International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Evaluating the Nutritional State in Adolescents and Adults Having Type 1 Diabetes Mellitus
Prakash Kumar Mishra, Manoj Patel, Deepak Jaiswal
Abstract
Background: Diabetes mellitus is a chronic condition affecting a large population globally and is associated with chronic under nutrition and obesity. It is vital to monitor the nutritional state of child subjects affected with type 1 diabetes mellitus owing to their growing age and correlation with celiac disease. Aim: The present study was aimed at evaluating the nutritional state of child subjects having type 1 diabetes mellitus in the Indian scenario and identifying the possible risk factors responsible for under nutrition. Methods: The study assessed child subjects with type 1 diabetes mellitus in a case-control manner where type 1 diabetics were cases compared to the healthy controls. For all the subjects, detailed history was recorded followed by clinical examination and anthropometric measures. Results: The mean age for controls and cases were 10.2±3.75 and 8.66±3.3 years respectively. Significantly lower anthropometric measures were seen in diabetic subjects compared to the controls with p<0.001. The subjects comprising the undernourished group belonged to large-size families compared to the subjects from the normal nutrition group with significant differences. Disease onset age for the undernourished group was higher compared to the undernourished group with 8.81±2.87 and 6.63±2.76 years. The significant negative correlation of HbA1c was seen with BMI-z and weight for age with p=0.005 and 0.003 respectively. Conclusion: The study concludes that subjects with type 1 diabetes mellitus have significantly lower anthropometric measures compared to normal subjects. Disease duration, large family size, female gender, and old children are independent predictors for undernutrition in subjects with type 1 diabetes mellitus. A significant negative correlation is seen in the metabolic control of diabetes (HbA1c) with weight for age and BMI.

2. A Novel Combination of Serum Pct and Nitric Oxide for Early Diagnosis of Neonatal Sepsis
Rupesh Kumar, Suresh Meena, Kailash Meena, Shakuntala Saini
Abstract
Introduction: Neonatal sepsis is general cause of mortality in new-born infants. It manifests either early (<7 days of birth) or late (>7 days). Despite of advanced neonatal treatment, sepsis still has significant effect on neonatal morbidity and survival rates. Aim and objectives: The present study, aimed to investigate serum levels of PCT and NOx in neonates and to find out the correlation between PCT and NOx, in establishing the early diagnosis of neonatal sepsis. we included the following subjects in our study. Materials and Methods: The clinical criteria taken as indicative of sepsis were: I. Mother suffering from fever or rupture of amniotic membrane >24 hr II. Low birth weight (< 2500 grams) and premature birth (<37 weeks).  III. Clinical Signs and symptoms of sepsis which includes diarrhea, vomiting, poor sucking and abdominal distension. IV) Control group – Healthy neonates with no clinical sign and symptoms and negative for lab findings. Results and Discussion: The present study was intended to estimate the levels of procalcitonin and nitric oxide levels in neonatal sepsis and to compare these values between controls and cases. As per the inclusion criteria we included 85 clinically proven cases neonatal sepsis and 35 controls. Even though the gold standard means for diagnosing sepsis is blood culture, the results of the blood culture are available only after minimum 12 hours and having high risk of contamination making it difficult to diagnose neonatal sepsis. Early diagnosis and early intervention is very important to save the life of the patient. Therefore, a rapid test with the best degree of sensitivity, reliability, and predictability is required for the early diagnosis and treatment of neonatal sepsis. We found significantly elevated levels of PCT and Nitric Oxide levels in subjects with neonatal sepsis as compared to healthy controls. Conclusion: We found elevated levels of pro-calcitonin and nitric oxide levels in neonatal sepsis, by measuring these parameters early diagnosis and early therapeutic intervention can be taken.

3. Utility of Urine Metabolic Screening Test to Diagnose Spectrum of Inborn Metabolic Disorders in Jaipur, Rajasthan
Rupesh Kumar, Suresh Meena, Kailash Meena, Shakuntala Saini
Abstract
Enzyme defect in biochemical or metabolic pathways leads to development of Inborn metabolic Disorders (IMDs) which are rare genetic or inherited disorders. Defect in biochemical or metabolic pathways alters proteins, fats and carbohydrates metabolism or impaired organelle function presenting as complicated medical conditions. IMDs involve great complexity of the underlying pathophysiology, biochemical workup, and molecular analysis, and have complicated therapeutic options for management IMDs lead to the physical and mental disability and death of infants, which can be prevented if detected early. Early detection of IMDs relies on a high index of clinical suspicion and co-ordinated access to specialized laboratory services So, the aim and objective of present study was to diagnose suspected IEM by using simpler and convenient urine biochemical tests 398 cases out of 512 referred cases of IEM suspicion showed the diagnostic pattern IMDs which was clinically correlated confirmed by the clinician who referred. Hence these parameters can be added as screening markers differentiate and diagnose IMDs.

4. Histopathological Study of Patterns of Thyroid Lesions in A Tertiary Care Centre in Central India
Priyamvada Singh, Manal Ashraf Ali, Farah Jalaly, Aizaz Fatima
Abstract
Background: Diseases of the thyroid gland are one of the most common endocrine disorders in humans. A significant burden of these disorders exists in India with about 42 million people suffering from thyroid disorders. The incidence and pattern of thyroid lesions depend on various factors which include sex, age, ethnic and geographical patterns. Majority of thyroid lesions are non-neoplastic or benign lesions. The aim of the present study was to determine various histomorphological patterns of thyroidectomy specimens along with their frequency and relationship with age and sex of the patient. Methods: This prospective study was conducted in the department of Pathology, Chirayu Medical College and Hospitals, Bhopal for a period of 18 months. The study included 70 thyroidectomy specimens received in the Department of Pathology, CMCH for histopathological analysis. Gross and histopathological analysis of the specimens was done and noted. The data was analyzed by standard statistical methods. Results: The commonest of the benign lesions was Thyroid Follicular Nodular Disease followed by Follicular Adenoma and Hashimoto’s thyroiditis. Most common malignant lesion was Papillary Carcinoma Thyroid followed by Follicular Carcinoma Thyroid. Age group of patients ranged from 16 to 73 years. The study showed a female predominance of 90%. Conclusions: The occurrence of thyroid diseases varies according to gender, age groups, and ethnicity. The study showed a female predominance. Peak age of incidence of thyroid lesions was between 51 and 60 years, however no age group was spared. Most common lesion was Thyroid Follicular Nodular Disease and most common malignant lesion was Papillary Carcinoma Thyroid. Radiological examination is helpful but histopathological examination remains the mainstay for definite diagnosis and management of thyroid neoplasms. The importance of awareness, self-examination and clinical suspicion cannot be over emphasized.

5. Evaluated Vitamin D3 Levels and Dermatological Complications among Regular and Frequent Alcoholic Dependents: An Observational Study
Sathish K.S., Monika. M. Gowda
Abstract
Background: The present study aims to determine Vitamin D3 levels among regular and frequent alcoholic dependents in order to identify different health problems. Methods: Study was carried out in Bangalore’s tertiary health care hospitals. As per the WHO recommendation; the patients were divided in two groups viz Group 1 (n=153) and Group 2 (n=98). A total 251 patients of which chronic (64.44%) and frequent (35.55%) alcohol dependents were taken. The data were compiled by R-statistical tool; Z and chi-square tests were employed to prove the hypothesis. Results: The group 1 shows significant correlation (p<0.001; Hz 3.61) between different diseases and health complications as compared with control population (Group 2). Health complications like alcoholic fatty liver diseases (12.95% hz 3.80%), cirrhosis (2.61% hz 1.69), acute kidney injury (1.31%,hz 1.22 ),bone nourishment (0.65%, hz 1.09 ), addictive behaviour (3.27%, hz 2.55 ), osteomalacia (1.96%,hz 3.30), osteoporosis and osteopenia (3.27%, hz 3.88 ), alcoholic myopathy (3.92%, hz 2.88), skin cancer (1.31%,hz <1.0 ).The body mass index (BMI) did not differ statistically (P > 0.05) between the two groups with mean age was 49.55 years with SD 2.33 (CI 95% 44.98-54.11years). The patients were assessed using both the prior and posterior data sets. According to the results, there are three income groups; low income (78.0%), mid income (12%) and high income (10%). According to the data, several diseases and illnesses were substantially more prevalent among the lower and middle class population, where regular alcohol dependents are more likely to experience health complications. Conclusion: Since alcoholic addiction is now more prevalent in rural areas and among illiterates, the government must act rapidly and enforce the updated strategy to stop alcohol addictions into effect. This research will also help to the physicians in their clinical decisions about the patients.

6. A Descriptive Cross Sectional Study to Determine the Cognitive Profile in Patients with Seizure Disorders
Savita patel, Richa Chaudhary, Sanjay Prasad
Abstract
Aim: To study the prevalence of cognitive profile in patients with seizure disorders. Methods: The study was conducted in a tertiary care hospital over a period of 1yr after taking informed consent from 100 patients by random sampling after fulfilling the inclusion criteria. Results: In our study we found Cognitive impairment in all domain of cognitive function in person with epilepsy including 11% subjects shown cognitive impairment in executive function, 61% subjects shown impairment in mental speed, 79% subjects shown impairment in visuo-spatial construction and 27% subjects shown impairment in attention, 75% subjects shown impairment in verbal learning and memory. Conclusions: The high prevalence of cognitive impairment among epilepsy patients calls for early neuropsychological assessment soon after the diagnosis of epilepsy beyond that, the baseline screening may also guide treatment plan and serve as an early indicator for rehabilitative care.

7. To Study the Clinical Correlation of Cognitive Domains in Patients with Seizure Disorders
Savita patel, Krishna Kumar Carpenter, Richa Choudhary
Abstract
Aim: To study the clinical correlation of different cognitive domains like Executive function, mental speed and attention in subjects with seizure disorders. Methods: The study was conducted in a tertiary care hospital over a period of 1yr after taking informed consent from 100 patients by random sampling after fulfilling the inclusion criteria. Results: In our study , We found Controlled oral word test & Digit symbol substitution test for executive function and mental speed was statistically significant with duration of seizure (p value 0.04 and p value 0.000 respectively) while rest clinical variables were not statistically significant P value >0.05. Color trails test for attention was statistically significant with duration of AED (p value 0.02) and medication status (p value 0.03) while rest clinical variables were not statistically significant. Conclusions: The high prevalence of cognitive impairment among epilepsy patients calls for early neuropsychological assessment soon after the diagnosis of epilepsy.

8. Assessment of Cardiac Sympathetic Functions in Type 2 Diabetes Mellitus Patients by Cold Pressor Test
Kapil Gupta, Harvendra Singh, Hemant Tahilramani, Himanshu Gupta
Abstract
Introduction: Diabetes Mellitus is a well-known chronic metabolic disorder which poses as a major medical health burden in the world and in India as well. In terms of autonomic neuropathy Diabetes is associated with early vagal withdrawal, and enhanced sympathetic tone. The objective of the present study was to assess the cardiac autonomic functions using Cold Pressor test in patients with type 2 Diabetes Mellitus (DM 2) and their subsequent comparison with healthy controls subjects. Methods: The Present study was performed in Department of Physiology, SMS Medical College, Jaipur recruiting 50 patients of type 2 Diabetes Mellitus (Cases) from Department of Medicine, SMS Medical College and 50 Apparently Healthy Age, Sex and BMI matched subjects (age range 35-50 years). Study conducted after obtaining approval from institutional ethics committee of SMS Medical College, Jaipur. Effects of Cold Pressor response on Systolic and Diastolic BP were used for analysis of cardiac sympathetic autonomic function. Results: There was a significant decrease in cold pressor response on systolic and diastolic blood pressure in Diabetic Mellitus group as compared to the apparently healthy control subjects. Statistical Analysis: For statistical analysis of data Unpaired ‘t’ test was applied, where p-valve <0.05 considered as statistically significant. Conclusions: Cold pressor test can be used for diagnosing as well as determining severity of cardiac sympathetic autonomic neuropathy in patients of Diabetes Mellitus.

9. Study Comparing the Function and Quality of Life of Patients Undergoing Total Knee Arthroplasty with Fixed and Mobile Tibial Platforms
Neeraj Agarwal, Amisha Agarwal Ostwal
Abstract
Objective: To compare patients receiving total knee arthroplasty (TKA) with fixed tibial platform versus moveable tibial platform in terms of function and quality of life. Methods: 55 patients in Group A underwent TKA with a fixed tibial platform, and 55 patients in Group B underwent arthroplasty with a mobile platform during the course of our evaluation of 110 patients with knee osteoarthritis. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Short Form Health Survey (SF-36), and the Visual Analogue Scale (VAS) of Pain were used to assess patients’ function and quality of life before surgery as well as at six months, a year, two years, four years, and eight years after surgery. Results: Regarding the numerous SF-36 dimensions, we saw that the patient groups’ average behaviour in terms of functional capacity scores, physical aspects, pain, and emotional aspects varied statistically over time. There were no significant changes in the other quality of life dimensions. We can see that the pain measured by the VAS and WOMAC pain scores exhibited a mean change in both patient groups throughout follow-up. At a 2-year follow-up, they were statistically worse in group A while being comparable to group B in all other respects. Conclusion: We found that the fixed platform group had reduced pain ratings and VAS after a two-year follow-up. These changes, however, did not persist at the halfway point, indicating that the mobile tibial platform arthroplasty offers a short-term benefit and may aid in the recovery process.

10. Early Detection of Hearing Loss in Neonate by Otoacoustic Emissions in Tertiary Care Hospital
Sonali Jain, P.C. Jain, Richa Gupta, Kashmira Kumawat, Shiv Kaushik
Abstract
Introduction: Hearing in human plays a significant role in communication. Hearing loss affects the social and cognitive development of the child. Henceforth early identification and intervention by screening test like Otoacoustic emission becomes an absolute necessity in neonates. The objective of this study is to detect the hearing loss in new-born at early stage. Materials and Methods: All the neonates born in a tertiary care centre were screened by OAE test during October 2021 to October 2022. A detailed maternal and birth history was taken. Result: Total of 154 neonates were screened with OAE test in both ears. 62 males and 76 female infants had bilateral PASS result. About 6 males and 10 females had REFER result on OAE. It was observed that 33% neonates with in utero infection, 28% of hyperbilirubinemia neonates had REFER in OAE, while 25% of neonates with meconium stain, 25% with low apgar score, 25% with family history of childhood Sensorineural hearing loss, Low birth weight neonates 10% had REFER in OAE. Less than 7% of neonates with preterm birth, intensive care and maternal co-morbidity had REFER in OAE. Conclusion: OAE is a non-invasive, easily available, quick screening test for hearing it helps to early detect hearing loss in neonates.

11. The Decision to Delivery Interval in Emergency Cesarean Sections and its Perinatal Outcome in A Tertiary Care Institute
Jaya Barla, Shashikant Pawar, Vaishali Korde-Nayak
Abstract
Introduction: A 30 to 75 minutes decision to delivery interval (DDI) is widely recommended for emergency cesarean sections. Our aim is to study the decision to delivery interval (DDI) and its effect on the neonatal outcome. According to NICE guidelines there are 4 categories for the urgency of cesarean sections (CS), depending on the indication. The ‘30 minute rule’ for a decision to delivery interval (DDI) states that category 1 CS should be done within 30 minutes, but due to various factors like non-availability of blood or blood investigations, the DDI might get delayed. The study has been done to find out whether a delay in the decision of CS and the delivery time is the only factor involved for neonatal outcome or not. Objectives: To find out whether a delay of more than the specified time given, has any effect on the neonatal outcome. Materials and Methods: It is a prospective observational study conducted over 6 months in the department of obstetrics & gynaecology in a tertiary care teaching hospital. Results: A total of 201 emergency caesarean sections have been reviewed. Average DDI was 79.52±112.37 minutes which was more than the recommended time, however there was no significant neonatal morbidity associated with the DDI. Conclusion: Decision to delivery interval is important in category 1 and 2 CS. However, in this study we conclude that there is no significant correlation between DDI of less than 30 minutes and the perinatal outcome. This time limit should be reconsidered especially in developing countries where infrastructure and manpower are severely limited. Also, DDI is not the sole factor responsible for neonatal outcome.

12. To Study Thyroid Dysfunction & Lipid Abnormalities in Patients Suffering from Cholelithiasis
Gaurav Modi, Bhupendra sharma, Rajesh Kumar, Ravindra Palsaniya
Abstract
Introduction: Gallstone disease (GSD) is one of the most common gastrointestinal diseases. Gallstones represent a significant burden for health care systems worldwide. Aim: To study thyroid dysfunction & lipid abnormalities in patients suffering from cholelithiasis. Methods: This was a hospital based case control study was carried at Department of General surgery, S. P. Medical College and associated group of PBM Hospital, Bikaner, Rajasthan. The subjects were divided into two groups based on presence of cholelithiasis. One group comprised 100 Patients of cholelithiasis in the case group and other had 100 healthy subjects in the control group. Serum lipid profile and thyroid function test has been used as a routine preoperative evaluation for the gallbladder surgery as a tool to check for functional status of the thyroid hence present study was design to investigate the relationship between the biochemical markers and cholelithiasis patients. Results: In our study age difference in case group (45.01 ± 12.29yrs) as compare to control group (43.14 ±13.32yrs). Serum cholesterol level is significantly higher in case group (193.01± 36.83mg/dl) as compare to control group ((159.28±18.26 mg/dl). serum triglyceride level is significantly higher in case group (187.01± 66.01mg/dl) as compare to control group (107.84±19.67mg/dl). HDL level difference in case group (49.32±8.12mg/dl) as compare to control group (52.15.±6.32 mg/dl) was statistically insignificant. serum LDL level significantly higher in case group (142.01± 37.98) as compare to control group (95.12± 14.97 mg/dl). Among the study group, 2 patients had clinical hypothyroidism, 11 patients had Subclinical hypothyroid, 1 patients had hyperthyroid and 86 patients were in euthyroid state. Among the study group, 3 patients had Subclinical hypothyroid and 97  patients were in euthyroid state. Conclusion: Our recommendation is that every patient with gallstones should be screened for lipid profile and thyroid status, serum TSH may be used as marker so that hypothyroid status could be diagnosed at early stage and progression to full blown hypothyroidism is halted.

13. Comparative Evaluation of Greek Stroke Score, Siriraj Stroke Score, and Allen Stroke Score for Differential Diagnosis of Intracerebral Hemorrhage and Infarct: Correlation with CT Scan Findings
Bajrang Kumawat, Bhavsinh Parmar, Aakash Sureshchandra Rajpal
Abstract
Introduction: The introduction highlights the global burden of stroke and the challenges in stroke management, particularly in resource-constrained settings. It introduces three stroke scoring systems – the Siriraj stroke score, Allen stroke score, and Greek stroke score – and acknowledges the limited evidence regarding their comparison. The objective of the study is to validate and compare these scoring systems against CT scan findings to improve early and accurate diagnosis for optimal treatment and patient outcomes. Material and methods: This section outlines the study design, which is a cross-sectional observational study conducted at GMERS Medical College, Gandhinagar in India. The study population consists of patients with acute stroke admitted to the emergency department. The sample size calculation is described, along with the inclusion and exclusion criteria. Data collection involves the use of a pre-validated questionnaire, encompassing various patient details and stroke scoring systems. Ethical approval and informed consent are obtained prior to the study. Results: The comparison of three stroke scoring systems, namely the Allen score, Siriraj score, and Greek score, with CT scan results revealed their diagnostic performance in differentiating between cerebral hemorrhage and cerebral infarct. The sensitivity for identifying hemorrhage was 90.0% for the Allen score, 86.6% for the Siriraj score, and 90.0% for the Greek score. In terms of infarct diagnosis, the sensitivity was 83.3% for the Allen score, 90.0% for the Siriraj score, and 86.6% for the Greek score. All three scoring systems showed similar values for specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy. Conclusion: In conclusion, the Allen score, Siriraj score, and Greek score showed high diagnostic accuracy in differentiating between cerebral hemorrhage and cerebral infarct. These scoring systems can be valuable tools for guiding treatment decisions in stroke patients.

14. Comparative Analysis of Squatting Facets on Femur, Tibia, and Talus: Insights from A Population in Northwest Uttar Pradesh and Cross – Population Comparisons
Stuti Srivastava, Abeer Zubair Khan, Kiran Chigurupalli, Karam Vir Singh, Neel Kamal Arora, Mahboobul Haque
Abstract
The aim of this study was to compare the occurrence and size of squatting facets on the talus, femur, and tibia in a population from northwest U.P with previous studies conducted on different populations and races. Materials and Methods: A total of 231 dry adult human bones (75 femurs, 75 tibias, and 81 tali) were examined. Measurements were taken using a digital Vernier caliper. Results: Squatting facets were present in 49.33% of the femurs, 48.64% of the tibias, and 60.49% of the tali. The average length, width, and area of the femoral facets were 15.34±6.13mm, 12.24±5.54mm, and 128.08±63.71mm2, respectively. On the tibia, the average length was 21.67±9.85mm, width was 6.96±2.44mm, and area was 101.42±52.13mm2. The mean length, width, and area of the medial facets on the talus were 6.75±3.73mm, 4.02±2.40mm, and 17.61±10.20mm2, respectively. The length of the lateral squatting facets on the talus was 9.89±5.28mm, width was 5.43±3.10mm, and area was 38.12±18.15mm2. Conclusion: Squatting facets are a direct result of changes in lifestyle. The higher occurrence of lateral squatting facets in the talus in this sample can be attributed to an uneven distribution of body weight, particularly towards the lateral side of the foot. It is also concluded that the incidence of these facets in the current sample is higher compared to Europeans, possibly due to different postural habits and lifestyle factors. These findings can be utilized as an anthropological indicator for distinguishing racial and regional characteristics of unidentified bones.

15. Study of Lipid Profile in Subclinical Hypothyroidism
Visakan B, Apoorva Janardhan, Madhura TL
Abstract
Background: Subclinical hypothyroidism (SCH) is defined as an elevated serum Thyroid Stimulating Hormone (TSH) level associated with serum free thyroxine (fT4) and free tri- iodothyronine (fT3) concentrations within the reference range with few or no symptoms of hypothyroidism. There are studies which report changes in lipid profile levels in patients with subclinical hypothyroidism. Materials & Methods: 50 cases and 50 controls were included into the study. Patients with subclinical hypothyroidism, age and sex matched with normal individuals in Adichunchanagiri Hospital and Research Center with respect to parameters such as FT3, FT4, TSH, LDL, HDL, VLDL TC and TGL levels were assessed. The mean levels amongst the cases and controls were compared. Statistical analysis was done by descriptive statistics and student “t” test. Results: The majority of the patients were females. We found an increased TSH, LDL, VLDL, TC and TGL levels, while there was a drop in the HDL levels. The mean ± SD level of TSH in controls and cases was found to be 2.31 ± 0.81µIU/ml and 7.07 ± 1.56 µIU/ml respectively with FT3 & FT4 levels within the normal range which confirmed the diagnosis of subclinical hypothyroidism amongst the cases. Comparison between the mean levels of TSH, LDL, HDL, VLDL TC and TGL were found to be statistically significant (p<0.05). Conclusion: We found an increase in the TSH, LDL, VLDL, TC, TGL levels except HDL levels, which were statistically significant. The results showed that there exists a definite relationship between subclinical hypothyroidism and dyslipidemias.

16. Clinicopathologic Features of Celiac Disease: A Retrospective Study from Tertiary Care Teaching Institute of Central India
Akanksha Jain, Kamal Malukani, Atishay Jain, Purti Agrawal Saini, Amit V Verma, Piyush Kumar Mishra
Abstract
Background: Celiac disease (CD) is an immunologically mediated chronic inflammatory disorder of the small intestine presented with malabsorption symptoms after ingestion of gluten. The gold standard for the diagnosis of CD is duodenal biopsy with positive serologic tests either anti-tissue Transglutaminase (t-TG) or anti endomysial antibodies (EMA). Material and Methods: This retrospective study was done in 36 duodenal biopsy confirmed cases of CD. The demographic characteristics such as age and gender, presenting features, ultrasonographic (USG) findings, upper gastrointestinal (UGI) endoscopic finding and serum t –TG levels were retrieved from previous records. The detailed microscopic examination of duodenal biopsy for villous architecture, crypt abnormality, villi to crypt ratio was done. The intraepithelial lymphocytes (IELs) were counted in 100 enterocytes. The staging was done according to Modified Marsh (Marsh–Oberhuber) criteria. The chi-square test was applied to know the association between modified marsh staging and t-TG levels, and endoscopic findings. Results: The mean age was 33.6 years with range of 3 years to 65 years. Male to female ratio was 1.3:1. The commonest presentation was chronic diarrhoea in 80.5% cases. Serum t-TG level was raised in 92.6% cases and abnormal endoscopic features seen in 69.4% CD cases. The mild, moderate and severe villous atrophy was seen in 7 (19.4%), 13 (36.1%) and 16 (44.4%) patients. Conclusion:The mainstay of the diagnosis of CD is duodenal biopsy. However, positive serologic tests like t-TG and mucosal abnormalities in UGI endoscopy help clinicians diagnose disease early and know the extent and severity of the disease.

17. Clinical Profile and Factors Influencing the Outcome of Acute Kidney Injury Cases Admitted in A Tertiary Care Centre of New Delhi, India: A Cross-Sectional Study
Ravi Jain, Harpreet Singh, Byomakesh Swain, Arvinder Kaur Heer
Abstract
Introduction: Risk factors and causes of acute kidney injury have been determined largely as a result of western studies conducted on the subject with limited data from India. There is a need to study the clinical profile of patients with acute kidney injury, identify the main causes and potential areas of intervention. Methods: It is a hospital based descriptive cross-sectional study carried out among patients with acute kidney injury admitted in ward and intensive care unit carried out in a tertiary care hospital of New Delhi. Adult patients (18 years and above) admitted in the institute who were diagnosed to have Acute Kidney Injury [according to RIFLE ( Risk, Injury, and Failure; and Loss and End-stage kidney disease ) criteria] for the first time, with no previous history of Acute Kidney Injury. Results: Sixty (61.2%) were males and thirty-eight (38.8%) were females. Maximum patients were in the age group 41-60 years. The mean age of study group was 55 (±16) years.  A total of 39 (39.8%) patients required renal replacement therapy. Patients were classified based on RIFLE criteria and it was observed that 64 patients (65.3%) were classified into risk group, 25 patients (25.5%) into injury category and 9 patients (9.2%) were grouped into failure category. After 3 months of follow up, 59 patients (60.2%) had complete recovery, 10 patients (10.2%) had partial recovery and 29 patients (29.6%) had fatal outcome. Conclusion: RIFLE criteria, electrolyte imbalance, kidney size can be used as useful prognostic indicators in predicting outcome of acute kidney injury and the necessary line of management for early correction.

18. Association of Placental Laterality with Development of Preeclampsia and Fetomaternal Outcome
Radhika Barada, Shabdika Kulshreshtha, Sushma Mogri, Yugansh Chouhan
Abstract
Background: Hypertension is one of the commonest medical complications of pregnancy as it contributes significantly to maternal as well as perinatal morbidity and mortality. The identification of this clinical entity and effective management play a significant role in the outcome of pregnancy, both for the mother as well as the baby. Aims: This study was conducted to study. 1) Correlation of lateral placental implantation by ultrasound study and development of preeclampsia on color doppler study. 2) Predictive accuracy of placental laterality with the development of preeclampsia. 3) Relationship between placental laterality in preeclampsia and fetomaternal outcome on the basis of APGAR score and NICU admission. Methods: The study was done among 59 preeclamptic pregnant patients who were admitted at and after 28 weeks of gestation in Obstetrics and Gynaecology department of GMCH over the period of one year. Results: Majority of patients 29 (49.1%) were aged 21-25 yrs, and the incidence was highest among  primigravida 45 (76%). Development of preeclampsia was highest in lateral placenta group. Overall prevalence of preeclampsia was found 2.47 times more with laterally located placenta compared with central ones. No correlation was found between development of preeclampsia and residence of the patient. Proteinuria (>1+) in lateral placenta group is higher  (57.1%) than central placenta group which is significant with a p value of 0.009. On Color Doppler abnormal uterine artery notching or high RI (>0.58) led to predicting PE in majority of the patients. Preeclampsia, antepartum hemorrhage and term prelabor rupture of membranes were more common in lateral placenta. The incidence of FGR was also found to be higher in patients with lateral 5 (11.9%) and centrally 1 (5.8%) implanted placenta. Conclusions: Lateral placenta along with uterine artery doppler abnormality at or after 28 weeks significantly increases the risk of preeclampsia. Appropriate obstetric intervention may be necessary to improve the pregnancy outcome and reduce preeclampsia related maternal as well as neonatal morbidity and mortality. A non-invasive ultrasound screening can be used to predict unfavorable pregnancy and neonatal outcomes.

19. Comparison of 0.25% Bupivacaine and 0.25% Bupivacaine with Dexmedetomidine Added as An Adjuvant in Caudal Analgesia for Elective Pediatric Herniotomies
Namratha L, Swathi Hegde
Abstract
Background: Caudal block is the most safe and effective method of postoperative analgesia in pediatric population. Local anesthetics when used alone for caudal epidural block are associated with the shorter duration of action, hence addition of adjuvant helps prolong the duration of action and provide effective postoperative analgesia in children undergoing various infraumbilical surgeries. Many adjuvants like opioids, alpha-2 agonists, magnesium sulphate etc have been used along with local anesthetics for increasing the duration of caudal analgesia. We have designed a study to assess the safety and efficacy of adding dexmedetomidine to 0.25% bupivacaine in caudal epidural block. This study aims at comparing the duration of post-operative analgesia in caudal blocks in groups with 0.25% bupivacaine  alone and 0.25% bupivacaine with dexmedetomidine. Methods: This study was conducted in 60 children of American Society of Anesthesiologists (ASA) physical status I and II, aged 1– 6years, undergoing elective herniotomies. The patients were randomly allocated into two groups of 30 each, Group B receiving (0.25%) bupivacaine 0.75 ml/kg + normal saline (NS) 1 ml and Group BD receiving  (0.25%) bupivacaine 0.75 ml/kg + 1 µg/kg dexmedetomidine in 1 ml NS. General anesthesia was induced in all children with insertion of Laryngeal mask airway. Caudal block was then performed and the children were observed for hemodynamic stability and duration of postoperative analgesia using FLACC pain score. Results: our study revealed that the mean duration of analgesia in Group B receiving (0.25%) bupivacaine 0.75 ml/kg + normal saline (NS) 1 ml was 4.59±0.47 hrs and that in group BD receiving (0.25%) bupivacaine 0.75 ml/kg + 1 µg/kg dexmedetomidine in 1 ml NS was 9.05±0.85 hrs with a p value of ≤0.001 which was Significant according to Student t Test. Conclusion: we hereby conclude that the addition of dexmedetomidine in the dosage of 1 µg/kg along with (0.25%) bupivacaine significantly prolongs the duration of postoperative analgesia with no significant  side effects making it a safe and effective adjuvant  for caudal epidural block.

20. A Comparative Study of Stress, Emotional Wellbeing Among Adolescents with and without Specific Learning Disorder
Mangayarkarasi, H. Ahamadu Nisha, S. Renganathan, A. Ramesh Babu
Abstract
Introduction: Specific learning disorder is a developmental disorder, manifesting as difficulty in reading, writing, comprehending or using language, calculations. Emotional and behavioral problems are common among children with learning disability and which often enhances the serious negative consequences for a child’s academic achievement and social development and forms vicious cycle. Based on this aim of our study is to assess and compare the level of stress, prevalence of emotional and behavioral problems among adolescents with and without specific learning disorder. Material and Methodology: This study was done as a hospital based cross-sectional study for a period of 3 months in 40 patients who diagnosed as a case of specific learning disorder by clinical and mental status examination and IQ assessment and test of academic abilities (NIMHANS INDEX) done by clinical psychologist. Patient fulfilling the criteria for Specific learning disorder, according to ICD- 10 Criteria. In age group between 12 -17 years whose patients whose parents giving informed consent were included in the study as cases. Results: It was inferred that there was no significant relationship between age of the study population and emotional and behavioral problems. Our study shows correlation of stress and emotional & behavioral problems in cases. It was also observed that stress levels positively correlated with the emotional symptoms, conduct problems, Hyperactivity, peer problem and Total difficulty scores in strength and difficulty questionnaire and stress levels negatively correlated with prosocial behaviors. Conclusion: Based on the findings in our study, it is understood that adolescents with specific learning disorder experiencing high level of stress and they have a high risk of emotional and behavioral problems comparing with adolescents without specific learning disorder. Early diagnosis and intervention of emotional and behavioral problems in patients with learning disorder makes a substantial improvement in self-confidence and social competency, which in turn leads to improvement in their ability of learning.

21. A Comparative Analysis of Clinical, Demographic and Mortality Indicators Between First, Second and Third COVID Wave in A Covid Dedicated Tertiary Care Hospital at Jaipur, Rajasthan, India
Kriti Goyal, Gaurav Dalela, Anupma, Nilofar Khayyam, Jitendra Panda
Abstract
Background: SARS-COV-2 virus causing Covid-19 disease has caused disruptive pandemic. A comparative analysis of first wave, second wave and third wave would suggest policymakers about better management of Covid-19 recurrence or its severity for future. Aim& Objective: The aim of this study was to compare clinical characteristics, age distribution, gender and mortality indicators between first, second and third wave of Covid-19 in a COVID dedicated tertiary care hospital at Jaipur, Rajasthan Methodology: This was a retrospective study done in Rajasthan University of Health Sciences College of Medical Sciences and hospital (RUHS CMS & HMS), a covid dedicated tertiary care hospital at Jaipur, Rajasthan. Comparison of relevant data was done between the first wave(August – December 2020), second wave (April – June 2021) and third wave (Dec 2021- Feb 2022) at Jaipur, Rajasthan. Results And Discussion: Out of 5838 RT-qPCR Covid positive patients admitted in 1st wave, 4333 were males and 1505 were females, in 2nd wave out of 5841 positive patients, 3946 were males and 1895 were females, and in3rd wave also 3002 were males and 1253 were females out of 4255 positive patients, indicating male preponderance. Most affected age in first wave was 51-70 years (35.02%) followed by 31–50 years(32.6%), in 2nd wave most affected age group was 31-50years(39.7%) followed by 18-30 years (28.9%) while in 3rd wave 18-30 years age group were most affected one(42.5%). Symptoms were mild in first and third wave while second wave had serious complications. Mortality was significantly higher in 2nd wave (5.5%) as compared to other waves (1.1% in 1st& 1.0% in 3rd). Conclusion: There was a shift of positivity towards the younger age in second and third wave as compared to first wave, most probably related with vaccination status in India. Males are more affected due to more mobility and carelessness. Severity was higher in second wave therefore, it is necessary to remain vigilant for newer variants and to study age, gender and severity in order to prevent morbidity and mortality.

22. Application of Various RBC Indices to Differentiate Iron Deficiency Anemia and Beta Thalassemia Trait Among Antenatal Women in A Tertiary Care Hospital
Monica Molli, Sridevi Sanapala, Gunta Sirisha,  Vasudeva Akkidasari,  Sunil Kumar K, Rajiv Savala, Nooka Jhansi Rani, Basumitra Das
Abstract
Introduction: The most frequent causes of microcytic anemia among antenatal women in India are iron deficiency anemia (IDA) and beta thalassemia trait(βTT). Hence it is important to differentiate between both the conditions to avoid unnecessary iron therapy in βTT patients. This study was done to screen antenatal women with β thalassemia trait using formulas derived from various Red cell indices. Aims And Objectives: This study aims to screen all microcytic (MCV<80fl) hypochromic (MCH<27pg) anemia for β thalassemia trait, to differentiate IDA from βTT and confirm the screened cases by HPLC. Also attempt has been made to assess sensitivity and specificity of various indices to identify βTT. Materials And Methods: A cross sectional comparative study was done in 200 antenatal women for a period of 2 years from October 2019 to September 2021 in department of clinical pathology at Tertiary care hospital.  Complete blood counts and various red cell indices were evaluated. There are 16 cases of hemoglobinopathies out of which 9 are β thalassemia trait and 184 cases are iron deficiency anemia. Four indices were calculated i.e., the Mentzer index (MI), Srivastava index (SV), Shine and Lal index (SL) and Red cell Distribution Width (RDW) index. These indices were calculated in patients having microcytosis (MCV<80fl) and hypochromia (MCH<27pg) and, all the cases are further subjected to HPLC for confirmation. Results: In the present study the index with highest sensitivity for diagnosing β thalassemia trait was Shine and Lal index (100%) and Mentzer index showed highest specificity with 99.5%. Positive predictive value (PPV) was highest for Mentzer index and Negative predictive value (NPV) was highest for Shine and Lal index. Youden’s index was highest for RDW. In the present study the percentage of correctly identified patients was highest for Mentzer index. Conclusion: It is vital to establish a screening model based on HbA2 levels and red cell indices for the differentiation of β TT from IDA in microcytic hypochromic anemia cases. According to the results of the present study MI and RDW index are considered as the most useful and reliable indices for screening β thalassemia trait, though HPLC confirmation is mandatory.

23. Clinico-Microbial Analysis of Catheter Associated Urinary Tract Infection
Akanksha Singh Chauhan, Pankaj Pranjal, R. Sujatha, Desh Nidhi Singh, Deepak Sameer, Khutija Sarah
Abstract
Background: The present study aimed to find out the factors responsible for catheter associated urinary tract infection (CA-UTI) and most effective antibiotic for empirical treatment of CA-UTI. Catheter-associated urinary tract infection (CA-UTI) is the most common nosocomial infection. The etiological agents of which may be varied depending on exposure of antibiotics. Advancing age, diabetes mellitus, duration of catheterization are the risk factors. Complications include prostatitis, epididymitis, pyelonephritis, and septicemia in high-risk patients, adding to hospitalization and morbidity. With this background the present study was undertaken. Material & Method: In this institutional based cross–sectional study, consecutive urine samples of 371 catheterized patients admitted in the hospital were included. They were processed by standard microbiological procedures. Isolated organisms were speciated, and antibiotic susceptibility performed as per standard guidelines. Result: The prevalence of catheter associated UTI was 40.43%. Out of 371 cases, 150 were culture positive in which Escherichia coli (46/165) was the predominant isolate followed by Klebsiella spp. (39/165), Pseudomonas spp. (35/165), Enterococcus spp. (19) and Staphylococcus aureus (7/165), and Candida glabrata (4/165). Nitrofurantoin and Piperacillin +Tazobactam were the most effective first line antibiotics. Conclusion: Development of CAUTI is common in ICU patients. Emphasis should be placed on good catheter management and reducing the duration of catheterization rather than prophylaxis in order to reduce the incidence. Culture and susceptibility testing play a vital role in the management if UTI occurs.

24. Risk Factors and Etiological Analysis of Surgical Site Infections Following Abdominal Caesareans
Isha Yadav, Desh Nidhi Singh, R.Sujatha, Khutija Sarah, Suneet Kumar Yadav4. Deepak Sameer Bind
Abstract
Background: The present study aimed to analyse the risk factors and etiological of Surgical site infection (SSI) following abdominal caesareans. Change in microbial profile and their sensitivity compel clinicians to conduct periodic analysis of SSI in their area. Material & Methods: This was a cross-sectional prospective analytical study conducted on 264 cases undergoing abdominal caesareans. Risk factors were asses that cause SSI. Patients were followed from the day of surgery till 30 days after the discharge. Samples collected from the wounds were processed by conventional microbiological methods, and AST was performed by using the Kirby Bauer disk diffusion method. Result: Postoperative hospital stay (65.4%), emergency procedures (81.8%), and patients with anaemia (96.3%) are significantly associated with the occurrence of SSI. The most common pathogen causing SSI is E coli (25.4%), followed by Pseudomonas aeruginosa (21.8%) and Staphylococcus aureus (16.3%), while the least isolated organism is Proteus (3.63%) and Acinetobacter (3.63%). Conclusion: To decrease the chances of SSI, a proper assessment of risk factors should be carefully done, and also, we should have to decrease the duration of surgeries, focus on antimicrobial audit, and ensures proper management. Also, conduct periodic surveillance to check on SSI.

25. Uric Acid: New Prognostic Marker in Line for Heart Failure: A Hospital Based Cross Sectional Study
Vartika Saini, Veer Bahadur Singh, Mayank Srivastava, Deepak D, Maniram Kumhar, Siddharth Bharatiya
Abstract
Introduction: It is widely known that there is a link between elevated uric acid levels and the risk of developing cardiovascular disease. Hyperuricemia influences the onset and progression of cardiovascular disease by affecting molecular signals like oxidative stress, insulin resistance, and inflammatory response. Insulin resistance can disrupt the uptake of myocardial glucose leading to myocardial energy metabolism disorder, all of which have an impact on the myocardium’s diastolic and contractile function. Materials and Methods: This cross-sectional study was conducted on 100 patients of heart failure, both new onset and decompensation of chronic heart failure, admitted in wards and MICU in department of medicine of JLNMC and attached Hospitals, Ajmer during the period of September 2021- September 2022. Result: This study observed a statistically significant relation between serum uric acid level and NYHA class (P value<0.001 ). There was a strong negative correlation between serum uric acid and heart failure with reduced ejection fraction (r= -0.892, P value<0.001) which was statistically significant. Discussion: In this study cases were divided based on serum uric acid level among NYHA class and it was observed that as the NYHA class of the severity of heart failure increased, Serum Uric Acid levels also increased to greater levels and this increase can be a preceding factor for progression to cardiorenal syndrome and various arrhythmias especially experienced by cases in NYHA III and IV class. The Mean± SD of uric acid was (8.23±0.71 mg/dl) while mean ±SD of left ventricular ejection fraction was (34.31± 8.73%). Serum Uric Acid can be used as an independent prognostic marker in assessing the severity of heart failure as it is easily available and inexpensive, in place of NT-proBNP which is expensive in a resource limited country and it may also be a useful tool in predicting the unfavorable outcomes in patients with heart failure.

26. A Comparative Study Between Limberg Flap and Z-Plasty in the Management of Sacrococcygeal Pilonidal Sinus at A tertiary Care Centre of Western Rajasthan
Pradeep Kumar Gupta, Rama Kishan Saran, Ramdayal Chouhan, Kishna Ram
Abstract
Introduction: Pilonidal sinus disease (PSD), most commonly seen in young men, is a chronic disease arising from the pilosebaceous in the sacrococcygeal region. There is still no standardization in surgery therapy. Efficacy, follow-up results and quality of life levels were compared in this study between the Limberg flap (LF) and the Z-Plasty procedure. Material and Method: This comparative study was performed on 46 symptomatic or recurrent cases of pilonidal sinuses admitted to the surgical departments of DR.S.N. Medical College, Jodhpur from June 2022 to December 2022. Result: The mean age of sacrococcygeal pilonidal sinus presentation was 29 years with a male predominance manifested by pain and seropurulent discharge as the most common complaints. Parameters regarding duration of surgery, average length of hospitalization, postoperative complications and postoperative period natal cleft depth corrections were comparable between the 2 groups, the difference is statistically significant. Conclusion: In conclusion, we can say that rhomboid excision and Limberg flap closure, with a shorter operating time, less length of stay in the hospital, low rate of postoperative complications, shorter time required for a complete wound healing and greater correction of the postoperative depth of the natal cleft is more suitable in treatment of pilonidal sinus disease than Z-Plasty.

27. Clinical Study on Peptic Ulcer Perforation and its Correlation with H. Pylori Infection, H. Pylori Eradication Therapy and Follow up Endoscopy at A Tertiary Care Teaching Hospital
Vidhyabharathi MS, P. Sumathi MS
Abstract
Introduction: Peptic ulcer disease is one of the most common disorders of the gastrointestinal system. A number of factors are found to initiate the progress the disease like H. Pylori infection, stress, NSAID use, smoking and alcoholism. Peptic ulcer perforation is an acute emergency complication when the contents of the stomach spill into the peritoneum. Aim of the study is to observe the prevalence of H. Pylori in peptic ulcer perforation cases and the rationale of H. Pylori eradication therapy post operatively in H. Pylori positive cases and follow up endoscopic biopsy at six weeks to confirm eradication and to investigate other factors associated with peptic ulcer perforation. Materials and Methods: This study was done as a prospective observational study, in patients who present in surgery casualty undergoing surgery for peptic ulcer perforation for a period of one year in a tertiary care teaching hospital. This study included 100 patients who present in surgery casualty undergoing surgery for peptic ulcer perforation. H. Pylori infection is confirmed by mucosal biopsy at the time of surgery using rapid urease test. H. Pylori eradication regimen is given to positive cases for 14 days. Follow up endoscopy done at 6 weeks and biopsy taken from gastric antrum and rapid urease test performed to confirm eradication. Results: The site of perforation was; in gastric antrum in 93% (n=93) of the cases in duodenum in 7% (n=7) of the cases.  Out of 100 patients, 63% (n=63) were rapid urease test positive. 37% (n=37) were rapid urease test negative Out of 100 patients, rapid urease test was positive in 63% (N=63) cases. H. Pylori treatment was given for 62 patients out of the 63 cases. One of rapid urease positive patients was not treated with H. Pylori regimen. Out of 62 patients treated for H. Pylori, around 92% (n=57) turned out negative while around 8% (n=5) were positive. Conclusion: Routine endoscopic examination of such patients should also form a part of the follow-up to look for ulcer healing postoperatively. There is a change in the trend of the management of peptic ulcer perforation with the advent of newer and less invasive techniques, such as laparoscopic or endoscopic perforation sealing technique. A multidisciplinary approach for perforated peptic ulcer management is of utmost importance and help in early recovery of the patient.

28. A Prospective Observational Study to Assess the Causes of Elective Surgery Cancellation in Different Operation Theatre on the Day of Surgery at Tertiary Care Centre of Southern Rajasthan
Alka Yadav, Devendra Verma, Basant K Dindor, Hemraj Tungria, Ravindra Gehlot, C P Sharma
Abstract
Background: Cancellation of planned surgeries on the day of surgery is a common problem in many medical facilities, despite significant investments in resources. This can lead to inefficient use of the resources and patient dissatisfaction. So this study was planned to evaluate the various reasons for cancellation and to identify potential solutions to this problem. Method: This observational, hospital-based cross-sectional study evaluated the reasons for all cancelled surgeries in different elective operation theatres at a tertiary care centre over a period of six months. The reasons for cancellation were avoidable or unavoidable and related to the hospital, patients, surgeon, or anaesthesia factors. Data on the cancelled operations were obtained from daily lists and documented in a proforma. Results: Total 2950 elective surgeries were planned during study period, out of which 379 (12.85%) were cancelled on the day of surgery amongst them majority 347 (91.56%) of cancellation of cases had avoidable (lack of space and time to perform surgery with existing infrastructure and resources 276 (72.8%), PAE unfitness 42 (11%), cancellation by surgeon 18 (4.7%), patients refusal 9 (2.3%) and 32 (8.44%) cases had unavoidable reasons (changes in the comorbid medical condition 26 (6.8%), unavailability of operating room 4 (1%),  additional investigation requirements in  2 (0.5%) patients). Conclusion: In our study, majority of cancellation are due to avoidable reasons, like overscheduling, frequent rescheduling of postponed cases and posting PAE unfit patients and can be reduced by effective coordination, proper discussions and time discipline amongst operative team including surgeons, anaesthetists and OT staff.

29. A Cross-Sectional Study of Clinical Profile and Pattern of Medicinal Opioid Abuse: A Hospital-Based Study in Vindhya Region
Akshat Varma, Daisy Rure, Surabhi Pandit, Dheerendra Mishra, Nimisha Mishra, Sunil Kumar Ahuja, Makhan Shakya, Balram Patidar, Umesh Pathak
Abstract
Introduction: A drastic shift from conventional substances of abuse such as tobacco, alcohol, and cannabis to pharmaceutical agents such as opioid-containing syrups, tablets, and Intravenous opioids has been noted of late in the developing Indian society. Various factors play a crucial role in the etiology of substance use. The present study was conducted to improve the understanding and strengthen the battle against this debilitating social and medical issue. Objectives: To study the Clinical profile and pattern of Medicinal Opioid Abuse and their consequences on the affected population and their families. Methods: The present study was an observational cross-sectional study, which enrolled 51 patients. This study was conducted in the Dept. of Psychiatry, Shyam Shah Medical College, Rewa. The socio-demographic data was collected by administering a semi-structured pre-devised questionnaire. A detailed interview was conducted to procure the relevant history and data required for the study. Result: The mean age at onset of opioid use was 23.5 ± 4.8 years; all subjects were males, 64.7% were married. 89.2% were literate. 47.1% subject’s occupation was semi-skilled, with family income > 10000/month. 58.8% of medicinal opioid abusers belonged to the urban community. The most commonly abused medicinal opioid was opioid-containing syrup (64.7%). The predominant initiating factor was Peer Pressure (41.2%). The most common psychiatric co-morbidity was Generalized anxiety disorder and Social Phobia, and the most common medical co-morbidity was Hepatitis and Hypertension. Legal (29.4%), personal (64.7%), and family-related (23.5); issues were prevalent in the study sample. Conclusion: The youth; especially in the urban settlement is rapidly indulging in opioid use; leading to serious deterioration in their personal, social and occupational aspects of life. A preventive approach and timely intervention in those with ongoing medicinal opioid dependence along with social support could go a long way in the management of pharmaceutical substance misuse.

30. Management of Early-Stage CKD: Discuss the Strategies for Managing Early-Stage CKD (Stages 1-3), including Lifestyle Modifications, Blood Pressure Control, Glycemic Control (In Diabetes), and the Use of Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors. Evaluate the Evidence Supporting these Interventions
Aditya Prakash Dinkar, Pankaj Hans, Gautam Kumar Sandilya, Sanjay Kumar Das
Abstract
Background: Effective management of chronic kidney disease (CKD) is necessary to slow the disease’s progression and lessen the likelihood that it will have adverse effects. This study aims to compare the relative efficacy of various treatments for Chronic Renal Disease Stages 1-3. Methods: A comprehensive literature review was conducted to consolidate studies, meta-analyses, and clinical trials on treating CKD in its earlier stages. The evaluated research examined the influence of dietary and behavioural modifications on managing CKD. A patient-data-based retrospective investigation also included five hundred individuals in stages 1-3 of CKD. The individuals’ medical histories, current health conditions, and test results were all collected and analysed. Results: There is substantial evidence to support the use of lifestyle modifications, such as diet, exercise, quitting smoking, maintaining a healthy weight, and consuming alcohol in moderation, in treating CKD in its earlier stages, according to the reviewed research. Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) have also been shown to be especially useful for regulating blood pressure and halting the disorder’s progression. Similarly, individuals with diabetes and CKD who carefully managed their blood sugar levels had improved renal outcomes. In addition, the retrospective patient data analysis revealed that patients who adhered to these treatments experienced significantly less disease progression and enhanced kidney function. Conclusion: The findings of this study, which are based on a comprehensive literature review and a retrospective analysis of patient data, highlight the importance of effectively managing CKD in its early stages by adopting a healthier lifestyle, lowering blood pressure, and maintaining healthy blood sugar levels. These interventions enhanced renal outcomes and slowed the progression of CKD in a sample of 500 individuals in the early stages of the disease. These findings support the notion that these measurements should be incorporated into CKD patients’ routine care. Additional research and prospective trials are required to obtain a better understanding of the long-term benefits and improve the treatment of early-stage CKD.

31. A Descriptive Study of the Clinical Profile of Psychiatric Referrals from the Dermatology Unit in a Tertiary Care Center
Swati Surabhi, Pawan Prakash, Barjesh Kumar, Chandramohan Kumar, Shailendra Kumar, Prashant Kumar
Abstract
Objective: To study and examine the clinical profile of psychiatry referrals to tertiary care dermatology units. Methodology: The medical records of dermatology patients transferred to the psychiatric department were evaluated retrospectively. Assessing demographics, mental diagnoses, comorbidities, and skin conditions. There was a total of 200 people included in the sample; 60% of them were women and 40% were men. Results: The study analysed all patients who were referred. The characteristics of the patients dominated the caseload. Most referrals had mental diagnoses. Patients suffer from multiple comorbidities. Dermatological conditions were also associated with mental referrals. Conclusion: The results of this study cast light on the clinical profile of dermatology-based referrals to psychiatry from tertiary care centers. The high prevalence of comorbidities and the association between certain dermatological conditions and psychiatric disorders emphasise the need for integrated dermatology and psychiatry care. These findings can be used to enhance patient care and referral systems and inform the development of collaborative treatment methods. The underlying mechanisms in this population should be investigated further, and patient care should be optimized.

32. A Hospital-Based Comparative Study of Modified Ziehl Neelsen Staining in The Diagnosis of Osteoarticular Tuberculosis Patients
Purbasha Ghosh, Soumen Kar, Kaushik Mandal, Poulami Nandi
Abstract
Objectives: In this study, the prevalence of osteoarticular tuberculosis (OTB) was assessed and the diagnostic efficacy of modified Ziehl Neelsen staining (MZN) vs standard Ziehl Neelsen staining was compared. Methods: In this cross sectional and comparative research, individuals with clinically proven cases of OTB who were older than 18years were included. Exclusion criteria included patients who are not willing to participate or less than 18years of age. As an outpatient procedure, FNAC is done to obtain the clinical sample following all the standard aseptic advisory. The sample was taken with a disposable syringe with 20-gauge needle, following all sterile procedures. Numerous clinical specimens were gathered to ensure the accuracy of the diagnosis. Specimens were transported to the Microbiology laboratory for smear preparation, staining, and reading of the stained smears immediately after collection. A minimum of 2 smears were prepared using the specimens from each patient. The group A specimens were stained using ZN staining while the group B specimens were stained using the MZN staining technique, Chi square test is performed for statistical analysis. Results: Most of the smear positive patients i.e 35 (68.62%) of ZN staining and 37 (67.27%) of MZN staining were in age group of 28-47years. Majorities of patients in ZN staining 30(58.82%) and MZN staining 32 (58.18%) group were males. Conclusions: In the population of middle-aged males, OTB was more prevalent. In comparison to the Ziehl Neelsen staining technique, the Modified Ziehl Neelsen staining approach had a higher rate of OTB smear positivity. Therefore, MZN is a more accurate method for detecting osteoarticular tuberculosis.

