International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Comparison of Frictional Resistance in Four Different Types of Nickel Titanium Wires: An Invitro Study
Canmany. E, Jayanthy M. S, Sumitha. S
Introduction: Orthodontic biomechanics are largely based on delivering optimal and predictable force system, which is often mediated by metal wires. From the 19th century NiTi wires played a major role in orthodontics with their extremely spring back property. But still they have their own drawbacks of increased frictional resistance. This in-vitro study was done to compare and evaluate the changes in the frictional resistance characteristics of four types of NITI wires in as received condition and after subjecting them to a simulated oral environment for a duration of 4 weeks.  Materials and Methods: The four types of nickel titanium wires, M-Nitinol, Teflon coated M-Nitinol, thermodynamic super elastic NiTi (Neo Sentalloy), super elastic ion implanted NiTi (bio force Sentalloy with longuard) are selected. The selected wires were assigned in to four major groups. Each group had a sample of 16 wires. Individual groups were further divided into 2 sub samples- sub sample A and sub sample B each containing 8 wires. Sub sample A in each group were used as controls tested in as received condition. Sub sample B were used as experimental group tested after subjecting them to a simulated oral environment over a duration of 4 weeks. They were tested for the frictional resistance. Results: Paired T test and Anova followed by Tukey HSD test showed Statistical significance at 1% level. Conclusion: Surface modified Nickel Titanium wires; Teflon coated M Nitinol and Ion implanted NiTi perform more efficiently in reducing the frictional resistance of the wires, heat activated Neosentalloy showed very minimal stress relaxation in simulated oral environment.

2. Prevalence of Hepatitis D in Jaundice Patients in Tertiary Care Hospital
Shrivastav MS, Vadsmiya M, Patel BC
Background: In 1977, Rizzetto et al in Italy identified Delta or Hepatitis D virus. Hepatitis D virus is a small RNA virus. It is a defective virus in human in sense that it requires helper function of HBV genome. The objective of this study is to determine prevalence of hepatitis D in jaundice patients attending tertiary care hospital, Ahmedabad, to determine prevalence of hepatitis D in HBsAg reactive patients, To determine various age and sex specific prevalence of Hepatitis D, and To assess severity of infection in HBV and HDV. Material & Methods: This study was carried out of 1571 patients, suffering from Jaundice, admitted at tertiary care hospital, Ahmedabad from December 2015 to July 2017. Each serum sample was tested for HBsAg antigen by enzyme immunoassay at our serology lab in microbiology department. Confirmed HBsAg reactive samples serum was collected immediately in plastic disposable vials to avoid contamination and stored in freezer at – 200C. Each HBsAg reactive serum sample were tested for HDV Antigen ELISA & Anti-HDV Antibody ELISA. Results: Among 1571 patients’ prevalence of HBsAg Antigen reactive among jaundice patients was 11.2%. HD antigen detection in HBsAg reactive patients was 2.27%. total Anti-HD antibody detection in HBsAg reactive patients was 6.25%. Conclusion: we conclude that the prevalence rate of hepatitis D virus infection was 0.7% in jaundice patient and 6.25% in hepatitis B reactive patients at tertiary care hospital, Ahmedabad. Male were more seen to be infected with HDV than females. This HDV prevalence can be decreased by global HBV vaccination, increasing awareness, improved preventive measures and changes in the socioeconomic conditions in a fast-developing country like India.

3. Effect of Trunk Strengthening Exercise on Functional Outcome in Post-Stroke Patient
Rakesh Kumar, Deepak Lohar, Jafar Khan, Dipika Balala
Background: Stroke is a leading cause of death and long-term disability worldwide. Trunk movement control plays a crucial role in functional tasks and is associated with functional outcomes in stroke survivors. Impaired trunk muscle strength and control are common in stroke patients, affecting various motor skills and activities of daily living. Effective rehabilitation strategies targeting trunk control are needed to improve functional outcomes. Methods: This randomized controlled trial aimed to investigate the effect of trunk strengthening exercises on trunk performance and functional outcome in post-stroke patients. Thirty post-stroke subjects between 50 and 60 years, with a duration of 3 months to 1 year, were randomly assigned to either an experimental group or a control group. The Trunk Impairment Scale (TIS) and the Functional Independence Measure (FIM) were used as outcome measures. Results: Baseline characteristics of age, sex, and duration were comparable between the groups. The experimental group showed a significant improvement in TIS scores after the intervention (p = 0.007). However, the change in the TIS score did not reach the minimal clinically important difference. The FIM score did not show a significant change (p = 0.180). Conclusion: Trunk strengthening exercises had a limited impact on functional outcomes in post-stroke patients. Although the TIS score improved significantly, the change was not clinically meaningful, and the FIM score did not show a significant change. Larger studies with more rigorous designs are needed to further explore the potential benefits of trunk strengthening exercises in stroke rehabilitation.

4. The Impact of Trunk Strengthening on Functional Independence and Trunk Performance: A Randomised Trial
Rakesh Kumar, Deepak Lohar, Jafar Khan, Dipika Balala
Background: Trunk stability and functional independence are crucial for individuals to perform daily activities and maintain their quality of life. Impaired trunk performance and reduced functional independence can significantly impact various tasks. Therefore, interventions targeting trunk strength and function are important in rehabilitation and physical therapy. Methods: This randomized controlled trial aimed to assess the effect of trunk-strengthening exercises on functional independence and trunk performance. The study included post-stroke individuals aged 50-60 years, attending a rehabilitation center or receiving physiotherapy. Outcome measures such as the Total Independence Score (TIS) and Functional Independence Measure (FIM) were used to assess functional independence, while standardized assessments measured specific trunk performance tasks. Results: In the control group, the TIS score showed a statistically significant improvement (p = 0.027), but none of the subjects achieved the desired level of improvement. The FIM score did not show a significant change (p = 0.109). Comparing the experimental and control groups, there were no significant differences in TIS (p = 0.755) or FIM (p = 0.713) changes. Conclusion: The control group showed a significant improvement in TIS, but not in FIM. The changes in outcome variables were similar between the experimental and control groups, suggesting that the intervention did not yield significantly different outcomes. Further research is needed to explore alternative approaches or modifications to interventions targeting the assessed outcome variables.

5. To Study Comparison of 25 G Quincke and 25 G Whitacre Spinal Needles for Post-Dural Puncture Headache in the Subarachnoid Block
Shivrambhai D Prajapati, Bhargav R. Patel, Sachinkumar S. Patel, Ankit R Sorathiya, Dixitkumar B. Modh, Meetkumar Kansagra, Jaldeep Patel
The incidence of PDPH with the use of two different spinal needles was studied in this randomized control trial. The study comprised two hundred patients belonging to ASA PS Grade I/II who were randomly allotted to two groups of hundred each. Group-I was using the 25G Quincke spinal needle and Group II was using the 25G Whitacre spinal needle in patients undergoing elective surgery. With the data obtained there was a statistically significant rate of decrease in the incidence of PDPH in patients belonging to Group-II compared to those of Group-I.

6. Identification of Biochemical Markers for Early Disease Detection and Diagnosis
Shiv Shankar Bharti, Debjit Mitra
Background: When diseases are identified and diagnosed early, timely interventions and improved patient outcomes are possible. Early disease detection and diagnosis could be dramatically enhanced if accurate biochemical markers are identified. This research paper identifies and validates biochemical markers for early disease detection and diagnosis in a large dataset. Methods: One thousand patients with various diseases were the subject of a retrospective investigation. We collected and analysed clinical data, including patient demographics, medical history, and laboratory results. We utilised cutting-edge statistical methods, such as machine learning algorithms and multivariate analysis, to look for biological indicators that could indicate the earliest stages of the disease. Results: The study uncovered several potentially useful biochemical markers for early disease detection. 85% of early-stage lung cancer cases and 25% of advanced-stage lung cancer cases were found to have elevated levels of circulating tumour DNA (ctDNA). In a separate cohort of Alzheimer’s patients, specific cerebrospinal fluid (CSF) biomarkers, such as amyloid-beta and tau proteins, demonstrated a sensitivity of 92% and a specificity of 89% in distinguishing early-stage disease from healthy controls. The consistency of these results across subgroups strengthens the therapeutic relevance of these indicators. Conclusion: The results demonstrate the diagnostic potential of biochemical markers for early disease detection. ctDNA in lung cancer and CSF biomarkers in Alzheimer’s disease are promising early, non-invasive diagnostic markers. If these markers were incorporated into standard clinical practice, timely interventions and individualised treatment plans would be achievable. More retrospective studies are required to verify these markers in larger cohorts and more diseases.

7. Correlation of Transcutaneous bilirubin and Total serum bilirubin in term and near-term neonate while on phototherapy and 24hrs after its cessation
Arvind Kumar, Prabudh Paritosh Mishra, Bheemrao Kamble
Background: This Study investigated the correlation among Transcutaneous Bilirubin (TcB) and Total Serum Bilirubin (TSB) levels in term and near-term neonates during Phototherapy and 24 hours after its cessation. Methods:  A retrospective cohort study was conducted from February 2022 to March 2023, involving a sample size of 230 neonates. TcB and TSB measurements were obtained at baseline, during Phototherapy, and 24 hours after cessation. The correlation between TcB and TSB levels was assessed using statistical analysis. Results: During Phototherapy (r = 0.85, p <0.001) and 24 hours after (r = 0.79, p <0.001), there was a statistically significant positive correlation among the mean TcB and TSB levels. This correlation held for newborns who were either full-term or very close to attaining this developmental milestone. In contrast, TcB consistently provided inaccurate estimates of TSB concentrations, especially at higher bilirubin levels. Conclusion: According to the outcomes of our research, there is a strong correlation among the levels of TcB and TSB in full-term and near-term neonates during Phototherapy and 24 hours after the conclusion of treatment. The measurement of TcB has the potential to be an effective noninvasive method for monitoring bilirubin levels in these neonates; however, it is essential to note that this method may result in a slight underestimation of TSB levels at higher concentrations. These results lend credence to the potential efficacy of TcB in the treatment of jaundice in infants, paving the way for early interventions and decreasing the need for invasive blood samples to diagnose jaundice.

8. Prospective Study of 30 Cases of Humerus Diaphyseal Fractures in the Adult Population
Tank Parag M, Damor Harshal N, Dave Dhrumil S, Patel Dhaval V, Vadera Tejas S
Background: Fractures of the humerus comprise 5% to 8% of all long bone fractures, of which diaphyseal fractures account for approximately 3%. With improved implant design and surgical techniques, the Operative management of diaphyseal fractures has been widely accepted. Re-establishing length, alignment, and rotation with stable fixation are the goals of operative intervention to allow an early range of motion and ease in continuing daily living activities. This study aims at studying the operative outcomes of diaphyseal fractures. Methods: We included 30 patients treated with various operative techniques in the study. Operative techniques include open reduction internal fixation with plating and close reduction internal fixation with intramedullary nailing. Acute diaphyseal fractures of the humerus based on AO/OTA classification with a minimum of 6 months of follow-up are included. Proximal and distal intra-articular fractures are excluded. ASES score & Rodriguez Merchant criteria were used for functional outcome assessment. Results: We had 53.4% had excellent and 40% had good results and 87% had no postoperative complication. Conclusion: Operative management of humeral diaphyseal fractures results in good to excellent functional outcomes with minimal complications. Despite improved implant design and better surgical techniques, Proper pre-operative planning and post-operative rehabilitation are more important to obtain excellent results.

9. Clinicohaematological and Biochemical Profile of Anemia in Pediatric Age Group
Prabudh Paritosh Mishra, Bheemarao Kamble, Arvind Kumar
Background: Anemia is a prevalent hematological disorder in the pediatric population, affecting child health and development. Understanding the clinicohaematological and biochemical profile of anemia in children is crucial for accurate diagnosis and effective management. Methods: This cross-sectional study investigated the clinicohaematological and biochemical profile of anemia in pediatric patients. A sample of 200 children (aged 1-12 years) with confirmed anemia was included. Relevant clinical data, hematological parameters, and biochemical markers were collected. Hemoglobin levels, serum iron, red blood cell indices, and ferritin levels were analyzed. Statistical analysis, including correlation and subgroup comparisons, was performed to identify associations between clinical, hematological, and biochemical variables. Results: The average age of the study’s participants was 6.8 years at the time it was conducted. There were 200 individuals in total, including 120 males and 80 women. Hematological testing revealed that iron deficiency anemia accounted for 65% of all cases of anemia. Hemolytic anemia accounted for 20% of all cases of anemia, followed by all other varieties of anemia combined, which accounted for 15%. Using diagnostic criteria that are unique to each type of anemia, we discovered statistically significant differences in hematological parameters. Those with iron deficiency anemia have statistically significantly lower serum iron and ferritin concentrations than those with other forms of anemia (p 0.001). There was evidence of an interaction between hematological and biochemical indicators in cases of juvenile anemia. Conclusion: This study provides insights into the clinicohaematological and biochemical anemia profile in a sample of 200 pediatric patients. Iron deficiency anemia was the most common type, followed by hemolytic anemia and other classes. Hematological and biochemical parameters differed significantly among anemia types, with lower serum iron and ferritin levels observed in iron deficiency anemia cases. The findings emphasize the importance of comprehensive evaluation, including hematological and biochemical parameters, for accurate diagnosis and management of anemia in children. Further research is needed to explore additional contributing factors and develop targeted interventions for prevention and treatment.

10. Cesarean Section in Primiparous Women in A Tertiary Care Centre in South Tamilnadu: A Retrospective Study
S S Gayathri, Sumathi, Sudha, Swathisree
Introduction: Cesarean section is a life-saving commonest surgical procedure undertaken for medical reasons to save the lives of women and their babies. The primary cesarean section rate is drastically increasing over the last two decades. Aims and objectives: To determine the rate, antenatal risk factors, indications, intraoperative, and postoperative complications of cesarean delivery in primiparous women. Materials and Methods: This is a retrospective study conducted from March 2022 to February 2023. The study included all primiparous women who were delivered by cesarean section after viable gestation. The information was collected from the records and then analyzed. Results: The total number of deliveries during the study period was 15192 out of which cesarean deliveries were 6994 (46.07%), and the number of primiparous women who underwent cesarean section was 3926 (25.84%). The most common age-group in the study group was 21–25 years(42.29%). Out of 3926 women, 459(11.69%) were preterm, 2390 (60.87%) were term, and 1077 (27.43%) were postdated pregnancy. Most 3118(79.41%) of them were referred from peripheral hospitals. The most common antenatal risk factors were hypertensive disorders 836 (21.29%), anemia 741 (18.87%) postdated pregnancy 1077 (27.43%). The most common indication of cesarean section was non-reassuring fetal heart rate (FHR) and fetal distress (31.61%) followed by Cephalopelvic disproportion (22.96%). Out of 3926 women, 3441 (87.64%) had undergone emergency cesarean section. 372(9.47%) patients had postpartum haemorrhage, four (0.10%) had peripartum hysterectomy. There was two maternal mortality (0.05%) postoperatively during the study period. Conclusion: Women who need cesarean section should be identified accurately to reduce the rate of cesarean section in primipara and also to reduce maternal and fetal complications.

11. Mupirocin Resistance among Clinical Isolates of Staphylococcus Aureus from Skin and Soft Tissue Infection in Tertiary Care Centre, Tamilnadu
C. Senthilvadivu, Stalin M.
Staphylococcus aureus is the most common pathogen responsible for skin and soft tissue infections (SSTIs) worldwide. Mupirocin (pseudomonic acid A) has been widely used as a topical antimicrobial agent for treating SSTIs caused by Staphylococcus aureus. It is an analogue of isoleucyl adenylate and binds to the bacterial isoleucyl-tRNA synthetase (IleS) target near ATP-binding sub-site. Most isolates that demonstrate high-level mupirocin resistance have acquired plasmid-mediated mupA, which encodes a novel isoleucyl RNA synthetase. Mupirocin resistance is being reported in many parts of the world. In India, mupirocin resistance (25%) among MRSA was reported. Hence, this study was undertaken to screen for mupirocin resistance among Staphylococcus aureus isolates. A non-repetitive S. aureus isolates were obtained from patient with SSTI were processed by standard procedures. Antibiotics tested included, Cefoxitin (30 µg) disc for MRSA screening, Mupirocin (200µg) disc used to distinguish isolates with high-level resistance from isolates that are either susceptible or have low-level resistance, Mupirocin (5µg) disc used to distinguish isolates that are susceptible to mupirocin from isolates with either low-level or high-level. The PCR was carried out for the detection of ileS2 (mupA) gene responsible for the high- level mupirocin resistance. A total of 96 isolates included in this study, of which 76 (79%) were found to be MRSA and 20 (21%) isolates were found to be MSSA. Of 96 S. aureus isolates 11% were found to be mupirocin resistant, of which 7(63%) found to carries mupA gene and all of them were MRSA, suggesting there might exist the possibility that high level resistant strains evolve in this study area and also to screen for both low level mupirocin resistance and high level mupirocin resistance by disc diffusion for better appropriate results.

12. Etiological Profile of Thrombocytopenia in Central Kerala and Pseudo Thrombocytopenia: A Diagnostic Pitfall in Automated Analysers
Feby T Francis, Magdalene K F, Antony Peter
Background: Thrombocytopenia is fall of platelets to below 150,000/micro L. It produces clinical symptomatology when the count falls below 100,000/micro L. Early detection and initiating suitable corrective measures avoids life threatening situations. Wide spread use of automated analysers could result in the diagnosis of pseudo thrombocytopenia/spurious thrombocytopenia resulting in a major diagnostic pitfall. In the post COVID pandemic years there were several case reports of COVID patients developing antibody against EDTA leading to platelet aggregates, hence spuriously low platelet count in automated analysers. Detection of pseudo thrombocytopenia is very important nowadays as it can avoid unnecessary interventions and treatment. Aim and Objectives: To identify the etiological factors of thrombocytopenia, calculate the incidence of spurious thrombocytopenia and evaluate their causes; to establish the importance of peripheral smear examination in managing thrombocytopenia. Materials and Methods: The study was undertaken at a tertiary care centre in central Kerala, India between August 2022 and February 2023; 07 months. Random Blood samples shown platelet counts <150000/micro L in haematology analyser were taken. Peripheral smear examination of such samples was undertaken to exclude the presence of platelet clumps. Incidence of pseudo thrombocytopenia was calculated. Etiological and epidemiological spectrums of thrombocytopenia were identified in correlation with other haematological parameters including bone marrow findings. Spurious thrombocytopenia samples were analysed separately and classified according to clinic-pathological diagnosis. Results: A total of 1000 samples assessed using automated haematology analyser, using EDTA anticoagulant vaccutainers shown platelet counts <1,50,000/micro L were analysed. Detailed etiological analyses including history, laboratory investigations, bone marrow study in necessary cases were done. Viral infection constituted for the 45.7% of the total blood samples showing thrombocytopenia’s, followed by bacteriological infections constituting to 18.6% of the total cases. Parasitic infection like malaria constituted for 64/1000 (06.4%), alcoholic liver disease constituted for 57/1000 (05.7%), pregnancy was the cause in 51/1000 (05.1%), drug intake in 68/1000 (06.8%) patients and Leukaemias in 94/1000 (09.4%) patients. Among the 1000 cases 21 cases (2.1%) were diagnosed to have platelet clumps in peripheral smear examination (spurious thrombocytopenia/ pseudo thrombocytopenia). When these samples were examined using sodium citrate anticoagulant only 4 cases showed platelet clumps. Conclusion: Prevalence of pseudo thrombocytopenia (02.10%) among 1000 patients with thrombocytopenia is significant. Among the true thrombocytopenia patients viral infections were the commonest cause. The other causes were Alcoholic liver disease, malarial parasitic infection and Leukaemias.

13. Clinical Spectrum and Management of Glaucoma in Pseudoexfoliation Syndrome
Yash Rajubhai Gandhi, Rohit Kumar Yogi, Trupti Arvindbhai Bhesaniya
Background and Aim: One of the most widespread causes of secondary open angle glaucoma in the world is pseudoexfoliation. The present study is conducted to determine the clinical profiles with pseudoexfoliation syndrome. Hence the present study was done with the aim to document the prevalence of ocular clinical profile of pattern in patients with pseudo-exfoliative material attending general ophthalmology outpatient department of a tertiary care hospital. Material and Methods: In the present analysis a total of 48 patients, who attended the outpatient department of ophthalmology, medical college and hospital and were diagnosed with pseudoexfoliation were investigated. The visual acuity was assessed using the Snellen chart for visual acuity. Pseudoexfoliation glaucoma was diagnosed on the basis of pseudoexfoliative material on slit lamp examination, IOP>21 mm Hg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, glaucomatous field defects on perimetry. Results: Age range of 61–70 years had the highest occurrence of pseudoexfoliation, accounting for 23, followed by 51–60 years with 17 cases. In the 48 individuals included in the current investigation, 20 patients had bilateral pseudoexfoliation and 28 patients had unilateral pseudoexfoliation. Our analysis revealed that 17 patients had elevated intraocular pressure. Our analysis of 48 cases revealed that 15 had open angle glaucoma and 2 had narrow angle glaucoma. 11 men and 4 women made up the group of 15 patients with open angle glaucoma. Conclusion: pseudoexfoliation is more common as people age and that it is typically unilateral when it first manifests but gradually develops into bilateral pseudoexfoliation, necessitating frequent follow-up in unilateral cases. Pseudoexfoliation has a higher glaucoma incidence, and the majorities have open angles.

14. Humeral Mid-Shaft Fracture with Primary Radial Nerve Palsy – Posterior Approach: A Case Series
S. Rajasekaran, T.C. Premkumar, M.F. Mohamed Rifan
Introduction: Radial nerve injury is one of the most common peripheral nerve palsies associated with a fracture of the humeral shaft. Early nerve exploration is only recommended in proven radial nerve injury rather than neuropraxia. The purpose of this case series is to analyse the advantage of posterior approach in the treatment and outcome of primary radial nerve palsy, in surgically treated humeral shaft fractures in Govt Theni Medical College Hospital. Materials and methods: All patients who had humeral shaft fractures with primary radial nerve palsy presented to Govt Theni Medical College Hospital during the period from March 2021 to August 2022 were included in the study. All cases were done under interscalene block given under USG guidance. Fracture fixation was done with plate osteosynthesis by posterior approach. Post operative check x ray was taken assess the fracture reduction. Follow up was done bimonthly during the first 3 visits and monthly thereafter for a period of 6 months. Results: Among the 32 patients with humeral shaft fractures associated with primary radial nerve palsy, 22 (69%) showed successful recovery of the motor function within 6 months follow up. 4 patient showed partial recovery of motor function after 6 months and they were further followed for another 3 months. 4 patients had complete radial nerve palsy who were referred for reconstructive surgery to the plastic surgery department. 2 patients lost follow up. Conclusion: Posterior approach for plate osteosynthesis holds a better approach in managing shaft of humerus fractures with primary radial nerve palsies with better outcome and recovery.

15. Prevalence and Cause of Stillbirth
Singh Suchita, Kalundia Neelam
The study was conducted to know the prevalence and cause of stillbirth in Dept of Obstetrics and Gynaecology, RIMS, Ranchi. Data was collected for 100 cases referred to tertiary health centre in 2017-2019 which include the demographic characteristics, high-risk factors, maternal and fetal outcome. It was found that the majority of the cause of stillbirth was anaemia (26%), malaria (13%), maternal diabetes (13%), maternal blood pressure (26%), and infectious disease (42%) were observed in stillbirth cases.

16. Study of Clinical Profile of Patients with Asthma COPD Overlap
Shivangi Goswami, Nishant Srivastava, Parag Sharma, Lokendra Dave
Background: This study was done to observe Clinical characteristics of patients with Asthma COPD overlap. Methodology: This study was done in Department of Respiratory Medicine, Gandhi medical college Bhopal. 108 patients with Asthma COPD overlap patients with more than 40 years of age who had documented history of asthma in past were considered for study. Patients with any other respiratory illness and those who did not give consent were excluded from the study. Results: Out of 108 patients, 55.6% were males and 44.4% were females. 54.6% were of age group 41 to 50 years followed by 25% in 51 to 60 years of age group. Most common clinical features were breathlessness was present in 90% cases, chest tightness in 46% of patients. Among different exposures, 51.8% patients had history of smoking and 44.4% patients had history of biomass fuel exposure. Smoking was found to be statistically significant (p value<0.05) for the development of ACO in asthmatic patients. Conclusion: In this study, it was found that smoking exposure was significantly associated with development of ACO in asthmatic patients. But no significant association was found with development of ACO in patients with allergic rhinitis along with asthma or those who had family history of asthma.

