pap) stain. Results: Of the total 100 patients examined, 43% cases were of the group consisting of 26 to 35 years old females with vaginal discharge. The most frequent findings on per speculum examination were thick, whitish discharge in 73% of cases, and Bacterial Vaginosis (BV) in 71% of cases was diagnosed as the most common infectious diseases.  Conclusion: A Pap smear must be used as a routine OPD test for all sexually active women, presenting with vaginal discharge, to detect vaginal microorganisms and premalignant conditions of cervix.

161. A Cross Sectional Study to Assess Knowledge of Health Care Workers Regarding Measles Vaccine and Cold Chain Management at Health Facilities in a District of Jammu and Kashmir, India
Ghulam Mustafa Kataria, Wahida Kouser
Abstract
Background: In India, particularly in Jammu and Kashmir, maintaining the quality of vaccines has been one of the major obstacles to immunisation programmes. This might be mostly explained by health professionals’ expertise in cold chain management. This study was undertaken since there hasn’t been much research relating to health professionals’ understanding of cold chain management in Jammu and Kashmir. Methods: A cross-sectional study was conducted in Rajouri district in Jammu and Kashmir within one month. 95 Healthcare workers were recruited in this study, but only 92 met the inclusion criteria. A structured questionnaire was made, and the collected data were analysed by using Statistical Package for Social Sciences version 23. Results: Females made up the majority (77.2%). The age range of 30-44 years was represented by 61.9% of participants. The majority (59.8%) had a minimum of ten years of job experience. However, just 26.1% of people had a bachelor’s degree or more. The first dosage of the measles vaccine was administered at a time that almost all of the medical staff were aware of. The knowledge evaluation score was computed using a 100% scale. 20% was the average knowledge score. Most healthcare professionals are unsatisfactorily knowledgeable about cold chain management and the measles vaccination. Conclusion: It was determined that healthcare personnel’s knowledge of vaccines and cold chain management was inadequate. We advised the relevant health authorities to regularly educate staff members about the many facets of immunisation and vaccine management. To determine the cause of the lack of knowledge among healthcare professionals, further in-depth study is needed.

162. A Comparative Clinical Study of Collagen and Paraffin Gauze Dressing on Skin Donor Site in Shyam Shah Medical College Rewa, Madhya Pradesh
Ajay Kumar Pathak, Anaswara M, Siddharth Jain, Alkesh Kumar Meena
Abstract
Background: The surgical treatment known as split-skin grafting (SSG) falls mainly under the purview of plastic surgery. Wounds, deficiencies after excision of cutaneous lesions, and donor sites of fascio-cutaneous flaps can all be covered by SSG. Partial thickness damage is sustained during the harvest of a split-thickness skin graft. Although the rate and length may be altered by local, systemic, environmental, and other factors, complete re-epithelialization occurs in 10-14 days. Aims and Objectives: The goal of this study is to compare the healing, discomfort, secretion, infection, and expense of using conventional paraffin gauze dressing with collagen-based dressings on a donor-site split-thickness graft. Study was performed at Shyam Shah Medical College in Rewa, Madhya Pradesh, ran a one-year, hospital-based, non-randomized control experiment. Seventy patients participated in the research. Materials and Methods: Two groups were created from the selected sample. There were two approaches taken to treat the donor site. A collagen sheet was used on one, while paraffin gauze was used on the other. Post-operative discomfort, complications, and recovery times were compared between the two groups. Mean, proportion and percentage were employed as descriptive statistics to present the findings. The correlation between the numbers was analyzed using the Chi-square test. The continuous variables were analyzed using the Student’s t-test and the repeated measures ANOVA. The cutoff for significance was set at P0.05. Results: According to the predetermined sample size, 70 patients participated in this research. Patients in the Case group had collagen dressings applied to their STSG donor sites, whereas those in the Control group had paraffin gauze dressings applied. Post-operative discomfort in patients treated with collagen dressings was rated as mild to severe. These patients had a decreased need for analgesics, allowing for earlier mobilization. Collagen has this key benefit when used as a donor site dressing. By reducing the likelihood of infection, which saves time and money for the hospital staff and minimizes patient discomfort, we observed that collagen modestly promotes epithelization. Conclusion: Collagen-based dressings, as opposed to traditional paraffin gauze dressings, were observed to improve healing time and post-operative pain scores at the donor site for split-thickness grafts in this study.

163. Analytical Study of Management and Outcome of Burns in Pediatric Age Group in SSMC Rewa
Saurabh Saxena, Alkesh Kumar Meena, Neha Shrivastava, Siddharth Jain
Abstract
Background: Fire has served as well as destroyed mankind. It is good servant but bad master. Since the evolution of man, he has created fire, which was a major source of energy for keeping warm under extreme temperature, source of cooking food and stay away from wild animal. But with advantage the injuries caused by fire has come as a necessary evil accompanying the good. Aims and objective: The present study aim to analyse to different aspect related to burn injury in paediatric age group and its preventive measure, magnitude of burn management and their outcomes in Vindhya region Rewa (M.P.). Materials and Methods: This prospective analytical study was carried out on paediatrics patients admitted in Burn Unit of Surgical wards of Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa (M.P.) during of 1st June 2019 to 31st May 2020. The objective was to analyse the demographic characteristics and outcomes and patterns of electrical injuries, to assess the demography, degree of disability and loss of life due to electrical burn in paediatrics patients. Result: We had 112 patients (76 male and 46 female) of electric burns admitted in our centre. Most of the accidents leading to the electrical burn injuries could have been prevented. Conclusion: Prevention is possible by increasing public awareness through primary education among the rural people and by taking adequate precautions such as the use of personal protective equipment’s (insulated gloves and footwear.) and following national electrical codes.

164. Comparison of the Effect of 2 Mg & 4 Mg IV Zolendronate on Bone Mineral Density at the Lumber Spine on Menopausal Women with Osteoporosis
Yogesh Kumar Gautam, Harpreet Singh, Pookhraj Choudharay
Abstract
Background: Postmenopausal osteoporosis is a serious skeletal condition requiring immediate attention to improve the bone mineral density & preventing fractures. Zolendronate is currently most commonly used in the treatment of osteoporosis in postmenopausal women. Aims & Objectives: To compare the effectiveness of 2 mg and 4 mg iv ZA on the change in the lumbar spine (LS) BMD in postmenopausal women with osteoporosis at one year. Material & Methods: This randomized controlled clinical trial was conducted in Department of Orthopaedics from January 22 till January 23. The study recruited 60 postmenopausal women in age range 50 -80 yrs who had achieved menpause at least 5 yrs back. Patients were randomized into two groups: Group A- received a single IV infusion of 2 mg zolendronate in 100 ml of normal saline over 30 min & Group B- received a single IV infusion of 4 mg zolendronate in 100 ml of normal saline over 30 min. Parameters analysed were serum calcium along with albumin, phosphorus, alkaline phosphatase, creatinine, 25(OH) D, plasma intact parathyroid hormone, and bone turn over markers & bone mineral density of lumbar spine (L1‑L4), nondominant FN, and TH were measured at baseline, 6 months, and at 12 months Adverse events were noted. Results: This randomized controlled clinical trial included 60 osteoporotic postmenopausal patients, out of which 56(94%) had osteoporosis at LS, whereas osteoporosis at FN and TH was present in 15 (25%) and 13 (21%) patients, respectively. The BMD at both LS and FN were raised significantly at 12 months in both Group A & Group B which was statistically significant. But the percentage increment in BMD at 12 months was higher in Group 2 as compared to Group 1.The levels of β-CTX and P1NP showed a reduction at 6 months the effect of which was sustained at 12 months in both the groups. Mild adverse events like fever & flu were noted within 3 days of the drug administration which was symptomatically treated. Conclusion: The study concludes the better efficacy of 4mg dose over 2 mg dose of iv zolendronate & supports its use in increasing the bone mineral density at lumbar spine at completion of one year.

165. Soft Tissue Tumors: Histopathological Spectrum and Clinicopathological Characteristics at a Tertiary Care Center
Bhavana Garg, Jubeda Bano, Indu Choudhary
Abstract
Background: Soft tissue tumors (STTs) are a rare and diverse group of neoplasms that arise from nonepithelial extra-skeletal tissues of the body. This study aimed to analyze the histopathological spectrum and clinicopathological characteristics of STTs diagnosed at the tertiary care center in Udaipur, Rajasthan, India. Methods: This retrospective study was carried out in the Department of Pathology at Pacific Medical College & Hospital over a period of three years from January 2018 to December 2021. The data collected were entered into a Microsoft Excel spreadsheet and analyzed using SPSS version 25. Results: A total of 100 cases of soft tissue tumor were included in this study. Of these, 83 cases (83%) were benign and 17 cases (17%) were malignant. The most common site for both benign and malignant tumors was the extremities (37% of all cases), followed by the head and neck (29%). Adipocytic tumors and tumors of the peripheral nerve sheath were the most common types of benign tumors, respectively. Conclusion: Accurate histologic classification and additional ancillary studies such as immunohistochemistry, cytogenetics, and molecular genetics are needed for accurate diagnosis and prognostication of soft tissues tumors.

166. Nevus Lipomatosus Superficialis: A Rare Case Report
Deeksha Singh, Bhuvan Adhlakha, Shalini Shukla, Samridhi Allahabadi, Shivani Kalhan
Abstract
Nevus lipomatosus superficialis is a rare hamartoma of skin. It occurs due to presence of mature adipose tissue in dermis. It is of two types classical and solitary. Here we report a case of 30 year old female with a slowly growing pedunculated growth in right gluteal region for 6 years. Growth measures about 3×2 cm. Microscopically underlying dermis shows mature adipose tissue which shows no connection with subcutaneous fat. Adipose tissue also seen interspersed between collagen bundles. A final diagnosis of Nevus lipomatosus superficialis was made.

167. Clinical, Epidemiological Analysis of Vaginal Discharge and to Establish Quick Etiopathological Diagnosis in OPD Setting
Sangeeta Gupta Prasad, Ankita Singh, Ishita Sharma
Abstract
Background: One of the commonest problem encountered in women in reproductive age group is vaginal discharge. The aim is to gain knowledge about the clinical, socio-epidemiologic profile and to establish a quick etiopathogenesis in OPD of a tertiary care centre. Method: A total of 200 women were enrolled in this study, conducted over a period of 1 year at American International Institute of Medical Sciences, Udaipur. Information regarding the sociodemographic profile was obtained through pre-structured questionnaire. For quick cytological diagnosis, samples taken from vaginal fornices with 2 dry cotton tipped swabs were examined in OPD using wet mount saline microscopy. Result: Maximum incidence of vaginitis is in the age group 21-30 years (121/61%), more common in multipara (88/44%). Clinical and cytological studies show highest incidence of bacterial vaginosis (104/ 54%). Average perception regarding the aetiology, infective route, ill effects, and preventive methods were noted. Conclusion: Combining the clinical symptoms with the cytological studies increases the diagnostic accuracy. Information about the socio-demographic profile is essential in formulating health policies.

168. A Study of Cases of Blunt Abdominal Trauma: A Prospective Study
Abrar Ahmed Aazam, Vivin Thomas Varghese, Sonal Vaishnav, BL Bairwa
Abstract
Commonest cause of blunt abdominal trauma was found to be Road Traffic Accident. Commonest age group is in between second, third and fourth decade, with male preponderance. In all age groups, males are affected more than females. Most of the patients were admitted within first six hours of injury. In my study, liver is the most commonly involved organ followed by spleen. In this study, USG remains the most suitable investigation in our setup, while CT scan plays a significant role in polytrauma with multiple organ injuries. Out of 100 cases, 72 patients managed conservatively, and 28 required the operative intervention. There are complications associated with the operative mode of treatment; most commonly being wound infection. Highest incidence of operative intervention was found among the patients of road traffic accident. Two patients having liver injury, expired. They were managed conservatively.

169. Study of Association between Body Fat & Diabetic Neuropathy in Middle Aged Adults with Type-2 Diabetes Mellitus at SMS Medical College & Attached Hospital Jaipur (Rajasthan)
Kirtesh Sharma, Mahendra Kumar, Mukesh Kumar Bunkar, Rati Mathur
Abstract
Background: Diabetes and its complications have a significant impact not only on the individuals’ economy but also on their quality of life. Diabetic neuropathy is the most common neuropathy and is associated with a wide range of clinical manifestations. Obesity and increased body fat causes insulin resistance which promotes low-grade inflammation. This inflammation influences endothelial dysfunction and micro-vascular complications. This study evaluated the association of glycemic control and body fat with diabetic peripheral neuropathy in Type 2 Dm patients. Materials & Methods: After taking necessary permissions, a cross sectional study was conducted at Department of Biochemistry and Department of Endocrinology, SMS Hospital, Jaipur. This study includes 50 Type 2 DM cases having Diabetic neuropathy (DN) aged 20-55 years compared with 50 Type 2 DM cases without Diabetic neuropathy. Samples were analyzed for the measurement of serum glucose by Colorimetric method, body fat mass by bioimpedance analysis and HbA1C measured by latex turbidimetric method. Results: Results were analyzed statistically by Student’s t-test and Pearson correlation coefficient test. mean Body Fat levels for DN Positive cases was 27.60 ± 5.00 % and that for DN Negative Cases was 24.47 ± 2.72 %. Body fat levels were significantly high in DN positive patients. There was statistically highly significant positive correlation between Body fat levels with Fasting blood sugar and HbA1c in diabetic patients. Conclusion: Obese patients have a higher prevalence of neuropathy in type 2 diabetes cases. The neuropathy in this population is associated with lower quality of life and higher pain scores, indicating that the neuropathy is clinically important. Current clinical practices should concentrate on the management of obesity in cases of diabetes in with neuropathy. Early preventive strategies like life style changes (e.g. healthy diet, regular exercise, maintaining ideal body weight, absolute avoidance of smoking, alcohol) should be adopted.

170. A Comparative Study of Serum Calcium, Phosphorus and Amylase in Chronic Kidney Disease Patients at SMS Medical College & Attached Hospital, Jaipur, Rajasthan
Mukesh Kumar Bunkar, Mahendra Sharma, Kritesh Sharma, Gigaram Verma, Neelima Hemkar
Abstract
Background: Chronic Kidney Disease (CKD) is a progressive loss in renal function over period of many months or years. As compared to the past decades, the number of kidney diseases leading to end CKD is increasing in India. The disease is associated with the decreased glomerular filtration rate (GFR). As the GFR declines, there is accumulation of metabolic end products excreted by Kidney. Serum Calcium, Phosphorus and serum amylase levels may be disturbed in CKD. So we aimed to evaluate serum Calcium, Phosphorus and Amylase levels in Chronic Kidney Disease patients with healthy controls. Methodology: After taking necessary permission study conducted in Department of Biochemistry and Urology & Nephrology Clinic and Medical Outdoor of S.M.S. Hospital, Jaipur. 95 cases of CKD compared with healthy controls for Serum calcium, Phosphorus and amylase. Observation: Results were analysed statistically by student’s t test and pearson correlation coefficient test. Mean Calcium, Phosphorus and amylase level in CKD patients was 6.44 ± 0.78 mg/dl, 10.31 ± 1.50 mg/dl,  104.43 ± 20.89 U/L respectively and in controls 9.54±0.58 mg/dl, 3.57 ± 0.48 mg/dl and 52.27 ± 13.89 U/L respectively. This difference was statistically significant (p<0.01). Conclusion: Due to derangement of serum calcium, phosphorus and amylase levels level in patients with CKD estimation of serum level of serum calcium, phosphorus and amylase even in the early stage CKD is recommended.

171. Evaluation of Anxiety Levels in Patients undergoing Interventional Pain Procedures
Puneet Kumar, Manish Kumar Singh, Manoj Kumar Chaurasiya, Sarita Singh
Abstract
Anxiety is a mental condition of apprehension, worry and concern over dangerous events correlated with physiological alertness. Chronic pain patients who require interventional pain procedures provide unique challenges to anaesthesiologists. This patient population often presents with significant psychiatric comorbidities and complex poly-pharmacy. Anxiety can produce apprehensive reactions that result in an increase in distress experienced by the patient and make the management and control of pain more difficult. Planning interventional pain procedures can also augment the levels of anxiety in patients. Concurrent anxiety, hyper-algesia, and claustrophobia can make interventional management of these patients difficult. Interventional pain procedures often require patient awareness and feedback for specific aspects of the procedure to avoid serious complications.
Consequently, it is important to discover an alternative therapy to relieve anxiety and pain. It is well known that anxiety can alter the course of pain. There are various pharmacological strategies to reduce anxiety but the current short-acting anxiolytic agents like Benzodiazepines and pain-relieving opiates are associated with numerous side effects such as drug tolerance, abuse and sedation. Pre-procedure counselling, along with non-pharmacological techniques like such as spiritual rituals, music, meditation, and information provision like an informed and explained consent are known to be strategies helpful in reducing pre-procedural anxiety.
This study is one of the few studies done on patients undergoing interventional pain relieving procedures. Based on our findings, we come to know how significantly prevalent is anxiety in such patients of different age & gender groups as well as we can see how appropriate counselling and education before the procedure can cause a decrease in anxiety levels. Further, more studies are needed which will help further to identify factors contributing to anxiety thereby improving outcomes in patients undergoing interventional pain relieving procedures.

172. Study of Post-Operative Complications of Phacoemulsification and its Visual Outcome in Chidambaram, Tamil Nadu
Nithyapriya Chinnaraju, Vidhya Elango, Sriram Balaji
Abstract
Background: Cataract remains the leading cause of curable blindness in the world. In India, Cataract is responsible for 50-80% of the bilaterally blind. At present Phacoemulsification is fast growing in popularity and is opted as a surgery of choice for cataract extraction due to its various advantages. But phacoemulsification has its own share of complications and a long learning curve. This study is focussed upon the post-operative complications of phacoemulsification. Methods: This is a prospective study of a group of 50 patients who underwent Phacoemulsification at Rajah Muthiah Medical College Hospital, Chidambaram, Tamil Nadu from May 2011 to May 2013. The patients were classified based on type of cataract. Thorough pre-operative examination was done by slit lamp bio-microscopy, indirect ophthalmoscopy and OTI B Scan Ultrasonography. The exclusion criteria included significant corneal opacification, uveitis, pre-existing glaucoma and pre-existing posterior segment disorders. The keratometry and IOL power were calculated using OTI/Sonomed A Scan. The surgical techniques were performed under local anaesthesia. Phacoemulsification was done with the Appasonic Galaxy I phaco emulsifier system. Post operatively the patients were assessed on 1st day, 1st week, 1st month and after 6 months. On every visit, BCVA (Best Corrected Visual Acuity) was assessed and slit lamp examination was done. Keratometry readings were taken on the 6th month visit to assess post-operative astigmatism by comparing them with pre-operative keratometry readings. Results: Surgically induced corneal astigmatism had a general shift towards ATR (Against The Rule). Incisions of 2.8 mm length were least astigmatic than 6mm incisions. The group showed preponderance to a lesser degree of astigmatism with incisions closer to the limbus. Conclusions: The study showed that post-operative astigmatism and inflammation were minimal. Visual recovery and patients’ rehabilitation were accelerated with phacoemulsification.

173. Prospective Study of Perinatal Outcomes in Infants of Diabetic Mothers
Abhinay Bhaskar Darwade, Parikshit Pundalik Deore, Avinash Dinkar Saindane
Abstract
This prospective study aimed to investigate the incidence of perinatal complications in infants of diabetic mothers and the impact of maternal glycemic control on neonatal outcomes at Deenanath Mangeshkar Hospital, Pune, from April 2011 to April 2012.
Out of 1074 deliveries during the study period, 118 involved pregnancies with diabetes, resulting in a gestational diabetes incidence of 9.4%. Among the 130 live born infants of diabetic mothers studied, there were no reported mortalities. Approximately 13.07% of the mothers had pregestational diabetes, while the rest had gestational diabetes. Vaginal delivery occurred in 40.7% of cases, with assistance provided in 35% of these deliveries. Cesarean sections were performed in 59.2% of cases. Full-term deliveries were observed in 73.07% of cases, and 26.92% were preterm. The incidence of low birth weight was 20%, while rates of large for gestational age, appropriate for gestational age, and small for gestational age were 32.23%, 63.63%, and 4.13% respectively, based on Indian growth curves. Neonatal complications, excluding preterm and large/small for gestational age infants, were present in 67% of cases, with hypoglycemia being the most common (48.46%). Hypoglycemia was more prevalent in the pregestational diabetes mellitus group compared to the gestational diabetes mellitus group. Hyperbilirubinemia and hypocalcemia were also frequently observed. Major malformations were found in 17% of cases, predominantly cardiac malformations, with atrial septal defects being the most common structural heart disease.
The study highlights the significance of implementing meticulous, protocol-based care for infants born to diabetic mothers.