33. A Study of Association between Fundus Changes and Lipid Profile in Patients of Essential Hypertension
Sanjay Kumar Das, Pankaj Hans, Aditya Prakash Dinkar, Gautam Sandilya
Abstract
Background: People with essential hypertension, a form of cardiovascular disease, frequently experience end-organ injury, such as retinal abnormalities. There is a substantial correlation between dyslipidemia and essential hypertension. The relationship between alterations in the fundus and a person’s lipid profile in Patna patients with essential hypertension is not fully understood at this time. Methods: The aim of this research was to examine the connection between fundus alterations and lipid profile in Patna residents who have been diagnosed with essential hypertension. Patients with essential hypertension were culled from area hospitals and clinics for this cross-sectional study. Retinal alterations were evaluated via fundus examinations, and lipid profile variables were analysed per protocol in the lab. The potential relationship between fundus alterations and lipid profile was investigated using statistical methods including correlational analysis and multivariate regression. Results: Two hundred individuals diagnosed with essential hypertension (mean age of 55,6 years; 60% men, 40% women) participated in the study. Upon examination of the fundus, abnormalities including cotton-wool patches, arterial constriction, arteriovenous nicking, and haemorrhage were observed on the retina. Other modifications included patches of cotton fibre. 75% of the participants displayed retinal alterations characteristic of hypertensive retinopathy. Significantly elevated levels of total cholesterol (mean 230 mg/dL, standard deviation 40 mg/dL), triglycerides (mean 180 mg/dL, standard deviation 30 mg/dL), and low-density lipoprotein cholesterol (mean 160 mg/dL, standard deviation 25 mg/dL) were indicative of dyslipidemia in a substantial number of patients. Higher total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were associated with more severe retinal abnormalities (p 0.001 for all three variables). Even after controlling for parameters such as age, gender, and blood pressure, the multivariate regression analysis revealed a significant (p 0.05) independent association between fundus changes and lipid profile. Conclusion: According to our results, fundus alterations are strongly linked to lipid profile in Patna patients with essential hypertension. The need of a thorough examination and therapy strategy addressing both symptoms of hypertension and dyslipidemia is highlighted by the occurrence of retinal abnormalities in these patients. The risk of cardiovascular problems from essential hypertension may be reduced or avoided altogether with early detection and treatment. To better understand the mechanisms at play here and assess the clinical consequences over the long run, more study is needed.

34. Risk Factors and Etiological Analysis of Community Acquired Urinary Tract Infection In Rural Area of Kanpur, UP.
Anjali Tiwari, Desh Nidhi Singh, R Sujahta, Shrawan Kumar, Dilip Kumar Sinha
Abstract
Background: This study was undertaken to find out the risk factors and etiological analysis of community acquired urinary tract infection in rural area. Urinary tract infection is the second most common infection in community after respiratory tract infection. UTI is an infection caused by presence and growth of microorganism in urinary tract. To treat UTI broad spectrum antibiotic are used. Material and Methods: Cross – sectional analytical study has been performed among suspected UTI patients of both genders and all age group visiting outpatient departments. Study participants have been recruited by convenient sampling technique. On CLED agar culture the clean -catch mid -stream urine sample from the suspected patients. Antimicrobial susceptibility test was carried out using the Kirby – Bauer disc diffusion method. ESBL production was done by using the double – disk diffusion method. Result: Total of 170sample 91 urine samples was positive for bacteria with significant bacteriuria. Females were predominantly (69.2%). Diabetes mellitus was observed as the commonest risk factor followed by History of UTI and kidney disease. The most common Uropathogen isolated was Escherichia coli (62%), followed by Klebsiella sp. (29.1%).  In gram negative bacilli GNB), Prevalence of sensitivity was highest for Polymyxin -B and colistin followed by Piperacillin and nitrofurantoin and piperacillin-tazobactam While in gram positive bacilli (GPC) isolates were highly sensitive to nitrofurantoin and vancomycin followed by, linezolid and teicoplanin. Out of 91 positive cases 3 (3.2%) cases showed ESBL production. Conclusion: This study revealed the E. coli was the predominant bacteria pathogen of community acquired UTI in Kanpur, India. Regular monitoring of the antibiotic sensitivity pattern of UTI pathogens for commonly used antimicrobial agents should be carried out in a particular region for optimal empirical therapy.

35. Evaluation of Prescribing and Utilization Pattern of Drugs Used in Post Cataract Surgery Patients at Tertiary Level Teaching  Hospital in Western Rajasthan
Kanchan Choudhary, Sumita Tanwar, Vinod Kumar Chhipa, Najmul Hasan, Ajay Kumar
Abstract
Introduction: Cataract is the worldwide leading cause of blindness and the most prevalent ocular disease. In India, 62.6% cases of blindness due to cataract. Cataract surgery induces uncontrolled infection and inflammation which may leads to serious side effects, use of medicines is considered one of the most cost-effective medical interventions for treatment and prevention of disease. Aim: To analyze and evaluate the drug utilization pattern in postoperative patients undergoing cataract surgery using world health organization (WHO) core prescribing indicators. Materials and Methods: A Cross-sectional prospective observational study carried out over a period of six month from July 2021 to December 2021. Total 500 patients were selected during our study and were analyzed on the basis of inclusion and exclusion criteria. Results: we analyzed a total of 500 prescriptions which includes 2889 drugs. Average no. of drugs per prescriptions was 5.7 with maximum 46.2% had 6 drugs. All patients were prescribed eye drops and the commonest FDC eye drops prescribed being gatifloxacin with prednisolone (69.2%). All prescriptions are with antibiotic and analgesic 2.6% injections were observed. About (28.6%) of the drugs were prescribed by brand name and (71.3%) by generic name. Percentage of drugs prescribed from essential drug list (55.4%). Conclusion: Topical drugs were commonly prescribed to treat ocular infections. Evaluation of drugs using WHO core prescribing indicators showed that the number of drugs prescribed by generic names and from NLEM was low.

36. A Study on Circulating Serotype Diversity of Dengue Virus During 2021-2022 in A Tertiary Care Hospital, North-West Zone, Rajasthan
Ashwini Bairwa, Anjli Gupta, Abhishek Binnani, Geeta Tinna
Abstract
Introduction: DENV-2 is associated with more severe dengue and has significant association with DHF (dengue hemorrhagic fever) in comparison to DENV-1, DENV-3 and DENV-4. So, infection with DENV-1 followed by DENV-2 is more dangerous than infection with DENV-4 followed by DENV-2. This increases the necessity of serotyping of dengue virus with every outbreak/ every year. Methods: The Cross-sectional study was conducted in the Department of Microbiology, Sardar Patel Medical College, Bikaner and about 9000 blood samples were collected out of which 332 sero positive samples for NS1 antigen &/ IgM antibody were stored & studied from P.B.M. & A.G. of hospitals from April 2021 to April 2022. Results: 92.47% patients were NS1 positive and 7.53% patients were NS1 negative. 85.84% patients were IgM negative, 10.84% patients were IgM positive and 3.31% patients were IgM equivocal result. 84.64% samples were of low titrate IgG and 15.36% samples were of high titrate IgG. 84.34% patients had primary dengue infection and 15.66% patients had secondary dengue infection. Out of 332 sample identified as 30(9.04%) DENV-1, 289(87.05%) as DENV-2, 9(2.71%) as DENV-3 and 1(0.30%) as DENV-4. Three (0.90%) cases were co-infected with serotypes DENV-1,2. DENV-2 was found to be predominant serotype. Conclusion: In conclusion, this study reveals that all four serotypes and co-infection with multiple serotypes were found to be circulating in Bikaner Rajasthan which suggests that this could be a hyper endemic province for dengue. DENV-2 was the predominant serotype followed by DENV-1. Thus the results of the present investigation can assist in designing control strategies for future epidemics and to determine the evolutionary pattern of the emerging Dengue virus.

37. Evaluating the Efficacy of Intraperitoneal Bupivacaine Alone, or with Dexmedetomidine or with Tramadol for Pain Management Following Total Laparoscopic Hysterectomy
Ketan Pipaliya, Ronak B Ramanuj
Abstract
Introduction: Laparoscopic total hysterectomy (LTH) is a minimally invasive surgical procedure for gynecological conditions. Effective post-operative pain management is crucial for patient recovery and satisfaction. Intraperitoneal bupivacaine has shown promise as a method for providing analgesia in LTH. This study aims to compare the analgesic efficacy, opioid consumption, adverse effects, and patient satisfaction of intraperitoneal bupivacaine alone, dexmedetomidine, or tramadol in LTH. Materials and Methods: A prospective, randomized, double-blind study was conducted at Padmakuvarba General Hospital Rajkot from June 2022 to Feb 2023. The study included 120 female patients undergoing elective laparoscopic hysterectomy. Patients were assigned to one of three groups: intraperitoneal bupivacaine alone, bupivacaine with tramadol, or bupivacaine with dexmedetomidine. Standardized surgical techniques and anesthesia were employed. Pain intensity was assessed using the Visual Analog Scale (VAS) at various time points post-surgery. Secondary outcomes included time to first analgesia request, total analgesic consumption, and occurrence of adverse effects. Results: The study included 120 female patients undergoing laparoscopic hysterectomy, divided into three groups: Group A (intraperitoneal bupivacaine alone), Group B (bupivacaine with tramadol), and Group C (bupivacaine with dexmedetomidine). Patients in Groups B and C had significantly lower post-operative pain scores compared to Group A at all time points (p < 0.001). The time to first analgesia request was significantly longer in Groups B and C compared to Group A (p < 0.001). Total analgesic consumption over 24 hours was significantly lower in Groups B and C compared to Group A (p < 0.001). Adverse effects such as nausea, vomiting, pruritus, shoulder pain, and hypotension were more frequent in Group A compared to Groups B and C. Conclusion: In conclusion, the addition of dexmedetomidine to intraperitoneal bupivacaine in patients undergoing laparoscopic hysterectomy resulted in better pain control, longer time to analgesic request, and lower analgesic consumption compared to bupivacaine alone or tramadol.

38. A Study of the Dimensions of Pedicles in the Dried Human Typical Thoracic Vertebrae
Varghese P D, Rajad R, Veena Nair, Reshmi R
Abstract
Knowledge of the morphometry of the pedicles of thoracic vertebrae is important for the placement of screws for treating various degenerative disorders of the spine. The morphometry varies considerably among different races and gender. The morphometric knowledge is necessary for designing specific screws and thereby minimizing operational hazards. The study was conducted on 100 dry human typical thoracic vertebrae obtained from the Department of Anatomy, Govt. T.D Medical College, Alappuzha. The measurements taken were pedicle width (PW) and pedicle height (PH). In our study, the mean pedicle width on the right side was found to be 4.2420 + 1.044 mm and on the left side was 4.2473+0.917mm. Mean pedicle heights on the right and left sides were 10.8495 +1.172mm and 10.8481+1.082mm respectively. The findings of the study are similar to the observations made by other Indian researchers. However, the measurements were lower when compared to those of the western population. These differences could be attributed to their larger physique.

39. A Morphometric Study of the Glenoid Cavity in Dried Human Scapulae
Veena Nair, Reshmi R, Rajad R, Rani Raphael M
Abstract
Knowledge of the morphometry of the pedicles of thoracic vertebrae is important for the placement of screws for treating various degenerative disorders of the spine. The morphometry varies considerably among different races and gender. The morphometric knowledge is necessary for designing specific screws and thereby minimizing operational hazards. The study was conducted on 100 dry human typical thoracic vertebrae obtained from the Department of Anatomy, Govt. T.D Medical College, Alappuzha. The measurements taken were pedicle width (PW) and pedicle height (PH). In our study, the mean pedicle width on the right side was found to be 4.2420 + 1.044 mm and on the left side was 4.2473+0.917mm. Mean pedicle heights on the right and left sides were 10.8495 +1.172mm and 10.8481+1.082mm respectively. The findings of the study are similar to the observations made by other Indian researchers. However, the measurements were lower when compared to those of the western population. These differences could be attributed to their larger physique.

40. A Cross-Sectional Study on Behavioural and Psychosocial Impact of COVID-19 Pandemic on Children of Medical Health Care Workers
Surabhi Pokhariyal, Nutan Singh, Bindu Deopa, Yuvraj Pant, Amit Singh
Abstract
Background: COVID-19 pandemic has adversely affected children’s behaviour and psychological development by disrupting routine life activities. Children of healthcare workers were at an increased risk of anxiety and depression due to prolonged working hours and quarantine of parents. Aim & Objectives: To study the psychosocial impact of COVID19 on children of health care workers by evaluating anxiety, aggression, and depression. Material & Methods: An institutional based cross-sectional study was conducted on 200 children of healthcare workers, aged 8 to 16 years in Dr. Shushila Tiwari hospital Nainital. A pre-formed questionnaire using standard scales, including demographic data and behavior changes, described in terms of anxiety, depression, and aggression was filled for each child in detail. Data was tabulated and subjected to statistical analysis. Results: The study population comprised of 51% females and 49% males.The mean age of children included in the study was 11.27±2.87 years. Statistically significant increase in screen time and sleep duration and decrease in outdoor activity in post-covid period was observed in this study (p<0.0001).3%children exhibited verbal aggression, 4.5% exhibited physical aggression and 2% showed auto-aggression in the post-covid period.3% exhibited aggression against property(p<0.05) Depression was observed in 17% children after pandemic (p=0.0001). Generalized anxiety disorder, significant school avoidance, social anxiety disorder and separation anxiety disorder were noted in 2%,10%, 12.5% and 11.5% children respectively in the post-covid period (p<0.05). Conclusion: COVID-19 pandemic posed unprecedented challenges to healthcare workers worldwide, producing a substantial psychosocial impact on their children. Attention must be paid to need of psychological support and counselling services to this group of children (COVID BABIES).

41. Identification of Risk Factors in Trauma for Predicting Post-Operative Abdominal Septic Complications
Manas Ranjan Behera
Abstract
Objective: Septic complications are the most common cause of death in trauma patients who survive beyond 48 hours. Early diagnosis and treatment of infectious complications is essential to prevent life threatening complications like Systemic Inflammatory Response Syndrome (SIRS) and MultiOrgan Dysfunction Syndrome (MODS). Aim: To study the various risk factors for septic abdominal complications following laparotomy for trauma. Method: This prospective study was carried out at Maharaja Krishna Chandra Gajapati Medical College & Hospital, Brahmapur, within a year. Sixty patients above the age of 12 years, who underwent laparotomy for abdominal trauma in the Surgical Department of tertiary care hospital, were included in the study. Various patient variables were compared with postoperative septic abdominal complications like wound infection, wound dehiscence, anastomotic leak and intra-abdominal abscess. Data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In the total 60 patients (35.60±16.54), significant association was seen between wound infection and dehiscence with the time interval between trauma and surgery (p<0.001). Lesser Revised Trauma Score (RTS) (p<0.001). Variables such as age, gender, co-morbidities, Body Mass Index (BMI), pre-hospital care received, intraoperative findings and duration of ICU stay had no association with outcomes (p>0.05). Conclusion: In trauma patients, factors like low RTS score, high ISS score, need for ICU stay and the presence of associated injuries may help the surgeons to decide in which patients to go for techniques like delayed closure of the wound, stoma instead of bowel anastomosis, etc., which may help to reduce postoperative septic complications.

42. Apache II Score Evaluation of Routine Ilesostomy Results in Ileal Perforation
Manas Ranjan Behera
Abstract
Objective: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth most common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score. Method: This study was conducted in the 60 patients, who were admitted from causality and surgical outpatient department with a proven diagnosis of ileal perforation peritonitis. The patients were scored using by APACHE II into either of the two groups, Group A: < 10 score. Group B: >10 score. Patients were operated for primary closure or ileostomy formation and were divided into two groups of 30 each depending on the surgical management. Group I (n = 30): These patients were managed by primary repair of the perforation with or without resection‑anastomosis. Group II (n = 30): These patients were managed by ileostomy formation with closure/resection of the perforation. The outcome was assessed by postoperative complications and duration of hospital stay as related to APACHE II score. Results: Typhoid accounted for 38.3% of ileal perforations, Tuberculosis 15%, trauma 5% and nonspecific 41.6%. The majority of the perforations were single (90%), of size < 0.005) more done in patients with APACHE II score < 0.005) more done in patients with APACHE II score ≥10. As the APACHE II score increases the percentage of complication rate and hence hospital stay also increases, 12.97 ± 3.50 days in patients with APACHE II P< 0.001). Conclusion: Enteric fever is the most common cause of perforation peritonitis. Higher APACHE II scores in secondary peritonitis correlated significantly with the higher mortality and morbidity of the patients.

43. To Derive a Regression Formula between Hand Length and Height of an Individual and to Compare Reliability and Accuracy of Foot Length and Hand Length in Estimation of Height
Rajeev Hingorani, Gaurav Jain, Gaurav Agarwal
Abstract
Background & Method: The aim of the study is to derive a regression formula between hand length and height of an individual and to compare reliability and accuracy of foot length and hand length in estimation of height. As stature attains its maximum at around 21 years of age and senility related changes of stature starts appearing after 30 years. Result: The mean with SD of the average hand length was 18.6842±0.8176 and 17.5092±0.6697 for males and females respectively. Pearson correlation between foot length and stature was 0.713 in males and 0.681 in females which shows the more reliable and strongly significant correlation index in males in comparison with the females (p˂0.001**). Pearson correlation between hand length and stature was 0.721 in males and 0.783 in females which shows the more reliable and strongly significant correlation index in females in comparison with the males (p˂0.001**). Conclusion: Sample linear regression equations have been derived to estimate stature from foot length and hand length. Both foot length and hand length showed positive correlation with stature as indicated by the regression coefficient (r) in both the sexes. The correlation between foot length and stature was more in males than females and stature indicating foot length to be a better predictor of stature in males.

44. Pregnancy Rates Increasing by Endometrial Scratching
Gitanjali Patri, Roshan Kumar Naik
Abstract
Objective: The aim of this study was to examine the effect of endometrial scratching in women with unexplained infertility. Method: A randomized controlled study was conducted in Hi Tech Medical College, Rourkela and a private practice setting. A total of 105 couples with unexplained infertility were randomly allocated into two groups: group A comprised 54 women who underwent endometrial scratching in the luteal phase of a spontaneous menstrual cycle; and group B included 51 women who underwent a placebo procedure. The main outcome measured was cumulative clinical pregnancy rate after 6 months and miscarriage rate. Results: Clinical pregnancy rate was significantly higher in the women experiencing endometrial biopsy than in the control group (25.9% and 9.8%, respectively, P = 0.04). There was no significant difference in miscarriage rate between pregnant women in the endometrial injury group and pregnant women in the control group (12.5% and 16.5%, respectively, P = 0.79). Conclusion: Endometrial scratching may improve clinical pregnancy rates in couples with unexplained infertility. Adequately powered studies are mandated to confirm or refute the findings.

45. Adenomyosis Is the Most Common Reason for Hysterectomy in People Aged 30 to 52 Years and the Increasing Prevalence of Adenomyosis
Gitanjali Patri, Roshan Kumar Naik
Abstract
Objective: The presence of adenomyosis (ADS) may increase complication rates associated with laparoscopic hysterectomy (LH) due to an increased weight of the uterus, increased vascularization of the uterus, impaired myometrial tissue, and presence of additional gynecological pathologies such as leiomyoma or endometriosis. The aim of the present study was to evaluate perioperative and early postoperative parameters in patients with or without adenomyotic lesions. Method: The study included patients who underwent LH in a university hospital. Patient data were retrieved from the hospital records and reviewed retrospectively. Sixty-one patients (85.9%) without adenomyotic lesions comprised the control group. Ten patients with adenomyotic lesions (14.1%) were regarded as the study group. Results: In this study, the mean age of the patients was 50.93±9.39 years. The mean uterus size was significantly higher in patients with ADS (p=0.02). There was no statistically significant difference in perioperative variables such as delta hemoglobin (Hb), insertion of pelvic drainage catheter, and invasive assessment of the urinary tract between both the groups (p=0.27, p=1.0, and p=0.67, respectively). The difference between the groups in terms of postoperative blood transfusion was not statistically significant (p=0.25). There was no statistically significant difference in the postoperative maximum body temperature, length of hospital stay, and duration of urinary catheterization between both the groups (p=0.77, p=0.36, and p=0.75, respectively). Conclusion: LH appears to be a safe alternative for patients with ADS. Large-scale, prospective, and randomized trials are required in order to suggest the routine use of LH in patients preoperatively diagnosed with ADS.

46. Maternal Delays in Seeking Emergency Obstetric Care in Eastern India: Prevalence and Risk Factors
Meena Mehta
Abstract
Objective: To quantify the incidence of and contributing elements to pregnant women’s delayed use of emergency obstetric care. Method: Within a year, facility-based cross-sectional research employing a quantitative technique was carried out at Rajendra Institute of Medical Sciences, Ranchi. With the use of a single population proportion formula, a sample size of 250 was established.  Epi Info version 3.3.2 software was used to enter data that was afterwards exported to SPSS version 20 for statistical analysis. With a 95% confidence interval, a variable is declared statistically significant if P <0.05. Results: Of the 250 participants, 203 respondents (27.2%) stated that they had difficulty deciding whether to seek emergency obstetric treatment. With a range of 30 minutes to 18 hours, the average delay duration was 90 minutes. Age of the mother, amount of education, monthly income, and ANC follow-up status all had a significant impact on whether a mother delayed seeking emergency obstetric treatment. Conclusion: Husbands used the lines to discuss choosing to get obstetric treatment. This suggests that women have little autonomy in making health-related decisions for themselves. Health extension workers, health centre staff, district officers, and programmers should place an emphasis on raising awareness, developing income-generating mechanisms, and enhancing mothers’ capacity for decision-making to address maternal delay one.

47. Assessment of Patients’ Haematological Complications in A Hospital-Based Prospective Study
Subrat Mohanty, G Krishna Prasad
Abstract
Objective: In orthopaedic surgery, haematological post-operative problems are a worldwide issue that frequently occurs. Therefore, the purpose of the current study was to evaluate different post-operative haematological problems that could arise in people having orthopaedic surgery. Method: 100 patients who underwent orthopaedic surgery at the PGIMER & Capital Hospital, Bhubaneswar for a year were the subject of this prospective study, which was done. All blood bank data, including the number and date of transfusions obtained, were reviewed for medical records. Each postoperative data point was recorded separately and examined in an Excel sheet. The 17.0 version of SPSS was used to analyse the data. The level of significance was evaluated using the chi-square test. Results:  The current study involved a total of 100 individuals. The subjects’ average age was 57.3 years. 58 of the 100 participants were men, and 42 were women. 91 of the individuals had elective orthopaedic procedures, whereas the remaining 9 had emergency procedures. In our study population, knee and hip surgery were the next most frequently performed surgical procedures after spine surgery. Post-operative haematological problems were observed in 31 patients in total. 21 patients experienced transfusion as a result of these problems. There was significant bleeding in 4 cases. Conclusion: Haematological problems do happen to a considerable percentage of patients having different kinds of orthopaedic procedures. Future research including a larger sample size is advised to examine the relationship between haematological problems and patient prognosis.

48. Colorectal Carcinoma Clinical Assessment and Management
Manas Ranjan Behera
Abstract
Objective: Colorectal cancer is the third most common type of cancer in the world and the increased survival of the colorectal cancer population is very significant. Thus, it becomes relevant to study the symptoms associated with the progression of the disease and treatment, for proper clinical management. The aim of the study was to describe the clinical and epidemiological profile of colorectal cancer patients and identify the most prevalent signs and symptoms patterns. Method: Cross-sectional study evaluating the prevalence of symptoms in 348 colorectal cancer patients admitted to a referral oncology hospital. We applied MSAS-BR scale and, through factor analysis with principal componente analysys, we performed the grouping of symptoms. Results: There was a predominance of men, aged 60 years or older, married, white, with high school, moderately differentiated tumor, stage III/IV disease, colon cancer and no distant metastasis. The most prevalent symptoms were weight loss (67.53%) and the least prevalent were mouth sores (2.01%). The groupings of symptoms established were “fatigue and psychic symptoms”, “gastrointestinal symptoms”, “self-perceptive symptoms” and “general symptoms”, which described 80% of the symptoms presented. Conclusion: We evidenced the importance of identifying these symptoms clusters in order to improve strategies for clinical management in patients with colorectal cancer.

49. The Clinical Profile and Management of Ventral Hernia
Manas Ranjan Behera
Abstract
Objective: Abdominal wall hernias are a familiar surgical problem. Millions of patients are affected each year, presenting most commonly with primary ventral, incisional, and inguinal hernias. A ventral hernia is defined by a protrusion of an organ or tissue through a defect in the anterior abdominal wall fascia. Ventral hernia constitute 4% of total hernia patient admitted in ward. The aim is to study the varied presentations, etiology, distribution according to age /sex, predisposing factors, anatomical distribution of ventral hernias. Method: This is a prospective descriptive study carried out at Maharaja Krishna Chandra Gajapati Medical College & Hospital, Brahmapur, within a year. During the study period, 50 patients of ventral hernias were included. Results: Incisional hernias constituted 46% of all ventral hernias. Female preponderance was seen in incisional hernias with Female to male ratio is 1. 9:1, whereas in epigastric and umbilical / para umbilical hernias male predominance was seen. Most of the ventral hernias presented in 4th to 6th decades. 78% of ventral hernias were uncomplicated at the time of presentation. Swelling was the most common complaint followed by pain. Conclusion: From our study it was concluded that Incisional hernias constituted 46% of all ventral hernias. Female preponderance was seen in incisional hernias with Female to male ratio is 1. 9:1, whereas in epigastric and umbilical / para umbilical hernias male predominance was seen.

50. To Compare Early Outcomes of Nonabsorable Polypropylene Mesh and Partially Absorbable Composite Mesh in Laporoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia
Manas Ranjan Behera
Abstract
Objective: Laparoscopic hernia repair is in vogue in the present era. Both the operating surgeon and the patient are concerned about postoperative inguinodynia which has now replaced recurrence as the predominant factor affecting quality of life. Our study aimed to compare early postoperative outcomes with the standard non absorbable polypropylene and the newer partially absorbable composite meshes. Method: This was a prospective study carried out at Maharaja Krishna Chandra Gajapati Medical College & Hospital, Brahmapur within a year. A total of 60 patients with unilateral uncomplicated inguinal hernia were included in the study and randomly divided into two groups, one each for one kind of mesh. Patients underwent Transabdominal Preperitoneal (TAPP) repair of hernia after taking written informed consent. Follow-up was done in the immediate postoperative period and at three months. Patients were compared for inguinodynia, the sensation of heaviness, seroma/hematoma formation and return to work activities. Standard statistical tests were applied and a p-value. Results: Patients in the composite group complain of significantly less pain as compared to those with the non-absorbable mesh at three months (p-value <0.003). They also report less sensation of heaviness over the groin area. However, the incidence of seroma formation was higher in the composite group (20%) when compared to the nonabsorbable group (6.67%). An earlier return to work was seen in the patients with composite mesh. Conclusion: Use of composite mesh in TAPP is associated with better patient outcomes in terms of less postoperative pain and an earlier return to work.

51. A Study on the Surgical Outcomes of Early and Delayed Laparoscopic Appendectomy
Manas Ranjan Behera
Abstract
Objective: The aim of this study was to validate the pros of laparoscopic appendectomy (LA) over open appendectomy (OA) and to compare various primary outcome measures in the management of acute and recurrent appendicitis. Method: Total of 60 patients with acute and recurrent appendicitis were included in the study. Thirty patients underwent OA and 30 underwent LA. Both groups were comparable clinicopathologically and demographically. Various intraoperative and postoperative parameters were compared. Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. Mann–Whitney U test was used to compare continuous variables and chi-squared test was used to compare categorical variables. p-Value <0.001 was statistically significant. Results: The median age of patients undergoing OA and LA was 24.9 and 25.2 years (p < 0.221), respectively. Female: male ratio in OA and LA was 1.30 and 1.14, respectively (p < 0.795). Mean operative duration in LA and OA group was 47.17±14.39 minutes and 36.9 ±12.33 minutes (p <0.001), respectively. Mean length of postoperative stay in LA and OA group was 3.69±0.71 days and 5.28±0.63 days (p <0.000), respectively. Median visual analogue scale score in LA and OA group was 3.5 and 5 (p ¼ 0.001), respectively. Mean time to return to normal activity in LA and OA group was 8.13±1.33 days and 10.10 ± 2.20 days (p < 0.000), respectively. About 6.66% patients in LA group and 13.33% in OA group had postoperative wound infection (p < 0.652). Mean scar scale scoring done on 30th postoperative day was 4.23 in LA and 8.23 in OA (p<0.000). Conclusion: LA is more promising than OA in the management of acute and recurrent appendicitis. LA offers lesser operative site pain in the postoperative period, shorter postoperative hospital stays, earlier recovery, and return to normal activities and cosmetically better scars on 30th day follow-up. No conversions or significant difference in wound related complications were seen in both groups. Prolonged intraoperative duration was the only drawback of LA.

52. Acute Scrotal Swelling: A Clinical Study
Manas Ranjan Behera
Abstract
Objective: cute scrotal swelling is a group of heterogeneous disease of the scrotal organs, that have a similar clinical picture and which may require surgical treatment. The aim was to study the clinical presentation, differential diagnosis, and management of different acute scrotal conditions. Method: prospective study was at Maharaja Krishna Chandra Gajapati Medical College & Hospital, Brahmapur within a year, conducted 100 patients among aged between 13-70 years, presenting with acute scrotal swelling. After obtaining ethical committee approval, the study was conducted among the patients who were presented with acute scrotal swelling with informed written consent from the patient. Results: Epididymo-orchitis was found in 48 out of 100 patients and torsion of testis (17), Epididymoorchitis was found to be common clinical condition followed by torsion of testis which occurs in younger individual. Scrotal swelling associated with pain was the most common presenting feature, where fever and urinary symptoms being most common feature in epididymo-orchitis. Haemogram, urine analysis were not conclusive but supportive to clinical diagnosis. Ultrasound of scrotum was 92.58% sensitive and 100% specific. The period of hospitalisation was found to be more in fournier’s grangrene (mean 25 days.) rather than epididymo-orchitis. Conclusion: In our study shows acute epididymo-orchitis found to be commonest condition followed by torsion of testis. Testicular torsion is a true surgical emergency which required careful examination, proper evalution and prompt treatment with early surgical management.

53. Effect of Ticagrelor Vs. Clopidogrel in STEMI after PTCA
Hansraj Meena
Abstract
Objective: Acute coronary syndrome patients have an inflammatory response, which is known to have an impact on platelet aggregation. Our goal is to better understand the connection between the intensity of the inflammatory response and the outcomes of antiplatelet medication after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Method: The 203 STEMI patients who had primary PCI as part of this retrospective, single-center analysis were divided into two groups according to the antiplatelet treatment they were given when they were admitted (clopidogrel vs. ticagrelor). Based on the tertiles of the distribution of high-specificity C-reactive protein levels before to PCI, three categories of inflammation were identified: low, middle, and high. Platelet aggregation function was measured as residual ADP-induced platelet reactivity on light transmittance aggregometry throughout hospitalisation and follow-up. At admission and a year after PCI, inflammation indicators were assessed. Results: At intermediate and high levels of inflammation, residual ADP-induced platelet aggregation was significantly higher among clopidogrel users than among ticagrelor users. In the clopidogrel group, statistically significant differences in platelet aggregation function were observed among the three levels of inflammation. At 1 year post-PCI, ticagrelor users had significantly lower levels of interleukin-1βand higher levels of interleukin-35 and transforming growth factor-β. Conclusion: At different inflammation levels, ticagrelor provides more potent platelet inhibition than does clopidogrel, suggesting that ticagrelor might exert a more stable antiplatelet effect at higher levels of systemic inflammation. Furthermore, ticagrelor is associated with reduced indices of inflammation on follow-up after PCI, suggesting that anti-inflammatory effects might play a role in the clinical benefit observed with antiplatelet therapy, which would provide an additional rationale for using ticagrelor in STEMI patients undergoing primary PCI.

54. To Derive a Regression Formula between Hand Length and Height of an Individual and to Compare Reliability and Accuracy of Foot Length and Hand Length in Estimation of Height
Rajeev Hingorani, Gaurav Jain, Gaurav Agarwal
Abstract
Background & Method: The aim of the study is to derive a regression formula between hand length and height of an individual and to compare reliability and accuracy of foot length and hand length in estimation of height. As stature attains its maximum at around 21 years of age and senility related changes of stature starts appearing after 30 years. Result: The mean with SD of the average hand length was 18.6842±0.8176 and 17.5092±0.6697 for males and females respectively. Pearson correlation between foot length and stature was 0.713 in males and 0.681 in females which shows the more reliable and strongly significant correlation index in males in comparison with the females (p˂0.001**). Pearson correlation between hand length and stature was 0.721 in males and 0.783 in females which shows the more reliable and strongly significant correlation index in females in comparison with the males (p˂0.001**). Conclusion: Sample linear regression equations have been derived to estimate stature from foot length and hand length. Both foot length and hand length showed positive correlation with stature as indicated by the regression coefficient (r) in both the sexes. The correlation between foot length and stature was more in males than females and stature indicating foot length to be a better predictor of stature in males.

55. Ki-67 Index in Oral Squamous Cell Carcinoma: Two Year Study at a Tertiary Care Centre of Kashmir
Tazeen Jeelani, Rubina Bhat, Ghazanfar Rashid, Aiffa Aiman, Rukhsana Akhtar, Zafirah Zahir, M Iqbal Lone
Abstract
Introduction:  Squamous cell carcinoma of the oral cavity is among ten most common cancers in the world, and accounts for almost 3-5% of all the malignancies.  Ki-67 is non-histone nuclear protein, that helps in regulating the cell cycle. It is related to survival as well as prognosis of various neoplastic lesions. The advantage of using Ki-67 is that its expression occurs in almost all phases of the cell cycle, except in G0 phase and early G1 phase. Material and Methods: The study was conducted in the department of pathology sher-i- Kashmir institute of medical sciences Srinagar Kashmir from January 2019 to december 2020. The case history of 60 patients histo-pathologically diagnosed as squamous cell carcinoma with different grading and staging was transcribed from patient’s individual clinical records followed by anti-Ki 67 monoclonal antibody IHC study. Each case slide was analyzed for ki-67 index at Proliferation margin. Paraffin sections of formalin-fixed tissues were used for both histological and immunohistochemical evaluation. Results: Correlation of Ki-67 index was done with grade and stage of squamous cell carcinoma. The mean ki-67index in well differentiated OSCC (n=38), moderately differentiated OSCC (n=20) and poorly differentiated SCC (n=2) was 41.2%, 55.4% and 65.6% respectively, with standard deviation of 8.9- 9.27 and a significant P-value of 0.012. Conclusion: It can be concluded that Ki-67 index has no significant prediction in tumor stage, while as ki-67 index was found to have direct prediction in grade of the tumor, I,e: higher the grade of tumor, higher was ki-67 index and vice versa.

56. Prospective Study of Outcome of Nocturnal Wrist Splint versus Local Steroid Injection in Mild and Moderate Carpal Tunnel Syndrome
Sreeja Hareendranathan Radhamani, Juliet Roseline John, Kabeer Kaithadiyil Abdul Khayar Kutty, Sajith John, Bindhu Vasudevan
Abstract
Carpal tunnel syndrome, a common entrapment neuropathy involving median nerve at the wrist is characterized by pain and paresthesia of hands and in severe cases numbness and weakness of thenar muscles. Non-surgical methods have a role in management of mild and moderate cases of CTS. Common options include nocturnal wrist splint and local steroid injection. We could not come across any Indian studies comparing these two methods. This prospective observational study conducted at Government medical college Ernakulam aimed at comparing these two modalities of treatment in mild and moderate cases of idiopathic CTS in patients older than 18 years of age. Patients were allowed to take informed decision to choose either nocturnal wrist splint or ultrasound guided local injection of 40 mg of triamcinolone. They were followed up with BCTQ clinical severity score and functional status score (primary outcome) as well as peak latency and distal latency in NCS (secondary outcome) at 6 weeks and 6 months. Difference between BCTQ score, peak latency and distal latency at 6 weeks and at 6 months from the baseline between the splint and steroid group was compared using Mann Whitney U test. A patient preference for nocturnal wrist splint was noticed in this study mainly because of its non-invasive nature. Both the wrist splint and steroid group showed improvement in BCTQ clinical severity score and functional status score and NCS parameters at 6 weeks and 6 months. There was a greater improvement in the steroid group at 6 weeks. However, the initial advantage seen with steroids when compared to wrist splint declined to non-significant levels at 6 months. This study shows that local steroid injection produced an earlier relief of symptoms which continued at 6 months follow up. Nocturnal wrist splint though lagged behind steroids at 6 weeks follow up in terms of relief of symptoms, there was no significant difference between the two groups at 6 months follow up.

57. Role of Complete Blood Count (CBC) Parameters as A Prognostic Assister in Management of Hospitalised COVID-19 Patients: Study from A Tertiary Health Care Centre
Priyadarshini Biswal,  Pranati Pradhan, Lity Mohanty, Subhasis Mishra,  Debjyoti Mohapatra, Mousumi Biswas, Pragyan Lisha Panda, Asaranti Kar,  Kalpalata Tripathy
Abstract
Background: Complete blood count (CBC) parameters has always been a very important and informative assessor in the diagnosis and management of infectious diseases. It is also a rapid, cheap and simple procedure without much inconvenience to patients. CBC parameters of COVID 19 patients recently have shown variations from normal CBC parameters as well as some new variations in comparison to other viral infections. The aim of our study is to observe the various CBC parameters of COVID 19 patients and assess them in the diagnosis and prognosis of disease. We also aimed to compare CBC parameters of ICU and non-ICU patients in order to assess the severity of the disease by an early and cost-effective method in order to handle the huge surge of COVID patients during the pandemic waves. Materials and Methods: CBC reports of around 500 hospitalised COVID-19 patients were examined which also included ICU patients from April 2021 to December 2022 that also included the huge second and a mild third wave also. Different parameters like TLC, DC, Platelet count, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocytes ratio (PLR) were observed and correlated with severity. Various CBC parameters were studied and comparison was done between COVID ward cases and ICU cases. Results: Total 500 CBCs were examined and correlated with normal range in CBC. Most (92%) of the patients showed neutrophilia along with lymphopenia. Eosinopenia was observed in 76% of patients. NLR was also higher in 92% of COVID-19 patients. Platelet count was lower in ICU patients (29%) as compared to ward patients (11%). PLR was also significantly high in ICU patients. Conclusion: Various CBC parameters can help in diagnosing COVID-19 patients and also can be adopted as a prognostic marker during management. Pandemic waves of COVID 19 brings a surge of patients with constraints in time and economy as well as for bed and ICU availabilities Hence, CBC parameters have a crucial role along with other inflammatory markers in assessing severity of COVID 19 patients and imply early interventions to bring down the death rates.

58. Clinicopathological Study and Immunohistochemical Expression of Ki-67 Among Breast Tumors in A Tertiary Care Centre
Sunil Kumar Komanapalli, Urmila Devi Pathivada, Priyanka Lakshmi Narasimha Akella, Gunta Sirisha, Sridevi Sanapala, Rajani Kuna, Basumitra Das
Abstract
Introduction:  Breast, an anatomical site is constantly under the varying influence of sex hormones and it is one of the frequent sites of neoplasms in the human body. Breast cancer is the leading cause of death in women aged 15–54 years worldwide. Apart from clinical parameters, molecular markers like ER, PR, HER 2 neu and Ki-67 which is a cell proliferative index (PI) are targets or indicators of highly effective therapies against invasive breast cancer. Accurate assessment is essential and mandatory. Aim: The present study was intended to know the frequency of occurrence of various breast tumors in relevance with the age and their histopathological features. The Ki-67 (PI) was calculated for various breast tumors. Methodology: An observational study was conducted by light microscopy and immunohistochemical examination of 340 lumpectomy and mastectomy specimens at the Department of Pathology over a period of 2 years between July 2017 – June 2019.Statistical evaluation was done using unpaired t-test. Results: Benign tumors are more common than malignant tumors accounting for 61% and 33% cases respectively. Most common age group for benign tumors is 21-30 years whereas for malignant tumors the age range is 51-60 years. Most common benign tumor is fibroadenoma (FA) followed by benign phyllodes tumor. The precursor lesions that encountered are atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS). The common histological type of breast carcinoma was invasive breast carcinoma –no special type (NST) accounting for 90.2% cases. The mean Ki-67 PI of conventional fibroadenoma and fibroadenoma with focal phyllodes like areas is lower than cellular fibroadenoma and benign phyllodes tumor. The mean Ki-67 PI of ADH was lower than DCIS. There is increase in the mean Ki-67 PI with increase in the grade of the tumor. The overall mean Ki-67 PI of benign tumors are lower than precursor lesions and malignant tumor. Conclusion: In the present study evaluation of Ki-67 helped us to know the variability in the proliferation rates among various breast tumors. Thus, analysis of Ki-67 expression may be useful in clinical practice and when used along with hormone receptor status.

59. A Prospective, Open Label, Randomized Control Trial to Evaluate the Efficacy, Changes in Quality of Life and Treatment Adherence of Oral Rosuvastatin in Management of Plaque Psoriasis
Ranit Bag, Abhishek De, Mohua Sengupta, Sushobhan Pramanik, Patralekha Raychowdhuri
Abstract
Background: Psoriasis is a chronic, autoimmune, inflammatory disease characterized by scaly red patches on the skin that has great negative effect on quality of life. Rosuvastatin, a lipid-lowering medication, is considered a promising drug in treating plaque psoriasis due to their pleiotropic effect. Objectives: To evaluate efficacy of oral rosuvastatin with escalating doses on mild to moderate plaque psoriasis with Psoriasis Area and Severity Index (PASI), to assess the effectiveness of rosuvastatin in improving quality of life using Dermatology Life Quality Index (DLQI), and to assess medication adherence using Medication Adherence Rating Scale (MARS). Methods: An open label, randomized control trial, where 52 patients with plaque psoriasis were enrolled after considering inclusion and exclusion criteria. Patients were randomly divided into four groups: a control group that received standard therapy consisting of topical glucocorticoids, antihistaminic and skin emollient and treatment groups receiving 5mg,10mg, 20 mg of rosuvastatin along with standard treatment continued daily for 8 weeks. Patients were assessed for PASI, DLQI scores, routine blood parameters and LFT tests done at baseline,4 weeks and 8 weeks, while MARS was assessed at 4 weeks and 8 weeks. Results were statistically analysed using GraphPad Prism version 9 software. For intragroup comparison at 0, 4 and 8 weeks, repeated measures ANOVA was done. Intergroup comparisons were done by one-way ANOVA and statistical significance implied by p value<0.05. Results: At the end of the study, while on intragroup comparison all the groups showed significant improvement in PASI (p<0.0001), DLQI (p<0.0001) and MARS score (p<0.0001) at 4 weeks and 8 weeks, on intergroup comparison, none of the intervention groups had any significant advantage over the control group in terms of change of PASI, DLQI or MARS across the study duration. There was also a significant rise in hepatic ALT (p<0.001) and AST (p<0.001) enzymes levels in all the rosuvastatin receiving groups while the control group had a reduction in the ALT levels (p = 0.0012). Conclusion: Oral rosuvastatin in any of the clinically given doses of 5 mg, 10 mg or 20 mg failed to provide any extra benefits when added to the standard treatment of topical glucocorticoids, antihistaminic and skin emollient cream.

60. COVID-19’s Effect on Hepatic Functions
Tariq Salim, Gayatri Gawade,  Akhil Nagpal, Dadasaheb Maindad
Abstract
Background: COVID-19 infection is a recent pandemic that has occurred in three years with varying severity and impact around the world. It has an impact on the respiratory tract. It also affects multiple systems, including the hepatobiliary, as a result of systemic inflammation associated with the respiratory tract. It is being studied how much it affects the liver, what the outcome is, and whether there is any correlation between disease severity and hepatic involvement. The link between COVID infection and hepatic involvement was investigated in this retrospective study. We also looked into the relationship between disease severity markers and hepatic involvement. Aim and Objectives: To investigate the impact of COVID-19 infection on hepatic function. Material and Methods: This is a retrospective study conducted at Bharti Vidyapeeth Medical College in Pune, Maharashtra, India, a tertiary care centre. Data were collected from Covid-19 patients admitted between October 2021 and March 2022 were screened for abnormal liver function. An increase in hepatic parameters (AST, ALT), or total bilirubin that exceeds two times the upper limit of normal. D-dimer, CRP, and ferritin levels were used to determine disease severity. Data on abnormal liver function and disease severity parameters were gathered and analyzed. Results: We discovered 54 (4.08 percent) patients with deranged liver function in the form of raised hepatic parameters (SGOT and/or SGPT) two times the upper limit of average value after reviewing the records of 1123 patients. Males outnumbered females (46:8). Around two-thirds of the patients were over the age of forty. SGOT and SGPT are affected more frequently than other liver function test parameters. The higher the inflammatory marker levels is the more severe the hepatic involvement. All patients recovered, and no one died as a result of liver failure. The hospital stay was also proportionately longer in patients with more severely impaired liver function. Conclusion: COVID infection frequently affects the liver. Hepatocellular damage ranging from mild to moderate is expected. In patients without a history of liver disease, there is no overall influence on outcomes.

61. Evaluation of Efficacy of Intra-Articular Injection of Inj Methylprednisolone Versus Inj Triamcinolone in Knee Joint Osteo Arthritis
Aniruddhsinh Gadhvi, Vandana Trivedi
Abstract
Background and Aims: OSTEOARTHRITIS (OA) of the knee is one of the most common rheumatic disorders and a frequent cause of pain and disability, particularly for elderly. Present clinical study was designed to evaluate and compare efficacy of intra-articular inj. METHYL PREDNISOLONE 40 Mg versus Inj TRIAMCINOLONE 40mg with local anesthetic agent in patients having osteoarthritis knee. Methods: In the present study 60 patients between the ages of 30 and 80 years having Osteoarthritis Knee were divided into 2 random groups, Group D (n=30) Methylprednisolone group and Group T (n=30) Triamcinolone group. Both groups compared for pain relief by Visual analogue score (VAS), Behavioral pain score, Subjective pain score, social and psychological aspects of life by Knee osteoarthritis outcome score (KOOS) And New Oxford Knee score. Results: Study reveals improvement in VAS score, Behavioral pain score, subjective pain score , KOOS questionnaire, quality of life, work performance, sleep pattern, feeling of hope for life, enjoyment of recreational activity without pain was similar in both groups up to 6th week of intra-articular injection. But improvement in New Oxford knee score was found to be better in patients who received intra-articular administration of Methylprednisolone Group D (37.36±3.13 ) with local Anesthetic compared to those who received Inj. Triamcinolone group T was (34.43±5.98) with local anesthetic which is statistically significant (P=0.02). Conclusion: we conclude that intra-articular Inj Methylprednisolone and inj Triamcinolone are equally effective without side effects with Regular physiotherapy for Osteoarthritis Knee.

62. Functional outcome of Subtrochanteric Fracture of Femur Treated with Long Proximal Femoral Nail at Bundelkhand Medical College Sagar (M.P.)
Rajesh Kumar Meena, Gaurav Agarwal, Anshul Gupta, Roopa Agrawal, Mansi Gupta
Abstract
Background: Subtrochanteric fractures are one of the common fractures encountered in orthopaedic practice and one of the important causes of morbidity and mortality in elderly patients1. Early surgical intervention is needed in majority of the patients to avoid the major complications and hence, subtrochanteric fractures are mainly treated with plates, screws and proximal femoral nailing. Objectives: To assess the functional outcome of proximal femoral nailing among patients with sub-trochanteric fractures. Material and Methods: This was a single centre, hospital (inpatient) based, prospective, observational study. All those patients who were more than 18 years and less than 80 years of age with subtrochanteric fracture and treated with Proximal Femoral Nailing within 2 weeks of injury were included and followed up for a period of 6 months. Functional outcome was assessed by Harris hip Score. Results: Total 50 patients were included in the study. Most of the patients were from age group 41-50 Years. Male constituted 22 (44%) of the study group. Majority of number of cases were due to road traffic accident (54 %). According to the Seinsheimer Classification, 3A constituted majority of patients (34%). After surgery, neck shaft angle ranged from minimum 110° to maximum 138°, average being 128°. The average limb length discrepancy noted was 0.288 cm. The radiological union signs were seen at average 12 weeks and weight bearing of patients was started in average 14 weeks. Harris hip Score was >90 in 58%, followed by 81-90 in 28%, 70-80 score was observed in (6%), whereas <70 was observed in 8.0%. Conclusion: Proximal femoral nail is a very good implant in treating subtrochanteric fracture as it is a load sharing implant and it is a closed procedure.

63. A Prospective Study to Evaluate Diagnostic Efficacy of Ultrasound and Colour Doppler in Predicting Malignancy in Nodular Thyroid Disease with Pathological Correlation
Abhishek Mishra, Sunita Dashottar, Anoop Kumar Nair, Arun Kumar, Anushree Mishra
Abstract
Background: Nodular thyroid disease presents with one or more nodular lesions in thyroid gland which may be clinically occult. Thyroid nodules occur frequently in general population and are estimated to show a prevalence of 4-7% by palpation alone and  20-76% by ultrasound (USG) in adults. The prevalence reported by USG correlates with the surgery and autopsy prevalence in the range of 50-65%[5]. Majority of these lesions are readily detected by high resolution ultrasonography (USG). Objective: To evaluate the diagnostic efficacy of ultrasound in predicting malignancy in nodular thyroid disease with pathological correlation. Methods:  A prospective study was carried out from Jan 2013 to Oct 2014 in 130 patients of both sexes in a tertiary care hospital reporting for neck swelling. The USG results were reported as benign, malignant and suspicious for malignancy. Results: The majority of the patients were females in age group of 21-50 years. Anterior or lateral neck swelling was the presenting complaint in all cases. Among 130 patients, 150 thyroid nodules were evaluated 32 nodules were interpreted as malignant in USG. Overall, after pathological correlation, 42 nodules confirmed to be malignant. The strong sonological predictors for malignancy in thyroid nodules were markedly hypoechoic echotexture, poor ill-defined margins, taller than wide shape, lack of perinodular halo, central color flow in doppler and presence of cervical lymphadenopathy. The overall diagnostic accuracy of ultrasound in predicting malignancy in nodular thyroid disease was about 77.4%. Conclusion: Ultrasonography is safe, reliable and radiation free diagnostic tool for delineating malignancy in thyroid nodules. It has fairly acceptable sensitivity and specificity.

64. Role of FNAC in Risk Stratification of Thyroid Lesions Using the Bethesda System for Reporting Thyroid Cytopathology
Avani Dangar, Riya Patel, Ridhi Bhimani, Roshani Chaudhari, Kiran Delwadia
Abstract
Introduction: 3-7% of people have palpable thyroid nodules, which are a common finding. The majority of these nodules are benign, however between 5 and 15% of instances are malignant, depending on the patient’s age, sex, history of radiation exposure, family history, and other circumstances that call for additional investigation. Due to its low cost and minimally invasive nature, thyroid FNA followed by cytological evaluation is thought upon as the standard of therapy. Interpretation of FNA results thus becomes the key step in order for clinicians to advise if more invasive evaluation is necessary. The best diagnostic method for assessing thyroid nodules prior to surgery is fine-needle aspiration cytology (FNAC). The introduction of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provided the opportunity to establish a worldwide standard for reporting and terminology guidelines for diagnostic categories. Aim and Objectives: To determine the distribution of diagnostic categories and subcategories of reported thyroid nodules in our institute according to TBSRTC.To assess the rate of risk of malignancy of thyroid lesion by using TBSRTC and its importance in preoperative as well as therapeutic management. Material And Method: This is retrospective study for a period of 6 months of all the cases of thyroid lesions that were referred to pathology department for FNAC. Results: In this 6 months study we received a total 60 cases of thyroid nodules, including 57 females (95%) and 3 males (5%) and there was female predominance. As per our study middle aged female (33-44 year) are more affected with thyroid lesion.  In this study,Utilising TBSRTC, the outcomes of cytological reports were categorised.: (i) 2 cases (3.3%) of Nondiagnostic, (ii) 52 cases (86.7%) of Benign, (iii) 1 case (1.7%) of Atypia of undetermined significance or follicular lesion of undetermined significance, (iv) 3 cases (5.1%) of Follicular neoplasmor suspicious for follicular neoplasm, (v) 1 case (1.7) of Suspicious for malignancy – Suspicious for papillary carcinoma, (vi) 1 case (1.7%) of Malignant – Papillary thyroid carcinoma. Conclusion: In conclusion, fine needle aspiration cytology is a useful test that is regarded as the gold standard for assessing thyroid nodules.The prognostic usefulness of FNAC is improved by combining it with additional and more sophisticated diagnostic procedures, such as immunocytochemical studies and molecular pathology techniques. As the Bethesda system is a tiered classification, it provides an effective approach for the categorisation of lesion, clinical/surgical management of thyroid lesion. In the present study, the malignancy rate of thyroid lesions is less compared to other study, as many patients are either lost in follow up or referred to a higher centre. Poor socio economic status (iodine deficiency) has also contributed more towards diagnosis of Benign lesion.

65. Open Necrosectomy for Necrotizing Pancreatitis: An Institutional Experience
Dharma Reddy, Vivaan Dutt, Gururaj Gundad, Sahana N
Abstract
Background: The natural history of necrotizing pancreatitis is variable. Infected pancreatic necrosis is an indication for intervention, and requires intensive monitoring and surgical care in a well-equipped setup. Aim: We described our institutional experience in the management of 25 patients with infected pancreatic necrosis using open approaches. Methods: 25 patients who presented to our institution between 2014 and 2018 were enrolled into this study retrospectively. Once assessed to have severe AP, they were shifted to the ICU and resuscitation was done. Necrosectomy with percutaneous drainage was the surgical technique adopted, with gastrostomy where feasible. Patient outcomes were measured in terms of mortality, complications and length of post-operative stay. Results: Patients underwent the procedure at a mean timing of 23.52 ± 3.14 days. The most common etiology was chronic alcohol consumption, followed by biliary stone. The average duration of surgery was 122.8 ± 23.37 minutes. 6 patients (24%) developed complications post operatively. Mortality in the post-operative period was 4 patients (16%) Conclusion: Increasingly a step-up approach is advocated in the surgical management. Our study indicates that in a tertiary care center, open debridement is often the optimal approach. It also provides a valuable contemporary comparison group to minimally-invasive approaches.