17. Prevalence of Sino-Nasal Masses in A Tertiary Care Hospital
Ravishu Kandhari, Richa Gupta, Shiv S Kaushik
Background: Sinonasal masses is very common problem encountered in ENT OPD among all age groups of people. All types of SNM presents with similar symptoms like nasal obstruction, rhinorrhea, epistaxis, oral symptoms, facial swelling , etc. which can be differentiated with the help of thorough clinical examination, nasal endoscopies, radiological investigations like Xray PNS, CT PNS, MRI PNS and can be confirmed with the help of histopathological examination. The aim of this study is to observe the prevalence of Sinonasal Masses in a tertiary care hospital. Findings: A total of 62 patients were observed in this study, age ranging from 7 to >70 years with maximum number of cases belonging to 11-20 years of age group. This study shows male predominance with male to female ratio of 1.48:1. The most common presenting symptom was nasal obstruction seen in 59 patients followed by nasal discharge seen in 56 patients. Otalgia was the least common symptom seen in 4 patients only. Antrochoanal polyp was the most common type of SNM seen in 34(54.83%) cases followed by ethmoidal polyp in 17(27.41%) cases. Among benign neoplastic SNM nasopharyngeal angiofibroma was seen in 2(3.22%) cases. Sqamous cell carcinoma was the only malignant neoplastic SNM seen in 2(3.22%) cases. All the samples of SNM were postoperatively confirmed with the help Histopathological examination. Conclusion: Nasal obstruction was the most common symptom seen in the patients. Polyps are the most common non-neoplastic lesion whereas squamous cell carcinoma is the most common malignant neoplastic lesion. Medical management play a very limited role, so surgery is the treatment of choice for benign lesions and a combination of surgery and radiotherapy for malignant lesions. Histopathological examination plays a very crucial role in confirmation of diagnosis.

18. Comparative Evaluation of Efficacy of Intra-Articular Injection of Platelet Rich Plasma Versus Hyaluronic Acid in Treatment of Early Osteoarthritis of Knee
Palthi Srikanth, Mohammad Rafi Shaik, Deepak Jagarlamudi, Veer Abhishek Goud
Background: Osteoarthritis of the knee is common and often leads to significant physical disability. While classic conservative therapeutic approaches aim for symptoms like pain and inflammation, procedures like the intraarticular application of hyaluronic acids (HA) or platelet-rich plasma (PRP) gives a less invasive treatment and improves functional quality in patients with initial stages of knee osteoarthritis. This study was conducted to compare the efficacy of intra-articular injection of platelet-rich plasma with hyaluronic acid for the treatment of patients with early osteoarthritis of the knee. Methodology: This Randomized prospective clinical study was conducted at Dr. Patnam Mahender Reddy Medical College, Chevella in Rangareddy, Telangana between March 2022 to February 2023. A total of 100 patients (50 treated with PRP and 50 with HA) were treated with three weekly intra-articular injections. Clinical examinations were performed before treatment, at 6 weeks, 3rd month, and 6th month post-injection intervals. VAS & WOMAC scores were determined at each examination. All patients are subjected to ultrasound of the involved knee joint and joint space is measured and charted out both pre and post-procedurally. Complications were also recorded. Results: The mean age of patients in group PRP was 49.92+7.72 and group HA was 54.16+5.36. The mean pre-procedural VAS and WOMAC scores of group PRP were 7.22+0.97 and 74.20+4.85 respectively and group HA were 69.80+4.68 and 6.86+0.81. At the end of 12th month, the mean VAS and WOMAC score improved to 3.06+1.24 and 33.40+7.59 in group PRP and 4.98+0.89 and 56.1+4.769 in group HA respectively. By the end of 12th month follow up, 38 (73.58%) patients reported excellent results, 10 (20.75%) patients reported good results and 2 (5.66%) patients reported poor results. By the end of the 12th month follow-up, 35 (75.43%) patients reported excellent results, 10 (19.29%) patients reported good results and 5 (5.26%) patients reported poor results. Conclusion: Results indicated that intra-articular PRP group shows better functional outcome and reduction in pain component than HA group in OA knee patients.

19. Study of Functional and Clinical Outcome of Retrograde Intramedullary Interlocking Nailing in the Management of Extra-Articular Supracondylar Femoral Fracture
Pradeep Khinchi, Mahaveer Meena, Manohar Lal Carpanter, Naveen Ratwal, Purushottam Jhawar, Qadir Anwar Tak
Aim: The aim of our study is to evaluate the functional and clinical outcome of retrograde intramedullary interlocking nailing in the management of extra-articular supracondylar femoral fracture. Introduction: Fractures of the Distal femur are complex injuries that pose a challenge to orthopedic surgeon. Closed femoral nailing minimizes soft tissue damage and minimizes the blood loss. The anatomical alignment, stable internal fixation, rapid mobilization, and early functional rehabilitation of the knee are the effective ways of management of distal femoral fractures which can be achieved by Intramedullary interlocking nail. Method: 25 Patients were studied during study period sept 2020 to march 2022. Data collected by verbal history taking, diagnosis was made on clinical and radiological basis. Fractures were classified according to Muller’s classification. patients were taken for surgery (retrograde intramedullary nailing) and evaluated for pain, function, range of motion, deformity, time of radiological union as per NEER’S RATING SCORE. Result: Age was ranging 18-75 years. 48% were Type A1, 44% were Type A2, 8% were A3 type as per mullers classification. There were 4 open and 21 closed type of fracture. radiological union was seen within 3 to 6 months in 22 patients, within 6 to 8 months in 2 cases and one patient had delayed union. Average knee flexion was 110 degree in 17 patients and 8 patients had flexion more than 110 degree. There were 5 patients with knee pain,1 with shortening,1 with implant failure, 1 with delayed union,2 with superficial infection, and 1 patient had mild restriction. Using Neer’s scoring system there were 72% patients with good to excellent results. Conclusion: Retrograde intramedullary supracondylar nail is a good fixation system for distal third femoral fractures, particularly extra-articular type. It has benefits of less periosteal stripping, reduced blood loss, decreased hospital stay and less surgery duration. Early surgery, closed reduction, at least two screws in each fragment and early post- operative knee mobilization are essential for good union and good knee range of motion.

20. A Retrospective Cross Sectional Analysis of Drug Induced Diseases in A Tertiary Care Teaching Hospital Western Rajasthan
Rajesh Ramwani1, Puja Khanna Malav, Savita Saini, Chetan Prakash Suman, S.K. Mathur
Introduction: Adverse drug reaction (ADR) has been implicated as a leading cause of considerable morbidity and mortality worldwide. The prevalence rate of ADRs has been reported to range from 0.16 to 15.7 per cent. Drug induced diseases (DIDs) are well known but least studies. Data on DIDs from India are not available. Hence, this retrospective study was conducted. Material& Methods: The present study was conducted in the department of Pharmacology, Government Medical College Kota. It was a cross sectional retrospective observational study carried out over a period of one year from Jan 2022 to December 2022. Data were collected to evaluate the prevalence and profile of DIDs in Adverse Drug Reaction Monitoring (ADRM) Centre, working under Pharmacovigilance Programme of India (PvPI) in a tertiary care teaching hospital from north India (Government Medical College, Kota) using suspected drug reactions monitoring data collection form used under PvPI. Results: In this study, indoor & outdoor patients’ were analyzed and patient reported experience adverse drug reaction on the basis inclusion and exclusion criteria. The total number of ADR events reported during the one year study period was 1385 and out of these 546 (39.42%) were the drug induced disease rate. Among them 243(44.5%) were male and 303(55.5%) were female. The maximum number of patients were found to be in geriatric age group 301(55%); followed by adult 201 (36.8%) and paediatric population 44(8.05%). Mean duration of appearance of DIDs was 28.05±9 days. Conclusion: Our study concluded that, the total number of reported ADR events, Drug Induce disease rate found high. The maximum number of patients was found to be in geriatric age group. In our study, Maximum ADR events were probable followed by possible according to causality WHO-UMC scale. Our findings show that DIDs are significant health problem in our country, which need more attention.

21. Management of Infected Non-Union Tibia Fracture by Ilizarov Method: A Prospective Study
Qadir Anwar Tak, Mahaveer Meena, Manohar Lal Carpanter, Naveen Ratawal, Pradeep Khinchi, Purushottam Jhanwar
Background: Infected non-union of long bones is a chronic and debilitating disorder. It is difficult to treat infected non-union. Various treatment modalities used to treat infected nonunion and ilizarov is one of them. The aim of the study to evaluate outcome of infected non-union tibia fracture managed by ilizarov method using A.S.AM.I. criteria and also evaluation of complications related to process. Methods: The study was on 15 patients, 13males and 2 females, Mean Age between 22 to 55 including study period from August 2020 to March 2022. Functional result and bony result were assessed using A.S.A.M.I. criteria. Results: The study included 15 cases of with 13 males & 2 female, mean age 37.53 yrs. 100 % were compound fractures. All cases were treated by tibia corticotmy – 53.33% proximal, 46.66% distal. Improved ROM was noted in all cases. 66.66% cases had excellent & 26.66% had good bone results. 60% cases showed excellent and 33.33% cases showed good functional result. We achieved union in 100 % cases, eradicated infection in all. 1case had persistent pain and all cases return to activities of daily living (ADL). We had some complications, PTI was commonest (60% cases). Conclusion: Ilizarov method now a days is a good technique to check infection and achieve union in infected non-union of tibia by the principal of distraction osteogenesis.

22. To Compare the Success Rate of Pterygium Surgery by Conjunctival Auto Graft with and Without Limbal Stem Cell in Primary and Recurrent Pterygium
Vikas Gupta, Amit Gupta
Background: Pterygium is a common ocular disorder characterized by the growth of abnormal tissue on the conjunctiva, usually extending onto the cornea. The conjunctival stem cells play a crucial role in maintaining the health and integrity of the ocular surface. They possess the remarkable ability to regenerate damaged conjunctival tissue and promote healing. This regenerative potential has led to the emergence of conjunctival stem cell grafting as a promising technique in pterygium surgery. This study is planned to compare the results of pterygium surgery with and without conjunctival stem cell grafts, evaluating their efficacy, safety, and long-term outcomes. Materials and Method: It is a hospital based prospective observational study conducted in the Department of Ophthalmology, Mahatma Gandhi Medical College, Jaipur, Rajasthan. After detailed ocular and systemic history, a through ocular examination was done. Detailed slit lamp examination was done to know the extent of pterygium and any other ocular abnormality. An informed consent was taken from all patient included in this study. All calculations were performed using SPSS® version 15 (Statistical Packages for the Social Sciences, Chicago). Results: we found that recurrence of pterygium depends on Type of surgical technique, age of patient at the time of surgery, type of pterygium, Grade of pterygium. In our study serious complications like glaucoma, corneal edema, corneal perforation, development of cataract did not occurred in any case.

23. Functional Outcome of Intraarticular Fracture Distal End Radius in Adult Treated by Variable Angle Volar Locking Plate
Navin Kumar Ratawal, Mahaveer Meena, Qadir Anwar Tak, Pradeep Khichi, Purshottam Jhanwar
Background: INTRA-articular distal end radius fractures are difficult to manage and so various treatment modalities have been described. Variable angle locking plate is a novel development of LCP is the recent method to fix simple to complex fractures of distal end radius. Objectives: To evaluate functional outcome in fractures of distal radius fixed with variable angle volar locking plate. Methods: In this study, 25 cases of intra-articular fractures of distal end radius were surgically managed by open reduction and internal fixation using variable angle volar locking plate in the Department of Orthopaedic Surgery Jhalawar Medical College Hospital The age of the patient in this study, ranged from 21 years to 80 years). All patient were evaluated for radiological &functional outcome according “Sarmiento’s modification of Lindstrom’s criteria & Mayo Score” respectively. Results: All the patients had good union. The mean time of union was 12 weeks. Stiffness was noted in 12% cases (3 patients), 4% (1 patient) show malunion, 8% cases (2 patients) had superficial infection which was controlled by dressing and antibiotics and 4% (1 patient) had broken screw. In our follow up, average mayo score in 1st week is 12, 2nd week is 60, 3rd week is 73, 4th week is 80, 5th follow up is 84.6. Conclusions: The results are evidence that Variable angle locking plates are good implant in the treatment of intra-articular unstable fractures of distal radius. It allows effective anatomic realignment and early wrist mobilization.

24. The Study of Conrticosteroid Injection Therapy in Patients with Lateral Epicondylities
Rajesh Kumar Chaudhary
Background: To the study of conrticosteroid injection therapy in patients with lateral epicondylities. Methods: This study was conducted on outpatient in the Department of Physical Medicine and Rehabilitation, Mahatma Gandhi Hospital Banswara (Rajasthan). Age between 18 and 65 years of age insidious onset of lateral elbow pain lasting for 3 months. Inclusion criteria were pain over the lateral humeral epicondyle with pain severity by visual analogue scale (VAS) provoked by at least 2 of the following. Results: The mean VAS Score of patients who receive Inj. Corticosteroid at the time of presentation was 7.20. After the Inj. given the mean VAS score was decreased to 2.41 and 0.53 at one and three months respectively. This change was statistically significant. The mean Pain free grip strength of patients who receive Inj. Corticosteroid at the time of presentation was 19.21 after the inj. given the mean pain free grip strength was decreased to 20.45 and 20.97 at one and three months respectively. This change was statistically significant. Conclusion:  We concluded that shown significant improvement in their outcome i.e. in PRTEE score, VAS score and pain free grip strength but better improvement of symptoms is seen in the steroid injection group.

25. Evaluation of Hospital Admission, Discharge and Follow-Up by Obtaining POPC & PCPC Delta Score and Comparing It to the POPC & PCPC Score Declines: A Prospective Observational Study
Bhagyashree Baghel, Karan Joshi, Jeetendra Singh
Purpose: The purpose of the present study was to examine hospital admission, discharge, and follow-up by obtaining a delta score and correlating it to the Pediatric Overall Performance Category Scale (POPC) and the Pediatric Cerebral Performance Category Scale (PCPC). Further, this study compares the POPC/PCPC delta scores and score declines among two groups of patients, viz., PICU-admitted patients and ward-admitted patients. Methods: A prospective observational study was carried out at the pediatric intensive care unit (PICU) of the Shyam Shah Medical College, Sanjay Gandhi Memorial Hospital, and Gandhi Memorial Hospital over a 12-month period. A Purposive sampling technique was used to choose 200 kids (100 PICU admissions and 100 Ward admissions) between the ages of 28 days and 17 years who had been in the PICU for at least 24 hours. The scales used to assess the child’s performance were: (i) The Glasgow Outcome Scale; (ii) The Functional Status Scale; (iii) The Pediatric Cerebral Performance Category Scale; and (iv) The Pediatric Overall Performance Category Scale. Result: The PCPC and POPC Delta scores of the study population mostly had no change between admission, discharge, and follow-up. The PCPC decline between admission and discharge was significantly associated with the type of admission. PICU patients generally had higher declines in cerebral Performance as compared to the Ward cohort. Ward patients had a greater proportion of no change as compared to PICU patients. Conclusion: The study found that patients admitted to the PICU had poorer cerebral and overall performance as compared to patients admitted to the Ward. The difference in performance was much greater at follow-up as compared to discharge. The study demonstrated that neurological and cardiovascular pathologies also had a significantly poorer outcome as compared to pathologies of other systems.

26. Low Dose Dexmeditomidine for Maintaining Hemodynamic Stability in Patients Undergoing Craniotomy for Supratentorial Tumors
Anupam S. Thomas, Basheer P.M.A.
Background and Aims: Maintaining hemodynamic stability during craniotomy and intracranial surgery is of utmost importance for the post-operative evaluation of neurological integrity and stability. Many anaesthetic techniques are in practice to ensure hemodynamic stability, among which the preoperative use of low dose dexmeditomidine during intracranial surgeries is a newer and recent method. We wanted to find out whether a low dose of dexmeditomidine followed by infusion would provide stable hemodynamics and hence this study. Methods: This was a prospective cohort study in which 60 patients of either gender or sex, ASA I or II posted for supratentorial tumor surgery were randomly divided into 2 groups. 1st group (Group D) received Inj dexmeditomidine 0.5mcg /kg over 20 minutes and the second group received saline in equal volumes (Group ND), twenty minutes before induction, followed by standard general anaesthesia as per hospital protocol for neuroanaesthesia. A maintenance dose of 0.4 mcg/ kg/hr of dexmed infusion was started after the bolus dose for group D. Hemodynamic parameters were measured during skull pin insertion, after induction, during surgery and at extubation. Results: Qualitative data analysis was done using student t test. Quantitative data were compared between 2 groups using Chi square test. Significant increase in heart rate were noted in group ND than the dexmed group p<0.001. Also, systolic Bp increase was also noted in the ND group than the dexmed group p<0. 001.But there was no statistically significant difference in diastolic BP.Conclusion: Dexmeditomidine bolus followed by low dose infusion provides hemodynamic stability in patients undergoing craniotomy for supratentorial surgeries.

27. Paediatric Ocular Diseases in a Tertiary Care Eye Centre
Ashwani Meherda, Deepak Choudhury, D. Anuradha
Background: Congenital ocular anomalies are one of the important causes of childhood ocular morbidity and blindness. Visual impairment is one of the most common disabilities affecting children. A chromosomal/ genetic abnormality, an intrauterine infection, or maternal toxin is often involved. Aim: To study various paediatric ocular diseases in a tertiary care eye centre of Southern Odisha. Material & Methods: This was a prospective observational type of study of 2 years duration (from October 2017 to September 2019). 155 eyes of 118 patients of pediatric age group of both sexes with congenital ocular anomalies were included in the study. Detailed patient history and maternal obstetrics history was taken. Detailed systemic examination was done to rule out presence of any other malformations. Detailed ocular examination was done and recorded. All laboratory investigations were done. Results: Out of 118 patients, 69 (58.47%) cases were males & 49 (41.53%) cases were females. Male to female ratio was 1.4:1. The age of presentation of congenital ocular anomalies was found to be highest (40.67%) in the age group of < 1 years. History of consanguineous marriage was found in 11 (9.32%) cases. The most common mode of presenting symptom was watering (41.52%), followed by defective vision (28.82%). Nasolacrimal duct obstruction was the most common anomaly, found in 52 (44.06%) cases, followed by coloboma, found in 30 (25.43%) cases. Conclusion: Majority of cases were reported in less than 1 year of age group. Congenital nasolacrimal duct obstruction was found to be the most common congenital ocular anomaly followed by coloboma and congenital cataract.

28. A Prospective Observational Study of Lower Genital Tract Injuries in Multipara during Vaginal Deliveries in a Tertiary Institution
S. Lavanya Kumari, Koppirala Nikhila, B. Arunakumari
Background: This study was conducted to assess the incidence of maternal lower genital tract injuries, study the various types of maternal lower genital tract injuries during vaginal delivery and to assess complications and morbidity due to lower genital tract injuries. Methods: This was a hospital-based prospective observational study conducted among 100 female patients admitted to the labour room for vaginal delivery in the Government General Hospital Kakinada, from December 2019 to October 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Majority of genital tract injuries occurred in the second gravida of about 69%, 1% of cases belong to the fifth gravida. 76% of cases are booked and 24% are unbooked. Among the women with co-morbidities, the frequency of genital tract injuries in preeclampsia was 10%. The frequency of genital tract injuries in GDM was 2%. The maximum number of genital tract injuries occurred in women with a normal duration of labour (78%). 62% of cases have a birth weight of 3.6-4 kg. 6% of cases have a birth weight of 2.5-3 kg. 60% of cases of genital tract injuries occurred during spontaneous delivery. 40% of cases of genital tract injuries occurred during outlet forceps delivery. 44% of cases were 2nd degree perineal tears. 2% of cases were cervical lacerations. Conclusion: Skilled birth attendants in labour, vigilant labour monitoring, identifying risk factors such as perineal injuries in previous deliveries, a big baby, a timely episiotomy, a proper Ritgen’s manoeuvre, timely and adequate suturing, the allocation of medical personnel depending on risk factors, the provision of emergency obstetric care services that are accessible and affordable, and perineal care in the postnatal period help a lot in reducing the rate of genital tract injuries and complications.

29. A Comparative Study of Serum Magnesium & Glucose in Women with Polycystic Ovarian Syndrome and Healthy Controls
Pankaj Birla, Meeta Sharma, Chitra Upadhyay, Sangeeta Meena
Background: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, with a global prevalence of approximately 7-10%. The aim of this study is to conduct a comparative analysis of serum magnesium and glucose levels in women with PCOS and age matched healthy controls. Methods: A prospective study was conducted, collecting data on Blood glucose and magnesium levels in 70 cases of PCOS and healthy females. Student’s t-test and chi-square test were used for analysis and comparison. The study was conducted from Jun 2021 to November 2022. Results: The mean serum magnesium levels in PCOS cases (1.88 0.21 mg/dl) is less as compared to controls. (2.09 0.77) and this difference is statistically highly significant (p 0.001). Importantly, fasting blood sugar levels were significantly elevated in women who had PCOS compared with those who had healthy controls (p = 0.001). The negative linear correlation observed between mean Fasting blood glucose and serum magnesium level further strengthens the potential interplay between these two parameters. Conclusion: Serum magnesium and serum glucose levels are important biomarkers for early detection of metabolic changes and identification of individuals at increased risk of developing cardio-metabolic syndrome associated with the PCOS, which can facilitate the implementation of appropriate interventions to mitigate the long-term complications.

30. Evaluation of Anaesthetic Effects of Intrathecal 2-Chloroprocaine with or Without Fentanyl in Perianal Surgery: A Prospective and Randomized Study
Hemant Kumar Meena, Hemraj Tungria, Ganesh Gupta, Rama Kant, Ruchi Gupta, Deepak Mehra
Introduction: Spinal anaesthesia is reliable and safe technique for perianal surgeries. 2-Chloroprocaine has a rapid onset and short duration of action and less systemic toxicity. The primary goal of ambulatory anaesthesia is rapid recovery leading to early patient discharge with minimal side effects. Aim: This study was aimed to evaluate the effectiveness of 2-chloroprocaine with or without fentanyl in perianal surgeries in terms of block characteristics as primary objective and to note haemodynamics and any side effects as secondary objective. Study design: A prospective, randomized, double blind interventional study. Methods: Sixty adult patients of 18-60 years, of either sex, ASA grade I or II posted for perianal surgeries under spinal anaesthesia were randomized into two groups of 30 each, in which one group (CF) received1% 2-chloroprocaine 3 ml (30mg) with fentanyl 0.5ml (25mcg) and other group (CS) received 1% 2-chloroprocaine 3ml (30mg) with normal saline 0.5ml. Results: The mean time to peak sensory level in Group CF was 8.20±0.96 min and in Group CS, it was 8.66±0.95 min (P = 0.065). The mean duration of sensory block in Group CF was 96.20±10.30 min and in Group CS, it was 90.60±10.92 min (P = 0.045). The mean duration of motor block in Group CF was 90.47±8.67 min and in Group CS, it was 88.43±8.67 min (P= 0.31). The mean duration of analgesia in Group CF was 117.60±11.54 min and in Group CS, it was 111.28±11.66 min (P = 0.039). Conclusion: Addition of fentanyl 25 mcg as an adjuvant to 2-chloroprocaine (30 mg) resulted in marginal but statistically significant prolongation of sensory block duration and time to rescue analgesia in patient undergoing perianal surgery under spinal anaesthesia.

31. An Analysis of Methods of Middle Ear Reconstruction and Their Effect on the Auditory Gain and Causes of Graft Failure in CSOM
Dhavala Dakshinamurthy, Mannam Ramesh, Ravindra Babu
Background: Chronic suppurative Otitis media (CSOM) is a suppurative inflammatory disease of the middle ear cleft affecting its mucoperiosteal lining, clinically characterized by discharge from the ear and conductive deafness. A large number of surgical methods are adopted using various graft materials to reconstruct the tympanic membrane and the Ossicles to improve the hearing. Aim of the study: To analyze the role of surgical methods, graft material used in the restoration of anatomy and function of the middle ear mechanism; to study the causes of their failure. Materials: 78 Patients aged between 18 years and 67 years were studied for the effects of different Tympanoplasty procedures on the auditory gain and causes for graft failures over a period of two years. The patients were analysed after history taking, ENT clinical examination, radiological and auditory investigations and operative procedures. Cortical Mastoidectomy or modified radical Mastoidectomy with ossiculoplasty and tympanic membrane reconstruction were undertaken using autologous, heterologous and synthetic materials (TORP, PORP) for graft. Type I, II and III Tympanoplasty procedures were adopted. Postoperative hearing assessment after 6 months was done to conclude. Results: Among the 78 patients there were 21/78 (26.92%) 18 to 27 years, 27/78 (34.61%) in the age group of 28 to 37 years and 18/78 (23.07%) in the age group of 38 to 47 years. The mean age was 36.76± 5.34 years. There were 51/78 (65.38%) males and 27/78 (34.61%) females. Out of 78 patients, 44/78 (56.41%) were tubotympanic CSOM and 34/78 (43.58%) with Atticoantral CSOM. In Tubotympanic CSOM patients, PTA was 45 to 50 dB in 08.97% patients, 35 to 45 dB in 12.82% patients. Air bone gap of 35 to 30 dB was 15.38% patients, 30 to 25 dB in 08.97% patients. There was no statistical significant correlation between the various incidences of CSOM patients in the study (p value was more than 0.05). Conclusions: The final outcome of different Tympanoplasty procedures and Ossiculoplasty procedures using various graft materials was not based on the factors such as Gender, site, size of tympanic membrane perforations, grading of pneumatization but the principle of total eradication of the disease in the middle ear cleft and suitable reconstructive methods adopted based on the remnant ossicles and tympanic membrane.