174. Temporalis Fascia Graft versus Sliced Tragal Cartilage Graft for Type-1 Tympanoplasty: A Comparative Study
Kothapally Rajashekhar, Ranjana D Telkar, Harkawal Kaur Khanuja
Abstract
Introduction: Tympanoplasty is a tissue transference procedure to reconstruct the tympanic membrane perforation inline of chronic otitis media. Cartilage graft and temporal fascia graft are reliable methods for tympani membrane reconstruction. The aim of this study was to compare the temporalis fascia graft versus sliced tragal cartilage graft for type-1 tympanoplasty. Material and Methods: A source of forty-eight participants with safe type chronic otitis media aged between 14 to 60 years were included. Study participants were randomly divided into group 1 or cartilage group and group 2 or fascia group were undergone mastoidectomy with type 1 tympanoplasty or type 1 tympanoplasty alone. Postoperative follow-up was done at 1st week, 3rd week and 3rd month and pure tone audiometry was conducted to check the hearing gain. Results: The hearing gain was 9.42 dB in group 1 and 5.64dB in group 2. The mean difference was statistically not significant between study groups (p>0.05). One case in each group showed retraction and 12.5% and 29.17% of cases showed reperforation in type-1 tympanoplasty alone and type-1 tympanoplasty with CM respectively. Conclusion: The temporal fascia graft and sliced tragal cartilage graft are effective for type 1 tympanoplasty. However, type 1 tympanoplasty with sliced cartilage graft have showed better hearing gain than temporal fascia graft.

175. A Comparative Study of the Impact of Acute Febrile Illness during Pregnancy
Shradha Jain, Shubhangi Soora, Kanchan, Beeravolu Mounika Reddy
Abstract
Introduction: Fever during pregnancy causes significant maternal and foetal complications. The coexistence of pregnancy may aggravate the risk to maternal life. The most common antenatal complications observed were preterm labour, premature rupture of membranes, oligohydramnios and intrauterine growth restriction. Material & Methods: Total 160 pregnant women more than 20 weeks of gestation were enrolled in which 80 were acute febrile (fever less than 7 days) and another 80 were afebrile subjects. Patient history, antenatal, Intra-natal, Postnatal and Foetal outcome complications were identified and monitored. Results: 78.75% had fever in the third trimester. 36.25% of febrile and 20% of non-febrile patients experienced premature labour. 36.25% babies born to febrile moms and 10 % from afebrile mothers required NICU admission. Conclusion: If the cause of the fever is identified and treated appropriately, the maternal and foetal problems may be prevented.

176. Prevalence of Diabetes Mellitus in Myocardial Infarction Patients: An Observational Study
Sunil Jain
Abstract
Background: According to reports, diabetes is a standalone risk factor for the development of cardiovascular disease. According to data from the World Health Organisation (WHO), cardiovascular disease is having a greater global impact on mortality and morbidity. Material & Methods: Our tertiary care hospital served as the site of the current observational study, which lasted six months, from June to November 2018. After receiving written informed consent, we enrolled 100 AMI patients. Results: 60% of the study participants had normal blood sugar levels, 25% had diabetes mellitus that they were already aware of, 11% had the condition discovered for the first time while in the hospital, and 4% had elevated blood sugar levels brought on by stress. Conclusion: Increased blood sugar was linked to acute cardiovascular conditions, particularly in individuals with acute myocardial infarction, and was also a predictor of prognosis and recurrences.

177. Correlation of Pulmonary Function Test and 2 D Echocardiography in Patients of Acute Myocardial Infarction
Sunil Jain, Nidhi Sanwalka
Abstract
Background: Atherosclerotic vascular disease, which lowers left ventricular function and raises pulmonary vascular pressure, is the most common cause of AMI. Although pulmonary function tests are a non-invasive and generally available method of assessing pulmonary function, their association with left ventricular function following AMI warrants further exploration. For complete investigation, advanced tools such as sophisticated spirometry and 2D echocardiography are required. Understanding the heart-lung relationship is critical, especially in resource-constrained environments. Methods: In this investigation, pulmonary function tests were combined with 2D echocardiographic data in AMI patients. The literature lacked baseline data on pulmonary function tests. To further understand left ventricular function, the researchers examined LVEF and spirometry characteristics, stratifying individuals based on pulmonary function. Results: The study found that AMI patients had poorer LVEF values, especially those with front wall MI. FEV1 and PEFR decreased significantly as LVEF decreased, showing the impact of decreased left ventricular performance on pulmonary function. The FEV1/FVC ratio study revealed a restrictive pattern, with FVC falling faster than FEV1. Conclusion: This study examines the relationship between pulmonary function tests and left ventricular performance in patients with acute myocardial infarction. Pulmonary function tests can be used as a stand-in for assessing left ventricular function.

178. Pediatric Population Home Medication Review for Drug Compliance Assessment A Community-Based Study
Partha Kumar Chaudhuri, Divya Singh, Bhuwan Kumar Singh
Abstract
Objective: Drug compliance is a key factor in determining a treatment’s safety and effectiveness. Medication compliance is the question of whether a patient is taking their medications as prescribed by a doctor and in the appropriate quantity and timing. Failure to comply can result in therapy failure or have long-term effects. Due to their unique pharmacokinetic characteristics, the pediatric population is a particularly vulnerable segment of society and needs to be handled with the utmost caution. The information regarding pediatric compliance was gathered for this community-based prospective trial by reviewing each study subject’s home medication regimen. Methods: In this community-based prospective study, which was conducted by Rajendra Institute of Medical Sciences, Ranchi within a year, data on pediatric compliance were gathered by reviewing each study subject’s home prescription regimen. 150 children participated in the trial, and they were evaluated for their medication compliance. Results: It was discovered that 52% of the population showed low adherence, 30% demonstrated medium adherence, and 18% demonstrated strong adherence. The research population’s noncompliance with its treatment was around 82%. Conclusion: Since the majority of the participants in this research were noncompliant, it is essential to raise public awareness about drug adherence.

179. Outcome of Treating Primary Hypothyroidism in Correction of Mildly Elevated Serum Prolactin Level in Menstrual Disorders
Renuka Keshri, Arshi Praveen, Rajni Kaushav, Abhilasha Jha
Abstract
Introduction: Association of hyperprolactinemia with primary hypothyroidism is well known in the literature however, marked elevation of serum prolactin in subclinical hypothyroidism (SCH) has not been commonly reported. Elevated levels of serum thyroid stimulating hormone (TSH) and serum prolactin are seen in different menstrual irregularities. Method: In our study, we have assessed serum prolactin and serum TSH levels in females suffering from menstrual disorders and implication of treatment of primary hypothyroidism on serum prolactin level. Result: Our study shows that the treatment of primary hypothyroidism with thyroxine sodium corrects mildly increased serum prolactin level concomitantly. Conclusion: The treatment of primary hypothyroidism with thyroxine sodium brings serum prolactin level down and toxic effects of treating hyperprolactinemia separately may be avoided.

180. Advancement of Oral & Maxillofacial Surgery with CBCT
Santosh Mishra, Rahul Mishra, Madhuri Shukla, Varun Arya
Abstract
2Cone Beam Computed Tomography (CBCT) is a most valuable imaging technique used in oral and maxillofacial surgery. The introduction of CBCT for imaging the oral and maxillofacial region, holds a major change from two dimensional to three-dimensional approach. CBCT provides a complete 3D view of the oral and maxillofacial structures with high resolution which helps for accurate diagnosis, treatment planning and postoperative outcomes compared to conventional 2D images. Radiation exposure to the patient is very low in CBCT. The main clinical applications of CBCT arein oral and maxillofacial surgery, orthodontics, periodontics and in endodontics. The aim of this article is to review on the advantages, disadvantages and clinical applications of CBCT in the oral& maxillofacial surgery.

181. Deep Subfacial Approach for Temporomandibular Joint Ankylosis Patient with Evaluating Facial Nerve Injury by “Facial Nerve Grading System”
Santosh Mishra, Madhuri Shukla, Rahul Mishra, Sushma Mishra
Abstract
Background: Preservation of the functional integrity of the facial nerve (FN) is a critical measure of success in temporomandibular joint (TMJ) surgery. In spite of the development of a myriad of surgical approaches to the TMJ, FN remains at risk. The deep subfascial approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the FN and thus, is the safest method to avoid FN injury. Objectives: To assess FN injury following TMJ surgery using deep subfascial approach and measuring it on House and Brackman facial nerve grading system (HBFNGS). Materials and Methods: Twenty TMJs in 18 patients were operated for TMJ ankylosis, using “the deep subfascial approach.” FN function was assessed postoperatively at 24 h, 1 week, 1 month, 3 months, 6 months using HBFNGS. Statistical analysis was done using SPSS 16.0. Results: Of 20 surgical sites 3 sites showed Grade III (moderate) FN injury and 17 sites showed Grade II (mild) FN injury at 24 h. The condition improved with time with full recovery of FN at all surgical sites at 6 months. Conclusion: The deep subfascial approach has a distinct advantage over the conventional approaches when dissecting the temporal region and is the safest method to avoid injury to FN.

182. Medical Students and Their Preference for Educational Resources: A Cross-Sectional Study
Varidhi Thaman, Sehaj Chahal, Richa Ghay, Gurdev Goyal
Abstract
Objectives: To identify the educational resources medical students are using for self-study. Methodology: A self-administered questionnaire was designed after a literature search and validation. It was sent to medical students through wats app and email. Students were asked about the educational resources they use, both online and traditional, resources they used while learning new concepts and when revising concepts. Whether they used question banks, smartphone applications, and reasons for attending tutorials. Results: While selecting their educational resources, 52% wanted their resource to be concept based,34% opted for clinical-based learning, 6.8% for a quick learning medium,4.4% for pre-prepared notes, and 2.8% went for question-based learning. For learning new topics, 54% of respondents prefer traditional resources (lectures, textbooks, and handmade notes) while 46% prefer e-learning platforms (smartphones apps, question banks, and online resources). For the revision of topics, 50.8% of respondents chose e-learning platforms while 49.2% prefer traditional resources. 50.8% reported attending lectures as fulfilling the importance of attendance.  73.6% of the respondents preferred lectures as an educational resource for both learning new topics and revision of previously learned topics. majority of respondents (74.4%) preferred smartphone apps as an educational resource for both learning new topics and revision of previously learned topics. 65.6% of students used you tube and 25.6% used google as an additional educational resource. Conclusion: There is a shift from a teacher-centered approach to self-directed learning and more independent learning. Students prefer blackboard teaching, yet medical faculty must bring forth technology-enhanced teaching learning, and assessment resources to stay more relevant and apropos.

183. Clinico-Epidemiological Study of Acute Flaccid Paralysis at N.S.C.B. Medical College, Jabalpur
Shivanand Solanki, Shammi Jain, Shiv Singh Manjhi
Abstract
Background: Acute flaccid paralysis (AFP) is the sudden onset of weakness and floppiness in any part of the body in a child under the age of 15 or if a clinician suspects polio in any person of any age, excluding adults, spastic paralysis, old cases, or cases with apparent causes such as trauma. This study aims to know the epidemiology and clinical characteristics to describe the incidence and differential diagnosis of potential causes of AFP in the Jabalpur region and will be supported by polio surveillance. Materials and Methods: An institution-based prospective study included all cases fulfilling the AFP case definition. History, clinical examination, and necessary investigations were performed, and the required treatment was given. Regular follow-ups were done, and the final classification was made along with the AFP surveillance team. Statistical analysis was done using predesigned proforma and analyzed using statistical software -S.P.S.S. version 21 & Medcalc 19.5. Results: Out of 119 patients, the majority were male, belonged to a low socioeconomic category, and most of their father’s occupations were manual (63.9%). The provisional findings showed that the majority of the cases were due to GBS 30.3% followed by 14.3% dyselectrolytemia, 8.4% isolated facial palsy, 7.6% viral myalgia, 6.7% hemiparesis, 4.2% paraplegia, 2.5% meningitis, 2.5% meningoencephalitis, 2.5% traumatic neuritis,  1.7% quadriplegia, 1.7% adp, 0.8% floppy neck, 7.6% unknown and 9.2% other. Fever and sensation loss were present in 30.3% and 92.4%, respectively. It was also found that other parameters’ distribution was not statistically significant except for the parameters listed. Conclusion: AFP was more common in males, especially those from low socioeconomic categories whose father’s occupation was manual. Moreover, G.B.S. was one of the common causes of AFP, and it could be the most common differential diagnosis among all AFP included.

184. Nutritional Support Following Emergency Laparotomy: A Retrospective Cohort Study from the Surgical Ward at Shyam Shah Medical College, Rewa, Madhya Pradesh
Alkesh Kumar Meena, Abhilash Singh, Gautam Tayade, Saddam Singh
Abstract
Background: While adequate nutrition after major abdominal surgery is linked to fewer postoperative complications and shorter hospital length of stay (LOS) after elective procedures, there is a paucity of research focusing on the adequacy of nutrition following emergency laparotomies (EL). Aims and Objectives: To examine the correlation between sufficient nutrition and improved outcomes, such as decreased postoperative complications and shorter hospital LOS, following emergency procedures, specifically after EL in the surgical ward of Shyam Shah Medical College in Rewa, Madhya Pradesh. Materials and Methods: To conduct the study, retrospective data from 200 adult patients who underwent EL between January 2022 and December 2022 at Shyam Shah Medical College in Rewa, Madhya Pradesh, were analyzed. The focus was evaluating nutrition adequacy and identifying complications during the first ten days after the surgery. Results: The results revealed that 50% (100 patients) achieved overall nutrition adequacy of at least 80% during the initial ten postoperative days. Patients who received adequate nutrition, surpassing 80% of the recommended caloric intake, achieved their nutritional targets by the second day after the operation. Conversely, patients who received lower nutrition delivery, falling below 80% of the calculated calories, increased their caloric intake during the first five postoperative days but failed to reach the desired 80% level. Multivariate analysis indicated that not achieving 80% nutrition adequacy was associated with postoperative ileus, loss of appetite, and higher individual energy requirements. Conclusion: During the first few postoperative days after EL, inadequate nutrition supply is a typical complication. Oral nutrition is the best way to start feeding this population in the surgical ward. Careful monitoring of nutritional supplementation is essential for people who cannot eat orally.

185. Evaluating Analgesic Efficacy of Ultrasound-Guided Ilioinguinal – Iliohypogastric Nerve Block in Patients Undergoing Unilateral Inguinal Hernia Repair
Kapil Prajapati, Sakshi Jain, Nidhi Pandey, Mili Yadav
Abstract
Background: Inguinal hernia repair is one of the commonest surgeries performed. Poorly controlled post-operative pain following herniorrhaphy might be a predisposing factor for the development of chronic pain. The use of ultrasound for nerve block enhances the success rate. Aim and objective: To gauge the analgesic efficacy of ultrasound-guided ilioinguinal (IL) – iliohypogastric (IH) nerve block in patients undergoing unilateral inguinal hernia repair. Materials and Methods: Sixty patients of the American Society of Anesthesiologists grade I–II undergoing elective unilateral inguinal hernioplasty were studied between Jan 2020 to Dec 2020. Patients were randomly divided into USG-guided II-IH blocks performed with 15 ml of normal saline (Group C; n=30) and 15 ml of 0.25% bupivacaine (Group S; n=30). A visual analogue scale (VAS) score was used for pain assessment. Patients who had VAS of 3 or more received i.v. Pentazocine. Patients were monitored for VAS scores and total analgesic consumption for 24 hours. Results: II-IH block reduced VAS score at 2, 4, 6, 8, and 12 hours. This nerve block with 0.25% bupivacaine resulted in 7.50 hours of analgesia. Rescue analgesia was consumed less in group S. No complication was observed in this study. Conclusion: Ultrasound-guided ilioinguinal-iliohypogastric nerve block is an effective and safe adjunct to multimodal post-operative analgesia after inguinal hernia repair surgeries. This reduces rescue analgesia consumption and provides a good VAS score. No complication was observed in any group.

186. Study of Inflammatory Markers and Lipid Profiles on Obese and Non-Obese Patients with Rheumatoid Arthritis
Swati Pathak, Shreya Nigoskar, Amrita Vamne, Shraddha Singh
Abstract
Obesity has been identified as a significant risk factor for various chronic diseases, including rheumatoid arthritis (RA), which is characterized by joint inflammation. Obesity is also associated with increased levels of inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The objective of this study was to examine whether obesity has a confounding effect on ESR and CRP levels in patients with RA who are in a low disease activity state or remission, as indicated by the clinical disease activity index (CDAI). Material and Methods: To categorize adult rheumatoid arthritis (RA) patients based on body mass index, the study divided them into two groups: obese and non-obese. Additionally, relevant exclusions were implemented to eliminate factors that could contribute to elevated inflammatory markers. The study then conducted an analysis comparing C-reactive protein (CRP), lipid profile, and erythrocyte sedimentation rate (ESR) differences between the obese and non-obese groups. Results: In comparison to non-obese individuals (n = 28), obese patients with RA (n = 28) exhibited higher CRP and ESR (p-values 0.0001 and 0.001, respectively). Additionally, compared to non-obese females, obese females with RA had significantly higher CRP and ESR levels. In contrast, men did not significantly differ. Two non-obese RA patients (3%), and twenty-one obese (24.7%) RA patients, both showed increased CRP (difference of about 22% [24.7 minus 3]. The difference between 16 non-obese and 40 obese RA patients with high ESR was almost 23% (47 minus 24.2). Conclusion; Therefore, we conclude that 22% and 23% of patients, respectively, obesity was the attributable cause of falsely elevated CRP and ESR.

187. Evaluation of the Incidence and Common Causes of Maternal Near Miss among the Cases Admitted in Tertiary Health Care, Jharkhand, India
Suchita Singh, Neelam Kalundia
Abstract
Background: Maternal Near Miss is defined (WHO) as a woman who survives life threatening conditions during pregnancy, abortion & childbirth or within 42 days of pregnancy termination, irrespective of receiving emergency medical/surgical interventions. Because different ways of definitions and identification criteria were used to measure maternal near-miss and no standard definition for maternal near-miss until 2009, there were heterogonous estimate of the prevalence of maternal near-miss across different countries. Aim: This study was undertaken to evaluate incidence and common causes of Maternal Near Miss among the cases admitted in labour room emergency at RIMS, Ranchi. Methods and Materials: This study facilitates determining of the overall incidence of maternal near miss cases who were admitted in labour room. In this study, all the maternal near miss cases were included which met the comprehensive criteria of WHO. Inclusion criteria opts all antenatal & post-natal women upto 42 days of post termination of pregnancy who were admitted in labour room, RIMS, Ranchi, to calculate the incidence and evaluate causes and their management of near miss cases. Informed consent, couselling, high risk and complications were explained to all the patients and to the attendants of the patients who were prepared for emergency lifesaving procedure or surgical interventions. Opinion of physician, Neurophysician, Surgeon, Cardiologist and Critical care Doctors and other department will also be taken where needed for management of the patients. Results: Out of 200, maximum number of near miss cases belonged to age group 21- 30years followed by those of age group of less than 20 year were 58 (29%), only 5 cases were more than 30 year of age. Out of 200, 139 (69.5%) near miss cases were Hindu, 34(17%) were Muslim while 27(13.5%) were Christian. Out of 200 cases,183 (91.5%) belonged from rural area while 17(8.5%) were from urban area. Out of 200 cases, 89.5% cases came from low socioeconomic status lower middle (no-20, 10%). Out of the 200 cases 49 (24.5%) cases were uneducated, maximum number cases 125 (62.5%) were taken primary education, while only 5 (2.5%) were taken graduation. Out of 200 cases 121 (65.5%) were unbooked, 79 (39.5%) were booked. Out of 200 cases, 60 (30%) were without ANC, 61(30.5%) cases had irregular or inadequate ANC, while 79(39.5%) cases had regular ANC. Out of 200 cases, 182 (91%) were married, 18(9%) cases were unmarried. Out of 200 cases 102 (51%) were pregnancy induced hypertension case while 55 (27.5%) were haemorrhage, 20 (10%) cases were septic abortion, 10 (5%) were rupture uterus 10 (5%) were obstructed labour, only 3 (1.5%) cases were puerperal sepsis. Out of 200 cases 132 (71%) near miss case were due to very severe anaemia, 38 (18%) had Jaundice, 4 (2%) had Sickle cell disease. Out of 200 cases 55 (27.5%) cases were needed ICU admission. Out of 200 cases due to anaemia 18 (9%) cases had residual morbidity. Conclusion: Maternal Near miss incidence ratio was 20.94 per 1000 live birth, RIMS is the highest referral centre there is increased number of admission here. Direct causes of near miss event were important cause, in which pregnancy induced hypertension was leading cause for the events which contributed 51% out of which antepartum eclampsia was 37.5%. Indirect cause were also major contributing factor in near miss events, Anaemia being the main cause (66%).