66. A Clinical Investigation at AIIMS Patna found A Link Between Non-Alcoholic Fatty Liver Disease and Gallstone Disease in the Hospitalized Patient Group
Mohammad Nehal Ahmad, Prashant Kumar
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) risk factors include gallstones and cholecystectomy. This may be due to the fact that NAFLD and gallstones both share a number of risk factors for development. There isn’t enough data available yet to conclusively link these clinical disorders together. Aim: to ascertain whether there is a significant relationship between cholecystectomy and NAFLD and gallstones. Methods: To identify hospitalizations with a diagnosis of gallstone disease (GSD), which includes calculus of the gallbladder without cholecystitis without obstruction and acquired absence of the gallbladder, as well as NAFLD, which includes simple fatty liver and non-alcoholic steatohepatitis, we studied from March 2020 to November 2021. Using logistic regression and correcting for confounding factors, odds ratios (ORs) evaluating the connection between GSD (which includes gallstones and cholecystectomy) and NAFLD were determined. Results: In individuals with GSD, the prevalence of NAFLD was 3.3%, compared to 1% in patients without GSD. NAFLD was more common in 64.3% of GSD-afflicted women than in 35.7% of GSD-afflicted men. Multivariate-adjusted research revealed a relationship between NAFLD and gallstones after adjusting for numerous variables linked to NAFLD and GSD. Men were more likely than women to have NAFLD and gallstones together. In comparison to men, women had a greater correlation between NAFLD and cholecystectomy. P value for each comparison was below 0.001. Conclusion: Women with GSD are more likely than men to have NAFLD. The correlation between cholecystectomy and gallstones and NAFLD suggests that these conditions may be risk factors for NAFLD.

67. Assessment of Bone Mineral Density in Post-Menopausal Women with Rheumatoid Arthritis
Swati Pathak, Shreya Nigoskar, Shraddha Singh, Amrita Vamne
Abstract
Introduction: postmenopausal individuals with rheumatoid arthritis (RA) had their levels of bone mineral density (BMD) and inflammatory markers compared to their body mass. Material and Methods: The study included 60 postmenopausal women with active RA who were lean, overweight, or obese. These patients femoral BMD, high sensitivity C-reactive protein, interleukin-6, and tumour necrosis factor (TNF)-a serum levels were assessed. Results: In comparison to the lean subjects, obese women were found to have significantly higher total femoral BMD and total T-score (p B 0.01). BMD measurements and CTX levels were shown to significantly correlate with body mass parameters (p B 0.01 and p 0.05, respectively). TNF-a concentrations were negatively correlated with neck BMD values that had been corrected for BMI (p 0.05). No correlations between BMD and other inflammatory indices were discovered. OPN levels were found to have inverse relationships with body mass (p 0.05), waist circumference (p 0.05), and the length of the postmenopausal period (p B 0.01). Conclusion: The bone metabolism in postmenopausal women with active RA is significantly influenced by body mass and inflammatory markers, particularly hs CRP and TNF-a.

68. Perfusion Index A Probable Indicator of Hypotension following Propofol Induction: A Prospective Observational Study
Manoj Kumar Soni, Mahipal Singh Dhaka, Siddharth Rathore, Hemant Singh Rajawat, Jitendra Yadav, Pankaj Garg
Abstract
Background and Aims: Hypotension with the induction of propofol is a common problem. It is claimed that the perfusion index (PI) can predict hypotension after subarachnoid block. Our theory, which suggests that PI may predict hypotension after propofol induction, states that there is a cutoff value for the perfusion index below that hypotension becomes more likely. Methods: 55 participants in this prospective, observational research with ASA physical status I & II underwent planned general anesthesia-based surgery. After induction of anaesthesia with titrated dose of propofol, all the baseline vital parameters and PI were evaluated every minute from baseline to 10 minutes after induction. Hypotension was characterized as a fall in mean arterial pressure (MAP) below 60 mm Hg or a reduction in systolic blood pressure (SBP) of over 30% from baseline. Results: Within the first five minutes following induction, the incidence of hypotension utilizing SBP and MAP standards was 29% and 36%, respectively, whereas severe hypotension was 20%. Baseline PI 1.03 had a sensitivity of 87.5% & a specificity of 92.3% for predicting the occurrence of hypotension at 5 minutes. Area under the curve (AUC)) for the ROC curve was 0.913 with a 95% CI ranging from 0.806 to 0.972. (P <0.001). Conclusion: Following propofol induction, hypotension can be predicted using the perfusion index.

69. A Cross Sectional Study on The Effects of Burn-Related Factors on Anxiety, Depression, and Self-Esteem in patients with Burn Injuries
D.Felex Maree Angelo, Hariharan Palaniappan, William James Alexander Gnanadurai
Abstract
Burns are injuries that are difficult to recover from physically, psychologically, and financially, and many under-researched factors can cause them. The current study’s objectives were to evaluate burn patients’ levels of anxiety, low mood, and self-esteem as well as different burn-related variables that may have an impact on them. 100 patients with burn injuries were enrolled in this cross-sectional study from a govt tertiary care hospital. Using the Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Rosenberg Self-Esteem Scale, respectively, the patients’ levels of anxiety, depression, and self-esteem were evaluated. Upon medical stabilization and within 2 to 8 weeks of the injury, an assessment was conducted. Data was collected and statistical analysis was performed. The majority of the study’s sample was male, married, and had an average age of 33 years. The majority of injuries were accidental burns. The majority had burns that covered 20–59% of their total body surface area (TBSA), and 55% had facial burns. TBSA and anxiety, despair, or low self-esteem did not appear to be significantly correlated with one another. The same was true for face burns. However, there was a strong correlation between deep burns and depression (p=0.01) and anxiety (p=0.02). Burn injuries and burn depth are linked to high incidence of anxiety and depression. Adjustment and recovery in these individuals depend on a number of additional elements, such as the patient’s psychological state, the type and severity of the damage, and the subsequent medical treatment. To determine the extent and determinants of psychological issues in burn patients, more research is necessary.

70. Comparing Cervical Length Measured by Transvaginal Ultrasound with Bishop Score for Predicting Successful Labor Induction
Shubhangi Soora, Kanchan, Beeravolu Mounika Reddy, Shradha Jain
Abstract
Background: Labour induction is one of the most common obstetric interventions. The baby should be born naturally, as it would be the optimum situation. We have a wide range of tools at our disposal that can help us successfully induce labour. The current study sought to ascertain whether transvaginal ultrasound, which assesses cervical length, might predict labour induction outcomes more accurately than clinical evaluation as determined by the Bishop score. Methods: A total of 100 eligible women participated and underwent cervical assessment using transvaginal ultrasound and Bishop score. Labor induction followed the hospital’s standard protocol, including the use of Dinoprostone gel. Up to three doses of the gel were administered intracervically at 6-hour intervals if necessary. The progress of labor, time from induction to delivery, and mode of delivery were recorded. Results: This study found that approximately 65% of primi singleton pregnancies undergoing induction of labor with dinoprostone gel resulted in successful vaginal delivery within 24 hours. The transvaginal cervical length showed better predictive value than the Bishop score for delivery within 24 hours (p=0.001). While the Bishop score had higher sensitivity, the transvaginal cervical length had higher specificity and positive predictive value. Both cervical length and Bishop score were significant predictors of successful induction of labor (p=0.01). Conclusion: According to the study, there is a substantial correlation between both transvaginal sonography measures and the time from induction until delivery. Within 24 hours of induction, transvaginal cervical length assessment offers the highest sensitivity for predicting vaginal births.

71. Long Term Outcome of Total Hip Replacement (THR) Cases
Lokesh Thakur, Brandon Eric Dkhar, Sunil Raina, Bhanu Awasthi, Rahul Bains, Prajwal Anand Srinivasan, Rishabh Bansal
Abstract
Background: THA is a successful orthopedic procedure that provides pain relief, restores function, and improves quality of life for patients with hip pain. Surgical techniques, biomaterials, prosthesis design, and fixation techniques have evolved over time. Sir John Charnley is credited as the father of THA for developing the fundamental principles of the artificial hip. Over 300,000 THAs are performed annually in the United States. Methods: Patients underwent clinical evaluation using the Modified Harris Hip Score, WHOQOL score for quality of life assessment, and WHODAS 2.0 for disability assessment. Complete records of patients who had died during the study period were evaluated using the verbal autopsy proforma. Follow-up was conducted telephonically due to the Covid-19 pandemic and related restrictions, with verbal consent obtained before administering the questionnaire. Results: The mean modified Harris Hip Score was 81.54 (out of 100), thus indicating good functional outcome. The mean disability score of our study participants was 7.57, thus indicating good satisfaction of the study participant. The mean score of WHO-QOL BREF domain 1 was 62.67 (SD 8.56), domain 2: 70.24 (SD 10.81), domain 3: 81.02 (SD 16.25) and domain 4: 79.95 (SD 14.96) thus indicating a remarkably good quality of life of the patients post-surgery. Hence they report with significantly high physical ,mental and social improvements. Conclusion: THA has had a revolutionary impact on the quality of life for individuals since the 1960s. It is considered “the operation of the century.” The number of THA procedures performed annually is significant, with a growing trend worldwide. THA continues to be an important and successful intervention for patients with hip pain.

72. Histomorphological Analysis of Polyps of Gastrointestinal Tract- A Retrospective Study from A Tertiary Care Centre
Lavanya Narasingamoorthy, Raja Gopal
Abstract
Introduction: Polyps are more common in colorectal region of total gastrointestinal (GI)tracts. Even though most of the polyps are benign, neoplastic polyps derives significant attention. Understanding the prevalence, distribution and morphological types will improve the screening and treatment strategy. Aim of this study is to analyse the polyp specimens that were presented in our Institute. Materials and Methods: This is a retrospective study done in our Institute between January 2022 to December 2022. The study included the polyps and polypoidal lesions of gastrointestinal tract either received as biopsy, polypectomy, or resected specimens. Ulcers and frank malignant lesions were excluded from the study. Results: Total number of GI specimens received in the study period were 2541, among them 131 were polyp specimens and that were taken into analysis. Median age of the study population was 56 (range 16-98 years), commonest decade was 5th decade. Males has more prevalence than females (ratio 1.75:1). Large intestine was the common site for polyps and serrated lesions were more common morphological type. Most of the serrated and adenomatous polyps were associated with dysplasia. Malignant polyps were squamous cell carcinoma, adeno carcinoma and Lymphoma. Intestinal polyposis noted in few cases. Conclusion: Polyps are increasing in their incidence. Colorectum was the common region involved. Now serrated lesion were more commonly noted and they were almost associated with dysplasia.

73. Comparative Evaluation of Plaque Index in Kirkland Flap with Platelet Rich Fibrin and Kirkland Flap Without Platelet Rich Fibrin in Chronic Periodontitis Patients
Shubhangi Sharma, Sunny Sharma, Ramandeep Singh
Abstract
Background: Evaluation of plaque index in kirkland flap with platelet rich fibrin and kirkland flap without platelet rich fibrin in chronic periodontitis. Method: Group-A It was comprised of 10 individuals to which kirkland flap procedure was performed with PRF in chronic periodontitis patients. Group-B It was comprised of 10 individuals to which Kirkland flap was performed without PRF in chronic periodontitis patients. Result: There is statistically significant difference present between the mean plaque index at various durations in both the groups (p<0.001).

74. A Study of Radiological and Functional Outcomes of Dual Plating in the Treatment of Distal Femur Fractures
P Sai Prashanth Reddy, Pashap Avinash Reddy, Deepak Pushkar
Abstract
Background: In distal femur fractures stable fixation can be achieved by using two plates on the distal femur. The presence of a medial plate, in addition to the lateral plate, is recommended for specific cases, such as when there is bone loss in the medial supracondylar region, low trans-condylar bicondylar fractures, medial Hoffa fractures, peri-prosthetic distal femur fractures, non-union following unsuccessful fixation with a single lateral plate, poor bone quality, and comminuted distal femur fractures (AO type C3). We in the current study tried to analyze the outcomes of distal femur fractures treated with dual plating. Methods: The selected cases were examined clinically for abnormal mobility and crepitus. Anteroposterior and lateral X-rays of the femur with the knee are part of the radiological examination, coupled with a pelvic X-ray to rule out proximal femur fractures. Three-dimensional reconstruction of CT images was carried out. The Distal femur multi-fragmentary intra-articular fractures were fixed with a distal femur locking compression plate on the lateral side and a locked medial plate using the subvastus approach was used in the cases of the study. Results: In this study out of n=20 cases of distal femur fractures treated with dual plating showed, n=1 out of 20 patients had a range of motion less than 70o, n=2 patients had flexion up to 70o, n=4 patients between 70o to 90o of maximum flexion and n=14 patients had 90o or more of flexion. A knee score of 70 and above is considered as good and in our study, n=15 out of n=20 patients had a score of more than 70 and the remaining n=5 patients had fair and poor results. The overall mean score in our study was 73.4 ± 5.5. Conclusion: The utilization of dual plating in treating complex distal femur articular fractures is a feasible option that is both safe and efficient. It should be considered an essential technique for surgeons. This approach offers several advantages, including achieving anatomical reduction, providing a stable fixation, enabling early mobilization of patients, and reducing the risk of varus collapse.

75. Study of Visual Outcome after Cataract Surgery in HIV/ Hbsag Seropositive Patients Operated at A Tertiary Eye Care Facility
Jineel Bhatt, Mittal Kuchhadiya, Shilpa Bhatt
Abstract
Background and Aim: Incidence of cataract may be increased in HIV+ patients due to chronic systemic inflammation, hyperlipiaemia, insulin resistance, kidney diseases etc. that are seen either due to the disease itself or HAART therapy. While regarding Hepatitis B, India falls in the intermediate hepatitis B virus (HBV) endemicity group, with prevalence rate of 2% to 4% in the general population. The aim of this study is to describe the epidemiology and clinical findings of cataract and the long-term outcomes of cataract surgery in HIV+ or HBsAg+ patients. Material and Methods: Present study was performed from. January 2020 until January 2023, records of all patients undergoing cataract surgery in Dept. of Ophthalmology at a tertiary medical college were analysed. The patients who were diagnosed HIV / HBsAg positive prior to surgery were segregated. Detailed pre-operative examination was done of all patients, who included corrected vision, anterior segment examination by slit lamp, fundus examination by direct/ indirect ophthalmoscope, intra-ocular pressure by applanation, etc. All the said patients underwent Small Incision Cataract Surgery (SICS) by a trained resident / consultant. Main outcome measures were: visual acuity before and after surgery, type of cataract, ocular and systemic comorbidities, intraoperative and postoperative complications, and changes in anterior and posterior chamber inflammation. Results: There were 55 patients who underwent cataract surgery who were either HIV+/HBsAg+. Nuclear sclerosis with posterior subcapsular cataract was the most common (32.7%) cataract, while 27.3% patients presented with mature / hypermature cataract. Out of all the patients, there were 3 HIV+ patients in whom evidence of past anterior/ intermediate uveitis was noted notably old keratic precipitates on cornea, sectoral iris atrophy, and posterior synechiae. Conclusion: Cataract surgery with IOL implantation leads to significant visual improvement in HIV+ and HBsAg+ patients. Evidence of past episode of anterior uveitis was noted in 9% of HIV+ patients, all of whom had excellent visual outcomes.

76. Assessment of Oxidative Stress Levels in Newly Diagnosed Type II Diabetes Mellitus
Sreemannarayana J, Keerti Sharma, Ankalayya B, Irfan Ali Khan
Abstract
Diabetes mellitus is a chronic metabolic disorder that is characterized by high levels of blood glucose resulting from either the inadequate production of insulin or a diminished ability of the body’s cells to respond to insulin. India, in particular, has a high burden of diabetes, with over 60 million people affected by the condition out of a population of 1.3 billion. The role of accelerated oxidative stress in the development and progression of diabetes and its complications is widely acknowledged and supported by scientific research. The objective of the current study is to evaluate the levels of oxidative stress markers in individuals diagnosed with Type 2 diabetes. Materials and Methods: The aim of this study was to evaluate the oxidative stress parameters in individuals newly diagnosed with Type 2 diabetes mellitus. Levels of TAOS and malondialdehyde had been measured in 147 normotensive subjects (Group – 1) and 147 Type -2 diabetes mellitus patients (group – 2). Commercially available kits used for the estimation of oxidative stress markers in both groups. Results: The results of our study indicate that patients with Type 2 diabetes mellitus exhibit increased oxidative stress, as evidenced by elevated levels of plasma malondialdehyde and decreased levels of total antioxidant status.. The fasting blood sugar levels are also substantially excessive in newly identified Type -2 diabetics in comparison to the control group. Conclusion: from this study, it’s far concluded that patients with type -2 diabetes mellitus having extended stages of malondialdehyde (MDA) are at higher risk of developing CAD. So any disturbances in balance between the levels of oxidants and anti-oxidants as seen in people with diabetics are the primary reason behind developing CAD.

77. Physical Fitness Index of Male Medical Students in Tertiary Health Care Hospital: A Cross-Sectional Study
Kalashilpa Chittikanna, Vandali Jyothi
Abstract
Introduction: A healthy lifestyle includes physical activity as a key element. A significant risk factor for non-communicable diseases is insufficient physical activity. Considering that medical students are the future healthcare providers, it is important to assess their physical condition. Modified Harvard step test is a tool used for assessing Physical Fitness. The goal of the current study was to compare the physical fitness of inactive medical students with medical students who played regular football. Materials and Methods:  In a tertiary care hospital, this cross-sectional study was carried out between January 2022 and June 2022. The study enrolled 60 male first-year MBBS students between the ages of 18 and 22. out of 60 students 30 were athletes and 30 were non-athletes. Their height, weight, body mass index, basal heart rate, and physical fitness index using the Harvard Step test with Indian height adjustment were measured. Chi-square test and t-test were used for the statistical analysis, and a p-value < 0.05 was regarded as significant. Result:  Athletes had an average age of 20.84±1.43 years, whereas nonathletes had an average age of 20.86±1.74 years. Athletes had average BMI of 20.62±2.04kg/m2, whereas non-athletes had an average BMI of 22.32±2.86 kg/m2. Athletes had lower resting and post-exercise recovery pulse rates than non-athletes, which was statistically significant. The Physical Fitness Index (PFI) was found to be significantly higher in athletes than in non-athletes. Thus, it was found that athletes had greater physical fitness than non-athletes. Conclusion:  The study found that students who participated in regular physical activity had higher levels of fitness than inactive students.

78. Estimation of Serum Levels of C – Reactive Protein in Pyogenic Pediatric Meningitis: A Cross-Sectional Study
Pankaj Singh Chauhan, Nandni Dixit, Priykant Tomar, Ankush Jain
Abstract
Background and Objectives: Bacterial meningitis represents a significant public health concern on a global scale. C-reactive protein (CRP) has proven to be a valuable diagnostic tool in distinguishing between bacterial and aseptic meningitis, particularly in cases where bacterial culture of the blood and spinal fluid yields negative results. The aim of this study was to assess and estimate the serum levels of CRP among pediatric patients diagnosed with meningitis of bacterial origin. Materials & Methods: The observational cross-sectional study was conducted at a tertiary care medical teaching hospital located in central India. Patients who met the predefined inclusion criteria were carefully selected for participation in the study after obtaining their informed consent. Collection of cerebrospinal fluid samples followed standard guidelines. Phenotypic identification of bacteria, along with antimicrobial susceptibility testing, was carried out using automated techniques. The quantitative estimation of CRP was performed through a solid-phase, sandwich-format immunometric assay employing a gold antibody conjugate. Throughout the study, human rights, welfare, and autonomy of the participants were safeguarded in accordance with national ethical guidelines. Results: Among the 170 cases included in the study, the median age was found to be 3 years. The most frequently isolated bacterium was Escherichia coli, followed by Klebsiella pneumoniae. Out of the total participants, 53 individuals (31.17%) exhibited elevated levels of serum CRP. Furthermore, it was observed that serum CRP levels were higher in cases associated with Gram-negative bacterial etiology. On average, cases attributed to Gram-negative bacteria demonstrated higher mean serum CRP levels. Conclusion: Serum CRP levels were notably higher in cases of meningitis caused by Gram-negative bacteria.

79. Serial Serum Albumin Levels as A Prognostic Marker in Critically Ill Patients
Manish Kumar Gurjar, Vijendra Sharma, Ravindra Kumar Tiwari, Pinki Tak, Rajesh Jain
Abstract
Introduction: Albumin’s the most plentiful protein in human plasma. As an index of patients’ nutritional and metabolic status, it has been employed by a number of investigators. Aim: To estimate serum albumin concentrations in critically ill patients after they have been admitted to Intensive Care Unit and assess the role of continuous SA measurement as an independent diagnostic indicator. Methods: A cross-sectional observational study on 100 critically ill Patients admitted to ICU for at least 5 days or more at tertiary care hospital, Ajmer from September 2021 to September 2022. Patient with chronic liver or kidney disease, nephritic syndrome, protein-losing enteropathy and chronic malnutrition were excluded from study. Results: Out of 100 patients 62% were discharged (survivors) and 38% died (non-survivors). Using the logistic regression equation derived from our study, it was found that it correctly identified 83.87 % (Sensitivity) patients to survive and 78.95 % (Specificity) patients to die. Overall, it was 82% accurate (accuracy) in the prediction of the outcome of the patient. Conclusion: One major factor influencing the outcome of severely ill patients dependent on mechanical ventilation is likely to be a serial estimation of serum albumine levels.

80. Clinical Investigation of Large Ovarian Cysts with Various Presentations
Asmita J. Solanki, Rajeshkumar Majithiya, Bharatkumar Chaudhari, Jayshriben R Majithiya
Abstract
Background and Aim: In earlier case reports, the laparoscopic therapy of large ovarian cysts was discussed. Despite this, laparotomy is the preferred treatment for most individuals with large ovarian cysts. As a result, the current study’s goals were to identify the varied presentations of big ovarian tumours and to tailor surgical intervention to each appearance. Material and Methods: This hospital-based prospective interventional study was conducted by the departments of general surgery and obstetrics and gynaecology at an Indian tertiary care facility. All women who visited the Obstetrics and Gynaecology Department with a history of an abdominal lump and who had an examination and an ultrasound that ruled out an ovarian cyst were included in the study population. In all, 40 participants were enrolled in the study. Surgical intervention was performed on the study subjects in accordance with the USG and histopathology reports. To check for recurrence, all of the operated study participants underwent two years of follow-up. Results: About 75% of cysts were 10 to 20 cm in size, whereas 25% were 20 to 33 cm in size. 37.5% of them were simple. About 30% of cases had tortion, 7.5% had cyst rupture, and 12.5% had infection. Malignant cysts made for about 12.5%. Laparotomies were performed in all instances, and cystectomy was the procedure of choice. There was no sign of a cyst recurring. Conclusion: Gynaecologists face a clinical problem when treating large ovarian cysts. All of these patients must undergo surgery because quite a few of them could result in problems. The treatment for malignant ovarian cysts must include chemotherapy.

81. A Comparative Study of Foetal Trans Cerebellar Diameter and Other Established Sonographic Parameters for Estimation of Gestational Age in Second and Third Trimester at Tertiary Care Hospital
Priya Goyal, Ruchi Saxena, Medhamani Saxena, Vishakha Karwasara
Abstract
Introduction: The gestational age is of importance in management of pregnancy and planning of appropriate therapy and intervention. TCD appears to be the most reliable age independent biometric parameter in the evaluation of true gestational age. We have tried to compare relationship between TCD and other foetal parameters (BPD, HC, AC, FL) between 15 to 40 weeks of gestation for estimation of gestational age. Aim: To study accuracy of trans cerebellar diameter as a reliable foetal parameter on USG to assess gestational age at second and third trimester. Method: Comparative cross sectional study conducted in Department of obstetrics and Gynecology, Sardar Patel Medical College &AGH, Bikaner (Rajasthan) on 200 antenatal pregnant women between 15 weeks to 40 weeks of gestation from May 2021 to 2022 who subjected to USG for estimation of GA by FL, BPD, AC and TCD. Result: The foetal TCD showed a significant linear correlation with GA, BPD, HC, AC and FL (P<0.001). The correlation was the highest with GA followed by FL, HC, BPD and was the least with AC (0.8937). Conclusion: Foetal trans cerebellar diameter shows a good correlation with gestational age.

82. Evaluation of Electrolytes and Electrocardiogram Changes in Chronic Renal Failure Pre and Post Dialysis: A Comparative Study
Deepa Thadani, Gaurav Kansara, Gaurang Anandpara
Abstract
Background: Patients with chronic kidney disease (CKD) can remove harmful metabolic waste products from their blood in an artificial manner using dialysis. The death rate for dialysis patients remains high despite significant advancements in technology and pharmaceutical care. Nine to thirteen percent of hemodialysate patients in India pass away within a year.  Patients with CKD commonly experience abnormal electrocardiographic (ECG) results. Objectives: Reviewing the electrolyte changes following the dialysis process and figuring out how frequently different ECG abnormalities occur in CKD patients were the goals of the study. Materials and Methods: This cross sectional study was conducted 214 patients with chronic kidney disease on Hemodialysis. All patients underwent 12 lead electrocardiograms (ECG). Blood samples for Serum Electrolytes were collected before and after Hemodialysis, and compared using Z test. p value less than 0.05 was considered as significant. Results: Following hemodialysis, serum sodium increased but serum potassium and chloride decreased.  In 21.0% and 9.4% of patients, respectively, left ventricular hypertrophy and atrial fibrillation were noted. Conclusion: Prognostic relevance of blood potassium, sodium, and chloride anomalies in CKD patients receiving hemodialysis. To check for cardiovascular illness, an ECG should be performed on every hospitalised CKD patient.

83. Elevated First Trimester C-Reactive Protein as Predictor of Gestational Diabetes in Telangana Population
Jayaprada Thigula
Abstract
Background: C-REACTIVE PROTEIN levels are a significant biomarker of post-inflammatory conditions associated with various clinical conditions, including type II TYPE-II DIABETICS. Hence, C-REACTIVE PROTEIN elevation in gestational TYPE-II DIABETICS patients also predicts CVD and other vascular conditions. Method: 85 pregnant women with gestational diabetes in the first trimester and the same number of normal pregnant women in the controlled group were compared. Blood sugar (fasting and postprandial) and C-reactive protein, BODY MASS INDEX, age, and period of gestation (weeks) were compared in both groups. Results: BODY MASS INDEX of the gestational TYPE-II DIABETICS group was 26.03 (±3.38), 22.82 (±2.16) in the controlled group, t test was 7.37 and p<0.001. Apart from blood glucose parameters, C-REACTIVE PROTEIN levels were elevated in gestational TYPE-II DIABETICS patients, and p<0.01 (p values were highly significant). Conclusion: In the present, C-REACTIVE PROTEIN values were higher in gestational diabetes due to inflammation and oxidative stress. These findings are important for obstetricians and gynaecologists to predict the risk factors of pregnancy and the foetus and treat efficiently to avoid morbidity, and mortality in such patients.

84. Etiology and Clinical Profile of Pleural Effusion in A Tertiary Care Center of India: A Descriptive Study
Bhogilal Vitthaldas Patel, Urvesh Arvindbhai Mistry, Ketankumar Ramesh Bhai Jansari, Rajesh Solanki, Vinubhai Chhaganlal Singel, Pooja Pragnesh Patel
Abstract
Background and Aim: An abnormal or excessive fluid buildup in the pleural space is known as a pleural effusion. The aetiology of pleural effusions presents a challenge to the clinician because it varies based on the area and population being studied. The purpose of this study was to determine the aetiology and clinical characteristics of individuals who presented to tertiary care teaching hospitals with pleural effusion. Material and Methods: The Department of Pulmonary Medicine at tertiary care teaching hospitals in India conducted this study. 100 patients in total were enrolled in the trial. A full history and the demographic information gathered were retrieved. The results of tests like a complete hemogram, random blood sugar, renal function tests, serum proteins, chest x-rays, and pleural fluid analyses as well as tests like abdominal and chest ultrasound, echocardiograms, computed tomography scans of the chest, fine needle aspiration cytology, and pleural biopsy reports (if performed) were gathered. Results: Dyspnea (73%) was the most prevalent presenting symptom, followed by cough (57%), fever (51%), and chest discomfort (46%). In 36% and 42% of the patients, respectively, weight loss and appetite loss were present. Tuberculosis was the most common cause of exudative pleural effusion in 61% of patients. Pneumonia in 6% cases, Malignancy in 5% cases, Empyema  in 4% cases and Rheumatic arthritis, Pancreatitis and Uremia 1% of each patients. The most frequent etiology of Transudative pleural effusion was CCF in 6%, Cirrhosis of liver in 3%, chronic renal failure in 3%, Hypothyroidism in 2% and Hypoalbuminemia in 1% patients. Conclusion: In everyday clinical practise in India, pleural effusion is a prevalent clinical phenomenon. Exudative effusions are frequently brought on by tuberculosis, parapneumonic effusions, and cancer. When pleural fluid cytology results are negative, pleural biopsy should be performed.

85. Treatment Modalities of Gingival Hyper Pigmentation
Vasudhara Rathwa, Anil Kumar Rathva, Ashit Bharwani
Abstract
Oral pigmentation is commonly observed in people with melanin dominance, in particular.  The term “gingival pigmentation” refers to the gingiva’s coloring as a result of lesions and diseases linked to a variety of extrinsic and intrinsic causes. The causes of gingival pigmentation are complex and multifactorial. The treatment of gingival pigmentation has become more important over time because to the rising demand for aesthetics. Despite the fact that gingival pigmentation is not a pathological issue, patients frequently want aesthetic surgery. The gingiva’s hue can be consistent, and its look can change significantly according on the location, depth, and pigmentation level.
Following areas of the mouth exhibit oral pigmentation:
Lower vermillion border (the exposed pink or the reddish marginnof a lip)
Tongue
Oral mucosa
Gingiva
Palate
Melanin hyperpigmentation has been treated with de-pigmentation techniques like scalpel surgery, gingivectomy with free gingival autografting, electro surgery, cryosurgery, chemical agents like 90% phenol and 95% alcohol, abrasion with diamond bur, Nd: YAG laser, and CO2 laser. The instances that follow describe several surgical de-pigmentation methods, including electrocautery, carbide bur abrasive technique, and knife surgery. When it comes to cosmetic results, a conventional scalpel produced better results than any other.

86. Assessment and Comparison of Effect of Combination of (1%) Chloroprocaine and (0.5%) Hyperbaric Bupivacaine with Fentanyl and (1%) Chloroprocaine and (0.5%) Isobaric Ropivacaine with Fentanyl in LSCS
Aviral Srivastava, Yeshli Thakur, Jaya Sinha, Sadhana Sanwatsarkar
Abstract
Introduction: Sub arachnoid block (SAB) provides a rapid and reliable anaesthetic technique for caesarean section. The principal side effects of SAB are a reduction in maternal blood pressure and hence uteroplacental blood flow; inadequate effect leading to maternal pain and conversion to general anaesthesia. Decreasing dose of intrathecal local anaesthetic (LA) improves cardiovascular stability. Addition of opioid allows safe reduction of LA dose with equal success and less severe side effects.1 The present study was done to evaluate combination of (1%) Chloroprocaine and (0.5%) Bupivacaine with Fentanyl and (1%) Chloroprocaine and (0.5%) Ropivacaine with Fentanyl in LSCS along with assessment of intra-operative hemodynamics, onset and duration of blockade, Apgar score of newborn, and various adverse effects. Materials and Methods: This randomized controlled trial study was carried out in the Department of Anaesthesia, Sri Aurobindo Medical College and PG Institute, Indore, among 100 consented patients allocated into 2 groups of 50 each:  Group CB [Chloroprocaine (1%) 1 ml+Hyperbaric Bupivacaine (0.5%) 1.5ml+20 mcg Fentanyl] and Group CR [Chloroprocaine (1%) 1 ml+Isobaric Ropivacaine (0.5%) 1.5ml+20 mcg Fentanyl] posted for LSCS using a proforma, pre-anaesthetic evaluation, investigations followed by induction of anaesthesia and administration of test drug. Data was collected, compiled and analysed using R Studio (Open source analytical tool). Result: Mean age, weight and height of the study participants in Group CR and CB was 30.68±3.717 years, 59.18±6.249 kg, 159.32±5.219 cm and 31.08±3.741 years, 58.98±5.334 kg and 158.98±5.752 cm respectively. In terms of onset of sensory block, achievement of peak sensory level, onset of motor block and achievement of max motor blockade, the duration in CR was significantly shorter compared to CB (p-value<0.05). Similarly, duration of motor and sensory block was also less in CR and was statistically significant (p-value<0.05). At all the time intervals, the difference between the mean HR, RR, MAP and VAS of the two groups was found to be statistically non-significant (P˃0.05) i.e. these parameters did not vary with the groups they belonged to. Majority patients in both the groups (CR=54%; CB=70%) did not require a dose of analgesia (p-value>0.05). Apgar score of the newborn did not vary according to the group and the association was found insginficant (p-value=>0.05). However, association of the groups with maximum level of sensory analgesia was highly significant (p-value=0.000).More patients (32%) in group CB had side effects such as bradycardia, hypotension, nausea & vomiting, shivering etc. as compared to group CR (18%). Conclusion: Intrathecal combination of (1%) Chloroprocaine and isobaric Ropivacaine (0.5%) with fentanyl provides clinically effective anaesthesia in LSCS with adequate sensory and post operative analgesia. It causes shorter duration of motor analgesia without causing change in hemodynamic parameters which helps in early ambulation and improved patient satisfaction, addition of chloroprocaine causes faster onset, reduce dosage and better hemodynamic stability with no adverse effects.

87. Comparison Between Guys Stone Score and S.T.O.N.E Score in Patients Undergoing Percutaneous Nephrolithotomy
P.R. Saju, Suresh Ashik
Abstract
Background: This study was conducted to estimate the stone-free rates and complication rates in patients with different grades of Guy’s stone score and S.T.O.N.E. nephrolithometry scores undergoing percutaneous nephrolithotomy, study the correlation between Guy’s stone score and S.T.O.N.E. score and operative times, length of hospital stay and other selected outcomes, and compare the area under the curve for Guy’s stone score and S.T.O.N.E. score for post-percutaneous nephrolithotomy outcomes. Methods: This was a hospital-based prospective observational study conducted among 164 patients who underwent Percutaneous Nephrolithotomy (PCNL) in the Department of Urology, Government Medical College, Thiruvananthapuram, over a period of one year, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean Guys stone score in the study population was 1.75 ± 0.95, whereas the mean S.T.O.N.E score was 7.45 ± 1.22. The overall complication rate in our study was 25.61%. The complication rates had a significant correlation with the Guys stone score (p<0.0001) as well as with the S.T.O.N.E. score (p<0.0001). There was a significant correlation between the Guys stone score and stone free rate (p < 0.0001) as well as between the S.T.O.N.E. score and stone free rate (p < 0.0001). Conclusion: Both GSS and STONE scores are equally effective in predicting the success rate as well as complication rates associated with PCNL. Operative time and length of hospital stay also correlate with both scores studied. However, the fluoroscopy time does not correlate with either scoring systems used.

88. Percutaneous Catheter Drainage as Treatment of Necrotizing Pancreatitis
Natasha Nuna, Vikas Chalotra
Abstract
Objective: The purpose of this study was to evaluate the role of percutaneous catheter drainage (PCD) as treatment of necrotizing pancreatitis. Results: There were 23 male and 7 female patients with mean age of 42 (range 25 – 65 years). 14 (46%) were cured with percutaneous catheter drainage. 22 (73%) patients showed significant reversal of multiorgan failure (P value < 0.05 in pre PCD and post PCD insertion serum creatinine, need of ventilation and CRP values). 3 deaths and 10% PCD related complications were observed in this study. Thus Percutaneous catheter drainage can act as primary treatment of necrotizing pancreatitis or to stabilize the critically ill patients to withstand the surgery. Conclusion: Percutaneous Catheter Drainage is a safe and important treatment option that can be lifesaving and effective whether used alone or in adjunct to surgery and decreases the treatment cost burden to the patients.

89. Study on Co-Relation between Serum Vitamin D Level and Essential Hypertension
Shiv Purari, R. D. Singh, Sanjay Kumar, K. Kishore
Abstract
Vitamin D insufficiency affects almost 50% of the population worldwide. This pandemic of hypovitaminosis D can mainly be attributed to lifestyle and environmental factors that reduce exposure to sunlight, which is required for ultraviolet-B (UVB)-induced vitamin D production in the skin. Importantly, conditions associated with reduced UVB- induced vitamin D production, such as high latitude, industrialization, and dark skin, have all been associated with increased blood pressure values. The aim of this study is to study the level of vitamin- D in patients with essential hypertension, to identify whether any association exists between age, sex, body mass index, and, to study Diabetes, and target organ damage and the presence of decreased level of Vitamin-D.

90. A Prospective Study on Road Traffic Accidents and Their Pattern of Injury Admitted to Indira Gandhi institute of Medical Sciences Patna
Ritesh Kumar Singh, Saroj Kumar Ranjan, Nawal Kumar Singh, Sanjeev Kumar
Abstract
Background: Road traffic accidents (RTA) have become a major public health issue of the world particularly in the developing nations. It is the price we pay for the rapid urbanization, modernization and economic development. Objectives: To study the demographic profile of Road traffic accidents victims. To study pattern of injury in victims of road traffic accidents. Material and Methods: This study conducted at Indira Gandhi Institute of Medical Sciences Patna Study duration of Two years. The study group comprised of all the road traffic accident cases reporting to IGIMS causality in the above period. All patients were screened for the inclusion criteria and all those who met these inclusion criteria, were enrolled in the study after obtaining their due informed consent to take part in the study. Conclusion: Most of the victims are due to rural trauma with marked male preponderance, 75% are of age 20–49 years most productive for their family and the country. High risk driving, not following speed limits common factors responsible for these RTAs. Stricter traffic law enforcement is a need in rural areas. If RTAs are considered an Epidemic of modern times, then prevention is its vaccine.

91. Study of Histopathological Findings in Non-Infectious Erythematous Papulosquamous Lesions of the Skin
Talari Radhamadhavi, Hymavathi Bathina
Abstract
Background: Erythematous papulosquamous lesions are known to be of high frequency. It is reasonable to consider them in a group because all of them show similar morphological characteristics. Specific histopathological diagnosis is important to distinguish these lesions as the treatment and prognosis varies significantly. Aims: To study the histopathological findings in noninfectious erythematous, papulosquamous lesions of the skin. Materials and Methods: A cross sectional descriptive study conducted from August 2014 to July 2016. Biopsy of clinically diagnosed/suspected cases of noninfectious erythematous papulosquamous skin diseases were performed in the Department of Dermatology and were sent to the Department of Pathology for histopathological examination. Results: A total of 100 cases were studied. Lichen planus was the most common disease (50%) followed by Psoriasis (30%), Pityriasis lichenoides (8%), Pityriasis rubra pilaris (4%), Pityriasis rosea (3%), Parapsoriasis (2%), Lichen striatus (2%), Lichen nitidus (1%). Lesions occurred in all age groups but were common in young and middle aged individuals. Males were commonly affected except in Lichen planus and Pityriasis rubra pilaris. 25 cases had 2 or more differential diagnosis clinically and definitive diagnosis was given by histopathological examination. Conclusion: The contribution of histopathology to the final diagnosis was significant. Skin biopsy is thus valuable in daily dermatology practice.

92. Correlation between Clinical and Histopathological Diagnosis in Noninfectious Erythematous Papulosquamous Lesions of the Skin at a Tertiary Care Hospital
Talari Radhamadhavi, Hymavathi Bathina
Abstract
Background: Papulosquamous diseases are characterized by scaly papules and plaques with similar clinical features which causes diagnostic confusion. Aim: The aim of the study was to correlate clinical diagnosis with histopathological diagnosis in various noninfectious erythematous papulosquamous skin lesions. Method: Skin biopsy specimens clinically diagnosed/suspected non-infectious erythematous papulosquamous skin diseases were studied in the Department of Pathology. Samples were subjected to hematoxylin and eosin staining. Results: Out of 100 samples studied, Lichen planus consists 50 cases is the commonest group, followed by Psoriasis of 30 cases, Pityriasis lichenoides of 8 cases, Pityriasis rubra pilaris of 4 cases, Pityriasis rosea of 3 cases, Parapsoriasis of 2 cases, Lichen striatus of 2 cases, and Lichen nitidus of one case respectively. The predominant histopathological finding in lichen planus was band like infiltrate in the dermoepidermal junction and the predominant histopathological finding in psoriasis is acanthosis. The study involved 50 cases of Lichen planus, in which 46 cases showed positive clinicopathological correlation. The study involved 30 cases of Psoriasis, in which 24 cases showed positive clinicopathological correlation. There is 100% clinicopathological correlation in Pityriaisis lichenoides, Pityriasis rubra pilaris, Pityriasis rosea, Parapsoriasis, Lichen striatus and Lichen nitidus. 90% of clinically diagnosed papulosquamous lesions were correlated with histopathological diagnosis. These findings along with other specific findings and clinical correlation were used to give a conclusive diagnosis. Conclusion: Lichen planus was the commonest papulosquamous lesion. Good clinicopathological correlation is very much necessary for diagnosis. Hence a combination of proper clinical observation and histopathological study will give a conclusive diagnosis.

93. A Brief Cognitive Assessment of Patients with Schizophrenia and its Correlation with Disease Severity and Disability: A Tertiary Hospital Based Cross Sectional Study
Siddharam Jambaladinni, Navendu Handa, Arun V Gadad, P Sevanth
Abstract
Background: The present study was conducted to assess the cognitive functions in patients with schizophrenia and to study the relationship between cognition and disease severity and disability. Methodology: A cross sectional study conducted by including 50 patients diagnosed with Schizophrenia. Had used PANSS, DSST, Trail making test, Category fluency test and IDEAS scale to assess the patients. Results: Average age was 38.5±7.8 years with male predominance. On analysing the PANSS, 47 (94%) of the study population were mildly ill and two were moderately ill and one was severely ill. Out of 50, 6 patients could not complete the DSST analysis, 15 (30%) had the score between 21 to 30, 11 (22%) of them were scored between 21 to 30, 10 (20%) had the score of 10 or less than that. On analysing the IDEAS, 24 (48%) of them had moderate quantified disability, 16 (32%) with mild and 10 (20%) with severe disability. Association between PANSS with trail making test was moderately significant (0.073), digital symbol test (0.08) and the IDEAS score (0.06) but the Category fluency test had the significant association with p value of <0.01. Conclusion: There was significant positive association of PANSS score had with category fluency test with the p value of <0.01 but there was moderate association observed with trail making test, digital symbol test and IDEAS score. Although the difference was XIV clinically significant, only moderate significance on statistical analysis was proved. This indicates that category fluency test could obtain us the better assessment compared to other but, not negligible.

94. Maternal and Fetal Outcome in Early Versus Late Detected Asymptomatic Bacteriuria During Pregnancy in Tertiary Care Hospital
Uzmaparveen Qureshi, Mohammed Ebrahim Malek, Pooja P Patel, Nikulkumar R Thakkar
Abstract
Introduction:  Untreated asymptomatic bacteriuria (ASB) during pregnancy may lead to acute pyelonephritis, Pregnancy induced hypertension, preterm labour, low birth weight foetus, etc. These obstetric problems are less common when they receive adequate and prompt treatment. The aim of the current study was to compare the obstetric outcomes following therapy in early versus late detected ASB. Materials & Methods: A prospective cohort study was conducted among 250 pregnant women at a tertiary care hospital of Gujarat. They were screened for asymptomatic bacteriuria by urine culture and sensitivity. They were grouped into asymptomatic bacteriuria negative and early detected culture positive (<20 week) and late detected culture positive groups (32 to 34 week). They were followed for obstetric outcome. Results: Prevalence rate of ASB is 16.9%. As compared to ASB negative groups, the likelihood of Urinary tract infection, pregnancy induced hypertension, preterm labour, Low birth weight, intra uterine growth retardation was considerably greater in the LD and ED group. Conclusion: Early detection and treatment of ASB during pregnancy at less than 20 weeks prevents complications like PIH, IUGR, PTL, PPROM and LBW. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy new-born.

95. Burden of Organochlorine Pesticides and Their Association with Occurrence of Lymphomas
Mohammed Sharique, Sunil Gupta, Vijay Laxmi Gupta, Neha Sharma
Abstract
Background: Unheeding use of these chemical pesticides in farming, animal husbandry, factories and public health operations has emerged as a long-term irreversible environmental damage, throughout the globe. Apart from causing acute and chronic toxicity, organochlorine pesticides are also known to increase the risk of carcinogenesis by acting as carcinogens themselves and also by suppressing the immune system which has the ability to destroy the process of carcinogenesis in the body. Material & Methods: A total of 135 study subjects were recruited, out of them 55 lymphoma patients were recruited into this case-control study and 80 patients were taken as control. Organochlorine pesticides were extracted and separated from the samples by liquid partition and column chromatography so they may be analyzed by gas chromatograph.. The qualitative and quantitative estimations of organochlorine pesticides were carried out by gas chromatograph. Results: organochlorine pesticide levels in control subjects were 0.3456 ± 0.017mg/L and in Lymphoma patients were 0.4874 ± 0.069 mg/L (P value > 0.05). The pesticide burden in observed NHL patients was 0.5253 ± 0.103mg/L and followed by a total pesticide burden in HL patients was observed at 0.4482 ± 0.092mg/L. This difference between lymphoma and mean pesticide levels was not found statistically significant (P value > 0.05). Conclusion: Training and extension programs by the Ministry of Agriculture for safe pesticide usage should be improved and expanded. Occupational exposures can be reduced through changes in application methodology.

96. Auditory Reaction Time and Visual Reaction Time in Asymptomatic HIV
Sharda Sangale, Mrunal Phatak
Abstract
Background: Auditory reaction time and visual reaction time were measured in asymptomatic HIV positive persons and corresponding controls to detect impaired central information processing mechanisms in the early stages of HIV. Objective: To perform auditory reaction time and visual reaction time in asymptomatic HIV positive persons and corresponding controls. Material and Methods: In this study,100 participants were selected in the age group 25-45 years. In study group, 50 participants were included, who were HIV positive and asymptomatic (CD4 count > 350 cells/mm3) and were not on Anti Retro Viral Treatment (ART). In control group 50 healthy age matched HIV negative individuals were included. We measured auditory reaction time (AR Time) using low frequency and high frequency sounds and visual reaction time (VR Time) using red and green lights. Results: Study of auditory reaction time and visual reaction time in asymptomatic HIV revealed that, auditory reaction time for high frequency (ART HF), auditory reaction time for low frequency (ART LF), visual reaction time for red light (VR Time Red) and visual reaction time for green light (VR Time Green) were significantly prolonged in study group than control group. Conclusion: Study of auditory reaction time and visual reaction time in asymptomatic HIV positive persons suggests impaired central information processing mechanisms in the early stages of HIV. Hence, auditory reaction time and visual reaction time can be important to detect impaired central information processing mechanisms in the early stages of HIV.

97. A Study of Clinical Profile and Outcome in Children with Foreign Body Ingestion at a Tertiary Care Centre
Sreelatha Martha, Manchireddy Madhuri, Thota Usha Rani, Cherukuri Nirmala
Abstract
Background: The presence of foreign bodies in the airway and food passages may be difficult to diagnose and often overlooked, as it mimics many other clinical entities. Diagnostic delay may cause an increase in mortality and morbidity. Methodology: This cross-sectional study was taken up to analyze the clinical profile and outcome in children with foreign body ingestion. All children in the age group of 1 month to 12 years admitted to Niloufer Hospital, Hyderabad during the period from January 2019 to December 2019 with either a history of FB ingestion or clinical features suggestive of FB ingestion were included in the study. Demographic data like age, gender, clinical features (C/F) duration of illness, and type of foreign body were noted. Chest X-ray or X-ray abdomen was done for all cases. All children fulfilling the inclusion criteria were observed either for the natural passage of foreign bodies or subjected to procedural removal by endoscopy/laparotomy based on the need on a case-to-case basis. Procedure findings like the type and location of the foreign body were noted. Results: Of the total 68 children studied 72% of cases were below the age of 3 years. 54.41% of cases were males and 45.58% were females. Common presenting symptoms were vomiting (39.70%) followed by cough (26.47%) and pain abdomen (13.23%).17.64% of cases were presented with no symptoms other than the history of some foreign body ingestion. Among all the cases studied,95.5 % of cases were recovered without any complications. The outcome was good with no mortality. Conclusions: Foreign body ingestion occurring in children is mostly accidental and associated with significant morbidity. The common age group is infants and toddlers. A strong suspicion among them with a presentation of sudden onset of symptoms will lead to early diagnosis and early intervention if needed, will lead to a better outcome.

98. Etiology and Mode of Presentation of Chronic Liver Diseases in South Rajasthan: A Single Center Study
Pankaj Gupta
Abstract
Objective: This study is conducted to delineate the etiology and clinical profile of chronic liver disease of 400 patients. Method: This is a prospective, hospital based study conducted on a sample size of 400. Every case was clinically assessed by a physician before enrollment. The questionnaire administration, data procurement was done by trained interviewers, under supervision of clinicians. All patients provided written informed consent to participate in this observational study. Result: Out of the total sample size, 33.9% presented with decompensated cirrhosis. Alcoholism (34.3% )was the commonest cause of cirrhosis while Hepatitis B (33.3%) was predominant cause of chronic liver disease in general and non-cirrhotic chronic liver disease (40.8% ). Hepatitis B (46.8%) was the commonest cause of hepatocellular Cancer.11.7% had diabetes. Observations of our study will help guide a contextually relevant liver care in India. Conclusion: This study provides a much needed and useful sketch of the clinical patterns, etiologies and overall trends in access as well as relevant care utilization of CLD in India as well as could serve as a framework for similar endeavor in other developing countries as well.

99. A Qualitative Study of Blended Learning in Indian Medical Education System Conducted in Lucknow
Hemachandran Jeldi, Samreen Farooqui, Sara Siddiqui, Asad Khalid
Abstract
Background: Blended education methodology is currently being used by several academic medical institutions to improve education. To execute blended learning seamlessly and fulfil its goals, we identified its strengths, weaknesses, opportunities, and threats (SWOT) from key users’ perspectives. Methods: Integral University, IIMSR, Lucknow, India did a qualitative study in 2021 with 23 medical educator interviews and document analysis. SWOT analysis was applied. Results: The encouragement of educator-student interactions, students’ learning needs and self-learning, and problem-solving skills were the greatest strengths. University administrator’ cooperation, congruence with the national health education reform strategy, and access to the university’s common infrastructure helped implement it. However, culture readiness and technical, institutional and infrastructure limitations hampered this effort. Its maintenance was threatened by the paucity of an autonomous e-learning centre for improved planning techniques and services providing support- technical and in person, the lack of effective evaluation and surveillance of virtual activities and the absence of user privileges. Conclusions: This study suggests that blended learning can sometimes be a double-edged sword, requiring a thorough examination. Such interventions should acknowledge weaknesses and risks while retaining strengths and opportunities. Thus, actively considering SWOT components might assist apply the proper techniques to maximize benefits.

100. Hysteroscopy as Evaluating Tool in Women with AUB a Prospective Study
Dolly Ramnani, Deepti Sharma
Abstract
Objectives: 1)To study clinical profile of women presenting with abnormal uterine bleeding  who underwent hysteroscopy for evaluation 2) To correlate its observations with ultrasonographic findings and histopathology 3) To assess sensitivity and specificity of hysteroscopy to detect various intrauterine pathology. Methods: This was a prospective study conducted at the Department of Obstetrics and Gynaecology, Sir Sayajirao General Hospital, Vadodara over a period of 1 year. A total of 31 women were enrolled. Study was conducted over a period of one year from 16th April, 2009 to 15th April, 2010. Complete biodata and clinical history were elicited. Women were thoroughly examined and investigations were carried out. Hysteroscopy with 5mm, 30° hysteroscope was used. Histopathological confirmation was done. Women were followed up after six weeks and at six months. Results: The specificity of hysteroscopy was 77.77%, its positive predictive value was 84.6%, its negative predictive value was 77.77% and its overall efficacy was 81.81% with abnormality detection rate of 48.78% for AUB. Conclusion: Hysteroscopy has become the tool of choice for the evaluation of the endometrial cavity, including for assessment of abnormal uterine bleeding. It is a reliable method for evaluation of AUB, especially in benign lesions like endometrial polyp and submucous myoma, as well as in diagnosing endometrial cancer or hyperplasia. Thus, it can be used as first line diagnostic method in these abnormalities with dual advantage of possibility of operative interventions also.

101. Study of Burden Among Caregivers of Patients with Psychiatric Disorders
Pranvi Gupta, Manmeet Singh, Raghav Arora, Parul Gupta
Abstract
Introduction: The major issues faced in India regarding mental health are lack of mental health workforce, financial aid, stigma and caregiver burden. Family members are the primary caregivers of the persons with mental illnesses in most of the non-western world. This demand can cause significant stress for caregiver. This study tries to investigate the burden of caregiver of psychiatric patients. Aims and Objectives: The objectives of the study were to assess the level of burden on caregivers and associate it with various demographic variables. Materials and methods: It is a cross – sectional study of 100 patients. Socio – demographic profile and Zarit Burden Interview were used to assess the data. Results: The research was conducted with the enrolment of 123 candidates with response rate of 81.30%. Among these, 13 did not give consent and 10 dropped out. This resulted in a total sample of 100 caregivers of patients. Maximum belonged to the age group of 30-40 years. The mean age was 36.32± 3.62 years. Majority of the caregivers were FEMALES (62%) and 38 % were males. About 83% were married followed by 17% who were single or separated. Among relationship of caregivers with the patient, maximum were spouses (43%); husbands (35%) and wives (8%) of the patients. The maximum caregivers were those who had average duration of care giving less than 5 years i.e., 62%. 38% caregivers had spent greater than 5 years.

102. Microscopic Approach versus Endoscopic Approach for Type 1 Tympanoplasty: Our Experience
Kinnari Rathod, Shweta Mittal, Payal R. Vadher
Abstract
Introduction: chronic otitis media is common entity for which tympanoplasty is done. The aid of a microscope or an endoscope is necessary to carry out the tympanoplasty. In the present work, we seek to compare endoscopic and microscopic approach for type-1 tympanoplasty for different aspects. Material and Methods: This is an analytical study in which data was collected from 50 patients who underwent tympanoplasty in our department in our respective hospital July 2022 to May 2023. Patients above 15 years of age with inactive chronic otitis media tubotympanic type operated for type-1 tympanoplasty. Result: Equivalent number of cases underwent microscopic and endoscopic type-1 tympanolasty. As far as graft taken up is concern both approaches had similar surgical outcome. Hearing gain was almost similar. Average hearing gain in microscopic tympanoplasty group is 11.0±3.14 dB and in endoscopic tympanoplasty group is 11.30±2.97 dB. Conclusion: Both microscopic and endoscopic methods are outstanding for type-1 tympanoplasty with merits and demerits of each method. A meticulous selection of patient will be beneficial for endoscopic approach.