32. Adherence to Treatment of Hypertension: A Comparison amongst Patients Registered in Health Facilities in Rural and Urban Areas of A District in Rajasthan
Kusham Lata
Background: India is facing an increase in cases of non-communicable diseases (NCDs) in general and hypertension in particular. Uncontrolled hypertension is caused by non-adherence with antihypertensive treatment. Although few studies have been conducted in different parts of the country to demonstrate adherence in hypertensive patients, little has been documented in Rajasthan on the matter. Aim: To assess the adherence to treatment of hypertension among patients registered in government health facilities in rural and urban areas of Churu district in Rajasthan. Method: In this cross-sectional study, a list of all districts of Rajasthan was procured. One district (Churu) was chosen by random sampling method. The study area included all rural and urban government health facilities in the selected district. All hypertensive patients registered at these rural and urban health facilities between January 2021 and December 2021 who consented to the study were included in the study. Using a pre-designed and tested questionnaire, demographic characteristics, enrollment details, and clinical characteristics were collected through face-to-face interviews, and their personal medical records were reviewed to confirm treatment. Result: The study was carried out on 5160 hypertensive patients. Adherence with antihypertensive treatment was 50.74%. 52.43% of males followed treatment adherence within 3 months of follow up period versus 49.08% of females. 56.03% of hypertension patients in rural areas adhered to the treatment, compared to 40.81% in urban areas. Patients older than 60 years were more compliant (54.45%) than patients ≤ 60 years (46.22%). Conclusion: Gender, place of residence, and age were found to be statistically significant factors in determining community adherence to medical recommendations for treating hypertension. Compared to their counterparts, treated patients show a significant improvement in blood pressure control.

33. Assessment of Metabolic Syndrome in Reproductive Aged Women with Polycystic Ovarian Syndrome: A Cross-Sectional Study
Mamatha Pulloori, S. Nirmala, Jyothi Gunda
Introduction: Polycystic ovarian syndrome (PCOS) is an endocrine disorder affecting reproductive age group women and exhibiting complication including anovulatory infertility, menstrual irregularities, hirsutism, and long-term complications like diabetes, cardiovascular complications. Development of metabolic syndrome in women with PCOS can leads to long term complications. The present study was aimed to evaluate the metabolic syndrome in the women with PCOS of reproductive age group. Material and Methods: A source of 124 participants of reproductive age attending the OPD, Department of gynecology between age group 18-40 years was included. Laboratory investigations, BMI, waist circumference, fasting blood glucose were measured. Results: The prevalence of metabolic syndrome was 41.93%. Age, BMI, obstetric score, and clinical problems had statistically significant mean differences (p 0.05). The mean values of triglycerides were 123 mg/dl, HDL was 47.48 mg/dl, LDL was 102.85 mg/dl, total cholesterol was 165.5 mg/dl, and fasting blood sugar was 106.2 mg/dl in women with metabolic syndrome. Conclusion: The results of present study showed in women with PCOS who were in the reproductive age range, the prevalence of metabolic syndrome was 41.93%. Women over 26 years who have a large waist circumference and BMI over 26 kg/m2 are more likely to develop metabolic syndrome.

34. Assessment of Thyroid Dysfunction in Women with Normal Vs Preeclampsia Pregnancy: A Case Control Study
S. Nirmala, Mamatha Pulloori, Jyothi Gunda
Introduction: Thyroid dysfunction has impending effect during pregnancy on both the mother and the fetus. Preeclampsia is a possible pregnancy-related complication in women with hypothyroidism. Th present study was aimed to assess the prevalence of hypothyroidism in the women with preeclampsia. Material and Methods: A total of 94 cases with preeclampsia between 18-35 years and age and gestational age matched control subjects belonged to >20 weeks were recruited. 5 ml of peripheral venous blood was collected to analyse free T3, free T4 and TSH levels. Results: The prevalence of hypothyroidism was 40.43% in women with preeclampsia. The TSH levels were comparatively high in women with severe preeclampsia than mild preeclampsia and levels of FT3, FT4 and TSH were comparatively high in preeclamptic women with >34 weeks of gestation. The number of antihypertensive drugs intake was significantly reduced after delivery in women with preeclampsia. Conclusion: Hypothyroidism was substantially correlated with the severity of preeclampsia. Women with conditions including obesity, diabetes, hypertension, and TSH should keep track of their levels regularly to prevent hypothyroidism, which can cause preeclampsia and have an effect on both the mother and the foetal outcome.

35. A Randomized Comparative Study of Levofloxacin Based Triple Therapy with Standard Triple Therapy for Helicobacter Pylori Eradication
Amit Kumar Jha, Asha Kumari, Lalit Narayan Suman
Background: The isolation of Helicobacter pylori has opened the floodgates to a new era of discovery and understanding of gastro-duodenal pathology and heralded a revolution in the thinking about the pathophysiology and the treatment of PUD in particular. Preliminary data on triple therapies including either levofloxacin or azithromycin have shown positive results and suggest that these compounds could be promising for Helicobacter pylori treatment. As more is learnt about the organism and the disease process, it is hoped that a simple and an effective cure will be discovered. Aim: Comparison of levofloxacin-based triple therapy with standard triple therapy for helicobacter pylori eradication. Methods and Materials: The study was conducted in 72 patients attending the OPD of Gastroenterology. Patients were randomized according to a computer-generated randomization schedule, to receive a 7 days treatment with either Esomeprazole 20mg, Levofloxacin 500mg and Azithromycin 500mg, once daily (ELA) or Esomeprazole 20mg, Clarithromycin 500mg and Amoxicillin 1g twice daily (ECA). Esomeprazole was given 30 minutes prior to breakfast and dinner, whilst the antibiotics were taken together immediately after meals. The use of alcohol was discouraged during the study period. All the patients were continued with esomeprazole 20mg once daily for the next 3 weeks, followed by a drug-free period of 1 week. Within a week following completion of the 7 days study medications, patients came for the end-of-treatment assessment. Results: Twenty-nine (85.3%) patients in the ELA group, 33(94.3%) patients in the ECA group experienced an improvement in the severity of the symptoms, whereas 5(14.7%) patients in the ELA group and 2(5.7%) patients in the ECA group felt that the symptoms were unresolved or even worsened. In the ELA group, the lesions were completely healed in 21(61.76%) cases as compared to 27(77.1%) cases in the ECA group (X2=2.32, p=0.127). Helicobacter pylori infection was eradicated in 23(67.6%) cases, in the ELA group, whereas the eradication rate with the ECA group was 77.1% (27 cases) (X2=0.779, p=0.377). Conclusion: The present study demonstrates that once daily levofloxacin plus azithromycin-based triple therapy achieves Helicobacter pylori eradication rate comparable to that of the standard, twice daily triple therapy. Patient compliance, drug tolerability and side effects profile were almost the same in the two treatment groups. Hence levofloxacin-based triple therapies may represent a promising, alternative therapeutic option in the first-line therapy for Helicobacter pylori infection.

36. Chronic Constipation in Children Department of Pediatrics G.M.C. Chittorgarh
Mahendra Kumar Balot, Sharanabasava B, Anas Sheikh
The evaluation of chronic constipation with or without encopresis must begin with a careful history. The intervals between bowel movements and the size and consistency of stools deposited Into the toilet should be noted. Encopresis may be manifested as dirtying the underwear. The physical examination should include anorectal and neurological examination.
No specific organic cause can be found in the majority of children. One or several anorectal physiological abnormalities have been found by us and others in 80 out of 100 children with idiopathic constipation. These abnormalities include impaired rectal and sigmoid sensation and decreased rectal contractility during rectal distention. The external anal sphincter and pelvic floor muscles may be abnormally contracted during straining for defecation, and the child may be unable to defecate anorectal balloon. Most patients will benefit from a program designed to clear stools, to prevent further Impaction, and promote regular bowel habits. Fifty percent of patients will be cured after 1year.

37. Study of hsCRP in Type 2 Diabetes and its Association with Diabetic Retinopathy
A Manjula, Poornachandra, Sumaiya Anjum
Background: In worldwide, type 2 diabetes prevalence is increasing in the all age group population. This is a major cause for death and various non-fatal complications. In a recent study it is proved that high risk patients with type 2 diabetes mellitus can be reduced by modification of life styles. Objective: To assess the serum hsCRP levels in patients with type 2 diabetes and to analyse the levels of hsCRP with severity of diabetic retinopathy. Methods: This cross sectional-Observational study was conducted among patients visiting the OPD/or admitted in Department of General Medicine, KR Hospital, MMCRI Mysore. Results: Diabetes is one of the leading health issues in the world. Diabetic complications can lead to morbidity and mortality. There are multiple other factors that hasten the progression of diabetic complications. The study showed a correlation of serum hsCRP level with uncontrolled diabetes. It also proved an association between diabetic retinopathy severity with serum hsCRP levels. Conclusions: The study showed a significant correlation between serum hsCRP and diabetic retinopathy severity.

38. Evaluation of Role of CTLA4 Immunohistochemistry in the Diagnosis of Colon Cancers
Ashwini Ramji
Aim: To assess role of CTLA4 immunohistochemistry in the diagnosis of colon cancers. Methodology: Fifty-four resected specimens of colorectal cancer of both genders were selected. From colectomy specimens, paraffin blocks were prepared on samples from the tumour areas and the nearby normal areas. On the sections and on the controls, IHC for CTLA-4 was performed. Results: Right side was involved in 30 cases and left side in 24. There were 23 males and 23 females. Procedure performed was sigmoidectomy in 7, hemicolectomy in 21, resection in 19, hartmann’s procedure in 4 and pancolectomy in 3 cases. The difference was significant (P< 0.05). Grade found to be well differentiated in 13, moderately differentiated in 31 and poorly differentiated in 10 cases. TNM staging was stage 1 in 15, stage 2 in 9, stage 3 in 28 and stage 4 in 2 cases. Perineural invasion was present in 11 and absent in 43 cases. Histopathological diagnosis was mucinous carcinoma in 8, adenocarcinoma in 27 and adenocarcinoma with mucinous component in 19 patients. Lymphovascular invasion was present in 24 and absent in 30 cases. Intensity of CD+4 cell uptake by tumour cell was 1+ in 14, 2+ in 19 and 3+ in 21 cases. The difference was non- significant (P> 0.05). There was a significant increase in the tumor quantity among those with uptake of 3+ with a mean difference of 19.5. The difference was significant (P < 0.05). There was a significantly high tumour infiltration among those with an uptake of 3+, with a mean difference of 19.8. Conclusion: Authors showed overexpression of CTLA‑4 in colorectal cancer specimens.

39. Comparison of Tramadol and Dexamethasone as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block
Yogesh Chauhan, Anilkumar Patel, Kaushikkumar D Prajapati, Parul Jagdishchandra Oza
Background and Aim: A list of supraclavicular block additions is available to help with the onset, severity, and duration of the block. These additives may also be wise for postoperative analgesia. In this study, we compared the effectiveness of tramadol and dexamethasone when combined with bupivacaine to block the supraclavicular brachial plexus in terms of the timing of the onset of sensory and motor blockade, the length of the sensory and motor blockade, haemodynamic factors, and the elapsed time before the first rescue analgesia in the first 24 hours following surgery. Material and Methods: 150 patients in ASA grades I and II, between the ages of 18 and 65, scheduled for upper limb orthopaedic procedures with supraclavicular brachial plexus blocks were divided into three groups of 50 patients each after receiving approval from the institutional ethical committee. Group I received 100 mg of tramadol (50 mg/ml) and 28 ml of 0.5% bupivacaine. 28 ml of 0.5% bupivacaine and 8 mg of dexamethasone (4 mg/ml) were given to group II. Group III received 2 ml of normal saline and 28 ml of 0.5% bupivacaine. It was observed when the sensory and motor block began and how long it lasted. From the time of baseline until the first rescue analgesic was used, hemodynamic variables were monitored. Results: In the current investigation, Group II (8.94 ± 1.58 min) experienced sensory onset time that was substantially sooner than that of Groups I (12.03 ± 2.40 min) and III (18.85 ± 4.48 min). In comparison to Group I (23.10 ± 3.56 min) and Group III (26.95 ± 3.67 min), Group II’s time of motor initiation was much earlier (14.48 ± 2.48 min). Maximum sensory block time was experienced by Group II patients (424.58 ± 41.98 minutes), followed by Group I (380.65± 59.47 minutes), and minimal sensory block time was experienced by Group III patients (301.39±53.69 min). Conclusion: The results of this study demonstrated that, of the two combinations, Dexamethasone was more efficient than Tramadol in the specified drug dose combination. It is also advised to do more research using other drug-dose combinations in order to confirm the results of the current study and establish the ideal and most efficient dose of adjuvants and local anaesthetic.

40. To Determine the Knowledge and Behaviours about the Treatment of Anaphylaxis in Children and Adolescents among Teachers
Kanchan Lata, Abhishek Kumar, Aishwarya Jaiswal, Sandeep Kumar Srivastava
Aim: Knowledge and behaviours about the treatment of anaphylaxis in children and adolescents among teachers is the goal of this study. Material and Methods: A cross-sectional research was carried out on the teaching staff in order to evaluate their levels of knowledge, confidence, and attitude towards their part in the execution and treatment of anaphylaxis. Participants in this research were chosen using a method that was neither random nor completely at the participant’s convenience. Results: Just 22.5% of the pupils are aware of any of their classmates who have anaphylaxis. The vast majority of the mentors had no awareness whatsoever on anaphylaxis. Drugs were the most common cause of anaphylaxis, accounting for 83.75 percent of reported cases, followed by pollens (68.75 percent). In addition, 88.75% of the instructors stated that eggs were the most prevalent meal that caused anaphylaxis, followed by bananas (72.5%). In cases of anaphylaxis, the most common first aid action that would be carried out by the teachers in our study was to call an ambulance service (53.75%); only 2.5 percent of teachers would consider administering an epinephrine injection, and additionally, 3.7 percent of the teachers reported that they would use an antihistamine, whereas 26.2 percent of the teachers reported that they had extremely poor knowledge of any drug administration. When asked about the correct way to administer epinephrine, the majority of the instructors who participated in the current research (62.5%) did not know the answer, and only 20% of them selected the appropriate approach, which is an intramuscular injection. Conclusion: The knowledge and practices of school teachers regarding anaphylactic reactions need to be strengthened. Teachers need further education regarding the management of allergic reactions encountered among students.

41. Dysnatremia and Risk Factors Leading to It in Sick Newborns Admitted in A Tertiary Care Hospital of Southern Rajasthan
Rajendra Kumar Sharma, Puneet Jain, Harsh Bala, Malvia S
Introduction: Hyponatremia and hypernatremia pose intricate challenges in the clinical realm, particularly among newborns. Many sick newborns admitted have been associated with dysnatremia and its ill effects. The study aims to find out the prevalence of dysnatremia and risk factors associated with it in sick neonates. Material and Methods: A cross sectional study on all the neonates admitted in NICU of Pacific medical college and hospital, Udaipur during the study period from December 2022 to May 2023. Those neonates who did not consent were excluded. Ethical clearance was taken. Serum sodium estimation was done for sick neonates. Result: A total of 154 sick neonates were included in the study, 147 neonates were successfully discharged and 7 (4.4%) neonates died during the hospital course. Out of 154 sick newborns enrolled, 83 (53.9%) were male while 71 (46.1%) were female. 65(42.2%) neonates had deranged serum sodium levels (dysnatremia). Hyponatremia was seen in 56(36.3%) neonates and hypernatremia was seen in 9(5.8%) neonates. Dysnatremia was significantly more frequent in preterm (p value 0.00001), LBW (p value 0.00001), Neonates with sepsis(p value 0.02), NEC (p value 0.003) and AKI (p value 0.001). Birth Asphyxia had dysnatremia but had no statistical significance (p value 0.61). Conclusion: The neonates with prematurity, low birth weight, NEC, sepsis and acute kidney injury were more significantly dysnatremic and moreimportantly hyponatremic. Dysnatremia can be fatal if not acted upon timely as 6(83.3%) neonates who expired had dysnatremia.

42. The Influence of Cardiovascular Diseases on the Diagnosis and Treatment of Anxiety Disorders: A Retrospective Study
Uday Narayan Sharma, Keshav Jee, Rajshri
Background: Anxiety and heart disease are now known to be related to health problems. On the other hand, more study needs to be done to fully understand how cardiovascular diseases affect and how anxiety disorders are found and treated. Such understanding is necessary to enhance patient care and outcomes. Objectives: Anxiety disorder diagnosis and therapy may be affected by heart disease and other cardiovascular risk factors, making a retrospective study essential. The primary objective of this research was to assess the impact of co-occurring anxiety disorders on cardiovascular and medical outcomes. Secondary objectives included estimating the prevalence of anxiety disorders among people with cardiovascular diseases and identifying potential risk factors related to comorbidity. Method: This retrospective study used electronic health data to look at the medical histories of 200 persons who had been diagnosed with cardiovascular disease. By looking at diagnosis codes and patient medical records, we were able to calculate the prevalence of anxiety disorders in the population we were studying. Logistic regression analysis was used to identify demographic and clinical characteristics associated with the development of co-occurring anxiety disorders. The effect of comorbid anxiety disorders on hospitalisation rates and other cardiology-related outcomes was also examined using chi-square analyses. Results: The study revealed that nearly 60% of individuals with cardiovascular issues also have anxiety disorders. Age (p 0.05), comorbid disorders (p 0.05), and gender (p > 0.05) were all associated with an increased likelihood of co-occurring anxiety disorders, according to logistic regression analysis. 75% of participants with concurrent anxiety disorders were hospitalised, compared to 25% of participants without anxiety disorders (p 0.05). Conclusion: This retrospective study demonstrates how substantially cardiovascular issues affect the identification and treatment of anxiety disorders. The prevalence of anxiety disorders among individuals with cardiovascular diseases reflects the importance of mental health screening in this population. According to the findings, age and co-occurring conditions play a significant influence in the development of comorbid anxiety disorders. Higher hospitalisation rates among individuals with both forms of anxiety disorders indicate the need for interdisciplinary treatment approaches. To enhance outcomes for this group, researchers must investigate the underlying causes and determine how to treat them.

43. The Bidirectional Relationship between Diabetes Mellitus and Major Depressive Disorder: A Retrospective Cohort Study
Uday Narayan Sharma, Keshav Jee, Rajshri
Background: Diabetes Mellitus (DM) and Major Depressive Disorder (MDD) are prevalent, chronic conditions that frequently occur together. The mutual influence between these disorders has significant implications for healthcare administration. This study aims to investigate the retrospective biological and psychosocial aspects and the epidemiological association between type 2 diabetes and major depressive disorder. Methods: 500 people aged 18 to 65 participated in a retrospective cohort study. Group A consisted of 250 people with a confirmed diagnosis of DM, while Group B consisted of 250 people with a confirmed diagnosis of MDD. Participants initially completed questionnaires regarding their demographics, medical histories, and mental health. Over five years, Group A participants were monitored for the development of MDD, while Group B participants were observed for the development of diabetes. Regression models and survival analyses were utilised to quantify the strength and direction of the association. Results: The correlation between diabetes and MDDare shown to go both ways in the cohort study. During the observation period, 65 people in Group A (26% of the total) were diagnosed with MDD. Participants with DM had a significantly increased risk of acquiring MDD compared to the general population (adjusted hazard ratio = 1.82, p< 0.001). During the observation period, Type 2 diabetes occurred in 53 people in Group B, or 21 per cent. Individuals with MDD were more likely to develop DM than those without MDD (adjusted hazard ratio = 1.66, p <0.001). Potential factors to the bidirectional interaction include shared pathophysiological mechanisms such as chronic inflammation and dysfunction of the hypothalamic-pituitary-adrenal axis. Conclusion: This cohort analysis supports that diabetes and major depressive disorder are linked bidirectionally. The results indicate a correlation between diabetes and subsequent development of MDD. This association could be the result of comparable pathophysiological processes. These results highlight interdisciplinary healthcare methods’ significance in managing disorders and mitigating their adverse health effects. Additional research is required to determine causal factors and design effective preventative and therapeutic strategies.

44. Comparison Between Propofol and Midazolam as Sedatives in Mechanically Ventilated Patients in ICU
Gouri Diwan, Akshay Raut, Bhavyaa Ranawat, Teesta Sen, Jeetendra Singh, Amruta Pingale
Introduction: The management of critically ill patients often requires invasive and uncomfortable procedures such as Tracheal intubation, Central line insertion, Arterial line catheterization, chest tubes and physical restraint. Furthermore, the intensive care unit (ICU) environment is filled with noise which greatly exaggerates the stress and anxiety of conscious patients. There is evidence that prevention of exposure to environmental noise, stress, anxiety can help improve outcome of patients. An important modality is the use of sedatives to prevent critically ill patients from being exposed to hazardous physical and psychological stimulus. Method: The study commenced after receiving approval from the institutional ethics committee and taking informed consent from the patients. A total of 60 patients were divided into the two groups of 30 each using computer generated random numbers. Result: This was a hospital based randomized control study conducted in the ICU of a tertiary care centre. A total of 60 patients were divided into following two groups of 30 each using computer generated random numbers. In Group ‘P’ patients randomized to the Propofol group received a loading dose of 0.5-1 mg/kg then an infusion of 25-75 mcg/kg/min adjusted to achieved the target Ramsay sedation score. In Group ‘M’ Patients randomized in Midazolam group received loading dose 0.03 to 0.3 mg/kg then an infusion of 0.012-0.024 mg/kg/h adjusted to achieved the target Ramsay sedation score. Conclusion: We were summarized from the current study that Propofol had a shorter mean recovery time than Midazolam. When compared to Midazolam, the Propofol group had a shorter mean extubation time and sedation time. In addition, the Propofol group spent less time on a mechanical ventilator in an intensive care unit than the midazolam group did. In comparison to the midazolam group, the propofol group had a lower percentage of side effects. The Ramsay sedation score did not differ significantly between the two groups.

45. Evaluation of the Effectiveness and Safety of Unilateral Paravertebral Block Compared to Traditional Spinal Anaesthesia for Inguinal Hernia Repair
Chittaranjan Panigrahi, Soumyakanta Sethi, Alok Kumar Sahoo
The surgical intervention known as inguinal hernia repair (IHR) is a frequently conducted procedure within the medical field. It can be carried out utilising general anaesthesia, regional anaesthesia, or peripheral nerve block anaesthesia. The utilisation of subarachnoid block is widely prevalent as the primary modality for lower abdominal surgery and orthopaedic surgery. Despite having ample experience, the utilisation of unilateral paravertebral block (PVB) as a primary anaesthetic modality remains suboptimal in the medical field. Consequently, this study was undertaken to assess the effectiveness of Paravertebral block in the context of unilateral inguinal hernia repair, in comparison to spinal anaesthesia. This prospective, randomised, single-blinded case-control study was conducted at the Department of Anaesthesiology, SCB Medical College, Cuttack, India, from April to September 2022, following the acquisition of institutional approval. The study was conducted on a cohort of 30 patients who were scheduled for unilateral inguinal hernia repair.

46. To Evaluate the Effects of Adjuvant Clonidine in Combination with Bupivacaine, As Compared to Solo Bupivacaine for Axillary Brachial Plexus Block: A Comparative Assessment
Alok Kumar Sahoo, Chittaranjan Panigrahi, Soumyakanta Sethi
Background: The extension of axillary block is advantageous in numerous cases as it permits a more protracted or comprehensive surgical procedure while reducing the need for additional analgesic medications. In this study, we conducted a comparative analysis of the efficacy of Clonidine as an adjuvant to Bupivacaine (0.5%) and Bupivacaine plain in the context of axillary brachial plexus block. The Visual Analogue Scale (VAS) score and other block characteristics were systematically assessed at regular intervals and in the postoperative period. Methods: A cohort comprising 110 adult patients classified under ASA 1, 2, and 3 were systematically assigned to two distinct groups using an alternate allocation method. In this study, Group A was administered a solution containing 0.25% Bupivacaine (40 mL) along with 1 mL of clonidine at a concentration of 150μg. On the other hand, Group B received a solution consisting of 0.25% Bupivacaine (40 mL) along with 1 mL of 0.9% saline. These solutions were administered via perivascular Axillary block. Results: The patient cohorts exhibited similarities in regards to age, gender, presence of concurrent medical conditions, and American Society of Anesthesiologists (ASA) classification. In the bupivacaine clonidine cohort, the duration of analgesia was extended by an average of 208 minutes in comparison to the administration of bupivacaine alone. The initiation of sensory and motor blockade was reduced by an average of 2.7 minutes and 3 minutes, respectively, in the clonidine treatment cohort. The average duration of sensory block in the bupivacaine-clonidine group was 503.3 ± 125.9 minutes, whereas in the bupivacaine only group, it was 287.1 ± 82.9 minutes. The results indicate a notable extension in the clonidine cohort, amounting to approximately 216.2 minutes. The average duration of motor block in the bupivacaine-clonidine group was found to be 409.8 minutes, whereas in the bupivacaine only group, it was observed to be 259.6 ± 74.8 minutes. This indicates a statistically significant increase in duration of 150.2 minutes in the clonidine treatment group. The study observed several side effects, namely hypotension, bradycardia, and sedation. The incidence rates of these side effects were 7.3%, 9.1%, and 36.3%, respectively, in the bupivacaine-clonidine group. In comparison, the bupivacaine only group had incidence rates of 1.8%, 3.6%, and 9.1%, respectively. Conclusion: Clonidine serves as a valuable adjunct to bupivacaine in the context of Axillary block. It greatly extends the period of pain relief, as well as the duration of sensory and motor blockade. Additionally, it expedites the initiation of sensory and motor blockade, albeit to a lesser extent.