188. Use of Autologous Blood as Tissue Glue for Conjunctival Grafting during Pterygium Excision Surgery
Nida Khan, Sandeep Jain
Abstract
Background: Pterygium is a triangular growth of connective tissue enveloped by conjunctival epithelium, extending beyond the cornea. The primary treatment is surgical excision. Objectives: To demonstrate a simple technique for improving attachment of conjunctival autografts in pterygium surgery and assess the efficacy of using a patient’s own blood for securing the graft. Materials and Methods: This was a prospective interventional study that was carried out in the department of Ophthalmology of a multispecialty tertiary health care hospital and research centre in central India. Following the excision of pterygium, conjunctival autograft was applied onto the scleral surface after achieving hemostasis. The evaluation of graft adherence was conducted within a time frame of 15 minutes after surgery. Results: Out of 220 cases with nasal Pterygium who had excision & conjunctival autograft using autologous blood, 200 cases (200 eyes) completed the study. Among 200 cases, 90 were females & 110 were males. 130 patients had progressive pterygium while 70 had non-progressive pterygium. In post-operative complications, a ganuloma was seen in 8 patients (4% of subjects) and 22 patients had conjunctival hemorrhages (11%). 10 patients had graft dehiscence and retraction (5%), 8 had graft oedema (4%), and 4 had a pterygium recurrence within 3 months (2%). 20 patients improved their visual acuity. Level of cosmesis achieved was satisfactory. Conclusion: Using autologous blood as tissue glue is a useful and cost-effective alternative for graft fixation, resulting in less discomfort and improved patient satisfaction. Also, the complications linked with the use of fibrin glue and suturing are circumvented.

189. The Ocular Side Effects of Use of Contact Lens in Patients Presenting at Tertiary Care Centre
Vartika Srivastava, Sweta Singh, Jaidrath Kumar, Dewabrat Pandey
Abstract
Introduction: Contact lenses have not only corrected refractive errors but have also improved people’s appearance and provided greater freedom in daily activities, leading to an enhanced quality of life. However, contact lenses may also cause complications that can be disappointing for patients, compelling them to switch from contact lenses to other forms of vision correction if feasible. However, such transitions are not always easy and may also bring complications of their own. Aim and Objectives: To provide a better concept of understanding contact lens related problems. Addressing contact lens problems properly can prevent contact lens dropout and lessen the consequences. Material and Methods: A convenient sampling technique was used to collect data in a cross-sectional study conducted over a period of four months from April to August 2021. The study was conducted at Sarvodaya Hospital and Research Centre after ethical clearance from the ethical committee. The study included subjects aged 15 to 55 years who had been using contact lenses for more than one year. Participants were informed about the study’s purpose, duration, and confidentiality, and their consent was obtained. Result: The average years of contact lens use was 8.35 ± 5.81 years, with a range of 1.5 to 30 years. Most contact lens users (96%) had myopia and used contact lenses with minus power, ranging from -0.50 to -17.00 D, with a mean value of -4.46 D ± 3.69 D. A significant (X2 = 31.636; p = .000) association was found between corneal changes and years of contact lens use. Number of subjects with corneal changes increased with increase in number of years of contact lens use. It was determined that all of subjects those who used contact lenses for 26 – 30 years and half of subjects those used contact lenses for 21 – 25 years presented with corneal change. Conclusions: It was concluded that long term use of contact lenses induced many corneal changes (neovascularization, staining, infiltrates, abrasions) among contact lens users. As the number of years of contact lens use and minus power of contact lens increased, more corneal changes were found.

190. Pulsed Radiofrequency in Frozen Shoulder, How Effective and Safe It Is?
Reema Chaudhary, Chandra Shekhar Singh, Abhishek Kumar, Manoj Kumar Chaurasiya
Abstract
Background: Frozen shoulder has been treated by conventional (continuous) radiofrequency but with fear of post procedure nerve damage. Aims & Objective: In the present study, we investigated the outcome and safety of pulsed radiofrequency of suprascapular nerve as a treatment for frozen shoulder after failure or non-satisfactory result of conservative treatment. Material & Methods: The study included 28 patients of frozen shoulder, who had undergone one-month conservative treatment. Mean age was 54 years which included 17 females and 11 males. There range of motion at shoulder joint and Oxford Shoulder Score (OSS) were abduction 117.14 ±7.120, flexion 111.78±7.720, internal rotation 83.5±6.790, external rotation 83.5±4.260 and OSS 30±3.26. These patients received Pulsed Radiofrequency of supra-scapular nerve under fluoroscopic guidance’s. Patients were followed for six months. Results: There was significant improvement in range of motion at shoulder joint and OSS, abduction 121.42±7.550 p value 0.0005, flexion 115.71±7.900 p value 0.0011, internal rotation 85.35±6.920 p value 0.01174, external rotation 86.21±4.560 p value 0.00749 and OSS 38.5±3.33. p value 0.0001, with no post procedure complications. Conclusion: Pulsed radiofrequency offers effective and safe treatment for frozen shoulder.

191. Thyroid Function in Beta Thalassemia Major Children: A Cross Sectional Hospital Based Study
Adarsh Verma, Sunita Koreti, Ajay Gaur
Abstract
Background: Thalassemia is most common Haematological genetic disease out of which 6-30 percent have hypothyroidism. Today patient has increased life expectancy and better quality of life because of hypertransfusion therapy but this has also lead to haemosiderosis. The thyroid gland is affected much before the thyroid pituitary axis which is less susceptible then the gonadal axis to iron induced damage and with the use of Iron chelators the survival rates have improved. Objectives: To estimate thyroid function in Beta Thalassemia major children and to determine correlation of thyroid function with Serum ferritin level. Methods: This is a cross sectional study done in the Thalassemia Day care centre, Department of Pediatrics, Kamlaraja Hospital and J.A. Group of hospitals of G.R. Medical College, Gwalior. All diagnosed thalassemia major children of 1 to 18 years of age group were included. Results: Among 81 Thalassemia patients, 56 patients (69.14%) were Euthyroid and 25 patients (30.6%) have hypothyroidism. Out of 25 hypothyroidism patients 18 (22.2%) were having subclinical hypothyroidism, 7 patients (8.6%) were having Primary hypothyroidism and none of the patients have secondary hypothyroidism. There were no cases of hyperthyroidism. Conclusion: From the study it was concluded that Beta thalassemia patients have a higher chance of developing hypothyroidism. Chronicity of disease, Number of blood transfusion and levels of serum ferritin are risk factors for hypothyroidism in beta thalassemia patients. Also, there is an increased risk of Stunting among the subjects.

192. Study of Blood Indices in Alcoholic Subjects
Chitrawati Bal Gargade
Abstract
Alcoholism is a chronic, progressive, and potentially fatal disease. The major health risk of alcoholism includes liver disease, heart disease, pancreatitis, central nervous system disorders, disorders of hematopoietic system, and certain forms of cancer. The effects on haemopoietic system are both direct and indirect, with anemia being commonly seen in alcoholics. This study is done to evaluate effect of alcoholism on blood indices. Total 50 moderate to severe alcoholics were included in study. Blood indices which included Hemoglobin, RBC count, MCV, MCH, MCHC were estimated by cell counter. Results shows mean haemoglobin content and RBC count was less than normal values which tells that most of alcoholics are anemic. Mean values of MCV was more than normal range, which shows anemia seen in alcoholics was macrocytic. MCH and MCHC mean values are almost normal which tells that anemia in alcoholics was of macrocytic normochromic.

193. Analysis of Quality Indicators in Molecular Laboratory of a Tertiary Care Hospital in India
Bhumika Gaur, Roli Solanki, Komal Patel, Purav Patel, Parul D. Shah
Abstract
Introduction: Quality indicators are important parameters to enhance the quality of the clinical laboratory services. Due to the extensive testing processes, errors cannot be completely avoided in a clinical laboratory. To minimize errors, however, adequate training, QC checks, and regular procedure evaluations are beneficial. Objective: The objective of the study was to establish and evaluate quality indicators on an ongoing basis as an effort to increase quality. Methods: This retrospective study, different quality indicators in a molecular laboratory in northern Gujarat were assessed over the course of a year (September 2020–August 2021). Data of total 8176 samples were summarized. Each Quality indicator was examined at the end of the month after being divided into the pre, analytical, and post-analytical stages, respectively. Result: As summarization of total 8176 samples, we found a cumulative error rate for all quality indicators of 346 (4.23%). Preanalytical errors were the most common 180 (2.20%), followed by analytical errors 114 (1.39%), and post analytical errors 52 (0.63%). Conclusion: There is no question that by continuously striving to develop the outcome of these quality indicators through the adoption of corrective measures over time, the quality of laboratory services and patient care would be improved.

194. Comparative Analysis of Surgical Efficacy between TURP and Thulep in Patients with Prostatic Enlargement
Ankit Kumar Bhati, Pardeep Tanwar, Ravdeep Singh, Mohamad Imran
Abstract
Introduction: This study focuses on prostatitis, a common urinary tract complication in men, particularly those over 50 years old. Antibiotics are commonly used for treatment, with extended periods of administration for more severe cases. Surgical interventions like transurethral resection of the prostate (TURP) and laser treatments are effective for managing benign prostatic hyperplasia (BPH). Thulium laser enucleation of the prostate (ThuLEP) is a newer technique that allows for total removal of the transition zone with minimal side effects. Thulium lasers are increasingly utilized in urology. Aims and Objective: To comparatively analyze the efficiency of surgical outcome after  Transurethral Resection of the Prostate (TURP) and Thulium Laser Enucleation of the Prostate (ThuLEP). Methods: This prospective observational study was conducted at Pacific Medical College and Hospital from January 2021 to December 2022. It focused on 50 patients diagnosed with Benign Prostatic Hyperplasia (BPH) who visited the surgery OPD/IPD. The study obtained a comprehensive medical history, diagnosed BPH using AUA criteria, and performed diagnostic tests. Pre- and post-operative assessments were conducted, including various parameters. Inclusion and exclusion criteria were established, and statistical analysis was performed using SPSS and Excel. Ethical approval and patient consent were obtained. Results: The study analyzed the baseline characteristics of the patients, including age, PSA, prostate volume, hemoglobin level, and IPSS. Comorbidities such as hypertension, CAD, CHF, and diabetes were also assessed. The mean age, PSA, and prostate volume were compared between the ThuLep and C-TURP groups. The study found a decrease in IPSS after the operation in both groups. ThuLep showed significant improvements in operation time, change in IPSS, VAS, blood loss, and change in hemoglobin compared to C-TURP. Hospital stay and uroflowmetry had no significant difference. Complications were higher in C-TURP, with urinary retention and urethral stricture being more common. UTI rates were similar in both groups. Conclusion: The study has concluded that ThuLep is associated with a more significant reduction in IPSS compared to C-TURP.

195. Study on Maternal, Perinatal and Early Neonatal Outcome and Complications in Pregnant Females with Sickle Cell Disease
Deepa Sethi, Rabindra Naik, Nina Mishra, Madhumita Nayak, P Narmada Reddy
Abstract
Introduction: Women with sickle cell disease (SCD) have a higher risk of complications during pregnancy, including stillbirth, early delivery, and pre-eclampsia. However, there is a dearth of up-to-date information on outcomes and therapeutic approaches. Pregnancy outcomes for people with SCD are being worked on to improve through enhancing reproductive services and raising awareness of the necessity of timely prenatal care. Aims and Objectives: To evaluate the maternal, perinatal and early neonatal outcomes and complications in pregnant females with sickle cell disease. Methods: 23 pregnant women with sickle cell illness, sixty-one with sickle cell trait, and eighty-four healthy controls were investigated in a prospective observational study carried out in India. Exams as varied as those for haemoglobin, obstetric history, and prenatal problems were performed on the participants. A complete blood count, urine analysis, ultrasound, and other diagnostic procedures were carried out. Patients were given care consistent with hospital policy, which often included blood transfusions. Delivery method, need for neonatal care, and other maternal and infant outcomes were noted. Results: Hydroxyurea (HU) and sickle cell disease standard of care (SOC) were studied side-by-side. Most patients (67%) were in their early 20s, and the mean age was 23 based on baseline data. Similar rates of pregnancy and abortion were seen among patients. Weight was considerably higher in the SS group compared to the control group. Compared to the AS and control groups, pregnant women with sickle cell disease had significantly lower haemoglobin levels and a higher rate of complications. Conclusion: Patients with sickle cell illness benefit from a multidisciplinary approach to pregnancy monitoring, which leads to better fetomaternal outcomes.

196. A Cross Sectional Prospective Study on Antimicrobial Drug Utilization in the Department of Surgery at a Tertiary Care Teaching Hospital
Tamil Selvan M, Kumaraswamy KC, Keerthana S
Abstract
Objectives: (1) To assess the utilization of antimicrobials in surgery. (2) To assess the Pharmacoeconomic status of the antimicrobials utilized in Surgery. Materials and Method: This research employed a Cross-sectional, prospective, observational study. This study was conducted at Department of Surgery at JSS Tertiary Care Teaching Hospital. Study will be carried out for period of 6 months The Samples of the study were Simple random technique The method of data collection will be cross-sectional, prospective, data’s will be directly collected from patient prescription by observation for a period of 1 year. Results: In 200 case sheets, Various antibiotics are prescribed for various indications in surgery department. Drug utilization studies have the potential to make objective evaluation and analysis of health professionals work and provide them with feedback to stimulate thinking about their practice and looking for the ways to improve their own performance. The most commonly admitted indication was GI and liver related problem with 20%, and most commonly prescribed antibiotic was Cefaperazone+Sulbactam with 30%, and the most used FDC is Cefaperazone+Sulbactam with 57%, Most of the prescription follows monotherapy with 92%. The cost minimizing analysis has been done for various drugs in this study. Analysis: The data of two pharmaceutical drug price list was collected, The Mann Whitney U test revealed that the drug price were difference between hospital (MD-294, N=11) compared to alternative companies (MD-215, N=11) which was not statistically significant [U=51, Z= 0.624, P=0.5333]. Conclusion: Preference to Cefaperazone+sulbactam was on the higher side. Prescribing drugs by brand name was high and generic name was low. Hence, prescribing drugs by generic name and drugs from Essential drug list has to be encouraged.

197. Cross Sectional Study of Diagnostic Contribution of Cerebral Magnetic Resonance Imaging and Cranial USG among Patients of Infantile Seizure in a Tertiary Care Centre in Western India
Suresh Kumar, Mamta, Rajendra Poonia, Anu Bhandari, Kuldeep Mendiratta
Abstract
Introduction and Importance of this Study: Seizures are caused by abnormally synchronous and excessive brain activity. The causes of seizures in infancy are mostly brain structure-related, like HIE, CNS malformations, brain haemorrhage, brain infarcts, CSVT etc. These conditions are diagnosed by pediatrician by clinically but require imaging for exact diagnosis. Currently cranial US and MRI are modality for these condition for diagnosis. This study was to compare the function of MRI in determining the cause of neonatal seizures to that of C-USG in the diagnosis and management of neonatal seizures. If only C-USG had been utilized, the diagnosis could have been missed, and cerebral MRI added to the information.This study will demonstrate the role and advantages of MRI in identifying the aetiology of neonatal seizures, which will give the treating physician specific anatomical information on the neonatal convulsions, assisting in patient care and improving the efficacy and accuracy of treatment. Results:60 patients with seizure who are younger than 90 days have been taken. All cases were screened by USG and then considered for MRI. Out of these, almost half are cases of HIE; the second most common cases were haemorrhage; other cases are cases of CSVT; cerebral infarcts; ventriculitis; meningitis; cystic encephalomalacia; porencephalic cyst; hydranencephaly; metabolic causes and normal. In our study, MRI showed detailed findings that were missed on USG. Conclusion: The study shows HIE as the highest aetiology, followed by hemorrhagic causes. Based on the findings of the present study, the frequency of pathologic findings in neonatal brain ultrasonography was 85% and in MRI was 96%. Thus, MRI brain scans are superior to USG scans for the evaluation of infantile seizures.

198. To Compare Fentanyl versus Dexmedetomidine Added to Low Dose Bupivacine for Lower Limb Surgery: A Prospective Randomised Double Blind Study
Mahima, Rajni Mathur, Ajay Kumar Saini, Chetali Das
Abstract
Background and Aims: The usual dose of bupivacaine cause sympathetic block, prolonged and strong sensory and motor block, which may not be preferred in some patients. Low dose diluted bupivacaine reduces the spinal block’s spread and promotes quick recovery, but it might not offer enough sensory blockage. Dexmedetomidine, a more selective 2 agonist, and short-acting lipophilic opioid fentanyl are used to lower the dosage of bupivacaine and its side effects. In this study, we sought to determine which combination of low dosage bupivacaine and fentanyl or low dose bupivacaine and dexmedetomidine produced a superior grade of anaesthesia. Methods: Using the opaque sealed envelope approach, 60 patients were randomly divided into two groups for this prospective randomised double blind trial in a tertiary healthcare facility. Group 1 (n=30) received intrathecally bupivacaine 0.5% heavy (0.8 ml) in combination with fentanyl (25 mcg) and normal saline (0.3 ml), with the goal of achieving a final bupivacaine concentration of 0.25% (1.6 ml). Group 2 (n=30) received intrathecally 0.5%heavy bupivacaine in combination with 5mcg dexmedetomidine and normal saline (0.3ml) to achieve final concentration of 0.25% bupivacaine (1.6ml).Time to achieve highest level of motor blockade, highest level of motor blockade, time to achieve peak sensory block level, peak sensory block level (PSBL), time to achieve T10 block level, intra-operative vitals (SBP, DBP, MAP, HR, SpO2), VAS, time at first rescue analgesia, and post-operative adverse effects were all measured. Results: The median time to reach PSBL (P=0.02), the highest level of sensory block (P=0.00), the highest degree of motor block (P=0.00), the VAS score, and the time to administer the first rescue analgesia (P=0.00) all showed statistically significant differences. The intra-operative vitals and side effects showed no statistically significant differences. Conclusion: The anaesthesia administered by both groups was sufficient for lower limb procedures with stable hemodynamics. Dexmedetomidine is preferable to fentanyl because it promotes the distribution of block and extends the duration of post-operative analgesia for day care surgery such ambulatory knee operations.

199. Peripheral Neuropathy Prevalence among Type 2 Diabetes Patients Attending an Indian Diabetes Clinic
Rakesh Kumar, Sudhanshu Shekhar Jha
Abstract
Background: In India, the burden of diabetes-related microvascular and macrovascular consequences is enormous. There are more persons developing DM problems as a result of the rising prevalence of diabetic mellitus (DM). In India, the prevalence of diabetic peripheral neuropathy (DPN), which can range from 18.8 to 61.9%, is the most prevalent complication among people with DM. Early detection of DPN can lessen its effects. Primary care screening services can aid in the early detection of problems and enhance patient health outcomes for people with diabetes. The purpose of this study was to evaluate the risk factors for DPN and its prevalence among type 2 DM patients who visited the diabetic clinic. Methods: 300 individuals with type 2 diabetes who were enrolled in the Government Medical College and Hospital, Purnia from September 2021 to August 2022 underwent a cross-sectional study. A standardized questionnaire was used to gather data, which was then followed by a thorough visual and physical examination of the foot. Urine was obtained to check for albumin presence, while a blood sample was provided to determine HbA1c. Results: One hundred and seventy (44%) of the 300 individuals had neuropathy, of which 85 (51%) were symptomatic. Higher HbA1c levels (OR = 2.86; p < 0.017), elementary schooling and less educational status (OR = 3.33; p <0.002), length of DM (OR = 1.72; p < 0.037), the presence of urine albumin (OR = 2.56; p < 0.032), and peripheral vascular disease (OR = 2.84; p <0.002) were predictors for DPN. Conclusion: According to the current study, rural areas have a significant frequency of peripheral neuropathy. Frequent screening can aid in the early detection of DPN and help prevent complications like foot ulcers, which ultimately result in amputation.