103. Association of Leucocyte Count, Troponin I and Serum PRL Level in Pregnants as Predictors of Cardiomyopathy with Hypertensive Disorders
Sridevi HS, Srikar GB, Sahana Patil
Abstract
Introduction: Hypertension and proteinuria after the 20th week of pregnancy characterize the complex illness known as preeclampsia. Activation of leukocytes is implicated, which is thought to cause inflammation and vascular injury. Cytokines released by activated leukocytes cause damage to the endothelium. Activation of neutrophils has been explicitly linked to the increased inflammatory response observed in preeclampsia. Aims and Objectives: The study aims to assess leukocyte count, Troponin I levels, and serum PRL levels in pregnant women with hypertensive diseases. Methods: In a hospital setting, a prospective cohort study was carried out with the participation of 265 hypertension patients. The purpose of the study was to collect blood samples from preeclampsia and eclampsia patients in order to evaluate the levels of biomarkers. The patients were then monitored for a period of time equal to five months after delivery to ascertain whether or not they had acquired peripartum cardiomyopathy (PPCM). Results: The main findings of the study indicate that individuals with PPCM had significantly higher mean total leucocyte counts compared to those without PPCM. The average serum prolactin levels were also significantly elevated in the PPCM group. These results suggest a potential association between higher leucocyte counts, elevated serum prolactin levels, and the presence of PPCM. Additionally, the study found that Troponin I levels differed significantly between the two groups, indicating its potential as a biomarker for distinguishing individuals with PPCM. Conclusion: The study has concluded that the outcomes of this study indicate that markers such as the total leucocyte count, serum prolactin, and Troponin I can be considered early predictors of PPCM.

104. A Study of Oral Mucosal Lesions
Palak Patel, Alpesh V. Patel, Nehal R. Patel, Foram Parikh, Hardikkumar Medtiya, Rutvij Mehta, Gaurang Rajai
Abstract
Background: The oral cavity has been looked upon as a ‘window to the body’ and ‘mirror of general health. There are common potentially malignant disorders like leukoplakia, erythroplakia, oral submucous fibrosis, lichen planus; some systemic disorders can also be premalignant. We undertook the study to find out common conditions in our region and their demographics to see the etiological factors associated with them. Methods: This study consists of 560 patients who presented to the ENT department of our institution from November 2020 to November 2022 with lesions of the oral cavity. After complete ENT examination, provisional diagnosis was made. Biopsy was taken to confirm the clinical diagnosis cases with suspicious premalignant lesions which were diagnosed clinically. Results:  In present study, majority of oral lesions were seen in the age of 21-60 year. Out of 560 patients 330(59%) were males and 230(41%) were females. The most common site of involvement was buccal mucosa followed by tongue. Oral submucous fibrosis seen in maximum number of patients as habit of pan masala chewing is more prevalent in Gujarat. In present study 71 patients are having malignant lesion ,202 with premalignant lesion,287 with benign lesion. Conclusion: In Indian population, oral lesions are very common due to various systemic diseases, addictions and low socio-economic state. Oral submucous fibrosis, leukoplakia common premalignant conditions seen in middle aged patients. Early diagnosis and prompt treatment prevents morbidity as well as disease progression. Tobacco consumption in all forms smoking tobacco and alcohol, are the major risk factors associated with malignant lesions.

105. Medical Teachers’ Attitude towards Using of Audio-Visual Aids in Lecture Classes
Nirmalya Saha, Mukut Roy
Abstract
Background: The teaching method to educate medical students has dramatically changed with the introduction of audio-visual aids. Medical teachers’ preference for using audio-visual aids in didactic lecture classes has become essential. So, the present study was conducted to evaluate on medical teachers’ attitude towards using of audio-visual aids in lecture classes. Materials and Methods: This questionnaire-based study was conducted among seventy medical teachers in Tripura Medical College & Dr. B.R.A.M. Teaching Hospital, Agartala, West Tripura. Results: Most of the medical teachers (94.3%) recognized the importance of using audio-visual aids during lecture classes. Regular use of audio-visual aids during lecture classes was observed by 60% of the teachers. Also, 64.3% of the teachers opined to use of appropriate audio-visual aid during your lecture classes and 52.9% of the teachers preferred of using mixed audio-visual aids during lecture classes. Conclusion: The present study revealed that the most of the medical teachers preferred to use audio-visual aid/s during lecture classes. This had changed the teaching attitudes of medical teachers in a constructive manner where the information can easily be combined and concise.

106. A Study to Assess Parent Attitudes towards Childhood Vaccines
Navneet Khandelwal, Sadaf Ikram, Shiv RK Dubey
Abstract
Background: This study aimed to assess parent attitudes towards childhood vaccines and identify the factors influencing their vaccine-related decisions. The study focused on participant characteristics, vaccine acceptance and uptake, and factors influencing parent attitudes towards vaccine. Methods: A quantitative survey was conducted with 500 parents or legal guardians of children aged 0-18 years. The survey included questions on participant demographics, vaccine acceptance and adherence, and factors influencing parent attitudes towards vaccine. Data were analyzed using descriptive statistics. Results: The participants were diverse in terms of socioeconomic backgrounds, ethnicities, and educational levels. The majority were female (68%) and aged between 25 and 40 years (62%). Overall, 82% of parents reported vaccinating their children according to the recommended immunization schedule. Concerns about vaccine safety were the most common reason cited by parents who did not fully adhere to the schedule (46%). While 62% of parents expressed confidence in the safety and effectiveness of childhood vaccines, 18% were uncertain, and 20% expressed some level of skepticism. Factors influencing vaccine attitudes included safety concerns (46%), misinformation (38%), trust in healthcare providers (72%), belief in vaccine effectiveness (58%), support for vaccine mandates (64%), and personal experiences (26%). Qualitative interviews revealed several themes, including the importance of trust and communication with healthcare providers, specific concerns about vaccine safety and the need for more long-term safety data, the influence of social networks and online communities, emphasis on individual rights and autonomy in vaccination decisions, and the need for improved vaccine education and access. Conclusion: The study highlighted the complexity of factors influencing parent attitudes towards childhood vaccines. While the majority of parents expressed confidence in vaccines and adhered to the recommended immunization schedule, concerns about vaccine safety, influence of misinformation, trust in healthcare providers, and personal experiences emerged as significant factors shaping vaccine attitudes. Understanding these factors is crucial for developing targeted interventions and communication strategies to promote vaccine acceptance and uptake.

107. A Study to Assess Parental Knowledge and Practices Regarding Child Nutrition
Jayendra Arya, Janani Dinakaran, Shubhangi Yagnik, Sardar Vikram Singh Bais, Prakash Vir Arya, Sunita Arya
Abstract
Background: This study aimed to assess the demographic characteristics, parental knowledge, and practices regarding child nutrition among 500 parents of children aged 2 to 12 years. The participants were diverse in terms of age, gender, educational background, and socioeconomic status. Methods: Data was collected through surveys and interviews. Demographic characteristics, including age, gender, educational background, and socioeconomic status, were recorded. Parental knowledge was assessed through questions about macronutrients, micronutrients, and recommended daily servings of food groups. Parental practices were examined in terms of meal planning, grocery shopping habits, food preparation, food choices, and strategies for limiting unhealthy foods. Results: The majority of participants were female (78%) and aged between 25 and 40 years (62%). Educational background varied, with 40% having a high school diploma, 35% having a bachelor’s degree, and 25% having a postgraduate degree. The participants came from different socioeconomic backgrounds, including various income levels and occupations. Parental knowledge revealed gaps, with only 60% correctly identifying macronutrients and 45% having knowledge of essential micronutrients. Understanding of recommended daily servings of food groups was limited, with only 35% accurately estimating the number of servings. Parental practices varied, with 72% planning meals in advance and 68% cooking meals at home using fresh ingredients. However, 42% reported daily consumption of sugary snacks and beverages by their children, and 65% experienced difficulties in introducing new foods. Conclusion: The study identified suboptimal parental knowledge and practices regarding child nutrition. Gaps were observed in macronutrient and micronutrient knowledge, as well as understanding of recommended daily servings. Parental practices highlighted the need for improvement in food choices, meal planning, and limiting unhealthy food consumption. Targeted interventions and educational programs are crucial to address these knowledge gaps and promote healthy practices, ultimately improving child nutrition and overall health outcomes.

108. A Comparative Study of RIPASA and Modified Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis
Ray, E. Rakesh Raj, S. Selvakumaran, Kapil Baliga
Abstract
Background: The most Common emergency seen in general surgical practice is acute appendicitis. The most widely used scoring methods for its diagnosis are the Alvarado and Modified Alvarado scores (MASS), however they perform poorly in some groups. Objective: In order to determine whether is a superior diagnostic tool for acute appendicitis in the Indian population, we compared the RIPASA score with MASS. Methods: A retrospective study was done in the Department of General Surgery, IGMCRI Pondicherry, between August 2018 and October 2019. 100 participants who Were diagnosed as appendicitis were recruited in the trial. They Were scored based on RIPASA and MASS. Either a CT scan, an intraoperative discovery, or a post-operative HPE report supported the final diagnosis. Both RIPASA and MASS were used to compare the final diagnosis. For both RIPASA and MASS, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined. Results: In terms of Specificity (96% vs. 89%) and Positive Predictive Value (93% vs. 80%), as well as to some extent in terms of Diagnostic Accuracy (75% vs. 71%, it was discovered that RIPASA performed better than MASS. While the two models’ sensitivities (49.4% and 67.6%, respectively) and negative predictive values (69 and 67%) were comparable. Conclusion: When compared to MASS, RIPASA is a more precise and detailed rating method for our local population. It decreases the proportion of appendicitis cases that are overlooked and effectively eliminates individuals who require a CT scan for diagnosis (scoring 5-7.5).

109. Relation between Helicobacter pylori Infection and Clinical and Functional Severity of Bronchial Asthma
Prasad K Manden, Manohar V Reddy
Abstract
Background: Helicobacter pylori (H. pylori) causes Gastritis in humans and prevalent in more than 50% of the world’s populations. Apart from infecting the gastric mucosa it can cause extra-intestinal diseases like Allergic Asthma, Multiple sclerosis, Diabetes Mellitus. Aim of the study: To study the relation between Pylori infection of the gastric mucosa and severity of Bronchial Asthma. Methods: A prospective Analytical Study was undertaken at NMC Specialty Hospital in Abu Dhabi, UAE between 2019 and 2022.  Totally 132 patients of Bronchial Asthma were included. Asthma was graded as per GINA grading. Laboratory investigations and radiological tests to confirm were done. Spirometry, H. Pylori tests were done to study the relation between the H. Pylori infection and severity of B. Asthma.  Results: There was no significant statistical difference between the incidence of Asthma and the age, gender and family history of Asthma of the patients in the study. But there was statistical significance in the Asthma patients with history of smoking and GERD incidence of B. No statistical significance noted in regards to the incidence of grades of Asthma in relation to their status of control. There was statistically significance of inverse relation between positive H. Pylori Ag and Positive Ig G of H. Pylori in blood in the patients with B. Asthma. Conclusions: There was an infrequent association between Helicobacter Pylori infection and Bronchial Asthma in patients with an evident inverse relation in terms of grading of Asthma and its status of control. Hence the H. Pylori infection was positively related with the control of the disease. To understand the exact mechanism a larger scale studies are needed since it was not clear.

110. A Prospective Randomized Study of Comparison between Primary Vs Delayed Primary Skin Closure in Gastro Intestinal Perforation Peritonitis
Shiv Kumar Bunkar, Syed Khalid Akhtar, Naresh Meena, Saksham Rakesh
Abstract
Introduction: Peritonitis is one of the most common surgical emergencies encountered in day-to-day practice. Aim: comparison of primary skin closure technique and delayed primary skin closure technique. Methods: A prospective, randomized, single blinded trial of 60 patients was done in Department of General Surgery at the J.L.N. Medical College & Hospital, Ajmer from August 2021 to Dec 2022. In all the cases a detailed history, physical examination and investigation were done as per proforma. Results:  Demographic profile of our study population in both groups was statistically insignificant. Modified graham patch repair was done in 16 and 14 patients, primary repair was done in 10 and 11 patients, resection & anastomosis was done in 4 and 5 patients in Group PC and Group DPC respectively. Infection was seen in 11 patients of Group PC in comparison to 4 patients in Group DPC (p<0.05).)The mean duration of surgery was 115.17 ± 9.53 min in Group PC and 103.97 ± 7.81 min in Group DPC (p<0.0001). As per Southampton scoring system occurrence of SSI was significantly higher in Group PC as compared to Group DPC (p=0.005). Staphylococcus was the major organism grown in culture, The mean hospital stay was 15.13 ± 3.28 days in Group PC and 11.10 ± 2.09 days in Group DPC, which was significantly longer in Group PC as compared to group DPC (P<0.05). Conclusion: the strategy of delayed primary wound closure seems to be significantly better than the primary closure in decreasing the rate of SSI without increasing the duration of hospital stay for those patients who had undergone exploratory laparotomy for contaminated wound.

111. Prevalence and factors associated with Anemia among pregnant women in a rural area of Katihar district, Bihar
Soni Rani, Arun Kumar Pandey
Abstract
Introduction: Anemia is a severe public health problem and more prevalent in pregnant women, particularly in developing countries like India. The prevalence of anemia among pregnant women is 56% in developing countries, as reported by World health organization. According to National family Health survey-5 factsheet, the prevalence of anemia is 63.9% in rural areas of Bihar. Objectives:  1. To find out the prevalence of anemia among women in rural area. 2. To study the factors associated with anemia among pregnant women. Methodology:  This cross-sectional study was carried out among 217 pregnant women registered at our Rural Health Training Centre. All these pregnant mothers gave informed consent to participate in the study. A structured interview schedule was administered and hemoglobin levels were recorded from their Mother Child Protection Card. A mean hemoglobin value was calculated and anaemia was defined as a Hemoglobin level <11 g/dl as per WHO classification. Results: The overall prevalence of anemia among pregnant women was 81.57% in the rural area. Factors such as age, educational status, diet, type of family and gravidity influencing its causation. Conclusion: The high prevalence of anemia among pregnant women in rural area is a major public health problem. Awareness regarding factors associated with anemia is very important. There is need to be strict implementation of National Nutritional Anemia Prophylaxis programme in rural areas.

112. Incidence of Macular Edema Following Cataract Surgery among Diabetic Patients in A Tertiary Care Centre
Arathy S Menon, Sija S, Manoj Venugopal
Abstract
Purpose: To find the incidence of macular edema following cataract surgery among diabetic patients. Method: This study will be carried out in outpatient department at Govt. T D Medical College, Alappuzha for 18 months from start of the study. All patients with T2DM undergoing cataract surgery for whom preoperative OCT is possible will be enrolled in the study. After taking history, BCVA(best corrected visual acuity) , Colour vision and IOP will be assessed. Examination of anterior segment & posterior segment of the eyes are done with the help of a slit lamp biomicroscope. Central foveal thickness by OCT will be measured. HbA1c within 2 weeks of cataract surgery will be collected. BCVA(best corrected visual acuity), Fundus and central foveal thickness will be assessed at 1and 3 months during follow-up. Results: Incidence of macular edema following cataract surgery in diabetic patients is 6.9%with 95% CI 0-16.1%. Among those who had macular edema, 7 patients (24.1%) had cystoid macular edema. 3 patients(10.3%) had spongiform like diffuse retinal thickening . 2 patients (6.9%) had mixed type. CFT in uncontrolled diabetic eyes (>7 HbA1C) increased by 35.1 +/- 34.1 at 1 month post operatively, which was greater when compared with eyes with controlled diabetes [29.0 +/-19.3] at the same time periods. P=0.573. CFT in diabetic eyes with duration >10 years increased by 43.6+/- 39.4 at 1 month post operatively, which was greater when compared with diabetic eyes with duration <10 years [24.45 +/-12.4] at the same time periods. P=0.069. This was not statistically significant even though there was large increase. This may be due to small sample size. CFT in diabetic eyes with retinopathy increased by 43.9+/- 39.7 at 1 month post operatively, which was greater when compared with eyes without diabetic retinopathy [24.2 +/-11.2] at the same time periods. P=0.061. CFT increase after SICS or phacoemulsification type of cataract surgery were comparable from pre-operative to 1 month post-operative period. (p=0.928). After surgery, CFT decrease from 1 month to 3 month were greater in phacoemulsification compared to SICS.(P=0.68). Conclusion: Incidence of macular edema following cataract surgery in diabetic patients is 6.9%with 95% CI 0-16.1%. increase in CFT up to I month after cataract surgery is observed in all patients. HbA1c at the time of surgery may be taken as a predictor of increase in CFT after cataract surgery (p=0.0573). Increase in CFT was more in patients with diabetic retinopathy(p=0.061) , with uncontrolled diabetes (p=0.573) and with diabetes of more than 10 years duration(p=0.069). In those who had macular edema majority was cystoid macular edema followed by spongiform like diffuse retinal thickening followed by mixed type. Eventhough it is statistically insignificant we found that in phaco emulsification , decrease in CFT from 1month to 3 month was greater when compared to SICS. So in diabetes phaco emulsification would be better than SICS.

113. Clinical Characteristics and Outcome of Children Presenting with Diabetic Ketoacidosis at Tertiary Care Hospital
Chirag A Banker, Priyankaben Makwana, Jatin Jadav
Abstract
Background and Aim: Diabetic ketoacidosis is a significant consequence of type 1 diabetes in children and is linked to a higher risk of morbidity and mortality. Present study describes out experience of DKA management and outcome in a pediatric population at a tertiary care hospital in India. Material and Methods: The current analysis is a cross-sectional study conducted in the medical college’s affiliated hospital in collaboration with the pediatric intensive care unit department. Two years were spent doing the study. The investigation was conducted on patients who had been hospitalized and had been diagnosed with diabetic ketoacidosis. A total of 104 children presented with diagnosis of DKA admitted in the hospital were included in the study. All patients were observed for clinical characteristics every hour, blood sugar every two hours, arterial/venous blood gas analysis every four hours, and serum electrolytes every hour. Every 12 hours, renal function tests were measured. When the blood sugar at admission was >250 mg/dl with acidosis, diabetic ketoacidosis was identified. Results: The most common presenting complaints were polyuria and polydipsia in 84 patients, loss of weight was noted in 96 patients, fever was noted in 62 patients, and vomiting and abdominal pain was found in 56 patients. The children included in the study were divided into three groups the majority of the children (56) presented with severe DKA, the moderate DKA was noted in 28 children and in 20 patients there were mild DKA. Conclusion: DKA can develop in persons with diabetes mellitus that has already been diagnosed or it might be the first sign of the condition. Osmotic symptoms such polyuria, polydipsia, and fatigue are the most prevalent at the time of admission, followed by vomiting and abdominal pain. This study highlights the need for creating awareness, early referral and timely management of T1DM presenting not only in DKA but also during the ambulatory management.

114. A Comparative Study of Effect of Angiotensin Receptor Blocker Alone and with Atorvastatin on Biochemical Parameters in Mild to Moderate Hypertensive Patients
Kavita Rathore, Renu Sharma, Avika Mathur, Jitendra Zaveri
Abstract
Background: Hypertension is one of leading cause for cardiovascular, renal and other serious illnesses world-wide. Angiotensin receptor blockers (ARBs) and Statins are the mainstay for the treatment. In this study, we compared effect of Telmisartan alone and with Atorvastatin in mild to moderate hypertensive patients. Methods: Total 137 patients were included. Group I (n=69) received Telmisartan 40 mg OD and Group II (n=68) received Telmisartan 40 mg OD with Atorvastatin 10 mg OD for 16 weeks. Baseline and post-treatment estimation of biochemical parameters like fasting and postprandial plasma glucose levels, serum Na+, serum K+ levels, lipid profile, Monitoring of Systolic and diastolic BP, pulse rate and adverse drug effects evaluation were carried out. Results: Telmisartan alone significantly decreased Plasma glucose levels (fasting and post prandial) as compare to the Telmisartan with atorvastatin. Even, with atorvastatin showed slight increase in fasting blood glucose levels. Both groups showed favourable results on lipid profile but decrease was more with Telmisartan with atorvastatin. There was an increase in HDL-cholesterol was noted in both the groups. Both the groups shows significant decline (p < 0.05) in systolic and diastolic blood pressure levels. Pulse rate changes were minimal in both the groups. Slight increase in Serum K+ level was noted in both the groups (p > 0.05). Adverse events profile showed that Telmisartan alone (group I) produce less adverse effects as compare to Telmisartan with Atorvastatin. Conclusion: Telmisartan improves biochemical parameters along with significant reduction in blood pressure and it gives synergistic effects with Atorvastatin.

115. Knowledge and Attitude Regarding Human Monkeypox Infection Among Health Care Professionals: A Cross-Sectional Study in A Tertiary Care Hospital in Northern Uttar Pradesh
Thomas M, Agrawal P, Prakash JS, Matreja PS, Patrick S, Singh P
Abstract
Background: In order to effectively combat monkeypox, healthcare professionals (HCPs) must be knowledgeable about the condition and have a positive outlook on it. Little is known about the knowledge and attitude of HCPs in Uttar Pradesh during the outbreak of this non-endemic disease. Methods: A cross-sectional online survey was used to gauge 121 HCPs’ attitudes and knowledge regarding monkeypox.  Frequency reporting was employed to evaluate general attitudes and knowledge. The link between the research variables was evaluated using Spearman’s rank correlation coefficient, while the Mann-Whitney U test and Kruskal Wallis test were employed to measure the difference. A p value of 0.05 or lower was considered significant. Results: A total of 121 HCPs took part, and none of them showed particularly high levels of expertise, with the majority (69.4%) showing somewhat low levels. More participants (72.7%) displayed a neutral attitude towards monkeypox preparedness and eventual control. The Shapiro-Wilk test showed that the data did not have a normal distribution. There were no discernible differences in knowledge and attitude scores across the different demographic factors. Spearman’s rank correlation (rs = 0.109, p value >0.05) indicated a somewhat positive association between Knowledge and Attitude scores, which was statistically insignificant. Conclusions: HCPs in Uttar Pradesh have relatively less knowledge about human monkeypox compared to their attitude towards prevention and treatment. An effective strategy for the institute, the state as well as the nation’s readiness for this monkeypox outbreak might be implemented to impart knowledge and perform practical sessions for the same.

116. Ultrasonographic Analysis of Painful Shoulders and Correlation of Rotator Cuff Pathologies with Clinical Findings
M. Suresh Kumar
Abstract
Introduction: Shoulder pain ranks third most common presenting issue in orthopaedic outpatient department. In the examination of various shoulder illnesses, ultrasonography (USG) and magnetic resonance imaging (MRI) are widely used. The current study compared the accuracy of USG in detecting rotator cuff injuries and clinical features in patients with shoulder pain. Methods: 50 patients with a history of shoulder pain were referred for shoulder USG based on clinical examination. All patients had Ultrasonography of the shoulder joint, followed by an MRI scan of the affected shoulder. Results: MRI revealed that 74% of cases had either partial thickness tear, full thickness, or a combination of partial and full thickness rotator cuff injuries, whereas ultrasonography revealed that 66% of patients had either single or combined rotator cuff tears. MRI revealed rotator cuff damage in 74% of study subjects. Using MRI as a reference, ultrasound shows sensitivity of 86%; specificity of 100%; positive predictive value of 100%; and negative predictive value of 98% in identifying full thickness rotator cuff tears. It had a sensitivity of 72%, a specificity of 68%, a positive predictive value of 84%, and a negative predictive value of 54% for partial thickness tears. Using MRI as a reference, the overall accuracy of USG in detecting any rotator cuff rupture was 84%. The degree of agreement between MRI and ultrasonography in diagnosing rotator cuff tears is regarded significant (kappa coefficient =0.59, p=0.004). Conclusion: Because ultrasonography is less cost, non-invasive, patient-friendly, and widely available, and it may be the first line of investigation. In the examination of rotator cuff anomalies, USG produced comparable results than MRI; and USG should be used as the first line of investigation in patients presenting with shoulder pain.

117. Management of Idiopathic Congenital Talipes Equinovarus by Ponseti’s Technique-Outcome Analysis
Mayank Shrotriya, Gaurav Agarwal, Sheela Jain, Roopa Agrawal, Rajesh Kumar Jain
Abstract
Background: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common congenital orthopaedic condition characterised by an excessively turned-in foot (equinovarus) and high medial longitudinal arch (cavus). Untreated, it causes permanent impairment, deformity, and agony. Interventions can be conservative (such as splinting or stretching) or surgical. Objectives: To analyze the outcome of Ponseti’s technique in management of idiopathic Congenital Talipes Equinovarus. Material and Methods: This was a single centre, hospital (inpatient) based, prospective, observational stud involving infants less than 6 months of age at the time of enrolment. The clinical result among the study participants were evaluated one year following therapy. The severity of CTEV was assessed using Pirani Score. Results: A total of 32 infants accounting for 54 feet were treated as a part of this study: 22 participants had bilateral CTEV (44 feet), and 10 participants had unilateral CTEV (10 feet). The success rate of treatment of CTEV among 54 feet treated using the Ponseti technique was 96.29%. Only two feet (in two different participants) did not have the desired outcome. The primary reasons in both cases were non-compliance with the treatment protocol. The median number of casts was 7 per foot ( range 3 to 18 casts). Number of casts applied were higher among participants having bilateral CTEV. A total of 72.2% of participants required tenotomy as a part of treatment. The most common complication was soreness (10.5%) followed by the crowding of toes (4.7%). The most difficult deformity to treat is to correct cavus. Conclusion: Ponseti’s technique had very high success rate among young infants who followed treatment protocol and complied with follow up.

118. Prophylactic Ephedrine to Prevent Hypotension Following Spinal Anaesthesia in Elective LSCS Patients: A Prospective, Double-Blind Case Control Study
Ruchi Gupta, Devendra Verma, Basant K Dindor, Hemraj Tungria, Alka Yadav, Harshita Damor
Abstract
Introduction: Spinal anaesthesia is most commonly used for obstetrics anaesthesia. It is commonly associated with hypotension, which is due to sympathectomy causing peripheral pooling of blood and reduced cardiac output. Exaggerated response to sympathectomy is seen in these obstetrics cases and hypotension itself has too many detrimental effects on maternal as well as on foetal outcome. So to combat this we planned this study to assess the incidence and prevention of postspinal hypotension after prophylactic ephedrine in patients undergoing elective cesarean section. Methodology: In this randomised double blind case control study we recruited 70 parturients of 18-45 years with singleton pregnancy scheduled for lower segment caesarian section (LSCS) under spinal anaesthesia belonging to ASA grade II, who were randomly allocated into 2 groups of 35 each: Group 1 (nonprophylactic group) received 500 ml Ringer lactate IV and Group 2 (prophylactic group) received 10 mg ephedrine in 500 ml Ringer lactate IV prior to spinal anaesthesia. Inj. 0.5% Bupivacaine heavy 2ml (10mg) was used for spinal anaesthesia. We evaluated hypotensive episodes, rescue vasopressor (inj. Mephentermine 6 mg/dose) requirement and adverse effects. Results: The incidence of hypotension was 40% and 17.14% in group 1 and group 2 respectively (p<0.05). The total requirement of rescue vasopressor drug, mephentermine was higher in group 1 (168mg) in comparison to group 2 (60mg) (p=0.034). Incidence of nausea & vomiting (Group 1 –3/35, Group 2-1/35) was similar, minimal and statistically comparable (P =0.11) among the two groups. Conclusion: Prophylactic use of 10 mg ephedrine as intravenous (IV) infusion, effectively reduces the incidence of postspinal maternal hypotension without significant adverse effects.

119. Proximal Femoral Nail: A Case Series of 40 Intertrochanteric Fracture Cases Who Underwent Proximal Femoral Nail in Govt Theni Medical College Hospital
S. Rajasekaran, T. C. Premkumar
Abstract
Introduction: Intertrochanteric fractures are considered one of the commonest fractures in the population owing to the advancing age and longevity. Treatment options are available in various forms for managing intertrochanteric fractures. A case series of 40 intertrochanteric fractures who underwent surgical management by proximal femoral nailing in Govt Theni medical College hospital during the period of June 2022 to December 2022 and a follow up for 3 months. Materials and Methods: The study was conducted in Govt Theni medical College hospital From June 2022 to December 2022 in the Department of Emergency medicine and Department of Orthopaedics. The patients were followed for 3 months duration. Results: Postoperative radiographs showed a satisfactory fracture reduction in 30 patients. 10 out of 40 patients showed complications. 2 patients showed non-union of the fracture. They were taken for redo surgery with grafting. 4 patients showed features of infection and underwent debridement supported by antibiotics. 1 patient showed feature of broken screw with non-union who was taken for redo surgery with nail removal, re-nailing and bone grafting. 2 patients showed Z phenomenon and 1 patient showed reverse Z phenomenon due to screw migration which needed screw removal. Conclusion: From the above case series, it is evident that the proximal femoral nailing is much superior implant in treating intertrochanteric fractures with less number complications which is acceptable in any surgical procedure.

120. Clinico-Mycological Analysis of Otomycosis in A Tertiary Care Hospital
Kalpana S, Mohammed Waseem Faraz Ansari, Sameena ARB
Abstract
Introduction: Otomycosis is an acute, subacute, or chronic superficial fungal infection of the external auditory canal that is most frequent in tropical and subtropical regions of the world and can result in hearing loss and ear drum perforation. The current study was conducted to find fungal agents and their relationships with various factors. Materials and Methods: The study was conducted at a tertiary care hospital, Ballary. The study included 60 patients over the age of 10 with clinically confirmed otomycosis. Certain patient information, such as age, gender, and clinical presentations, as well as potential risk factors and clinically observable findings, were documented. Microbiological causes were determined by culture of samples taken from each participant. The data were statistically evaluated and are presented in a tabular format. Result: According to the findings of our study, most of the patients were between the ages of 20 and 30. Males were seen more frequently than females. The most often detected risk factor was self-cleaning of the ears, which was observed in 30% of the study population, followed by mustard oil instillation in 26% of the study group and usage of antibiotic ear drops in 24% of the study group. Hearing loss was described as the most common presenting symptom in 76% of the study group, followed by pruritis in 70%, earache in 52%, and a sensation of a plugged ear in 48%. Aspergillus was the most often isolated fungus, seen in 66% of the total population. Aspergillus fumigatus was the most prevalent species isolated from samples, accounting for 56%. Candida was the second most commonly isolated fungus, accounting for 24% of the group. Conclusion: In this study, the most prevalent fungus isolated from otomycosis patients were Aspergillus and Candida species. The current study further emphasises the need of education in eradicating the aforementioned predisposing risk factors in order to reduce the occurrence of Otomycosis.

121. Clinical Assessment of the Effectiveness of Tacrolimus and Triamcinolone Acetonide in the Treatment of Oral Lichen Planus
Varun Singla
Abstract
Introduction: Lichen planus (LP) is a mucocutaneous, chronic, autoimmune condition that affects the skin, scalp, nails, and genital mucosa. The goal of the study was to assess the effectiveness of topical administration of TA orabase and Tacrolimus (TAC) ointment along with intralesional triamcinolone acetonide (injection TA) for symptomatic cases of OLP. Materials and Methods: 100 symptomatic OLP patients were enrolled in the prospective trial. For the first four weeks, they received a 0.5 ml intralesional injection of TA once a week, followed by one injection in the sixth week, coupled with 0.1% TA mucosal paste and 0.03% TAC ointment, tapered doses until the eighth week. On a 10 cm visual analog scale (VAS), subjective symptoms including BS and pain were evaluated, while objective markers like the size and location of the lesion were graded using a modified version of the Thongprasom et al. criteria scale. After an 8-week treatment period, differences were compared, and at the 20-week mark, follow-up assessments were made to note any recurrence lesions. Results: 20 % had partial improvement, and 80 % had complete illness remission. Both the BS and pain VAS scores dramatically increased. The average size of active lesions shrank, and there were fewer treatment sites, both of which were indicators of improvement. In the 20th week, 40% experienced a relapse. Conclusion: Combining TA with TAC is a helpful treatment strategy for the therapy of symptomatic OLP. Our findings suggest that patients have statistically improved.

122. A Study on Nebulized Hypertonic Saline in the Treatment of Acute Bronchiolitis in Infants and Children in a Teaching Hospital of Bihar
Naz Yasmeen, Amrit Raj, Prem Kumar, Mohammed Shamim, Nupur Kumari, Alka Singh
Abstract
Background: Bronchiolitis is a common lower respiratory tract disease of infant and young children. Most episodes are caused by respiratory syncytial virus (RSV), although recently an increasing number of respiratory viruses have been incriminated in causing the same clinical syndrome. Bronchiolitis is the leading cause of hospitalization in infancy. Aim: To study the efficacy of nebulized hypertonic saline in treatment of acute bronchiolitis. Materials and Methods: This prospective observational study was done on 110 babies between one month to 24 months of age who were admitted in a teaching hospital of Bihar over a period of one year from March 2022 to February 2023. All patients who fulfilled the inclusion criteria were give nebulized hypertonic saline (3% saline in our study). Hypertonic saline nebulizations were given every 6 hours to start with. Then after improvement in clinical severity score (CSS), frequency of nebulization was adjusted to every 8 hours. Clinical condition was analysed before and after nebulization. Results: A total of 110 patients were included in the study of which majority (86, 78.18%) were males. Mean age was 5.75 ± 5.66 months. Mean respiratory rate at admission was 65.77±8.78 per minute, mean oxygen saturation was 89%, 63% of patients had chest retractions and 58% had wheezing. There was significant improvement in respiratory rate, oxygen saturation, chest retractions and wheezing after three consequent nebulizations. Conclusion: 3% saline nebulization is an effective way to treat bronchiolitis. It significantly reduces CSS and length of hospital stay.

123. A Comparative Study of Case-Based Learning with Traditional Teaching Method in Microbiology among Second Year MBBS Students
Kalpana S, Mohammed Ansari, Sangeetha C Patil, Sameena ARB
Abstract
Background: Traditional medical microbiology education has relied on an organism-centric, didactic lecture approach that lacks clinical relevance and appeal. Case-based learning, as opposed to didactic lectures, has been found in studies to increase comprehension and understanding of the subject. As a result, the current study was conducted to determine whether CBL is an effective teaching tool for Medical Microbiology and to assess students’ perceptions of the utility of the CBL method in Microbiology. Methodology: This cross-sectional study was conducted among 2nd year MBBS students of 2020-2021 batch. The study design included a pre-test, a CBL discussion on a specific topic, and a post-test following the CBL session. MS Excel and SPSS version 22 were used to gather, tabulate, and statistically analyze the data. Results from the pre-and post-tests were compared using the student’s “t” test, and a p-value of < 0.05 was regarded as statistically significant. Students’ perceptions of the CBL approach were assessed using a Likert scale ranging from strongly disagree to strongly agree. Results: When pre-and post-test results were compared, the students’ performance significantly improved. The majority of students supported CBL activities. Over 92% of the students thought CBL classes kept their attention and inspired them to learn more effectively. 90% of the students thought CBL was a useful tool for their learning. More than 88% of students said that CBL enhanced their capacity for analytical thought and problem-solving. More than 91% of the students thought that CBL enhanced their communication abilities. 95% of the students felt that CBL increased their ability to link theoretical knowledge with practical case data, rule out and rule in potential diseases and aetiologies, and make a diagnosis. The benefits of CBL sessions for information retention and long-term memory were favoured by more than 91% of the students. Conclusion: It is concluded that CBL is an outstanding tool for motivating and promoting student learning. It strengthens students’ analytical reasoning, clinical reasoning, conceptualization, and retention of knowledge.

124. An Overview of Recent Trends in Lactational and Non-lactational Breast Abscess
Rajesh Gangadhar Patil, Yashodhar Deepak Mahimkar, Mehernosh Firdosh Gardin
Abstract
Background: Breast abscess is a common disease encountered in the surgery department. It is usually managed by ultrasound-guided aspiration as well as incision and drainage with antibiotic coverage. A breast abscess is of two types- lactational and non-lactational. The purpose of this study was to find an association between the lactational status of women with breast abscess, in relation to clinical variability, bacteriological variables, blood parameters along with its management. Methodology: This is a prospective, observational study over a period of 18 months, done at a medical college hospital, which is a tertiary care center. The study participants included 60 patients above 18 years of age, who were presented to the outpatient department and emergency services with features of breast abscess. Among the study subjects, 48 were in lactational and 12 were in non-lactational cases of breast abscess. Clinical, bacteriological, and blood parameters were studied and compared along with the management of these patients within the groups of lactational and non-lactational breast abscesses. Results: The most common organism found in both groups was Staphylococcus aureus comprising 83.3% in the lactational group and 58.4% in the non-lactational group. Other organisms in the non-lactational groupwere Group B Streptococci (25%), Proteus (8.3%), and Acinetobacter SPP (8.3%). There was no significant difference in the groups of lactating and non-lactating breast abscess with respect to age, chief complaints, site of an abscess, a local rise of temperature, blood parameters, management and hospital stay as per Chi-Square test (p>0.05). Conclusion: There was an increase in the incidence of breast abscess observed among lactational than the non-lactational group of patients. Staphylococcus aureus was found to be the most common agent among both groups. Mixed flora was common in cases of non-lactational breast abscess when compared to lactational abscess. The clinical features and blood parameters are similar for both groups.

125. A Cross Sectional Study for Growth and Quality of Life Assessment among Multitransfused Thalassemia Patients and Factors Affecting it in Kumaon Region of Uttarakhand, India
Deeksha Choudhary, Ritu Rakholia, Pooja Agarwal
Abstract
Background: Thalassemia is the most common genetic disorder worldwide and widely found in the tropical and subtropical regions of Mediterranean countries. These patients need frequent and lifelong transfusions that affects their growth and quality of life. This study evaluate growth and quality of life and factors affecting it in multitransfused Thalassemia patients. Material and Methods: A cross sectional study was conducted on 60 Beta Thalassemic and 60 healthy matched controls of 2-16 years. WHO charts for growth and PedsQLTM 4.0 Generic core scale was administered for quality-of-life assessment. Results: This study showed 36.7% were moderate and 10% were severely undernourished while 28.3% were moderate and 15%were severely stunted among thalassaemic children. Maximum cases of stunting and undernutrition belonged to 5-10 years age with pre-transfusion hemoglobin <8gm/dl, serum ferritin 1500-3500ng/dl and frequent transfusions. Also, quality of life was poorly affected with mean score 46.27±3.02 in cases when compared to controls 87.50±1.52. Physical functioning scored the lowest followed by emotional, social and school. Quality of life was poorly affected by factors like low pre transfusion haemoglobin levels, frequent transfusions and poor compliance for chelation therapy. However, there was no association found between quality of life and serum ferritin levels in our study. Conclusion: Findings in our study shows that regular blood transfusions with growth monitoring and proper chelation therapy is important and can improve both growth and quality of life in thalassemia patients.

126. Rhino Orbital Mucormycosis in Patients with RTPCR Positive COVID-19 Infection at A Tertiary Care Hospital
Kalpana Singh, Shewta Bandhopadhyay, Dhiraj Balwir, Nikhil Charhate, Nita Gngurde, Jeetendra Singh
Abstract
Introduction: Corona virus disease (COVID-19) causes an immune-compromised state and increases susceptibility to various secondary infections like mucormycosis. Post-COVID-19 especially in the second wave there was a phenomenal increase in the cases of mucormycosis. Aim: The aim of the study was to document the cases of rhino orbital mucormycosis presenting at our tertiary care institute during COVID-19 era and to study the outcome of these patients. Materials and Methods: The study was a prospective hospital based study, conducted after the approval of Ethics committee. It was carried out from April 2021 to June 2021 in the tertiary care institute. All patients reported to us with diagnosed covid 19 infections along with clinical features, signs and symptoms of mucormycosis and microbiologically proven cases of mucormycosis were included. The diagnosis of covid 19 was based on RT-PCR test on nasopharyngeal / oropharyngeal swabs. The patients record included history taking, drug treatment, ophthalmological examination and radiological imaging studies. The patients were treated with intravenous amphotericin B, FESS (functional endoscopic sinus surgery). Retrobulbar injection of Amphotericin B or exenteration was decided case wise. Results: Twenty patients were seen with the mean age of 49.95 years. The most common clinical symptom was ptosis in 85% cases, total external ophthalmoplegia in 65% cases and no perception of light (No PL) in 59.09% cases. Retrobulbar injection of Amphotericin B was given in 7 patients (35%) cases and exenteration was performed in 12 cases (60%) cases with a survival rate of 58.33%. Conclusion: Retrobulbar injections of amphotericin B along with surgical debridement and systemic amphotericin B should be considered in patients of orbital mucormycosis who have definite orbital involvement but with minimal vision loss or are poor surgical candidates for exenteration.

127. Histopathological Pattern of Malignant Sinonasal Tumors
Ameet G, Zashank S Joshi, PK Rangappa
Abstract
Background: Malignant tumors of sinonasal tract constitutes less than 1% of all malignancies in the body and about 3% of all head and neck cancers. Malignant tumors of sinonasal tract are of different histological types and are usually seen between the 5th and7th decades of life. The initial symptoms of sinonasal tumors are similar hence histological examination is necessary to decide whether a particular tumor is malignant. Objectives: Present study is undertaken to evaluate the histopathological pattern in sinonasal malignancies in a tertiary care centre. Materials and methods: Prospective observational study was conducted for a period of 18 months and histologically proven primary sinonasal malignancies were included in the study and were classified according to the WHO classification immunohistochemistry was done whenever necessary. Results: 28 cases of malignant tumors in nasal cavity and paranasal sinuses majority were squamous cell carcinoma accounting for 11 cases (39.28%), followed by olfactory neuroblastoma 4 cases (14.28%), and mucoepidermoid carcinoma 3 cases (10.71%) other cases observed were adenocarcinoma, adenoid cystic carcinoma, adenosquamous carcinoma malignant melanoma, plasmacytoma, lymphoma, chordoma, teratocarcinosarcoma, malignant mixed tumor and malignant ameloblastoma. Conclusion: The time of presentation of sinonasal malignancies is very late with diverse symptoms, diverse histologies and diagnosis. A proper clinical, radiological and pathological data is needed for proper management of sinonasal malignancies.

128. Evaluation of Combination Therapy in the Management of Vaginitis
Vidhi Singh, Shivani Panwar
Abstract
Introduction: The efficacy of vaginitis treatment regimens that combine antimicrobial and antiviral agents was evaluated. Antibiotics plus probiotics or intravaginal pH modulators have shown promise in lowering BV recurrence rates. Recurrent or complex cases of VVC may benefit from a combination of topical corticosteroids and antifungal or antibacterial agents. Vaginitis treatment options include antiseptics, which have also been proposed. Aims and Objectives: This study aims to assess the efficacy of combination therapy in the treatment of vaginitis, considering the varying causes of vaginitis. Methods: Convenience sampling was used to enroll sixty patients with complaints of vaginal discharge from a university gynaecological clinic for this clinical trial. The patients all reported having vaginal discharge. A series of diagnostic evaluations were carried out to diagnose vaginal candidiasis, bacterial vaginosis, or non-specific vaginitis. These evaluations included symptoms, vaginal pH, fungal components, the Whiff test, gynaecological exams, the Amsel criteria, and clue cells. Results: The study has found that the frequency of adverse effects and improvement in symptoms for vulvovaginal candidiasis, bacterial vaginosis, and non-specific vaginitis. All groups experienced considerable improvement in symptoms while on therapy. The study also showed that the typical VAS satisfaction ratings for oral metronidazole and combined treatment. Satisfaction levels were similar, comparing the two approaches to treating bacterial vaginosis and non-specific vaginitis. Conclusion: The study has concluded that combination therapy significantly improved vaginitis than a mono-therapy of metronidazole.

129. Study on the Efficiency of Early Delivery versus Expectant Management in Late Pre-Term Patients with Pre-Eclampsia
Vidhi Singh, Shalini Srivastava
Abstract
Introduction: Pre-eclampsia is a multisystem pregnancy disease that dramatically increases mother and fetal mortality. Delivering after 37 weeks reduces the chance of complications for the mother and child. The best time to deliver in advanced pre-eclampsia (34-37 weeks) is unknown because of the need to assess the hazards of continuous expectant care against those of planned early birth. Clinical necessity should be considered alongside the 37-week close monitoring suggestion. Aims and Objectives: To compare the efficacy and outcomes of early delivery with that of expectant management in late-stage pre-term patients who have pre-eclampsia. Methods: In a year-long randomized controlled trial, 80 pregnant women with pre-eclampsia or superimposed pre-eclampsia were divided into two groups: “Planned Delivery” and “Expectant Management.” The study compared the outcomes of early planned delivery versus standard expectant management. Participants and healthcare professionals were blinded to the interventions. The research evaluated baseline characteristics, maternal and perinatal outcomes, and conducted statistical analyses to assess the effects of the therapies. Results: In-hospital patients were divided into scheduled delivery and expectant management groups. Perinatal issues were more common than maternal issues in the planned delivery group. Secondary outcomes showed that the scheduled delivery group had fewer incidences of maternal morbidity and improved on some markers. Scheduled deliveries had a higher risk of infant admission and a slightly higher median birthweight. Apgar scores and umbilical arterial pH were identical in both groups. Conclusion: The study has concluded that the planned delivery can be found to have more improved maternal outcomes than expectant management.

129. Study on the Efficiency of Early Delivery versus Expectant Management in Late Pre-Term Patients with Pre-Eclampsia
Vidhi Singh, Shalini Srivastava
Abstract
Introduction: Pre-eclampsia is a multisystem pregnancy disease that dramatically increases mother and fetal mortality. Delivering after 37 weeks reduces the chance of complications for the mother and child. The best time to deliver in advanced pre-eclampsia (34-37 weeks) is unknown because of the need to assess the hazards of continuous expectant care against those of planned early birth. Clinical necessity should be considered alongside the 37-week close monitoring suggestion. Aims and Objectives: To compare the efficacy and outcomes of early delivery with that of expectant management in late-stage pre-term patients who have pre-eclampsia. Methods: In a year-long randomized controlled trial, 80 pregnant women with pre-eclampsia or superimposed pre-eclampsia were divided into two groups: “Planned Delivery” and “Expectant Management.” The study compared the outcomes of early planned delivery versus standard expectant management. Participants and healthcare professionals were blinded to the interventions. The research evaluated baseline characteristics, maternal and perinatal outcomes, and conducted statistical analyses to assess the effects of the therapies. Results: In-hospital patients were divided into scheduled delivery and expectant management groups. Perinatal issues were more common than maternal issues in the planned delivery group. Secondary outcomes showed that the scheduled delivery group had fewer incidences of maternal morbidity and improved on some markers. Scheduled deliveries had a higher risk of infant admission and a slightly higher median birthweight. Apgar scores and umbilical arterial pH were identical in both groups. Conclusion: The study has concluded that the planned delivery can be found to have more improved maternal outcomes than expectant management.

130. Study on Prevention of Preeclampsia using Calcium Supplements in Early Pregnancy
Vidhi Singh, Shivani Panwar
Abstract
Introduction: As recommended by WHO, regular calcium supplementation reduces the risk of preeclampsia. Limited food intake communities at high risk of preeclampsia also benefit from calcium supplementation. Preeclampsia and hypertension diseases are a leading cause of maternal mortality. Calcium supplementation is a low-risk, affordable measure to improve maternal and newborn health. Preeclampsia has complex causes and can only be treated by delivering the placenta. Calcium supplementation prevents nearly 50% of preeclampsia cases. Preeclampsia affects 2% of pregnancies and contributes to perinatal and maternal fatalities, mostly in low- and middle-income nations. Aims and Objective: To analyze the efficiency of calcium supplements in early pregnancy in preventing preeclampsia. Method: This study involved 90 participants in a randomized, double-blind, placebo-controlled design to evaluate a new obstetric care intervention’s efficacy and safety. Participants were assigned to either the Calcium group, receiving 1.5 g of Calcium daily after 20 weeks’ gestation, or the Placebo group. Primary and secondary outcomes were assessed after a 12-week period, and compliance was measured through surveys and follow-up. Inclusion criteria included women with a history of preeclampsia or eclampsia and an interest in future pregnancies. Exclusion criteria encompassed factors such as age, existing pregnancy, use of calcium supplements, certain medical conditions, and personal choices regarding contraception and consent. Results: The study found that the Placebo group had a higher rate of complications before allocation. Compliance rates were similar between the groups, indicating comparable adherence to the intervention. Pregnancy outcomes, including pregnancy loss rates and the frequencies of live births and pregnancies progressing to 20 weeks of gestation, did not significantly differ between the Calcium and Placebo groups. Preeclampsia occurrence showed no statistically significant difference between the groups. Other outcomes did not show significant changes, including gestational blood pressure, proteinuria, pregnancy loss, preeclampsia severity, preeclampsia onset, and maternal problems. However, more individuals in the Calcium group required postpartum hospitalization of 7 days or longer compared to the Placebo group. The study found no statistically significant differences between the two groups in most outcomes assessed. Conclusion: The study has concluded that Calcium can significantly prevent preeclampsia in early pregnancy.

131. Therapeutic Evaluation of Clindamycin in Bacterial Vaginosis among Pregnant Females
Vidhi Singh, Shalini Srivastava
Abstract
Introduction: Using clindamycin to treat “bacterial vaginosis (BV)” in pregnant women successfully lowers symptoms and improves pregnancy outcomes. Depending on the severity of the infection, it can be given orally or vaginally. It should be used cautiously and under medical supervision despite its relative safety. There are occasions when clindamycin won not work. Therefore, it is important to have backup plans. Aims and Objectives: This research aims to determine whether clindamycin is effective for treating “bacterial vaginosis” in pregnant women. Methods: A year-long prospective study was conducted on 100 patients at our hospital’s Gynaecology department. The patients were divided into two groups: Clindamycin group (received Clindamycin) and Placebo group (received placebo).  The study used a Nugent score of 7 as the threshold for defining bacterial vaginosis. The double-blind, placebo-controlled experiment included women without a history of late miscarriage or premature birth. Participants were randomly assigned to receive placebo. Results: Table 1 shows the baseline characteristics of Clindamycin and Placebo trial participants. Pregnancies, miscarriages, premature labour, perinatal death, smoking status, maternal age, education, and parity are included. Both groups had 28-year-old mothers and similar gestational weeks. High school or college was the norm. Clindamycin had a greater nulliparous rate (47.3%) than placebo (41.9%). Smoking, miscarriages, inductions, fetal losses, and pregnancy count are also listed. The table compares Clindamycin with Placebo baseline features. Conclusion: The study has concluded that clindamycin has no fatal maternal and fetal outcomes so it can be used during pregnancy in patients with bacterial vaginosis.

132. A Clinical Study on Role of Bubble CPAP in Respiratory Distress Syndrome in Preterm Neonates
Khushbu Aggarwal, Pukhraj Garg, Jaiprakash Narayan, Ashok Kumar Chaudhary
Abstract
Background: Non- invasive ventilation like continuous positive airway pressure (CPAP) in spontaneously breathing neonates with respiratory distress improves survival and also reduces the incidence of chronic lung disease in newborns. The aim of our study was to study the effectiveness of CPAP in Respiratory Distress Syndrome (RDS) in preterm newborns in different weight and gestational groups. Materials And Methods: This cross- sectional descriptive study was performed in the NICU of JANANA (part of JLN hospital Ajmer) and JLN hospital Ajmer itself, tertiary care centres in Ajmer, Rajasthan on 140preterm neonates admitted immediately or within 24 hours after birth with Silverman Anderson Score 4-7 with Respiratory distress syndrome. Results: Total 140 preterm neonates with RDS recruited in our study. Among them 71 (50.71%) were males and 69 (49.29%) were females.Overall success rate of B-CPAP was noted to be 72.85%. Good recovery was seen among babies with birth weight of 2-2.5 kg and >2.5 kg i.e 100%. There was a significant difference in outcome of bubble CPAP between birth weight <1000gm(51%) and birth weight ≥1000 gm(83%). (p=0.0011). Most infants with gestational age <28 weeks had B-CPAP failure (60%). Gestational age 28-29weeks also had higher number of CPAP failure as compared to gestational age 30- 31 (17.88%), 32 to 34 weeks (12%) and ≥35 weeks of gestation which was lowest around 0% (p-0.0003). Outcome of cases of RDS was also affected by initial respiratory severity score – SAS. Higher percentage of CPAP success was seen with initial scores 4(78.9%) and 5(84.75%) as compared to higher scores 6(59.26%) and 7 (62.5%) [p value – 0.018]Sepsis was seen as the commonest morbidity in this study cohort. Overall, 49 out of 140 cases (35%) had sepsis. Sepsis was seen in larger percentage of cases in failure group. 27 out of 38 failed cases had sepsis (71%) while only 28 cases out of 102 (21%) in recovered group had sepsis but its value as a predictor of CPAP failure could not be proven. Birth weight <1000gm, gestational age <30 weeks and initial SAS score ≥ 6 proved to be significant predictors of CPAP failure. Conclusion: Bubble continuous positive airway pressure is a safe and effective mode of respiratory support in preterm neonates with respiratory distress syndrome.

133. A Study of Prevalence of Dysmorphic Features in Children with Congenital Heart Disease and their Association with type of CHD
Nishna, Jaiprakash Narayan, Radha, Anil Kumar Jain
Abstract
Introduction: Congenital heart disease (CHD) accounts to 28 percent of major congenital anomalies, accounting it to be the most common among them. Children with Congenital heart disease often have various dysmorphic features. Objectives: To study the prevalence of dysmorphology in children with CHD and their association between cyanotic and acyanotic types of CHD. Methods: A cross sectional observational study was conducted on 127 children with congenital heart disease admitted in JLN Medical College during the study period. Various dysmorphologies were noted. Prevalence of dysmorphic features and if any dysmorphic feature is significantly associated with the type of CHD (cyanotic or acyanotic) were statistically determined. Result: 75.5% of the sample had some form of dysmorphism, of which the most common was face dysmorphism. Hypertelorism and total face dysmorphism were significantly associated with cyanotic CHD. Conclusion: Dysmorphisms when found in any child warrant the clinician to look for any congenital cardiac anomalies. This helps in early diagnosis and thus, better survival of such children. The dysmorphology can even give a hint about the presence of probable cyanotic variant of CHD.