47. Findings on Liquid-Based Cytology Prepared Smear among Women with Vulvo-Vaginal Itching and Discharge
Joy Philip Reang1, Padi Yasung2, Purba Biswas
Aim: To analyse pathological changes and association between socio-demographic characteristics of itching and discharge, in women presenting vulvo-vaginal itching and discharge. Method: This was a descriptive cytological hospital based prospective study conducted in Pathology department obtained from outpatient clinic of Obstetrics and Gynaecological department. Study was based on 274 women with complaints of vulvo-vaginal itching and discharge were obtained for cytological examination in a Liquid Based Cytology (LBC) collection vial to look for pathological changes. Pap smears samples (EZIPREP) were taken from all these patients with spatula and endocervical cytobrush and slides prepared. The remnant material on the spatula and cytobrush was centrifuged after being treated in Pap spin collecting liquid. The cell button was used to prepare smears, which were then fixed and stained with Papanicolaou stain. Data analysis was done using appropriate statistical tests. Result: The age of participants ranged from 20 years to 72 years with mean age being 33.4 years. All patients had vaginal discharge with different consistency. Bacterial vaginosis was the most prevalent infection found in 34 (12.4%) cases. Trichomonas infection was found in 6 (2.19%) cases, candida species in 4 (1.45%) cases, squamous intraepithelial lesion SIL 14 (5.09 %) cases and majority were negative for intraepithelial lesion NILM 216 (78.83%) cases. Bivariate analysis showed that in case of factors associated with discharge, women of 41-50 years of age showed higher risk, but in case of factors associated with itching, women aged >60 years showed higher risk, and when associated with both discharge and itching, women aged between 31-40 years showed higher risk. Our study found that age exhibited mild variation in risk-related symptoms, recommending further research with larger sample sizes. Conclusion: LBC is likely to continue to be the predominant technique for cervical cytology screening due to societal prerogatives and cytologists’ preferences for the method. Bacterial vaginosis is found to be the most predominant cause of vaginal infection and thus serve as a key for researchers to find its underlying cause for an appropriate diagnosis. Common symptoms like discharge and itching have been linked to a variety of conditions, from cancer to bacterial vaginosis, which would not have been found by a simple clinical examination. Thus, Pap smear screening and examination in accordance with accepted standards are required.

48. Study of Clinical Profile and Prognostic Indicators in Open Globe Injury in A Tertiary Eye Care Centre
Sanjukta Mahapatro, Sujata Padhy, Dammala Anuradha, Prangya Panda

Our study looked to identify the prevalent types of open globe injuries observed at our medical facility, assess the degree of visual impairment resulting from these injuries, and evaluate the visual prognosis following treatment. This study was a prospective investigation conducted within a hospital setting over a span of 2 years (March 2021 to April 2023). A cohort of 68 patients with ocular trauma were enrolled as participants in this study. All subjects underwent ophthalmologic assessment, which encompassed evaluation of visual acuity, examination of the anterior segment of the eye, assessment of extraocular movements, measurement of intraocular pressure, and examination of the fundus. Ophthalmic injuries were observed with higher frequency among individuals in the middle-aged adult population (32.25%). The prevailing mechanism of injury observed in this study was road traffic accidents (RTA), accounting for 35.29% of all reported cases. Road traffic accidents (RTAs) are the predominant aetiology of ocular trauma encountered at our institution, owing to its location in close proximity to a state highway. It is worth noting that such incidents are preventable, and the visual prognosis is contingent upon the precise location and dimensions of the injury, as well as the magnitude of the resulting ocular impairment.

49. SLE with Haemoregic Cyst
Chandra Shekhar Jaiswal, Manoo Aggarwal, Atul Kumar, Dinesh Kumar Thakur
Various cases of anaemia presenting with positive ANA were studied and a case series of such cases made and studied. SLE may be present along with persistent anemia in the presence of positive ANA for prolonged periods of time. It is recommended that patients with a positive ANA and persistent anemia serially be looked for clinical and laboratory manifestations of SLE in other organs.

50. Hemodynamic Changes in Hemodialysis Patient
Birpal Singh Yadav, Rajesh Kumar, Praveen Raghuwanshi, Dinesh Kumar Thakur
Objective: To study the evaluation of hemodynamic during haemodialysis and to determine the frequency of haemodialysis induced hypotension & myocardial ischemia. Methods: This study was conducted in the Department of Medicine CIMS Chhindwara during a period from September 2020 to October 2022. To assess various complication seen during HD. Present study includes a sum total 300 patients selection on random sampling method. Out of 300 patients there were 129 ARF/AKI and their haemodynamics were studied and results derived. Results: Eleven of the 21 patients experienced a hypotensive period (H group) during dialysis, while the remaining 10 patients had no such event (NH group). Age, dry weight, time on dialysis, interdialytic weight gain, ultrafiltration rate/kg dry weight, and medication were comparable between the two groups. Before dialysis systolic arterial pressure appeared to be lower in the H group, although this was not significant (127±26 vs.151±46 mmHg. Baseline values in both groups for heart rate, SI, TPRI and CVP also did not show any significant differences. Most hypotensive patients developed severe symptoms, which necessitated intervention. Conclusion: We conclude that dialysis related hypotension in our patient group did not result from an inability to maintain blood volume or from decreased cardiac filling. Hypotension appeared to result from the inability to adequately increase arteriolar tone and a reduction in left ventricular function.

51. Study of Correlation of Retinal Nerve Fibre Layer Thickness and Optic Disc Parameters with Visual Field Indices in Normal Population, Glaucoma Suspect and Diagnosed Cases of POAG
Kanoje Jyoti, Warkhede Padmini, Siddiqui Pervez Ahmed
Introduction: POAG is major worldwide cause health concern, because of its usually silent and progressive nature. It is one of the leading preventable causes of blindness in the world. Aim: To study the correlation of retinal nerve fibre layer thickness and optic disc parameters with visual field changes in Normal Population, Glaucoma suspects and Primary Open Angle Glaucoma. Materials and Methods: It was hospital based, prospective, non-randomised case study of 30 patients of POAG, 70 suspects of glaucoma, and 70 Normal Age matched controls for duration of one year. Results: The mean age of patients in POAG group were 58.63±11.373. We found a correlation between VF global indices and OCT RNFL thickness parameters in the POAG. Statistically significant and positive correlation (.464) between MD and RNFL average thickness; negative correlation (-.441) between PSD and RNFL average thickness were defined in the POAG group. These correlations between MD, PSD and RNFL thicknesses are clinically important. Conclusion: SD-OCT is capable of detecting early changes of glaucoma at the level of RNFL in glaucoma suspects with normal appearing discs and visual fields. OCT has been shown to obtain accurate and reproducible RNFL and retinal thickness measurements. OCT can help in timely diagnosis of pre perimetric glaucoma. OCT can serve as a useful tool in diagnosis, management, prognostication and research in glaucoma.

52. Incidence of False Positive Pelvic Lymph Node in Carcinoma Urinary Bladder: A Single Centre Experience
Sumanta Kumar Mishra, Sumit Kumar Panda, Jagat Ballav Jagdev, Pabitra Kumar Mishra
Background: To assess the diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) in predicting pelvic lymph node (LN) metastases in cervical cancer patients. Methods: This study enrolled 31 patients with FIGO stage IA1-IIB uterine cervical cancer who underwent hysterectomy with pelvic lymphadenectomy and underwent CT, MRI, and PET/CT prior to surgery between December 2019 and March 2023. LN metastases were defined by an LN diameter 1.0 cm and/or the presence of central necrosis on CT, an LN diameter 1.0 cm on MRI, and a focally increased FDG uptake on PET/CT. For pelvic LN metastases, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The sensitivity, specificity, PPV, NPV, and accuracy for detecting pelvic LN metastases were 51.4%, 85.9%, 41.3%, 90.1%, and 80.3%, respectively, for CT; 24.3%, 96.3%, 56.3%, 86.8%, and 84.6% for MRI; and 48.6%, 89.5%, 47.4%, 90.0%, and 82.9% for PET/CT, respectively. PET/CT and CT had a higher sensitivity than MRI (p=0.004 and p=0.013, respectively). MRI had a higher specificity than PET/CT and CT (p=0.002 and p=0.001, respectively). The difference between PET/CT and CT in terms of specificity was not statistically significant (p=0.167). Conclusion: These findings indicate that preoperative CT, MRI, and PET/CT exhibited low to moderate sensitivity and positive predictive value, and moderate to high specificity, negative predictive value, and accuracy. To anticipate pelvic LN metastases, additional efforts are required to enhance the sensitivity of imaging techniques.

53. A Clinical Study of Surgical Management of Acute Intestinal Obstruction: An Experience in a Tertiary Care Hospital
Venkatram Reddy Sankepalli, Mukka Gopinath
Background: The most frequently encountered intra-abdominal issue for general surgeons in their practice is bowel obstruction. The symptoms can range from mild discomfort and abdominal distension to severe sepsis or hypovolemic shock, necessitating immediate intervention. To study various patterns of presentation, various causes, the significance of early recognition, diagnosis, treatment, and outcomes. Methods: Patients exhibiting signs and symptoms of acute obstruction underwent the appropriate surgical procedure after initial resuscitation. During the postoperative period, patients were carefully monitored, and their parameters were recorded hourly or every four hours, depending on their general condition and toxemia. Nasogastric tube aspiration, intravenous fluids, and antibiotics were administered as part of the postoperative care. Any complications that arose were documented and treated accordingly. Results: A total of 40 cases were included in the study. Out of which 30 were males and 10 were females. Resection and anastomosis were performed in 10 cases, encompassing instances of adhesion, stricture, ileocaecal growth, volvulus of the small intestine, and multiple strictures of the jejunum due to a carcinoid tumor. Adhesiolysis was conducted in 4 cases, Anatomical hernia repair was undertaken in 9 cases, with 7 being inguinal hernias (Bassini repair) and 2 being incisional hernias. Untwisting of the sigmoid volvulus was performed in 3 cases, while hemicolectomy was carried out in 4 cases. Conclusion: Intestinal obstruction remains a significant surgical emergency. Late presentation of patients with complications poses a challenging problem for surgeons in terms of management. Patients presenting with symptoms of bowel obstruction require prompt resuscitation and correction of electrolyte imbalances, as these can be severe and life-threatening. The increasing number of abdominal and pelvic surgeries has led to postoperative adhesions becoming the most common cause of intestinal obstruction.

54. Assessing Serum Progesterone with Reference Interval During Three Trimesters of Normal Pregnancy in Indian Females
Priyanka J. Herenz, Indira Kujur, Suman Kumari, Sarita Tirkey
Background: During pregnancy, the hormonal environment becomes a vital predictor for both fetus and mother. To predict feto-maternal outcomes, a specific concentration of hormones measured during each trimester can serve as a reliable predictor. The literature data suggest the reference of progesterone considered normal in females of West may be inapplicable in Indian pregnant females as they have different reproductive profiles. Aim: The present study was conducted to assess the reference range of progesterone assay particular to a trimester in healthy pregnant females of India. Methodology: In 138 healthy pregnant females from all three trimesters of pregnancy were included in the study. Progesterone levels were assessed from the serum of included subjects using ELISA (Enzyme-linked Immunosorbent Assay). Results: The results of the present study have shown a gradual increase in levels of serum progesterone during pregnancy. Conclusion: The present study concludes that a marked difference is seen between the established reference range of progesterone to the values seen in healthy Indian females.

55. Inducible Clindamycin Resistance Among Staphylococcal isolates at A Tertiary Care Centre, Gujarat
Rinku Ramawat, Chaitali S Dabhi, Rupal M Patel
Introduction: The increasing incidence of a variety of infections due to Staphylococcus aureus and other species of genus Staphylococcus, especially, its expanding role of community-associated methicillin -resistant S. aureus (MRSA)—has led to emphasis on the need for safe and effective agents to treat both systemic and localized staphylococcal infections. Clindamycin has been used successfully to treat variety of infections due to MRSA in adults and children. There is a mechanism of macrolide resistance in Staphylococcus spp. which also affects the lincosamide and type B streptogramin characterizing the so-called Macrolide-Lincosamide- type B Streptogramin (MLSB) resistance, whose expression can be constitutive (cMLSB) or inducible (iMLSB) and is encoded mainly by ermA and ermC genes. The cMLSB resistance is easily detected by susceptibility testing used in the laboratory routine, but iMLSB resistance is not. Simple laboratory testing (the erythromycin-clindamycin “D-zone” test) can separate strains that have the genetic potential (i.e., the presence of erm genes) to become resistant during therapy from strains that are fully susceptible to clindamycin. Aim: The study was planned to detect prevalence of iMLSB, cMLSB and MS phenotype resistance of clinical isolates of Staphylococcus aureus and Coagulase Negative Staphylococci (CONS) at tertiary care hospital, Gujarat. Material and Methods: This cross-sectional study was conducted on 105 isolates of Staphylococci from 1stMay 2021to 31st December 2021 at Microbiology section of Central Diagnostic Laboratory using Vitek 2 compact and manual disk diffusion method on Muller Hinton Agar. D test was performed on all the isolates of Staphylococci. Results: Out of 105 tested isolates, 19.05% were D test positive (iMLSB), 9.52% were constitutive phenotypes (cMLSB), 26.66% were D test negative (MS phenotype).The prevalence rate of both (iMLSB) and (cMLSB) was higher in Methicillin resistant isolates compared to Methicillin sensitive isolates. Conclusion: This study revealed recent magnitude of inducible clindamycin phenotype which could be easily missed while performing Kirby–Bauer disk diffusion method.So, it is recommended for clinical microbiology laboratory to routinely perform D‑test in all clinically isolated Staphylococci to prevent treatment failure.

56. Study of Vitamin D Levels in Laboratory Personnel in the Medical College of Northern Telangana
Nandini Kondagadapu, M Shalini
Background: Vitamin D plays a crucial role in maintaining overall health and well-being .Vitamin D studies have shown its deficiency to be a major health problem affecting an estimated one billion individuals globally. Aim and Objectives: To know about Vitamin D levels in laboratory personnel in the medical college of Northern Telangana. Materials and Methods: This was cross-sectional study, conducted on 100 laboratory personnel (70 MLT students and 30 Lab technicians) from Prathima Institute of Medical Sciences, Karimnagar. Study has been conducted in Department of Biochemistry, for the duration of 1year from April 2022 to March 2023. Participants were included after getting their informed consent and ethical approval from the Institutional ethical committee of our Institute, and following inclusion and exclusion criteria. Results: Out of all study participants we have observed 10% of the study participants had deficiency of vitamin-D, 41% had insufficient levels of vitamin D and 49% had sufficient vitamin-D levels. Conclusion: Prevalence of vitamin D deficiency was very less, also deficiency was strongly associated with sun exposure, diet and addiction like smoking or drinking.

57. Metabolic Syndrome a Risk Factor of Nephrolithiasis: A Case Control Study
Anil K.B., M. Nazar
Background: This study was conducted to determine as to whether metabolic syndrome is a risk factor for nephrolithiasis among patients and whether individual components of metabolic syndrome are risk factors for nephrolithiasis. Methods: This was a hospital-based case control study conducted among 238 patients who underwent evaluation for the presence of metabolic syndrome at the Department of Urology, Governmental Medical College Alappuzha, over a period of 18 months after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: A total of 238 patients were enrolled in the study after counselling and informed consent. 119 had ultrasound-proven nephrolithiasis, and the rest of the patients were controls. All were evaluated for components of metabolic syndrome. The average age of patients was 43.45, waist circumference was 95.01, BMI was 22.82, systolic BP was 129.01, diastolic BP was 79.99, FBS was 91.58, HDL was 49.91 and triglycerides was 151.68. Male predominance was noted with 77.3 percent of participants enrolled in the study. Primary outcome: metabolic syndrome as a risk factor for nephrolithiasis is proven with a p-value of 0.008. Secondary outcomes: obesity and dyslipidemia were proven to be independent risk factors with a p-value <0. 001. However hypertension and diabetes mellitus do not independently increase the risk of nephrolithiasis. Conclusion: Metabolic syndrome when present acts as a risk factor for nephrolithiasis and components of the syndrome obesity and dyslipidemia are independent risk factors. Hypertension and diabetes mellitus do not form independent risk factors.

58. Effect of Eustachian Tube Function on Tympanoplasty Outcome
Ankit Kumar Tiwari, Surendra Singh Moupachi, Meenakshi Ambulker, Surbhi
Background: Eustachian tube play a vital role in the pathogenesis of middle ear cleft disease Normal eustachian tube function (ETF) is responsible for successful tympanoplasty outcome. Pre operative eustachian tube function test should be done. Aim & Objective: To evaluate the role of Eustachian tube function in successful graft uptake in tympanoplasty. Method: A prospective study was done on 50 patients, with mucosal type of chronic otitis media (COM). Eustachian tube function (ETF) was assessed with various methods like impedance audiometry (Toynbee’s method), methylene blue dye etc. and correlation of graft uptake with preoperative eustachian tube function was done. Result: Out of 50 patients 78% had normal eustachian tube function and 22% had partially impaired eustachian tube function. Tympanoplasty was successful in 94% patients with normal eustachian tube function and 54% patients with partially impaired eustachian tube function. Conclusion: There is a strong association between eustachian tube function and graft uptake. Thus, proving that eustachian tube plays a major role in the graft uptake. So preoperative eustachian tube function should be done.

59. Temporal Bone Fracture and its Effect on Hearing
Choubey Mishra Surbhi, Moupachi Surendra Singh, Siddiqui Yasmeen, Tiwari Ankit Kumar
Temporal bone fracture is commonly associated with head injury. As temporal bone enclose the organ of hearing, its fracture can beassociated with hearing loss which can deteriorate quality of life. In this study Aim is to access the most common type of temporal bone fracture, its etiology, gender distribution, presentation and to access degree and type of hearing loss in patients with temporal bone fracture. One-year prospective study of head injury patient admitted in the Sanjay Gandhi Hospital, SSMC Rewa was conducted. Examination and HRCT Temporal Bone done. 100 cases of patients with temporal bone fracture were underwent examination and hearing assessment. Type, degree hearing loss, age, gender, cause of injury, clinical presentation, facial nerve palsy, otorrhoea, vestibular symptoms, tinnitus were analysed. In results RTA is most common cause of head injury. majority were male, between 30 -40 yrs of age. Longitudinal fracture is most common and presents commonly with blood in EAC and Moderate degree conductive hearing loss is most common.

60. Effect of Intracuff Paracetamol 1.0% W/V in Prevention of Emergence Coughing and Sore throat
S Renganathan, S.C. Ganesh Prabhu, P. Mageswari, S Indumathi, Arbind Kumar Choudhary
Endotracheal intubation is a common procedure under general anaesthesia, but it can result in a number of airway complications. The study’s main goal is to determine whether intra-Tracheal cuff paracetamol 1.0% w/v reduces moderate to severe emergence coughing in general anaesthesia patients after tracheal extubation and during the post-operative period, as measured by the modified Minogue scale. This study also showed that 1% paracetamol prevents cuff pressure rise. Anaesthesia duration and postoperative tracheo-laryngeal morbidity were also examined. Material and Methods: A prospective, randomised, comparative study was planned on patients undergoing general anaesthesia using entrotracheal intubation in the Department of Anaesthesiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamilnadu. This study comprised 18-65-year-old ASA I and II patients without comorbidities. The study eliminated those who needed 3 or more laryngoscopy or bougie intubation attempts. Result: In this study showed a substantial decrease in sore throat and cough compared to the control group. Intracuff paracetamol also reduces emerging cough and post-procedure sore throat. Conclusion: Intracuff paracetamol lowers post-surgery coughing. Intracuff paracetamol also reduced sore throat sensations overall.

61. Comparative Analysis of Deep Vein Thrombosis Incidence and Risk Factors in Medical and Surgical Intensive Care Unit Patients
Jitendra Agarwal, Ravindra Pratap Singh
Deep vein thrombosis (DVT) is a common and potentially life-threatening complication among patients admitted to the intensive care unit (ICU). This study aimed to compare the incidence of DVT in medical and surgical ICU patients and assess the associated risk factors. Additionally, the study examined the effectiveness of prophylactic measures in reducing DVT occurrence. Materials and Method: A retrospective analysis was conducted on medical records of 500 ICU patients, including 250 medical and 250 surgical patients, admitted between January 2022 and December 2022. The presence of DVT was confirmed through diagnostic imaging techniques such as venous ultrasonography or venography. Results: The overall incidence of DVT among ICU patients was found to be 15% (n=75). Interestingly, the incidence of DVT differed significantly between medical and surgical ICU patients, with 25% (n=62) of medical ICU patients and 5% (n=13) of surgical ICU patients experiencing DVT (p<0.001). Several risk factors were identified in both medical and surgical ICU patients, including advanced age (OR=2.56, 95% CI: 1.63-4.02, p<0.001), prolonged immobilization (OR=3.18, 95% CI: 2.10-4.81, p<0.001), presence of central venous catheter (OR=2.24, 95% CI: 1.49-3.35, p<0.001), and previous history of DVT (OR=1.89, 95% CI: 1.12-3.19, p=0.018). In the surgical ICU subgroup, major surgeries involving the lower extremities showed a higher risk for DVT (OR=2.86, 95% CI: 1.68-4.87, p<0.001). Regarding prophylactic measures, anticoagulant therapy with low-molecular-weight heparin was associated with a significant reduction in DVT incidence (OR=0.36, 95% CI: 0.22-0.60, p<0.001) in both medical and surgical ICU patients. Conclusion: In conclusion, DVT is a prevalent complication in ICU patients, with higher incidence rates observed in medical ICU patients compared to surgical ICU patients. Several risk factors were identified, highlighting the importance of preventive strategies. The use of low-molecular-weight heparin as prophylaxis demonstrated a significant reduction in DVT occurrence. These findings emphasize the need for regular DVT risk assessment and implementation of appropriate prophylactic measures to improve patient outcomes in the ICU setting.

62. Comparative Evaluation of Propofol-Ketamine and Propofol-Fentanyl Combination For minor Surgical Procedures
S. Saiprabha, B. Mohamed Sameer, P. Sivaranjani, G. Balaji
Combining a sedative agent with an analgesic agent for short surgical procedures done under intravenous sedation can offer a lot of advantages especially when short acting agents are chosen. In our study we combined propofol with either ketamine or fentanyl and formed two groups of patients undergoing short surgical procedures with 40 members in each group. Group I received Inj ketamine 0.5 mg/kg over 2 minutes followed by Inj propofol at rate of 1 ml over 3 seconds till the end point of induction. Group II received injection fentanyl 1.5 µg/kg followed by 1 ml propofol till the end point of induction. Parameters assessed include hemodynamics, recovery profile and complications. Data were collected and analysed using appropriate statistical tests. Results: Demographic profile was comparable between the two groups. Pulse rate, systolic blood pressure, respiratory rate were statistically better in Group I(Ketamine) and diastolic blood pressure and saturation were comparable. But clinically the changes were insignificant. Recovery profile was better with Group II. Complications like pain at the site of injection, PONV were more in Group II. Conclusion: Both combinations are clinically effective and comparable with some advantages favouring Ketamine group (Group I).

63. Spectrum of High Vaginal Swab Isolates and Ultrasound for Evaluation of Cervical Factors in Prediction of Preterm Prelabour Rupture of Membrane
Arathy Haridas, Jayanta Ray, Sourish Debbarma, Suparna Sutradhar,Tapan Majumder
Background: PROM can cause significant maternal and fetal morbidity and mortality. PROM is an obstetric enigma and several other risk factors in addition to cervical factors and genital tract infection, have been implicated in its causation. Prediction and prevention of prelabour rupture of membrane would offer the best opportunity to prevent its complications. Objectives: The current study was undertaken to determine the spectrum of high vaginal swab isolates and ultrasound for evaluation of cervical factors in prediction of preterm prelabour rupture of membrane. Materials and Methods: This observational study was conducted in the department of Obstetrics and Gynaecology, AGMC Agartala, Tripura among 230  pregnant women attending the Obstetric OPD, based on certain inclusion and exclusion factors. All patient particulars and risk factors for PPROM like previous history of preterm birth or prelabour rupture of membrane were collected using a preformed questionnaire.  High vaginal swab and USG to know cervical length was done once in each trimester. All patients were followed up to delivery. Associations between high vaginal swab findings and ultrasound findings and PPROM was looked into. Results: The mean (standard deviation) of age of the study population was 25.1 (4.2). History of preterm birth and history of abortion were present in 13.9% and 22.2% of the mothers respectively. The mean gestational age of the study population at PPROM, and at delivery were 29 and 29.6 weeks respectively. PPROM was seen in 6.5% of the study population. Thirty-five (15.2%) of the study population had chorioamnionitis. Neonatal sepsis was seen in 18.3% of the study population. Funnelling of the cervix is seen in 35.2% of the study population. It was present in only a third (30.7%) of mothers with no PPROM, while it was seen in all (100%) of patients with PPROM. The difference in the proportions were statistically significant. The mean cervical length in mothers with PPROM was significantly shorter than in mothers without PPROM. Cervix length less than 25 mm is seen in two-thirds of mothers with PPROM and Cervix length more than 25 mm one third of mothers with PPROM. The difference in the proportions were not statistically significant. Positive HVS are associated with PPROM in 93.3% of cases while a positive HVS was associated with no-PPROM in 89.3% of cases. All the HVS positive patients received conventional treatment as per departmental protocol. The difference between the proportions were not statistically significant. The most common organisms isolated in the no PPROM and PPROM groups were Staphylococcus aureus, (42.2 versus 40%) and E coli (23.9% versus 26.7%) respectively. Conclusion: This study has shown no significant difference in the spectrum of high vaginal swabs in mothers with and without PPROM. Significantly shorter length of cervix and presence of funnelling is seen in patients with PPROM as compared to mothers with no PPROM.