200. A Community Based Comparative Study on Menopausal Health Issue of Urban and Rural Women of Northern India Specially Bihar
Shahin Bano, Rajkishore Singh
Abstract
Background: Women’s health throughout menopause is a significant issue since it affects their happiness and quality of life. This research aims to examine the similarities and differences in menopausal health concerns experienced by urban and rural women in Bihar, Northern India. Methodology: Women from both urban and rural areas of Bihar were included in a cross sectional study to facilitate comparison and The Study was conducted at JNKTMCH from January 2022 to December 2022. Women amid menopause, aged 45 to 60, were the primary demographic. Sampling methods included randomly drawing from pools of people living in both urban and rural locations. Healthcare utilization, Menopausal symptoms, and demographics were all collected using a standard questionnaire. Chi-square tests and t-tests were used to assess the data and determine whether or not there was a significant difference between the characteristics of urban and rural women. Results: Two hundred and fifty women lived in metropolitan regions, while the remaining 250 lived in rural areas, for 500 participants. Those in rural areas were found to have a significantly higher prevalence of menopausal symptoms than those in urban areas (p 0.05). Rural women rated hot flushes, nocturnal sweats, and mood swings as more severe (p 0.01). Furthermore, women in rural areas were less likely to seek medical attention for menopausal symptoms than those in urban areas (p 0.05). Conclusions: This research shows menopausal health concerns are more prevalent among urban than rural women in Bihar. Menopausal symptoms are more common and severe in rural areas, where women also have more trouble getting medical care. These results highlight the importance of developing specialized programs and expanding access to healthcare services to meet the unique requirements of women in both urban and rural settings. Healthcare practitioners and policymakers should work together to create comprehensive menopausal health initiatives that increase knowledge, broaden access, and give women the support they need during this time.

201. Coagulation Profile of Cancer Patients in a Tertiary Care Hospital Located in North Bihar
Ratandeep Singh, Nirvana Rasaily Halder, Babai Halder, Bikramjit Singh Khurana
Abstract
Introduction: Cancer patients exhibit marked derangements in hemostatic system, which leads to increased risk of thrombosis and hemorrhage. They are more prone to develop a hypercoaguable state or chronic DIC. With the spread of malignancy fibrin production and fibrinolysis are both increased, with elevated platelet, tumor microparticles and D dimer levels. Deep vein thrombosis and pulmonary embolism can have disastrous consequences. By analysing the BT, CT, PT & APTT and other coagulation parameters the morbidity and mortality can be reduced. Materials and Methods: All patients with proven cases of malignancy were included with healthy controls. Venous blood anticoagulated with EDTA & Tri sodium citrate was obtained for platelet count and coagulation studies respectively. PT, APTT values and platelet counts were obtained from the patients along with comparison of control cases. Results: In our study, most cases showed thrombocytosis (38%) compared to controls (2%), with increased Prothrombin time (90%), Activated partial thromboplastin time (58%) compared to age matched controls having PT and APTT values mostly within reference range. Conclusion: Cancer patients exhibit deranged coagulation profiles compared to normal population. It is imperative to obtain coagulation parameters in such patients as it reflects their overall health status and risk of complications related to coagulation abnormalities. They help predict the risk of bleeding or thrombotic events.

202. An Outcome of the Management of the Vesico-Vaginal Fistula: Experience
Nilam Kumari, Sanjeev Kumar, Abhinav Deep, Shubhangi Sharma, Wakhariya Darshit Narendra, Sharad Goel
Abstract
Background: Patients with vesico-vaginal fistula (VVF) must receive the appropriate treatment in order to recover normal urinary function and experience an improvement in their quality of life. The purpose of this study was to conduct a retrospective analysis of the outcomes of VVF management, with a focus on surgical repair techniques, prognostic factors, and postoperative care. Methods: In a retrospective cohort study, the medical records of 60 patients diagnosed with VVF and surgically treated at a tertiary care facility were reviewed. The demographic information of the patients, the fistula characteristics, surgical procedures, and the outcomes were all recorded. Using descriptive statistics, a summary of the patients’ and the VVF’s characteristics was compiled. Multivariate logistic regression was used to analyze the variables found to have an effect on the outcomes, and the success rates of various surgical procedures were compared using the appropriate statistical tests. In addition to this, a postoperative complications analysis was conducted. The SPSS application was used to conduct the statistical analysis. Results: Patients with vesico vaginal fistuala were chosen based on a variety of patient demographics and fistula characteristics. Multiple surgical procedures, including vaginal, abdominal, and minimally invasive procedures, were utilized in the operating room to complete the necessary repairs. Both the overall success rate of VVF closure and the efficacy of various surgical procedures were calculated and analyzed. The outcomes of surgery were examined in relation to a number of variables, including the extent of the fistula, its location, and the number of previous attempts to repair it. We also accounted for any complications that resulted from the operation. Conclusion: This retrospective cohort study was conducted, and both its findings and the factors that influence VVF care are examined. The findings contribute to our comprehension of the factors that affect the success of surgical procedures and the efficacy of various surgical approaches. The findings emphasize the importance of tailoring treatment strategies to the unique characteristics and repair history of each patient. In addition, it is acknowledged that standardized postoperative care procedures are essential for reducing complications and improving patient outcomes. Additional research is required to confirm these findings and investigate potential novel VVF management strategies.

203. A Clinical Examination of Genital TB as a Cause of Infertility in NSCB Medical College, Jabalpur
Shraddha Chandrakar, Dipti Markam, Sharad Narayan Sharma, Ravi Prakash Singh
Abstract
Background: Genital TB accounts for 5-18% of cases and causes irreversible damage to the fallopian tube and uterus. This study was aimed to evaluate the incidence of genital tuberculosis as a cause of infertility. Aims and Objectives: To estimate the incidence of tuberculosis in infertile women and to determine the histological pattern of involvement, clinical spectrum, and impact on infertility in women infected with tuberculosis. Materials and Methods: Hundred female with infertility were studied at the Department of Obstetrics and Gynaecology NSCB Medical College, Jabalpur, from January 2020 to December 2020. In addition to through sociodemograpohic parameters each patient underwent diagnostic laparoscopy and a thorough inspection of the fallopian tubes, ovaries, pelvic peritoneum, Douglas pouch, and peritoneal cavity. Results: Out of 100 infertile patients, 20 developed genital TB. In 10 (50%) instances, the fallopian tube was the most common location of involvement in genital TB. There were 15 cases of primary infertility and 5 cases of secondary infertility in genital TB. Conclusion: According to the findings, genital TB frequently manifests as primary infertility. Menstrual problems were not a common symptom. The fallopian tube was the most commonly involved location in genital TB.

204. A Prospective Randomized Interventional Controlled Study to Compare the Effect of Intrathecal Tramadol with Placebo for Prevention of Shivering under Subarachnoid Block
Ajay Kumar Saini, Rajni Mathur, Mahima, Chetali Das
Abstract
Introduction: Peri-anaesthesia shivering is a common complication following subarachnoid block (SAB). Subarachnoid Block is the preferred means of anesthesia for lower abdomen, pelvis, and lower limb surgery. Aim and Objective: Comparison of intrathecal tramadol versus placebo for prevention of shivering under subarachnoid block. Material and Methods: A prospective, randomised, double-blind, controlled study was created. A total of 108 cases were chosen by the sealed envelope method and divided into two equal groups. Group A (54 cases) received intrathecal tramadol with bupivacaine, while group B (54 cases serving as a control) received intrathecal bupivacaine. The peri-operative body temperature, peri-operative hemodynamic parameters, and peri-operative shivering events were all documented. Result: In this study, group A’s mean age was 36.03 years old, whereas group B’s mean age was 36.9 years old. In group A, 16.6% and 9.26% of patients experienced nausea and vomiting, respectively, while 14.8% of patients shivered both during and after surgery. Patients in group B who had peri-operative shivering and nausea made up 64.81% of the patient population. Conclusion: When given intrathecally to patients scheduled for surgery under sub-arachnoid block, tramadol 20 mg and 3ml of 0.5% heavy bupivacaine play a significant role in the prevention of the incidence of anesthesia-induced shivering with early onset of both sensory and motor components of the sub-arachnoid block.

205. To Evaluate Changing Trends and Outcomes of Obstetric Hysterectomy over Last Decade
Yashi Jaiswal, Bharti Parihar, Neetu Ahirwar
Abstract
Objective: To evaluate changing trends and outcomes of obstetric hysterectomy over last decade. Methods: The study subjects who underwent obstetric hysterectomy between 2011- 2020 were included in this study. Each case record files were studied in detail for demographic, clinical characteristics, operation notes, intraoperative and post-operative findings to find out various independent risk factors associated with obstetric hysterectomy. In PPH cases undergoing hysterectomy it was noted what medical and surgical measures were carried out prior to landing into Obstetric Hysterectomy. Post-operative findings were also noted. In cases of rupture uterus, involvement of uterine vessel, ligaments, bladder involvement were also looked for. Maternal and foetal outcomes in terms of morbidity and mortality were noted. Results: Obstetric hysterectomy was associated with caesarean delivery in 83 (79.04%), then with normal vaginal delivery in 22 (20.95%). Most common risk factor for rupture uterus was previous LSCS in 101 (37.94%). followed by Grand multiparty in 39 (18.5%), placenta previa in 28 (14.35%) and obstructed labour in 24 (12.30%). Rupture uterus was the common indication, in 68 (34.9%) morbidly adherent placenta was indication followed by PPH in 24 (12.3%) and Ruptured Secondary Abdominal Pregnancy > 28 weeks in 1 patient. Most common cause of maternal mortality was hemorrhagic shock in 20 cases (10.3%) followed by MODS in 2 (7.7%) cases. Conclusion: In order to lower the rate of caesarean sections, institutions must monitor and reevaluate the indication for the procedure. A skilled obstetrician, paediatrician, or anaesthetist should be involved from the beginning of the procedure because of the intricacy of the surgery and the potential for life-threatening complications. In order to lower the frequency of life-threatening obstetric haemorrhage and uterine rupture, family welfare and reproductive health policies in underdeveloped countries must be implemented more effectively.

206. A Study of the Clinical Characteristics of Meconium Aspiration Syndrome in Relation to Gestational Age and Birth Weight, as well as the Immediate Result in NSCB Medical College Jabalpur Madhya Pradesh
Shraddha Chandrakar, Dipti Markam, Krishnakant Rawat, Ravi Prakash Singh
Abstract
Background: Meconium aspiration syndrome (MAS) is described as respiratory distress in a newborn born via meconium-stained amniotic fluid (MSAF) with typical radiological abnormalities and symptoms that cannot be explained otherwise. It is one of the most prevalent causes of infant respiratory distress globally, with a death rate of up to 40% in afflicted newborns. Objectives: To examine the clinical profile of meconium aspiration syndrome (MAS) in neonates in relation to gestational age and birth weight, as well as their immediate outcome, and to identify feto-maternal risk factors for MAS that, if identified early, could improve long-term fetal outcome and ensure neurologically intact survival. Methods: A prospective observational study was conducted on 115 newborn cases of meconium aspiration syndrome who were admitted to the above center. All preterm, term, and post-term infants (suitable for gestational age and birth weight) born routinely or by cesarean section or forceps who met all of the MAS criteria and were admitted to the NICU within the above-mentioned time period were included in this study. Results: Out of 1130 babies born through meconium-stained amniotic fluid, 729 cases with respiratory distress were admitted to NICU during this period of time, and MAS was noted in 110 babies (15.09%). There were 83 (75.45%) males and 27 (24.54% females) among the 110 cases. MAS was more common in term newborns (59.09%). Birth asphyxia was the most prevalent consequence related to MAS (29.09%). Babies died at a rate of 27.27%, with ARF+ Pneumothorax being the most common reason. Conclusion: Prediction, early identification, and timely treatment of newborns with MAS reduces the likelihood of long-term consequences and neurologically intact survival.

207. A Study on Clinical Profile of Neonatal Seizures with Special Reference to Biochemical Abnormalities in NICU
Vibhas Ranjan, Rijwan Haider
Abstract
Background and Objectives: 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. To assess the importance of biochemical abnormalities in neonatal seizures and to evaluate the clinical profile, time of onset and its relation to etiology of neonatal seizures. Methodology: The present study included 110 neonates presenting with seizures admitted to NICU of DMCH, Laheriasarai. 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.

208. Prevalence and Patterns of Antibacterial Susceptibility During Pregnancy in NSCB Medical College, Jabalpur, Madhya Pradesh
Shraddha Chandrakar, Dipti Markam, Sharad Narayan Sharma, Ravi Prakash Singh
Abstract
Background: Asymptomatic bacteriuria (ASB) has a comparable prevalence in pregnant women as it does in women who are not pregnant (between 4 and 7 percent). As age, parity, age, and history of asymptomatic urinary tract infection all have a role in the development of ASB, so do lower socio-economic statuses. Aim and Objectives: This study aimed to (1) determine the incidence of ASB at NSCB Medical College Jabalpur and (2) determine the most common causative microorganisms and their antibiotic susceptibilities. Materials and Method: From January 2020 to December 2020, 230 healthy pregnant women who had their first prenatal visit at NSCB Medical College Jabalpur were screened for bacteriuria. Antibiotic resistance testing was conducted, and the results were analyzed. Results: Ten percent of pregnant women had ASB. Except for those living in rural areas (χ2 = 4.454, p=0.0348), demographic and obstetric variables did not substantially affect the prevalence of ASB. Escherichia coli was the dominant bacteria (52.17%). Imipenem and aminoglycosides were the most sensitive against uropathogens, while nalidixic acid, ampicillin, amoxicillin, and cotrimoxazole were less sensitive. Conclusion: Researchers observed that ASB was common among pregnant women. Except for residing in a rural location, neither demographic nor obstetric factors significantly affected the risk of ASB. From what we can see, screening all pregnant women for ASB would be prudent.

209. FOGSI Gestosis Score as a Predictor of Pre-Eclampsia: An Observational Study
Anjalee Yadav, Juhi Agarwal, Shwetha K
Abstract
Objective: To evaluate FOGSI Gestosis score as a predictor of pre-eclampsia and to study the various factors affecting it. Methods: 200 Women with preeclampsia, eclampsia attending prenatal clinics and 200 delivering during same period and found to have no preeclampsia, eclampsia were enrolled as control. The patients were provided with the study information sheet and consent form and were explained about the relevant details about the study. All the data were collected with the help of pre structured pre tested proforma. Antenatal and intra-natal details were noted. Maternal and foetal outcome in terms of morbidity and mortality were noted. Results: Comparison of Gestosis Score parameters, it was found that age more than 35 years, Obesity, primigravida, MAP > 85mmHg and Chronic vascular disease (Dyslipidaemia) were significant predictor of preeclampsia with Odds ratio of 3.114, 6.858, 3.24,256, 7.63 and 3.22 respectively. It was also found that Multifetal Pregnancy and Hypertensive disorder in previous pregnancy were significant predictor of preeclampsia with Odds ratio of 3.82 and 2.81 respectively. Chronic hypertension, Inherited/Acquired Thrombophilia and Autoimmune disease were significant predictor of preeclampsia with Odds ratio of 8.98, 22.10 and 3.82 respectively. Conclusion: Fogsi gestosis scoring system offers the possibility of segregating high-risk pregnancy to mitigate the adverse effect of preeclampsia. Screening would improve the ability to identify, monitor these women before they develop severe symptom.

210. The Outcome of Breech Presentation After 34 Weeks of Period of Gestation of Pregnancy in NSCB Medical College Jabalpur Madhya Pradesh
Shraddha Chandrakar, Dipti Markam, Krishnakant Rawat, Ravi Prakash Singh
Abstract
Background: Management of breech presentation at term remains controversial in modern obstetrics. Currently, cesarean sections are routinely performed despite a lack of supporting data. Aim and Objective: A study was conducted to evaluate the route of delivery, and the maternal and perinatal outcome in cases of singleton breech presentation beyond 34 weeks of period of gestation. Material and Method: A prospective observational study was carried out at NSCB medical college Jabalpur MP over one year. This study included 225 cases of breech presentation beyond 34 weeks. The external cephalic version was carried out in suitable cases. Data on the delivery method and maternal and neonatal outcomes were gathered and examined for this group of patients throughout their pregnancies. Result: There were 154 incidences of breech presentation out of 4745 total births (3.24%), with 45.3 percent occurring in first-time mothers and 54.7 percent in those who had already given birth. Seventy-one out of 225 (31.5%) women experienced spontaneous cephalic versions. The external cephalic version had a 59% success rate, with 17 of 29 births going smoothly. Most breech births (65%) were accomplished through cesarean section, while 35% were born vaginally (including 6 assisted breech births). Conclusion: Even in the late third trimester, a sizeable percentage of breech fetuses will undergo a spontaneous version. When a singleton pregnancy is diagnosed as being in a breech position, an external cephalic version can be used to avoid a cesarean section.

211. Study of Primary Caesarean Section in Parous Women at a Tertiary Care Centre
Archana Dhakar, Aruna Kumar, Shubha Shrivastava, Tinny Pratibha
Abstract
Objective: To study the indications of primary caesarean section in parous women and to study the maternal and fetal outcome in these women. Methods: All Parous women undergoing primary caesarean section beyond 28 weeks of gestation and fulfilling the inclusion and exclusion criteria were included in the study. After explaining the purpose of the study and taking written informed consent, data was collected. Results: Majority of the study participants were in age group 21- 25 years, from the rural area and belong lower/ middle income group. Majority of the study participants were unbooked and underwent emergency LSCS under spinal anesthesia. Majority had spontaneous onset of labor. Fetal distress followed by antepartum haemorrhage were the most common indications of LSCS. Maternal complications were present in 8.3% of the study participants, PPH was the most common complication seen among mothers. Most common fetal complication was    respiratory distress followed by birth asphyxia. 2.9 % of the babies had congenital anomalies. 15.6% of the babies required resuscitation and16.8% of babies‟ required NICU admission. Conclusion: This study emphasizes the need of regular antenatal checkups and institutional delivery of all women as prior uneventful vaginal birth does not guarantee a repeat successful vaginal delivery.

212. Comparing the Effectiveness of JH Balloon Tamponade and Foley’s Condom Balloon Tamponade in Preventing Atonic Postpartum Hemorrhage: A Study from NSCB Medical College, Jabalpur
Shraddha Chandrakar, Dipti Markam, Sharad Narayan Sharma, Ravi Prakash Singh
Abstract
Background: Postpartum hemorrhage (PPH) is one of the major causes of massive obstetric hemorrhage in obstetric settings. World Health Organization (WHO) and the Federation of Gynecology and Obstetrics (FIGO) recommend using uterotonics followed by intrauterine balloon tamponade to manage PPH. Aim and Objectives: This study evaluates the efficacy and safety of two methods for controlling atonic postpartum hemorrhage: the JH balloon tamponade and the Foley’s condom balloon tamponade (FC). Materials and Methods: One hundred patients with atonic PPH were split into two groups for the prospective randomized control trial: Group 1 (n=50) was treated with Foley’s condom balloon management, and Group 2 (n=50) was treated with JH balloon tamponade. The outcome metrics were the time to inject the UBT and the time to halt bleeding. The balloon’s slipperiness and other unwanted consequences were also recorded. Long-term effects on menstruation, the uterine cavity, and pregnancy were assessed by following the patients for six months. Results: The success rate of JH balloon tamponade was 92% (p=0.74), while the success rate of FC balloon tamponade was 88% (p=0.74). Four of the four failures in the JH group were treated with B-Lynch sutures and uterine artery ligation (p=0.418), while two of the six failures in the FC group were treated with each of these procedures (p=0.418). Mean times to make, insert, and inflate the catheter (3.01 vs. 3.12 minutes; p=0.09) and to halt bleeding (7.08 vs. 6.91 minutes; p=0.65) were similar between the FC and JH groups. Slippage of balloon tamponade occurred in 1 patient in the JH group compared to 10 patients in the FC group (p=0.008). No long-term complications were reported by patients in either the FC or JH groups after six months of follow-up. During their regular menstrual periods, they experienced no discomfort. Conclusion: The success rates of the Foley’s condom balloon and the JH balloon tamponade were high and similar to 92%. Both balloon tamponade methods efficiently use available resources and may be made quickly and easily even at a health center with limited means located in a rural area. Therefore, both balloon types can be employed effectively in atonic PPH treatments as a non-invasive alternative to surgical interventions.