134. A Study of Normative Blood Pressure Values in Healthy Indian Neonates and Comparison Between Upper Limb and Lower Limb Blood Pressures
Radha, Jaiprakash Narayan, Nishna, Anil Kumar Jain
Abstract
Objective: To provide current normative BP values for healthy neonates without any confounding maternal or neonatal factors during the first week of life using an oscillometric method and to compare BP recordings between upper limb and lower limb. Study design: Hospital based prospective longitudinal study. Setting: Neonatal unit of a tertiary care teaching hospital in north India between December 2021 and December 2022. Participants: 400 healthy neonates with gestational age between 34 and 41 weeks and birth weight between 1500 g and 4000 g were enrolled in the study. Neonates with congenital anomalies, sick neonates requiring intensive care, mothers with hypertension, gestational diabetes or substance use were excluded from the study. Procedure: For all neonates, four limb BP (SBP, DBP and MBP) was measured at four time points i.e., within 1st hour of birth, at 24 hours, at 48 hours and on 7th postnatal day by oscillometric method. Results: Normative BP charts (including 5th, 10th, 25th, 50th, 75th, 95th, 99th percentile values) were developed based on the gestational age. SBP, DBP and MBP values increased with birth weight, gestational age, and postnatal age. SBP, DBP and MBP recordings were significantly higher in upper limbs as compared to lower limbs. However, there was no difference in BP recordings between male and female. Conclusion: This study provides normative BP charts as well as gestational age wise percentile charts of BP values in healthy term and preterm neonates without any neonatal or maternal confounding factors which is helpful in the definition of hypotension and hypertension in this population.

135. Quality of Life Assessment after Laparoscopic Versus Open Mesh Hernioplasty for Inguinal Hernia
Kirtan Gosai, Pranav Parthasarthi, Jekee Patel, Parth Patel
Abstract
Background: Historically, the success of a hernia repair was measured by lack of recurrence. With the advent of mesh reinforcement and refinement in technique, recurrence rates after herniorrhaphy have significantly improved. Subsequently, postoperative Quality of life (QOL) has become an important outcome measure following herniorrhaphy. Our Aim in this study is to assess the Quality of life after open versus laparoscopic inguinal mesh hernia repair in severity of pain, sensation of mesh, movement limitation in different position by using Carolinas Comfort Scale. Method: A total of 100 cases which met the inclusion and exclusion criteria were included in this hospital based prospective study. After taking informed and written consent of the patients, they have been operated by either open or laparoscopic methods of inguinal hernia repair randomly. The subjects were allocated into two groups according to the type of repair. Both the group of patients have been compared for various outcome measures for quality of life using Carolinas Comfort Scale on post-operative day 1 and 3. Result: Present study concludes that there is less sensation of mesh, pain sensation and limitation of movement in different posture and activity after laparoscopic mesh hernioplasty as compared to open mesh hernioplasty in first three post-operative days. Conclusion: Present prospective randomised study concludes that there is difference in quality of life after laparoscopic and open mesh hernioplasty in first three post-operative days. So, quality of life after laparoscopic mesh hernioplasty is better than open mesh hernioplasty in the first three post-operative days.

136. The Diagnostic Utility of Myelofibrosis in Bone Marrow  by Trephine Biopsy in Chronic Myeloid Leukemia
Meghavi Joshi, Kosha Panchal, Silky Patel
Abstract
Introduction:  The presence of myelofibrosis in bone marrow in CML is the important feature to be assessed. Trephine biopsy is done in CML  to support the diagnosis when marrow cannot be aspirated in follow-up cases and primarily when marrow is dry. Aim: This study aimed to document bone marrow findings with further evaluation by reticulin stain for grading of myelofibrosis in chronic myeloid leukemia. Methods: Patients were diagnosed as CML over the period of 3 years  at tertiary referral cancer center of Gujarat. All clinical and Hematological findings and bone marrow findings were correlated and  reticulin stain applied on bone biopsy for evolution of grading of fibrosis. Results: Among 100 CML patients, the mean age range of presentation was 40-50 years with  Male predominance. CML chronic phase most commonly encounter 62%. The fibrosis was found highest in the chronic phase constituting 64%. The total number of cases which showed presence of fibrosis were 44 out of 100 on H&E section and reticulin stain was performed. Out of 44 cases showing fibrosis, 19 cases showed Grade-I fibrosis,16 cases showed Grade-II fibrosis, 8 cases showed Grade-III fibrosis,1case showed focal fibrosis. Conclusions: Chronic myeloid leukemia – chronic phase is the most common presenting phase and variable grades of fibrosis was present in most of cases. Molecular evidence of the BCR-ABL fusion gene for confirmation of CML by FISH technique. The need for trephine biopsy is also important to recognize fibrosis at an early stage as extensive fibrosis may indicate therapy failure and worse prognosis.

137. Quality Control in Processing of Respiratory Specimens in Microbiology Laboratory: A Systemic Review
Mohmed Soeb Jankhwala, Jaymin Kaushikbhai Bhatt, Dushyant D Desai, Parth NiranjanBhai Soni
Abstract
Introduction: This systematic review summarizes the current evidence on quality control (QC) practices in processing respiratory specimens in microbiology laboratories. Method: A comprehensive literature search was conducted in various databases such as PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar from 2010 to 2023, resulting in 37 articles meeting the inclusion criteria. Result: Studies were published between 2010 and 2023, with 76% published in the last five years. Various study designs were employed, including observational studies (57%), systematic reviews or meta-analyses (22%), expert opinions or recommendations (14%), and original research (8%). The study populations were diverse, including patients with respiratory infections (43%), individuals in long-term care facilities (5%), laboratory personnel (8%), and the general population (8%). The most commonly studied specimen types were sputum (43%) and nasopharyngeal swabs (30%), followed by bronchoalveolar lavage (11%), tracheal aspirates (5%), and other types (11%). The processing and testing methods employed in the studies varied, with some comparing different methods or evaluating specific techniques. A significant majority of studies (78%) recommended or implemented QC measures, including the use of standardized protocols and guidelines (38%), regular monitoring and evaluation of laboratory performance (30%), participation in external quality assurance programs (27%), and continuous training and education of laboratory personnel (24%). Conclusion: This systematic review highlights the importance of QC practices in processing respiratory specimens in microbiology laboratories. The studies included in the review exhibited heterogeneity in terms of journals, study designs, specimen types, processing methods, and testing methods employed. Nonetheless, the majority of studies emphasized the implementation of QC measures to ensure the reliability and validity of laboratory results.

138. Study of Vitamin D3 Level in Non-Diabetic Patients with Subclinical Hypothyroidism
Abdulrahman H. Amer, Kaushik S Chaudhari, Mayurkumar Goradhanbhai Makadia, Himanshu Patel
Abstract
Introduction: The deficiency of vitamin D is a major health problem worldwide. In recent studies vitamin D deficiency has been shown to be associated with increased risk of diabetes mellitus, atherosclerosis and autoimmune condition like autoimmune thyroiditis. There has not been any clear research that shows the association between the vitamin D deficiency and hypothyroidism. The present study aims to explore the levels of vitamin D in the subjects with subclinical hypothyroidism. Subclinical hypothyroidism is defined by normal serum T3, T4 levels and serum TSH level falling between 4.2 to 10 mU/L without any clinical signs and symptoms. The aim of the current study was to study the vitamin D level in nondiabetic subclinical hypothyroid subjects and to compare the vitamin D level with controls. Materials & Methods: The cross-sectional study was conducted among 100 subjects of subclinical hypothyroidism (S. TSH level between 4.2 – 10 mU/L, normal S. T3 and S. T4) while, the control group consisted of 100 healthy individuals at Shree Krishna Hospital and H. M. Patel Centre for Medical Care and Education – Gujarat. The vitamin D levels are measured using Electrochemiluminescence method on Cobas E411 analyser. Results: There is no significant difference between the case and the control groups for the age, sex, fasting blood sugar, HbA1c, S. T3 and S. T4 level. The vitamin D levels are significantly lower in the cases with subclinical hypothyroidism than the controls. Conclusion: Our study suggest that the subjects with subclinical hypothyroidism showed vitamin D insufficiency or deficiency and there is strong negative linear correlation between the levels of S. TSH and vitamin D in all the study subjects.

139. The Relationship between Plasma Homocysteine Levels and Diabetic Complications in Patients with Type 2 Diabetes Mellitus
Mohammad Amzarul, Ravi Kishore Reddy Vintha, Mohammad Tahazzul, Samreen Farooqui, Deepti Gangwar, Sara Siddiqui
Abstract
Background: Patients with Diabetes Mellitus have 2- to 6-fold increase in the prevalence of cardiovascular disease (CVD) as compared to non-DM subjects. Epidemiological data has shown that DM is synergic with other conventional risk factors. Total plasma homocysteine (tHcy) is an emerging CVD risk factor. We did a cross-sectional study to explore the relationship between tHcy and CVD in patients with DM. Methods: The present study was conducted in department of medicine in collaboration with department of Physiology in IIMSR for a period of one year from June 2022 to May 2023.A total number of 316 diabetic patients between age group 25-65 years were enrolled from the diabetic clinic and those admitted in the Department of Medicine IIMSR who satisfied the selection criteria (n=316). Results: Out of 316 diabetic patients, 197 have duration of diabetes less than 5 years, out of these 116 (58.9%) had normal and 81 (41.12%) had raised plasma Homocysteine level. 108 diabetic patients had duration between 5 to 10 years, out of these 46 (42.59%) patients had normal and 62 (57.4%) patients had raised plasma Homocysteine level which was statistically significant (x2=1.91, p=0.019). 11 patients had duration more than 10 year So, majority of diabetic patients who had raised plasma Homocysteine level had duration between 5 to 10 years. Out of 316 diabetic patients, 26 (8.2%) patients had stroke and 24 (7.5%) had coronary artery disease. These patients had significant elevation of plasma homocysteine level as compared to those patients who had no evidence of cerebrovascular or cardiovascular disease (p=<0.001). homocysteine level . Conclusions: This study concludes plasma homocysteine level can be considered as an early marker, It can be concluded from our study that diabetic patients who had elevated homocysteine level have more complications in the form of nephropathy, neuropathy, retinopathy and higher incidence of cerebrovascular disease and ischemic heart disease as compared to those diabetic patients who had normal plasma homocysteine level. We also recommend for routine screening of plasma homocysteine level for purpose of treating elevated homocysteine concentrations in the wider adult populations.

140. A Comparison of Attenuation of the Pressor Response to Laryngoscopy and Intubation with Intravenous Fentanyl and Intravenous Butorphanol
Dhivya, Jayalakshmi B.K., Sri Devi S.
Abstract
Background: This study was conducted to compare intravenous fentanyl and intravenous butorphanol with regard to the attenuation of the pressor response to laryngoscopy and intubation (systolic pressure, diastolic pressure, mean arterial pressure, mean pulse rate, rate pressure product, post-extubation respiratory rate, and post-extubation sedation score). Methods: This was a hospital-based randomized prospective study conducted among 60 patients who were scheduled for various elective surgeries, which was conducted in Govt. Kilpauk Medical College and Hospital, Chennai, and Govt. Royapettah Hospital, Chennai, from May 2013 to September 2013 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: There was a significant rise in the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product when compared to the pre-operative values in both the fentanyl and the butorphanol groups. The rise in hemodynamic parameters following intubation was significantly lower in the butorphanol group than in the fentanyl group. The increase in the heart rate, diastolic blood pressure, mean arterial pressure and rate pressure product was short lived in the butorphanol group when compared to the fentanyl group. Both the butorphanol group and the fentanyl group were comparable with respect to events of intraoperative hypotension and intra operative bradycardia. There was no significant respiratory depression post-extubation in both groups. Conclusion: Butorphanol could be an effective alternative to fentanyl for attenuating the hemodynamic stress response to laryngoscopy and intubation.

141. Utility and Effect of Case Based Learning and Conceptual Learning of Biochemistry Classes in First Year Medical Students
Mohana Kumari Chidananda, Shilpa H.D., Leelambika C.
Abstract
Background: Case based learning (CBL) and conceptual learning are newer methods of learning in medical education.  CBL engages us with real life case scenarios, involving ourself in self-directed learning. Conceptual learning guides students to understand the abstractions. Introducing CBL and conceptual learning with didactic lectures will lead to deeper understanding of the subject. Aims and Objectives: We wanted to study and put forth the perception of first year MBBS students towards CBL and conceptual learning in understanding biochemistry in medical education. Methodology: First year medical students were taught biochemistry topics by didactic lecture. Followed by the lecture, either CBL or conceptual learning-based questions on respective topics were posted through digital platform for students to analyse the question. Responses were collected through google forms. Post Didactic lecture and post CBL or conceptual learning test were conducted and compared. A questionnaire addressing different aspects of CBL and conceptual learning were given to students after completion of all the topics. Result: Performance of the students significantly improved after CBL and conceptual learning as compared to didactic lectures (p<0.0001). 89.2% of students developed positive attitude in learning biochemistry after CBL and conceptual learning and found these methods to be helpful for studying biochemistry (88.4%). Interaction with peer groups (82.2%) and teachers (74.8%) has been increased post CBL and conceptual learning. 91.3% of students improved their clinical reasoning skills and clinical competence. 58.8% of students did not find CBL and conceptual learning as extra work and time consuming. Conclusion: CBL and conceptual learning has inculcated interest to understand biochemistry more thoroughly and develop Scientific reasoning skills which would help them to understand the medicine better.

142. Molecular Diagnosis of Mycobacterium Tuberculosis in CSF Sample of Suspected TB Meningitis Patients and their Drug Resistance Pattern by Geno type MTBDR plus Line Probe Assay Method at Tertiary Care Centre of Western Rajasthan
Laxmi Meena, Smita Kulshreshtha, Dashrath Kumar Meena
Abstract
Introduction: Tuberculous meningitis (TBM) is one of the most serious clinical manifestations of tuberculosis with distressing levels of neurological morbidity. Aim: To determine the positivity of tuberculosis in CSF sample of suspected TB meningitis patients by Mycobacterium Growth indicator tube (BACTEC-MGIT960) liquid culture and first and second line drug resistance pattern by LINE PROBE ASSAY method. Methods: A cross-sectional study carried out from 110 CSF samples aged above 18 years received in TB & DST Lab, Department of Microbiology, IDI block, Kamla Nehru Chest, Hospital, Dr S.N. Medical college Jodhpur, Rajasthan during August 2022 to January 2023. Result: Age group 41-50 yrs old patients were highest in number followed by >61 yrs old. Only 4.5% are ZN staining positive, MGIT culture were 23.64% and MTP64 card test was positive in 9.1% samples. ZN stain and MGIT results in relation to MTP64 results were found to be statistically significant (p<0.0001). All 10 samples processed for MTBDRplus genotype LPA, all are sensitive to first line ATT. Conclusion: This study reveals that all the samples which are MTP 64 card positive are sensitive to first line ATT.

143. Efficacy of Rotary and Reciprocating Single-File Systems and Hand Files for Gutta-Percha Removal in Endodontic Retreatment with or without Solvent: An in-Vitro Study
Monalisa Debbarma, Harbinder Singh
Abstract
Background: In this study, we wanted to compare the effectiveness of single-file reciprocating systems and rotary systems in removing endotoxins and bacteria in endodontic retreatment, compare the efficacy of hand file, nickel titanium rotary instrument, and reciprocating instruments for removing filling material from extracted human teeth. Methods: This was a hospital based study where 90 mandibular premolar teeth were collected from the Department of Oral and Maxillofacial Surgery from Awadh Dental College and Hospital, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In comparison of coronal values between the groups using one-way ANOVA, it was found to be statistically significant. In pairwise comparison of coronal values between the groups using Tukey post-hoc analysis, statistically significant difference existed between the mean values of the group pairs: I vs V, III vs V and III vs VI. In comparison of middle values between the groups using one-way ANOVA, comparison of apical values between the groups using one-way ANOVA was found to be statistically significant. In pairwise comparison of apical values between the groups using Tukey Post Hoc analysis, statistically significant difference existed between the mean values of the group pairs: I vs III, II vs III, III vs IV, III vs V and III vs VI. In comparison of the total values between the groups using One-Way ANOVA was found to be statistically significant. In pairwise comparison of the total values between the groups using Tukey Post Hoc analysis, statistically significant difference existed between the mean values of the group pairs: III vs V and III vs VI. Conclusion: Wave One reciprocating file system used with ProTaper Universal retreatment system showed more efficacy in removing gutta-percha and sealer from the root canal walls when compared to Neoniti Rotary Files and H-files. The use of solvent, Endosolv R did not improve the removal of filling material from the root canals.

144. Diagnostic Accuracy of Abdomino-Pelvic Contrast Enhanced CT scan to Detect Muscle Invasion in Bladder Cancer
M.K. Manu, Nigil Abdul Jalal
Abstract
Background: The standard imaging work-up for gross hematuria and suspected urothelial tumor has shifted from excretory urography to cross-sectional modalities such as ultrasonography (USG), CT, and magnetic resonance (MR) imaging. Cystoscopy and biopsy are the standard of reference for bladder evaluation. Accurate and effective imaging to determine the stage of the primary tumor and/or nodal metastasis in patients with bladder carcinoma is crucial in deciding whether patients should be treated conservatively, or with surgical or radio chemotherapeutic treatment. Regarding the primary tumor, the question of depth of invasion is crucial as the prognosis is far worse for muscle invasive disease (T2, T3, T4). We conducted this study to investigate the diagnostic accuracy of contrast enhanced CT scan compared to histopathology post Trans Urethral Resection of Bladder Tumor (TURBT) in determining muscle invasive disease. Methods: This single centre retrospective study was conducted in the Department of Urology, Government Medical College, Thiruvananthapuram, India. All patients who underwent TURBT (Transurethral Resection of Bladder Tumour) surgery during the period from September 2019 to September 2021 under the department of Urology were enrolled in the study. Exclusion criteria were patients with allergy to contrast material used in CT and those patients who were in renal failure. There were 110 cases in total. Results: Abdominopelvic CT scan had 88.37% sensitivity to detect muscle invasion as compared to histopathology. Fair agreement exists between histopathology and abdomino-pelvic contrast enhanced CT findings with kappa of 0.213 and p value of 0.009. Overall concordance rate was 62.73% and overall discordance rate was 37.27% between histopathology and CT findings. Age and visible tumour in cystoscopy were significant risk factors for muscle invasion. With the increase in age(years), risk of muscle invasion significantly decreased with odds ratio of 0.964(0.929 to 1). Patients with visible tumour in cystoscopy had significantly high risk of muscle invasion with odds ratio of 31.315(5.458 to 179.678). On performing multivariate regression, visible tumour in transurethral cystoscopy was found to be a significant independent risk factor of muscle invasion with adjusted odds ratio of 32.502. Conclusion: Through this study we find that abdominopelvic CT scan had 88.37% sensitivity to detect muscle invasion as compared to histopathology which is the gold standard for the same. Hence abdominopelvic CT scan can be utilised to reliably screen for muscle invasion in bladder carcinoma and may be helpful in staging bladder carcinoma prior to resection and biopsy itself, although further studies using larger numbers of patients are required in future to substantiate the same.

145. Comparison of I-GEL and LMA – Supreme in Patients Undergoing Elective Surgeries under General Anaesthesia: A Prospective Randomised Study
Durgesh Bankar, Preeti More, Tanvi Dhawale, Priyanka Bhot, Nupur, Chaula Doshi, Sarla Pandya
Abstract
Background: In this study, we wanted to compare I-GEL and laryngeal mask airway LMA – Supreme in patients undergoing elective surgeries under general anaesthesia. Methods: This was a hospital based randomized, prospective controlled study conducted among 60 patients undergoing elective surgical procedures in the Department of Anaesthesia, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Ease of insertion of supraglottic airway device (SGA) device was significantly better with IGEL (96.7 %) as compared to LMA – SUPREME (80 %). The difference was statistically significant (p < 0.05). Mean oropharyngeal leak pressure was significantly higher in I-GEL cases as compared to LMA – SUPREME cases (28.65 vs 24.13 mm Hg; p < 0.05). Mean insertion was observed to be significantly faster in I-GEL cases as compared to LMA – SUPREME cases (23.32 vs 29.58 sec; p < 0.05). Conclusion: I-GEL was easier and faster to insert and required less attempts of insertion when compared with LMA-Supreme. I-GEL’s non inflatable thermoplastic elastomer cuff fitted snugly creating a good anatomical seal. The I-GEL also showed less peri- and post-operative complications i.e., blood on removal, hoarseness of voice, sore throat, and dysphagia – as its noninflatable cuff probably decreased the risk of airway tissue compression and hence tissue ischemia. Both   I-GEL and LMA-SUPREME showed no incidence of severe airway trauma, such as laryngeal stridor, laryngospasm, bronchospasm, hypoxia, or aspiration. We thus conclude that I-GEL is a better in view of ease of insertion, placement was rapid and also less traumatic to airways than LMA-SUPREME. So, I-GEL is a cheap and effective SAD alternative to LMA-SUPREME.

146. Physical Fitness Index and Body Fat Percentage in Students – A Cross Sectional Study
Reena Renjit, Jaya Mary George, Sheena P.S., Jery Antony
Abstract
Background: Studies show that students who are physically active tend to have better grades, attendance, cognitive performance (e.g., memory), and classroom behaviours (e.g., on-task behaviour). This study was conducted to evaluate the distribution and relationship between physical fitness index and body fat percentage among students at Government Medical College, Thrissur. Methods: This was a cross-sectional study conducted among 210 students in the Department of Physiology, Government Medical College, Thrissur, from January 2020 to January 2021. PFI and body fat percentage were recorded. Descriptive statistics were used in the study. Results were expressed as percentages and proportions within appropriate confidence intervals. Results: The majority (28.1%) of the study population (n=59) had a poor PFI. Males had a higher mean PFI of 74.4 when compared to the females’ mean PFI of 66.0. Males had a higher mean body fat-free mass of 52.7 when compared to the females’ mean fat-free mass of 43.7. Conclusion: Majority of the students have a poor physical fitness index, which is not a good sign. It is high time that the students take care of their physical health so as to live a life free of diseases.

147. Antibiotic Sensitivity and Bacteriology of Chronic Suppurative Otitis Media in Department of ENT in MIMS Hospital, Vizianagaram
Pentapati Chaitanya, K. Naga Manohar, H. Ramesh
Abstract
Background: Chronic Suppurative Otitis Media (CSOM) is defined as persistent inflammation of the middle ear or mastoid cavity. The aim of this study was to evaluate the antibiotic sensitivity and resistance patterns in CSOM patients attending ENT outpatient department and design an appropriate protocol to treat these patients without further increasing the incidence of resistant strains. Methods: This is a prospective observational study conducted among CSOM patients who presented to the ENT outpatient department with ear discharge. Ear swabs from these patients were collected and sent to the microbiology department for bacterial culture and sensitivity along with gram staining. Results: Of the 58 patients studied, 64% were males and 36% were females. Of the organisms isolated Staph aureus (53%) was most common followed by Pseudomonas (36%). All the gram-positive organisms were sensitive to gentamycin, amikcin and cotriamoxazole, and all gram-negative organisms were sensitive to netlimycin, amikacin and ciprofloxacin. Conclusions: All CSOM patients should be advised to get their ear swab sent for pus culture and sensitivity, and they should be advised to receive antibiotic therapy based on sensitivity report and never use antibiotics randomly to reduce the incidence of antibiotic resistance.

148. A Clinical Study on the Correlation between Primary Open Angle Glaucoma and Serum Lipids
Vijay Kumar T.S., Satyendranath Shetty B.
Abstract
Background: One of the leading causes of blindness in the world is Glaucoma. The primary risk factor is Intra Ocular Pressure. But some cases progress even with control of intra ocular pressure. This substantiates the view that there are independent risk factors in pathogenesis of Glaucoma. This study was carried out by us to study the relation between Primary Open Angle Glaucoma and Serum Lipids. Methods and Materials: This study was conducted on 45 patients with POAG and 45 individuals without Glaucoma (Controls). Ophthalmic examination was performed on all patients and Fasting Lipid profile including Total Cholesterol, Low density lipoprotein, High Density Lipoprotein and Triglycerides were measured and analysed between cases and controls. Results: It was noted that the level of total cholesterol, total glycerol and LDL were significantly higher in cases than in controls with P values < 0.06. level of HDL was lower in controls but it was not statistically significant. Conclusion: Dyslipidemia is an independent risk factor for POAG. High levels of Serum Cholesterol, Serum Triglycerides and serum LDL corelate significantly with POAG.

149. A Study of Histopathological Pattern of Breast Lesions in Central India, Madhya Pradesh
Abha Patel, Mariya Khatoon Ansari, Gautam Chandakoshi, Geeta Devi
Abstract
Introduction: The breast is a common site for pathologies which predominantly involves the female breast. While benign diseases are more common, malignancies are of utmost concern for the patients, clinicians, and the pathologists. Aim: This study aims to evaluate the frequency, age, gender, and histopathological features of breast lesions in a tertiary care hospital. Materials and Methods: This retrospective study was conducted in the Department of Pathology, in tertiary care centre, central India, Madhya Pradesh, from January 2020 to December 2022. Tissue for hematoxylin and eosin (H and E) sections was fixed in 10% formalin and subjected to routine paraffin-embedded processing and stained with H and E stain. The histopathological features were noted, and the tumors were diagnosed based on the WHO classification. Results: Out of 290 cases of breast lesions, 12 were inflammatory lesion (4.1%), 199 were benign breast lesions (68.6 %) and 79 were malignant (27.2 %) with a benign and malignant ratio of 2.52:1. Fibroadenoma was the most common benign breast lesion, being 174 out of 199 (87.4 %) and infiltrating duct carcinoma was the commonest malignant breast lesions. Breast lumps most commonly affected 26-35 years of age group (37.5%). Females accounted for 281 cases (96.8%) with female to male ratio of 31.2:1. Conclusion: Study of histopathological patterns of breast lesions plays an important role in diagnosis, treatment, and prognosis of breast lesions. This study highlights incidence and pathological characteristics of a wide range of breast lesions. The clinical diagnosis of a breast lump must be correlated with histopathological diagnosis for correct and adequate treatment of patient.

150. A Comparative Study between Intrathecal Neostigmine in Variable Doses (50mG and 100mG) Versus Fentanyl (25mG) for Postoperative Pain Relief
Rama Kant, Ganesh Gupta, Shilpa Sharda
Abstract
Introduction: Spinal anaesthesia is a widely practiced technique in anaesthesiology. Spinal anaesthesia is thought to be an easy technique and has proved to be extremely safe when managed well. Post-operative pain is of great concern for patients and to control it a challenge for anaesthesiologist. Aim: The aim of our study is to compare efficacy of analgesia following intrathecal administration of fentanyl and neostigmine, to assess the duration and extent of analgesia, to compare the haemodynamic changes and to study side effects. Methods: Eighty patients of ASA I and II of age group 18-60 yrs physical status undergoing elective lower abdominal and lower limb surgery were enrolled into this study. The patients randomly divided into 4 groups of 20 patients each. Group1-Neostigmine50µg(1ml)+Bupivacaine15mg(3ml). Group2-Neostigmine100µg(1ml)+Bupivacaine15mg(3ml). Group3-Fentanyl 25µg(1ml)+ Bupivacaine15mg(3ml). Group4-Normal saline 1ml +Bupivacaine 15mg(3ml). Level and duration of anaesthesia, VAS score, adverse effects were noted. Results: The mean duration of analgesia (min) distributed among each group in relation to the first dose of rescue analgesia administered at VAS 4/5 are group1 – 302.65±47.36, group 2 – 280.55±31.26, group 3 – 215.25±29.47 and group 4 -156.65±32.08. Thus group1 had longest mean duration of analgesia as compared to other groups. Maximum level of sensory block T4 achieved in more number (13) of patients in group 1 as compared to 12 in group 4, 9 in group 2 and 10 in group 3. Conclusion: Intrathecal neostigmine results in post-operative pain relief that too is dose dependent and more or less similar to analgesia obtained with fentanyl. Intrathecal neostigmine could be an alternative to opioids for postoperative pain relief and 50µg is better than 100µg having lesser adverse effects.

151. Comparison of Duration of Laryngoscopy and Hemodynamic Responses to Endotracheal Intubations Performed with Video Laryngoscope versus Mccoy Laryngoscope in Adult Patients Scheduled for Elective Surgery under General Anaesthesia: A Prospective Randomized Non-Blind Study
Sonali Gupta, Prakash Chandra Audichya, Anupriya Sahaya, Swati Sharma, Sonu Ola, Krishan Gopal Jangir, Vijay Kumar
Abstract
Background & Objectives:  Laryngoscopy and endotracheal intubation can cause exaggerated hemodynamic responses during intubation. Different laryngoscope blades and video laryngoscopes have been explored to reduce these responses. Aim is to evaluate the king vision video laryngoscope in comparison to McCoy laryngoscope with respect to hemodynamic response, duration of intubation, ease of intubation in ASA grade 1 and 2 patient undergoing with elective surgery under General anaesthesia. Methods: This study included 60 ASA I and ASA II patients aged 18-65 undergoing elective surgery. The patients were randomly assigned to two groups: Group V 30 patients (laryngoscopy with video laryngoscope), Group M 30 patient (laryngoscopy with McCoy blade). Hemodynamic parameters (HR, saturation, SBP, DBP, MAP) were monitored at baseline, before intubation, and at various time intervals after intubation. The duration of laryngoscopy and the hemodynamic changes following intubation were recorded. Results:  The study found no significant differences in age, gender distribution, ASA grade, MPG grade, or number of attempts between the king vision video laryngoscope and McCoy laryngoscope groups. However, the McCoy laryngoscope took longer for laryngoscopy (33.46±3.41) p-value 0.001*. Heart rate and blood pressure were higher in the McCoy group at various time points during and post intubation. The mean Heart rate at Intubation (T0) p value 0.002 *, post-intubation (1 minute) p value 0.011 *, post-intubation (3 minutes) p value 0.008 *and post-intubation (5 minutes) p value 0.020 * was significantly more among McCoy Laryngoscope. The mean MAP at Intubation (T0) p value 0.008*, post-intubation (1 minute) p value 0.010, post-intubation (3 minutes) p value 0.046* and post-intubation (5 minutes) 0.033 *was significantly more among McCoy Laryngoscope. Conclusion: It was concluded that the King Vision Video Laryngoscope was better in term of blunting hemodynamic response arising out of laryngoscopy and intubation along with shorter duration of laryngoscopy when compared to McCoy laryngoscope.

152. A Review of Retinoblastoma and its Current Management
Aishwarya Kulkarni
Abstract
Retinoblastoma is a malignant tumor of the eyeball commonly seen in small children. Its management is becoming complex as it is becoming necessary to rely on International Classification of Retinoblastoma (ICRB). The treatment also depends upon germline mutation, available institutional resources and psychosocial factors of the family.  Pub Med was used to make the write up of this review article from 1945 to 1996. The keywords used for this search were retinoblastoma, germline mutations, family history, EBRT, Chemotherapy, Intra-arterial chemotherapy and chemotherapy, intravenous chemotherapy, and chemo reduction. The hypotheses for the origin and spread of Retinoblastoma were discussed, followed by the current treatment since 2020 which included intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC), intra-vitreal chemotherapy (IvitC), radiation-based therapies (external beam radiotherapy [EBRT] and plaque radiotherapy), and Enucleation. An overall consensus treatment options practiced in India were discussed in detail.

153. A Retrospective Study of PPH Cases at A Tertiary Health Care Centre
Shanmugapriya, Padmapriya, E. Sukanya, Sowmya
Abstract
Background: Postpartum haemorrhage is an obstetric emergency where it is one of the leading causes of maternal deaths worldwide. Many complications associated with maternal mortality are preventable and avoidable if rational scientific approaches are taken to management. The 1997-1999 UK confidential enquiries concluded that the routine use of national guidelines resulted in a significant decrease in deaths. Hence, this study is aimed to analyse risk factors, causes of PPH and morbidity and mortality due to PPH. Aim of this study is to study about risk factors, causes, morbidity and mortality of Postpartum Haemorrhage. Methods: This study was conducted in Department of Obstetrics and Gynecology, Government Dharmapuri Medical College, Dharmapuri as a retrospective observational study, study included all cases of PPH (including referred-in cases) in study period of June 2020-June 2022. Records were analyzed with respect to maternal age, parity, socio-demographical & etiological profile and various complications occurring as sequelae to postpartum hemorrhage and the maternal deaths. Results: Records were analysed with respect to maternal age, parity, aetiology and maternal consequences in cases of PPH. In our study, incidence of PPH was found to be 1.2 % Most common cause of PPH was uterine Atony (80%).The second most common cause of PPH was Genital tract Trauma (17%). 16% of the cases needed transfusion of blood. Maternal death due to PPH in our study was 0.02%. Conclusion: Proper risk stratification and identification, skilled management along with the timely referral will lead to significant reduction in maternal morbidity and mortality. Maternal deaths due to PPH are clearly declining due to timely referral, intervention and education of healthcare workers.

154. Comparative Analysis of the Dexmedetomidine, Lignocaine, and Their Combination on the Hemodynamic Response During Laryngoscopy and Intubation
Pujaben A Barad, Pringalkumar Pravinbhai Gohil, Arpit Shah
Abstract
Background and Aim: Several pharmaceutical and non-pharmacological methods have been used to lessen the hemodynamic response to laryngoscopy and endotracheal intubation. The current study set out to determine whether Lignocaine (1 mg/kg), Dexmedetomidine (0.5 mcg/kg), or a combination of these two low dosages (Dexmedetomidine and Lignocaine) would be more successful in lowering the hemodynamic response to intubation. Material and Methods: 150 total ASA grades After receiving approval from the institutional ethical committee, 1 patients between the ages of 18 and 60 were enrolled for the study. By using the envelope method, patients were sorted into three groups of 50 each: Group L, Group D, and Group DL. Vital indicators such HR, SAP, DAP, and MAP were measured at baseline, following the administration of the study drug, during induction, and 1, 3, 5, 7, and 15 minutes after intubation. Results: It was discovered that for the whole 15-minute study period following intubation, the mean HR and BP in group DL stayed below baseline values. Conclusion: It is generally known that BP and, to a lesser extent, HR fluctuations that are more than 20–25% from baseline may be harmful. Therefore, it is vital to keep an eye out for this alteration even when the findings are within the usual range. A combination of low dose dexmedetomidine (0.5 mcg/kg) and lignocaine (1 mg/kg) effectively reduces the pressor response during laryngoscopy and intubation without having any negative hemodynamic effects, as opposed to lignocaine (1.5 mg/kg) alone or a high dose of dexmedetomidine (1 mcg/kg) alone.

155. Panoramic View of Histopathology of Nephrectomy Specimens
Shatarupa Das, Ranu Tiwari Mishra, Noopur Gupta, Sanjay Totade, Jagmohan Singh Dhakar
Abstract
Background: Kidneys are affected by various disease processes resulting in permanent deterioration of function causing significant morbidity and mortality. Nephrectomy is the standard surgical procedure performed in cases of suspected malignant renal disease and End Stage Renal Disease (ESRD). Objectives: To evaluate histopathological features of various lesions in nephrectomy specimens and classify renal neoplasms as per “WHO Classification of Renal Tumors” and study their age and gender distribution. Materials and Methods: A retrospective study is done for a period of 1 year from January to December 2021 which includes 41 specimens received in the Department of Pathology at Netaji Subhash Chandra Bose Medical College, Jabalpur. Patient particulars and radiological details were noted. According to CAP protocol, representative sections were submitted, H&E staining and reporting was done. Results: In the 41 received specimens, the age varied from 1-78 years, majority were in 31-50 years with 20 cases (50%). The male: female ratio was 1:1.1. Non-neoplastic lesions were 30(73%) and neoplastic were 11(27%),all were malignant. Among malignant lesions, 3 cases each of Papillary Renal Cell Carcinoma and Chromophobe Renal Cell Carcinoma (60%),2 cases(20%) clear cell Renal Cell Carcinoma,1 case of post chemotherapy Wilm’s tumour were reported. A rare case with hidden malignancy of “Urothelial Carcinoma and glandular differentiation’ and Xanthogranulomatous Pyelonephritis was also reported in a nephrectomy specimen of nephrolithiasis. Among 30 non-neoplastic lesions, most common diagnosis was chronic pyelonephritis with 24 cases (80%) followed by 2 cases each of necrotizing granulomatous pyelonephritis and xanthogranulomatous pyelonephritis(13.4%).Out of 24 cases of chronic pyelonephritis,1 case showed squamous metaplasia of calyx. Another rare case of post chemotherapy myeloid sarcoma also showed chronic pyelonephritis. Conclusion: Meticulous histopathological examination of surgical specimens is necessary for proper diagnosis and further treatment as it not only confirms clinical diagnosis but may also detect unsuspecting associated malignant lesions.

156. Effects of Training on Pulmonary Function Test in Long Distance Runners
Sanjay Nehe, Ranjit Ambad, Chandralekha Singh
Abstract
Background: Running is one of the most popular exercises practiced across the world. Owing to regular exercise during running, long distance runners usually have increased pulmonary/respiratory capacity compared to non-exercising individuals. The present study was conducted in a tertiary care academic hospital with an aim to assess pulmonary function test in long distance runners. Methods: A total of 50 long distance runners and 50, age matched individuals with leisure-time physical activity or activities done for less than 20 minutes or less than 3 times/week were included in the study. The PFT was performed by using Medspiror (Computerized spirometry) after reinforcing the method of test to each participant. Result: All parameters of PFT like forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), forced expiratory volume in three second (FEV3), peak of expiratory flow rate (PEFR) and FEV1/FVC ratio were significantly high in long distance runners and controls. Conclusion: Physical exercise in any form has positive effect on respiratory system of an individual. As running improves/enhances vigor of respiratory muscles, it increases the function of pulmonary system. The current study, underscores the importance of regular running to improve the pulmonary function.

157. Strain Imaging: Utility in Early of Chemotherapy Induced Cardiac Dysfunction Diagnosis, an Edge Over Routine Echocardiography
Bhavesh Talera
Abstract
Introduction: cancer is the second-leading contributor to mortality worldwide, and between 2020 and 2025, In terms of the most common cause of mortality, it is anticipated to surpass heart disease. Global longitudinal strain was assessed by Negishi et al. using speckle tracking in breast malignancy patients, in addition to it was found that strain was an additional interpreter of decreased LVEF as well as an independent predictor of chemotherapy-induced cardio-toxicity. In current breast cancer patients, strain imaging has also been utilized towards identify subclinical cardiotoxicity brought on by radiation therapy. Conventional echocardiogram revealed no differences, but at all post radiation management interval periods aimed at left-sided patients nevertheless not aimed at right-sided patients a decline in global strain as well as anterior wall strain (area of greatest mean dose) was seen. Aims and Objectives: To determine the efficacy of strain imaging over routine echocardiography in early diagnosis of cardiac dysfunction induced by chemotherapy. Methods: A randomized controlled trial with 200 patients divided into two groups, “GLS-guided and EF-guided, was conducted to measure the efficacy of surveillance of anthracycline-based cancer therapy-induced cardiotoxicity. All facilities involved performed calibration exercises to ensure accurate measurement of echocardiographic data. Patients underwent baseline echocardiograms before starting or supplementing anthracycline medication, followed by echocardiograms every three months. Patients in the GLS-guided arm received ACE inhibitors and beta-blockers upon diagnosis of LVEF-CTRCD or a 12% relative GLS reduction. Results: The study found that the difference in left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) between baseline and 1-year follow-up for patients in the EF-guided and GLS-guided groups. The difference in LVEF between the two groups was not statistically significant (P=0.68), but the GLS-guided group had a slightly smaller reduction in GLS compared to the EF-guided group (P=0.09). Both groups had a significant reduction in LVEF and GLS from baseline to 1-year follow-up (P<0.001). The results suggest that GLS-guided surveillance may help prevent a significant reduction in LVEF to the abnormal range in patients receiving anthracycline-based cancer therapy. The GLS-guided group had significantly higher rates of receiving ACE inhibitors/ARBs (P<0.001) and beta-blockers (P=0.006) compared to the EF-guided group. Both groups had similar rates of achieving maximal doses of ACE inhibitors/ARBs and beta-blockers. The results suggest that GLS-guided surveillance may lead to higher rates of receiving cardioprotective medication in patients receiving anthracycline-based cancer therapy. Conclusion: The study shows that using global longitudinal strain (GLS) for surveillance of cardiotoxicity in patients undergoing anthracycline-based cancer therapy can help prevent a meaningful fall of left ventricular ejection fraction (LVEF) to the abnormal range.

158. Socioeconomic and Lifestyle Factors of Childhood Obesity Among School Students in the Metro City of Western India: A Cross-Sectional Study
Mahesh Shinde, Praveen Davuluri, Amit Mohite
Abstract
Introduction: An increase in the prevalence of obesity among young people is anticipated by the year 2030, making this a serious public health concern. Obesity risk is increased by a low socioeconomic level (SES) and by family problems. The issue is perpetuated by traumatic experiences in early life and a lack of access to healthy foods. The problem is made much worse by urbanisation, technology, and sedentary lives, especially in India. Aims and Objectives: This cross-sectional study examines the relationship between childhood obesity and socioeconomic and personal characteristics in a large city in Western India. Methods: a cross-sectional study of students by employing a randomised sampling technique that considered both school type and proportional allocation. This method collected data regarding demographics, eating patterns, and junk food consumption with the use of tool semi-structured survey administered during a single visit. Results: 309 students from various religious and educational backgrounds are shown in Table 1. Table 2 presents gender-specific anthropometric and BMI results. Table 3 compares BMI to religious affiliation, parental education, occupation, and junk food consumption at different schools. Table 4 shows that private schools, Muslims & Christian religion and parents with professional or commercial backgrounds are likelier to have children with abnormal BMIs. Parent’s education, occupation, and junk food intake had no significant relationships. Conclusion: The study demonstrates that private schools have a major childhood obesity problem. Again, this study is limited by its cross-sectional methodology, Indian BMI classification, lack of physical activity and sexual maturity assessments.

159. Comparative Analysis between Valproate and Phenytoin in Convulsive Status Epilepticus in Pediatric Population
Prashant Kariya
Abstract
Introduction: Status epilepticus (SE) is a common neurological emergency in children that calls for prompt and aggressive treatment and occasionally presents a therapeutic challenge to the attending physician. The main anti-epileptic impact is brought about by voltage-dependent sodium channels being inhibited. Phenytoin reduces sodium input into neurons, which reduces excitability, by acting on the intracellular portion of the ion channel. Since action depends on both use and concentration, it should start as soon as an effective concentration is attained. The most frequent neurologic emergency, generalized convulsive status epilepticus (GCSE), accounts for 1% to 2% of all visits to the emergency room. Any seizure lasting more than 30 minutes is considered to be in the status epilepticus (SE), regardless of whether awareness is affected or whether subsequent seizures occur without a break in consciousness. Aims and Objectives: To compare the efficacy between valproate and phenytoin during status epilepticus among children. Methods: A randomized double-controlled study was conducted on 100 pediatric patients who visited the outpatient department. Injections of sodium valproate (Valprol, 5 mL per 500 mg, Intas Pharmaceuticals, India), and sodium phenytoin (Ciroton, 2 mL per 100 mg, Ciron Pharmaceuticals, India) were used. The baseline characteristics were determined before the drug treatment and the outcome assessment factors were assessed after the drug treatment of each group at prescribed dosage and duration. required statistical analysis was conducted. Results: The patients were divided equally into 2 groups phenytoin and valproate. Males are more in valproate group (60%). Generalized convulsive seizure are mostly seen in valproate group (90%) compared to phenytoin group (76%). Hypocalcemia is seen mostly in phenytoin (12%) than valproate (10%). The primary outcome is seen in 90% of phenytoin group and 82% in valproate group. The phenytoin group had a greater rate of additional medicine to control the seizure after control of the seizure by study drug (21.3%) compared to the valproate group (11.6%). Conclusion: This study has demonstrated that phenytoin and valproate are equally effective in reducing seizure frequency in the treatment of paediatric convulsive status epilepticus

160. Vertigo and Thyroid Disorders: A Correlational Study
Raghav Mehta, Aditi Sharma, Priya Dogra, Mukesh Dagur, Rashmi Goyal
Abstract
Background: Thyroid hormones play a role in the development and functioning of the inner ear. Therefore, it was hypothesised that a derangement in the thyroid hormone levels can affect the cochleo-vestibular system. Methods: The present study included 30 cases BPPV were studied. All the subjects underwent thyroid function tests-serum T3, T4 and thyroid stimulating hormone (TSH) and full Vertigo workup. Results: Out of all 30 cases 14 showed altered Thyroid Profile. Conclusions: There seems to be an association between functional thyroid hormone levels and BPPV. Therefore, altered Thyroid metabolism may have a role in the causation of vestibular dysfunction as in BPPV.

161. Surgical Mesh an Eye Support Post Total Maxillectomy: A Case Study and Review of Literature
Mehta Raghav, Sharma Aditi, Dogra Priya, Punjabi Mohit, Goyal Rashmi, Dagur Mukesh, Patidar Pradeep
Abstract
Introduction: Post Maxillectomy reconstruction is more commonly done by prosthesis. Surgical management by microvascular grafting or autogenous tissue is more agreeable but is not always possible. Also surgical reconstruction is expensive, not readily available and if failure occurs then prosthetic reconstruction becomes a better option. Given the irregular cavity created post Maxillectomy and the shape of the orbit, meshes provide a reliable alternate to bone and help in preventing enophthalmos, diplopia, visual acquity defects, restricted eye movements etc. Material and Methods: After complete removal of the maxilla and achievement of hemostasis, the mesh was cut to adequate shape. The mesh was then inserted in the defect to form a sling and sutured to soft tissue around zygoma and attached soft tissue laterally and to nasal septal mucosa or turbinates medially using Vicryl 3-0 sutures. Adequate support was achieved for the orbital contents in a hammock like fashion. Incision was closed and the cavity given time to heal and approximately 3-4 weeks after surgery a fabricated obturator is used for rest of the cavity. Conclusion: Prolene propylene mesh though a primary material in abdominal surgery can be used to as an effective Post Total Maxillectomy Orbital support both in case of obturator use or in free flap repair.

162. Association of Hyperprolactinemia with Hypothyroidism in Infertile Women: A Cross Sectional Observational Study
Swati Gett, Sushila Bhuriya
Abstract
Background: Thyroid and prolactin hormone levels are associated with fertility disorders among women. This study aims to find out the correlation between hyperprolactinemia and its correlates with hypothyroidism in female infertility. Aims & Objectives: To assess the biochemical association of hyperprolactinemia in infertile women with hypothyroidism. Material & Methods: This cross-sectional observational study recruited 100 infertile women who came to the Department of Obstetrics & Gynecology, of our tertiary care hospital from April 2022 to March 2023. Women diagnosed with primary infertility & marriage span of >2 year were included in the study. Complete history taking, general & medical examination was conducted by an experienced gynecologist. Venous sample was collected & sent to lab for assessment of Complete blood count, haemoglobin level, renal function test, blood sugar levels, and serum TSH & Prolactin levels. Normal serum TSH levels considered were 0.35-5.5 μIU/ml. Hyperprolactinemia was considered if prolactin levels were >25 microgram/L. Results: A total of 100 patients were enrolled in this study, out of which 21% were <24 yrs. age, 36% were 25-29 yrs of age, 33% were 29-39 yrs of age, 26% were of 30-34 yrs age & 17% were in 35-40 yrs of age. The mean age, duration of marriage, mean serum TSH levels & serum Prolactin levels were observed to be higher in infertile women (p value <0.05). No statistically significant difference in the mean serum TSH levels & serum Prolactin levels were observed in primary & secondary infertility groups (p value >0.05). A positive correlation was observed between the age of women, the number of years of marriage & infertility was observed (p value <0.05). A positive correlation between mean serum TSH levels & serum Prolactin levels were observed (p value >0.05). Conclusion: Abnormally high prolactin levels & low thyroid levels were observed in infertile women. Infertile couples should be regularly screened for evaluation of prolactin and TSH levels for an early intervention & conception.

163. The Use of Fibular Fixation with Plating as Supplementary to Intramedullary Interlocking Nailing of Tibia for Distal Third Both Bones Fracture of Leg: A Prospective Study
Lokesh M, Kiran Kumar HV, Santosh Kumar K, Nayeemulla Baig
Abstract
Introduction: Distal tibia extra-articular fractures are often a result of high energy trauma, fall from height or twisting injuries. They are commonly associated with fibular fractures and soft tissue injuries. Both bones fracture has been correlated with higher severity of injury than those with isolated tibia fractures. The goals of study are to include correction and maintenance of sagittal and coronal alignment, establishment of length and rotation and early functional range of movements of knee and ankle. As there is mismatch between the diameters of nail and the medullary cavity, with no nail-cortex contact, the nail may translate laterally along the coronally placed locking screws and increases stress in place on the locking holes to maintain fracture alignment post-surgery leading to varus or valgus deformity. Methodology: The study was conducted in the department of orthopaedics at KIMSH Bangalore. All patients included in the study were assessed clinically and confirmed radiologically to avoid any other pathology. Plain radiographs of Knee, Leg and Ankle in AP and lateral view of affected site were taken. After diagnosis, the patients were selected for the study depending on inclusion and exclusion criteria. Surgery was performed under strict aseptic precautions. All the patients underwent same method of treatment and were assessed post operatively based on the Karlstorm-Olerud Performance Score. Regular OPD follow up done at 6, 12 and 24 weeks. Results: Post-operative wound care was sought and physiotherapy started. By the end of 3 months, the affected limb had similar range of motion as the normal limb and out of 20 cases, the results were excellent in 13, Good in 5 and fair in 1 and Poor in 1 case. The alignment was well maintained in both sagittal and coronal plane. Conclusion: Fixation of the fibula along with interlocking nailing of the tibia for distal third fractures both bones leg decreases the mal-alignment of the tibia and mal-rotation of the ankle as compared with only interlocking nailing.

164. Assessment of Ultrasound-Guided Transversus Abdominis Plane Block with Bupivacaine and Ropivacaine as Adjuncts for Postoperative Analgesia in Laparoscopic Cholecystectomies
Joji P John, Sayooj K S, Safiya Sherrin MK, Azeem V P
Abstract
Aim: To assess ultrasound-guided transversus abdominis plane block with bupivacaine and ropivacaine as adjuncts for postoperative analgesia in laparoscopic cholecystectomies. Methodology: Fifty American Society of Anesthesiologists Physical Status I/II patients of either sex, aged 18–65 years, scheduled to undergo 4-port laparoscopic cholecystectomy of both genders were divided into 2 groups of 25 each. Group I underwent ultrasound-guided TAP block with 0.25% bupivacaine (plain) and group II underwent ultrasound-guided TAP block with 0.375% ropivacaine (plain). All patients were assessed for post-operative pain and rescue analgesic consumption at 10 min, 30 min, 1 hour, 4 hours, 8 hours, 12 hours and 24 hours time points. Results: Group I had 15 males and 10 females and group II had 13 males and 12 females. The mean weight in group I was 63.2 Kgs and in group II was 62.8 Kgs. The mean height was 157.4 cms in group I and 159.3 cms in group II. Duration of surgery was 72.4 minutes in group I and 75.2 minutes in group II. The difference was non- significant (P> 0.05). The mean pain score at 10 minutes in both groups was 0.0. At 30 minutes was 1.5 in group I and 0.0 in group II. At 1 hour was 1.9 in group I and 0.0 in group II. At 4 hours was 2.3 in group I and 2.4 in group II. At 8 hours was 2.1 in group I and 2.2 in group II. At 12 hours was 1.5 in group I and 2.0 in group II. At 24 hours was 1.1 in group I and 1 in group II. The difference was significant (P< 0.05). Conclusion: The ultrasound-guided deposition of ropivacaine 0.375% in the TAP provided superior analgesia in the early post-operative period in comparison to bupivacaine 0.25% in patients undergoing laparoscopic cholecystectomy.

165. A Cross-Sectional Survey on Psychosocial Challenges in Hard of Hearing Students During COVID-19 and Proposed Methods on E- Learning
Packiaraj Selvajothi, Subramanian Kuzhali, Nallasivam Lavanya, Sangayya Sangeetha
Abstract
Background: The Covid-19 pandemic will be ruminated in the history as the whole world is facing a global crisis. Though it is combated efficiently by appropriate treatment and preventive measures, it has left behind psychosocial challenge. The hard of hearing community in this pandemic situation are having a severe psychosocial impact especially among school and college students. The aim of the present survey is to assess the psychosocial status of hard of hearing students not attending school due to lockdown during this Covid 19 pandemic through a questionnaire. Material and Methods: A cross-sectional descriptive questionnaire survey was done to evaluate COVID-19-related awareness and the psychosocial challenges among hard of hearing individuals in December 2020, in Tamil Nadu. The questionnaire included a set of 17 questions which were framed to assess the knowledge of Covid-19 and to determine the psychosocial status through Likert scale. All data were statistically analysed using SPSS 20.0. The significance level of tests was fixed at p<0.05. Results: A total of 113 hard of hearing individuals in the age group between 15-25 years years participated in the study. 42% of the study population either strongly agree or agree that maintaining social distancing affects communication. 77 % have felt that wearing mask is very important in preventing COVID 19. 91% and 89% of the study population have either agreed or strongly agreed that wearing mask affects communication with others and could not understand what other people converse due to hinderance of lip reading by masks. 95% felt the need for specially designed customised transparent face masks are necessary for easy communication. Conclusion: This study assessed COVID-19-related awareness and the psychosocial status among the hard of hearing. The present study would like to state and emphasise the need and importance of transparent face masks. Connectedness with hard of hearing population effortlessly, is needed during this pandemic situation to make the society more comfortable for them.