64. Perceived Stress Levels and Relieving Strategies Among Medical Students During Three Waves of COVID Pandemic
Rijul Ranjan, Chhavi K Gupta, Manish Garg
Introduction: The Coronavirus disease (COVID-19) spread globally in March 2020. From the beginning of the pandemic to October 4, 2021, the coronavirus infected 235.08 million people worldwide, and 5,009,716 of whom died. As a consequence,  remote learning or work, as well as limitation of physical activity, forced unexpected changes in daily life routines. The COVID-19 pandemic impacted the mental health of people around the world, including a high prevalence of depression, anxiety, insomnia, posttraumatic stress disorder (PTSD), and psychological distress. Objectives: To Assess the nervousness and anxiety level in medical students. Methodology: The study design was Cross sectional study and qualitative and quantitative type from June 2022- August 2022. The study was planned and conducted among undergraduate medical students of NCRIMS, Meerut. Result: 93% of respondent spent time with their family and friends, 80% of them used social media, 65% listened to music, 62% used sleep, 51% watched web series and shows, 51% do regular exercise, 39% consumed alcohol and smoking, 22% used to dance or do cooking, 21% read books, 20% do yoga and 8% do meditation to relieve their stress. Conclusion: The stress is a vital factor that is responsible for a lot of physical and mental changes in medical students. The way a person deals with stress depends on a lot of factors ranging from personal to environmental.

65. A Prospective Randomised Control Study to Check Best Time to Start Pulmonary Rehabilitation in Intensive Care Unit at a Tertiary Referral Centre
Rajani Sasikumar, Mohamed Foda Hendi, Zeyad Faoor Alrais, Smriti Sasikumar, Alshaimaa Ahmed Elsharkawi, Rohan Singh
Background: PICS is considered as a public health burden because of the accompanying neuro-psychological and functional disabilities. Cognitive impairment is reported anywhere between 25% to three-fourth of the of critical care survivors. Major risk factors associated with cognitive impairment are stroke, acute respiratory distress syndrome, sepsis, trauma, respiratory failure necessitating prolonged ventilator support, or premorbid systemic conditions. However, recently, numerous researchers have recommended initiating an early pulmonary rehabilitation, during the period of hospitalization or soon after discharge.An early pulmonary rehabilitation commenced within three weeks after hospitalization is viable, safe, and efficient. It also improves exercise tolerance, reduces symptoms, and augments quality of life. Objective: To oversee whether with a timely pulmonary rehabilitation patient may be weaned early and discharged from ICU. Methodology: The present randomized controlled trail was conducted by the at Intensive Care unit of Rashid Hospital which is attached to Rashid University from June 2019 to December 2019. This study consecutively enrolled newly admitted adult patients (≥ 18 years old) who were admitted to ICU, Rashid Hospital, to receive mechanical ventilatory support either noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) on the day of study inception. A total of 62 patients were included in the study who were further randomized into 36 subjects in H0 is the cohort like the existing one and 26 subjects in H1 which is the cohort where the plan to start the timed intervention. Results: A total of 23 patients were females accounting for 37% of the patients and the remaining 39 were men accounting for 63% of the patients enrolled in the study. Among the study participants, 44 of them presented with comorbidities accounting for 71% and 18 patients did not report comorbidities, accounting for 29%. Highest number of pulmonary rehabilitations was started on the second day of admission to the ICU. Eleven patients out of the 62 study participants expired in the ICU. Hence, the survival rate was estimated as 82% among the study participants post treatment. No significant difference was seen for weaning days. Conclusion: Although conclusive evidence could not be generated from the study about the association of early rehabilitation with weaning a gap in research till date has been identified. The research shows that early weaning can be attained irrespective of tailored rehabilitation program, in contrary to certain studies which state that early intervention with a pulmonary rehabilitation aid in early weaning.

66. An Autopsy Based Study of Deaths in Women within Seven Years of Marriage brought to Agartala Government Medical College & GBP Hospital, Tripura, India
Suanjan Das, Juthika Debbarma, Jayanta Sankar Chakraborty, Pranab Choudhury
Dowry deaths, a form of violence against women, continue to be a pressing issue in India. This study delves into the incidence, demographic characteristics, socioeconomic factors, circumstances, and causes surrounding these tragic incidents. Through an analysis of 108 cases over a one and a half year period, data were collected from the Mortuary of the Department of Forensic Medicine and Toxicology at Agartala Government Medical College.  The study uncovers compelling insights, revealing that young women aged 18 to 20 are the most vulnerable to dowry deaths witnesses the highest number of fatalities. Notably, the majority of cases arise within the first three years of marriage, primarily within the confines of the husband’s and in-laws’ homes.  Burns emerge as the leading cause of death, followed by hanging, poisoning, road traffic accidents, and physical assault. Shockingly, suicide represents the most prevalent manner of death among the victims. The study also highlights the prevalence of illiteracy and lower socioeconomic status among the affected individuals, with the majority adhering to the Hindu religion.  Addressing this critical issue necessitates a comprehensive approach, encompassing legal measures, educational initiatives, employment opportunities, and awareness programs. Collaborative efforts involving law enforcement agencies, women welfare organizations, public servants, and the judiciary are vital for effecting change.  By curbing alcohol and substance abuse, promoting monogamy, and encouraging honest means of income generation, it is possible to curtail dowry deaths. The findings of this study hold significant implications for policymakers and stakeholders, serving as a clarion call to combat violence against women and foster a safer society for all.

67. An Epidemiological Study of Hanging Cases Brought to the Mortuary of A Teaching Hospital of Tripura
Sutirtha Das Gupta, Pranab Choudhury, Pradipta Narayan Chakraborty, Jayanta Sankar Chakraborty
Background: According to WHO, 800000  people die due to suicide every year and becomes the top three causes of death among males and females aged 15 – 44 years10.  According to the NCRB (National Crime Reports Bureau) report 2009 & 2015, in India, the major correlates of suicide were family problems (23.7%), illness (21%) [including insanity/mental illness (6.7%)], unemployment (1.9%), love affairs (2.9%), drug abuse/addiction (2.3%), failure in examination (1.6%), bankruptcy or sudden change in economic status (2.5%), poverty (2.3%) and dowry dispute (2.3%)12.  Hanging is a common and accessible method of committing suicide. There is an increasing tendency for suicides by hanging in India. The profile of victims in hanging includes married females or unmarried males in the age group of 21-30 years, stressors in the form of unemployment, harassment for dowry, prolonged illness, failure in examinations, financial interpersonal problems¹⁹.  Number of people committing suicide in Tripura in 2015 is 746 (of which number of hanging is 528)12. However, there is scarcity of data regarding the true extent of the problem as well as the epidemiological aspects of hanging in this state of Tripura. In this context, the present study was undertaken to generate an epidemiological database which in turn will help the law enforcing agencies and the concerned NGOs to take steps and create awareness among the vulnerable strata of the population of the state. Methods: This cross-sectional descriptive study was carried out among the  deceased persons autopsied at Agartala Government Medical College & G.B. Pant Hospital having the history & signs of hanging. Study Duration was one and half year (January 2019 – June 2020). Data collection was started after approval of the synopsis by the ethical committee and acceptance by the university. All cases of asphyxial deaths with hanging as cause of death were accepted as inclusion criteria whereas any such dead body which is putrefied was considered as exclusion criteria. All the autopsy cases fulfilling the inclusion and exclusion criteria during the study period were selected. Complete enumeration technique (census) was followed to select the study subjects. Data was statistically analysed. Results: 176 asphyxial deaths with hanging as cause of death was studied for a duration of one and half year. Majority (24.4%) of the study subjects belonged to 31 – 40 years of age group followed by 21 – 30 years and 41 – 50 years (22.7% and 15.3% respectively). Mean age was 38.0 (±16.3) years. 76.1% of the study subjects were male and 23.9% were female. Proportion of married, unmarried, widow/widower and divorced/separated were 72.2%, 18.8%, 9.1% and 0% respectively. Among the females, 47.6% were menstruating at the time of hanging. 54.5% of the study subjects were from rural area while 45.5% of them from urban area. 19.9% of the study subjects were farmer followed by business activity (16.5%) and home maker (14.8 %). majority of the subjects were from middle class family (69.9%) followed by lower middle (23.9%) and upper middle class (4.5%).  Among the victims, previous suicidal attempts were present only in 5.7% cases. In majority cases (21.0%) psychiatric disorders were the main motive for hanging.  Atypical hanging was most common found in the study subjects. 65.3% of the study subjects had complete hanging while 34.7% of cases had partial hanging. In 91.5% cases ligature mark was present above the thyroid cartilage and the mark was interrupted in 79% of cases. Dribbling of saliva was found in 74.4% cases and in 58.0% cases tongue was protruded out. Thyroid cartilage and hyoid bone were found fractured in 2.3% and 1.7% cases respectively. Conclusion: Atypical hanging was most common as per classification of hanging based on position of knot. In most of the cases, ligature mark was prominent and was present above the level of thyroid cartilage. More than half of the cases, the knot were on right side of the neck. Dribbling of saliva from the angle of mouth was observed in majority cases. Thyroid cartilage and hyoid bone were found in most of the cases. Majority of the victims were from young age group. Clothing material was the main ligature material. More than two third of the incidents were happened in indoors. Psychiatric disorders were the main motive for hanging. Majority of the study subjects did not have addiction.

68. Assessing the Incidence, Management, and Prevention Strategies for Sports-Related Orthopedic Injuries
Ravi H Rangareddy, Syed Azher Hussain, Avinash
Background: Sports-related orthopedic injuries are a common concern among athletes and individuals engaged in sports activities. This study aimed to examine the incidence, management approaches, and preventive strategies for such injuries. Methods: A cross-sectional study was conducted involving 385 participants recruited from a sports clinic. Participants, aged 15-45 years, were assessed for orthopedic injuries during their clinic visits. Data on demographic factors, injury characteristics, management approaches, and preventive strategies were collected. Statistical tests, including chi-square and Fisher’s exact tests, were utilized to examine associations between variables. Results: The study population had a sports-related orthopedic injury incidence rate of 18.9%. The most common types of injuries reported were sprains and strains (42.6%), fractures (23.4%), and dislocations (12.8%). Acute trauma during sports activities (56.4%) was the primary mechanism of injury, followed by overuse injuries (33.2%) and accidents during training (10.4%). Medical treatment was the predominant management approach (62.1%), with interventions such as medication, physical therapy, and immobilization. Surgical interventions, including fracture fixation and ligament reconstruction, were performed on 27.8% of participants. Rehabilitation programs were prescribed to 89.6% of participants. Preventive strategies included the use of protective equipment (76.4%), regular strength and conditioning training (51.8%), and education and awareness programs (62.9%). Significant associations were found between demographic factors, injury characteristics, management approaches, and preventive strategies (p < 0.05). Conclusion: This study provides valuable insights into the incidence, management, and prevention of sports-related orthopedic injuries. Findings emphasize the importance of appropriate medical treatment, rehabilitation programs, and preventive measures, such as protective equipment and targeted training. Associations between various factors and injury incidence, management, and prevention were identified. These results can inform evidence-based strategies to reduce the burden of sports-related orthopedic injuries and promote athlete well-being.

69. Assessment of Patient Reported Outcomes and Satisfaction following various Orthopedic Procedures, Such as Joint Replacements, Spinal Surgeries, or Fracture Management
Ravi H Rangareddy
Objective: This study aimed to assess patient-reported outcomes (PROs) and satisfaction following orthopedic procedures, including joint replacements, spinal surgeries, and fracture management. Methods: A total of 208 participants who underwent orthopedic procedures were included. Demographic and clinical characteristics were collected and analyzed using descriptive statistics. PROs were evaluated using validated outcome measures specific to each procedure, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form Health Survey (SF-36). Patient satisfaction ratings were collected using a structured survey. Subgroup analyses and regression analyses were conducted to explore associations between PROs, patient satisfaction, and demographic/clinical factors. Results: The study population had a mean age of 52.3 years, with a relatively balanced gender distribution. Joint replacements were performed in 45.2% of participants, followed by spinal surgeries (32.7%) and fracture management (22.1%). Participants reported significant improvements in PROs following joint replacements, with higher WOMAC and SF-36 scores indicating reduced pain, improved physical function, and better health-related quality of life. Spinal surgery patients demonstrated reduced disability and improved well-being as reflected in lower Oswestry Disability Index (ODI) scores and higher SF-36 scores. Fracture management patients showed improved functionality and quality of life, with higher SF-36 scores and lower Disability of Arm, Shoulder, and Hand (DASH) or Lower Extremity Functional Scale (LEFS) scores. Patient satisfaction ratings were high for all procedures, with joint replacement patients reporting high satisfaction with pain relief and functional improvement, spinal surgery patients reporting high satisfaction with pain management and overall treatment, and fracture management patients expressing high satisfaction with pain management and functional recovery. Subgroup analyses revealed significant differences in PRO scores and patient satisfaction ratings across the procedures, with joint replacements consistently demonstrating the highest scores. Conclusion: Orthopedic procedures, including joint replacements, spinal surgeries, and fracture management, result in significant improvements in PROs and high levels of patient satisfaction. These findings emphasize the effectiveness of these interventions in addressing pain, functional limitations, and overall well-being in patients undergoing orthopedic procedures.

70. Evaluation of the Effect of Iron Sucrose and Ferrous Ascorbate for the Treatment of Anaemia during Pregnancy: A Randomised Controlled Trial
Ritvija Dixit, Adreena Mittal, Parul Singhal, Saborni Dey
Background: Anaemia during pregnancy is a prevalent condition associated with adverse maternal and fetal outcomes. Traditional oral iron supplementation often faces challenges in terms of efficacy, tolerability, and compliance. This study aimed to evaluate the effectiveness of alternative iron formulations, iron sucrose and ferrous ascorbate, in treating anaemia during pregnancy through a randomized controlled trial. Methods: A total of 400 pregnant women with anaemia were randomized into four treatment groups: iron sucrose, ferrous ascorbate, traditional oral iron, and placebo. The primary outcomes assessed were changes in hemoglobin levels and the proportion of participants achieving target hemoglobin levels. Secondary outcomes included adverse effects, pregnancy outcomes, quality of life, compliance rates, and patient satisfaction. Results: Both iron sucrose and ferrous ascorbate demonstrated significant improvements in hemoglobin levels compared to traditional oral iron and placebo (p < 0.001). The proportion of participants achieving target hemoglobin levels was higher in the iron sucrose and ferrous ascorbate groups (p < 0.001). Adverse effects were generally mild, with no significant differences between the treatment groups (p = 0.052). The iron sucrose and ferrous ascorbate groups showed lower incidences of preterm birth and low birth weight (p < 0.05) and higher quality of life scores (p < 0.001). Compliance rates were high across all groups, with the highest satisfaction reported in the iron sucrose and ferrous ascorbate groups (p < 0.001). Conclusion: Iron sucrose and ferrous ascorbate demonstrated superior efficacy in improving hemoglobin levels and achieving target hemoglobin levels compared to traditional oral iron and placebo. These alternative iron formulations also showed favorable safety profiles and positive impacts on pregnancy outcomes, quality of life, compliance, and patient satisfaction. These findings support the consideration of iron sucrose and ferrous ascorbate as potential alternatives for the management of anaemia during pregnancy, providing better options for pregnant women and their offspring.

71.  A Study on Attitude of Undergraduate MBBS Students towards Different Teaching Methods
Mallaiyan Manonmani, Kavitha Meiyappan, Vasanth S
Aim: The study was conducted in order to evaluate the attitude of I year Undergraduate Medical students towards various methods used for teaching in Medicine. Materials and Methods: The first year Medical students of Government Sivagangai Medical College were recruited for the study. A questionnaire prepared with relevant questions, was circulated among the participants, collected back and the results with analyzed using descriptive statistics. Results: Out of 100 students involved in the study, 82 % of the students felt that powerpoint presentations with videos help them to understand the concepts better. About two thirds of the students find it difficult to see the words written on the blackboard.50% of the students felt that there should be small group discussion at the end  of each session. Conclusion:  The study gives an insight into various teaching methodologies based on students’ perspective which will help us to improve our teaching methods in future.

72.  Clinical and Radiological Predictors of Outcome in Tuberculous Meningitis
Bhimaray Katageri, Megha B Amarapur, Mamatarani, Nandini Devru
Tuberculosis (TB) is a disease which has been affecting humanity since archaic ages. Robert Koch demonstrated that tuberculosis was caused by Mycobacterium tuberculosis in 1882. Tuberculous meningitis was first described as a distinct pathological entity in 1836. Materials and Methods: The study was conducted in the Department of Medicine of ESIC Medical College and Hospital & GIMS Medical College, Kalaburagi from May 2022 to February 2023. Results: One subject was diabetic and two were hypertensive. Two patients had underlying renal disease. None had underlying liver disease. Demographical features like sex of the subjects and age groups was not significantly associated with severe disability (P = 0.278, > 0.05; p = 0.156, > 0.05 respectively). Conclusions: Even after complete treatment of TBM, morbidity remains high. Fever, headache, vomiting, altered sensorium are most common symptoms. Convulsion is a less common symptom. Abducens nerve is the most commonly involved cranial nerve.

73. Incidence and the Factors Associated with Megaloblastic Anemia: A Tertiary Care Study
Rehan Saifuddin, Anusha. Inti, Raju Jakkula, G.R. Raveendra Varma, Omkar Eswara Babu Danda, Bhamidipati. Venkatarao
Background: Macrocytic anemia and aberrant erythrocyte formation are two features of the hematological condition known as megaloblastic anemia. The main reasons are deficiencies in folate and vitamin B12. The purpose of this study was to ascertain the prevalence of and investigate risk factors for megaloblastic anemia in a tertiary care setting. The medical records of 100 patients at a tertiary care facility who were diagnosed with megaloblastic anemia were used in a retrospective analysis. The following information was extracted: demographics, comorbidities, food preferences, medication history, and laboratory parameters. Data analysis techniques included descriptive statistics, chi-square testing, and logistic regression. Results: The median age of the study population was 55 years, with a higher frequency of men (60%) than females. Gastrointestinal issues (45%), gastric procedures (25%), diabetes mellitus (20%), and autoimmune conditions (10%) were among the comorbidities. A laboratory investigation showed that 60% of patients had a folate shortage and that 75% of patients had low serum vitamin B12 levels (mean: 150 pg/mL). Megaloblastic anemia had an incidence rate of 10 per 1,000 person-years. Conclusion: The incidence and contributing factors of megaloblastic anemia are discussed in this tertiary care study. Comorbidities, malabsorption disorders, and nutritional deficits all have a big impact on how this condition develops. Early identification and effective management are crucial. To confirm these results and investigate additional risk variables, additional study is required.

74. Correlation between Pterygium and Dry Eye: A Clinical Study
Chandni Karole, Manoj Balke, Anjali Dadu
Purpose: Correlation between pterygium and dry eye: A clinical study. Materials & Methods: 200 patients with unilateral pterygium who attended ophthalmology outpatient department at Nandkumar Singh Chauhan Government Medical College, East Nimar (Madhya Pradesh) during a period of 3 months were included in the study. All selected patient underwent anterior segment & slit lamp examination for tear film break up time, marginal tear meniscus height, Schirmer’s test-1 and 2. Test results were compared in pterygium eye (case) and contralateral normal eye (control) of the same patient. Data was entered in Microsoft Excel and SPSS was used for statistical analysis. Results: Numbers of patient taken for this study were 200 aged 20 to 80yr. Mean ± SD of Schirmer test 1 in cases eye is 20.28 ± 11.41 and in controls eye 24.18 ± 9.69 a Mean ± SD of Schirmer test 2 in cases eye is 14.04 ± 9.21 and in controls eye 17.08 ± 8.73. Tear film break up time =/< 10 seconds found in 56.6% cases eye and 43.4% control eyes, >10 seconds found in 48.8% cases eye and 51.2% control eyes. Marginal tear meniscus height is =/< 0.2 mm found in 144 cases eye and 136 control eyes and it is >0.2 mm found in 56 cases eyes and 64 control eyes. Marginal tear meniscus height, tear film break up time and schirmer tests showed significant relation between grade 2 and 3 pterygium with dry eye. Conclusion: There is a significant correlation between pterygium and dry eye. As pterygium progresses it leads to abnormal tear film and dry eye.

75. Growth Parameters and Growth Hormone Levels in Children with Nephrotic Syndrome
Mallaiyan Manonmani, Kavitha Meiyappan
Aims and Objectives: Nephrotic syndrome is a common renal disorder seen in pediatric population. Proteinuria is the hallmark of this disorder. Corticosteroids form the mainstay of treatment for nephrotic syndrome. Growth retardation is likely in nephrotic syndrome either due to the disease or due to the corticosteroid therapy. So, the present study was undertaken to assess the growth parameters and the growth hormone levels in children with nephrotic syndrome. Methodology: Forty cases of nephritic syndrome and thirty seven age and sex matched controls were included in the study. The growth parameters were measured and serum growth hormone levels were estimated in them by using enzyme linked immunosorbent assay (ELISA). Results: The weight and height of the cases were significantly less when compared to the controls. There was no significant difference in the body mass index (BMI), mid arm circumference and upper segment- lower segment ratio between the two groups. The growth hormone levels were significantly higher among the cases when compared to the controls. After one month of treatment, there was a significant increase in the height and decrease in body mass index of the cases. Conclusion: Our conclusion is that the growth parameters are altered and the serum growth hormone levels are increased in children with nephrotic syndrome.

76. Comparison of Outcome of Locking Plate Fixation and Closed Intra-Medullary Interlocking Nail in the Management of Extra Articular Distal Tibial Fracture in Jharkhand Population
Shashi Kant Suman, Abhishek Guria, Sarani Sagen Dahanga
Background: Tibial fractures delay in reunion and healing due to a lack of vascularity because of the least muscular coverings anteriorly; hence, they are also called as bones of tendons. Management of distal tibial fractures is quite challenging for orthopaedic surgeons. Hence, different techniques are used to treat tibial fractures. Method: Out of 60 patients, 30 were operated on with interlocking mail and 30 with locking plate fixation. Patients were regularly followed up to 1 year post-operatively, assessed clinically and radiologically to rule out any complications, and treated the same. Results: Duration of surgery: 40–60 minutes 21 (70%) ILN groups and 11 (36.6%) plating groups in 61–80 minutes 9 (30%) ILN groups, 11 (36.6%) plating groups and > 80 minutes in 8 (26.6%) plating groups were observed. Weight bearing after surgery in 8–10 weeks, 21 (70%) in the ILN group, 12 (40%) in the plating group, in 11–12 weeks, 9 (30%) in the ILN group, 12 (40%) in the plating group, in 13–14 weeks, 6 (20%) plating groups were observed. Duration of fracture union radiologically 17.9 (± 1.46) in the ILN group and 20.76 (± 1.80) I plating group, t test 62 and p<0.001, post-surgical complications were more or less the same in both groups. Conclusion: In the present pragmatic study it is proved that closed Inter medullary nailing is preferable than plating technique because early union and decreased implant related problems.

77. Knowledge, Attitude and Practices of Parents Regarding Antibiotic use for Upper Respiratory Tract Infections in Children
Jagannadh Karthik Putrevu, Manoj Kumar Mukkala, Chirla Suman, Prakash Chandra Gouda
Upper respiratory tract infections (URTIs) are frequently observed in paediatric populations. Antibiotics are still being prescribed despite the fact that the majority of upper respiratory tract infections (URTIs) are caused by viral pathogens. The utilisation of antibiotics in this context is deemed inappropriate and the superfluous administration of such medications may potentially contribute to or elicit antibiotic resistance. The issue of unwarranted antibiotic utilisation among paediatric populations poses a significant apprehension regarding the emergence of antibiotic resistance within low- and middle-income nations in the process of development. The primary objective of this study is to assess the level of knowledge and attitudes exhibited by parents of paediatric patients with upper respiratory tract infections in relation to the utilisation of antibiotics and their practices in administering antibiotics within a tertiary care hospital situated in Visakhapatnam. The present cross-sectional study was conducted from May 2022 to October 2022, targeting parents with a child under the age of 18 who sought care at the general paediatrics outpatient clinics of the Department of Paediatrics, NRIIMS, located in Visakhapatnam, India.