213. A Sonographic Measurement of Spleen in Relation to Age and Gender
Rahul Kulhari, Dhiraj Saxena, Seema Gupta
Abstract
Methods: The cross-sectional study was conducted in Anatomy and Radiology Department SMS Medical College from June 2020 to 31 December 2022 on 130 subjects on morphometric analysis of spleen size and it’s correlation with age and sex. The mean and standard deviation of all parameters was calculated accordance to accepted statistical methods (Microsoft excel 2007). The difference in mean of various parameters were tested for significance using unpaired ‘t’ test and Chi square test. Results: In our study we found that mean spleen length in males was 9.644 ± 0.6978 whereas the mean spleen length was 9.181 ± 0.1509 in females i.e. the mean length of spleen was more in males as compared to female and application of t test showed that this difference was statistically significant. Conclusion: It can be concluded that the basic knowledge of splenic dimensions by ultrasonography may be essential for providing the guideline and reference value to the radiologists, surgeons and clinicians for splenic diseases in Jaipur region.

214. Epidemiology of Mucormycosis Cases Admitted at Tertiary Care Hospital Northern Western Rajasthan
Seema Mehta, Rekha Acharya, Gaurav Sharma, Renu Sethia
Abstract
Background: This study was thus conducted with an objective to describe the epidemiological aspects of mucormycosis cases presenting to a tertiary care centre in Northern Western Rajasthan, India, as well as to identify potential risk factors for mucormycosis. Methods: This ambispective study is conducted at government medical college associated tertiary care center in Bikaner, Northern Western Rajasthan. It is an effort to describe the epidemiology, predisposing risk factors, presenting symptoms, and mucormycosis disease outcome in admitted patient at PBM hospital during and after second wave of COVID-19 epidemic in India. This ambispective study was conducted on 161 mucormycosis positive cases admitted in PBM Hospital, Bikaner, Rajasthan from 1st Jan to 31st Dec. 2021.  Study is based on medical records and telephonic interview of mucormycosis positive cases. Results: Majority of study population (28.57%) belong to 61-70 years followed by (19.25%) in 51-60 years, (17.39%) in 41-50 years and (14.91%) in 31-40 years, thus constituting 80.12% in 31-70 years. Mean age was 49.4 ± 16.8. Majority of study population 60.87% were male and 39.13% patients female. Male to female being 3:1. 52.80% of study population resided in urban area. Hindus were maximum (86.33%), (7.45%) patients were Muslim and (6.21%) patients were Sikh.93.78% study population were married and 6.21% unmarried. 66.45% of study population lived in joint family and 33.54% in nuclear family. Majority of study population 52.17% and 44.73% respectively belong to SES class Ⅱ and Ⅲ, 91.77% of study population literate and 8.22% illiterate. Conclusion: Majority of patients were young Hindu Male belong to socio-economic status class-II and living in joint family.

215. A Cross Sectional Study of Morphological & Morphometric Parameters of Sacral Hiatus and it’s Importance in Caudal Epidural Block
Priyanka Jindal, Sangita Chauhan, Seema Gupta
Abstract
Background: To evaluate the morphological & morphometric parameters of sacral hiatus in order to study the anatomical variations of sacral hiatus which will be useful for administering caudal epidural block and improve its reliability and success rate. Methods: After approval from Institutional Ethics Committee, this study was conducted in the Department of Anatomy, SMS Medical College and attached group of Hospitals, Jaipur, Rajasthan. Results: Most commonly sacrum is made up of five vertebrae. Present study also documented similar composition in 46 (92%) sacra whereas 2(4%) cases were made up of 4 segments. The most common shape of sacral hiatus encountered in present study was Inverted-V (48%) followed by Inverted-U (32%) cases and in rest of the cases the shape of sacral hiatus was dumbbell shape (4%) and irregular (16%). Apex of sacral hiatus was mostly seen at 4th sacral vertebra in 74% of cases, at 3rd and 2nd sacral vertebra in 24% and 24% of cases respectively. Conclusion: The opening at the caudal end of sacral canal is known as sacral hiatus. It is formed due to the failure of fusion of laminae of the fifth (occasionally 4th) sacral vertebra. The sacral hiatus transmits the fifth sacral nerve and coccygeal nerves. The dural sac ends at the level of second sacral vertebra above the sacral hiatus. Therefore, it forms a convenient region for caudal epidural anaesthesia of structures innervated by these nerves.

216. A Morphometric Study of Brachial Artery and its Branches at SMS Hospital Jaipur
Rakesh Swami, Chandrakala Agarwal, Seema Gupta
Abstract
Background: To study MORPHOMETRIC of brachial artery & it’s branching pattern and length of brachial artery. Methods: The present study was conducted on 40 upper limbs of 20 embalmed cadavers (both male & female) in the Department of Anatomy, S.M.S. Medical College, Jaipur. These were labeled from 1-20 with letters R or L corresponding to right or left limbs respectively. The Brachial artery was dissected & traced proximally to the continuity with the axillary artery at the level of the lower border of teres major. Results: In the present study 20% of specimens showed variation in morphological and morphometric pattern of BA. The brachial artery showed trifurcation in 5% of specimens., 5% of specimens trifurcated into radial, ulnar and common interosseous arteries. Conclusion: The Brachial artery and its branching pattern have been of great interest to anatomists and surgeons, interventionists and radiologists, due to wide clinical and radiological implications. Brachial artery is used in diagnostic angiography, cardiac catheterization for angioplasty, carotid stenting, transbronchial access for endovascular renal artery intervention and embolectomy through arteriotomy on brachial artery. Better anatomical knowledge about the branches of brachial artery and their variations are essential in avoiding iatrogenic injuries by surgeons and also during interpretations of angiograms by radiologists.

217. Left Ventricular Mass Assessment in Prehypertensive Subjects by Echocardiography
Deepak Kumar Das, Tarun Agarwal, Bindu Garg, Deep Chandra Pant, Smita Gupta
Abstract
Introduction: High blood pressure is a strong risk factor for cardiovascular disease. The Joint National Committee on High Blood Pressure (JNC) identified a new category of blood pressure in adults termed pre-hypertension. Keeping BP below 120/80 mm Hg may provide important health benefits later in life. Methods:  Total 201 subjects were selected from general population with the age between 18-70 years. Blood pressure was measured with mercury sphygmomanometer and prehypertension was classified according to JNC 7. 101 subjects were found to be prehypertensives and 100 were normotensives. Two-dimensionally guided M-mode echocardiography was performed by standard methods. Results: BMI and BSA were elevated in prehypertensives. HR, SBP, DBP, PP & MAP were significantly elevated (p<0.001) in prehypertensives compared to normotensives. A statistically significant difference was noted in LVIDd, LVIDs, PWT, LVM and LVMI between two groups in male populations whereas in female populations only LVM and LVMI were statistically significant. Conclusion: Such findings carry prognostic implication.  Early diagnosis of prehypertension will help to take necessary preventive measures to reduce cardiac morbidity and mortality in later period.

218. Assessment of Cardiovascular Risk Factors in Post-Menopausal Females
Deepak Kumar Das, Tarun Agarwal, Deep Chandra Pant, Smita Gupta
Abstract
Introduction: Menopause is not a disease, but a physiologic phase of a woman’s life, due to the changes of their hormonal status. Menopause is a physiological period of a woman’s life during which she lacks menstruation continuously for 12 months. Lives have been extended with improved diagnosis and treatment modalities, and women spend 20-30 years in the post-menopausal period. Fastidious symptoms may be associated with changes in the metabolism together with new cardiovascular risk factors, particularly aggressive for the female cardiovascular system, unprepared because of the protection due to the fertile period. Changes of the lipid profile, obesity, hypertension, glucose intolerance and diabetes mellitus may intervene as severe risk factors. Cardiovascular disease represents therefore the most frequent cause of mortality and morbidity also in the female gender more than cancer. These changes are often ignored in Indian scenarios which are the important determinant of cardiovascular risk factors. Early diagnosis of these factors helps in early treatment and thus helps in a healthy ageing. Objectives: Assessment of cardiovascular risk factor in Postmenopausal women. Methods:  Total 150 females were selected from general population with the age between 25-65 years. They were divided into two group namely premenopausal and postmenopausal women with each group having 75 subjects. 2D echocardiography was performed by standard methods. Blood sample was taken for Lipid profile and blood sugar in fasting state. Results were compared using student t test. Results: Age and BMI shows significant difference in Postmenopausal women. Pulse & Blood Pressure profile shows a significant difference. IVSTd, IVSTs and PWT show significant difference in postmenopausal females. LVM and LVMI were statistically significant in Postmenopausal females. Fasting blood sugar, Serum Cholesterol, triglyceride, HDL and LDL shows statistically significant difference. Conclusion: Potentially, adverse changes in LVM, LVMI, fasting blood sugar and lipid profile in postmenopausal women of the study group remark that this group of women is at increased risk of having complications associated with cardiovascular disease in near future. Early and timely detection and primary prevention can avoid morbidity and mortality in this high risk population. Early diagnosis of changes in postmenopausal women will help us to take preventive measures early so as to reduce cardiac morbidity and mortality and to make healthy ageing.

219. Dental Implant Procedures in Partially Edentulous, Periodontally Week Compromised Patients
Santos Mishra, Rahul Mishra, Anuradha Mishra, Madhuri Shukla
Abstract
Aim: The purpose of the present study was to perform a review using a systematic approach to evaluate the long-term (X5 years) success of implants placed in partially edentulous patients with a history of periodontitis as evidenced by loss of supporting bone and implant loss. Material & Methods: An electronic search of the National Library of Medicine, Washington DC (Medline-PubMed) was performed using specific search terms to identify studies assessing, in periodontitis patients, the success of implants with regard to bone level outcomes. Search was performed on abstracts registered up to October 2003. Results: The searches identified 877 abstracts. Titles and abstracts were independently screened by two reviewers to identify publications that met the inclusion criteria. Review of these abstracts resulted in 13 publications for detailed review. These papers were reviewed by the three authors. Finally four papers which met the criteria of eligibility were independently selected by the three reviewers. Conclusion: Based on the limited data, it seems justified to conclude that the outcome of implant therapy in periodontitis patients may be different compared to individuals without such a history as evidenced by loss of supporting bone and implant loss.

220. A Comparative Study of Laparoscopic Technique versus Open Repair for Inguinal Hernia
Md Sharique Nizami, Saurabh Kumar, Vikram Kumar
Abstract
Background: Inguinal hernia, a common surgical problem, requires treatment to prevent complications and improve patient outcomes. The debate continues as to whether laparoscopic or open repair techniques are superior. This study assesses the success rates of laparoscopic and open inguinal hernia repairs in Bihar. Methods: The 100 Bihar people who needed laparoscopic or open inguinal hernia repair were the subject of a retrospective study. Demographic information, recurrence rates, complications, postoperative pain scores, and duration of hospital stay were related between the two groups. Statistical study was used to determine the significance of the observed differences. Results: The laparoscopic (10%) and open (15%) repair groups had comparable recurrence rates. The two techniques also observed similar rates of postoperative pain and complications. Laparoscopic procedures were associated with shorter hospital stays than open procedures. Statistical analysis demonstrated the importance of these results. Conclusion: This study demonstrates that both laparoscopic and open hernia repairs are equally effective at reducing the risk of recurrence and causing roughly the same level of postoperative discomfort. Laparoscopic surgery has the advantage of reducing the duration of hospital stays. Resources, surgeon experience, and patient characteristics should be considered when deciding between laparoscopic and open repair. It is suggested that additional research be conducted to substantiate and assess the long-term effects of these findings.

221. Sugar Substitutes in Prevention of Dental Caries: A Systematic Review
Dushyant Pal Singh, Saurabh Jain, Chetan Sharma
Abstract
Introduction: A dynamic relation exists between sugars and oral health. There are many sugar substitutes available on the market today, both non-caloric and caloric, which have a low or even no cariogenic potential. Even if some of these products have economic, technologic and toxicologic shortcomings, sugar substitution is an important part of caries prevention. Objectives: To assess the effectiveness of various sugar substitutes on preventing dental caries in children and adolescents. Materials and Methods: All randomised controlled trials (RCTs), including cluster randomised trials but excluding cross-over trials were included for review. Children and adolescents below 18 years of age who have permanent or deciduous teeth, or both were included in the study. Primary outcomes measured dental caries on use of sugar substitutes. Secondary outcomes measured the harmful effects of sugar substitutes. Results: Lower rate of caries in subjects in the xylitol or sorbitol pellet groups compared to a group of children who were not assigned to a chewing group. Use of sugar substitutes demonstrated reduced incidence of dental caries in children and young adolescents. Conclusion: The evidence is strong enough to support the regular use of sugar substitute gum as a way to prevent caries.

222. Minimal Intervention Dentistry: Systematic Review
Dushyant Pal Singh, Saurabh Jain, Chetan Sharma
Abstract
Introduction: All work in the health field is aimed basically at conservation of the human body and its function. Loss of even a part of a human tooth should be regarded as a serious injury, never to be considered lightly, and the tooth is certainly worthy of the most careful restoration. Aim and Objectives: To assess of MID is to keep teeth healthy and functional for life. A most important element is achieved through implementing the important strategies for keeping teeth free from carious lesions. Materials and Methods: Types of studies included in the review Early caries detection and risk assessment, Remineralisation of demineralised enamel and dentine, Optimal caries preventive measures, minimally invasive operative interventions, Repair rather than replacement of restorations. Results: Fluoride during the remineralisation/demineralisation cycle leads to its incorporation into the crystalline structure of the carbonated hydroxyapatite, which not only decreases crystal solubility, but also increases the precipitation rate of enamel mineral in the presence of calcium and phosphate due to the lower solubility of fluorapatite.15The fluoride decreases enamel solubility in two ways: (1) the fluoride ion is more stable in the crystal lattice than the hydrogen ion and (2) it interacts with the calcium ions on the crystal surface, interacting closely and binding strongly. Conclusion: Minimally invasive dentistry requires a change in philosophy in our approach to managing dental caries. Dental caries needs to be viewed as a bacterial disease rather than the end product of that disease—a hole in the tooth.

223. Assessment of Oral Health Related Quality of Life and Oral Health Status Among Institutionalised Elderly Population in Jaipur City: A Cross Sectional Study
Dushyant Pal Singh, Chetan Sharma
Abstract
Introduction: Oral diseases and disorders can affect general health, wellbeing and quality of life in geriatric individuals. As the GOHAI appeared to have acceptable reliability and validity in all ages. Aim and objectives: To assess oral health status among elderly individuals aged 60 years and above. Methodology: A total of 7 old age homes were present in the Jaipur city. All elderly individuals in these old age homes formed the study population. WHO Oral health assessment, 1997 and GOHAI was used in the study. Results: Out of 225 participants, 142 participants were in 60-65 years age group. About 10.7% (n=24) said they often and very often had sensitive teeth or gums. Oral health status showed 10.9 mean number of missing teeth per patient, this highlights on the loss of functional edentulism and poor oral health of the elderly institutionalized patients. There was statistically significant association between age and socioeconomic status. Conclusion: The study establishes a strong need for the prevention of edentulism and better geriatric oral health care to all institutionalized elderly population.

224. Oral Health Status of Geriatric Population: Cross Sectional Study
Dushyant Pal Singh, Shikha Jain, Chetan Sharma
Abstract
Introduction: As the GOHAI appeared to have acceptable reliability and validity in all ages, it was recommended that the name of Geriatric Oral Health Assessment Index (GOHAI) be changed to the General Oral Health Assessment Index (GOHAI). Aim and objectives: Oral health related quality of life using GOHAI index. Methodology: Visit old age homes were present in the Jaipur city. The data was entered on to a personal computer and the analysis was done using the SPSS (statistical presentation software system) for windows (version 17).  Descriptive statistics was carried out. The statistical significance was fixed at 0.05. Results: About 34.7% (n=78) never had any trouble biting or chewing any kind of food. Half of the participants (50.7%) were always able to swallow comfortably. Teeth or dentures of 66.7% (n=150) participants never prevented them while those of 1.3% (n=3) often prevented them from speaking the way they wanted. About 29.3% (n=66) said that they were sometimes able to eat without feeling discomfort while 5.3% (n=12) were often able to eat without discomfort. Conclusion: The study focus on the need to conduct similar studies with more diverse population and influence the policy makers in the country to include geriatric oral health care.

225. Assessment of Accuracy of BISAP Score as a Predictor of Severe Acute Pancreatitis in Shyam Shah Medical College, Rewa, Madhya Pradesh
Anil Chouhan, Shiv Shakti Yadav, Varsha Sukhla, Rahul Kumar Giri
Abstract
Background: The prevalence of acute pancreatitis  (AP)  has increased in the last  20  years. Most patients with AP experience a clinical course that is mild and self-limited. However, 10% to 20% of patients develop a rapidly progressive inflammatory response, necessitating prolonged hospital stays, and high morbidity and mortality rates. Various scoring systems are already in place to assess the severity of acute pancreatitis. BISAP score offers the advantages of being inexpensive, rapid, and simple. Aim and Objectives: To analyze the predictive value of BISAP score in developing severe AP (SAP) and mortality rates. Materials and Methods: This study enrolled 138 patients with acute pancreatitis admitted to surgical wards of Shyam Shah Medical College Rewa, Madhya Pradesh, between January 2022 to December 2022, meeting the inclusion criteria. Results: The percentage of severity,  necrosis,  various organ failure,  death,  and hospital stay increased as the BISAP score increased. Regarding sensitivity and specificity, the accuracy of the BISAP score for predicting severe acute pancreatitis was 76.2% and 63.4%. Patients with severe acute pancreatitis had BISAP scores of 3 and above. Conclusions: BISAP can be used to identify the patients who are at risk, and this information can serve as early guidance for appropriate and necessary therapy,  improving patient outcomes. The present study concludes the increased accuracy of the BISAP score for risk stratification.

226. An Examination of the Stress and Sleep Patterns of Paramedical Students during the COVID-19 Lockdown
Pritam Kumar, Amrita Narayan
Abstract
Objective: Students’ mental health has been affected by the implementation of the statewide lockdown to stop the further spread of the Covid-19 virus and the warning of social exclusion and isolation. All the worried paramedical students experience dread, tension, and anxiety as a result of these sudden adjustments. The purpose of this study was to assess the relationship between paramedical students’ reported stress levels and the start of sleep. Method: 130 first-year paramedical students from Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, who took part in the study within a year were the subject of an observational study. The information was gathered using Internet surveys. Chi-square analysis was used to examine the data. Results: The participants’ body mass index (BMI) was 20.92±3.41 Kg/m2, and their average age was 19.97±1.20 years. The mean PSS score, or perceived stress score, was 18.18 ±11.18. It was shown that there was no significant relationship (p=0.156) between the PSS Score and the difficulties falling asleep. To relieve stress, 24.61% of students engaged in hobbies such as painting or other forms of art, 7.45% dance, 15.66% physical activity, 25.36% music, and 14.17% in yoga. Conclusion:  The paramedical students are significantly more stressed as a result of the Covid 19 shutdown.

227. Immunohistochemical Analysis of P-53 and Ki-67 Expression in Surface Epithelial Ovarian Tumor
Mahima Goel, Kanchan Srivastava, Shilpa U. Vahikar, Shaila Mitra, Reeta Singh, Alpana Bundela
Abstract
Background: Ovarian cancer is the sixth most common female cancer worldwide and third most common gynaecological cancer. Surface epithelial tumors of ovary (SEOT) are commonest among of all ovarian tumors and their malignant forms represents about 90% of malignant ovarian tumors. It is well known for its late presentation at advanced stage. Recently molecular and proliferative markers including p-53 and Ki-67 have emerged as promising adjuvant diagnostic tool for early diagnosis and identification of their biological behavior. Over expression of p-53 and Ki-67 has been claimed to be a marker of aggressiveness in SEOT. Aim And Objectives: To study and interpret the expression pattern of p-53 and Ki-67 in benign, borderline and malignant SEOT and assessing early aggressiveness and tumour progression of SEOT. Material & Methods: The study was performed on 100 consecutive resected specimen of SEOT received in pathology department over a period of one year. 10% Formalin fixed, paraffin embedded tissue sections were stained by haematoxylin & Eosin stain for histological analysis and immunohistochemical staining was performed using monoclonal antibodies against p-53 and Ki-67 in all the cases. The expression pattern of p-53 and Ki-67 was studied in terms of proportion score in p-53 and Labelling index (LI) in Ki-67. Result: In the study of 100 cases of SEOT benign lesions (49%) followed by malignant lesions (37%) and borderline lesions (14%). The expression of p-53 was less in benign (7/49, 14.3%) than borderline (8/14, 57.1%) and malignant tumors (33/37, 89.2%). The Ki-67 expression was more in malignant (35/37, 94.6%) than borderline (13/14, 92.8%) and benign tumors (5/49, 10.2%). A positive correlation were observed in p-53 and Ki-67 expression with tumour grade and FIGO stage. Their co-expression was seen in 46% of cases that was statistically significant (p- value < 0.000012). Conclusion: p-53 and Ki-67 expression correlate with worse prognosis in SEOTs and are useful adjuvant marker for understanding of biological behavior of these tumors which helps in guiding appropriate management and therapy in these patient.