166. Carbapenem Resistance in Clinical Isolates of Escherichia Coli among Patients Visiting A Tertiary Care Hospital, in Central India
Navdeep, Harshada Shah, Amit Kumar Bhart, Komal Singh
Abstract
Introduction: The emergence and increase of Carbapenem resistance in Escherichia coli is now posing a serious threat to human health around the world. Our study aimed to investigate the phenotypic and genotypic detection of Carbapenem resistance among E. coli isolates. Material Method: The present study was carried out in the Department of Microbiology, Index Medical College, Hospital & Research Centre (IMCHRC) Indore (M.P.). Various clinical samples were collected from the patients attending Medical College, Hospital & Research Centre (IMCHRC) Indore (M.P.). Total 215 E.coli isolates were examined regarding age, sex, departments and Carbapenemase resistance among different clinical specimens such as urine, pus, blood, CSF and respiratory secretions received in microbiology laboratory. Results: It is observed that out of 215 E.coli isolates, about 153 (71.16%) isolates were from male patients while 62 (28.83%) were from female patients. The majority (53.95%) of isolates were from urine samples. Out of 215 E. coli isolates, total 63 (29.30%) were carbapenem resistant. Conclusion: the rate of Carbepenem resistant E.coli is rising very quickly and becoming most important problem in the part of infectious diseases. Hence, now it is very important to detect the changing pattern of resistance as soon as possible to prevent the sread of resistant bacteria and modifying the strategies of treatment.

167. Inducible Clindamycin Resistance among Staphylococcus Aureus from Clinical Isolates Samples in Tertiary Care Hospital Center, Indore (M.P)
Komal Singh, Harshada Shah, Amit Kumar Bharti, Navdeep
Abstract
Introduction: Antimicrobial resistance agents of staphylococci species are raising problems all around the epidemic area. Staphylococcus aureus infections to treatment by antibiotics were renewed be attractive to age of macrolide-lincosamide-streptogramin B (MLSB). Medical disturbance have to describe due to all of kind mechanisms that confer resistance to MLSB antibiotics. In this present study were aimed to detect the iCR and sentivity to erythromycin in staphylococcus aureus and where these study the was correspondence between clindamycin and Methicillin resistance other than methicillin sensitivity. Materials and Methods: From July 2020 to June 2021in this period, out of 155 (46.3%) staphylococcus aureus were isolated from different clinically specimens in the study. According to CLSI-2019-20,21 guidelines detection of antimicrobial susceptibility test (AST) was done by Kirby-Bauer’s disc diffusion method. For using perception inducible clindamycin resistance and erythromycin résistance was perform to detection by d test according to CLSI guideline and where deferent phenotypes method were interpreted as methicillin-sensitive (MS) phenotype negative test, constitutive MLSB phenotype and inducible (iMLSB) phenotype as positive test. Results: Among 155 Staphylococcus aureus were isolated predominate from pus 48 (30.9%) followed by 36 (23.7%) were urine and where 27 (17.4%) were blood. In this present study were isolated to sensitivity such as linezolid and vancomycin. Out of which 155 (51.7%) were isolated in staphylococcus aureus resistant to erythromycin and among in this present study 91 (58.7%) were MRSA followed by 64 (42.3%) were MSSA. Among the 155 isolates resistant to erythromycin, where 50 (32.3%) inducible iMLSB D were test positive followed by 69 (44.5%) were negative test among MS phenotype and where 36 (23.2%) were isolated among cMLSB phenotype. Compare to more than one method using were detection inducible percentage %, constitutive cMLSB and MS phenotype resistance were equal in the MRSA and MSSA in staphylococcus aureus. Conclusion: d-testing might help to decide whether to use Clindamycin sensitivity in Staphylococci species infections when erythromycin resistance as confirmation by Kirby Bauer disc diffusion method according CLSI 2020-21 guideline.

168. Diagnostic Utility of  Reporting Thyroid Lesion Cytology by the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)
Pooja Kesharwani, Amit V. Varma, Sanjana Ahuja, Kamal Malukani, Harshita Deep Sahu
Abstract
Background: Fine needle aspiration cytology, is an initial investigation in evaluation of thyroid lesions. Due to lack of standardized system for reporting thyroid lesions in cytology; in 2007, TBSRTC was introduced. It is a six tier system. Aim: To compare The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) with the conventional Cytopathology method and their concordance with histopathological diagnosis. Objective: To compare the morphological diagnosis and classification of thyroid lesions as per conventional Cytopathology method & TBSRTC . Also compare the cytological diagnosis of thyroid swellings with the radiological findings and histopathological proven cases as and when possible. Material & Methods: The study included 163 cases of thyroid swellings in which 59 cases underwent surgery. Clinical and radiological details were retrieved from the hospital database and were subjected to histopathological evaluation. Results: In our study, out of 163 cases, majority were females ( 139, 85.3%) . Age ranged from 17-77 years; mean age was 43 years. Adequacy rate was 92 %. Category II had maximum cases; i.e, 122 .The sensitivity, specificity , PPV and NPV in 59 cases were 94%, 82%, 89%, 90% by conventional cytopathology method; and 97% , 86% , 92% , 95% by TBSRTC respectively. Thus overall TBSRTC was found to be better. Conclusion: Category I and II had more accurate categorization index. Category V and VI had precision in the diagnosis, that indicates clear cut distinctions between the two ends of spectrum . Category III and IV cases had high discordant rate. This suggests that there is need for further clarity for diagnostic categorization. The findings of TBSRTC could be further refined by applying more advanced immune cytochemical methods and molecular genetic analysis.

169. Study to Determine the Association of Cholelithiasis, Choledocholithiasis and Hypothyroidism
Mo Faisal, Rekha Porwal, Divija Dutta, Ram Prasad
Abstract
Introduction: Hypothyroidism causes dyslipidaemia and stasis of bile and sphincter of oddi dysfunction causing cholelithiasis and choledocholithiasis. Aim: to study the prevalence of hypothyroidism in patients presenting with cholelithiasis/ choledocholithiasis. Methods: This cross-sectional study was conducted on 100 patients having cholelithiasis/ choledocholithiasis. All the patients were assessed for thyroid profile, lipid profile and prepared for cholecystectomy after abdominal ultrasound. Results: Among 100 patients, the majority them were in 40–49 (40%) years age group, 24 (35.29%) of them were females and 16 (50.00%) were males. 26 patients have hypothyroidism (7- clinical and 19 – subclinical). The mean total cholesterol level was 151.46 ± 26.57 mg/dl in euthyroid and 232.34 ± 33.72 mg/dl in hypothyroid patients, mean LDL level was 95.27 ± 21.46 mg/dl in euthyroid and 153.92 ± 28.68 mg/dl in hypothyroid patients which was statistically significant (p<0.0001). Mean HDL level was comparable in all patients. Among the hypothyroidism patients 18 (69.29%) were female and 8 (30.77%) patients were male. Conclusion: When treating patients with cholelithiasis or choledocholithiasis, physicians should be aware of the possible background of hypothyroidism and should consider evaluation of thyroid function in female patients at least 40 years of age.

170. A Study on Role of Nasal Obstruction Symptom Evaluation Scale in the Management of Allergic Rhinitis
Hitender Basista, Rohit Saxena, Sanjeev Awasthi
Abstract
A variety of symptoms are possible for patients with allergic rhinitis. The intensity of symptoms is evaluated using the 5-point Nasal Obstruction Symptom Evaluation Scale (NOSE) and levels of absolute eosinophil count. (AEC). A prospective observational research including 70 patients in a tertiary care hospital was conducted. A complete clinical examination, AEC results, and a NOSE scale score based on symptomatology were all reviewed together. The individuals were treated with intranasal steroid spray, and a NOSE scale symptom evaluation was carried out as a follow-up after three months of treatment. The NOSE scale and AEC values were related in our experiment. The mean NOSE 1 scale and mean AEC values for the research population were 60.07 and 15.71, respectively.

171. A Cross-Sectional Study of Adverse Drug Reaction in Hiv Patients Taking Antiretroviral Treatment from Government Medical College, Kozhikode
Jeevan Jacob, Vishnu Radhakrishnan
Abstract
Introduction: The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system. As the infection progresses, the person becomes more susceptible to opportunistic infections due to affected immune system by HIV, which may leads to an advanced stage known as acquired immunodeficiency syndrome (AIDS) within 10-15 years. The duration can be significantly slows down by different antiretroviral regimens used in Anti-retroviral Therapy (ART). So the present study was conducted with objectives, to estimate the adverse drug reaction (ADR), and to assess their causality, severity in patients under ART. Methodology: Approximately 152 patients were recruited by following certain set of inclusion and exclusion criteria since July 2015 to June 2016. The collected data was analysed by SPSS software (Descriptive, Chi-square test). The p value <0.05 was considered statistically significant. Results: Out of 152 patients (75 were males and 77 were females), 21 (13.8%) patients had experienced ADRs, comprising 11(52.4%) male patients and 10 (47.6%) female patients. The majority of ADRs occurred in patients aged 41-50 years constituting 9 (42.9%). The majority of ADRs were related to hematological 10 (47.6%), cutaneous 4 (19.1%), gastrointestinal 3 (14.3%), hepatotoxicity 2 (9.5%) and neurological 2 (9.5%). Most adverse drug reactions occurred in the first 4 weeks of antiretroviral therapy. Out of the total ADRs, 13 (61.9%) had mild, 7 (33.3%) moderate intensity and 1(4.8%) had severe ADRs. WHO causality assessment showed 42.9% probable and 57.1% possible ADRs. Conclusion: ADRs are more likely to occur within the first four weeks after initiating treatment with highly active antiretroviral therapy (HAART). In order to prevent occurrence of severe ADRs and to improve ART adherence close monitoring of the patient is required during therapy.

172. Comparative Clinical Study of Dexmedetomidine and Fentanyl for Attenuation of Haemodynamic Response to Laryngoscopy, Tracheal Intubation and Intra-Operative Pneumoperitoneum in Patients Undergoing Laparoscopic Cholecystectomy
Shrinivas Kulkarni, Irfan M P, Devireddy Hemaswapnika, Lavanya Kaparti
Abstract
Background: The pressor response during laryngoscopy, intubation and pneumoperitoneum (PNP) which is part of a huge spectrum of stress responses, results from the increase in sympathetic and sympatho-adrenal activity. Laparoscopic cholecystectomy is favoured by many because of less postoperative pain compared with the open approach; nevertheless, pain is still a frequent complaint. Objective: To know the effect of Dexmedetomidine v/s Fentanyl for attenuation of hemodynamic response in laparoscopic cholecystectomy. Methods: Our study was prospective, randomized, double‑blind comparative clinical study done to evaluate the efficacy of dexmdetomidine and fentanyl in attenuation of pressor responses to laryngoscopy, intubation and PNP in laparoscopic cholecystectomy (LC). Total number of 80 patients belongs to 18-55years of American Society of Anesthesiologists Class I/II of both sex for Laparoscopic cholecystectomy (LC), were included. The patients were made into two groups of 40 patients each. Group D received dexmedetomidine and Group F Fentanyl with loading 1µg/kg over 10 min followed by maintenance 0.2 µg/kg/h throughout the PNP. Result: Significantly attenuated hemodynamic stress response was observed in group D interms of HR, SBP, DBP, MAP. There was significantly less sedation, longer time of request of first rescue analgesia and postoperative analgesic requirements in group D when compared with group F. No significant side effects were noted in both groups. Conclusion: Dexmedetomidine is superior to fentanyl for the attenuation of hemodynamic response to laryngoscopy, tracheal intubation and intra-operative pneumoperitoneum in patients undergoing laparoscopic cholecystectomy also reduces the requirement of rescue analgesics post operatively.

173. Efficacy and Safety Assessment of Indacaterol Acetate and Glycopyrronium Bromide Combination in Patients of Bronchial Asthma
Md Hanzalah, Mohd Ashraf Alam, S. Ziaur Rahman, Zuber Ahmad, Raihan Mannan
Abstract
Background: Asthma in the bronchi is a severe problem, affecting 18% of the global population. Asthma and chronic obstructive pulmonary disease (COPD) were with indacaterol, a new beta-2 agonist, and glycopyrronium, a muscarinic receptor antagonist. Both medications have shown promise in treating asthma, but their potential synergistic impact has to be studied. Aims: The present study aimed to assess the efficacy and safety of combined indacaterol acetate (110µg) and glycopyrronium bromide (50µg) ‘IND-GLY’ in patients of mild to moderate bronchial asthma. Methods: In this trial, we used a randomized, prospective, open-label design. Fifty-seven patients were included in the research and given IND-GLY via dry powder inhaler once daily. Evaluation of PFT and symptom score was used to evaluate effectiveness. At the start, after 45 minutes, after 21 hours, on days 3, 7, 14, and 28, we measured forced expiratory volume in a second (FEV1). Researchers created the Naranjo Adverse Drug Reaction (A.D.R.) Probability Scale to quantify the chance of adverse medication responses. Results: The study showed that there were significant improvements in FEV1 (p<0.05) and clinical symptom score (p<0.05) compared to the baseline values. Conclusions: It was determined that IND-GLY is clinically effective and safe in individuals with mild to moderate bronchial asthma. There was evidence that the treatment was helping all hours of the day.

174. A Study on the ‘Neutrophil Lymphocyte Ratio (NLR)’ As Prognostic Marker in Adult Patients with Acute Ischaemic Stroke (AIS)
Birata Debbarma, Sutanuka Khasnabish, Debaprasad Chakrabarti
Abstract
A cost-effective and reliable marker in prognostication of Acute Ischaemic Stroke (AIS) may be helpful in predicting the clinical outcome of stroke patients in low income and resource-limited countries like India. Of late, NLR(Neutrophil Lymphocyte Ratio) has been found as an indicator for prognosis in acute stroke, but data on its relation with length of hospitalisation, and functional outcome in ischaemic stroke are very limited. This study is aimed at determining the association between NLR and functional outcome among AIS patients. Materials and Methods: The study was a prospective cross sectional cohort study conducted among cases of acute ischaemic stroke (AIS) admitted in the medical ward in Tripura Medical College and Dr. BRAM Teaching Hospital during the study period. A total of 101 eligible AIS cases were selected between June 2021 to June 2022. The NLR was calculated at admission and after 30 days of ischaemic stroke during follow-up. The functional outcome was assessed by MRS (Modified Rankin Scale) at admission and at discharge. Results: The mean age of the study population was 60.28±10.72 years with two third cases were male (70.29%, n=71) and 29.70 %( n=30) cases were female. The mean NLR on day 1 and day 30 were 2.91±0.90 and 1.83±0.58, respectively. There was a positive correlation between NLR and length of hospital stay (r=0.96 ;). Conclusion: NLR is a helpful marker in predicting duration of hospital stay and follow-up functional outcome after one month among patients hospitalized with acute ischemic stroke.

175. Role of P16INk4a And Ki-67 Immunostaining as Specific Biomarker of Cervical Intraepithelial Lesions among Cervical Biopsy Samples: A Diagnostic Study
Rama Kumari, Rajni Joshee, Anju Repaswal, Anita, Bhageerath, Kamlendra Singh Chaudhary
Abstract
Introduction: Cervical carcinoma, fourth most common cancer among women globally. The diagnosis on histopathology is considered as gold standard ,but pathologist faces diagnostic dilemmas not only because of overlap in morphological features among different grades of CIN but also due to intero bserver and intrao bserver variability especially during grading of CIN which affect the prognosis of the patient. For the prognostication and grading of tumours ,an application of IHC marker p16 and proliferative marker like Ki67 become imperative. Aim: Role of p16ink4a and ki-67 immunostaining as specific biomarker of cervical intraepithelial lesions among cervical biopsy samples. Method: Paraffin block of cases that fulfilled the inclusion criteria will be selected. Issued blocks will be cut serially at 3 to 5-micron thickness using rotatory microtome to prepare slides. Slides will be stained with routine hematoxylin and eosin stain and then mounted with DPX to review, after confirming and noting the diagnosis and microscopy details, sections will be taken for P16INK4a and Ki-67 staining. Results: According to P16 IHC 72.86% of cases shows positive expression followed by 7.14% shows equivocal expression and remaining 20% cases shows negative expression. .According to Ki-67 IHC 78.57% cases shows positive expression and 21.43% cases shows negative expression . P16 IHC is 100% sensitive, 85.71% specific and 95.59% accurate in predicting positive results among cervical lesions. Ki-67 IHC is 96.49% sensitive, 92.31% specific and 95.71% accurate in predicting positive results among cervical lesions. P16 IHC and Ki-67 IHC shows almost perfect agreement in diagnosis malignant lesion among cervical biopsies with kappa value of 0.951. Conclusion: Ki-67 and p16/INK4a can be used as complimentary tests for differentiating dysplastic and nondysplastic lesions. They also help in confirming the diagnosis in these cases as different lesions have specific treatment protocols based on the degree of dysplasia. The importance of p16/INK4a in cervix is that it is specific for HR-HPV associated dysplasia and is seen in high-grade lesions and few low-grade lesions with high tendency to progress to a higher grade.

176. Grading of Lymphocytic Thyroiditis Cytologically and Relationship to Hormonal Condition of the Thyroid
Bikash Kumar Singh, Bibhash Gogoi
Abstract
Background: The second most frequent thyroid lesion identified on FNAC after goitre is lymphocytic thyroiditis. Along with FNAC, other diagnostic factors include clinical characteristics, thyroid antibody titres, thyroid hormonal profile, and ultrasonography. The goal of the current study was to assess thyroid fine needle aspirates for the presence of lymphocytic thyroiditis, grade lymphocytic thyroiditis cases using predetermined cytological criteria, and determine the relationship between cytological grades and thyroid hormonal status. Materials and Methods: From February 2021 to January 2022, this study was carried out at the Lakhimpur Medical College, Department of Pathology in North Lakhimpur, Assam. According to Bhatia et al., cytological criteria were used to further categorise lymphocytic thyroiditis patients that had been reported using the Bethesda system. Where data were available, cytological grades were associated with thyroid hormonal status. Results: According to the Bethesda method, a total of 162 cases of lymphocytic thyroiditis were documented in our study. Further grading revealed that grade II thyroiditis accounted for the majority of cases (104, 64.2%), followed by grade I (48, 29.6%), and grade III (10, 6.2%). Out of the 78 cases with accessible thyroid hormonal profiles, the majority of patients (42; 53.85%) were hypothyroid. Euthyroid (21; 26.92%) and hyperthyroid (15; 19.23%) individuals were next in line. With a P value greater than 0.05, there was no statistically significant correlation between grades and hormone status. Conclusion: The “gold standard” test for diagnosing lymphocytic thyroiditis is still the FNAC. However, in our investigation, there is no statistically significant link between the cytological grades and thyroid hormonal condition.

177. Etiological Profile and Outcome of Thrombocytopenia in Neonates Admitted to NICU in A Rural Tertiary Care Centre
Ankitha C, Sunil Kumar P, Mahendrappa K B, Madhunandan Krishnegowda
Abstract
Background: Neonatal thrombocytopenia (NT), accounts for one-third of all admissions to NICU. Mortality due to thrombocytopenia can be decreased by optimal time recognition, early intervention and appropriate management addressing the underlying illness and platelet transfusions. Objectives: The study aimed to estimate the prevalence, associated maternal and foetal predisposing factors of thrombocytopenia. The study also estimates immediate outcomes among various grades of thrombocytopenia and platelet transfusion cutoffs. Methodology: A prospective, observational study carried in NICU at Adichunchanagiri Hospital & Research Centre from February 2021 to September 2022. The outcome was measured in terms of need for platelet transfusions, bleeding manifestations, need for parenteral therapy, oxygen support, duration of hospital stay and mortality. Results: Prevalence of Thrombocytopenia in NICU-admitted neonates was 27.56% with an overall mortality rate of 12.1%. Out of 124 thrombocytopenic neonate mothers, 33.1% (41) had gestational hypertension followed by PROM 32.3%, GDM at 20.2%, Rh Immunization 9.7% and APH 2.4%. In the study, 59.7% of the neonate had sepsis followed by RDS 36.3%, IUGR 33.90%, MAS 16.10%, birth asphyxia 13.70%, and NEC 8.90%. 16.1% required platelet transfusion. The overall mortality rate in our study was 12.1%. Conclusion: The prevalence of NT is 27.56% among NICU-admitted neonates. Maternal predisposing factors such as gestational hypertension, antepartum haemorrhage, Rh immunization and GDM and the neonatal predisposing factors such as sepsis, premature birth, RDS, NEC, and DIC are associated with neonatal thrombocytopenia. DIC, NEC and birth asphyxia directly influence the severity of thrombocytopenia and thereby the mortality.

178. Prevalence and Antibiotic Susceptibility Profile of Acinetobacter Species Isolated from Urinary Tract Infection at Tertiary Care Hospital, Gujarat
Pipaliya BP, Dabhi C S, Soni ST, Shah PK, Vegad M M
Abstract
Introduction: Recently Acinetobacter has emerged as an important nosocomial pathogen and various studies demonstrated it as a primary pathogen involved in outbreaks of hospital acquired infections. This ubiquitous organism has ability to survive in the hospital environment due to its capacity to colonize human and environmental surfaces of the hospital. Indiscriminate use of antimicrobials as a part of empiric or definitive treatment leads to emergence of multidrug resistance which is constant threat to healthcare setting. This signifies the need of continuous surveillance of antimicrobial susceptibility profile of Acinetobacter in various geographical areas to decide appropriate empiric antibiotics which strengthens the antimicrobial stewardship programme. Even now adays trend of increasing prevalence of Acinetobacter is observed in community acquired infection. Aims & Objectives: This study was aimed to determine prevalence of Acinetobacter species& to know antimicrobial susceptibility profile of Acinetobacter species from patients having Urinary Tract Infection. This study was carried out to avoid the injudicious use of antibiotics and outcome of this study would be useful to establish policy on effective empiric antimicrobial treatment in this geographical area. Materials and Methods: In this observational retrospective study, data was collected at the Department of Microbiology B.J Medical college, Ahmedabad from January-2017 to August-2018 using Laboratory Information System (LIS)and considering only urine samples collected at Microbiology laboratory, from various areas of hospital including wards, Intensive care unit and Outpatient department. Identification of organism was done by conventional culture and antimicrobial susceptibility using manual biochemical test performed form growth obtained on culture medias& Antimicrobial drug sensitivity by employing Kirby-Bauer disk diffusion techniques on Muller Hinton Agar according to recent CLSI guidelines. Colistin screening agar was used to screen colistin. Final data analysis was done using Microsoft Excel data sheet. Results: Out of 19, 247 urinary samples received at Microbiology laboratory, only 317 Acinetobacter species were isolated from urine samples. The highest number of isolates 111from Surgery department and least from Gynaecology ward 17. Colistin susceptibility was 97.74% followed by Imipenem and Meropenem susceptibility profile, 65.62% and 64.98% respectively. Least sensitive were Ampicillin- Sulbactam, Cefepime and Ceftazidime with percentage of 32.18%, 37.54% and 36.28% respectively. Conclusion: Non-fermenter Gram negative bacilli emerge in recent years as an important health care associated pathogen and to prevent the spread of the bacteria having resistant profile, it is critically important to implement antibiotic policies, surveillance programmes for multidrug resistant organisms and infection control practices very judiciously.

179. Comparison between Conventional and Ultrasound Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Hari Damodar Singh, Rabindra Kumar, Janki Nandan Thakur, Pradeep Kumar
Abstract
The study compares the conventional subclavian perivascular approach with the ultrasound-guided technique for supraclavicular brachial plexus blocks. It examines parameters such as procedure time, block onset and duration, success rate, overall effectiveness, and complications. The goal is to assess the advantages and limitations of each technique. This study involves 60 patients divided into two groups: conventional and ultrasound-guided blocks. Parameters such as procedure time, block onset and duration, success rate, and complications were assessed. The study followed ethical guidelines, used randomized sampling, and employed statistical analysis. Preoperative evaluations, standard procedures, and continuous monitoring were conducted during surgery. Data collection occurred post-operatively at specific intervals. Statistical tests were used for comparison, considering p-values for significance. The demographic data showed an equal distribution of age groups between the two groups, and the gender distribution was comparable as well. The ultrasound-guided technique took slightly more time for the procedure compared to the conventional technique. However, the onset of motor and sensory blockade was significantly faster with the ultrasound-guided technique. The duration of sensory and motor blockade was shorter in the ultrasound group compared to the conventional group. There were no significant changes in pulse rate, systolic blood pressure, or diastolic blood pressure between the two groups. The incidence of complications and the need for analgesic supplementation were lower in the ultrasound group. Overall, the study suggested that the ultrasound-guided technique for supraclavicular brachial plexus block provided faster onset of blockade, shorter duration, and reduced analgesic supplementation compared to the conventional technique.

180. Neoplastic and Non-Neoplastic Ovarian Mass Fine Needle Aspiration Cytology with Histological Correlation
Bibhash Gogoi, Bikash Kumar Singh
Abstract
Background: Several variables affect the efficacy and accuracy of image-guided FNAC in the pre-operative identification of ovarian masses. However, this approach makes it challenging to diagnose borderline tumours. However, epithelial tumours can be correctly identified as benign or malignant. This study’s primary goal was to evaluate the USG-guided FNAC’s sensitivity, specificity, and diagnostic accuracy in neoplastic and non-neoplastic ovarian masses using histopathology as the gold standard. Methods: This study comprised 80 patients who were identified as having probable ovarian masses by clinical and imaging methods between February 2022 and January 2023. FNA was carried out under USG guidance, and a diagnosis was made. Histopathological analysis supported the cytological diagnosis. To find the association between cytological and histological diagnosis, descriptive statistics were used. Results: Twelve cases of benign non-neoplastic cysts were identified after investigation of the fine needle aspirated material. Thirteen instances could not be classified because of ambiguous results or insufficient cytological aspiration material. Except for one case of mucinous cystadenoma, which was diagnosed as borderline mucinous cystadenocarcinoma, all benign cases on histological investigation were classified as benign tumours. On histological inspection, a case that was first classified as borderline mucinous adenocarcinoma was shown to be mucinous adenocarcinoma. The FNAC’s accuracy, specificity, and sensitivity were 82.3%, 92.3%, and 84.2%, respectively. Conclusion: For the quick and reasonably accurate diagnosis of ovarian masses with good sensitivity and specificity, use image assisted FNAC. All ovarian tumours can be classified into benign and malignant lesions with meticulous cytological screening, reducing needless surgical morbidity.

181. Detection of Metallo-Β-Lactamases Producing Pseudomonas Aeruginosa which are Received from the Patients in our Laboratory at DMCH, Laheriasarai, Bihar
Nazia Anwar, Tarannum Yasmin, Farmood Alam
Abstract
Aim: Pseudomonas aeruginosa is a gram negative bacillus that produces metallo-β-lactamases (MBLs) and causes several nosocomial infections. The present study was carried to identify such MBL-producing strains in patients. Methods: From March 2021 to February 2022, the current study was conducted at the Darbhanga Medical College and Hospital in Laheriasarai, Bihar. The clinical isolates and the MBL prevalence was detected using 3 phenotypic methods namely Combined disc test, Double disk synergy test, and Modified Hodge test. Results: Total 85 consecutive isolates of P. aeruginosa were isolated from various clinical samples. The present findings revealed that 41 to 50 years aged patients produced the highest percentage (24.71%) of isolates. Compared to a urine sample, a pus sample made up the majority of samples (55.29%). Overall Cefotaxime has maximum resistance of 70.58% followed by Cefazidime 67.05%, Gentamicin 55.29%, Amikacin 38.82%, Tobramycin 41.17%, Piperacillin- Tazobactum 37.65% and Imipenem has 18.81% resistance among isolates. In 45.88% isolates, MBL production was present. MBL producers made up 81.25% of the imipenem-resistant isolates. Among MBL producers Cefotaxime, Ceftazidime and Imipenem showed highest resistance whereas least resistant was found in Piperacillin, Tazobactum and Polymyxin-B. Conclusion: The initial basic screening tests would be crucial for identifying new drug strains and would help in creating an antibiotic policy for a specific region.

182. Rapid Diagnostic Tests in Comparison with Multiplex Polymerase Chain Reaction for Early Diagnosis of Malaria, Dengue and Chikungunya in Cases of Acute Febrile Illness
Kilikdar Mousumi, Jampala Srinivas, Ansari Aman, Siraj Safiya, Chitrans Pallavi, Rehman Zainab
Abstract
Introduction: Malaria, dengue (DENV) and chikungunya (CHIKV) are one of the most common causes of acute febrile illness (AFI). As they share some common clinical features, it becomes imperative to confirm the diagnosis of these febrile illnesses at the earliest by performing appropriate laboratory tests. This will establish a specific diagnosis with specific treatment. Aim: This study was conducted to evaluate the diagnostic value of various rapid diagnostic tests (RDTs) in comparison with Multiplex PCR for the early diagnosis of Malaria, Dengue and Chikungunya in cases of AFI. Materials and Methods: A cross sectional and analytical study was conducted to evaluate various RDTs for early diagnosis of DENV, malaria and CHIKV in AFI cases admitted to a tertiary care hospital over a period of 12 months. Blood samples were tested by RDTs and multiplex PCR for diagnosis of DENV, malaria and CHIKV. Results: Out of total 200 AFI cases, 63 were positive for DENV, malaria and CHIKV by RDT (31%) out of which 38 patients were also positive by PCR (19%) and 25 patients (12.5%) were only positive by RDT but negative by PCR while comparing RDT and PCR. The diagnostic value of RDT for DENV, malaria and CHIKV were evaluated using PCR as the reference standard. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of DENV RDT was 76.3 %, 100 %, 100 % and 94.7% respectively. Whereas the sensitivity, specificity, PPV and NPV of malaria RDT was found to be 34.8%, 100%, 100% and 92.2% respectively. We observed that the sensitivity, specificity, PPV and NPV of CHIKV RDT was 50%, 100%, 100% and 99.5% respectively. Conclusion: Early and accurate diagnosis plays a crucial role in management of AFI cases and thus preventing morbidity and mortality. In this study, various RDTs were evaluated using PCR as the reference standard. Sensitivity of RDT was found to be low. Though RDTs and PCR are useful for early diagnosis, RDT are better in terms of rapidity, cost and simplicity. Hence, RDTs should be used in conjunction with reference standard for better prognosis of AFI cases.

183. Comparative Study of Spinal Ropivacaine 0.75% with Fentanyl and Bupivacaine 0.5% with Fentanyl for Elective Caesarean Section in Telangana Population
Saritha, Kothapally Girish Reddy
Abstract
Background: The analgesic efficacy of three different spinal solutions (Ropivacaine, bupivacaine, and Fentanyl) was compared for elective caesarean sections. Method: Out of 80 patients, 40 received 10 mg of hyperbaric bupivacaine with 20 micrograms of fentanyl, and 40 patients (group RF) received 15 mg of hyperbaric ropivacaine with 20 micrograms of fentanyl. Hemodynamic parameters and the sensory and motor blockage, APGAR score were compared in both groups. Results: Demographic profile, i.e., parameters, i.e., weight, height, BMI, duration of surgery was same in both the groups, hence the p value was insignificant (p>0.001) but the comparative study of motor and sensory blockades had a highly significant p value (p<0.001). VAS scores at different intervals of 4 hours, 6 hours, and 8 hours had significant p values (p<0.001).  The Apgar score at 1 minute was also highly significant (p<0.001). Conclusion: The present pragmatic study proved that, hyperbaric ropivacaine with fentanyl is an ideal alternative to hyperbaric bupivacaine with fentanyl in  patients undergoing cesarean sections.

184. Study of Maternal and Perinatal Outcomes in Pregnant Women with First Trimester Vaginal Bleeding in Andhra Pradesh Population
Myneni Pujita, Gowthami Dumpula
Abstract
Background: Vaginal bleeding in pregnancy is a common complication. It is associated with miscarriage or spontaneous abortion, ectopic implantation, preterm delivery, molar pregnancy, and low birth weight foetus. It may cause a risk; therefore, it has to be evaluated and treated meticulously. Method: 50 (fifty) pregnant women with first trimester vaginal bleeding were studied. A physical and obstetrical examination has been carried out. Investigations include Hb%, CT, BT, ABO “Rh”, HIV, syphilis, HbsAg, HCV, urine, FBS, TSH, and HCG in every patient. USG was performed to know the stages of pregnancy, the period of gestation, cardiac activity, the size of the sub-chorionic hemomatoma, presence of adnexal mass, and the free fluid. Results: Clinical manifestations were: 12 (24%) were aged between 18-25, 26 (52%) were aged between 26-35, 12 (24%) were >35 years. The bleeding volume in the study – 2 (4%) had spotting, 11 (22%) had moderate bleeding, and 37 (74%) had high volume bleeding. 28 were nulliparous (56%), 14 (28%) were para 1, 5 (10%) were para 2, 3 (6%) were > para 2. 17 (34%) had a previous history of bleeding, and 7 (14%) had a history of abortion. The obstetrical complications were: 12 (24%) had premature labour; 3 (6%) had premature rapture of the membrane, 7 (14%) had placental abruption, 2 (4%) had IU death; and 2 (4%) had IU growth retardation. The outcome of pregnancy 10 (20%) had abortions, 5 (10%) had termination of pregnancy, 19 (38%) had normal vaginal deliveries, 2 (4%) had caesarean sections, 6 (12%) had a minute 5 Apgar score, and 8 babies (16%) were admitted to the NICU. Conclusion: It is concluded that, vaginal bleeding in the first trimester has diagnostic value for maternal and fetal complications and is a challenge for obstetricians and gynaecologists to evaluate and treat efficiently.

185. Prevalence and Spectrum of Ocular Manifestations in COVID-19 Patients at A Tertiary Care Centre: A Retrospective Cross- Sectional Study
Shweta Anirban Bandopadhyay, Kalpana Ramnayan Singh, Anirban Tushar Ranjan Bandopadhyay, Rakesh Narayan Patil
Abstract
Introduction: Ophthalmologists can play an important role in COVID-19 pandemic by identification of ocular symptoms which are like warning bells to the arrival of the deadly COVID-19 disease. The study highlights the spectrum of ocular manifestations of the COVID-19 pandemic along with the need for early diagnosis and subsequent treatment for the same. The current COVID-19 pandemic has affected all organs of the body with the eye being no exception. Eye being an entrance window for COVID-19 infection, Ophthalmologists can contribute to the prevention of its spread by early detection and treatment. This study will add to our knowledge the prevalence of various ocular manifestations in COVID-19 infection. Objectives: To find out the proportion and spectrum of ocular manifestations in patients of COVID-19. Material and Methods: This was a retrospective cross-sectional hospital-based study. It was conducted at Department of Ophthalmology and Covid Care Centre affiliated to a tertiary care institute in Nashik district. COVID-19 patients who were being treated in the Covid Care Centre (OPD, IPD and ICU) were included in the study. Total 1221 patients were included for the present study. A detailed history of the patients was noted. The patients in covid care centre – ward and ICU were examined with a torch light and bedside visual acuity was undertaken. COVID-19-positive patients attending the OPD underwent thorough ocular examination by recording their visual acuity on the Snellen’s chart, anterior segment evaluation on slit lamp and fundus examination by indirect ophthalmoscope and 90 D lens. Results: Out of 1221 patients, ocular manifestations were observed in 13.8% (168) patients. Dry eye was the most common ocular manifestation which was observed in 4.99% (61) participants, followed by Epiphora in 3.93% (48) and Conjunctivitis in 1.97% (24) participants. Orbital Mucormycosis was also observed in 1.63% (20) patients. Conclusion: This study found proportion and various common ocular manifestations of COVID19 disease which helped patient to get diagnosed early and receive the treatment required. Thus, the ophthalmologists play a very crucial role in fighting this pandemic by remaining vigilant in patients presenting with ocular symptoms.

186. A Study on Resistance to Systemic Antifungal Drugs in Dermatophytosis
Patta Appa Rao, Malladi Subramanya Sarma, Durga Eswara Anand Oruganti, Burle Gowtham, Praveen Kumar Lakinena
Abstract
Dermatophytosis is a common fungal infection of the skin caused by dermatophytes. This study aimed to identify the species of organisms causing dermatophytosis and evaluate their susceptibility to commonly used antifungal medications. A cross-sectional descriptive study was conducted on 100 patients diagnosed with superficial dermatophytosis. Data on demographics, disease history, and clinical manifestations were collected. Samples were obtained from lesions and hair, and microscopic examination and culture were performed. Trichophyton, Mentagrophytes and Trichophyton rubrum were the most commonly isolated species. Tinea corporis was the predominant clinical type. Antifungal susceptibility testing revealed Terbinafine to have the lowest minimum inhibitory concentration (MIC) among the tested drugs. The study emphasizes the importance of accurate identification and susceptibility testing to guide effective treatment of dermatophytosis.

187. Study of Dosage of Prophylactic Intravenous Ephedrine for Spinal Induced Hypotension During Spinal Anesthesia in Cesarean Section in Telangana Population
Saritha, Swapna T
Abstract
Background: Spinal anaesthesia-induced hypotension occurs frequently, particularly in adults and patients undergoing cesarean section. Spinal anaesthesia-induced hypotension (SAIH) is caused by arterial and venous vasodilatation resulting from the sympathetic blockade. Ephedrine has traditionally been considered the vasoconstrictor of choice. Method: Out of 70 (seventy), 35 were administered ephedrine and 35 in the controlled group were administered the same quantity of normal saline during spinal anaesthesia. Hemodynamic and neonatal outcomes were noted and compared. Results: In the comparison of systolic BP between both the groups at the time intervals of 1, 2, 3 and 15 there were significant values (p<0.001). Apgar 1 minute, 5 minutes, and umbilical cord PH were compared with controls and were also highly significant (p<0.001). Conclusion: The present pragmatic study has confirmed that I.V. infusion of Ephedrine was more effective than crystalloid preloading in preventing hypotension in parturients undergoing cesarean section without causing hemodynamic complications.

188. Study Of Histopathological Findings with Helicobacter Pylori Correlation in Upper GI Endoscopic Biopsies in A Tertiary Care Centre
M.S. Shruthi, R.D.Puvitha, G. Joshila Nandhini
Abstract
Introduction: Dyspepsia is defined as upper abdominal and epigastric discomfort commonly after meals, most common symptom being indigestion. The most common investigations used are barium studies and endoscopy to know the diagnosis of dyspepsia, but these as such alone is not enough for final diagnosis. Hence biopsy and histological examination of such lesions will be helpful in identifying the cause. Based on the primary objective of this study is to detect Helicobacter pylori infection in the patients with features of dyspepsia who undergo upper gastrointestinal endoscopy. Methodology: This prospective study was undertaken in Department of Pathology in a tertiary care centre. Hundred consecutive endoscopic gastric biopsies in patients presenting with symptoms of dyspepsia were included in the study. Various histopathological diagnoses in each case were noted down and were correlated with the incidence of H.pylori infection in each case. Density of H.Pylori was also assessed. Results: Of the hundred cases, 74 cases of chronic superficial gastritis was seen, gastric ulcer in 7 cases (7%) and adenocarcinoma in 16 cases (16%).Three cases(3%) showed normal histological findings. Among the 74 cases of chronic superficial gastritis where H.pylori was studied, 40 cases were positive for Helicobacter pylori (54.05%). Of the 7 cases of Gastric ulcer 5 cases were positive for Helicobacter pylori (71.42%). In 16 cases of adenocarcinoma studied 9 cases were positive for Helicobacter pylori (56.2%). Of all cases positive for H.pylori in our study, 3 cases had a bacterial density of grade 3, fifteen patients had a bacterial density of grade 2 followed by 37 cases with a grade 1 bacterial density. Conclusion: Early diagnosis and eradication of H.pylori not only improves symptoms but also helps to prevent complications associated with H.pylori infection. To conclude based on the findings in of the present study non- invasive tests for detection of Helicobacter pylori may be preferred choice for clinicians but histopathological demonstration has the advantage of accuracy. At the same time it gives us chance to study associated histopathological changes. Some of these changes may be of prognostic value.

189. Comparative Analysis between Clinical Findings and Magnetic Resonance Imaging Findings in Meniscal and Anterior Cruciate Ligament Injuries
Ashif Suthar, Suril Shah, Mahesh Khandelwal
Abstract
Background and Aim: In the orthopedic OPD, knee discomfort was reported by about 28% of the patients. The purpose of this study was to evaluate the accuracy of arthroscopic and clinical results in meniscal and ACL injuries to those obtained from imaging tests. Material and Methods: A prospective study was carried out over the course of a year on 100 patients at the Department of Orthodontics, tertiary care facility in India, after receiving approval from the institutional ethical council. An examination was carried out while the patient was under anaesthesia to confirm the indicators of instability following a proper MRI analysis by the surgeon. An arthroscopic procedure was carried out. The outcomes of arthroscopy, MRI, and clinical testing were contrasted. Results: The most frequent kind of injury was found to be a sports injury. 41 patients (41%) with a medial meniscus damage, 17 patients (17%) with a lateral meniscus injury, and 73 patients (73%) with an ACL injury had the clinical diagnosis confirmed. In our investigation, clinical examination demonstrated accuracy, PPV, NPV, sensitivity, and specificity of 81%, 100%, 83%, and 90% for medial meniscus tear, 50%, 100%, 100%, 80%, and 83% for lateral meniscus tear, and 89%, 100%, 100%, 63%, and 91% for ACL injury, respectively. The results of the MRI showed that the medial meniscus tear had 100% sensitivity, 100% specificity, PPV, NPV, accuracy of 100%, 67%, 75.5%, 100%, and 100% respectively; the lateral meniscus tear had 100%, 84.5%, 77%, 100%, and 100% respectively; and the ACL tear had 100%, 100%, 100%, 100%, and 100% respectively. Conclusion: Well executed clinical examination can provide an equal or superior diagnosis of meniscal and ACL injuries compared to MRI scan by obtaining correlation between clinical examination, MRI scan, and arthroscopy for these injuries. A MRI scan is probably more helpful in preventing needless arthroscopic surgery when clinical indications and symptoms are ambiguous.

190. Study of Clinical and Etiological Profile of Cerebral Palsy in Children of North Karnataka
Samruddhapoorn, Vijay Kolhar, Pradeep R Reddy, Srinivasrao G Shinde
Abstract
Background: Cerebral palsy (CP) is a disorder characterised by abnormal muscle tone, posture, and movement. Clinically classified as the predominant motor syndrome. Spastic hemiplegia, spastic diplegia, spastic quadriplegia, and extrapyramidal or dyskinetic As CP is associated with multiple secondary medical conditions, a meticulous diagnostic approach is required by the clinician. Method: The severity and aetiology of CP were studied in 80 (eighty) children under the age of 18. Vision, hearing assessment, and neuroimaging (CT / MRI) was performed. Results: The etiological factors were 39 (48.7%) birth asphyxia, 16 (20%) CNS infection, 14 (17.5%) bilirubin encephalopathy, 11 (13.7%) hypoglycemia, The co-morbidities included 64 (80%) speech problems, 44 (55%) seizures, 37 (46.2%) feeding problems, and 16 (20%) contractures and deformities. The types of CP were 52 (65%) spastic, 12 (15%) ataxic, 8 (10%) dyskinetic, 8 (10%) mixed, 55 (68.7%) quadriplegic, 19 (23.7%) diplegic, and 6 (7.5%) hemiplegics. Conclusion: Prematurity and low birth weight are important risk factors for children who develop CP. About half of all children who develop CP were born at term at normal birth weight with no identified risk factors. The exact aetiology of CP is yet to be known. 1 scale and mean AEC values for the research population were 60.07 and 15.71, respectively.

191. Evaluation of RIPASA Score Compared to Modified Alvarado Score in the Diagnosis of Acute Appendicitis
Saumya Sinha, Shakeb Ahmed, M. Arif Ansari
Abstract
Objective: The diagnosis of acute appendicitis is still a challenge because it is a common yet difficult surgical illness. Since there are numerous clinical mimics and the diagnosis is mostly based on clinical criteria, clinical scoring systems have developed to help identify the correct diagnosis. This study aims to evaluate the diagnosis precision in acute appendicitis with a lower rate of negative appendectomy; by comparing the RIPASA score with the modified Alvarado score on patients undergoing emergency appendectomy. Material and Methods: Over a two-and-a-half-year period, we prospectively compared the two scoring systems in 103 patients undergoing an emergency appendectomy to treat acute appendicitis. Statistical analysis was comparatively done by ANOVA utilizing statistical software (SPSS), Microsoft Excel datasheets, and calculation of statistical significance using the McNemar Chi square test. Results: The RIPASA scale was more appropriate than the modified ALVARADO scale, according to the diagnostic accuracy results, which were 95.15% for the RIPASA score and 64.08% for the Modified Alvarado score. Conclusion: Thus based on the greater sensitivity, the RIPASA score is a better tool in the evaluation of suspected appendicitis in the South Asian population.

192. Risk Factors and Outcome of Recurrent Ischemic Stroke: A Prospective Study
Ajay Kumar, Amrendra Kumar Singh, Ocean, Mayanand Jha
Abstract
Background: Due to the progressive rise in life expectancy, ischemic stroke-related mortality and morbidity are steadily rising globally. Numerous investigations were conducted in the past to determine the causes of ischemic stroke. However, information on the causes of recurrent ischemic stroke was scarce. Therefore, to decrease the mortality and morbidity from recurrent ischemic stroke, it is time-consuming to identify those risk factors. The study’s goal was to ascertain the frequency of ischemic stroke recurrences after a year of discharge from the hospital following a first-ever stroke. Methods: 75 patients with their first-ever ischemic stroke who were hospitalised to the Department of Medicine, JLNMCH, Bhagalpur, Bihar, participated in this prospective study. For a year, patients’ mRS were assessed three times per month. Recurrence was defined as a sudden beginning mRS worsening above the preceding one within this one-year timeframe. Results: 15 individuals had a stroke recurrence, including 4 who passed away because of it. Over 75 years old, or 50.0% of the population, had the greatest stroke recurrences. At three months, 16.0% at six months, 17.33% at nine months, and 21.33% at one year, the cumulative risk of recurrence rate was 14.7%. The most frequent risk factors among individuals with recurrent strokes included old age, male sex, hypertension, diabetes, and dyslipidemia. Conclusion: It was determined that among first-time stroke hospital patients, older male patients with numerous risk factors had a higher rate of recurrent episodes. The worst time for recurrence following the initial stroke was the first three months.

193. Study of Left Ventricular Diastolic Dysfunction in Non Hypertensive Asymptomatic Patient with Type 2 Diabetes Mellitus
Amrendra Kumar Singh, Ajay Kumar, Ocean, Mayanand Jha
Abstract
Background: Chronic hyperglycemia and abnormalities in the metabolism of carbohydrates, fats, and proteins are features of the syndrome known as diabetes mellitus, which is also characterised by an absolute or relative lack of insulin secretion and/or action. Congestive heart failure has been observed in diabetic people even in the absence of coronary heart disease, hypertension, or any other known structural heart disease. The objectives of this study were to examine the echocardiographic results in non-hypertensive T2DM patients and to evaluate the diastolic functions and their relationship to various parameters. Methods: From January 2022 to December 2022, this cross-sectional study was carried out at the JLNMCH in Bhagalpur, Bihar, outpatient department of medicine. There were 50 patients enrolled in all. The study included all patients of type 2 diabetes mellitus (DM) reported at the OPD of Medicine with blood pressure less than 130/80. A predesigned semi-structured questionnaire was used to collect the data. Results: Out of the 50 instances, diastolic dysfunction was present in 34 (68%) of them, with poor relaxation accounting for 27 (54%) of these cases, pseudonormality for 5 (10%), and restricted filling for 2 (4%) of them. Age, the length of diabetes, HbA1c levels, and the presence of retinopathy were revealed to be statistically significant (p 0.05) correlates of diastolic dysfunction. According to echocardiographic findings, there was a significant (p0.05) correlation between E/A, IVRT m-s, Deceleration time, and E/e’ and diastolic dysfunction. Conclusion: Patients with type II diabetes mellitus who have no clinically apparent heart disease have a higher frequency of left ventricular diastolic dysfunction.

194. Clinical Study and Management of Varicose Veins of Lower Limbs at DMCH, Laheriasarai, Bihar
Basudeo Prasad Jaiswal, Anil Kumar
Abstract
Background: Varicose veins are described as dilated, convoluted, subcutaneous veins that are less than 3 mm in diameter and clearly exhibit reflux when measured in the upright posture. Although varicose veins have been around since the beginning of time, current emphasis has been drawn to improvements in diagnosis and new therapeutic strategies. The current study aimed to investigate the clinical profile, risk factors and their correlation, various surgical techniques used, and consequences related to varicose veins. Methods: The current prospective study was carried out from January 2021 to December 2021 at the upgraded surgery department of the Darbhanga Medical College and Hospital in Laheriasarai, Bihar. Clinical examinations were conducted on cases that met the inclusion criteria, and duplex ultrasonography colour Doppler was used to diagnose varicose veins and record the location of incompetence. All cases underwent surgery and received six months of follow-up care. Microsoft Excel was used to tabulate the results and look for any necessary corrections. Results: 40 cases, 66.25% males and 33.75% females, a mean age of 40.24 years, and 40% of the cases were in the group of people aged 41 to 50. Right limb varices were present in 60% of patients, and lengthy saphenous veins were implicated in 52.5% of cases. 30% of instances below the knee exhibited perforator incompetence, while 85% had dilated veins. Saphenofemoral flush ligation with lengthy saphenous vein stripping occurs in 41.25% of cases. The most frequent surgical consequence was wound infection. Conclusions: Even though conservative management eases the symptoms, decisive management is always necessary, therefore operational management should be the primary line of treatment.

195. Study of Accuracy of Triple Assessment as A Clinical Tool for the Diagnosis of A Palpable Breast Lump
Basudeo Prasad Jaiswal, Anil Kumar
Abstract
Background: The prevalence of breast-related diseases is highest in both this country and the rest of the world. Breasts may be affected by a variety of lesions, including inflammation and cancer. Some lesions are more prevalent in young females than older women. In cases of non-neoplastic illnesses, early presentation and rapid diagnosis are crucial to reducing worry; in cases of carcinoma, they can prevent metastasis. In this study, the effectiveness of the Triple Assessment as a clinical tool for the identification of a palpable breast lump (physical examination, mammography, and fine needle aspiration cytology) was assessed. Methods: This prospective study was conducted in January 2022 to December 2022 in indoor and outdoor patients at the Upgraded Department of Surgery, DMCH, Laheriasarai, Bihar. Each patient was thoroughly examined, including the pertinent clinical history, physical exam, mammogram, histological results, and management. The study included a total of 50 breast cancer patients who had undergone various treatments.  Results: An inflammatory condition was found in 20.0% of the study’s total 10 cases, fibrocystic lesion in 36%, fibroadenoma in 24%, gynecomastia in 2%, and cancer in 12%. In 50 women ranging in age from 18 to 60, this comparative study revealed data from clinical evaluations, mammography, and histological findings. 10% of cases of malignant carcinoma are discovered, compared to 90% of cases of benign breast disease and other conditions. Conclusion: The most prevalent lesion in this study was fibrocystic disease, with an average age of presentation of 30 years. Malignancy was discovered in people older than 47. In contrast to 10 malignant lumps, 90 patients with breast lumps diagnosed as benign by Triple Assessment correlated with the histological findings. As a result, Triple Assessment’s overall accuracy in our study is 100%.

196. Colour Doppler Sonographic Analysis of Ovarian Stromal Blood Flow Between Women with Normal Ovaries and Women with Polycystic Ovarian Syndrome
Arpit Mahajan, Rekha Khare
Abstract
The highest incidence of polycystic ovarian syndrome found in 21-25 years age group followed by 25-30 years with mean (±SD) of patient 26.27±5.4 years. The burden of obesity is more in PCOS patients than normal fertile females. PCOS patients have increased ovarian volume with majority of patients lying in range of 10-19cc.The number of follicles increases in PCOS patients with maximum patients lying in range of 11-15 and mean of 14 and 3 in PCOS patient & normal patient respectively. Increased stromal echogenicity is very sensitive and specific criteria for differentiating PCOS and normal patients. Vascularity is significantly increased in ovarian artery and stroma with reduction in resistance to blood flow in PCOS cases as compared to normal women. Setting the criteria of velocity 20cm/sec for PSV allows maximum sensitivity (80 %) and specificity (85.45 %). We recommend setting the velocity threshold of 8cm/sec for end diastolic velocity (EDV) as it gave maximum sensitivity (90.91 %) and specificity ( 90.91 %).For resistive index (RI), most of the patients of PCOS fell in the group of 0.51. Setting the criteria at RI 0.6 gave a decent sensitivity and specificity of 83 % and 92.73 % respectively. The pulsatility index(PI) is reduced in PCOS patients, with 49 of patients having PI<2.0 with a sensitivity of 89.09 % and specificity of 98.18 %. If the value of PI is revised to <1.0, then the sensitivity becomes 60 % specificity becomes 98.28%. Setting the cut off value as <3.0 for systolic/diastolic velocity (S/D ratio) gave high sensitivity of 86.54 % but poor specificity of 43.64%.Thus the ovarian artery pulsatility index & systolic/diastolic ratio are the most sensitive tests. The pulsatility index is the most specific test in diagnosing polycystic ovarian syndrome. The overall best indicator is the Pulsatility index followed by end diastolic velocity.

197. Study of Clinical and Laboratory Profile of Patients of Subclinical Hypothyroidism
Sheetal Turakhia, Falguni Makwana, Divyang Makwana, Falak Saiyad, Jimy Patel, Akash Popat
Abstract
Background: Subclinical hypothyroidism is more common than overt hypothyroidism and it is associated with Coronary artery disease and many biochemical abnormalities. The aim of this study is to evaluate the clinical and laboratory profile of patients of subclinical hypothyroidism. Methods: Total number of 75 patients with established subclinical hypothyroidism who were admitted in the Department of General Medicine in Tertiary Care Hospital during the period of August 2018 to September 2020 were enrolled for the study. Results: The age group taken for study was 18 to 70 years. The mean age of patients suffering from subclinical hypothyroidism was 45.46. Out of 75 patients, 69(92%) patients were women while 6(8%) patients were men. In our study of 75 patients, 61.33% patients were asymptomatic, 10.67% patients reported having fatigue, 6.67% patients had musculoskeletal symptoms (proximal weakness, fatigue, slowed movements and reflexes, stiffness, myalgia, and less commonly, cramps and muscle enlargement), neck swelling(1.33%), cold intolerance(4%), constipation(4%), voice change(2.67%), depression(1.33%), infertility(2.67%), menorrhagia(1.33%) and weight gain(4%). Enlarged thyroid and dyslipidemia were also recorded. The mean of TSH (mIU/L) was 7.05+1.22 and the mean of FT4 (ng/dl) was 1.61+0.45. Finally, the mean of TPOAb (IU/mL) was 1.32+0.46. TPOAb was positive in 49(65.33%) patients. Conclusion: It is very important to timely detect the subclinical hypothyroidism and to treat them adequately to prevent them from converting into frank hypothyroidism and other complications.