78. To Study the Efficacy of Glycerol Magnesium Sulphate in Prevention of Superficial Thrombophlebitis
Radheshyam, Nidhi Arun, Md Nezammudin
Background: Thrombophlebitis is vein inflammation associated with blood clot formation. Percutaneous venous Thrombophlebitis is the inflammation of a peripheral vein brought on by irritation to the vessel lining. In patients receiving intravenous therapy, peripheral venous thrombophlebitis is common. Aim: The aim of the study was to study the efficacy of glycerol magnesium sulphate in prevention of superficial thrombophlebitis. Methods: This randomized controlled prospective study was carried out at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, within 2 years. 100 patients were randomly allocated in two groups, group H and group M. Results: In group H, the majority of patients i.e., 32% were 41-50 years, the number of females (60%) was higher as compared to males. In group M, the majority of patients i.e., 42% were 19-30 years, the number of males (64%) was higher as compared to females. PR was highest at 48 hours, SBP at 24 hours, DBP at 36 hours and temperature at 60 hours for both groups. Conclusion: We came to the conclusion that the QPS formulation of topical heparin was superior to the Glycerin Magnesium Sulphate in terms of preventing superficial thrombophlebitis.

79. Complications in Hands’ Dorsum Reconstruction via Groin Flap: A Prospective Study
Prakash Kumar, Sanjay Kumar
Introduction: The utilisation of the groin flap has been a longstanding practise in the field of reconstructive surgery for over four decades. Hand injuries are a prevalent phenomenon that necessitates effective management in order to optimise workforce productivity and alleviate the economic strain on a nation. The objective of this study was to investigate the efficacy of utilising a groin flap for the purpose of wound coverage on the dorsum of the hand. Objective: The objective of this study was to assess the efficacy of the “Groin Flap” technique for the reconstruction of defects on the dorsum of the hand in paediatric patients. Methods: This prospective study was carried out at the Department of Plastic Surgery, Patna Medical College Hospital, Patna, India. A cohort of 25 subjects were selected for the research investigation, employing a systematic sampling approach during the designated study duration. The subjects included patients who were admitted subsequent to experiencing electric burn injuries resulting in hand deformities, and subsequently underwent treatment involving the utilisation of pedicled groin flaps. Results: All paediatric patients who underwent pedicled groin flap surgery demonstrated normal functional outcomes, indicating successful treatment. Moreover, these patients exhibited the ability to independently engage in activities essential for their daily lives. All of the paediatric patients exhibited a favourable aesthetic outcome. Conclusion: The utilisation of the groin flap technique has been determined to be a valuable approach for the preservation and restoration of hand functionality. This method has consistently yielded favourable outcomes, both in terms of functional capabilities and aesthetic appearance, across various cases.

80. Study of Hyponatremia in Patients of Acute Stroke in a Tertiary Care Hospital
Ayaskanta Kar, Prasanna Kumar Rathor, Parsuram Jena, Maheswar Samanta
Background: Hyponatremia is a common electrolyte disorder observed in patients of neurological disorders & commonly is stroke patients, the etiology of which is either due to syndrome of in appropriate Antidiuretic hormone secretion (SIADH) or Cerebral salt wasting syndrome (CSWS). The aim of this study was to evaluate the etiology, incidence of hyponatremia in patients of acute stroke admitted to a tertiary care hospital. Methods: It was a prospective observational study conducted at PRM Medical College & Hospital, Baripada, Mayurbhanj, Odisha, India. 200 patient admitted with acute stroke (<48 hrs of onset) were investigated for hyponatremia (Serum Sodium < 130mmol/L). The data was analysed using chi-square test using SPSS software. Results: Among 200 stroke patients 76 (38%) had hyponatremia with mean serum sodium level of 126.4mmol/L. Out of 76 patients 50 (65.7%) had SIADH & 18 (23.6%) had CSWS & in 08 (10.5%) cases hyponatremia was of unknown etiology. SIADH was present in 36 cases of ischaemic stroke & 14 cases of hemorrhagic stroke & CSWS was detected in 11 patients of ischemic stroke & 07 cases of hemorrhagic stroke. In hemorrhagic stroke patients with hyponatremia, Right putamen hemorrhage was seen in 42.8% patients with SIADH & Right Thalamus hemorrhage in 57% patients with CSWS. In hyponatremic patients with ischaemic stroke, right middle cerebral artery ischaemia was observed in 52.7% cases with SIADH & left middle cerebral artery ischaemia in 63.6% cases with CSWS. The hospital stay of patients with hyponatremic stroke was more than patients with normal serum sodium level. Conclusion: In patients with hyponatremia secondary to stroke, ischaemic stroke is a common entity. SIADH remains a more frequently encountered etiology of hyponatremia in comparison to CSWS in stroke patients. The hospital stay of hyponatremic stroke patients was longer, hence monitoring of serum sodium is essential in hospitalized stroke patients. Close monitoring and prompt diagnosis of cause of hyponatremia is essential as their treatment are completely different.

81. Reverse Sural Flap for Regeneration of the Soft Tissues in the Ankle and Heel
Sanjay Kumar, Prakash Kumar
Introduction: It has never been easy to restore large soft tissue lesions in the ankle and foot. There has been varying success using reverse sural flaps and free flaps for this issue. Without microvascular repair, the reverse peroneal artery flap is an alternative that can be used reliably. Anterior and posterior tibial arteries form deep and reliable connections with the peroneal artery around the talus and ankle joint. When the short saphenous vein and the reverse sural artery were included into the flap, arterial input and venous drainage improved. Materials and Method: Over the course of two years, ten patients with significant heel deformities underwent repair with a reverse peroneal artery flap (pedicled). Final inset given after initial surgery has healed after 18–21 days. These patients were 45 years old on average. Results: All ten flaps displayed full survival, with no signs of even minor necrosis. Two patients reported minor donor site issues that were treated conservatively and resolved. Conclusions: For the purpose of covering significant soft tissue deformities of the heel and sole, RPAF is a very dependable flap. Without vascular microsurgery and without endangering the major vessels in the foot region, large abnormalities can be repaired. If there is prior knowledge of flapping perforators and a free fibula, RPAF is simple to do reliably.

82. Assessment of Nutritional Status and Stress Among Adolescent Girls
Kamala Kanta Mishra, Alok Kumar, Neera Kumari
Background: Adolescence, the transitional period between childhood and adulthood, plays an essential role in human existence. It has been stated that adolescence is a developmental stage characterised by challenges, tensions, and uncertainties that can cause stress and diminish adolescents’ future hopes. Methodology: Out of 170 females aged 10 to 19, 153 volunteered to participate in the study. They were evaluated on a seven-point scale containing 35 items that are divided into five categories: Physiological, Emotional, Social, Examination, and Behavioural Stress. Findings: The results showed that the food habits and dietary patterns of the participants had no effect on their stress levels. In general, meal-skippers had a higher mean stress score than those who did not skip meals. Frequent intake of fast foods in general (F = 2.409*), exam-related stress (F = 2.753*), and behaviour (F = 2.735*) were found to differ significantly among participants who consumed fast foods at various frequencies (Rarely, Monthly, Fortnightly, Weekly, Once in 2 days, and Daily). Non-consumers of fast food had significantly lower stress levels than those who consumed fast food. On average, those who consume fast food once every two days and on a daily basis have greater stress levels. There were also significant differences in the mean stress scores between those who skipped meals and those who did not. Conclusion: There is a need to develop effective strategies for implementing traditional health-promoting yoga programmes in order to promote physical and psychological health and stress management among adolescents, with a particular focus on females.

83. Comparison of Rapid Immuno- Chromatographic Card Test with Elisa in Diagnosis of Dengue Fever at Tertiary Care Centre
N Raghu Prakash Reddy, Satish Kumar Reddy.G, B V.V.V. Tejaswani
Background: As a result of its association with mortality and morbidity, dengue has emerged as a significant public health concern throughout India. It is the most prevalent mosquito-borne viral illness in humans. As a result, early and rapid laboratory diagnosis of dengue is critical.  For the quick detection of dengue, commercially available rapid tests that detect the presence of NS1 antigen and anti-dengue antibodies have been developed. Early dengue diagnosis is the only effective means of controlling disease progression. This study was conducted to compare rapid immune-chromatographic test with ELISA for detection of NS1antigen and IgM in suspected dengue patients. Materials and Methods: From April 2022 to March 2023, a cross-sectional study was conducted in the Department of Microbiology at Kamineni Medical College & Hospital. A total of 175 serum samples from patients suspected of having dengue infection were included in the study. All samples were tested using the rapid ICD test which detects NS1 antigen, IgM and IgG antibodies, as well as the Panbio Dengue Early ELISA, which detects NS1 antigens and the Panbio Dengue IgM Capture ELISA, which identifies IgM antibodies. Results:  The Rapid Dengue Day 1 card Test had a sensitivity and specificity of 93% and 98% for NS1 antigen detection, respectively, and 91% and 100% for IgM Antibody detection, respectively. Conclusion:  Rapid diagnostic assays for the early identification of dengue have a high sensitivity and specificity. Particularly in situations with limited resources, like the periphery health care centre, immunochromatographic testing (ICT) can show to be a very helpful instrument.

84. A Retrospective Study on Comparison of Weekly versus Three Weekly Cisplatin Based Chemotherapy with Concurrent Radiotherapy in Treatment of Oropharyngeal Cancer
Santosh Shubham, Tanmoy Roy, Maria Rose Joseph, Nisha Jha
This retrospective study evaluated the toxicity and loco regional response of cisplatin-based chemotherapy administered in conjunction with radiation therapy for oropharyngeal carcinoma. Group A received 30mg/m2 intravenously every week, while Group B received 100mg/m2 every three weeks for 120 patients with histopathology-confirmed oropharyngeal cancer. Both groups were treated with 66–70 Gy of 2D radiation. Chemotherapy and radiation weekly evaluated acute toxicity. The study found that weekly and triweekly cisplatin-based chemotherapy could be used to treat oropharyngeal cancer. Both groups had comparable rates of acute toxicity. Nevertheless, Group B (tri weekly regimen) demonstrated a higher loco regional response rate than Group A (weekly regimen), indicating treatment efficacy. This study demonstrates that concurrent chemoradiation with weekly or tri weekly cisplatin-based chemotherapy is feasible and well-tolerated for oropharyngeal carcinoma. Greater loco regional response rates and comparable toxicity were observed with the tri weekly regimen. These discoveries facilitate research on the treatment of oropharyngeal cancer.

85. A Study of Incidence and Causes of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in Nalanda Medical College and Hospital, Patna
Pankaj Kumar, Bablu Das
Cholelithiasis is a global phenomenon prevailing more or less all over the world. Among the biliary tract disorders, chronic cholecystitis associated mostly with cholelithiasis is the frequently encountered entity. The treatment for chronic cholecystitis due to gall stone diseases is cholecystectomy. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease but still there is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed and for whom conversion to open surgery is required.

86. A Study on Identifying Risk of Malignancy by Cytopathology Reporting of Peritoneal Fluid Effusion Using Newly Proposed International System for Reporting Serous Fluid Cytology
Saranya Balasubramanian, Roopmala Murugan, Kumudhini Priya Gunasekaran
Introduction: Peritoneal fluid effusion are generally formed in many disease situations and it is quite easy to collect it. Exposing it to analysis will help recognize the etiology of the disease process and thereby help the clinicians to plan the treatment plan correctly. The appliance of The International System for Reporting Serous Fluid Cytology will further make it easy for the clinicians with its simpler terminologies and clear categorization of entities. Materials and Method: All peritoneal effusion samples that were received for a period of past two years in our private laboratory were examined and categorized according to International System for reporting serous fluid cytology. Risk of malignancy (ROM) was also calculated. Results: Among 240 cases, 12 (5%), 209 (87%), 8 (3.5%), 8 (3.5%), and 3 (1%) were reported as ND, NFM, AUS, SFM and MAL respectively. Risk Of Malignancy (ROM) was calculated for the cases collected in this study are 0% for ND, 0.96% for NFM, 37.5% for AUS, 75% for SFM and 100% for MAL. Conclusion: The International System (TIS) for Reporting Serous Fluid Cytopathology is very easy to employ and gives high accuracy with clear diagnostic criteria for each category, hence makes it easy to communicate with the clinicians by employing simple terminologies.

87. A Cadaveric Study of Variations in the Origin and Course of Vertebral Artery
R. Deepa
Arterial variations are constantly very frequently seen in different arteries of the body and they are very significant from surgical and diagnostic point of view. Aim of this study is to find variations in the origin and course of vertebral artery. The vertebral arteries are major arteries of the neck. The vertebral arteries and their major branches, i.e. vertebrobasilar system, essentially supply blood to the upper spinal cord, the brain stem and cerebellum and variable parts of posterior cerebral hemispheres. Many types of variations in the origin and course of vertebral artery were found. The operative indication for surgery in the cervical region include spondylosis, a herniated intervertebral disc, tumor, infection and trauma. So, apart from knowing the clinical associations, the information which is consequential from the gross anatomical dissections of cadavers can be a valuable guide to the doctors for cautious pre-operative preparation in patients with an unusual course of vertebral artery and can help them in avoiding potentially life threatening complications.

88. Histopathological Study of Endometrium in Abnormal Uterine Bleeding
Suryakala Chappa, Dasari Mercy Mrudula, Michael L Anthony, Chowdari Balaji, J Karthikeyan
Background: Abnormal uterine bleeding (AUB) may be defined as a bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause. AUB is the commonest presenting symptom in gynaecology out-patient department which has significant morbidity. Endometrial sampling is a first diagnostic step in AUB, but its interpretation is quite challenging to the pathologist. Methods: This is a hospital based observational study for a period two years in the department of pathology, Andhra medical college from June 2018 to May 2020 with a sample size of 470 cases. Results: A total of 470 cases with a provisional diagnosis of AUB were studied. The present study includes patients in the age range of 16-66 years with mean age of 41.2 years. The maximum incidence of AUB was in peri -menopausal age (41-50years) and the most common presenting symptom was menorrhagia (62.97%). Majority of patient show normal cyclical endometrium (52%) and only few cases show a definite endometrial pathology. Among the organic lesions endometrial hyperplasia was the common finding(12.97%) which was more common in perimenopausal age. Conclusion: Abnormal uterine bleeding (AUB) is the commonest presenting symptom in women attending to gynecology department. Endometrial sampling could be effectively used as diagnostic step in AUB, to evaluate the causes of AUB in different age groups and helpful for the detection of hyperplasias and guides the physician in treatment.

89. Effects of Nitroglycerine and Lignocaine Spray on Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation
Sangeeta Nath
Laryngoscopy and endotracheal intubation are stressful, violating the protective airway reflexes. They lead to a rise in heart rate and blood pressure. This transient rise in blood pressure and heart rate may be detrimental to the patient, mainly with cardiac and neurosurgical disease. There is a need to explore the possibility of obtunding the pressor responses to laryngoscopy and intubation with use of Lignocaine spray or nebulization and using nitroglycerine. Lignocaine can be sprayed onto the airway mucosa to lessen the discomfort of laryngoscopy and endotracheal intubation.
Lignocaine and nitroglycerine spray are the treatments for the hemodynamic responses. Lignocaine can be applied to the skin by spraying or nebulizing it, among other methods. Lignocaine has been sprayed onto the airway mucosa to lessen the discomfort of laryngoscopy and intubation. Lignocaine becomes a fine mist or aerosol when nebulized, allowing it to get deeper into the airway. Hemodynamic responses mainly refer to hypertension, cardiovascular disease, neuronal disease, etc. Nitroglycerine and lignocaine help to mitigate the effect of these health issues, no matter what age. The effect of the disease on the coronary artery can be mitigated through these treatments.

90. Autopsy Study of Suicides in Adult Females in South Bangalore
Tonse SB, Kumar NT, More RM
Suicide is defined as “Death due to an intentional act or acts of the deceased who anticipates his or her resultant death”. Suicidal deaths among women have been increasing in Indian society and various cultural, religious, and social values have a major role to play. In view of the magnitude and frequency of suicidal deaths among females in south Bangalore and its impact on society, the present study was undertaken. Most of the victims in our study were married and belonged to the age group of 21-30 years. Majority of the women belonged to the lower middle socio-economic class. The highest number of decedents committed suicide due to distress as a result of suffering from chronic illnesses followed by domestic abuse or dowry-related abuse. The preferred method was hanging followed by ingestion of a poison.

91. Evaluation of HER2 Expression and Clinico-pathological Parameters in Gastric Adenocarcinoma: An Observational Study
Meghana Akula, Shailaja Koppula
Introduction: Gastric cancer remains the third most prevalent cancer-related death worldwide. Over expression of the human epidermal growth factor-2 (HER2) is linked to poor prognosis and therapeutic responsiveness. For patients with advanced gastric and gastroesophageal junction cancer that is HER2-positive, the combination of chemotherapy and the anti-HER2 monoclonal antibody Tratuzumab is now recommended. The present study was designed to assess the HER2 over expression in the cases with gastric adenocarcinoma. Materials and Methods: Forty-eight cases diagnosed histopathologically as adenocarcinoma of gastroesophageal junction and stomachabove 18 years of age. Specimens were undergone histopathological examination and assessed adenocarcinomas according to WHO classification and specimens were allowed for immunohistochemistry. Results: Tumors at pyloric canal (37.5%) were frequent and tubular adenocarcinoma (58.33%) was frequently observed tumor type. Out of 18 participants undergone immune histochemistry showed grade 0 and 1+ in 3 cases (44%), grade 2+ was observed in 3 cases (17%) and grade 3+ was seen in 7 cases (39%). Conclusion: HER2 overexpression was found in seven cases. Greater knowledge of HER2 expression in gastric cancer may influence new treatment modalities and improve staging techniques.

92. Study of Prevalence and Clinical Profile of Rifampicin Resistant Pulmonary Tuberculosis among Retreatment Patients by Expert MTB/RIF Technique
Vrunda Pethani, Suman Shil, Amit Dave, Swati Malani
Background: Multidrug-resistant tuberculosis (MDR-TB) is tuberculosis due to organisms which show resistance to both isoniazid and rifampicin, with or without resistance to other anti-TB drugs. Multidrug-resistant tuberculosis is  more common in patients who have previously been treated for tuberculosis  and public health efforts have typically focused on high-quality treatment of drug-susceptible tuberculosis to prevent acquisition of resistance while on therapy. Objective: To determine prevalence of MDR-TB (multidrug resistant tuberculosis) among sputum positive retreatment patients by CBNAAT (cartridge based nucleic acid amplification testing) method and to determine clinical profile of aforesaid patients. Methodology: A prospective observational study was carried out at a tertiary care hospital in Ahmedabad from June 2016 to Feb 2018. All sputum positive pulmonary TB patients on retreatment were included and isolated extrapulmonary tuberculosis patients on retreatment were excluded. According to the NTEP (National TB Elimination Program) guidelines, their sputa were subjected to CBNAAT testing. The testing was done in Microbiology laboratory at AMC MET Medical College, Ahmedabad. Results thus obtained were analyzed. Result: Out of total 1368 patients included in the study; the prevalence of MDR-TB patients was 13.8%(n=189). The mean age of patients in this study is 45.52 ± 7.38 yrs. MDR-TB was common in males (n= 130, 69%) than females (n=59, 31%). Mean body mass index (BMI) in the study is 19.98 kg/m2 and median BMI is 20.02kg/m2. Prevalence of MDR-TB is higher amongst lower socioeconomic status (n=100,53%). Risk factors to developing MDR-TB are diabetes mellitus (n=27, 14%), seropositivity (n=8,4%) and addiction (n=141, 75%) to smoking or alcohol or tobacco. Defaulter cases(n=101,53%) followed by relapsed cases(n=53,28%) and treatment failure cases(n=35,19%) suggested additional risk to develop MDR-TB. Chest x-ray findings and sputum grading suggested high infectivity amongst far advanced lung involvement(n=86,45%) and 3+ grading (n=67,35%) patients. Conclusion: From our study we would like to be conclude that Molecular techniques have revolutionized the diagnosis of MDR-TB. In our study out of total 1368 patients, 189 had MDR-TB   diagnosed through sputum CBNAAT. Males were more affected than females. Lower socioeconomic status, undernutrition, middle-aged, diabetics, HIV infected, alcoholics, smokers, tobacco addicts pose additional risk to develop MDR-TB. High infectivity was seen amongst far advanced lung lesions and 3+ sputum grading as per NTEP guidelines.

93. Estimation of Normal Values of Evans Index using Computerized Tomography of Brain in South Kerala Population
Jesin Elsa Jose, Manju Madhavan C., Girijakumari K
Introduction: Knowledge of the morphometry of the lateral ventricles of brain is important for the diagnosis of various conditions with ventriculomegaly. Evans index is the ratio of the maximum width of the anterior horn of the lateral ventricle to the maximum transverse diameter of the inner table of the skull. A clear understanding of the normal values of Evans index and variations of the ventricular system of brain is useful for clinicians, radiologists and neurosurgeons in their daily clinical practice. The present study was conducted to determine the normal values of Evans index using Computerized tomography of brain in South Kerala population. Materials and Methods: The study was jointly conducted by the Department of Anatomy and the Department of Radiodiagnosis, Government Medical College, Thiruvananthapuram. A total of two hundred CT brain of individuals above ten years of age, were taken. Hundred males and hundred females were included in the study group. The measurements taken for calculating Evans index were Total anterior horn width (TAHW) and Maximum intracranial diameter (MICD). Results: The mean Evans index in the study was found to be 0.258±0.05 in males, 0.255±0.03 in females and an overall mean of 0.256±0.04 was calculated. Conclusion: The present study shows that the mean Evans index in South Kerala population was in accordance with other studies, with a mean value of less than 0.3 in both males and females of all age groups. However, Evans index was found to be increasing in individuals who were above 60 years in both males and females when compared to the younger age groups.

94. Universal Safe Precaution Practices by Nurses in General Medicine Ward of Tripura Medical College
Manojit Debnath, Nirmalya Saha, Chinmoy Biswas
The health care related infections which are considered as major burden for patients and may cause life-threatening infections. An infection control programme may restrict the spread of infections in the hospital and health care setting this may be achieved by precautions and preventive measures. Health Care Workers (HCWs), including nurses are directly involved in patient care and are, therefore, more prone to acquiring these infections from patients directly or indirectly. The Universal Precautions (UPCs) can protect health care workers from various kinds of occupational blood exposure (OBE), hospital acquired infections (HAP).So, the present study was aimed to evaluate nurses’ knowledge on Universal Precautions (UPCs) and to evaluate the practices on Universal Precautions (UPCs) by the nurses of general medicine ward of Tripura Medical College & Dr. B.R.A.M. Teaching Hospital, Agartala, West Tripura. Knowledge and practice of hand hygiene was observed among 96.6% of the nurses.63.4% of the nurses always used personal protective equipments. Among the personal protective equipments, majority of the nurses were practicing wearing of gowns & aprons and gloves (83.3% and 76.6% respectively).73.3% of the nurses had not experienced of any needle stick/sharp injury in last 6 months which suggested a good UPCs practices in the ward. It was concluded that, the nurses in the general medicine ward had optimum knowledge on UPCs and they were practicing the Standard UPCs practices in the ward to improve the quality care of the patients and thus to improve the outcome of diseases in the ward.

95. Study of Testosterone Levels in Coronary Artery Disease with Poorly Controlled Diabetes Mellitus in Males
Pradnya Phalak, Abhijit Pratap
Introduction: Coronary artery disease including myocardial infarction is a growing pandemic worldwide and is an important cause of morbidity and mortality. Millions of lives are lost to coronary artery disease every year and is a significant medical problem. The disease is multifactorial, and an important risk factor is diabetes mellitus and patients having poor glycemic control. Testosterone is a steroid hormone which also has cardio metabolic benefits apart for reproductive functions. It is believed to cause vasodilatation of coronary vessels and thus protects or is beneficial against coronary artery diseases. Low testosterone is seen both in diabetes mellitus and as we age from adulthood to elderly. The study aims to compare the testosterone levels between diabetes mellitus patients and non-diabetes mellitus patients who have been diagnosed or suffered from acute coronary syndrome. Materials and Method: A total of 50 patients were included in the study, patients’ sample was tested for total testosterone, fasting blood sugar levels, glycated hemoglobin levels (HbA1c) and BMI was measured. Results: 42 out of 50 were diabetic and having a mean age of around 63 years. Testosterone levels were low in diabetic patients as compared to non-diabetic, which was statistically significant and the decrease in testosterone levels were proportional to the increase in fasting blood sugar and HbA1c levels, which was also significant however the relationship could not be statistically assessed due to insufficient data.  Discussion: All cases of acute coronary syndrome are associated with low testosterone levels. This finding is supported by numerous studies which highlight the cardiometabolic role of testosterone. Poorer the glycemic control as shown by increasing HbA1c levels lower the serum testosterone levels, which was a novel finding requiring further studies in this area.