228. Use of Antibiotic Steroid Gel Foam v/s Antibiotic Steroid Eye Drops after Endoscopic DCR: A Prospective Comparative Study
Monika Patel
Abstract
Introduction: Endoscopic dacrocystorhinostomy has evolved as an alternative treatment option with significant advantages and success rates for nasolacrimal duct blockage. Various intra operative factors like meticulous surgery and post operative factors like edema, crusting, infection, granulation affect the surgical outcomes. There are several possibilities of postoperative care to prevent crust or synechiae formation, but none of them is highly successful. Material and Methods: A prospective comparative study was carried out in tertiary care hospitals in Delhi NCR from April 2018 to December 2022. 24 patients diagnosed with symptoms of epiphora, having obstruction at the level of nasolacrimal duct were included in the study. The patients were followed up after 2 weeks, 4 weeks and 8 weeks. The subjects were assessed on the basis of ostium score and presence of crusting, secretions and synechiae. Result: The difference in the ostium scores of patients 2 weeks, 4 weeks and 8 weeks after treatment was analysed using a chi-square test. On comparing the results all the differences were found to be statistically non-significant (p=>0.05). Post operative factors such as crusting, secretions and synechiae were compared after 2 weeks, weeks and 8 weeks after surgery in group 1 and group 2 subjects using a z- test. The results were statistically not significant p= > 0.05. Conclusions: A meticulous surgical procedure is the key to an anatomical and functionally successful endonasal DCR surgery. Postoperatively the patients can be simply put on antibiotic steroid eye drops instead of different materials at ostium site for better results and patient satisfaction with equally successful results.

229. Parapharyngeal Tumours and its Management: A Study on 12 Cases
Perla Ambika, Maringanti Deepthi, Bhupender Singh Rathod Jatoh, Bhuvaneshwari Ganesan
Abstract
Background: The parapharyngeal space is an intriguing compartment of the head and neck. Pre-operative diagnostic accuracy has improved with the advent of CECT and MRI with fat suppression sequences and gadolinium for contrast. TORS has the approval of the US Government’s Food and Drug Administration (FDA) for use in early oropharyngeal cancers and benign lesions of the head and neck since 2009. This study is to have a clinical overview of the tumors of parapharyngeal space and various approaches in managing them. Methods: A prospective observational study was conducted over a period of 12 months in tertiary care centre, patients with parapharyngeal tumors of either age and sex of 10-60 years taken and patients unfit for surgery and who are not given consent were excluded. Results: There were 3(25%) males and 9(75%) females in the study. Average ages are 30-50 years,: post operatively 10 patients out of 12 patients of our study did not develop any new symptoms after the surgery in the immediate postoperative period including patients with preoperative vagal nerve palsy. 2 patients developed postoperative complications. Conclusion: No difference in surgical outcome with respect to patient age and sex. Age predilection was more among middle age group 30-50yrs,the risk of postoperative cranial nerve palsies are more with carotid body tumor Surgical resection may need to be extended to encompass the tumor by means of mandibulotomy .30% of these tumors are genetic in origin,3% are secretory,10% are multicentric.

230. Efficiency of Isoflurane and Sevoflurane on Length of Hospitalization and Emergence Time
Arvind Kumar, Jay Ram, Manish Singh, Abhishek Gautam
Abstract
Introduction: The following report has described the time of hospitalization as not distinct between isoflurane and sevoflurane. However, further plausible outcomes of employing soluble volatile anaesthetics that have been deferred emergence from anaesthesia and prolonged stays in the “postanesthesia care unit (PACU)”. Furthermore, this research paper has likened isoflurane and sevoflurane to emergence moment and PACU time. Aims and objectives: The study aims to determine the efficiency of isoflurane and sevoflurane on length of hospitalization and emergence time. Methods: This prospective study analyzed data from 80 patients, who underwent non-cardiac surgery at a hospital from April 2022 to March 2023. Demographic and morphometric data were collected from computerized anesthesia records. Patients who were admitted to the intensive care unit, had MAC percentage greater than 0.3, or skipped the PACU were excluded. Descriptive statistics and standard differences were used to compare the isoflurane and sevoflurane groups. Inclusion criteria were limited to patients receiving either isoflurane or sevoflurane anesthesia, with exclusion criteria for certain medical conditions or multiple anesthetics. Results: The study found that there is a significant difference between the two groups in terms of ASA physical status (p=0.004). The presence of metastatic cancer is significantly different between the isoflurane and sevoflurane groups (p=0.041). Other factors such as body mass index (BMI), patient age, duration of surgery, gender, and various medical conditions do not show significant differences between the two groups (p>0.05). Conclusion: The study has concluded that isoflurane can be used in most cases in PACU as it has many beneficial characteristics like longer emergence time of the patients.

231. A Comparative Study of Body Iron Status in Hypothyroid Patients and Healthy Controls at SMS Medical College and Attached Hospitals, Jaipur, Rajasthan
Harisharan, Nawal Kishor Sharma, Rashmi Gupta
Abstract
Background:  Iron plays an important role for both the synthesis as well as metabolism of thyroid hormones acting as a component of many enzymes including thyroid peroxidase (TPO). So, iron deficiency might lead to abnormal functioning of thyroid gland. So, our aim in this study was to compare the serum Iron, TIBC levels in newly diagnosed Hypothyroid patients and healthy individuals. Methodology: After taking necessary permission study was conducted in Department of Biochemistry and Department of Endocrinology S.M.S. Hospital, Jaipur. 30 Hypothyroid patients compared with Euthyroids for serum iron and TIBC levels. Observation:- Results were analysed statistically by student’s t test and pearson correlation coefficient test. Mean Iron, TIBC  in hypothyroid patients was 48.07 ± 12.89 µg/dl, 358.90 ±  56.64  µg/dl,  respectively and in controls 96.07 ± 28.00 µg/dl, 298.37 ±  55.27 µg/dl respectively. This difference was statistically significant(p<0.01). Conclusion: In hypothyroid patients serum Iron TIBC levels may be deranged so estimation of Iron, TIBC should be done as a routine.

232. A Study of the Incidence, Demographic Distribution, Predisposing Factors of Malignancies of the Oral Cavity at a Tertiary Care Center, South India
Sanal Mohan S., Anwar Rasheed
Abstract
Background: In this study, we wanted to determine the incidence of malignancies in individual sites and its relation to age & sex. We also wanted to determine the predisposing factors and their relation to individual sites. Methods: The study was done at the Department of Otolaryngology – Head and Neck Surgery, Travancore Medical College, Kollam, spanning over a five-years period from January 2017 to December 2021. 325 patients who presented with malignancies of the oral cavity were evaluated. The tumours of the salivary glands were excluded. All patients were thoroughly examined. A detailed account of the tobacco and alcohol habits was documented. All patients were appropriately investigated. Results: Males were most commonly affected in all sites and the male to female ratio was 2.3: 1. Subjects in the 41 – 60 years age group were most commonly affected with a mean age of 55 years. A significant proportion of the patients consumed tobacco or alcohol. 76.6 % of patients presented in an advanced stage (stage III or stage IV). Majority of the patients presented with complaints of ulcer, pain or local swelling. 39 % of the patients had anaemia on presentation. Conclusion: A well-coordinated effect is necessary for the prevention, early detection and treatment to tackle the growing incidence of malignancies of the oral cavity and its associated mortality and morbidity.

233. Leiomyomas of the Urinary Bladder: An Analytical Study
Saju P R, Ashik Suresh
Abstract
Background: Benign bladder tumours especially bladder leiomyomas are unusual tumours with significant clinical overlap with malignant bladder tumours. Their diagnosis often requires trans-urethral biopsy and histopathological analysis. However, follow-up protocols for benign bladder tumours are different from those for urothelial carcinoma. Methods: The retrospective descriptive study was conducted in a tertiary care centre, with data collected from a period between December 2017 and December 2020. All patients who were diagnosed and treated for leiomyomas and other benign tumours of the urinary bladder during the study period were reviewed retrospectively. Results: During the 3-year study period, 15 patients had been diagnosed with benign tumours of the urinary bladder. The majority of patients presented with LUTS (80%). Haematuria was also present in a significant number of patients as well (53.3%). The most common tumour was leiomyoma of the urinary bladder, with 6 cases. Conclusions: Distinction between benign and malignant bladder tumours is important as follow-up protocols differ between these entities. Definitive diagnosis required a transurethral biopsy from the tumour followed by histopathological analysis.

234. A Prospective, Randomized, Comparative Study of Effect of 0.5% Isobaric Levobupivacaine and 0.5 % Isobaric Levobupivacaine with Clonidine for Spinal Anaesthesia in Patients Undergoing Elective Lower Limb Orthopaedic Surgery
Naveen H.S., Prasannakumara V.R., Madhu K.R., Keshavamurthy G.R.
Abstract
Background: In this study, we wanted to evaluate the sensory and motor blockade properties of intrathecal 0.5 % isobaric Levobupivacaine and 0.5 % isobaric Levobupivacaine with clonidine in patients undergoing elective lower limb orthopaedic surgery. Methods: This was a hospital based prospective, randomized, comparative study conducted among 60 patients who were posted for elective lower limb orthopaedic surgeries in Apollo Speciality Hospital, Madurai, from December 2015 to June 2016 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Statistically significant difference in prolonged duration of sensory block and also prolonged duration of analgesia was observed in LC group compared to LS group. The onset of sensory block at T10 was faster in LC group compared to LS group. Time to attain maximum sensory blockade was also quicker in the LC group than in LS group. Onset of motor blockade between LC group and LS group was statistically significant and the time for maximum motor block between LC group and LS group was statistically significant. The duration of motor block was statistically significant between the two groups. Conclusion: 30 µg of clonidine as adjuvant along with 0.5 % isobaric levobupivacaine produces significant increase in duration of post-operative analgesia without producing significant haemodynamic changes.

235. A Case-Control Study of Lipid Profile and Liver Enzymes in Type-II Diabetes Mellitus at SMS Medical College & Attached Hospitals Jaipur (Rajasthan)
Mahendra Kumar, Kirtesh Sharma, Mukesh Kumar Bunkar, S K Vardey
Abstract
Background: Type 2 DM has been linked with dyslipidemia and elevation of some liver enzymes; in fact, it has been identified as independent risk factor for development of coronary artery disease (CHD). The liver helps to maintain normal blood glucose concentration in the system. This function is deranged in association with liver enzymes abnormality in type 2 DM and in obese individuals. It helps to predict any form of metabolic insult to the liver. The present work was designed to estimate the lipid profile and liver enzymes and to find the association between them in type 2 diabetes patients. Materials & Methods: After taking necessary permissions, a cross sectional study was conducted at Department of Biochemistry and Department of Endocrinology / Medicine, SMS Hospital, Jaipur. This study includes 30 patients suffering from type 2 diabetes aged 40-70 years compared with 30 controls. Samples were analyzed for the measurement of serum glucose, lipid Profile and Liver function tests by Colorimetric method and HbA1C measured by latex turbidimetric method. Results: Results were analyzed statistically by Student’s t-test and Pearson correlation coefficient test. Both Lipid Profile and Liver function tests were significantly elevated in patients as compared to controls. There was statistically highly significant positive correlation between Lipid Profile levels with GGT and Alkaline Phosphatase in diabetic patients. Conclusion: This study suggests routine monitoring of the commonly used lipid parameters (especially TG, TC and HDL-C) and LFT among patients with T2DM is warranted in our population which could be considered to be the epi-center for T2DM or CAD. Early recognition and appropriate treatment of significant postprandial dyslipidemia and altered LFT’s is of paramount importance in diabetics so as to reduce impending complications.

236. A Comparative Study of Serum Electrolytes and Calcium, Magnesium in Pre-Eclampsia Pregnancy and Healthy Controls at SMS Medical College & Attached Hospital Jaipur (Rajasthan)
Aditi Bagriya, Meenakshi Samaria, Rakesh Verma, Aman Bagriya, Pearl samaria, S K Vardey
Abstract
Background: Preeclampsia is characterized by the development of hypertension, proteinuria, and edema at 20th weeks of gestation and in its most severe form is associated with thrombocytopenia, disseminated intravascular coagulation, and hepatocellular damage.It is assumed that deficiency of several essential micronutrients may be a predisposing factor in the development of PE. The present study aimed to measure the levels of Calcium, magnesium, and electrolytes in patients with preeclampsia and to evaluate whether these parameters can be used as diagnostic markers of preeclampsia. Materials & Methods: After taking necessary permissions, a cross sectional study was conducted at Department of Biochemistry and Department of Obstetrics and Gynecology, SMS Hospital, Jaipur. This study includes 34 patients suffering from Pre-eclampsia aged 20-35years compared with 34 matched controls. Serum levels of Calcium, Magnesium and Electrolytes were measured by Spectrophotometryin fully Automated chemistry analyzer AU680 (BECKMEN COULTER). Results: Results were analyzed statistically by Student’s t-test. Mean Calcium for cases was 6.93 ± 0.72 mg/dl and for Controls was 9.55 ± 0.44 mg/dl which was statistically significant (p value < 0.01).The mean Magnesium levels for cases was 1.28 ± 0.16 mg/dl and for Controls was 2.15 ± 0.21 mg/dl. The value was higher for controls and was statistically significant (p value < 0.01).Similarly, Values of Serum electrolytes were found to be lower in Cases as compared to Controls in our study. Conclusion: The electrolyte and ion profile of 34 pre-eclampsia patients were studied and compared with that of healthy controls. The present study revealed that low serum Ca and Mg levels and electrolyte alterations mainly low sodium and low potassium are associated with pre-eclampsia, which might be attributed to the development and progression of the disease.

237. Incidence of Carcinoma Gall Bladder in Patients with Cholelithiasis in Tertiary Care Hospital, Hapur
Hardeep Balyan, Satwik Nishan,  Gyanendra Swaroop Mittal, Anubhav Arya
Abstract
Background: Gallbladder carcinoma is a rare complication of cholelithiasis. The aim of this study was to find out the incidence incidental carcinoma gall bladder in patients undergoing cholecystectomy for cholelithiasis. Methods: A total number of 430 patients who were operated at tertiary care hospital, Hapur over a period of 18 months, starting from July 2020 till December 2021, were included in this study. Cases admitted in various surgical wards were clinically evaluated and confirmed by ultrasonography for cholelithiasis. Results: Out of the 430 participants, maximum 237 (62.6%) had multiple stone and 161(37.4%) had single calculi, out of which 161 (37.4), 9 (5.50%) participants had Ca gall bladder. In our study, there were 2.8% incidence of ca gall bladder in patients who underwent laparoscopic surgery. In the study, a statistically significant high GB carcinoma was found among the patients who had single stone, stone>3cm, and body mass index (BMI). Conclusion: This study highlights the importance of considering the risk of Gall Bladder Carcinoma in patients having a simple cholecystectomy.

238. A Study of Intraoperative Complication of Port Entry Techniques in Gynaecological Laparoscopic Surgery
Mansi Gadhavi, Vijay Gadhavi, Jay patel, Bhavesh Airao
Abstract
Background: Over the last decade, a rapid increase has occurred in both the applications of operative laparoscopy and the number of surgeons using this technique. Although the complications of operative laparoscopy are low, they can be severe and life-threatening. The purpose of this study is to observe the major and minor complications of veress needle entry versus direct trocar for laparoscopy surgeries. Method: A retrospective study was carried out during the period of January 2022 and june 2022 among the 50 patients coming to Obstetrics & Gynaecology department at C.U. Shah Medical College in which verses Needle entry (VN) vs direct trocar entry (DT) method was used to create pneumoperitoneum in laparoscopic surgery. All data collected from medical record charts, patient details, clinical presentations and Ethical approval was obtained from ethical committee of institution. Result: Total duration of procedure(min) in  VN Group was 5.1± 1.2 and in  DT Group it was 4.3±1.3, while amount of gas used for pneumoperitoneum in litre was 5.6±0.8 in VN group and 4.1±0.6 in DT Group analysis shows in VN Group local site complication like port site leakage are seen in 12 patients, extra peritoneal insuffdlations seen in 6 patient, entry in wrong plane were found in 3 patient while loss of space was seen among 5 patients. In case of DT Group port site gas leakage was seen in 18 patients, extra peritoneal insufflations were found in 2 cases, entry in wrong plane was 1 and loss of space was in 1 patient. In systemic complication such as vascular injury only one and omental injury 2 cases were reported, and Nil cases were found in bowel trauma and gas embolism in VN Group. while DT Group vascular injury and gas embolism were nil. Bowel injury and omental injury were in 2 patient and in 5 patients. Conclusion: Direct Trocar entry is a safe alternative to the Veress needle entry technique for the creation of pneumoperitoneum. One of the main advantages of this technique is the reduced number of the blind insertions required to gain abdominal access. Other benefits are rapid creation of pneumoperitoneum, less gas use and decreased operating time.

239. A Histological Study of Beta Cell Mass in Head, Body and Tail Region of Cadaveric Pancreas among Diabetic and Nondiabetic People of Assam
Baneswar Baro, Bornali Hazarika, Bhabajyoti Bora, Usha Sarma, Rup Sekhar Deka, Gunamani Rabha
Abstract
Background: Pancreatic islets of Langerhans are characterized by spherical or ellipsoid clusters of cells embedded in the exocrine tissue. About  1-2 millions of islets present in different parts of human pancreas whereas maximum numbers present within the tail area. The beta cells are the most common and account for 50-80% of the cells in the islets. Beta cells mainly secrete insulin and alfa cells secret glucagon. Alteration in functioning of insulin and glucagon hampers the glucose homeostasis which leads to development of diabetes mellitus(DM). IHC technique applied to study beta cell mass in different parts of pancreas. Materials and methods: The study was conducted in the Department of Anatomy, Gauhati Medical College, Guwahati. A total of 103 specimens of human pancreas were collected after taking institutional ethical clarification from both male and female cadavers using simple random sampling method. Results & Observation: Distribution of beta cell mass in head, body and tail region of pancreas w.r.t. surface area of beta cell mass in IL of pancreas was done. Variable number of IL in different region of pancreas were analyzed which was more in tail region. ANOVA& F- value has proved that there is a highly significant difference among the 3 variables (head, body & tail). The ‘t’-value was highly significant in tail part and significant among head and body part. Conclusion: The data generated in our study with respect to beta cell mass provides the understanding the pathogenesis of diabetes mellitus. Though the present study was done on 103 CPs, further studies including a greater number of samples and advanced stereological procedure will provide better information and knowledge.  With the application of newer molecular technique, the detailed investigation of islets of Langerhans cells can be possible.

240. Supine versus Prone PCNL: A Single Centre Experience
Manu M K, Ashik Suresh
Abstract
Objectives: To compare the operative times, length of hospital stay, complication rate and stone free rate between patients undergoing supine PCNL and prone PCNL. Materials and Methods: A prospective observational study was conducted in our institution, involving 199 patients over a period of two years from 2019 to 2021. These patients were divided into two groups with 99 patients undergoing supine PCNL group and 100 patients undergoing standard PCNL group. The inclusion criteria included the presence of a renal calculus larger than 2.0 cm. Exclusion criteria included bleeding disorders, pregnancy, high risk for general anaesthesia. The measured data included number of punctures, operative time, fluoroscopy time, duration of hospital stay, complication rate and stone free rate. Results: Supine PCNL is associated with reduced operative times, compared to prone PCNL, with a p-value of <0.0001. However, there is no difference between the two procedures with respect to fluoroscopy time, blood loss, complication rate, stone free rate and length of hospital stay. Conclusions: Supine PCNL is an effective modality for the treatment of renal calculi with the added advantages of reduced operative time as well as simultaneous retrograde access, compared to prone PCNL. Larger scale studies are required for evaluating the advantages and drawbacks of the supine position with respect to the prone position for PCNL.

241. Arthroscopy & Arthrocentesis of the Tm Joint: in Relation of Pain & Functional Management: A Comparative Study
Santosh Mishra, Rahul Mishra, Anuradha Mishra, Madhuri Shukla
Abstract
In 2021 and 2022 720 patients with pain in the temporo-mandibular joint area were examined and treated. The authors describe their therapeutic protocol. Sixty-two patients were not relieved by conservative nonsurgical therapy and were treated by arthroscopy or arthrocentesis. In both groups the differences in functional result and in pain control were analysed. Results show that both arthroscopy and lavage are useful in improving function and diminishing pain. Arthroscopy shows better results for functional treatment whereas arthrocentesis and arthroscopy show similar results in pain control.