198. Breast Cancer Awareness among Females of Reproductive Age Group in Rural Area: A Cross-Sectional Study
Samina Mustafa Ausvi, Meraj Mustapha Ausavi, Satyajit Pattnaik, Sharon Rose Rayudu
Abstract
Background: Breast cancer is a significant global health issue, affecting millions of people around the world. In developing countries like India it accounts for a significant proportion of all cancer cases in country. Lower awareness about breast cancer in rural women reduces their chance of detecting breast cancer symptoms. Aim and Objective: To know awareness regarding breast cancer among female of reproductive age group of field practice area of RHTC. Material and Method : A cross-sectional study was conducted among women of reproductive age group, included total of 380 participants were included in the study, by simple random sampling. After getting informed consent and following inclusion and exclusion criteria. Results: In the study population it was observed 40.8% of the population were aware about breast cancer. Near about ¾ th of the study population (76%)were unaware about screening methods for breast cancer. Majority of the study participants (64.1%) were unaware about any risk factors of breast cancer, Near about one third of study participants (74.7%) were unaware about health care services available for breast cancer. Conclusion: The level of awareness of breast cancer among women of reproductive age of rural area is extremely low. Due to the high illiteracy rate and poor socio economic status among the study population of rural area affecting the awareness about breast cancer.

199. Comparative Evaluation of Traditional Breathing Exercise and Controlled Breathing Exercise with Sensory Cues and K-CAT: Effects on Chest Mobility and Breathing Pattern in Normal Individuals
Akshita Pokharna, Sonam Soni, K. M. Annamalai, Jafar Khan
Abstract
Background: Breathing is a complex physiological process crucial for gas exchange and oxygen supply. Various breathing exercises have been used to improve respiratory function, but their comparative effects on chest mobility and breathing patterns in normal individuals remain unclear. Methods: A controlled randomized design was employed with a convenient sampling method. Thirty normal healthy individuals (age: 18-40 years) were divided into two groups: Group A (n=15) received controlled breathing exercises with sensory cues and K-CAT, while Group B (n=15) received traditional breathing exercises. Pulmonary function tests were conducted before and after the 3-month intervention period. Results: The results demonstrate that Group A exhibited a notable enhancement in expiration time, suggesting improved pulmonary function in comparison to Group B. These findings highlight the potential benefits of the intervention on respiratory health outcomes and support its use as a therapeutic approach in relevant patient populations. Conclusion: Although slight improvements in respiratory parameters were observed, the intervention did not yield statistically significant changes in chest mobility and breathing patterns in normal individuals. Future studies with larger samples and robust designs are needed to fully evaluate the potential benefits of different breathing exercises on respiratory health.

200.  Effectiveness of Chest Mobilization with Breathing Exercises in ICU Oxygen-Dependent Patients: A Comparative Study
Abrar Hussain, Sonam Soni, Jafar Khan, Mohit Naredi
Abstract
Background: Respiratory physiotherapy employs chest physiotherapy techniques, including chest mobilization and breathing exercises, to improve respiratory function in patients with respiratory diseases. The effectiveness of these interventions in ICU oxygen-dependent patients requires further investigation. This study aims to evaluate their impact on respiratory function and the need for supplemental oxygen, informing clinical practice in ICU management. Methods: Random sampling was used to select the participants. The inclusion criteria were patients admitted to the Intensive Care Unit (ICU) who were oxygen-dependent and able to perform chest mobilization and breathing exercises. Exclusion criteria included severe cognitive impairment, unstable medical conditions, or contraindications to chest mobilization or breathing exercises. Results: Significant improvements were observed in spirometry values after the intervention in both Group A (mean difference: 640, P<0.05) and Group B (mean difference: 400, P<0.05). Group A had a lower mean score on the Modified Borg Category Scale (5.66) compared to Group B (6.8), indicating a significant difference (P=0.005). Conclusion: Combining chest mobilization with breathing exercises in ICU oxygen-dependent patients improves respiratory function, exercise tolerance, and patient satisfaction. Spirometry showed significant improvement in lung capacity and airflow, while the combined intervention enhanced exercise tolerance compared to mobilization alone, strengthening respiratory muscles and improving lung capacity.

201.  Exploring the Efficacy of Traditional Breathing Exercise Vs. Controlled Breathing Exercise with Sensory Cues and K-CAT in Enhancing Chest Mobility, Improving Breathing Patterns, and Optimizing Lung Capacities in Healthy Individuals
Akshita Pokharna, Sonam Soni, Jafar Khan, Vinodini
Abstract
Background: Breathing is a vital physiological process that plays a crucial role in gas exchange and overall well-being. Different breathing exercise approaches can have varying efficacy in enhancing chest mobility and improving breathing patterns. This study aims to explore the efficacy of traditional breathing exercises compared to controlled breathing exercises with sensory cues and K-CAT in healthy individuals. Methods: The study utilized a controlled randomized design with convenient sampling. Thirty healthy participants aged 18-40 were divided into two groups: Group A (controlled breathing exercises with sensory cues and K-CAT) and Group B (traditional breathing exercises). Pulmonary function tests were conducted before and after the therapy sessions, and pre-testing and post-testing phases were conducted one week prior to and after a twelve-week study period. Results: Descriptive statistics of participants showed a mean age of 20.7 years, height of 165.2 cm, and weight of 63.0 kg. A comparison of pre-test and post-test measurements within Group A showed slight improvements in various respiratory parameters, although not statistically significant. The comparison of forced vital capacity (FVC) between the two groups did not reveal significant differences. Conclusion: The findings suggest that the intervention implemented in this study may not have led to significant improvements in respiratory function. Further research and comparisons with other studies are necessary to validate these findings and gain a more comprehensive understanding of the effects of different breathing exercise approaches in enhancing chest mobility and improving breathing patterns.

202. Comparative Analysis of Chest Mobilization Techniques in ICU Oxygen-Dependent Patients: with and Without Breathing Exercises
Abrar Hussain, Sonam Soni, Jafar Khan, Ishrat Bano
Abstract
Background: Respiratory physiotherapy utilizes chest mobilization techniques and breathing exercises to enhance respiratory function and well-being in patients with respiratory diseases. This analysis compares the effectiveness of these interventions in improving respiratory function and overall well-being, particularly in ICU oxygen-dependent patients. Understanding respiratory conditions and their impact on respiratory health is essential for providing effective respiratory care. The findings have the potential to improve clinical practice and patient outcomes in respiratory physiotherapy. Methods: The study design was a comparative study comparing the effects of chest mobilization in ICU oxygen-dependent patients with and without breathing exercises. Random sampling was used, and the sample size consisted of 30 patients divided equally into two groups. The study duration was 12 weeks, with sessions lasting 30 minutes per day at PMCH Udaipur. Results: Chest mobilization significantly reduced breathlessness (p=0.01) for Group B ICU patients, with mean scores decreasing from 7.46 to 6.8. Group A had significantly higher spirometry values (p=0.003) compared to Group B, indicating improved lung function. Chest mobilization shows potential benefits in enhancing respiratory health for ICU patients. Conclusion: Incorporating chest mobilization techniques, possibly with breathing exercises, significantly improves respiratory function and reduces breathlessness in ICU oxygen-dependent patients, supporting the use of respiratory physiotherapy for improved outcomes. Further research is needed to examine long-term effects and safety considerations.

203. Comparative Evaluation of Post-Operative Cognitive Function in Patients Undergoing Septoplasty Using Controlled Hypotensive and Normotensive Anaesthesia
Manyata Nema, Neha Mehra, Gurpreet Kaur Atwal, Tenzin Kyizom, Robina Makkar
Abstract
Background: The phenomenon of postoperative cognitive dysfunction (POCD) after anesthesia and surgery is a recognized clinical concern that is characterized by a decline in cognitive performance. Controlled hypotension during anesthesia is a technique used to reduce blood loss in certain surgeries, such as septoplasty, and has been found to be effective in drying the surgical field, shortening the duration of surgery, and improving surgical access. However, the effect of controlled hypotension on postoperative cognitive function remains unknown. This prospective randomized study aims to compare the postoperative cognitive function of patients undergoing septoplasty using controlled hypotensive and normotensive anesthesiausing the Mini-Mental State Examination (MMSE) score. Methods: The present prospective, randomised, comparative study was conducted among 60 patients undergoing elective septoplasty under Department of Anaesthesiology and Critical Care. The study was approved by Institution Ethics Committee. All patients underwent prea anesthetic evaluation on the day prior to surgery. A total of 60 patients scheduled for septoplasty under general anaesthesia at SMIH, Patel Nagar, Dehradun, over a period of 18 months were recruited for the study. They were divided into two groups by using computer generated randomization code. Group A : (n =30) – Controlled hypotensive anesthesia using isoflurane, Group B : (n =30) – Normotensive anaesthesia using local anaesthetic agent and vasoconstrictor. Data were coded and recorded in MS Excel spreadsheet program. All statistical calculations were done using (Statistical Package for the Social Science)SPSS 21version (SPSS Inc., Chicago, IL, USA )statistical program for Microsoft Windows. Results: In our study, MMSE score at 30 minutes post-operative period, was lower in Group A [24.6 ± 0.6] than Group B [27.7 ± 0.7 ] and it was statistically significant [ p < 0.05]. Conclusion: Our results showed that patients in the controlled hypotension group experienced a statistically significant drop in MMSE score at 30 minutes postoperatively, while patients in the normotensive group did not experience a significant decline in cognitive function. These findings are consistent with previous studies that have reported a higher incidence of POCD in patients undergoing controlled hypotension.

204.  Functional Outcome of Intramedullary Screw Nail Fixation Versus Conservative Management in Displaced Midshaft Clavicle Fractures: A Randomized Controlled Trial
Sushil. H. Mankar, Yash. M. Dhanwani, Aadil. A. Jawre, Mahesh. D. Tumdam
Abstract
Background: Non-operative treatment is the treatment of choice for midshaft clavicle fractures. There may arise some problems like impairment of ROM of shoulder, disfigurement of the local area with bump at the site for the fracture which may be cosmetically distressing to patient and nonunion can occur when grossly displaced fractures are treated non-operatively. Patients with displaced clavicle fractures can be managed with either ORIF with plating or CRIF with intramedullary nailing. Problem with intramedullary nailing of clavicle was implant migration which has been solved with newer implant i.e SCREW NAIL. Article includes the comparison of clinical outcomes of patients with displaced clavicle fracture managed conservatively and surgically i.e with intramedullary screw nail. Material and Methods: 30 patients suffering from midshaft clavicle fracture were included in the study. 15 patients were managed conservatively with figure of 8 clavicular brace and 15 were managed surgically with CRIF with intramedullary screw nail fixation. 30 subjects will be equally allocated into two groups using a computer generated random allocation plan determined by www.graphpad.com software. Outcomes were measured using the UCLS scoring system of the clavicle. Follow-up was taken on 1st month, 3rd months, 6th month post-surgery. Results: A statistically significant difference(p value =0.0001) was found in the UCLS shoulder score between the operative and conservative group at 1 month post-operative follow-up probably due to the early mobilisation in the operative group. The average UCLS score in the operative group was found to be 24.27 ± 3.13 whereas in the conservative group it was found to be 16.4 ± 1.18. A statistically non-significant (p value=0.0524) result was found at 3 months follow-up between the conservative and the operative group. The average UCLS score for the operative groups were found to be 27.64 ± 2.59 whereas average UCLS score for the conservative group was 25.47 ± 3.14. It was found that there was statistically significant (p value=0.0003) difference in the UCLS score between the operative group and the conservative group at the end of 6 months. Most of the patients in the conservative age group were not able to achieve the highest functional scores compared to the operative group. The average UCLS score in the operative group was found to be 31.54 ± 1.39.whereas the average UCLS score for the conservative group was 29.27 ± 1.49. Conclusion: Open reduction internal fixation with intramedullary screw nail is a reliable method in management of the displaced fractures of midshaft clavicle with high union rates and better functional outcomes with surgery done by trained person compared to conservative management. There were no reported complications like implant migration with screw nail. The University of California and Los Angeles shoulder score at the end of 6 months were found to be better for the subject who underwent open reduction internal fixation with intramedullary screw nail compared to those managed conservatively. The time of union was found to be less for the subject who underwent ORIF with intramedullary screw nail compared to those managed conservatively.

205. Utility of Sepsis in Obstetric Score to Identify Risk of Intensive Care Unit Admission from Sepsis in Pregnancy
Beenish Yousuf, Shayesta Rahi, Sameena Sultana, Harvinder Kour
Abstract
Introduction: Sepsis prevention should be the primary objective with focus on strategies to improve antenatal care. The main objective of our study was to prospectively assess the usefulness of the Sepsis in Obstetric Score to identify women at risk of ICU admission for sepsis in pregnancy. Material and Methods: The present prospective and observational study was conducted in the Postgraduate Department of Obstetrics and Gynaecology, Lalla Ded Hospital over a period of 18 months on 130 patients. After obtaining ethical clearance from Institutional Ethical Committee and proper inclusion and exclusion criteria, women presenting with signs and symptoms of sepsis were enrolled for study and evaluated for various parameters. Results: This study demonstrated women experience the highest rates of sepsis in their second and third decades of life. A higher risk of infection is linked to pregnancy because of the mechanical and physiological changes it causes. Majority of our patients who required ICU admission had an SOS of ≥ 6. Moreover, individuals with SOS ≥ 6 had significantly greater rates of maternal mortality and longer hospital stays. The ROC analysis revealed that with a sensitivity of 89.5%, specificity (93.7%), diagnostic accuracy (93.1%), the optimal cutoff for SOS in predicting the ICU admission and maternal outcome was ≥ 6. Conclusion: The consistent rising in ICU admission rate, hospital stay and mortality rates for higher SOS scores infers that SOS is a useful prognostic tool for early assessment and triaging of the severity among patients suffering from pregnancy associated with sepsis.

206. Association of Cerebro-Placental Ratio with Fetal Outcome in Gestational Hypertensive Kashmiri Pregnant Women
Safora Shafaq, Sameer Ahmad Lone, Ambreen Qureshi
Abstract
Introduction: The cerebroplacental (CP) ratio is a known indicator of adverse pregnancy outcomes. In the third trimester, CPR should be viewed as a means of evaluation for foetuses. The aim of our study was to determine the association of cerebro-placental ratio with fetal outcome in pregnant Kashmiri women with gestational hypertension. Materials and Methods: This prospective research was carried out on 750 patients in the Postgraduate Department of Obstetrics and Gynaecology at the Lalla Ded Hospital, which is affiliated with the GMC Srinagar, over the course of 1.5 years (2019-2021). After getting informed consent, enrolled patients underwent a detailed medical history, examination and Ultrasound scanning was performed transabdominally to evaluate foetal weight, biometrics, and Doppler studies. Results: The mean maternal age at presentation was 28.1 SD 4.78 years with maximum number of cases seen between the age group of 25-29 years (56.4 %). 68.5 % were primigravida and majority of cases belonged to rural area (68.4%). Majority of cases 407 (54.3%) delivered by Caserean Section and about 97.3% of babies were live births. The one-minute APGAR score was <7 in only 28.4% and the five minutes APGAR score was <7 in only 23.2%. Most of newborns (75.2%) had been of average gestational age and 507 (67.6%) had Normal CPR. Among 750 patients with Abnormal CPR, 67.5% had Caesrean Section. Among patients with abnormal CPR, 8.2% had still-birth,57.4% were small for gestational age ,58.7% had APGAR SCORE <7 at 1 min, 48.9% had an APGAR SCORE of 7 at 5 minutes, 40.4% necessitate admission to the NICU, and 13.9% died. The difference between those with Normal CPR and those with Abnormal CPR was of statistical significance for all of the aforementioned parameters. Conclusion: CPR evaluates parameters on both placental side and also foetal response. They help us to identify foetuses that are at higher risk of adverse perinatal outcomes and therefore such foetuses can be closely monitored during delivery.

207. Comparative Study of the first Request for Intravenous Rescue Analgesia and the Total Analgesic Requirement Postoperatively in Brachial Plexus Block with Dexamethasone and without Dexamethasone as an Adjunct to Ropivacaine
Babita Lahkar, Pramila Saha, Kamal C. Deori, Mrinal K. Taye
Abstract
Introduction: A brachial plexus block is the most preferred procedure for upper limb surgeries. Adjuncts, when given with local anaesthetics, prolong the analgesic efficacy of the block. The aim is to compare patients receiving supraclavicular brachial plexus block with and without perineural dexamethasone to the following: 1. First request for IV rescue analgesia. 2. Total post-operative IV analgesic consumption within 24 hours. Methods: Sixty patients with physical status ASA I and II, aged 18 to 50 years of both sexes, were randomly allocated into two groups of thirty. Group A received a supraclavicular block with 0.5% ropivacaine (30 ml) and 1ml(4mg) dexamethasone perineurally and 1ml 0.9%normal saline intravenously. Group B received a supraclavicular block with 0.5% ropivacaine(30ml) and 1ml 0.9%normal saline perineurally and 1 ml (4mg) dexamethasone intravenously. The duration of the sensory blockade was noted in both groups. Results: The duration of analgesia in group A was found to be longer than in group B. The time for rescue analgesia in group A was 874.87 ±41.09 min compared to group B’s 615.17 ±39.69 min, with a p-value of 0.001. And the average consumption of analgesic (Inj. Tramadol-1 mg/kg) post-operatively up to 24 hours in group A (86.7 ±31.60 mg) was less than that in group B (151.4 ±32.66 mg). Conclusions: In supraclavicular brachial plexus block, dexamethasone given as adjuvant perineurally significantly delays the time of first request of intravenous rescue analgesia and decreases the total postoperative intravenous analgesic requirement.

208.  Efficacy of Subcision Alone and With 50% TCA Cross and Microneedling in the Management of Atrophic Acne Scars
Neena Kondapally, P. Ashwani
Abstract
Introduction: Acne vulgaris is a persistent skin disorder, causes papules, cysts, and open and closed comedones. Atrophic scars can develop as a result of improper treatment selection or the presence of severe acne vulgaris. Subcision, microneedling, tissue augmentation, and ablative and non-ablative lasers are only a few of the therapy options. The present study was created to assess the effectiveness of subcision alone, microneedling, and subcision with 50% TCA CROSS and microneedling in the management of atrophic acne scars due to the paucity of research on combination therapy. Material and Methods: Forty-eight participants with grade II, III and IV atrophic acne scars aged between 18 to 40 years and grade II, III, and IV atrophic acne scars according to Goodman and Baron acne scar grade were included. Based on treatment, participants were randomly divided into subcision alone and subcision with 50% Trichloroacetic acid (TCA) CROSS groups. Pre and post treatment images were assessed for the effect of the treatment method. Results: In group A, the overall patient satisfaction score was excellent in 3 cases, good in 8 cases and moderate in 13 cases. While in group B, satisfaction score was excellent in 4 cases, good in 10 cases and moderate in 10 cases. Conclusion: The subcision with 50% TCA CROSS and subcision alone were exhibited comparable outcome. However, subcision with 50% TCA CROSS had gained better patient satisfaction with minimal side effects than subcision alone.

209. A Prospective Study to Evaluate the Clinical and Radiological Outcomes of Plating in Patients with Intra-Articular Distal end Radius Fracture
Parth Panchal, Dhruvin Jitendra Patel, Jigar Narendrabhai Patel
Abstract
Background: Fractures of the distal radial end are one of the most common fractures of upper extremity. There is considerable debate regarding the best treatment approach for these fractures. Hence, this study was conducted to evaluate the functional and anatomical outcomes of volar plating for the treatment of distal radial fractures. Methods: This was a prospective study conducted at the department of orthopaedic at a tertiary care hospital in Western India for a duration of two years. All the patients with distal radial fracture belonging to age group of 50 to 70 years were included in the study after obtaining informed consent. Detailed history of trauma and demographic details were recorded. X-rays were taken to confirm the diagnosis and classify the type of fracture and degree of displacement or comminution was checked. A thorough pre-operative evaluation was conducted and open reduction with internal fixation using volar plate was performed. Physiotherapy exercises were prescribed. The outcomes were assessed at 6 weeks, three-, six- and 12-months post operation using DASH questionnaire and Sarmiento criteria for functional and anatomical outcomes, respectively. Descriptive statistics was used to describe the results. Results: A total of 50 patients were included in the study out of which 64% were male. The fracture was on right side in 70% patients. The main cause of fracture was fall on outstretched hand in 76% patients followed by road traffic accidents (RTA) in 24% patients. RTA was more common in males (91.6%) as compared to females. The most common type according to AO classification was C2 fracture (36%) followed by B3 (30%). In 86% of cases, fractures were healed within 3 months post surgery. 6 months follow up revealed that 72% patients had excellent results according to DASH score and 86% patients had excellent results based on sarmiento score. Poor result was not reported in any of the study participant. Conclusion: Volar locking plate is an effective method of fixation in individuals aged 50-70 years with distal radial end fracture, along with adequate immobilisation and routine physiotherapy exercises.

210.  Evaluation of Clonidine as an Adjuvant to Ropivacaine in Sciatic Femoral Nerve Block for Lower Limb Surgeries
Mechineni Srivani
Abstract
Background: The utilization of clonidine as an adjuvant to ropivacaine has demonstrated its ability to extend the duration of peripheral nerve blocks. However, the precise mechanism of action behind this effect remains uncertain. To address this, our hypothesis posits that when clonidine is used as an adjuvant to ropivacaine in an adductor canal block (ACB), the extension of block duration is primarily attributed to a peripheral mechanism. We aim to investigate this hypothesis while controlling for systemic effects. Methods: This was a randomized, double-blinded study that assigned patients into two groups: Group I, which received ropivacaine, and Group II, which received ropivacaine and clonidine. Each group consisted of n=25 patients, and the surgical procedure was performed under a sciatic femoral nerve block. The patients selected were ASA I and II categories and undergoing elective surgery of lower limbs. Results: The onset of sensory blockade in group I mean value of 9.5 ± 1.5 minutes in group II, the onset time mean value of 11.5 ± 1.8 minutes. The onset of motor block in the study in group I was 13.25 ± 1.0 minutes in group II was 14.2 ± 1.0 minutes. The duration of sensory block in group I was 11.75 hours which is relatively shorter than group II with a mean duration of 16.10 hours the p values were found to be significant. the duration of the motor block in group I was 10.8 hours as compared to group II with a duration of 12.5 hours and the p values were found to be significant. Conclusion: When clonidine is added to ropivacaine in a sciatic femoral nerve block, there is no significant difference observed in the onset of sensory and motor blockade compared to using ropivacaine alone. However, the addition of clonidine does lead to a prolongation in the duration of both sensory and motor blockade as well as postoperative analgesia when compared to using ropivacaine alone.

211.  Thyroid Dysfunction in Chronic Kidney Disease and its Correlation with EGFR
Shubham Upadhyay, Raghav Mittal, Shweta Sahay, Bharat Batham
Abstract
Introduction: Patients with chronic renal failure (CKD) often exhibit signs and symptoms suggestive of thyroid dysfunction. Various studies have reported conflicting results regarding thyroid function in uremic patients, including hyperthyroidism, hypothyroidism, and euthyroid state. Thyroid dysfunction is associated with increased mortality and severity of renal disease. The prevalence of thyroid dysfunction in CKD ranges from 13% in early stages to 70% in end-stage renal disease (ESRD). This study aimed to investigate the prevalence and correlation of thyroid dysfunction with estimated glomerular filtration rate (eGFR) in patients with CKD. Methodology: This cross-sectional observational study included 150 patients diagnosed with CKD. Participants were recruited from a hospital or clinic using a convenient sampling method. Demographic information, clinical parameters (thyroid function and kidney function), and data on potential confounding factors were collected. Statistical analysis involved calculating the prevalence of thyroid dysfunction, assessing the correlation between thyroid dysfunction markers and eGFR, and performing subgroup analysis. Results: The study analyzed the sex-wise age distribution of participants, revealing a median age of 55 years among males, females, and the total clinical trials. The prevalence of thyroid dysfunction among CKD patients was examined based on sex, showing that low T3 syndrome was present in 48.6% of males and 69.2% of females, low T4 syndrome in 18.9% of males and 30.8% of females, and high TSH in 2.7% of males and 7.7% of females. An association was found between thyroid hormone levels and renal function. Serum T3 levels were associated with the severity of CKD, even in the presence of normal TSH levels. Conclusion: This study contributes to understanding the age distribution, prevalence, and correlation of thyroid dysfunction in CKD patients. The findings emphasize the importance of considering thyroid function in the management of CKD. Further research is warranted to explore the clinical implications and potential interventions related to thyroid dysfunction in CKD patients.

212. To Study the Pattern of Drug Use and Safety of Medication Used in Liver Disease Patients at Tertiary Care Teaching Hospital
Madhvi Kareliya, Dinesh Kamejaliya, AjitaPillai
Abstract
Background: One of the most common non-communicable diseases, liver disease alters the pharmacokinetics of many medications, necessitating careful monitoring and dosing adjustments to ensure the best possible patient outcomes. Aims and Objectives: The present study was undertaken to evaluate the drug usage pattern and its safety profile in liver disease patients. Materials and Method: An observational and cross-sectional study was conducted in the department of medicine in a tertiary care teaching hospital from January 2020 to January 2021 after getting approval from the ethics committee. Male and female patients of all ages (below 12 years old) were included in the total of 100 people diagnosed with liver illness. Descriptive statistics were used to examine demographic information, clinical notes, medications prescribed, WHO prescribing core indicators, and adverse drug reactions. Results: The majority of the study’s participants (n=100) had non-alcoholic fatty liver disease. Liver disease was more common in men (74%) between the ages of 41 and 50. Antibiotics were prescribed to 77% of patients, and the average number of medications per patient was 8.17. Antibiotics made up 17.25% of all prescriptions written, while gastro protectives made up 23.9%. Cefotaxime was the most commonly given antibiotic (at 79%), with metronidazole coming in second at 32%. Antibiotics were responsible for the vast majority of reported adverse medication responses, including diarrhea, nausea, skin rashes, and AKT-induced hepatitis. Conclusions: Disease-drug interactions are likely with the indiscriminate use of numerous medications because the liver is the primary organ for the metabolism of many pharmaceuticals.

213. Estrogen Receptor Gene Polymorphisms and Risk of Myocardial Infarction
Sivaranjani, Swaathy Ramamurthy, Prathibhabharathi, M. Rasheed Khan
Abstract
Introduction: This study aimed to identify ESR1 gene polymorphisms associated with myocardial infarction susceptibility. Materials and Methods: The present study was carried out for one year on diagnosed patients of Myocardial infarction admitted to the ICU and Cardiology ward of Narayana Medical College and Hospital, Nellore. 100 subjects were studied, including 50 normal healthy individuals and 50 diagnosed myocardial infarction cases. In all the participants, estrogen receptor -1 gene polymorphism, BMI, blood pressure , fasting blood glucose, serum lipid profile, and creatinine were estimated and the mean values were compared and analyzed. Results: The mean levels of  BMI, BP, serum  TC, LDL, TAG, and VLDL were increased in cases but mean HDL decreased in cases was statistically significant  (p< 0.05). In the present study, TT genotypes of ESR1 gene polymorphism is significantly elevated to 42% in Myocardial infarction patients when compared to control subjects. 26%. CT genotypes are significantly less in patient groups at 28% when compared to control subjects at 34%. CC genotypes are significantly less in patient groups 30% when compared to control subjects 40%.  The frequency of the T allele of  PvuII was significantly higher in patients (56%) than in controls (44%). Conclusion: The present study concludes that ESR1 gene polymorphism may be a genetic marker for the development of MI.

214. Correlation Between Serum Pseudocholinesterase with Hematological and Biochemical Parameters in Organophosphorus Poisoning Patients of Dadra and Nagar Haveli
Jitendra Kumar S Parmar, Manjula J Babariya, Prateek Agrawal, Deepa Gupta
Abstract
Background: Organophosphorus (OP) poisoning is one of the most common poisonings seen in India. OP compounds act through inhibition of enzyme acetylcholinesterase and estimation of pseudocholinesterase (PCHE) activity strengthens the diagnosis in clinically uncertain cases of OP poisoning. This study was aimed to determine the prognostic significance of estimation of PCHE activity in OP poisoning. Material and Method: Patients of suspected OP poisoning of age group 12-70 years admitted to emergency unit at SVBCH, Silvassa Dadra and Nagar Haveli were enrolled. Serum PCHE level was estimated at the time of admission in all patients and OP poisoning cases were assessed according to PCHE level.  Results: The study involved 82 individuals age group 12-70 years including 41 healthy control and 41 cases. Out of 41 cases, 36.58% (15) males and 63.41% (26) females. Twenty-seven patients (65%) of OP poisoning were accidentally poisoned while fourteen (35%) cases were with suicidal intent. In all suicidal cases route of poisoning was ingestion whereas in all the accidental cases route of exposure was inhalational. PCHE levels were reduced in all the cases and the mean level was 1.99 ± 1.92 U/mL. Significant positive correlation was found between PCHE and serum Potassium levels and negative correlation showed with total leukocytes counts and random blood sugar levels. Conclusion: The study recommends hematological and biochemical investigation along with estimation of PCHE level at the time of admission to find early prognosis and treatment of patients.

215. Lipoprotein (A) Levels in Patients of Acute Coronary Syndrome Admitted in Coronary Care Unit, S P Medical College, Bikaner, Rajasthan
Ashok Kumar Lakhara, Devendra Agarwal, Rohitash Kularia, Subhash Gaur, P.D. Tanwar, Dinesh Choudhary
Abstract
Introduction: High levels of lipoprotein(a) [Lp(a)] are associated with increased risk of acute coronary syndrome (ACS). We explored whether Lp(a) exhibits a association with ACS. Methods: Hospital based cross-sectional study. Was conducted on 100 patients with acute coronary acute coronary syndrome (ACS). The serum lipo-protein(A) level was measure and ECG was done at the time of admission and repeated as necessary. Lp (a) was measure by antigen antibody agglutination test. Results: 49% patients were belong to age group 41-60 Yrs followed by 47% patients were more than 60 Yrs age group. 53% patients were male and 47% patients were female . 50% patients were belong to middle socio-economic status and 40% patients were belong to upper socio-economic status. 58% patients were obese followed by 37% patients BMI was normal and 5.00% patients were morbid obesity.31.00% patients were present with positive family history. 36% patients were present with positive smoking history. 30% patients were present with positive Tobacco chewing history. 25% patients were present with positive alcohol history. SBP was 128.02±11.06 mm of Hg and DBP was 80.02±8.01 mm of Hg.  FBS was 110.06±19.36 mg/dl and PPBS was 165.39±34.02 mg/dl. Serum cholesterol was 185.36±43.28 mg/dl,Serum triglyceride was 151.23±60.35 mg/dl, LDL was 107.58±36.24 mg/dl and HDL was 44.23±7.14 mg/dl.  lipo-a was 51.77±11.23mg/dl. The association between age and lipo-protein a level was found statistically significant(p value 0.001). The association between sex and lipo-protein a level was found statistically Insignificant(p value 0.321). Conclusion: Lp(a) seems to be an independent risk factor for acute coronary syndrome (ACS), and high Lp(a) levels increased the risk for acute coronary syndrome (ACS).

216. The Relation between Neutrophil Lymphocyte Ratio (NLR) and Grade of Severity in Dengue Infection
Suresh Kumar Sharma, Rohitash Kularia, Vijay Kumar Tundwal, Anita Sharma, Subhash Gaur, P.D. Tanwar
Abstract
Introduction: Dengue virus infection is one of the public health problems resulting in social and economic impacts. The prevalence of dengue virus infection increases every year with the wide endemic area. DHF is mostly found in tropical and sub-tropical climates, especially in urban areas. It is estimated that worldwide more than 50 million infections occur each year including 500,000 hospitalizations for dengue hemorrhagic fever, mainly among children with the case fatality rate exceeding 5% in some areas. Objectives: To identify the possible correlation between neutrophil to lymphocyte ratio and severity of dengue patients. Methods: This hospital based cross sectional study was conducted at Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, Rajasthan. Randomly enrolled total of 141 patients of Dengue fever with NS1 positive. Results: In our study we found that At day-3 majority of DF cases has NLR>3 (65.38%), majority of DHF cases has NLR between >1-≤2 (44.44%) and in DSS cases 40% has NLR>3 followed by 30% has NLR between >1-≤2, at day-6 majority of DF cases has NLR between >1-≤2 (39.42%), majority of DHF cases has NLR between >1-≤2 (48.15%) and in DSS cases 50% has NLR≤1 followed by 40% has NLR between >1-≤2 and at day-9 majority of DF cases has NLR ≤1 (36.54%), majority of DHF cases has NLR between ≤1 (70.37%) and in DSS cases 50% has NLR≤1 followed by 20% has NLR between >1-≤2 and >2-≤3. Thus, NLR was low in DSS and we found statistically significant difference in NLR with grade of severity. Conclusion:  The study concludes that NLR may be used as prognostic marker in management of dengue fever. There is a significant relation between NLR with grade of severity in dengue infection. This means that the lower the level of NLR, the heavier the clinical degree of dengue.

217. The Clinical Profile and Outcome of Ischemic Stroke Patients Admitted at a Tertiary Care Center in Western Rajasthan
Prem Prakash Geela, Inder Puri, Babulal Meena, Manoj Meena, Manmahendra Singh Jatu, S K Kochar
Abstract
Introduction: Globally, stroke is the second most common cause of death and the fourth most common cause of disabilities. More than 20 million individuals each year develop stroke, of which five million succumb to their illness. Objectives: This study is conducted to assess the factors affecting the outcome of ischemic stroke. Methodology: This is a hospital based retrospective cohort study was conducted in 101 ischemic stroke patients admitted in the Department of Medicine, S.P. Medical College, and P.B.M. Associated group of hospitals, Bikaner, Rajasthan. Results: The most common symptom was aphasia with left hemiparesis seen in 14.85% cases, followed by aphasia with right hemiparesis in 11.88%, aphasia with quadriparesis in 8.91%. Most patients had an NIHSS score between 4-15 depicting moderate stroke in 41.6% cases, followed by an NIHSS score between 21-42 depicting severe stroke (30.7% cases). The most common risk factor hypertension with diabetes in 11.88%, hypertension with smoking in 14.85%, hypertension with diabetes with alcohol in 4.95%, and hypertension with diabetes with smoking in 3.96%. 12.87% had only hypertension, 11.88% had only smoking, 8.91% had only diabetes. The most common risk factor hypertension with diabetes in 11.88%, hypertension with smoking in 14.85%, hypertension with diabetes with alcohol in 4.95%, and hypertension with diabetes with smoking in 3.96%. 12.87% had only hypertension, 11.88% had only smoking, 8.91% had only diabetes. The MRS grading analysis revealed that in 13.9% cases the MRS was grade 0 after 3 months, in 22.8% grade 1, in 5.9% grade 2, in 15.8% grade 3, in 7.9% grade 4, in 4% grade 5 while in 29.7% it was grade 6. There was a highly significant correlation between NIHSS score at admission and MRS grade after 3 months of discharge (p value<0.0001). Discussion: The mean age of females was 65.1±16.9 years while that of males was 60.4±14.3 years (p value-0.14). Age, a history of cerebrovascular events, smoking, alcohol consumption, physical inactivity, hypertension, dyslipidemia, diabetes mellitus, cardiovascular illnesses, obesity, metabolic syndrome, food, nutrition, and genetic risk factors are all major risk factors for stroke. In India, many hospital-based studies have investigated the stroke risk factors. Hypertension, diabetes mellitus, ischemic heart diseases, male gender, and age ≥65 years are main reported stroke risk factors in India. In our study, the most common risk factor hypertension with diabetes in 11.88%, hypertension with smoking in 14.85%, hypertension with diabetes with alcohol in 4.95%, and hypertension with diabetes with smoking in 3.96%. 12.87% had only hypertension, 11.88% had only smoking, 8.91% had only diabetes. Other risk factors were tobacco in 5.94%, previous history of stroke in 2.97%, atrial fibrillation in 1.98%, coronary artery disease in 1.98% and dilated cardiomyopathy in 0.99%. Conclusion: Preventive methods can be adopted to reduce the burned of modifiable risk factors. Furthermore, health administrators might use the information provided in our study to plan resource distribution. More research is required to investigate rehabilitative components and long-term consequences.

218. The Clinical Profile and Outcome of Haemorrhagic Stroke Patients Admitted at a Tertiary Care Center in Western Rajasthan
Manmahendra Singh Jatu, Inder Puri, Babulal Meena, N K Gahlot, Prem Prakash Geela, S K Kochar
Abstract
Introduction: Stroke is the second leading cause of mortality and the fourth leading cause of impairments worldwide. Each year, more than 20 million people have a stroke, and five million of them pass away as a result of their condition. The incidence of stroke has, however, quickly decreased in industrialised nations, with up to 85.5% of all stroke deaths occurring in underdeveloped nations, according to recent data. Objectives: To study NIH stroke scale at admission and MRS (disability scale) at discharge and follow up of haemorrhagic stroke patient. Methodology: Hospital based retrospective cohort study (with an internal comparison group) was conducted in 100 haemorrhagic stroke patients admitted in the PBM and attached group of hospitals, Bikaner, Rajasthan. Results: All cases had one or more risk factors, with dysphagia being the most common seen in 38% cases, followed by right hemiparesis in 33% cases, left hemiparesis in 25% cases, unconsciousness in 26% cases, dysarthria in 20% cases, paraparesis, and altered sensorium each in 4% cases. Most cases had multiple risk factors, with a combination of dysphagia and hemiparesis being the most common. The NIHSS score of cases ranged between 5-40, with 58% having a score of 21-40. Discussion: The majority of our patients were older adults, with hypertension being the most common risk factor. Our study also found significant differences in laboratory parameters between survivors and non-survivors, specifically in terms of RBS level, cholesterol level, and triglyceride level. Furthermore, our study found a strong correlation between baseline NIHSS score and long-term functional outcomes, highlighting the importance of NIHSS score as a marker for prognosis and potential for recovery in haemorrhagic stroke patients. Conclusion: Further research is needed to confirm our findings and to determine the clinical utility of laboratory markers in the management of haemorrhagic stroke in India.

219. A Comparative Study Between Topical Cyclosporine 0.05% and Topical Fluorometholone 0.1% in the Treatment of Vernal Keratoconjuctivitis
Hardik Patel, Geetika Srivastava, Harpal Sinh B. Jhala
Abstract
Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic as well as recurrent, Bilateral, noninfectious disease that that generally affects children mostly boys. VKC is seasonal and allergic disease and usually occur in spring and summer season. Objective: To study the efficacy of topical Cyclosporine (0.05%) and topical Fluorometholone (0.1%) in the treatment of vernal Keratoconjuctivitis. Methods: A Cross Sectional Study including 100 eyes of 50 Subjects with a mean age of 10.68 ± 3.21 years was undertaken at a tertiary eye care hospital. All the subjects with Vernal Keratoconjuctivitis who were prescribed either Cyclosporine (Group A) or Fluorometholone (Group B) eye drop were studied. Chi-square procedures and unpaired t test procedures were used to find out the significance value. Results: The mean age of patients was 10.44 ± 3.11 years in Group A & 10.92 ± 3.30 in Group B. The changes in Total Subjective Symptom Score(TSSS) were statistically significant. Treatment & after treatment TSSS were significantly improved to 0.32 ± 0.21 in Group A & 0.30 ± 0.24 in Group B. The changes in Total Objective Sign Score(TOSS) were statistically significant. Treatment & After treatment TOSS were significantly improved to 0.40 ± 0.19 in Group A & 0.36 ± 0.17 in Group B. Conclusion: Cyclosporine 0.05% may be a first line drug for treatment of vernal Keratoconjuctivitis as it does not causes sight threatening side effects as occur with use of steroid. Cyclosporine eye drops provides quick relief comparable to Fluorometholone with no rise in Intraocular pressure in mild disease. Thus it can be the first line of treatment for vernal Keratoconjuctivitis in mild cases while steroid drops are usually reserved for moderate and severe cases.

220. 2D Echocardiographic Assessment of Left Ventricular Function in Case of Myocardial Infraction
Darshak Makawana, Pooja Jariwala, Mittal Patel, Madhvi Kareliya
Abstract
Background: The quantitation of left ventricle (LV) volumes and ejection fraction is an important aspect of cardiac evaluation in all cardiac disorders. So, two-dimensional (2D) ejection fraction is meaningful when applied across populations or to stratify risk in individuals. Aims and Objectives: To assess the prevalence of left ventricular systolic and diastolic dysfunction in patients with acute myocardial infraction and to evaluate their association with variables such as smoking, diabetes, hypertension, Kilip class, type of myocardial infraction etc. Relationship between the echocardiographic indices of systolic and diastolic dysfunction with development of early in hospital congestive heart failure was also assessed. Material and Method: Individuals who were admitted for acute Myocardial Infarction in the Intensive Coronary Care Unit from Febuary  2019 to December  2020 were evaluated for Left Ventricular Systolic and Diastolic function by 2D Doppler Echocardiography within 48 hours of admission. On the basis of this wall motion analysis scheme, a wall motion score index (WMSI) is calculated for each patient. Diastolic function is assessed by measuring the Trans-valvular pressure gradients using Doppler Echocardiography. The systolic and diastolic dysfunction assessed by the above methods was correlated with other variables such as Age, Sex, Smoking, Type of Myocardial Infarction, Killip class. Results: There were 100 patients (male 72, females 28) included in the study with acute ST elevation Myocardial Infarction (MI). Anterior wall MI was found in 64 patients while inferior wall MI was seen in 36 patients. Males had higher incidence of Anterior MI compared to females. All the patients had regional wall motion abnormalities in their Echocardiogram and underwent thrombolysis. The mean Left Ventricular Ejection Fraction (LVEF) is lower in the Anterior MI group (p<0.05). Both left ventricular end systolic diameter and end diastolic diameters were higher in Anterior MI patents, but the difference was not statistically significant (p>0.05). The regional wall motion scoring index (RWMI) was higher in Anterior MI patients (1.57 ± 0.33 vs 1.30 ± 0.07). This was statistically significant (p<0.05) and can be explained by the difference in infarct dimensions among the groups. Older patients (age 56-60 years), presence of diabetes and smoking are significantly associated risk factors with heart failure in our study. LV Ejection Fraction had an AUC (area under the curve) of 0.862 which denotes that the LVEF has very high diagnostic accuracy in predicting heart failure (p value of <0.0001). Conclusion: In-hospital congestive heart failure is more common in anterior wall myocardial infarction patients. Left ventricular ejection fraction predicted early heart failure best. Smoking and diabetes were linked to early in-hospital cardiac failure after myocardial infarction.

221. Retrospective Analysis of the Ovarian Dermoids Via Radiographic Evaluation: A Clinical Study
Archana Patil, Nitu Ritvik Jaykar
Abstract
Background: Most common ovarian neoplasms seen are the Ovarian Dermoids which constitute nearly 15-20% of total ovarian neoplasms. Ovarian dermoid is usually seen in females of the reproductive age group, especially in the 2nd and 3rd decade of their life. Ovarian dermoid are slow-growing tumors comprising of various elements from multiple germ cell layers. Ovarian dermoid is usually diagnosed using USG (ultrasonography) and better assessment is done using MRI and CT. Aim: The present study was conducted to radiographically evaluate the ovarian tumors with the imaging data from different radiological modalities. Materials and methods: Ovarian dermoid cases were diagnosed with either MRI, CT, or USG. Imaging data were assessed by a minimum of two radiologists experts in the field. The collected data were subjected to statistical evaluation for results formulation. Results: Right side ovarian dermoids were seen in 62.5% (n=20) study subjects, left side was seen in 25% (n=8) study subjects, and bilateral ovarian dermoids were seen in 12.5% (n=4) study subjects. The lesion size was 6-10cm in majority of study subjects, in 65.62% (n=21) subjects followed by 0-5cm in 15.62% (n=5) study subjects, and 11-15cm in 12.5% (n=4) study subjects. The lesion size of 15-20cm and 21-25cm was seen in 3.12% (n=1) study subject. Ultrasonography was done in 40.62% (n=13) study subjects, CT was done in 15.62% (n=5) study subjects, and MRI was done in 12.5% (n=4) study subjects. Ultrasonography with computed tomography was done in 25% (n=8) study subjects, ultrasonography with MRI (magnetic resonance imaging) was done in 3.12% (n=1) study subject, and CT with MRI was also done in 3.12% (n=1) study subject respectively. Conclusion: The present study concludes that ultrasonography can readily detect ovarian dermoid, whereas, the cases with complications should further be assessed on MRI or CT.

222. Results of ORIF with Extramedullary Plate Osteosynthesis and Intramedullary Modified Ender Nailing in Humerus Diaphysealfractures in Adult Indian Population
Ejajahmed Ansari, Josal S Patel, Vipul Leuva, Hitesh Panchal, Gaurav Parikh, Smit Kagathra, Jawahar Jethva
Abstract
Introduction: Humerus shaft fractures happens in 3% of all fractures. Most of them are treated conservatively. Various surgical techniques are described in literature for surgical intervention of diaphysial humerus fractures. In our study we have done new modified ender nailing for humerus diaphyseal fractures. Materials and Methods: Total 48 Humerus shaft fractures were treated by operative management in tertiary care centre from July 2020 to May 2022 including both open and closed injuries, of which 22 patients underwent Intramedullary fixation with Modified Enders nailing and 26 patients were treated with Extramedullary fixation with plating. The clinical examination was done by two examiners independently followed by functional scoring with RODRIGUEZ MERCHAN CRITERIA and radiological scoring with RHUM (Radiographic Humerus Union Measurement). Results: Out of total 48 patients, 8 patients were lost to follow up. Out of the 40 patients there were 25 males and 15 female patients. The mean age of the patients at the time of injury is 38.10 years. Average time of union was 12 weeks in intramedullary enders fixation and 13 weeks in extramedullary fixation. Average RHUM score at the end of 3 months in intramedullary fixation is 9.15 and in extra medullary fixation is 8.45 and after 6 months is 11.45 and 10.8 respectively. Union rate was 100% in both type of fixation. Conclusion: The effectiveness of intramedullary fixation with modified Enders nailing and extramedullary fixation with plate osteosynthesis is comparable in viewpoints of radiological and functional outcomes with no significant differences. The intramedullary fixation with modified ender nailing is a better choice than extramedullary fixation with plate osteosynthesis in view of less soft tissue damage, less soft tissue irritation, and fewer chances of iatrogenic radial nerve palsy.

223. A Comparative Study of Early Versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis and its Associated Complications
Kumar Gaurab, Kumar Ratnesh, Himanshu Kumar, Swapnil
Abstract
Background and Objectives: Acute cholecystitis is a common surgical problem and was usually treated with conservative management followed by a delayed laparoscopic cholecystectomy after a interval of 6 to 8 weeks. Our aim was to compare the efficacy of immediate laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (LLC) in patients of acute cholecystitis, and also to assess the complications between the two. Materials and Methods: This is  prospective Study randomized controlled trial in JLNMC and Hospital Bhagalpur. Study duration of Two years. that was conducted on 50 consecutive patients diagnosed to have acute cholecystitis. 25 patients underwent immediate laparoscopic cholecystectomy within 24-72 hours of admission and 25 patients underwent a delayed laparoscopic cholecystectomy after 6-8 weeks of the initial episode. Conclusion: Early laparoscopic surgery had similar intraoperative and postoperative complications compared to delayed surgery in acute cholecystitis, but was associated with a shorter surgery and lesser stay in hospital.

224. A Randomized Comparative Study of Efficacy of Axillary and Infraclavicular Approaches for Brachial Plexus Block for Upper Limb Surgery Using Peripheral Nerve Stimulator
Saiprabha, D. Priyachithra, G. Balaji, B. Jeyarani
Abstract
Peripheral nerve block provides site specific, rapid onset, long lasting and effective anaesthesia and analgesia. Optimal pain relief and minimal side effects (e.g. nausea and vomiting) following surgery have a major impact on patient outcome. Peripheral nerve block for upper limb surgeries can be done by brachial plexus blockade. This can be done at the level of root, trunk, cord or terminal nerves. Nerve stimulator was invented for higher success rate and to decrease the complications. In our study, we compared injection of vertical infraclavicular technique with axillary technique, for brachial plexus block in patients undergoing distal forearm, wrist and hand surgery using a combination of 10 ml of 2% lignocaine and 10 ml of 0.5% bupivacaine and 10ml of 0.9% normal saline with the use of peripheral nerve stimulator (PNS). We compared the onset of sensory and motor block, time taken for complete sensory and motor block, duration of motor and sensory block, the success rate of nerve block and complications. All the data collected were entered into the Microsoft excel sheet and analyzed statistically. The p value of <0.05 was considered statistically significant. Results: In terms of efficacy the infraclavicular approach appears to be better than the axillary approach for brachial plexus block for surgeries done in distal forearm and hand.

225. To Study the Efficacy and Tolerability of Lamotrigine in Comparison with Carbamazepine as A First Line Drug in Newly Diagnosed Untreated Epilepsy Patients
Baldeep Singh, Jasleen Kaur Narula
Abstract
Epilepsy is a common neurological disorder affecting humans. The conventional antiepileptic drugs (AEDs) control seizure in 80% of the patients and possess various side effects like sedation, ataxia, teratogenicity etc. Lamotrigine(LTG), a phenyltriazine is safe and effective AED, both as add-on and monotherapy in patients with partial as well as generalised seizures. Thus, the present study was undertaken in 100 patients divided in two groups, to study the effect of lamotrigine as a first-line drug in the management of newly diagnosed untreated adult epileptics and to compare the efficacy and tolerability in comparison to carbamazepine(CBZ), a conventional antiepileptic drug.
Thus, we found that LTG was equally efficacious to carbamazepine as measured by reduction in seizure frequency. Sedation was the main side effect in CBZ group due to which nine withdrew from the study. Other side effects in CBZ study group were headache, rash, ataxia. Maculopapular rash was the main side effect in lamotrigine group, due to which two withdrew from the study. Other side effects in LTG study group were headache, asthenia, sedation. Thus, on comparing lamotrigine was better tolerated than carbamazepine and equally efficacious to carbamazepine in various types of seizure. Thus, lamotrigine may be useful as monotherapy in epilepsy.

226. A Comparative Study of Laparoscopic Assisted Vaginal Hysterectomy Versus Total Abdominal Hysterectomy in Benign Gynaecological Conditions: A Prospective Study
Yusra Mushtaq Shah, Omer Khurshid, Aijaz Ahmad
Abstract
Background: laparoscopic assisted vaginal hysterectomy (LAVH) has modernized and added another arrow to the surgeon’s quiver. To compare the TAH and LAVH for benign diseases. Methods: This prospective comparative observational study was undertaken to compare outcome of laparoscopic assisted vaginal hysterectomy with total abdominal hysterectomy for a total of 1 year in 60 patients who were undergoing hysterectomies for benign uterine abnormalities. 30 cases underwent TAH and 30 underwent LAVH. Results: The mean operative time in LAVH group was 175.3 minutes whereas in TAH group it was 95.2 minutes (p<0.001). 30% patients in TAH group had 250 to 500 ml of blood loss. In 90% of LAVH group blood loss was less than 250 ml (p<0.001). Mean blood loss was 290 ml in TAH group and 160 ml in LAVH group. 20% of patients in TAH group and 6.6% patients in LAVH group required blood transfusion (p>0.05). The mean postoperative hospital stay in LAVH group was 4.2 days and in TAH group it was 5.4 days (p<0.001). Mean hospital stay in LAVH and TAH was 4.2 and 5.4 days (p<0.001). Mean VAS in LAVH and TAH was 3.4 and 5.1 (p<0.001). Mean hours required for ambulation in LAVH and TAH was 7.7 and 11.7 hours (p<0.001). Return to daily activities after discharge was early with LAHV group i.e. 2 weeks. In 48 % of patients. In TAH group, it was late by 5 weeks in 58% patients and 7 weeks in 15% of patients. Conclusion: This study demonstrates that LAVH is better alternative than TAH in terms of less blood loss, early ambulation and early resumption of daily activities.

227. Accuracy of Intra-Operative Frozen Section in the Diagnosis of Ovarian Tumors
Mayuri Kute1, Rajendra Chaudhari2, Preeti Bajaj3, Jyoti Kasture
Abstract
Introduction: Discrimination of benign and malignant tumors during surgery in gynaecologic patients with adnexal masses is important for the management of the patient. Intra-operative frozen section analysis gives information about the characteristics of masses. Objectives: To compare frozen-section results with definitive histopathological results of ovarian tumors diagnosed intra-operatively. Materials and Methods: Specimens send in Normal Saline (NS) for frozen examined for gross features (Sample size -39). Sections are then submitted from representative areas. Further processing of frozen takes place followed by staining. The sections are then studied. The results are then conveyed to the operating surgeon within 25-30 minutes. The same specimen is then allowed to fix in 10% buffered formalin for approximately 24 hours and then submitted for routine paraffin procedure. The final reporting is done on these paraffin sections. Results: Frozen section results of the patients with a final diagnosis of ovarian tumors operated at our institute between September 2019 and September 2022 were analyzed. Data of 39 patients was analysed. Among 39 cases on frozen section, 27 (69.2%) cases were benign and 12 (30.8%) cases malignant. The results of paraffin block showed 26 (66.7%) cases to be benign and 13 (33.3%) cases as malignant. One case was reported to be false negative. Conclusion: Intra-operative frozen section is useful in situations where the nature of the ovarian tumor is uncertain whether benign or malignant. It is a highly sensitive and specific modality and thus helps the surgeon in planning further surgical management.

228. To Study the Occurrence of Mucormycosis in the Post Covid-19 Patients and its Association with Uncontrolled Diabetes Mellitus at a Tertiary Care Centre
Jyoti Kasture, Rajendra Chaudhari, Devangana Rajyaguru, Preeti Bajaj, Apurva Ramteke
Abstract
Introduction: Mucormycosis is becoming more prevalent among post COVID-19 patients. Diabetes mellitus (DM) is a risk factor for severe COVID-19 and mucormycosis on its own. Without prompt identification and treatment, the condition may advance quickly, with death rates from intra-orbital and cerebral complications recorded. AIMS AND Objectives: To study the spectrums of fungal infections in post Covid-19 patients on histopathology. Materials and Methods: A total of 104 random subjects who were admitted for signs and symptoms of mucormycosis and had a history of COVID- 19 infection were included. Results: The study revealed nasal and paranasal sinus involvement in a large number of patients. 73.08% patients had high BSL. DISCUSSION: In critically unwell patients with COVID-19 and DM, a high index of suspicion for Covid associated mucormycosis, especially if rhino-orbital or rhino-cerebral symptoms are present, is needed. Conclusion: We are learning more about the Covid-19 infection’s novel and long-term manifestations.