96. Retrospective Study in Eastern Odisha: The Most Common Site of Gastro-Intestinal Perforation
Parikshita Dalai, Jyotirmaya Nayak, Chandan Das, Jayashree Mallick
Introduction: Every time an abdominal incision is made on a patient, there is a risk of gastrointestinal perforation. The origin of the illness varies depending on where it is found. The purpose of this research is to identify the most prevalent GI perforation sites, together with their associated morbidity, mortality, and clinical aspects, in a tertiary care hospital in Cuttack, Orissa (SCB Medical College and Hospital Cuttack, Odisha).
Type: retrospective observational study. Time period of study: October 2021-October2011. Place of study: Department of General Surgery S.C.B. medical college & Hospital, Cuttack. Sample size: Convenient sample.
Materials of Study:
Inclusion: All patients with features of rigidity and guarding with pain abdomen and confirming as a gas under diaphragm in x-ray chest are included/Ultrasound findings of bowel perforation. Exclusion: All other cases which excludes all above mentioned clinical and diagnostic features. Aims and Objective: These patients were assessed with respect to clinical presentations, causes, site of perforation, surgical management, postoperative complications and mortality if any. Following resuscitative measures, all patients with peritonitis underwent emergency exploratory laparotomy, where the cause of perforation was explored and controlled. Conclusion: Early recognition, prompt intervention might lead to better outcomes and curtail mortality and morbidity associated with this disease. In the present study, most common site of perforation is noted.

97. Umbilical Cord Blood Serum Albumin as an Early Predictor of Neonatal Hyperbilirubinemia in Healthy Full-Term Newborns
Bhadra Singh B, Saluvendri Chandrakanth Reddy, Tummala Shilpa Reddy
Introduction: Neonatal hyperbilirubinemia is one of the most significant factors in early neonatal re-admissions. In a growing nation like India, socioeconomic issues are one of the most frequent causes of early discharge and less readmissions. Cord blood serum albumin, and cord blood serum bilirubin, are essential in predicting neonatal hyperbilirubinemia. The present study was aimed to assess the cord blood serum albumin in the prediction of neonatal hyperbilirubinemia at tertiary care hospital, Sangareddy. Material and Methods: A source of 120 full term healthy neonates with more than 2.5 kg birth weight and APGAR score above 7/10 at 1 minute were included. A two ml of cord blood was collected from the maternal side umbilical cord. The blood sample was utilized to analyse the total serum bilirubin and serum albumin. Results: The levels of serum albumin were ≤2.8 g/dl in 45.83%, 2.9-3.33 g/dl in 33.33% and ≥3.4 g/dl in 20.83%. The diagnostic prediction of albumin levels in related to neonatal hyperbilirubinemia showed sensitivity, specificity, positive predictive value and negative predictive values for serum albumin level ≤2.8 g/dl was 93.1%, 88.8%, 59.7% and 98.5%, for 2.9-3.3 g/dl was 7.5%, 58.2%, 3.8% and 80.4% and for >3.3 g/dl was 0%, 61.2%, 0% and 81.8% respectively. Conclusion: There was a significant correlation between healthy full-term infants with hyperbilirubinemia with low levels of cord blood serum albumin (2.8g/dl). Cord blood serum albumin is a sensitive marker for the diagnosis of neonatal hyperbilirubinemia.

98. Histopathological Study of Neoplastic and Non-Neoplastic Lesions in Colorectal Region
B. Victor Paul, B.P. Prasanna, Sunil Kumar Didgi, G. Sudhakar
Aims and Objectives: To study various non-neoplastic and neoplastic colorectal lesions to assess the age and sex distribution. To determine the various histological variants and to provide a diagnosis and comment on various colorectal lesions wherever possible by histopathological examination for a period of two years in a tertiary care hospital. Methods: This retrospective and prospective clinicopathological study of was conducted in a tertiary care hospital. The material for the study was resected and biopsied specimen of colorectal lesions including tumors and tumor-like lesions received for a period of 2 years. Paraffin sections are stained using Haematoxylin and Eosin stains. Special Stains and immunohistochemistry did wherever necessary. Results: In the present study among 70 colorectal biopsies 34 cases were Non neoplastic and 30 cases were malignant, 6 cases were benign neoplasms. Majority of cases seen in 11-40 years and 81-90 years age groups with slight male predilection. Chronic diarrhea or bleeding per rectum is chief complaint along with other symptoms. On histopathological examination 25 cases of chronic colitis were noticed in non-neoplastic group.30 cases of adenocarcinoma were seen among malignant lesions. Conclusion: Among all colorectal lesions colorectal cancer is associated with poor prognosis. Early diagnosis prevents the progress of disease when removed endoscopically. Pathological diagnosis is very important and comprehensive pathology report should include TNM staging, histological typing of tumour, grade, extent of invasion and metastasis plays vital role in patient care and the assessment of prognosis.

99. Study on Ocular Manifestation in COVID-19 Patients Admitted at Tertiary Care Centre
Simmy Prajapati, Crazy Bhanderi, Radha I. Dass
Background and Aim: There were several reports of eye redness and irritation in COVID-19 patients, suggesting that conjunctivitis is an ocular manifestation of SARS-CoV-2 infection. Reports continue to emerge on further associations of COVID-19 with uveitic, retinovascular, and neuro-ophthalmic disease. The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. With the accumulating evidence of ocular manifestations of the 2019 novel coronavirus disease (COVID-19), the study aimed to systematically summarize the ocular manifestations in COVID-19 patients. Material and Methods: This study was carried out in 60 patients who were admitted for treatment of covid 19 infections at COVID building at GG Government Hospital, Jamnagar. A thorough history is regarding the onset, duration, and characteristics of symptoms. Measurement of visual acuity, Visual acuity was recorded as 6 MFC, 5MFC. 1MFC or close to face finger counting, depending on distance (in meters) at which the patient is able to count fingers. The patient symptoms, ocular manifestations, chest computed tomographic scans, MRI in case of mucor and results of blood tests and reverse transcriptase–polymerase chain reaction (RT-PCR) from nasopharyngeal for SARS-CoV-2 were noted and analyzed. Results: Maximum numbers of the patients are of 51-60 year age group. Out of 60 patients 36 were male (60%) and 24 were female (40%). In our study we found redness as most common presenting symptoms, in 52 patients (87%). Second most common presenting symptom was watering in 30 patients (50%). Keratitis was present in 24 patients (40%), ptosis in 18 patients(30%), proptosis in 15 patients (25%) and ophthalmoplegia in 21 patients(35%). Out of 60 patients 34 (56.66%) patients develop retinal findings. Cotton wool spots and retinal hemorrhages were present in more in males compared to females. Conclusion: Conjunctivitis and lid edema are most common ocular maifestaion of COVID-19.Mucor mycosis was present in patients with known case of diabetes and recently diagnosed with diabetes secondary to judicious use of systemic corticosteroids.

100. Study to Evaluate the Efficacy and Safety of Intracameral, Combination of Tropicamide, Phenylephrine and Lidocaine Injection for Mydriasis and Anaesthesia in Cataract Surgery
Crazy Bhanderi, Simmy Prajapati, Devdatt J Gohel
Background and Aim: Cataract is the leading cause of blindness in India while refraction error and glaucoma are the second and third leading causes of blindness respectively in India. This study was performed to define clinically the effectiveness of direct injection of intra-cameral, a commercially available drug having combination of tropicamide, phenylephrine and lidocaine as for the maintenance of mydriasis and anaesthesia during cataract extraction and its possible side-effects. Material and Methods: This Interventional Study was conducted on 25 patients including indoor patient for cataract surgery. The visual acuity testing was done on Snellens charts of both eyes and if it was <6/60 then vision was tested with finger counting, hand movements, perception of light and perception of rays. After all this pre-operative evaluation; The drug, which is using in this study, contains two synthetic mydriatics (tropicamide and phenylephrine) and one local anaesthetic (lidocaine) active substances. It will be administered by injection into the eye at the beginning of cataract surgery, in order to enlarge the pupil of your eye (mydriasis) and to obtain anaesthesia in eye during the surgical procedure. Results: Maximum patients were in age group of 61-65 years with mean age 64 year. Method of drug given was different in total 25 patients as 1st method –drug was given directly IC 0.2 ml without TM in 5(20%) patients, 2nd method – drug was given IC injecting 1 ml In 500 ml USOL pint with preoperative dilatation by TMin 10 (40%) patients and 3rd method-drug was given directly IC 0.2 ml with preoperative dilatation by TM in 10 (40%) patients. On comparison, dilation of pupil by all methods was as follows: in method 1) out of 5 patients, 1(20%) patient was maintaining dilatation and 4(80%) patients were failed. In method 2] – 8(80%) patient was maintain and other 2(20%) patients were not and in method 3) – maintain by 7(70%) patients and 3(30%) were failed to maintain. Conclusion: Commercially available combination of tropicamide, phenylephrine and lidocaine intracameral drug is reduces the intraoperative pupil constriction when it was used along with pre operatively topical mydriatics. It is safe and effective way to achieve an adequate pupil size in order to carry out the cataract procedure.

101. Comparison between Bougies and Balloon Dilatation via Endoscopic Treatment for Oesophageal Stricture
Toral Darshak Mehta, Jignasha Prajapati, Ushadevi Ahirwar, Jahanvika Chauhan, Jaymin Contractor, Farida Wadia
Introduction: This study compares the result of endoscopic treatment of Oesophageal Strictures with bougies vs. balloon. Method: Patients having oesophageal stricture, suffering from dysphagia were undergone endoscopic treatment with either rigid bougies and/or balloon dilators. The results are reviewed and analysed. Result: Out of 25 patients, 8 patients became symptom free (dysphagia score 1,2) within 12 months of treatment. In 9 patients the outcome was moderate with occasional mild dysphagia (dysphagia score 3,4) with diet. There were 4 failures (dysphagia score 5,6). As a palliative treatment, stents were inserted in 3 of them with inoperable malignant strictures. Conclusion: It is concluded that dilatation with bougies and balloon is a safe and effective treatment for benign oesophageal stricture and should be utilized first for most strictures. Both balloon and bougie dilatation were effective in relieving dysphagia caused by benign strictures. Balloon dilatation were found to have low recurrence rate, required fewer procedures to achieve adequate luminal diameter and better patient tolerance compared to Bougie dilatation.

102. Comparison of TSH, Free T3 and Free T4 between different Equipments and its Clinical Implication
Toral Darshak Mehta, Sarita Patel, Neelam Karbhari, Ashish Agravat
Introduction: All major thyroid disorders are chronic, requiring laboratory evaluations for years together. Laboratory reports are likely to be obtained from various laboratories. Unless results are comparative across laboratories, clinician is faced with dilemma as to weather the serial change in reports represent change in clinical condition or not. Method: Serum samples were analyzed in Beckman Coulter Dxi600 and Vitros 3600 for TSH (n=33), Free T4 (n=35) and Free T3 (n=36). Results were analyzed by linear regression and Bland Altman Plot. Results: Linear regression plots found slop=1.07 and intercept=-0.11 for TSH, slope=2.07 and intercept=-0.51 for Free T4 , slope=0.71 and intercept=-0.93 for free T3. Conclusion: Although TSH results between Beckman Coulter Dxi600 and Vitros 3600 are comparable, there is lack of comparability among these equipments for Free T4 and Free T3 results. Clinicians evaluating serial Free T4 and Free T3 results in a patient must take in to consideration such variation while making clinical decision on treatment strategy.

103. A Retrospective Study was Conducted to Evaluate the Long-Term Effects of 177-Lutetium Labelled Somatostatin Analogues on Toxicity, Treatment Response, and Survival Outcomes in Patients Diagnosed with Progressive Neuroendocrine Tumors
Vivek Mathew James, Vikram R Lele, P Sai Sradha Patro, Rosenara Beegum T
Background: Peptide receptor radionuclide therapy (PRRT) has obtained approval in the United States for the therapeutic management of gastroenteropancreatic neuroendocrine tumours (NETs). However, there is a paucity of available data regarding the outcomes of PRRT specifically within populations residing in the United States. The objective of this study was to perform a comprehensive analysis of survival rates, toxicity patterns, and therapeutic response in patients who have received a minimum of three cycles of peptide receptor radionuclide therapy at a Tertiary Care centre located in Mumbai. Methods: A retrospective and prospective study was conducted over a one-year duration, focusing on a cohort of 87 individuals who underwent three or more cycles of 177Lu DOTATATE therapy (PRRT). The study encompassed data from the centre between 2008 and May 2016 (retrospectively), as well as data collected from June 2016 to June 2017 (prospectively). Results: Among the entire cohort of 87 individuals, 52.9% of the patients exhibited disease stabilisation. 20.7% of the patients exhibited a partial response to the therapeutic intervention.14.9% incidence of disease progression was observed among the patient population. Overall median survival was determined to be 45 months, and median survival from the date of the first cycle of therapy was 27.5 months. According to the results of our analysis, no significant haematological toxicity was observed. Conclusion: Our study showed that PRRT is overall well tolerated with most recipients experiencing only mild to moderate toxicity if the necessary precautions are undertaken. It should be considered earlier in the course of metastatic disease (in combination with other treatment options) and not as the modality of last resort.

104. Role of Ultrasonography and MRI in the Evaluation of Adnexal Masses in Women of Reproductive Age Groups with Histopathological Examination Correlation: A Hospital Based Cross Sectional Study in Barpeta
Devika K.R., Madhurjya Kumar Thakur, Sangita Mahela, Bharat Talukdar
The prevalence of adnexal mass lesions is 0.17 percent to 5.9 percent in asymptomatic women and 7.1% to 12 percent in symptomatic women of all ages. Differentiating between adnexal structures is a difficult and complex task. Recognising the severity of the problem, the objective is timely and appropriate evaluation and treatment with a positive outcome. The duration of the research was twelve months, from September 1, 2020, to August 31, 2021. Before beginning the investigation, written and informed consent was obtained from the participants. A hospital-based cross-sectional investigation was conducted on 50 patients referred to the Department of Radiology by the Department of Gynaecology at Fakhruddin Ali Ahmed Medical College and Hospital over a 12-month period.

105. Effect of Addition of Nebulized MgSO4 to Treatment of Acute Severe Asthma in Children
Aparna Kadambari, Rajesh Singh, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Background: Asthma is the most common chronic respiratory disorder in children that poses a life-threatening risk. The lower airway may suddenly tighten and swell when exposed to stimuli. The well-known bronchodilator salbutamol, which is inhaled, is typically used as the first line of treatment to ease bronchospasm. The purpose of this study is to compare the results of giving children with acute, severe asthma nebulized magnesium sulphate in addition to the conventional treatment. Method: The study was undertaken at the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from November 2022 to April 2023. The first step in treating acute, severe asthma in children aged 1 to 12 years old involved nebulizing salbutamol three times and ipratropium once. Additionally, intravenous steroids were provided to each patient. The patients who did not respond to this therapy and were still categorized as having acute severe asthma were randomly split into two groups, each consisting of 19 individuals. While each patient in Group B received 2.5 ml of isotonic saline through nebulizer, Group A patients received 2.5 ml (150 mg) of isotonic magnesium sulphate via nebulizer, three times 20 minutes apart. Salbutamol was also included in each nebulization. At the beginning of treatment, after 30 minutes, and after 60 minutes of treatment, the Yung Asthma Severity Score (ASS) was calculated. Results: Children in group A had a mean Asthma Severity Score of 6.95± 1.29 after 60 minutes, while group B had a mean Asthma Severity Score of 7.63± 1.03 (p <0.05). In group A, 10 (52.63%) children were admitted to the hospital and 9 (47.40%) children were discharged. In group B, 15 children (78.95%) were admitted to the hospital, compared to 4 (21.05%) who were discharged (p< 0.05). Conclusion: It has been determined that in children with acute severe asthma, nebulized magnesium sulphate in addition to salbutamol can produce better results than salbutamol alone.

106. Effects of Intravenous Ondansetron and Granisetron on Hemodynamic Changes and Motor and Sensory Blockade Induced by Spinal Anesthesia in Parturients Undergoing Cesarean Section
Krishna Kumar, Prerna
Background: For caesarean section mothers, spinal anaesthesia provides several benefits, although hypotension is thought to be the most common consequence and can be treated with a variety of methods. Giving a serotonin receptor antagonist before spinal anaesthesia is one of these therapies. The study objectives are to investigate the effects of two serotonin receptor antagonists on the hemodynamics, sensory, and motor blockade brought on by intrathecal bupivacaine in caesarean section patients. Methods: Twenty pregnant women in each group, with an ASA I-II physical state, underwent elective caesarean sections while receiving intrathecal bupivacaine spinal anaesthesia. Five minutes before spinal anaesthesia, group O was given an intravenous dose of 4 mg ondansetron diluted in 10 ml of normal saline, administered over a one-minute period. Group G was given the same dose of 1 mg granisetron, while group S received 10 ml of normal saline. We measured the average arterial blood pressure, heart rate, usage of vasopressors, sensory, and motor blockage. Results: While there was considerably faster sensory recovery in group G than groups O and S (P <0.05), decreases in mean arterial pressure were significantly smaller in group O than groups G and S with reduced vasopressor use. Actually, groups O and G experienced significantly lower rates of nausea than group S (P = 0.008). Conclusion: In parturient females undergoing elective caesarean section, intravenous 4 mg of ondansetron given before subarachnoid block significantly reduced both the hypotension and the doses of vasopressor used, whereas intravenous 1 mg of granisetron given before subarachnoid block induced a faster rate of sensory recovery compared to both the ondansetron and the saline groups, with no significant differences between the latter two groups.

107. A Comparative Study of the Efficacy and Safety of Rosuvastatin versus Atorvastatin in Patients of Type 2 Diabetes Mellitus with Dyslipidemia
Pant Suresh Keshava, Hirendra Kumar, Dinesh Kumar
Background: Cardiovascular disease (CVD), which is strongly connected with diabetes dyslipidemia, is responsible for over 80% of deaths in diabetic individuals. When treating dyslipidemia with elevated LDL-C, statins are the preferred medication. In order to inform current care methods for type 2 diabetes mellitus in the Indian population, this study analyzes the efficacy and safety of rosuvastatin to the widely used atorvastatin in patients with dyslipidemia. Methods: The study was a single blinded study conducted in JNKTMCH, Madhepura, Bihar from November 2022 to April 2023. Patients who met the requirements for participation were divided into two groups randomly. Atorvastatin (10 mg) was given to group I, and rosuvastatin (5 mg) was given to group II, orally each night before bed. On weeks 0, 6, and 12, serum TC, LDL-C, HDL-C, and TG levels were measured. Results: At the end of the 12-week period, the atorvastatin group’s percentage reduction in LDL-C levels was 33.58%, whereas the rosuvastatin group’s percentage reduction was 43.12%. Total cholesterol (TC) decreased by 24.85% in the atorvastatin group and by 30.8% in the rosuvastatin group. The increase in HDL-C levels was 7.1% in the atorvastatin group and 11.16% in the rosuvastatin group. These variations were statistically significant in all cases. Between the two groups, there was no discernible difference in the reduction of TG levels. Conclusions: When compared to atorvastatin 10mg therapy, rosuvastatin 5mg induces higher reductions in LDL-C and TC, equivalent reductions in TG, and a greater rise in HDL-C.

108. Comparison of the Clinical Efficacy and Safety of Ramosetron and Ondansetron for the Treatment of Postoperative Nausea and Vomiting in Patients Undergoing Spinal Anesthesia
Hirendra Kumar, Pant Suresh Keshava, Dinesh Kumar
Background: The most prevalent distressing symptom in the postoperative phase is nausea and vomiting. In order to prevent Post-Operative Nausea and Vomiting (PONV) following spinal surgery under spinal anesthesia, this study was conducted to assess the clinical efficacy and safety of prophylactic use of intravenous Ramosetron 0.3 mg with intravenous Ondansetron 4 mg. It also sought to ascertain the frequency of adverse effects with Ramosetron and Ondansetron. Methods: In this open-label, randomized research, 80 ASA I-II patients (aged 18 to 60) received intravenous Ramosetron 0.3 mg or Ondansetron 4 mg (n = 40 of each) just prior to the onset of anesthesia. Postoperatively, the incidences of nausea, vomiting, and retching were recorded, and safety evaluations were carried out at 0, 2, 6, and 48 hours following surgery. Results: Ramosetron had a complete response rate of 80% (32/40) while Ondansetron had a rate of 37.5% (15/40) (P 0.001). In the 48 hours following surgery, there were substantially fewer patients (5%) who needed rescue antiemetics when taking Ramosetron compared to the Ondansetron group (15%) (P<0.05). The incidence of side effects did not significantly differ between the two groups. Conclusion: In patients undergoing surgery under spinal anesthesia, ramosetron (0.3mg) prevented PONV better than ondansetron (4mg).

109. Study of Clinical Profile and Obstetric Outcomes among the Pregnant Women with Uterine Fibroids in Tertiary Care Hospital
Swarnim Swati, Minakshi Bajpayee, Abha Rani Sinha
Background: Fibroids are the most prevalent benign tumours; they depend on oestrogen and are uncommon before menarche and after menopause. Fibroids can unintentionally discovered during clinical examinations or imaging tests. Pelvic pain, dysmenorrhea, AUB, dyspareunia, and pressure feelings are some of the patients’ current complaints. Uterine or extrauterine fibroids are also possible. The purpose of this study is to identify the clinical characteristics and obstetric results in pregnant women with uterine fibroids. Methods: From November 2022 to April 2023, this study was conducted at the Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar. The study involved 48 pregnant women with uterine fibroids. Numerous factors were observed, including the mother’s age, parity, the number and size of fibroids, obstetric difficulties, and the route of delivery. At every antenatal visit, a comprehensive clinical examination and standard investigations were done. Each appointment included ultrasound to evaluate the foetal condition and track any changes in the fibroid’s size. Results: 43 of the 48 patients who were recruited and started the trial finished it. Patients’ median ages were 32.56±4.3 years; primigravida made up 27.91% of the population, while multigravida made up 72.09%. 74.82% of pregnancies were spontaneous, while 25.58% used assisted reproductive technology. There were 11.63% spontaneous abortions, 16.28% preterm births, and 81.08% full-term births. 75.68% of deliveries were by caesarean section, while 24.32 percent were by normal vaginal delivery. A threatening miscarriage affected 13.95% of women, preterm labour affected 16.28%, placenta previa caused antepartum haemorrhage in 5.41% of cases, and postpartum haemorrhage affected 6 (16.22%). Contrary to sub serosal fibroids and single fibroids, intramural location and multiple fibroids were linked to an increased risk of caesarian section. Conclusion: Pregnancy uterine fibroids are linked to an increased risk of harmful obstetric problems. For the best possible outcome, it is essential to have regular checkups during the antenatal time to identify any harmful obstetric issues.

110. A Study of the Laboratory Determinants in the Diagnosis of Geriatric Anemia
G. Joshila Nandhini, M.S. Shruthi, P. Suriyaprabha
Introduction: The prevalence of anaemia among elderly Indians, as reported in Indian cross-sectional studies is between 6 and 30 % among men and between 10 and 20 % among women. Thus, anaemia represents an emerg-ing global health problem producing a negative impact in the quality of life among the elderly and requiring greater allocation of health resources. Based on this aim of study is to identify elderly patients with anaemia and study the aetiology, clinical parameters, and laboratory parameters in these patients. Methodology: The cases received in the haematology department for peripheral smear reporting were screened and 100 cases that showed haemoglobin levels lower than standard WHO values were chosen. The entire medi-cal history was obtained from each of the cases including previous medical reports and imaging studies. Com-plete blood counts for all the samples was done and the RBC indices was noted along with total WBC count, differential count, platelet count and haematocrit. Ferritin, iron and TIBC for all samples was done and values obtained using colorimetric methods. Results: Among the aetiologies, iron deficiency anaemia was seen in 43% of patients, anaemia of chronic dis-ease in 32%, anaemia of chronic kidney disease and unexplained anaemia in 11 % each and 1 case β thalasse-mia. Among clinical features the commonest symptom was easy fatigability and commonest sign was pallor. Peripheral smear study showed that normocytic normochromic anaemia was commonest type. Conclusion: This study showed that the commonest cause for anaemia among elderly patients is iron deficiency anaemia followed by anaemia due to chronic disease. Geriatric anaemia is a disease that often goes unreported hence every effort should be made to identify the disease and evaluate the cause and it should not be ignored as merely being a part of ageing, for the consequences of anaemia can have higher morbidity in the elderly.

111. Study of Obstetric Referral Pattern in ICU admission at Tertiary Care Centre
Jhalak Agrawal, Rekha Wadhwani, Bharti Choudhary Parihar, Juhi Agrawal
Background &Method: The aim of the study is to study obstetric referral pattern in ICU admission at Tertiary Care Centre. Data Collection was done for a prospective study by investigator. The information was collected using a predesigned proforma. Result: 8.15% of ICU admission was seen amongst all the referred patients and 2.32 % mortality. Mortality index was 0.05.Maternal near miss mortality ratio: 18.6 : 1. Conclusion: Hypertensive disorders of pregnancy: most common indication for ICU admission in the center associated with unbooked status.

112. Role of Neomycin Cream in Management Patients with Epistaxis
Surendra Singh Moupachi, Pallavi Indurkar, Shubham Ojha, Harshit Wadbude
Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nose bleeds.