242. A Osteology Study on Assimilation of the Atlas Bone in Hyderabad Region
Vijaya Mangalur, Praveen Kumar M
Abstract
Introduction: Occipitalization of the atlas is defined as congenital bony fusion of the atlas vertebra to the base of the occipital bone of the skull. It is also known as assimilation of atlas, occipitocervical synostosis or atlantooccipital fusion. Materials and Methods: A total of 100 adult dried human skulls of unknown sex and age from the department of Anatomy, Kamineni medical college Narketpalli, Hyd, were included in the study. Results: Out of 100 adult human skulls studied, we observed atlantooccipital assimilation in 2 skulls amounting to 2 %. Each skull was carefully observed for variations. Findings in the skulls with atlantooccipital fusion were as follows. Conclusion: Occipitalization of atlas is the most common anomaly of the craniocervical junction which can remain asymptomatic for first 2 decades of life.

243. Role of MRI in Evaluating Pelvic Lymphadenopathy in Patients Diagnosed with Ca Endometrium
Saritha V, Jayasree L
Abstract
Background: MRI has crucial role in diagnosing and staging cases of Ca endometrium. Detection of maximum number of positive lymph nodes preoperatively facilitate more accurate surgery with good prognosis. Materials and Methods: This study was done in the department of Radiodiagnosis, Government Medical College, Trivandrum, Kerala. 55 patients were included in the study. Already diagnosed cases of Ca endometrium were subjected to MRI for the evaluation of extend of the disease. The data was expressed in number, percentage, mean and standard deviation. Statistical Package for Social Sciences (SPSS 16.0) version used for analysis. Results: Out of the total 15 patients with lymph node involvement only 13 cases were detected by MRI. 2 cases were false negative. The specificity and positive predictive value for detection of lymph nodes is 100% by MRI, but the sensitivity is only 86.6%. Conclusion: MRI is one of the valuable tools to evaluate and characterise the lymph node involvement in pelvis for patients diagnosed with endometrial carcinoma.

244. A Comparison of Intravenous Infused Esmolol and Dexmedetomidine on Hemodynamic Response to Laryngoscopy and Endotracheal Intubation in Elective Laparoscopic Gynecological Surgery
Dharmpal Atal, Chandrashekhar Chatterjee, Rama Chatterjee, Shailaja, Kiran Bala, Pawan Kumar Bairwa, Renu Garg
Abstract
Background: Rigid laryngoscopy and tracheal intubation remain the gold standard in airway management despite the emergence of new airway devices. These procedures ensure airway patency, ventilation control, and effective delivery of inhalation agents. However, they can stimulate sympathetic and sympatho-adrenal activities, causing temporary effects such as increased heart rate, blood pressure, intra-cranial pressure, and intra-ocular pressure. Complications like cardiac arrhythmia, myocardial ischemia, myocardial infarction, and cerebral hemorrhage may arise due to elevated catecholamine levels. Arterial hypertension during laryngoscopy and intubation primarily stems from increased cardiac output rather than systemic vascular resistance. Methods: Several drugs and techniques have been used to manage the hemodynamic response to laryngoscopy and intubation. These include deepening anesthesia, omitting cholinergic medications, pre-treatment with Nitro-glycerine and Isosorbide dinitrate, Propranolol, Droperidol, Lidocaine administration, Beta-blocker Esmolol, Clonidine, Dexmedetomidine, Calcium channel blockers, Gabapentin, and opioids like Fentanyl and Remifentanyl. The choice of technique or drug depends on surgery necessity, duration, anesthetic technique, route of administration, and patient’s medical condition. Results: Opiates reduce sympathetic response via vasodilation, vasomotor depression, and vagal center stimulation. Beta blockers effectively prevent heart rate elevation compared to blood pressure response. Esmolol, a short-acting β-1 adrenergic antagonist, ensures hemodynamic stability during laryngoscopy and intubation. Dexmedetomidine, a selective α2-adrenergic receptor agonist, provides analgesic and sedative effects when administered intrathecally, epidurally, or intravenously. It reduces cardiovascular response to tracheal intubation and lessens the need for thiopentone induction and perioperative fentanyl. Conclusion: This study aimed to compare the efficacy of Esmolol and Dexmedetomidine, belonging to different drug classes, in attenuating pressure response during laryngoscopy and endotracheal intubation for elective laparoscopic gynecological surgeries under general anesthesia.

245. Predictive Utility of Serum Ca-125 as a Biomarker in Pre-Eclampsia
Rathore Mahak, Mogri Sushma
Abstract
Objective: The present study aims to determine the positive predictive utility of CA-125 as a biomarker in women destined to develop pre-eclampsia. Method: After taking proper informed consent a total of 140 singleton pregnant females at or after 20 weeks were assessed for serum CA-125 at 20 weeks and followed up to term. The patients of pre-eclampsia formed one comparison group against non-pre eclamptic group. Result: There appears a strong co-relation between values of CA125 and incidence of pre-eclampsia as demonstrated by the table above and graph besides. The P value is <0.001, which is highly significant. In our study, the mean CA125 levels was 11.44 ± 4.89 IU/ml. In comparison to controls, preeclampsia patients’ mean CA125 levels were considerably higher, at 49.49 ± 21.0 IU/ml (p 0.001). Conclusion: Preeclamptic females had a mean CA-125 concentration that was substantially higher than that of normal pregnancies. A correlation between CA-125 level and the degree of pre-eclampsia was found to be positive. There exists a positive co-relation between levels of CA125, Systolic Blood Pressure, Diastolic Blood pressure, Serum uric acid and Serum Creatinine, all of which are predictors of pre-eclampsia.

246. A Comparative Study of Ropivacaine versus Ropivacaine Plus Dexmedetomidine under Epidural Anaesthesia in Lower Limb Surgeries
Surendra Meena, Tarun Lall, Veerendra Singh Gurjar, Kamlesh Kumar Malav
Abstract
Background: We designed a prospective study to examine the effectiveness of ropivacaine versus ropivacaine plus dexmedetomidine under epidural anaesthesia in lower limb surgeries because there are few studies that have examined the efficacy of dexmedetomidine as an adjuvant to ropivacaine in epidural anaesthesia. Methods: A prospective, randomised, double-blind, hospital-based study titled “A Comparative Study Of Ropivacaine Versus Ropivacaine Plus Dexmedetomidine Under Epidural Anaesthesia In Lower Limb Surgeries: Study at SMS Medical College Jaipur During 2021–23” was conducted on patients having lower limb surgery under epidural anaesthesia at the department of anaesthesia attached to S.M.S. Medical College, Jaipur with the goal of comparing ropivacaine versus ropivacaine plus dexmedetomidine under epidural anesthesia in lower limb surgeries. Results: The mean Sensory onset (min) in Group R was significantly higher (9.63±1.938 min) as compared to that in Group RD, 4.97±1.426 min. Time to achieve the highest level of sensory block and motor onset (in minutes) for groups R and RD was 16.53 ±1.196 and 11.80± 1.157, and also 14.77± 2.897 and 10.57± 2.932, respectively. A significant difference was observed in relation to the time to achieve the highest level of sensory block and motor onset (min). The mean SD of the sedation score was 1.80±0.407 and 2.90±0.607 in Groups R and RD. Respectively, this observation was statistically significant. (P= <0.001S). The mean duration of sensory and motor block in Group R and Group RD was 393.53±23.47 and 528.83±53.50 minutes, respectively, as well as 263.13±29.218 and 394.67±46.85 min, respectively.(P=<0.001S).i.e., groups were comparable according to the duration of the motor block. The mean value for the total number of rescue doses in Group R was 2.77 ± 0.43 more than in Group RD (1.97 ± 0.83), which was statistically highly significant. Conclusion: It was determined that the dexmedetomidine group performed better in terms of longer sensory block duration, postoperative analgesia with lower doses of rescue analgesic needed, and improved patient satisfaction. Dexmedetomidine produces a motor block and drowsiness that can last for a long time, which may not be ideal for ambulatory surgery or quick surgical operations.

247. Histopathological Study of Head and Neck Squamous Cell Carcinoma with Special Reference to P53 and P16
Gargi Roy Choudhury, Payel Hazari, Monoj Kumar Deka, Arindam Das, Shah Alam Sheikh
Abstract
Background and Aim: In this study, the prevalence of head and neck squamous cell carcinoma (HNSCC) is examined, as well as any potential associations between it and factors like HPV infection, tobacco usage, and alcohol intake. The purpose of the study is to determine whether the expression of p53 and p16 in these tumors correlate with one another. Material and Methods: This is a cross-sectional retrospective study. In this study, it is being investigated if head and neck squamous cell carcinoma specimens can be used to detect the presence of p53 and p16 proteins using immunohistochemistry. In the investigation, 50 samples from June 2019 to May 2021 were evaluated. The chi-square test was used to assess the percentage of p53 and p16 staining for squamous cell carcinoma of the head and neck region. A value of <0.05 was regarded as statistically significant. Results: According to the study, the male-to-female ratio is 1.5:1. 80% of the patients had cancers in their mouths, with 10% having tumors in their oropharynx. 18% also smoked while they were drinking, joined by 52% who had a history of smoking. It was seen that 68% of them had well-differentiated carcinomas. However, higher-grade tumors had higher levels of p53 and p16 expression (p<0.05). Conclusion: Our research has found that high levels of p53 and p16 are present in patients with head and neck squamous cell carcinomas and that a relationship between these markers and tumor grade exists. This information might be useful in the early detection and treatment of head and neck squamous cell carcinoma.

248. Surveillance of Respiratory Pathogens among Uncontrolled Type II Diabetes Mellitus Patients
Tejal D. Makwana, Hasmukh Asari
Abstract
Background and Aim: Diabetes mellitus is a standalone risk factor for lung infections, which present with severe clinical signs, frequent complications, and increased morbidity & mortality. It has been suggested that impaired lung function and insulin resistance, type 2 diabetes, glucose intolerance, and obesity are related. The goal of the current investigation was to ascertain the relationship between LRTI in DM patients. Material and Methods: In order to research the connection between DM and lower respiratory tract infections, 200 instances of DM with lower respiratory tract infections were examined over the course of a year. Using a pre-designed organised proforma, information on each chosen patient was meticulously gathered. Based on FBS/PPBS, oral glucose tolerance, and HbA1c criteria (i.e., FBS>126 mg/dl, OGT>2oomg/dl), diabetes is diagnosed. All patients underwent Ziehl-Neelsen staining and culture-sensitivity testing. When necessary, imaging tests including computed tomography and ultrasonography were carried out. Results: The age range most frequently impacted was 40 to 59 (n=114). Males were more impacted than females, with 38% of patients hailing from urban regions and 62% from rural ones. Patients’ socioeconomic level ranged from lower socioeconomic status (48%), middle socioeconomic status (34%), to upper socioeconomic status (18%). Instances of Mycobacterium tuberculosis were most frequently isolated. Additionally, strains of Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Escherichia coli, and Influenza A (H1N1) were isolated. In diabetic patients, Mycobacterium tuberculosis was the most isolated organism. Dry cough from early consolidation, prior antibiotic treatment, and incorrect sputum collection are the causes of inability to detect any organism in sputum in 35% of patients. Conclusion: LRTI and other DM-related complications are more likely to develop in DM patients with age greater than 50, duration greater than 4, and uncontrolled DM status. According to radiological findings, lesions that were moderately to severely progressed and that involved both sides were more prevalent.

249. Assessment of Post-operative Pain in Rural Patients: A Comparative Study of Numerical and Visual Analog Scales
Shikha Agrawal, Pranchil Pandey, Vaibhav Agrawal, Ramesh Agrawal
Abstract
Background and Objectives: Visual analog scales (VAS) and numeric analog scales (NAS) are crucial tools for assessing post-operative pain intensity in the fields of anesthesia and pain medicine. These scales rely on an individual’s cognitive and emotional abilities to provide subjective pain ratings. The documentation of pain scores is essential for comparative and analytical purposes in research articles. This study aimed to investigate the influence of literacy on post-operative pain scores measured by VAS and NAS, and to assess the agreement between these two scales. Materials & Methods: This study was conducted in the anesthesia department of a tertiary care hospital, following the appropriate guidelines for research ethics. Pain assessments were carried out using two types of scales, namely the Visual Analog Scale (VAS) and Numeric Analog Scale (NAS), at two specific time points: within five minutes and within 24 hours after the surgical intervention. The collected data from these time points were then subjected to statistical analysis, employing methods such as percentages, chi-square test, and regression analysis. Results: In this study, a total of 135 participants were included, with the majority being males (55.5%) and falling within the age group of less than 30 years (40.7%). The mean age was 35.60±16.4 years. About 40.7% of the participants were illiterate. A large proportion of the participants were able to rate their pain using both the Visual Analog Scale (VAS) and the Numeric Analog Scale (NAS), with 78.5% and 77.1% respectively. No significant associations were found between pain ratings and factors such as surgery type, duration, anesthesia nature, as well as age, sex, and literacy levels (p > 0.05). Conclusion: Irrespective of the literacy status, both the Visual Analog Scale (VAS) and Numeric Analog Scale (NAS) can serve as interchangeable post-operative pain assessment tools in the context of the Indian rural population.

250. A Study on Bacteriological Profile and Antibiotic Sensitivity Pattern for Sepsis in Children Aged 2 Months to 5 Years in a Tertiary Care Hospital
Praveen Deen Kumar N, Praveena B, Sankar Narayana C, Krishna Murthy G
Abstract
Background: Septicemia is a leading cause of morbidity and death in paediatric patients worldwide. One of the most difficult infections to control is that of by drug-resistant pathogens. Aim: The study is aimed to determine the principal etiological agents and antimicrobial susceptibility pattern of septicemia in paediatric patients at a tertiary care hospital. Material and Methods: A cross-sectional study was conducted on 2 months to 5 years old sepsis suspected patients. Blood samples were cultured by conventional method and Kirby-Bauer disc diffusion method was done to screen for antimicrobial susceptibility. Results: Of 300 participants, 103 (34.3%) of them had a positive blood culture. Among the Gram-negative isolates, Escherichia coli (67.75%) was the predominant isolate of which 17.3% were Carbapenem resistant. Among the positive isolates, Staphylococcus aureus (74.5%) was the predominant one and 35.29% were Methicillin resistant. Gram-negative isolates showed highest susceptibility to Amikacin, Meropenem and Piperacillin-Tazobactam. Gram positive organisms were sensitive to Linezolid, Vancomycin, Teicoplanin, Cotrimoxazole and Azithromycin. 44.6%. of isolates showed multidrug resistance and was highest in Escherichia coli. The average duration of hospital stay in culture positive cases was 16.9 days and 6.8 days in culture negative cases. Mortality rate observed was 10.6 % (31/300) and was highest in infants <1year and was more associated with Staphylococcus aureus infection. Conclusion: Given the variable nature of antibiotic susceptibility patterns and etiological agents of septicemia, it appears that ongoing assessment of the most common pathogens associated with bloodstream infections and detection of their sensitivity patterns to locally available antibiotics are reasonable measures.

251. A Cross Sectional Study to Determine Polycystic Ovarian Disease (PCOD) among Students of a Tertiary Care Teaching Hospital
Jagrati Kiran Naagar, Shweta Yadav, Sachin Singh Yadav
Abstract
Background: The incidence of childhood obesity is rapidly rising, which is the main cause of increased insulin resistance, the metabolic syndrome, dyslipidemia, and polycystic ovarian syndrome. India presently has the greatest number of type 2 diabetes mellitus patients worldwide. The prevalence of PCOD is unknown in the public, though. Objective: To estimate the prevalence of PCOD among students in Tertiary care teaching hospital. Materials and Methods: A cross sectional study was conducted among students of aged 16-24 years in a teaching hospital in BMC, Sagar (M.P.). Sample size of 256 students were randomly selected from various batches of medical and paramedical courses. Occurrence of hyper androgenic features and menstrual irregularities were evaluated, and they were physically examined. The diagnosis of PCOS was made based on Rotterdam’s criteria. Epi-info 7 was used for analysis. Results: Seventy-five students (30%) met the criteria to be diagnosed as polycystic ovarian syndrome. Twenty students (10%) had a history of thyroid dysfunction. The other clinical features of hyperandrogenism were like acne (25%), oily skin (13.5%), increased hair growth (7%), male pattern thinning of hair (9.75%). Conclusion: PCOD can be assumed of as a forerunner syndrome that, if screened for, can help in early identification of risk of highly morbid conditions, in adolescent girls.

252. Analysis of Comorbidities among Pregnant Woman Attending Outpatient Department of Tertiary care Institute
Jagrati Kiran Naagar, Shweta Yadav, Sachin Singh Yadav
Abstract
Background: In pregnancy Anaemia and Depression is an important factor associated with an increased risk of maternal, fetal and neonatal mortality, poor pregnancy outcomes, and impaired cognitive development. Objectives: To assess prevalence and factors associated with anemia & Depression among pregnant women attending antenatal clinic. Methods: A Facility based cross-sectional study was conducted on 284 pregnant women to at Tertiary Care Institute from June to August 2022. Data on socio-demographic and clinical characteristics of the study participants were collected using a Pretested structured questionnaire by interview and review of medical records. Binary Logistic regression analysis had been used to check for association between dependent and independent variables in all cases. P-value less than 0.05 was considered statistically significant. Results: The prevalence of anemia was found to be11.6% (95 % CI; 7.8%-14.8%) and Depression was 8.6% Pregnant women in the second and third trimester [AOR (95% CI), 8.31 (1.24-55.45), and P=0.029] were more likely to be anemic when compared to pregnant women in their first trimester. Pregnant women who did not receive iron/folic acid supplementation [AOR (95%CI),4.03(1.49 10.92), and P=0.01] were more likely to be anemic when compared to pregnant to women who did take supplementations. Conclusion: In this study the prevalence of anemia and Depression in pregnancy was low compared to the findings of others. Gestational age (trimester) and iron/folic acid supplementation were statistically associated with anemia.

253. Ultrasonography Facilitated Enteral Feeding Tube Implantation Among People with Severe Acute Pancreatitis: A Clinical Study Was Done at Shyam Shah Medical College Rewa (M.P.)
Anil Chouhan, Shailendra Singh, Dheeraj Kain, Poola Rahul
Abstract
Background: Clinical guidelines and more recent research advocate enteral nutrition (EN) as the mainstay of therapy for those with severe acute pancreatitis (SAP). A variety of strategies must begin EN within 24 to 48 hours following ICU admission. Aim and Objectives: To evaluate how a novel approach, including real-time ultrasonography, could assist with nasojejunal tube installation at the bedside in SAP patients. Materials and Methods: In the 15-bed surgery intensive care unit of a university hospital, a single-center, prospective descriptive study was carried out. In the study were forty SAP patients. The entire process of placing a nasojejunal tube at the patient’s bedside and using ultrasonography to direct tube positioning was carried out by a single doctor. An abdominal radiograph verified the final position of the nasojejunal tube. The procedure’s success rate, the time required, the period between the decision to use enteral feeding and the start of feeding, and the problems were all noted. Results: Forty-six intubations were conducted at the bedside on 40 patients utilizing an ultrasonography-assisted approach. In 38 of 40 patients (93.3%), nasojejunal tubes were successfully inserted. The average successful placement time was 22.07 ±5.78 minutes. The median period between the physician’s decision to implant a feeding tube and the start of feeding was 5.5 hours (2, 24). All patients experienced no adverse events. Conclusion: Nasojejunal tube implantation with this innovative technique is quick, easy, and reliable.

254. Assessment of Retroplacental Hematoma in first Trimester Bleeding at a Tertiary Centre in Bihar
Amrita Pritam, Sanjeev Kumar, Malvika Kumud, Sudha Bharti
Abstract
Background: Intrauterine hematoma is a common pregnancy complication and can occur at any time during the entire pregnancy. Aims and Objectives: The present study was conducted to assess retroplacental hematoma in first trimester bleeding. Materials and Methods: Two groups of 70 pregnant women with gestational age ranging from 6 to 14 weeks were formed. Group I were pregnant women who presented with threatened miscarriage, and group II (control) were pregnant women who presented without hematoma in the first trimester. Maternal and neonatal outcomes were assessed. Results: Pre-term labour was seen in 7 in group I and 2 in group II; IUGR was seen in 5 in group I and 1 in group II; PIH was seen in 4 in group I and 1 in group II; abruption was seen in 6 in group I and 2 in group II; and pre-eclampsia was seen in 3 in group I and 1 in group II. The difference was significant (P< 0.05). The mean gestational age at birth was 39.1 weeks in group I and 39.5 weeks in group II. The mean birth weight was 3.6 kg in group I and 4 kg in group II. Meconium-stained liquid was seen in 2 in group I and 4 in group II, and an Apgar score of 1 min <7 was seen in 18 in group I and 4 in group II, and an Apgar score of 5 min <7 was seen in 7 in group I and 1 in group II. The difference was significant (P < 0.05). Conclusion: Complications were more common with retroplacental hematoma than in the control group.