229. Usage of Blood and Blood Components in COVID-19 Patients in A Tertiary Health Care Centre: A Retrospective Study
Sheela Chikhalikar, Archana Patil, Preeti Bajaj, Saloni Sankhe
Abstract
Introduction: The novel coronavirus disease 2019 (COVID-19) pandemic caused the severe acute respiratory syndrome(SARS–COV–2). COVID-19 is a contagious disease which disturbed all aspects of the human life worldwide. Old age, immuno-compromised patients and patients with co morbidity were severely affected by the COVID- 19 infections. Healthcare systems were affected significantly all over the world. Outbreak of COVID-19 had a severe impact on the blood donation, supply as well as on blood safety. Transfusion was needed in few critically ill COVID-19 patients. Blood components transfused to COVID-19 patients were packed red cells predominantly, followed by fresh frozen plasma (FFP) and platelets. Blood centers had to maintain the blood inventory based on the demand of blood. Aims and Objectives: To find the usage of blood and it’s components in COVID-19 patients. To find the indications of blood transfusion in COVID-19 patients. Material and Methods: This retrospective observational study was carried out from May 2020 to May 2021 in Dr Vasantrao Pawar Medical College, Hospital & RC, Adgaon, Nashik. Study was done to know usage of blood and blood components transfused to COVID-19 cases who were admitted in our hospital.

230. An Observational Study of Ropivacaine 0.2%, Ropivacaine 0.5% and Bupivacaine 0.25% in Post-Operative Epidural Analgesia
Priyanka Kaurav, Neha Jain, Dinesh Thakur, Manish Shivani, Sunil Rajpoot, Sumit Bhargava
Abstract
Objective: The present study aimed to evaluate the quality of postoperative analgesia, hemodynamic profile, sensory block achieved with Ropivacaine (0.20% and 0.50%) and Bupivacaine (0.25%) used for epidural analgesia in lower limb orthopaedic surgery. Methods: In this observational prospective study the participants included a representative sample of patients admitted to the department of orthopaedics for lower limb surgeries. Study participants were allotted to the study groups sequentially. The first 30 recruited participants were allotted group I, the next 30 participants recruited was allotted group II and the last 30 participants were allotted the group III.  An epidural catheter (19 G) advanced cephalad 3–5 cm into the epidural space. Quality of postoperative analgesia, hemodynamic profile, sensory block was evaluated and findings recorded. Results: The duration of postoperative analgesia and onset of pain relief was longest in group II (Ropivacaine 0.5%), followed by the group I (Ropivacaine 0.2%) and was shortest in group III (Bupivacaine 0.2%). The mean time of onset of sensory blockade was quickest in group II (14.2%), followed by the group I, and was most delayed in group III (28.7 minutes). The total duration of sensory block was longest in group II (310.56), followed by group I and was shortest in group III (191.2 minutes) respectively. The difference in change in the blood pressure was not statistically significant between the group I (0.2% Ropivacaine) and group III (0.25% Bupivacaine).  The difference in change in the blood pressure was not statistically significant between the group I (0.2% Ropivacaine) and group II (0.5% Ropivacaine). None of the subjects included in the study had any side effects like bradycardia or hypotension.  Conclusion: The study subjects in group II showed the characteristics which are most desired by both an orthopaedic surgeon and anaesthetist during and immediately after the surgery. Thus, among the three-drug formulations compared in this study, the author believes that Ropivacaine given in concentration of 0.5% was most aptly suited for postoperative epidural analgesia in lower limb orthopaedic surgeries.

231. Nerve Conduction Velocity and Effect of Different Phases of Menstrual Cycle on it
Bhavna Gupta, Chhaya Batham, Shilpa Waghmare, Pratibha Verma
Abstract
Objective: The study was done to find out the effect of different phases of menstrual cycle on the Nerve conduction velocity in females. Methods: 50 normal menstruating women with age between 18 to 24 years, with regular menstrual cycle were randomly selected from the nearest nursing college hostel and were included in the study. Evoked electromyogram (EMG) was used to measure the nerve conduction velocity of median nerve in all the three phases of menstrual cycle i.e. proliferative, secretory and menstrual phase. Their mean values were calculated and compared in all the three phases. Results: When the mean of nerve conduction velocities in different phases of menstrual cycle were compared, a decrease in the NCV was observed in the secretory phase as compared to the menstrual and proliferative phase but the p value was not significant. Conclusion: Nerve conduction velocity of the peripheral nerves does not vary significantly during the different phases of the menstrual cycle. However these parameters should be kept in mind while conducting studies on nerve conduction velocities.

232. Clinical Evaluation of Outcome of Open and Closed Haemorrhoidectomy
L Srinivas, G Hemanth
Abstract
Background: Hemorrhoids are a very common problem affecting a large group of the population. Milligan-Morgan excision haemorrhoidectomy continues to be widely used as a treatment option for third- and fourth-degree hemorrhoids. On the other hand, Ferguson haemorrhoidectomy is thought to cause less postoperative pain due to its closed wound nature. The objective of this study was to compare the outcome of the two conventional methods of hemorrhoidectomy open and close for third-degree prolapse and complicated hemorrhoids. Methods: Patients who meet the inclusion and exclusion criteria were included. A total of n=40 cases allocated randomly generated computer numbers to two groups. Group, I patients will undergo an open approach to hemorrhoidectomy, as described by Milligan-Morgan. Group II patients, on the other hand, will undergo a closed approach to hemorrhoidectomy, as described by Ferguson. Both procedures will be performed under Spinal Anesthesia. Results: In our study, we observed a total of n=40 patients, with n=32 cases classified as grade III and 8 cases classified as grade IV. Among the n=32 patients with grade III, n=14 underwent surgery using the open method, while 8 underwent surgery using the closed method. Post-defecation VAS scores were analyzed in both groups of cases, it was found that the mean VAS scores at 24 hours of group II were slightly lesser than group I, and the p values were (<0.05) hence significant. Conclusion: We found that Ferguson’s closed approach has several important advantages over the Millian Morgan open approach in the treatment of hemorrhoidectomy. These advantages include reduced pain in the immediate postoperative period and at 24 hours, requiring fewer analgesic pills to control pain, leading to the reduced hospital stay and early return to work, along with a better wound healing rate.

233. Role of Ultrasonography in Evaluating Prostate Obstruction using Prostate Size and Post Void Residual Urine Volume: A Study from Western India
Dolubha Jilubha Sisodiya, Chaudhari Ajaykumar Sureshbhai
Abstract
Background: Benign prostatic hyperplasia (BPH) is one of the primary causes of morbidity in older adults. Without timely intervention, the risk of developing urinary obstruction is 2.5% higher in men with BPH. Prostate size or volume and reduced urinary flow rate are significant predictors of prostate obstruction and can be visualized on a real-time basis using ultrasonography (USG). Aims and Objectives: To evaluate the relationship between prostate volumes (PV) and post-void residual volume (PVRV) to predict the degree of obstruction. Materials and Methods: A tertiary care center in Gujarat studied fifty symptomatic and asymptomatic male patients with BPH (age ≥50 years) were studied at a tertiary care center in Gujarat. Sociodemographic details were recorded. The prostate size was measured by planimetric USG with the patient resting in a lateral decubitus position. Post-void residual volume was assessed with transabdominal USG. Results: Mean age of patients with BPH were 62.78±12.56, the majority being 51- 60 years (48%) of age. PV showed a significant increase in mean size in different age groups (P<0.001). An increasing trend in PVRV was observed with age; mean PVRV in patients with 51-60, 61-70, and >70 years age group was 54.82±18.21, 68.26±12.28, and 112.42±8.34 respectively (p<0.001). On Pearson correlation a significant positive correlation was obtained between prostate size and mean PVRV (p=0.001, r=0.575) and between age and PVRV (r = 0.623, p = 0.008). Conclusion: Post void residual urine volume and PV using USG can serve as a novel accurate non-invasive test for predicting prostate obstruction in patients with BPH in decision making. USG provides real-time transabdominal scanning and has no risk of ionizing radiation like other methods.

234. Quantitative Estimation of Salivary & Serum C-Reactive Protein & Alkaline Phosphatase Levels in Different Grades of Oral Squamous Cell Carcinoma
Madhurya Namana, Ayyagari Kameswara Rao, Kuna Rajani, Bolem Padmavathi, Parameswar Peela, Naga Hima Bindu Vennamaneni
Abstract
Background: Elevated Serum C-Reactive Protein (CRP) and Alkaline Phosphatase (ALP) levels can be considered as a prognostic indicator in Oral Squamous Cell Carcinoma (OSCC). They can act as indices of proliferation, metastasis and survival rate. However previous studies on these biomarkers in combination were rarely correlated.  The study aimed to compare salivary & serum CRP and ALP levels of adults with OSCC patients using quantitative estimation and relate them with Histological grading, and TNM staging. Materials and Methods: A total of 50 individuals of which 10 healthy individuals and 40 individuals with clinically histopathologically confirmed OSCC with deleterious habits were considered for the study. Incisional biopsy was performed from the lesion proper, haematoxylin and eosin staining was performed. In the consequent visit saliva and blood samples were collected from the confirmed patients and controls. The values of CRP and ALP were calculated using immunoturbidity method and Colorimetric method respectively. Statistical analysis was performed using  Kruskal-Wallis test, ANOVA and chi – square test. Results: There was statistically significant correlation between serum and salivary CRP, ALP levels in OSCC and also with TNM staging as compared to controls, with increase of histopathological grading- CRP/ ALP levels increased. Conclusion: To conclude, for assessment of survival rate the present study showed positive results. Further elaborated studies including larger cross section of population, pre and post treatment recurrence and survival period should be included, so that these biomarker values can be emphasized as one of the prognostic biomarkers of individual with OSCC.

235. Comparison of Transversus Abdominis Plane Block and Ilioinguinal-Iliohypogastric Nerve Block for Post-Operative Analgesia in Caesarean Section, a Single-Blinded Randomised Clinical Trial Study
Bimal Krushna Panda, Sheela Ekka, Dulal Kishun Soren, Mahendra Ekka, Kalicharan Kisku, Lina Baru
Abstract
Background: Effective and adequate post-operative analgesia for cesarean section is in demand due to increasing rates of cesarean deliveries which may promote earlier recovery, ambulation, and breast-feeding. Ultrasound-guided plane blocks. i.e., Transversus abdominis plane (TAP) block & ilioinguinal and iliohypogastric (II-IH) nerve blocks have added newer and better dimensions in providing post-CS analgesia without producing opioid-related adverse effects. Aim: To compare the total bolus doses of rescue analgesia requirement in 24 hrs. of the postoperative period in Ultrasound-guided ilioinguinal and iliohypogastric nerve block versus transversus abdominis plane block in patients undergoing LSCS. Methods: Single-blind Randomised clinical trial study was conducted on 70 patients undergoing LSCS under Subarachnoid block. They were non-selectively randomized into 2 groups, Group T were given a bilateral TAP block with 20ml of 0.25% ropivacaine on each side and Group-I were given a bilateral ilioinguinal-iliohypogastric nerve block with 10ml of 0.25% ropivacaine on each side after the completion of surgery. In the post-operative room\ward total dose of analgesic in 24hr post-operatively, time to first rescue analgesic, NRS score, early initiation of breast-feeding, and patient satisfaction score were recorded. Result: Total number of bolus doses of postoperative rescue analgesic consumption in 24 hr was significantly less in Group-I (1.60±0.65) than in Group T (2.68±0.52). The time to first rescue analgesia in Group-I (11.19±0.99) hrs. was also longer than in Group T (7.31±0.63) hrs. Also, the NRS score was also comparable in the two groups. Patient satisfaction and early initiation of breastfeeding were comparable in both groups. Conclusion: II-IH nerve block had a better analgesic effect than TAP block postoperatively in patients undergoing elective LSCS, with respect to the total dose of analgesic requirement and time to first rescue analgesia.

236. Evaluation of Caesarean Section Rate using the Robson’s 10 Group Classification in a Tertiary Care Centre
Aakriti Pandey, Suman Budania, Nipun Sharma
Abstract
Background: Cesarean section (CS) is an important indicator of access to, and quality of maternal health services. The World Health Organization recommends the Robson ten group classification system as a global standard for assessing, monitoring and comparing CS rates at all levels. Despite the lack of scientific evidence indicating any substantial maternal and perinatal benefits from increasing caesarean section rates, most of the studies are showing that higher rates could be linked to negative consequences in maternal and child health, still caesarean rates continue to increase worldwide, particularly in middle, high income countries, and have become a major and controversial public health concern. Therefore, we conducted this study to analyze the LSCS rate in the institute, to classify the indications of LSCS as per RTGCS and to find out strategy to decrease the prevalence of lower segment caesarean section. Material & Methods: This is a retrospective hospital-based study at tertiary care center. Data collection of one thousand pregnant females who delivered by caesarean section from the period of July 2020 to June 2022 was assessed for the study. There are six parameters as per Robson’s classification to classify all pregnant females for caesarean section. Entire information was entered in Microsoft excel sheet and analysis were done to decrease caesarean section rate. Results: In the present study, a total of 1000 pregnant women delivered by caesarean section was taken from July 2020 onwards. The total number of deliveries during this study period was 2741 and the overall caesarean section rate was 35.5%. Most of the patients belonged to Robson’s group 1,2&5. Conclusion: The overall CSR in the study is 35.5% which is high as compared to international studies, contribution of repeat CS is high. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate. More analytical studies based on Robson’s 10-group classification system are needed locally, to evaluate the indications of CS within each group.

237. Clinico-Etiological Profile and Predictors of Outcome in Acute Encephalitis Syndrome
Abhilash Dhariwal, Ritu Rakholia, Vineeta Rawat
Abstract
Background:  Acute encephalitis syndrome (AES) is a disease that has emerged rapidly in twenty first century with significant mortality, morbidity and various sensory-motor sequelae. Acute inflammation of brain parenchyma presents, with varied clinical presentation, have numerous aetiologies which remains unknown in majority of cases and it provides very short window period for the clinician to diagnose and treat the disease empirically and hence prevention is also of utmost importance. Materials and Methods: All patients (<16 years of age) diagnosed with AES, presenting to a tertiary care hospital in Kumaun region of Uttarakhand, India from January 2021 to June 2022 were included in this hospital based prospective study. Result: The varied clinical presentation was observed. Almost all the patients had fever and altered sensorium, half of the patients had symptoms of raised intra cranial pressure, signs of meningeal irritation, seizures and other organ system involvement. Major aetiologies identified were scrub typhus (25%), tuberculosis (14.7%), JE (11.8%), Dengue encephalitis (2.9%), Enteroviral encephalitis (2.9%), COVID-19 (1.5%), varicella (1.5%), unknown in 39.73% and mortality was 25%. Patients requiring ionotropic and ventilatory support had worst outcome. Conclusion: Early diagnosis and regional aetiology based empirical therapy are beneficial for better outcome of this dreaded disease. Apart from that prevention in the form of JE immunisation should be made a part of national immunisation schedule in Uttarakhand.

238. Drug Utilization Study in Respiratory Disorders in In-Patients of Medical Ward in A Tertiary Teaching Care Hospital
Bharati Desai, Dinesh Parmar, Jitendra Vaghela, Bhavisha Vegada
Abstract
Background: The study of prescribing pattern is a part of the medical audit and seeks to monitor, evaluate and if necessary, suggest modification in prescribing practices to make medical care rational and cost effective. Appropriate drug utilization it terms of efficacy, safety, convenience and economic aspects at all levels in the chain of drug use. Respiratory disease causes an immense worldwide health burden. In India, Asthma was one of the leading causes of morbidity and mortality in rural India. COPD is the fourth leading cause of death worldwide and the numbers are growing (CDC). Objectives: The aim of study is obtain data on the current prescribing pattern and drug utilization trend in Patients of Respiratory Disorders in a tertiary care teaching hospital with ultimate goal to promote appropriate use of drugs. Methods: The longitudinal, prospective, Observational study conducted for duration of 12 months on 620 Respiratory patients after approval from Institutional Ethics Committee. Results: Most common age group affected was 41-60 year. Majority of patients were male. Average number of drugs per encounter is 10.04, among this minimum 5 drugs prescribed and maximum 19 drugs prescribed. 72.88% drugs were prescribed by generic name. 67.79% drugs were prescribed from NLEMI 2015. 59.32% were prescribed from WHO model list of essential medicine. Majority of the drugs were given via oral route. Theophylline [29.37%] was the commonest drug prescribed. Majority of drugs were Drug acting on respiratory system followed by Anti-microbial Drug. Among the Antimicrobial Drugs, Amoxicillin was the commonest drug prescribed. Commonly used FDCs was amoxicillin + clavulanic acid 45.76%. Majority of patients had Chronic Obstructive Pulmonary Disease and Majority of patients was Tobacco Chewing. Conclusion: Despite some limitations such as single centre as well as relatively small sample size, the data generated from the present study can be used to plan multi-centric studies in the future. Drugs prescribed by generic name and drugs from WHO and National List of Essential Medicines should be promoted as it increase the rationality of prescription.

239. Ethical Issues in Medical Research and Patient Care
G Mahalakshmi, S.N. Saravin, Senthil Kumar Sivananthan, Kamala Veni S
Abstract
Medical field and patient care are crucial aspects of the healthcare system, aiming to improve human health and well-being. However, ethical considerations play a vital role in ensuring that research and patient care are conducted with integrity, respect for autonomy, and beneficence. This research paper examines the patient care, highlighting the importance of informed consent, privacy and confidentiality, equity in access to care, and conflicts of interest. Additionally, the paper explores ethical frameworks and guidelines that guide healthcare professionals and researchers in navigating these challenges. By addressing and resolving these ethical issues, medical research and patient care can uphold the highest standards of professionalism.

240. Anaesthesia in Obstetrics: Maternal and Neonatal Outcomes
Senthil Kumar Sivananthan, Kamala Veni S, G Mahalakshmi, S.N. Saravin
Abstract
Anesthesia plays a crucial role in obstetric care, providing pain relief during labor, facilitating operative deliveries, and managing various obstetric emergencies. This research paper aims to review the impact of anesthesia on maternal and neonatal outcomes in obstetrics. We will discuss the different types of anesthesia used in obstetric practice, including regional and general anesthesia, and evaluate their effects on maternal morbidity, mortality, and neonatal outcomes. The paper will also explore recent advancements in anesthesia techniques and their potential implications for improving obstetric care. By synthesizing existing evidence, this study aims to enhance our understanding of anesthesia’s role in optimizing maternal and neonatal outcomes in obstetrics.

241. Association between Refractive Errors & Amblyopia in 5-15 Year Children: A Study at Tertiary Care Center in Gujarat
Hardik Patel, Geetika Srivastava, Aruna Gupta, Harpal Sinh B. Jhala
Abstract
Introduction: Refractive errors are not uncommon in children and if not treated properly may lead to decreased visual acuity. Amblyopia is also one of the common visual problem which may lead to permanent disability. Common causes for Amblyopia are refractive error and strabismus. Methods: A total of 2741 children aged between 5 and 15 years were included in this hospital-based, cross-sectional study. All the children underwent examinations like uncorrected and best corrected visual acuity, Slit lamp examination, direct ophthalmoscopy, cover test at far and near, cycloplegic, and subjective refractions. The diagnostic endpoint for amblyopia was a best corrected visual acuity (BCVA) of <6/9 or 2-line inter-ocular optotype acuity difference. Chi-Square test was done for statistical analysis. Results: Out of 2741 children examined 636 children were diagnosed with refractive error. The prevalence of Refractive error and Amblyopia was 23.20% (n=636) & 3.39% (n=93) respectively with insignificant gender variation (p-value>0.05). The average age of presentation was 11.58±2.78 years. In 38.7% cases age of presentation was 5-10 years while rest belonged to > 10 years of age. Maximum no of amblyopia was due to myopic astigmatism {58.06% (n=54)}, Hypermetropic astigmatism 25.80% (n=24) followed by Myopia {8.60% (n=8]} and least in Hypermetropia {7.52%% (n=7)}. Binocular amblyopia was more (67%) then unilateral amblyopia (33%). Conclusion: As per the finding of our study, refractive error is a major risk factor for amblyopia. It emphasizes the need for visual screening of young children and management of refractive amblyopia at appropriate time.

242. Clinico-Epidemiological Profile of Vitiligo among Children: A Prospective Study from Tertiary Care Hospital of Central India
Parineeta Maria, Deep Bhardwaj, Bharat Gupta
Abstract
Background: Due to the loss of functioning melanocytes, vitiligo is a frequent acquired skin condition characterized by depigmented macules and patches. The stigma attached to vitiligo causes patients and their families to worry about how it may affect their appearance, which is one of the most significant features of the disease.In order to better understand the clinical pattern and systemic associations of childhood vitiligo in the central region of India, this study was conducted. Methods: The study included all vitiligo patients under the age of 18 who visited the Dermatology OPD of a tertiary care hospital between February 2021 and January 2022. The clinical characteristics of the patients were recorded in a predesigned proforma after obtaining the parents’ informed consent. The data that was collected was entered into an MS Excel spreadsheet. Frequency, percentage, and descriptive statistics such as mean and SD were used to present the data. Results: In our study, a total of 3643 pediatric patients attended the skin OPD during the defined study period and out of them 71 pediatric patients were diagnosed as having vitiligo. So, in our study the prevalence of vitiligo was 1.9%.The female patients (60.6%) were suffering more from vitiligo as compared to males (39.4%). The most common pattern of vitiligo was vulgaris (46.5%) followed by focal (35.2%) and mucosal (8.5%). The acrofacial and segmental pattern of vitiligo was seen in 5.6% and 4.2% of patients respectively. Conclusion: With an average onset age of 5 to 10 years, childhood vitiligo is a prevalent depigmenting disorder that affects more females than males, likely as a result of more worry over the disfiguring appearance of the disease in females.

243. Role of P16 and E Cadherin in Head and Neck Squamous Cell Carcinoma
Nimisha Srivastava, Chayanika Kala, Soni, Swapnil Gupta
Abstract
Background: The vast majority of head and neck cancers are oral squamous cell carcinomas (OSCCs) that arise from the epithelial lining of oral cavity, including tongue and lips.[4]E-cadherin is a transmembrane protein involved in cellular adhesion and polarity maintenance. E cadherin is expressed in almost all epithelial cells. Loss of E cadherin is associated with gain of tumor cell motility and invasiveness. Negative IHC in tumors occurs with loss of p16 protein function/expression. Therefore, there is dire need to understand relationship of HNSCC with various molecular markers that have been discovered in the last few years and which have offered potential new and early diagnosis and treatment therapeutic modalities. alternatives. Hence, this study was undertaken to evaluate expression of p16 and E cadherin in HNSCC cases. Methods: The present study was conducted in pathology department, during the period 2021-2022 among 50 cases of histopathologically diagnosed HNSCC. A pretested proforma was used to collect the clinicopathological parameters including age of patient, history of tobacco use, pan chewing, alcohol abuse, other relevant irritants, involvement of abnormal sexual habits, site of lesion, grade of tumor and lymph node metastasis. Histological assessment was done as slides prepared after biopsy were stained with hematoxylin and eosin stain and then studied for histological changes. Immunohistochemical evaluation included tissue processing where by automatic tissue processor and then paraffin blocks were prepared. In our study intensity of p16 and E cadherin staining was tabulated in accordance with Jang et al., and Simioneseu et al., respectively. A descriptive study was carried out for all the variables included in the study. The whole data was be entered in Microsoft Excel master sheet and analyzed using Statistical Package for Social Sciences (SPSS) version 20 software. Results: Our study comprises an analysis of 50 diagnosed cases of head and neck squamous cell carcinoma of which 44 (88%) lesions pertain to the oral cavity. In the present study it was noted that peak incidence of Head and neck Squamous cell carcinoma was 51-60 years. In our study, most common site of HNSCC was buccal mucosa which accounted for 36% and second being tongue, which accounted for 26%. Most of the cases in our study were well differentiated squamous cell carcinoma (52%) followed by moderately differentiated squamous cell carcinoma (42%).In our study, we correlated p16 positivity with relation to site of lesion, maximum positivity was found in buccal mucosa (77.8%), followed by tongue (84.6%). Conclusion: In our study enrolled 50 patients with histopathology-proven HNSCC and all the cases were assessed for the expression of p16 and E-cadherin by immunohistochemical study. We found that with increasing grade of tumor, p16 positivity decreased.

244. Quality of Life in Patients with Acne Vulgaris in A Tertiary Care Centre: A Cross Sectional Study
Garima Yadav, V.K. Garg
Abstract
Background: A persistent inflammatory condition of the pilosebaceous units known as acne vulgaris has a significant psychological impact and can lead to sadness, anxiety, and low self-esteem. Methods: To understand the effects of acne on quality of life, 240 people in the age range of 12 to 30 years participated in a hospital-based, cross-sectional, prestructured questionnaire study using the Cardiff Acne Disability Index (CADI) and Acne-specific Quality of Life (Acne-QOL). Results: The ratio of men to women was 2:3. Average age of the participants was 17.23 ±1.5 years. The typical CADI rating was 5.3. 44% of the patients had grade 2 acne, the most common type. According to the CADI questionnaire, the percentage of boys (61.9%) and females (59.6%) in the medium score was at its highest. The majority of patients with grade 1 acne had poor scores, followed by those with grade 2 acne. Maximum patients, according to the acne-QoL questionnaire, were in the 11–20 score range, followed by the 21–30 score range. Conclusions: In addition to being an aesthetic issue, acne has serious psychological effects. Therefore, when managing facial acne, the impact of acne on QoL must be taken into account.

245. Needle Stick Injury Rate and Its Reduction among the Healthcare Workers in A Tertiary Care Teaching Hospital
K Siva Bala Naganjan, M V Kiran Kumar, B V Rao, Rajesh Ranjan
Abstract
Background: Healthcare workers face various occupational hazards, including needle stick injuries (NSIs), which can increase the risk of blood-borne pathogen transmission. Despite the Needle Stick Safety and Prevention Act, an average of 385,000 sharp injuries occur annually among healthcare workers in hospitals worldwide. Underreporting is common due to fear of disease contraction, retrenchment, and inadequate reporting methods. In India, NSI incidence is unknown. NSIs carry an economic burden, and effective interventions include training in personal protective equipment, safe working practices, and introducing safety devices. This study aims to investigate NSI rates, identify causal factors, and develop strategies for prevention to create a safer working environment. Methods: This study was conducted at a tertiary care teaching hospital, including outpatient department and inpatient wards, a pre-operative room, and an imaging department. It excluded the intensive care unit and operating rooms. The study population comprised of all healthcare workers (HCWs) employed at the hospital during the study period. The study design was prospective, descriptive, and interventional. A convenient random sampling technique was used to observe HCWs during their functional hours. Data was collected through reviewing NSI data for the previous 12 months, and new NSIs were identified through self-reporting using a standard proforma. Continuous and scheduled training sessions were provided, and the NSI rates were presented to clinical department heads. Statistical analysis was performed using the chi-square test. Results: A tertiary care teaching hospital with a bed capacity of 1500 served 582834 and 765425 patients in 2021-2022 and 2022-2023, respectively, with an 23.8% increase in patient volume. The number of healthcare workers increased from 873 to 892 (2.1%) during the same period. The study reported 445 and 325 needle stick injuries (NSIs) among HCWs in 2021-2022 and 2022-2023, respectively, with a significant decrease in the overall NSI rate from 50.8% to 36.4%. None of the changes in the distribution of NSIs across various departments were statistically significant. The number of bore hole-induced NSIs increased significantly (30.6% to 41.2%), while the percentage of NSIs resulting in mucosal wounds decreased significantly (20.7% to 14.8%). Conclusion: The study highlights the importance of implementing interventions to reduce NSIs among HCWs and monitoring their effectiveness. The hospital should tailor interventions to specific departments and professions and explore new strategies to further reduce the incidence of NSIs.

246. Prescription Audit Using World Health Organization Core Prescribing Indicators in A Tertiary Care Teaching Hospital of South India
M V Kiran Kumar, K Siva Balanaganjan, B V Rao, Rajesh Ranjan
Abstract
Background: Inappropriate prescribing practices can have serious consequences on patient health, including increased morbidity and mortality, adverse drug reactions, and increased healthcare costs. Several studies have evaluated prescribing practices in different healthcare settings worldwide, including in India, where inappropriate prescribing practices are prevalent and contribute to a high incidence of adverse drug reactions and treatment failures. The present study aimed to evaluate the prescribing practices of healthcare professionals in a tertiary care teaching hospital in South India using the WHO core prescribing indicators. Methods: This was a prospective, observational hospital-based study conducted in both the inpatient wards and outpatient department of various specialties. A total of 659 prescriptions were randomly selected over a two-month period, excluding prescriptions for vaccines and neonates. The audit of the prescription included the completeness and legibility of the prescriptions, as well as core prescribing indicators recommended by the WHO, such as the percentage of drugs prescribed by their generic name, average number of drugs per prescription, percentage of prescriptions containing antimicrobial agents, percentage of injections per prescription, and percentage of drugs prescribed from the Essential Drug List (EDL). Descriptive statistics were used for data analysis. The study was approved by the hospital ethics committee. Results: In the study, 11.5% of prescriptions were illegible, and 68.6% were legible with ease. The average number of drugs per prescription (2.36±1.3) was higher than the WHO standard of 1.6-1.8, while the percentage of drugs prescribed by generic name (68.5%) fell short of the WHO standard of 100%. Additionally, 38.4% of prescriptions included antibiotics, and 11.2% included injections, both deviating from the WHO standards. However, 80.9% of drugs were prescribed from the essential drug list, which is close to the WHO standard of 100%. Conclusion: The study findings suggest that the prescribing practices in the tertiary care teaching hospital of South India need improvement with respect to completeness of patient identifier and prescriber details and dosage regimen information.

247. To Determine the Impact of Melasma on Quality of Life (Qol) Using Dermatology Life Quality Index (DLQI) in our Patients
Sheraun Karira, V.K. Garg
Abstract
Objectives: To determine the impact of melasma on quality of life (QoL) using Dermatology Life Quality Index (DLQI) in our patients. Patients and methods: An observational study was carried out at the Department of Dermatology, Santosh Hospital, Gaziabad from December 12, 2021 to June 11, 2022.A total of 200 patients suffering from melasma, of any severity, with age 18 years or above, belonging to either sex, who themselves were able to understand and fill the DLQI, were enrolled in the study. Using the DLQI questionnaire, consisting of 10 questions, patients were asked to score on a scale from 0-3 for each of 10 items. The data were analyzed after compiling the results. The higher the DLQI score, the poorer is the QoL. Results: Mean age of the patients was 29.90±7.18 years. There were 164 (82%) female and 36 (18%) male patients. The mean DLQI score of all patients was 34.90±5.18 years. The findings indicate several areas in which melasma had an impact on individual’s QoL, particularly in relation to symptoms and feelings and personal relationships. Women reported poorer QoL compared to men. Mean DLQI score was 16.00+4.93 in males and 17.32+5.28 in females. Patients with mild, moderate and severe disease had mean DLQI scores of 17.23±5.35, 20.32±3.99 and 24.0±2.0, respectively.

248. Effect of Dexmedetomidine as an Adjuvant to Bupivacaine on Duration of Analgesia, Motor and Sensory Blockade and the Intraoperative Hemodynamic Profile of Patients
Sankar Pal, Manas Karmakar, Ashok Das, Jatisankar Rudra
Abstract
Background: The addition of dexmedetomidine also allows for a reduction in the total dose of the local anaesthetic used, which translates into better hemodynamic stability in the intraoperative period. Dexmedetomidine has also been shown to have significant analgesic affect in the post-operative period much after the regression of the motor blockade which allows for early and pain free ambulation. In the view of these facts, this study was planned to compare the effect of dexmedetomidine on duration of analgesia, motor and sensory blockade and the intraoperative hemodynamic profile when used as an adjuvant to bupivacaine. Methods: This was a prospective study was done in Department of Anaesthesiology, Calcutta National Medical College during February, 2012 to March, 2013 among the patients (age: 18-65 years) undergoing elective infra-umbilical surgery. Total sample size i.e. 60 patients were randomly divided into 2 groups (Group B and Group D) of 30 patients each using a computer generated random number table. Motor blockade was assessed by using the modified Bromage scale bilaterally every 2 minutes. The regression for sensory and motor block was checked every 15 minutes in a post anaesthesia care room. Differences in demographic, anaesthetic and post-operative data were tested by independent Student’s t-test (continuous data) or by Pearson Chi-square test and Fisher’s exact test (categorical data). A p value less than 0.05 is taken as significant. Results: In our study, there was no fall or excess rise of heart rate in any group at any specific time period and mean heart rate in both groups were comparable over time. As oxygen saturation of different groups were almost identical with each other, it can be concluded that there was no hemodynamic and respiratory problem in any group. Group-B patients took 172.5±12.92 minutes to regain Bromage score 0, and group-D patients took 260.5±20.27 minutes. So, motor blockade was prolonged in dexmedetomidine group. Group-B patients asked after 156.5±18.76 minutes, but group-D patients requested for analgesic much later i.e. after 249±22.83 minutes. So, the inference would be that dexmedetomidine increases the time of post-operative analgesia. Conclusion: Our conclusion from the study is that dexmedetomidine as intrathecal adjuvant significantly prolongs the sensory and motor blockade of intrathecal hyperbaric bupivacaine without altering the onset of spinal anaesthesia.

249. A Study of Clinical Characteristics of Pregnant Women with COVID-19 Infection: A Single Centre Descriptive Study
Indira, G. Sridevi, P Kasikrishnaraja, K Dhivya, A. K Choudhary, VK Venkatesh
Abstract
Background and Objectives: The aim of this study is to describe the clinical characteristics of pregnant women who developed COVID infection. Materials and Methods: It was a cross-sectional descriptive study hospital-based assessment conducted at the Department of Obstetrics and Gynaecology at Govt Erode Medical College. All the pregnant mothers who were tested positive for covid 19 infection in the nasal and throat swab in RTPCR test admitted in the hospital between April 2020 to march 2021 were included in this study. Pregnant mothers who had symptoms like covid but who tested negative for covid 19 in RTPCR were excluded from our study. The age of participants ranged from 17 to 45 years. Results: A total of 379 participants were studied, 1.4% had varying degree of PPH, and incidence of preterm birth was 24%. Of the 379 positive cases 91% were in third trimester. Vertical transmission was zero. No case of intrauterine death or neonatal death was noted. Out of the 379 positive pregnancies 17 patients required oxygen and had significant CT changes. There was no maternal mortality due to covid 19 during this period. Conclusions: Inflammatory markers did not correlate with disease severity in our study population. No maternal and fetal mortality in our study. Intensive monitoring of vitals, early CT chest and oxygen therapy could be the reason for nil mortality. Relatively higher Preterm Labor is an area of concern.

250. A Prospective Study of Umbilical Coiling Index (UCI) and Perinatal Outcome in Term Low-Risk Pregnancies
Akshika Patel, Rajrani Sharma, Akanksha Agrawal, Rama Singh Chundawat, Priyanka Sekhasaria, Nenavath Pravalika Rathod
Abstract
Introduction: An umbilical coil is a vital organ which connects the mother and fetus and its main function is to provide nutrition to the fetus for 9 months. An abnormal umbilical cord may lead to uteroplacental insufficiency, fetal growth restriction, and fetal distress. Many studies on the umbilical coiling index have proven that abnormal UCI leads to adverse perinatal outcomes. Aims and Objectives: The primary aim of this study is to determine the relationship between the umbilical coiling index and adverse perinatal outcome. Materials and Methods: The population of the study included 150 pregnant women hospitalized for natural singleton labor with a gestational age (based on last menstrual period [LMP] or ultrasound confirmation by first trimester) of over 37 weeks with the cephalic presentation in Pacific medical college and hospital Udaipur. A Prospective study is conducted. The purposes of the study are explained to pregnant women and informed consent is taken. Conclusion: There was significant association of hyper coiling (UCI>90th) with LBW(<2.5kg) babies and NICU admission, and hypo coiling (UCI<10th) with meconium-stained liquor. Thus, antenatal detection of coiling index may be helpful to identify the fetus at risk and help in early detection and management.

251. Effectiveness of Methotrexate and Apremilast in the Management of Moderate to Severe Plaque Psoriasis: A Comparative Study
Ashwani, Neena Kondapally
Abstract
Introduction: Psoriasis chronic inflammatory skin disorder typically characterized by erythematous papules and plaques. Methotrexate acts by inhibiting dihydrofolic reductase enzyme and apremilast is an oral phosphodiesterase-4 inhibitor, which are effective in the management of moderate to severe psoriasis. The current study was aimed to evaluate the effectiveness of methotrexate and apremilast in treating moderate to severe plaque psoriasis. Material and methods: A total of 52 participants of both genders with moderate to severe plaque psoriasis attending outpatient department aged between 18 to 60 years were included. Participants were randomly divided in to group 1 (n=26) medicated with 7.5 mg Methotrexate per week and group 2 (n=26) medicated with Apremilast with a started dose of 10 mg and titrated to a maximum dose of 30 mg two time in a day. The participants were assessed for treatment response and adverse effects for a period of 4 months. The severity of psoriasis was assessed by psoriasis are severity index (PASI). Results: The mean age of onset was 36.7 years in group 1 and 35.28 years in group 2. 73.1% were suffering with <2 years and 46.2% were suffering with >2 years. SCALP was commonly affected part (80.8% each), followed by nails (61.5% & 57.7%), palm and sole (26.9% & 30.76%). 84.61% and 80.76% patients were achieved PASI75 in group 1 and 2 respectively. Headache is common adverse event followed by nausea, vomiting and lower abdomen pain. 3.84% of patients. Conclusion: Methotrexate and Apremilast did not show significant difference in achieving PASI75 at the end of 4th month of treatment and are equally efficacious in the management of moderate to severe grade psoriasis.

252. Efficacy and Safety of Intravenous Ferric Carboxy Maltose in Iron Deficiency Anaemia during Post-Partum Period after Pregnancy
Ved Prakash, Rekha Gaur, Nidhi Goel, Bhavesh Talera
Abstract
Objective: Ferric carboxymaltose (FCM), a polynuclear iron-hydroxide carboxymaltose complex is considered safe for treating postpartum anaemia due to high treatment adherence, enhanced iron storage normalisation, a low incidence of gastrointestinal side effects, and a short treatment duration. Therefore, this study aimed to test the efficacy of ferric carboxymaltose for the postnatal women having iron deficiency anaemia during postpartum period and pregnancy. Methodology/Material: Total of 200 participants were randomly selected from Obstetrics and Gynaecology Unit. Group A received parenteral ferric carboxymaltose administration while in group B iron sucrose was administered. The highest permitted dose of ferric carboxymaltose each week was 15 mg/kg, not to exceed 1000 mg/dose, administered intravenously over a period of about 15 minutes. For comparison, iron sucrose mixture was given three times per week in a single dose. Using the repeated measures ANOVA/Freidman test, the haemoglobin levels in both treatment groups were compared at baseline and after 21 days. Results: Overall ferric group shows 27.7% mean improvement while iron sucrose group had mean improvement of 25%. Regarding, mean corpuscular volume a significant mean improvement of 30% was reported in ferric group while 27% was reported in group B (p=0.0001).There were no severe adverse events that could have been fatal. Total of 5 women experienced localised side effects of ferric carboxymaltose including itchiness and irritation while another 9 experienced systemic side effects like giddiness, headache, and nausea. Conclusion: In conclusion, iron carboxyl maltose injection significantly improved Hb and other parameters in an effective and safe way with less side effects than iron sucrose complex.

253. Prevalence of Anxiety and Depression in Patients on Maintenance Hemodialysis for Chronic Kidney Disease
Lalit Kumar, Sachin Madan, Sushma, Varun Arora, B.L. Bhardwaj, Dalip Kumar Gupta, Vikas
Abstract
Background: Anxiety and depression, are prevalent among patients with chronic kidney disease (CKD) who are on maintenance hemodialysis and affect their quality of life. Anxiety and/or depressive symptoms among these patients have been found associated with duration of their illness. Methods: This is a cross-sectional study. A total of 75 patients with CKD and on hemodialysis at Adesh Medical College and Hospital, Shahabad, are included in the study during the period from February 2023 to April 2023. Data is collected using the Hospital Anxiety and Depression Scale questionnaire. Sociodemographic information, duration of illness, co-morbidities and compliance to hemodialysis is determined. Results: Of the 75 CKD patients, 34.7% has depression and 24% has anxiety symptoms. 61.3% of the participants are males and 38.7% are females. In this study, the mean age (in years) is 49.48 years. It is also found that only duration of chronic kidney disease has reached statistical significance and is independently associated with anxiety and depression among the participants (p value = 0.014). Conclusions: Anxiety and depression are prevalent among CKD patients, particularly among males and older patients. Thus, the present study will help in establishing a screening program to determine anxiety and depression in patients who are at risk. In addition, preventive measures should be implemented to avoid the occurrence of depression and anxiety so that patients’ quality of life must be improved.

254. A Comparative Study of the Effect of Oral Pregabalin Versus Oral Clonidine as Premedication on Early Postoperative Pain, Sedation in Laparoscopic Hysterectomy Under General Anesthesia
Eesha Banerjee, Alisha Sahu, Shaswat Pattnaik, Bhavna Sriramka, Diptimayee Mallik
Abstract
Background: Premedication is the cornerstone of good anesthesia practice. Pregabalin a lipophilic (GABA) analog, a novel anti-convulsant drug and has analgesic effect. Premedication with Clonidine alpha-2 agonist abolishes the stress response to the painful surgical stimulus by inhibiting pre- and possibly the post-synaptic α-2 adrenergic receptors in the spinal cord and medulla. Thus, we aim to compare the duration of postoperative analgesia, sedation, and recovery scores with premedication with oral Pregabalin versus Clonidine during the 1st 24 hours post-surgery among the patients posted for laparoscopic hysterectomy. Materials and Methods: This study was performed on 90 patients of ASA 1, of age 35 to 65 years female posted for laparoscopic hysterectomy, assigned to either of 3 groups of 30 participants randomly. All patients have taken oral Alprazolam (0.5 mg) at night before the operation. Preoperatively, patients had taken oral Pregabalin 75 mg tablet (group A, n=30), Clonidine 150 mg tablet (group B, n=30), and oral placebo tablets in group C(n=30) 60 minutes before surgery. Patients were induced with the injection of Fentanyl, Propofol, and Vecuronium Bromide, and anesthesia was maintained with N2O and O2 gas mixture with Isoflurane. Result: It was observed that all most all patients in group A experienced mild pain up to 4 hours postoperatively with VAS score not going more than 3 on average, while 5 patients in Group B experienced moderate pain after 2 hours of surgery, and the 4-hour VAS score was 4 or more on an average. There was not much difference in modified RSS score in group A and group B just after surgery, but 1hr post-operative score was higher among group A in comparison to group B (1.83 in group A vs 2.30 in group B). Modified Aldrete score was also observed to be less in the premedicated group compared to the control (9.73 in group A vs 9.70 in group B vs 10.00 in group C). Conclusion: It was concluded that clonidine and pregabalin both provide similar pain relief and sedation in the immediate postoperative period in our study. Pregabalin 75 mg pre-emptively provides better analgesia than clonidine 150 mcg. These two drugs are good pre-emptive analgesics for surgeries under general anesthesia and can be used alternatively.

255. Prevalence of Non-Exclusive Breastfeeding: A Community Based Cross Sectional Study
Divya Jain, Suresh Chandra Meghwal, Amit Kumar, Abhilasha
Abstract
Background: Breast milk is the nicest present a woman can give to her child. According to WHO, a kid should only be breastfed for the first 4-6 months before adding semisolid and solid foods to supplement breast milk until they are gradually able to take regular food. Breast milk is recommended by numerous organizations as the best food for infants. For several reasons, these groups advocate for a baby’s first six months to be spent exclusively breastfed. Aim & Objective: To determine the prevalence of nonexclusive breastfeeding. Methods: The study involved mothers of children aged 6 months to 2 years from the GMCH, Udaipur’s Rural Health Training Center (Loyra, Chiklwas, Thoor, Kavita, Madar) and Urban Health Training Center (Alu Factory, Neemach Kheda, Bhuwana outskirt). The random sampling approach will be used to take a sample from both areas in the same proportion. A well-designed, pre-tested, and pre-structured questionnaire will be used to gather the data (in English). Results: Out of 700 mothers, exclusive breastfeeding was done by 437 (62.43%) and 263 (37.57%) mothers had not given exclusive breastfeed to their infants. Conclusion: It has been concluded from the study that majority of mother are giving EBF to their infants and having good knowledge, positive attitude and practice towards Exclusive breastfeeding as compared to mothers not being able to give EBF to their infant. Even then it was good to see that majority of mothers who were not able to give EBF to the infant were using formula milk as compared to other alternatives of Breast milk.

256. Etiological Factors and Patterns of Clinical Presentation of Esophageal Fistulas
Devalkumar Manharbhai Patel, Gaurav Gattani, Jigneshkumar D. Damor, Prakash Kumar Mansangbhai Chaudhary
Abstract
Background and Aim: Esophageal Atresia (EA) with or without associated tracheo-esophageal fistula (TEF) is a common congenital anomaly occurring in 1/2500 to 1/4000 live births. This is life threatening if not managed early as it can lead to significant morbidity and mortality. Aim of the present study was to analyze the various etiological factors and patterns of clinical presentation of esophageal fistulas. Material and Methods: The present study was done in the department of the surgery, medical college & associated hospital. All the patients who were diagnosed with esophageal fistula during the study period were included in the study. Each patient was closely monitored and detail clinical course was recorded. The etiology of the fistula, the investigations done and undergone by the patients and the treatment done for each of the patients were recorded. Each patient’s natural course in the hospital was observed and analyzed. Results: A total of 92 patients with the esophageal fistula were included in the study. The total included patients were divided into two groups: one with malignant etiologies and other one with nonmalignant etiologies. The carcinoma esophagus was the cause of malignant tracheoesophageal fistula in all the 62 cases. The ECOG score was used for the assessment of performance status of patients. The score was found to be good (1-2) in 24 patients. The poor performance was found in significant number of 38 patients. In the present study, there were 30 patients with non-malignant fistulas. The most common etiological factor was found to be foreign body ingestion. A majority of patients had the typical swallow-induced cough the so-called Ono’s sign. Sixteen patients had complained of coughing of ingested food. Conclusion: Esophageal fistulas are complex and heterogeneous disorders. The mode of clinical presentation varies depending on the etiology. With respect to malignant tracheoesophageal fistulas, stenting of the esophagus and/or the airway is the current standard of care.

257. Assessment of Lumbar Lordosis in Medical Students with Low Back Pain: An Observational Study
Dilshad Ahmad Usmani, Rakesh Gupta
Abstract
Introduction: One of the main factors contributing to health issues is low back pain. Students, particularly medical students, are affected by this pain, which reduces their efficiency. Distinct and particular pathological etiology behind the back pain may be attributed to spodylolisthesis, kyphosis, scoliosis, etc. The typical human spine has a distinctive structural characteristic known as lumbar lordotic curvature (LLC). Only prospective studies that link current LLC with potential low back problems can clearly show the cause and effect relationship between LLC and LBP. The aim of the current study was to assess the lumbar lordosis in medical students who had low back discomfort. Materials & Methods: Present study was conducted on 340 medical students out of which 203 were males and 137 were females in the Department of Anatomy, Rohillkhand Medical College. Bareilly. Lumbar lordosis was measured by tangent method on each subject with the help of flexicurve. Results: According to the study, In both the sexes majority of cases belongs to the age group of 18 – 24 years. Demographic features of all the subjects were noted. Lumbar lordosis was measured and compared in different age groups of all the subjects and statistically significant result was found. Lumbar lordosis was increased with increasing age in both males and females. Conclusion: Increased lumbar lordosis with increasing age result in bad posture and leading to low back pain symptoms at early age. Intervention methods must be taken to reduce the discomfort and increase the efficiency of youth.

258. A Prospective Study Analysing Clinical Profile and Surgical Management of Patients with Dupuytrens Contracture
Mushtaq Ahmad Mir, Lubna Nabi, Asma Mushtaq, Bilal Ahmad Lone, Yawar Hussain, Bashir Ahmad Bhat, Yawar Nissar
Abstract
Background: Dupuytren’s contracture is a common condition that has the potential to be debilitating. It presents in a variety of manners and can be mild or more aggressive in its progression. Aim: To study the clinical profile of patients with dupuytrens disease and various surgical treatment modalities for it. Methods: 58 patients with dupuytrens contracture were included in this prospective observational study. On physical examination, severity of the contracture was noted and recorded using Goniometer, the degree of release after surgery was noted. Patients were followed up to 6 weeks, initially at 1 week, then at 3rd weeks followed by 6 weeks. Results: Most common age group affected was 45-65 years with male predominance. Hypertension was the most common comorbid illness followed by diabetes and hypothyroidism. 51.7 % patients were smokers. Right side was commonly involved (67.2%), left side hand was involved (25.9%) with 6.9% bilateral involvement. Regional palmar fasciectomy was commonly done followed by Radical palmar fasciectomy and needle aponerotomy. Majority of patients returned to normal work within 5-6 weeks. Conclusion: In conclusion Regional fasciectomy is an effective technique to treat Dupuytrens contracture in our setting with excellent outcome and minimal complications.

259. Results of Open Reduction Internal Fixation Versus Conservative Treatment in Cases of Fracture of the Styloid Process of Ulna
Sushil. H. Mankar, Aadil. A. Jawre, Yash. M. Dhanwani, Mahesh. D. Tumdam
Abstract
Background: Distal radius fractures constitute about 1/6th of all the fractures that are present. There is an association which is found between fracture of the radius (distal end) and ulna (styloid process). The Ulnar styloid provides support to a very important structure called the Triangular Fibrocartilage complex [TFCC]. According to some surgeons, the fixation of the styloid of the ulna avoids complications (Nonunion, instability). According to other surgeons, there were problems associated with the ulnar styloid fixation like implant prominence and post-surgery scar. Objective: To evaluate the result of internal fixation versus conservative management for ulnar styloid fracture. Materials And Methods: A Randomized Controlled Trial of 30 patients was carried out in the Orthopaedics Department, Rajiv Gandhi Government Medical College & Chhatrapati Shivaji Maharaj Hospital. The comparison is between 2 groups. Group A consists of subjects with ulnar styloid fractures with concomitant distal end or shaft radius fractures who are treated with fixation or tension band wiring for ulnarstyloid fractures and plating for distal or shaft radius fractures. Group B consists of subjects with ulnarstyloid fractures with concomitant distal end or shaft radius fractures who are treated with conservative methods (crepe bandage, wrist support) for ulnar styloid fractures and plating for distal end or shaft radius fractures. Follow-up was taken at 6 weeks, 3 months and after 6 months and results were calculated using Modified Mayo Wrist Score. Results: The majority of patients were in the age group 26-35 years 11(36.67%). The mean age in Operative Group A and Conservative Group B was 41.37±11.23 years and 42.38 ±10.76 respectively. The majority of subjects were male in the Operative Group (80%) and male in the Conservative Group (73.33%). It was observed that wrist flexion, extension, radial and ulnar deviation showed statistical significance among the two study groups. It was observed that pain and grip strength scores in the Operative Group and Conservative Group were statistically significant. Modified Mayo Wrist score in the Operative Group and Conservative Group was statistically significant. It was observed that 8 patients ( 53.33%) had excellent outcomes in Operative Group A as compared to 4 patients (26.67%) who had excellent outcomes inConservative Group B . Major complication in the Fixation Group was an infection in one patient and the major complication in Conservative Group was nonunion in two patients. Conclusion: Internal fixation in the form of tension band wiring in cases of ulnar styloid fractures associated with distal or shaft radius fractures has better results than conservative treatment in cases of ulnar styloid fractures associated with distal or shaft radius fractures. Local and systemic complications are negligible there by reducing hospital stay. Modified Mayo Wrist Score at the end of 6 months is significantly good in subjects who are treated with internal fixation in the form of tension band wiring as compared to subjects who are managed conservatively.

260. Hepatitis B and Hepatitis C – Seroprevalence and Correlation with C-Reactive Protein
Vijendra Singh Rawat, Neelima Ranjan, Isha Jain, Savita Bharat Jain
Abstract
Background: Viral hepatitis caused by Hepatitis B(HBV) and Hepatitis C virus (HCV) is a major public health problem specially in developing countries like India. Materials and Methods: Three hundred blood samples were collected from patients having clinical sign and symptoms of hepatitis and apparently healthy pregnant females. Detection of hepatitis B surface antigen, antibodies against hepatitis C virus and C reactive protein (CRP) was done in these samples. Results: The seroprevalence of HBV and HCV in our study samples was found to be 6.3% and 2.3% respectively. CRP levels were found to be raised in both HBV and HCV positive samples. Conclusion: Viral hepatitis caused by HBV and HCV continues to pose a threat as a significant health problem. Emphasis should be put on health education of the general and high-risk populations, along with health care workers to increase knowledge on preventive measures for these infections.

261. An Assessment of Functional Outcome of Surgically Treated Acetabular Fractures
Rushan A. Khan, Arvind B. Goregaonkar, Abhiraj R. Matre, Pooja Baranwal
Abstract
Background: Acetabular fractures are commonly seen in young and active individuals enduring high energy trauma. Acetabular fractures result from indirect trauma, transmitted via the femur. They occur after a blow to the greater trochanter, to the flexed knee, or to the foot with the knee extended. If left untreated, displaced acetabular fractures can lead to the development of premature arthritis of the hip. Since 1964, after Judet and Letournel’s research, operative management of such fractures has become the standard approach. Materials and methods: Single centre combined retrospective prospective study conducted in tertiary care centre in Maharashtra. Patients were treated for acetabular fractures using open reduction and internal fixation with plates and screws. Minimum follow up was done for 18 months. Results: The mean value of Harris Hip Score was 88.57 with significant P values showing that functional outcome was Good in patients treated with open reduction internal fixation at our institute. Excellent outcome – 56.7%, Good outcome – 16.7% and Fair outcome – 26.7%. 3.3% (1 patient) developed hip arthritis requiring total hip replacement. Conclusion: Acetabular fractures involve weight bearing joints of the lower limb; hence they must be restored as much as possible. Despite the best attempts, malreduction and inadequate fixation of acetabular fractures can occur. In those cases, Total hip arthroplasty may be needed subsequently in fracture when primary fixation fails.