255. A Comparative Study of the Efficacy and Safety of 5% Minoxidil and 1 Mg Finasteride in Male Androgenetic Alopecia Patients at a Tertiary Centre in Bihar
Aman Kishor, Jwala Kumar, Manish Ranjan Shrivastava, Zaki Anwar Zaman
Abstract
Background: Androgenetic alopecia (AGA) is responsible for 95% of hair loss in males over 50. However, AGA is far less frequent in women, with around 40% of women experiencing some degree of hair loss, particularly after menopause. In a gradual process, alopecia is caused by the 5-reductase enzyme converting testosterone to dihydrotestosterone (DHT), which causes hair follicles to shrink. Aims and Objectives: A comparative study of the efficacy and safety of 5% minoxidil and 1 mg finasteride in male androgenetic alopecia patients. Material and methods: Ninety males with Androgenetic Alopecia were included in this analysis. There were two Categories of patients. The total number of patients in each Category was 45. Patients in Category I were prescribed 1 ml of a 5% minoxidil topical solution twice daily, while those in Category II were given a 1 mg finasteride pill once daily. Hair was evaluated using a 7-point scale (-3 for significantly reduced, -2 for moderately reduced, -1 for slightly reduced, 0 for no change, +1 for slightly increased, +2 for moderately increased, +3 for significantly increased) applied to before- and after-treatment images. Results: The average pre-treatment hair density of the scalp in Category 1 was 95.85 hairs/cm2, whereas that of Category 2 was 97.68 hairs/cm2. After treatment, the average number of scalp hairs in Category I was 118.58 per square centimetre, whereas in Category II it was 108.96. There was a statistically significant split (P 0.05). Table 3 reveals that score -1 was seen in 3 in Category  2, 0 in Category 1 , 22 in Category 1 and 15 in Category 2, 1 in 9 in Category1 and 7 in Category 2, 2 in 7 in Category 1 and 8 in Category 2 and 3 in 7 in Category 1 and 11 in Category 2. The difference was significant (P< 0.05). Conclusion: The treatment of Androgenetic Alopecia with oral 1 mg finasteride was shown to be more successful than that with topical 5% minoxidil.

256. Assessment of the Early Neonatal Outcome in Babies with Low Birth Weight Born to Hypertensive Mothers at a Tertiary Care Centre in Bihar
Amrita Pritam, Sanjeev Kumar, Malvika Kumud, Sudha Bharti
Abstract
Background: Pregnancy-induced hypertension (PIH) is responsible for 8–10% of all preterm births, 18% of fetal and infant mortality, and 46% of infants born are small for gestation (SGA). PHI is not by itself an indication for caesarean delivery. Aims & Objectives: The present study was conducted to assess early neonatal outcome in low- birth weight babies in mothers with hypertensive disorders. Materials & Methods: In the present prospective cross-sectional study, there were 72 women who delivered low-birth-weight babies and had pregnancies that were complicated by hypertension. There were two groups of 36 patients each. Group I represented vaginal delivery, while Group II represented caesarean delivery. There were measurements made for early neonatal outcome, neonatal problems, and different types of hypertensive disorders in pregnancy. Results: Socio- economic status (SES) was higher in 4 in group I and 7 in group II, middle in 12 in group I and 10 in group II, and lower in 20 in group I and 19 in group II. Gravidity was Primigravida in 4 in group I and 22 in group II, and multi-gravida in 12 in group I and 14 in group II. The difference was significant (P < 0.05). APGAR score at 1 minute < 7, in group I was 25 and in group II was 26. At 5 minutes < 7, 13 were seen in group I and 12 in group II. NICU admissions were seen in 22 patients in group I and 28 in group II. Neonatal complications included birth asphyxia, seen in 12 in group I and 10 in group II; meconium aspiration syndrome (MAS), seen in 3 in group I and 2 in group II; and intraventricular hemorrhage (IVH), seen in 2 in group I and 1 in group II. The difference was significant (P <0.05). Conclusion: Neonatal outcomes are not worsened by spontaneous or induced vaginal delivery in women with hypertension who have good control, and caesarean section decreases morbidity for the mother.

257. Comparative Study of Change of HBA1C with Voglibose and Teneligliptin on Ongoing Metformin Monotherapy: A 12-Week Randomized Comparative Clinical Study
Manish Ranjan Shrivastava, Aman Kishor, Jwala Kumar, Zaki Anwar Zaman
Abstract
Background: One of the most challenging health problems of the 21st century is diabetes. 70% of all reviewed studies reported T2D prevalence of over 10% in Indigenous Peoples, who account for 6.2% of the global population. Dipeptidyl peptidase-4 (DPP-4) inhibitors are a relatively new class of antihyperglycemic agents that are now recommended as second- or first-line agents in the treatment of diabetes by guidelines like those of the American Diabetes Association (ADA) 2016, the American Association of Clinical Endocrinologists 2016, and the American College of Endocrinology 2016. Aim and Objectives: The present study was aimed to find out the comparative ability to reduce glycosylated haemoglobin (HbA1c) with voglibose (one alpha glucosidase inhibitors) and teneligliptin (DPP 4 inhibitor). Materials and methods: The present prospective cross-sectional study comprised eighty (80) patients with diabetes and on Metformin monotherapy with uncontrolled hyperglycaemia was a hospital based interventional study of both genders. Patients were divided into two groups for this clinical study in a prospective parallel group design. 40 patients were included in each group. Group A patients were on metformin+Voglibose combination therapy and Group B patients were on Metformin+teneligliptin combination therapy. Results: The mean baseline HbA1c value was 8.35% in the Group A (Metformin+Voglibose) and 8.45 % in the Group B (Metformin+teneligliptin). There was no significant difference between mean HbA1c level between these two groups. The mean baseline FBS value was 162±26.4 mg/dl in group A and 167±25.7 mg/dl in group B. Mean serum LDL level was greater reduced (-21.4mg/dl) in teneligliptin, group B than voglibose, group A (-8.5mg/dl) [p value <0.05]. HDL level was slightly increased in both the groups and greater in teneligliptin, group B. Mean serum triglycerides level was greater reduced (-20.2mg/dl) in teneligliptin, group B than voglibose, group A (-17.2mg/dl) but the differences are not significant. Conclusion: The present study highlights the overall HbA1c lowering effect of Metformin+teneligliptin combination is more than Metformin+ voglibose. There is significant elevation of serum HDL- cholesterol as compared voglibose.

258. Comparing Efficacy of Propranolol Plus Flunarizine Combination and Valproate Monotherapy in Migraine Prophylaxis at a Tertiary Centre in Bihar: A Randomized Control Trial
Jwala Kumar, Manish Ranjan Shrivastava, Shreya Shekhar, Aman Kishor, Zaki Anwar Zaman
Abstract
Background: Migraine is one type of headache, described as a recurring syndrome of headache associated with certain neurological dysfunctions in varying admixtures. It is the second most common cause of headache, and it is the most common headache-related and indeed neurologic cause of disability in the world, affecting about 15% of women and 6% of men over a period of 1 year. Aims and Objectives: The present study was conducted to assess the efficacy of propranolol plus flunarizine combination and valproate monotherapy in migraine prophylaxis in a tertiary care center. Materials and Methods: The present prospective cross-sectional study comprised 120 patients with migraine. Out of 120 patients, 24 did not meet the inclusion and exclusion criteria. Hence, 96 patients were enrolled. But six patients were lost to follow-up. The final analysis was done on 90 patients. Patients were divided into two groups for this clinical study in a prospective parallel group design. 45 patients were included in each group. Group I patients received valproate monotherapy, and Group II patients were on propranolol and flunarizine combination therapy. Results: The study was done on 90 patients with migraine. The mean age of Group I patients was 32.69 ±8.05 (mean SD) years, whereas the mean age of Group II patients was 31.82 ±8.74 (mean±SD) years, respectively. Males were 32 (35.56%) and females were 58 (64.44%). The reduction of headache at baseline was 9.86 with valproate monotherapy and 8.42 with propranolol + flunarizine combination therapy, at the 1st visit it was 6.07 and 5.82, and at the 2nd visit it was 2.81 and 2.19, whereas the reduction in MIDAS score at baseline was 19.50 with valproate monotherapy and 19.6 with propranolol + flunarizine combination therapy, at the 1st visit it was 10.23 and 10.6 and at the 2nd visit it was 5.72 and 5.61 in group I and II, respectively The difference was significant (P < 0.05). Conclusion: In the present study, we found that valproate and propranolol plus flunarizine combinations were both highly effective in migraine prophylaxis. Propranolol plus flunarizine combination therapy was proven to have a better outcome than valproate monotherapy in migraine prophylaxis.

259. A Cross Sectional Study on Awareness About Measles Among Mothers of Under- 5 Children Attending Tertiary Care Hospital, Telangana
M Sheeba Apoorva, Y Sai Krishna, Vimala Thomas
Abstract
Background: Measles remains as one of the significant causes of mortality and morbidity in the world. Despite the efforts of the governments, there are deficiencies in vaccine coverage for measles. Objective: To assess the knowledge of the mothers regarding measles and the reasons for delay in receiving the vaccine. Material & Methods: A cross sectional study was conducted in a tertiary care hospital for a period of 2 months using a pre designed semi structured questionnaire administered to the mothers in the local language. Conclusion: About half of the study subjects were not aware of measles and one – third of the under 5 children had delay in receiving the 1st dose of measles vaccine. The main reasons for delay in the vaccination were found to be -Child being ill, forgot vaccination scheduled date and the time of vaccination was not feasible.

260. Assessing Patient Satisfaction with Obstetrics and Gynaecology Outpatient Department at Katihar Medical College and  Hospital, Katihar
Shipra Bharati, Abhishek Sinha
Abstract
Background: Patient’s satisfaction is of utmost importance as a parameter of the quality of health care. Aim of the study is to assess satisfaction with the available services obtained from patients who were seen in outpatient department of obstetrics and gynaecology, Katihar Medical College, Katihar, Bihar, India. Materials and Methods: A cross-sectional survey was conducted using questionnaires among patients attending outpatient department of obstetrics and gynaecology, Katihar Medical College, Katihar, Bihar, India. The data were collected prospectively between 2nd March and 1st July 2022. After obtaining the consent of the individual, they were asked to complete a set of questionnaires immediately or face to face interview was done in cases where the patient was illiterate. The study instrument was a questionnaire which comprised of two parts. The first part related to respondent’s socio-demographic background and second part on patient satisfaction questions. Result: Majority of the respondents (70.0%) visited obstetrics unit while 30.0% of them visited gynaecology unit. 250 (62.5%) appointments were first attendance while rest were follow- up visits. The average patient overall satisfaction was 90.0 % in this study. Conclusion: Overall, the patients were satisfied with services of outpatient department of obstetrics and gynaecology, Katihar Medical College, Katihar, Bihar, India. Majority of the patients were satisfied with clinic facility, staff’s professionalism, healthcare provider’s attitude and quality of medical care.

261. Comparing the Efficacy of Inducing Labor with 25 Micrograms of Vaginal Misoprostol Against Cerviprime Gel in Term Pregnancies
Tarse Vishnu Gopalrao, Anita Pawar, Ashwini Jadhav, Pawan Bonde
Abstract
Background: This comparison research was carried out to assess the efficacy of 25 micrograms of intravaginal misoprostol with that of intracervical cerviprime gel in terms of the efficacy of the medicine, the foeto-maternal result, the side effects, and the complications of the pharmaceuticals. Methods: This research comprised a total of 150 first-time mothers who were full-term and had been admitted to the hospital for labor induction. They were given either misoprostol administered intravaginally or cerviprime gel administered intracervically based on a random drawing. In Group A, 75 women were given 25 micrograms of misoprostol intravaginally every six hours for a maximum of five doses. In Group B, 75 women were given 0.5 milligrams (2.5 milliliters) of intracervical cerviprime gel for a maximum of three doses. A comparison was made between the two groups’ neonatal outcomes, as well as the amount of time it took for induction to lead to birth, the average amount of time it took for labor to start, the APGAR score at 1 and 5 minutes, and how quickly labor started. Results: In the group that was given misoprostol, the average length of time it took for labor to begin was significantly less than in the group that was given cerviprime (P=0.49). In a similar manner, the period from induction to delivery was shorter with misoprostol (P>0.05) as compared to cerviprime gel. In the misoprostol group, the need for augmentation with oxytocin was lower (16%) as compared to the cerviprime group (46%), and this difference was statistically significant. The misoprostol group had a rate of cesarean sections that was 2% greater than the control group. Both groups had favorable outcomes for the newborns, with favorable maternal and neonatal complication rates. The cost of induction was significantly reduced for those who used misoprostol. Conclusions: In comparison to cerviprime gel, misoprostol is a medicine that is safe, effective, relatively inexpensive, and well tolerated by both the mother and the fetus. It was discovered to be a better inducing agent, has a short induction to delivery interval, which results in a shorter length of labor, and has a safety profile that is comparable for both the mother and the unborn child.

262. Electrocardiographic Alterations in Non-Obese Asian Indian Patients with Hypertension and Insulin Resistance
Sudhanshu Shekhar Jha, Rakesh Kumar
Abstract
Objective: The objective was to study the connection between insulin resistance and electrocardiographic alterations in hypertension without the interference of confounding factors, plasma glucose, and insulin responses to oral glucose. Methods: A prospective study consisting of 35 hypertension participants and 25 normotensive subject altogether was carried out from September 2021 to August 2022 at Government Medical College and Hospital, Purnia, a resting ECG was performed and categorized as normal or abnormal. Results: 17 of the 35 participants showed abnormal ECGs. The glucose tolerance of every hypertensive individual was normal. In comparison to normotensive and hypertension participants without ECG abnormalities, the serum insulin response of hypertensive subjects with ECG alterations was 42% greater. In participants with aberrant ECGs, the ratio of AUC glucose/AUC insulin, which measures insulin sensitivity, was considerably lower. The greatest levels of serum LDL cholesterol were found in hypertensive participants with irregular ECGs. Total cholesterol to HDL cholesterol was at an increased level. 17 hypertension participants (6 with and 11 without aberrant ECGs) showed a 51% decrease in the number of insulin receptors as compared to normotensive subjects. In 83% of cases, the correct classification was determined by multiple logistic regression analysis using mean blood pressure, serum total cholesterol, LDL cholesterol/HDL cholesterol, insulin level at 50 minutes in the OGTT, treatment, serum triglyceride, and the presence of a family history of diabetes, CHD, hypertension, or tobacco as independent variables causing ECG changes. The insulin level in the OGTT was the factor that had the greatest impact on the aberrant ECG readings. Conclusions: The information points to a potential link between electrocardiographic anomalies and hyperinsulinemia or insulin resistance in Asian Indian hypertension people who are not fat or diabetic.

263. Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants
Rajkishore Singh, Shahin Bano
Abstract
Background: Late preterm infants are more likely to be admitted to a NICU and develop complications there. This study aimed to determine whether or not mothers of late preterm infants who slept supine were more likely to have their infants committed to the neonatal intensive care unit (NICU). Methodology: Relevant research published between 2020 and 2022 was located through an exhaustive literature search. The Study was conducted at JNKTMCH from January 2022 to December 2022. Consideration was given to a study examining the relationship between late preterm infants sleeping in a supine position, Breastfeeding, postnatal smoking, and NICU hospitalisation. Data extraction and analysis determined the correlation between these variables and NICU admission. Results: Late preterm neonates sleeping supine, Breastfeeding, postnatal smoking, and NICU hospitalization were studied. Researchers found that supine babies were less likely to need neonatal critical care. NICU admissions were lower for babies whose mothers nursed them exclusively or for long periods. Smoking mothers admitted late preterm infants to the NICU more often. Conclusions: This study shows that late preterm infants that are breastfed quickly and sleep recumbently have fewer NICU visits. Healthcare practitioners must encourage and support these practices to improve the health of this at-risk group. Smoking reduction methods must be developed to lower NICU admission rates due to postnatal smoking. These findings affect clinical practice and public health activities to reduce late preterm newborns in the NICU and improve their health. The mechanisms and specific treatments for this population need more research.

264. A Cross-Sectional Study on Evaluation of Iron, Ferritin, TIBC, and LDH Levels in Hypothyroid Patients at a Tertiary Care Center
Madhav Kadam, Neeraj Chhari, Deepika Rathore, Piyusha Mahashabde
Abstract
Background & Objectives: This study aimed to examine the influence of hypothyroidism on serum ferritin, iron, total iron-binding capacity (TIBC), and lactate dehydrogenase (LDH) levels, considering their potential implications for thyroid function. Methods: The study included 100 age and sex-matched cases and controls. Serum thyroid profile and ferritin levels were measured using chemiluminescent immunoassay (CLIA) on a Mindray analyzer. Serum iron, total iron-binding capacity (TIBC), and lactate dehydrogenase (LDH) levels were assessed using ERBA chem7. Statistical analysis was performed to determine correlations between these parameters. Results: The study findings indicated a significant decrease in serum ferritin levels in hypothyroid patients compared to the normal control group (p < 0.001). Furthermore, hypothyroid patients exhibited significantly increased levels of total iron-binding capacity (TIBC). Conclusion: The results of the study suggest a correlation between hypothyroidism and decreased serum ferritin levels. The measurement of serum ferritin can be valuable in the understanding, diagnosis, and monitoring of hypothyroidism.

265. Cold Pressor Test in Medical Students as a Predictor of Hypertension
Kalashilpa Chittikanna, Vandali Jyothi, Sudhakara Babu Chelli
Abstract
Introduction: Early detection of hypertension risk is crucial to its prevention since hypertension is a significant risk factor for cerebrovascular morbidity and mortality. The cold pressor test, which measures how blood pressure reacts to an external cold stimulus, has been used to pinpoint hyperreactive people who are at risk of developing hypertension. Our study’s objective was to determine how the cold pressor test (CPT) affected medical students with and without a history of hypertension in terms of heart rate and blood pressure. Materials and Methods: This study was conducted on sixty normotensive children of normotensive parents and sixty normotensive children of hypertensive parents between the ages of 18 and 22 at Surabhi Medical College in Siddipet, Telangana, between February and August 2022. The cold pressor test has been performed. The obtained values were expressed as Mean± SD and compared using the student ‘t’ test. Result: The cold pressor test caused an increase in blood pressure and heart rate in all of the young, normotensive students. Blood pressure and heart rate returned to baseline five minutes after the removal of the stressor in students with no history of hypertension in the family. In contrast, the students whose parents were reported to be hypertensive exhibited elevated diastolic blood pressure five minutes after the stressor was removed. Conclusion: The present study revealed that the normotensive students who presented prolonged elevated diastolic pressure in response to sympathetic stimulation through the cold pressor test were prone to develop hypertension in the future.

266. A Prospective Observational Study and Risk Factors of Intra Uterine Fetal Demise at JLNMCH, Bhagalpur, Bihar
Madhavi, Tanu Kumari, Archana Jha, Anupma Sinha
Abstract
Background: A significant obstetrical complication that can be upsetting for parents and obstetricians alike is intrauterine foetal death. Finding the causes of IUFD will enable the development of a successful prevention strategy, preventing maternal problems in the process. The purpose of this study is to determine the prevalence, sociodemographics, maternal risk factors, and foetal features of cases of intrauterine foetal death. Methods: From March 2022 to August 2022, the current prospective study was carried out in the Obstetrics and Gynaecology Department of the Jawaharlal Nehru Medical College and Hospital in Bhagalpur, Bihar. The antepartum circumstances that resulted in foetal death were reported, and sociodemographic and clinical characteristics were observed and examined. Results: During this time, there were 1450 deliveries and 45 foetal deaths. In our study, the incidence of IUFD was 31.03/1000 live births. Conclusion: The main causes of foetal death are pregnancy-induced hypertension, severe anaemia, placental abruption, and congenital malformations of the foetus. All of the major causes of foetal death that were found here can be avoided. To lower the still birth rate, proper preconceptional advice and prenatal care are essential.

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