113. Correlation between Inflammatory Markers with Disease Severity of COVID 19 Infection
Amit Kumar Pradhan, Bholanath Maji, Subinay Datta, Sinjini Basu, Md. Alamgir Perwana, Mrinal Pal
Background: Patients with COVID-19 have characteristic of hyper inflammation, so the associated inflammatory biomarkers may be helpful for forecast the severity. But data for predicting severity of patients with COVID-19 infection are sparse and still under investigation. We aimed to investigate the association between several biomarkers such as serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin, with disease the severity. Methods: In the present study 150 COVID-19 patients aging between 18 and 45 years and 150 age and sex matched apparently healthy people were included. Then case group participants are subdivided into three sub-groups according to disease severity. Thereafter, all of the patients and healthy persons were subjected to the estimation of serum IL-6, D-Dimer, (LDH), CRP, ferritin, and PCT. Results: The result showed that among all inflammatory markers only IL6 and CRP are well correlated with disease severity but after multiple regression analysis it is found that the CRP concentration was not well correlation with other inflammatory markers in different severity. Conclusion: Compared to other inflammatory markers, we found that only serum IL6 concentration was significantly associated withCOVID-19 severity.

114. Study of Functional and Radiological Outcome of Proximal Tibial Fractures Managed with Locking Compression Plating Technique
Sonendra Kumar Sharma, Surendra Singh Yadav, Chandrashekhar Waghmare, Prakhar Jain
Background: Proximal tibial injuries are considered to be serious as well as challenging to manage as are common intra-articular fractures, representing 1-2% of all fractures. These fractures are common in two age groups: as higher-energy fractures in younger patients and lower-energy fractures in elderly patients secondary to osteopenia. proximal tibia fractures are inherently associated with less soft tissue coverage with increased risk of post-operative complications like infections, wound dehiscence, non-union, malunion or implant failure.  Our aim is to obtain anatomical articular congruity with accurate axial alignment using locking compression plate for optimum final outcome of proximal tibial. Aim: To restore of anatomical articular congruity, stability, and management of soft tissue injuries to promote early mobilization of knee joint. Objective: The present study was done to evaluate the effectiveness of Locking Compression Plate in the management of proximal tibia fractures using plating technique. Methods: 40 cases of proximal tibial fractures were treated by using locking compression plate and studied from July 2021 to June 2022 in Department of Orthopaedics, at Gajraraja  medical college and JAH, Gwalior, Madhya Pradesh. Results: The clinical assessment was made according to Rasmussen’s functional grading system. Final results showed excellent outcome in 25 cases and good outcome in 12 cases and fair outcome in two cases.All the selected 40 cases were followed up for 6 months. The average time for union of fracture was 16 weeks ranging from 12-22 weeks. An average flexion was achieved was 0-1200. We observed 12 cases of postoperative complications that included 3 infections, 5 knee stiffness, 3 varus deformity and 1 venous thromboembolism. Conclusions: Surgical management of proximal tibia fractures with plating  gave excellent reduction, rigid fixation to restore articular congruity and provides early motion to achieve optimal knee function and reducing post-traumatic osteoarthritis.

115. Assessing Psychosocial Issues, Perceived Stress and Anxiety among Patients of Somatic Symptom Related Disorder: A Cross-Sectional Study
Akshat Varma, Surabhi Pandit, Amrendra Kumar Singh, Dheerendra Kumar Mishra, Manju Rawat, Sneha Shukla, Umesh Pathak
Background: Somatic symptom and related disorder is a new category in DSM V including diagnoses of somatic symptom disorder, illness anxiety disorder, conversion disorder, psychological factors affecting other medical conditions, factitious disorder and other specified and unspecified somatic symptom and related disorders. A number of factors contribute to this disorder including genetics, biological and psycho-social vulnerabilities. Variations in symptom presentation are likely the results of the interaction of multiple factors within cultural contexts that affect how individuals identify and classify bodily sensations, perceive illness and seek medical attention for them. Aims: The present study aims to identify various psychosocial issues related to Somatic Symptom and related disorders, find association between stress and anxiety among these patients; as well as to explore their defense mechanisms. Methodology: 50 individuals attending Psychiatry OPD in SSMC, Rewa were interviewed, Somatic Symptom scale and Life Event Scale were applied to delineate the required data for the study. Inclusion Criteria- Individuals between 15-60 years and criteria as per DSM V for Somatic Symptom and related disorders. Exclusion – Any other psychiatric or physical illness. Required interventions were given in the form of psychotherapy and pharmacotherapy. Result: A female predilection was noted among the study population with 72% patients being females, youth unemployment and marital conflicts were issues of concern. Traumatic life events were present in several individuals. The most commons somatic symptom observed was Headache. High degree of stress and neurotic defense was noted among the study participants. Conclusion: This study is in conformation with bio-psycho-social model of somatic symptom disorder and gives a direction to psychological interventions in somatic symptom disorder.

116. Impact of Increased Screen Time on Myopia in Children and Young Adults during COVID-19
Vaishali Prajapati, Gautam Prajapati, Deepika Singhal, Hansa Thakkar, Dhruvi Shah, Dharti Thakkar, Kushang Shah
Purpose: To evaluate the prevalence of myopia in children and young adults and to correlate its association with duration spent in front of computer screens. Method: The study was conducted on 200 individuals between the age group of 07-25 years at a tertiary care hospital in Ahmedabad after taking consent. Detailed history taking and ocular examination were carried out. All the study participants were provided a self-structured questionnaire to determine the associated socioeconomic and ecological risk factors. Result: Out of the 200 participants examined during the 1.5 month study period, 57 children (28.5%) were found to have myopia. Of these majority (56.14%) were females with maximum number of children (36.84%) in the age group of 11-15 years. Presence of excess screen time (>4 hours/day) was noted in 54.49% children with a simultaneous reduced outdoor activity time. Maximum screen exposure was noted for smartphones and tablets (81.45%) followed by computers (12.28%) and least for television (5.26%). Also, among other risk factors , positive family history (47.37%) was found to have a significant association with prevalence of myopia in our study. Conclusion: A significant association is noted between increased screen time and the occurrence of myopia in young individuals.

117. Excipient Lung Disease- An Under recognized Cause of Sudden Death in Young Adults: An Autopsy Case Series
T. Subachitra, R. Sathyalakshmi, C. Arun Prabhakaran, Yogambal Muthureddy
Aim and Objectives: Sudden death in young adults can occur due to many reasons including myocardial infarction, Arrythmias, Myocarditis, Pulmonary embolism etc. Excipient lung disease is an under recognized cause of sudden death in young adults  which is characterized by multiple granulomas around the pulmonary vessels in intravenous drug abusers especially who misuse crushed oral tablets for intravenous  injection. This study describes the pathological features of excipient lung disease and the importance of postmortem assessment to know the exact cause of death.

118. Evaluation of Pulmonary Functions in Recovered Patient’s of COVID-19 Pneumonitis: A Prospective Study
Kumar Pranshu, Arpit Johar, Sanidhaya Tak, Kanchan Garg
Introduction: Every year, respiratory illnesses claim the lives of almost 7 million individuals around the world. Many viruses are to blame for these epidemics. One of the infections is COVID-19, a developing infection brought on by the coronavirus 2 virus that causes acute respiratory syndrome (SARS-CoV-2). Aim and Objectives: To assess the pulmonary functions in COVID-19pneumonitis recovered patients. Methodology: With approval from the institutional ethical committee and review board and written informed patient consent, the study was carried out at the Department of Respiratory Medicine, Pacific Institute of Medical Sciences, Umarda, Udaipur. Result: COVID-19 pneumonitis patients were categorised by onset of symptoms as mild(19.44%), moderate(48.14%) & severe(32.40%). CT scan severity score was found as mild(1-8), moderate(9-15) & severe (>15) considered as (45.37%), (48.14%) & (06.48%) COVID-19 pneumonitis patients respectively. Pulmonary function examination, it was found that FEV1(L), FVC(L), FVC(% Predicted), FEV1/FVC (%), TLC and DLCO were statistically significant between Severe and non-severe COVID-19 Pneumonitis patients respectively. (p<0.05). Conclusion: Even though the pulmonary dysfunction brought on by the SARS-CoV-2 infection got better over time, the affected patients didn’t fully recover after being released. Several COVID-19 patients experienced pulmonary dysfunction and abnormal lung CT results after recovering, with imaging abnormalities happening more frequently in severe individuals.

119. A Case of Streptococcus Mitis Urinary Tract Infection in an Infant
Mohanty A, Kundu R, Krishnamurthy S, Mandal J
Streptococcus mitis has been rarely associated with urinary tract infections. It is one of the species included in the viridans group of streptococci, which is otherwise a normal commensal of the female genital tract. Herein, we discuss a case of urinary tract infection by a strain of S. mitis in a 2.5-month-old infant with multiple congenital anomalies.

120. Medical Students’ Sleep Quality Following the COVID-19 Pandemic Lockdown in Erode, Tamil Nadu: A Cross-Sectional Study
Isaac Christian Moses, M.A. Vaithiyalingam, N.  Krishna Kumar, S. Mohamed Musthafa, Sasikala Gunasekaran, Panneerselvam Periasamy
Introduction: Few studies have explored the mental health during the outbreak period of the COVID-19 pandemic. Students’ academic success, interpersonal interactions, and propensity for mental illnesses are all impacted by their sleep quality. One of the recognised elements influencing a person’s sleep design is their personality. Medical students’ personality and academic success are both negatively impacted by poor sleep quality. Aim: The current research looked into the sleep quality among medical students in Post Covid-19Pandemic Lockdown in Erode, Tamil Nadu. Materials and Methods: 288 undergraduate medical students participated in a cross-sectional study that was performed on an institutional level. Structured questionnaires that were administered by interviewers were used to gather the data. Medical students learning in Erode had their sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results: 226 (78.5%) of the 288 medical students said they had poor sleep. The results of our study demonstrate a significant the global PSQI score (P< 0.05). Students who slept poorly scored less in exams. The findings show that, among students during the COVID-19 outbreak, were risk factors for psychological disorders. Our findings might serve as a guide for those conducting psychological disorder screenings. Conclusion: In the Post Covid-19 Pandemic Lockdown, medical students who don’t get enough sleep become depression. Medical students’ mental health and academic success are impacted by COVID-19. The findings show that, among students during the COVID-19 outbreak, personality characteristics were risk factors for psychological disorders. Future research on these personality traits may help to better understand how sleep disorders affect academic achievement.

121. A Comparative Study of Tympanoplasty Type 1 – Endaural versus Postaural Approach
Ramesh Chandra P, Leela Prasad TVSSN, Sudha B, Pratima P, Kalyani H
Background & Objectives: Chronic otitis media is the inflammation of the mucoperiosteal lining of the middle ear cleft characterized by ear discharge, a permanent perforation of the tympanic membrane, and impairment in hearing. It is one of the most common ear diseases encountered in developing countries due to poor socio-economic standards, lack of health education, and unhygienic habits. The aim of the study is to evaluate and compare the surgical outcome in Endaural and Postaural approach for Type-1 Tympanoplasty. Methods: The study was conducted in the department of ENT, Government ENT hospital, Andhra Medical College, Visakhapatnam among 100 patients from January 2018 to August 2019. Surgery was performed under local anesthesia by Endaural and Postaural approach. In 50 patients of Group A, Type 1 Tympanoplasty was done by the Postaural approach, in the remaining sample of 50 patients of Group B Type 1 Tympanoplasty was done by the Endaural approach. Pure tone audiometric tests were performed before surgery and 3 and 6 months postoperatively. Results: Patients were followed up for an average period of 6-12months. Graft uptake, Hearing assessment and Cosmetic results were observed in the post-op follow up. In the Endaural approach myringoplasty, the graft uptake at the end of 6 months was 96%, with 96% success rate in achieving improvement in hearing and 94% patients had excellent cosmetic results. In the Postaural approach, the graft uptake was 94%, with 94% success rate in  achieving improvement in hearing and 64% patients rated their cosmetic result as excellent. Conclusion: The Endaural approach to middle ear surgery is suggested as a good alternative to the postaural approach. The results are almost equal in both approaches. The selection of approach depends on surgeon’s expertise and patient’s preference.

122. Histopathological Study of Paediatric Renal Tumors in North-West Rajasthan
Anju Repaswal, Tanu Bano, Rama Kumari, Santosh Sharma
Introduction: Most renal tumours present with non-specific features of an abdominal mass usually detected incidentally. Aim: Histopathological study of paediatric renal tumors in North Western Rajasthan. Method: This was a Hospital based retrospective and prospective study conducted on 26 nephrectomy specimens ranging in age from 10 days to 18 years at Department of Pathology, Sardar Patel Medical College, Bikaner from January 2015 to December 2021. Results: Out of 26 nephrectomy specimens 23 were neoplastic lesion and 3 were non neoplastic in nature. Simple nephrectomy was performed for 14 (53.85%) cases and radical nephrectomy performed for 10 (38.46%) cases. In remaining 2 cases (7.69%) renal biopsy was taken. 14 (53.85%) nephrectomy specimens were received from right side and 12 (46.15%) specimens from left side. Among neoplastic lesions, 3 cases (13.04 %) of benign and 20 cases (86.96.%) of malignant diseases were found. In 20 malignant neoplasms, wilm’s tumor were 17(85.00%), which constituted vast majority of cases and renal cell carcinoma were 3 cases (15%). Conclusion: Wilm’s tumor was the most common and overall males were more affected then females.

123. Judging the Risk Factors of Catheter Induced UTI (Urinary Tract Infection) in Pediatric Subjects Admitted to ICU (Intensive Care Unit)
Bapurao S Kanthi, Shambu S Angadi, Avinash Bettasoge, Sandeep Rangaiah
Background: Catheter-induced urinary tract infections are among the most common causes of nosocomial infections. These contribute to nearly 30% of infections associated with the healthcare sector. The most vital predictor in Catheter induced urinary tract infections is catheterization duration. Aim: The present clinical study was aimed to assess the risk factors, microbiology, and occurrence of Catheter induced urinary tract infection in pediatric subjects admitted to the ICU (intensive care unit). Methods: The study assessed 31 child subjects with urinary tract infections admitted to the pediatric intensive care unit of the institute. The risk factors, microbiology, and occurrence were assessed in the study, and the results were formed. Results: Among 31 subjects with Catheter induced urinary tract infection, 48% (n=) were male subjects, and the rate of occurrence was found to be 7.2/1000 catheter days. The most common organism seen associated with Catheter induced urinary tract infections was E. coli, seen in 33% (n=) cases, followed by E. faecalis, seen in 31% (n=) cases. The risk factors seen significantly associated with the Catheter induced urinary tract infections were hospital stay (p=0.01), PICU stay (p=<0.001), and duration of catheter drainage (p=0.008). Conclusion: The present study concludes that Catheter induced urinary tract infections are common nosocomial infections seen in subjects admitted to pediatric ICU. The risk of these infections increases with the duration of PICU stay, hospital stay, and duration of catheter drainage.

124. Comparative Analysis of Obesity Prevalence and Associated Factors among Urban and Rural Adult Populations: A Cross-Sectional Study
Amitesh Kumar, Sanjay Kumar, Hemkant Jha
Objective: The objective of this study was to compare the prevalence of obesity and its associated factors among adults residing in urban and rural areas. Methods: A cross-sectional study was conducted on a sample of 500 adult participants (250 from urban practise area of DMCH and 250 from rural field practise area of RHTC, Kalyanpur ). Demographic information, lifestyle factors, and health-related variables were collected using standardized questionnaires. Body mass index (BMI) was calculated using height and weight measurements. Prevalence rates of obesity were determined based on BMI categories. The data were analyzed using appropriate statistical tests, including chi-square tests and logistic regression analysis. Results: The prevalence of obesity was found to be significantly higher in the urban population (47.2%) compared to the rural population (32.8%) (p < 0.05). Among the urban participants, 56.4% were classified as overweight compared to 43.6% in the rural group. The mean BMI was significantly higher in urban adults (28.5 ± 4.2) compared to rural adults (25.6 ± 3.9) (p < 0.05). Logistic regression analysis revealed that residing in an urban area was significantly associated with a higher risk of obesity (OR: 1.79, 95% CI: 1.24-2.58, p < 0.05), even after adjusting for age, sex, education level, income, physical activity, and dietary habits. Conclusion: This study demonstrates a higher prevalence of obesity among adults living in urban areas compared to those residing in rural areas. Residing in an urban area was identified as a significant risk factor for obesity. These findings highlight the need for targeted interventions and policies addressing urban populations to combat the rising obesity epidemic and improve public health outcomes. Further research is warranted to explore the specific factors contributing to the urban-rural disparity in obesity prevalence.

125. Comparing Clinical Outcomes of Senile Cataract Patients Undergoing Small Incision Cataract Surgery (SICS) and Phacoemulsification Cataract Surgery at a Tertiary Eye Care Hospital in India
Girish Dutt Chaturvedi, Ritu Chaturvedi
Introduction: Cataract is a medical condition characterized by the presence of a clouding or opaqueness in the normally clear ocular lens. This occurs when certain proteins within the lens start to clump together, leading to a gradual impairment of vision.In India, where the burden of cataract remains substantial, tertiary eye care hospitals play a crucial role in providing comprehensive eye care services to a vast population.  The findings from this study have the potential to contribute to the development of best practices and guidelines for cataract management, ultimately enhancing the overall vision-related healthcare in India and other regions facing similar challenges. Methodology: This research is a retrospective comparative study conducted at a tertiary eye care hospital in India. The study aims to compare the outcomes of senile cataract patients undergoing two different surgical approaches: Small Incision Cataract Surgery (SICS) and Phacoemulsification Cataract Surgery. The study included a total of 604 senile cataract patients who underwent cataract surgery at the tertiary eye care hospital during a specified period (Dec 2022 to May 2023).Data were extracted from electronic medical records and patient charts. Results: the study included 604 senile cataract patients undergoing either Small Incision Cataract Surgery (SICS) or Phacoemulsification Cataract Surgery. Both Small Incision Cataract Surgery (SICS) and Phacoemulsification Cataract Surgery demonstrated comparable visual outcomes, patient satisfaction, and quality of life improvements at the tertiary eye care hospital in India. Conclusion: This study provides valuable evidence supporting the effectiveness and safety of both Small Incision Cataract Surgery (SICS) and Phacoemulsification Cataract Surgery in managing senile cataract cases. The results suggest that both techniques can be considered as viable options for cataract surgery in this patient population. Individual patient factors, surgeon expertise, and resource availability can guide the choice of the most appropriate surgical approach. Further studies with longer follow-up periods and larger sample sizes may be beneficial to confirm and expand upon these findings.

126. Determinants Influencing Visual Outcomes following Cataract Surgery: An Observational study in North India
Girish Dutt Chaturvedi, Ritu Chaturvedi
Introduction: As per the World Health Organization (WHO), cataract stands as the primary cause of blindness worldwide, responsible for 47.8% of all cases. Alarmingly, one-third of the global blind population resides in India, with a staggering 80% of blindness in the country attributed to cataract. While cataract-related blindness is deemed highly preventable, it remains a prominent cause of visual impairment in middle- and low-income nations. The visual outcome following cataract surgery is influenced by various factors, such as the type and severity of cataract, surgical technique, intraocular lens (IOL) selection, pre-existing ocular conditions, and individual patient characteristics. Understanding the determinants that contribute to postoperative visual outcomes is crucial for optimizing surgical success and ensuring patient satisfaction. Methodology: This research is a retrospective observational study conducted at a District Hospital, Shivpuri (M.P) in North India. The study aims to investigate complication rates and visual outcomes among patients undergoing routine elective cataract surgery. The study includes a consecutive series of adult patients who underwent routine elective cataract surgery at the eye care center during a specified period (start date to end date). Patients with pre-existing ocular conditions, traumatic cataracts, or complex cataract cases were excluded from the analysis. Results: The study revealed wound-related complications were noted in 121 eyes out of 880 eyes that underwent MSICS. The maximum number of complications was in surgeons undergoing training. The common OCTET I complications among level 1 surgeons included corneal edema (29.4%), high IOP (14.2%), increased post-operative uveitis (10.3%) and hyphema (10%). The post-operative uncorrected visual acuity was good in 58.1% eyes on day 1 and improved to 77.4% cases at the end of 4 – 6 weeks. The post-operative BCVA was good in 82.6%, 96.3% and 97.7% eyes on post- operative day 1, days 7-10 and 4-6 weeks respectively. The BCVA was good in 97.7% of eyes at 4-6 weeks. The eyes with poor BCVA was only 0.1% at 4-6 weeks. Conclusion: The study findings revealed that wound-related complications were more prevalent among surgeons undergoing training (Level 1) during manual small incision cataract surgery (MSICS). Additionally, post-operative complications, as classified by OCTET I and OCTET II, showed variations across different surgeon levels. Post-operative uncorrected visual acuity (UCVA) improved from 58.1% on day 1 to 77.4% at 4 to 6 weeks, and best-corrected visual acuity (BCVA) showed excellent results, with 97.7% of eyes achieving good BCVA at 4 to 6 weeks.

127. Unveiling the Silent Threat: Investigating Glaucoma and its Predictors in Adult Ophthalmic Patients
Girish Dutt Chaturvedi, Ritu Chaturvedi
Introduction: Glaucoma causes progressive damage to the optic nerve and is the leading cause of irreversible blindness worldwide. Blindness from glaucoma is avoidable with early diagnosis and appropriate, sustained life-long treatment. The two most common forms of the disease are primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), with different patterns of disease occurrence. Despite a large amount of time and resources spent on treatment trials, there are still few effective treatments and limited involvement to reduce the incidence of glaucoma. The purpose of this study was to determine the magnitude of glaucoma and its predictors among adult patients. Methodology: The study was carried out in District Hospital, Shivpuri from September 2022 to February 2023. An institution-based cross-sectional study design was implemented. All patients aged 40 and above years old who visited the ophthalmic outpatient department were the source population, and patients aged 40 and above years old visited the ophthalmic outpatient department during the time of data collection were the study populations. Results: This study included 152 participants using a systematic sampling technique with a 90.7% response rate. In this study, (59%) of them were male. The mean (±SD) age of the participant was found to be 63 (±12.54) years. (23%) of the Hindu group had glaucoma among detected cases and by religion, Muslim had a high prevalence of glaucoma which is about 53 (20.8%). Accordingly, (6.3%), (3.2%), and (3.2%) of patients had hypertension, diabetes mellitus, and cardiac illness respectively. Sixteen (6.2%) patients with glaucoma had also a positive family history of glaucoma. (10.3%) patients with glaucoma were smokers. Overall prevalence of glaucoma identified in the study, the most common type was primary open-angle glaucoma followed by closed-angle glaucoma which was (48%), and (32%), respectively while (19.7%) of them had secondary glaucoma. Conclusion: Our study found a higher prevalence of glaucoma, which is primarily a disease of the elderly. Primary open-angle glaucoma is the most common subtype of glaucoma detected in this study. Family history of glaucoma, age, and increased intraocular pressure were significantly associated with risk factors of glaucoma in this study.

128. Exploring Fluctuation Asymmetry in Dermatoglyphic Patterns as Potential  Indicators of Breast Carcinoma: A Comparative Analysis
Aprajita Raizada, Vishwas Johri, Ramnath Takiar
Background: Carcinoma breast is one of the most widespread forms of cancer affecting women worldwide. Numerous screening tools have been devised. One such tool on which extensive studies have been conducted is dermatoglyphics.  Materials and Methods: In the present study, 100 cancer patients and 100 controls were studied and their finger and palm prints were taken using roller-ink method. Different parameters like radial and ulnar loop, whorls, arches, total finger ridge count (TFRC), absolute finger ridge count (AFRC), a-b ridge count, palmar angles (<atd, <tda and <dat) were studied. Their fluctuation asymmetry was studied in cancer patients as well as controls. Results: Fluctuation asymmetry was seen in index, finger, middle finger and little finger of cancer patients.  At the same time TFRC, AFRC, and palmar angle <tda and <dat in cancer patients showed fluctuation asymmetry. Conclusion: Fluctuation asymmetry in dermatoglyphics can be used as an effective screening tool in high-risk cases as well as early treatment can be started which will be beneficial to the patient and society as a whole.

129. Comparison of the Effectiveness and Safety of Laparoscopic (TAPP) and Conventional Open (Lichtenstein) Repair and There Outcome in the Management of Inguinal Hernia
Nilesh P. Suthar, Amit H. Desai, Harshadray N. Parmar
Background and Aim: Several tension-free surgical techniques, including the Lichtenstein approach, have been successfully applied to treat both primary and recurring inguinal hernias. The trans-abdominal preperitoneal procedure (TAPP), on the other hand, is a method for hernia repair using an intraperitoneal approach. Present study compared the operating time, post-operative hospital stay, and return to work, as well as cost effectiveness, complications, scar size, and the detection of clinically insignificant (occult) hernia on the contralateral side in TAPP. Material and Methods: The current randomized clinical trial was carried out from 1st January 2022 to 31st December 2022 at Nootan medical college and research center, Visnagar, Gujarat. The chosen patients were divided into two groups: group 1 received the TAPP repair for inguinal hernia repair, and group 2 underwent the Lichtenstein technique for inguinal hernia repair, each group consisting of 50 patients. The study outcome was the hernia recurrence, chronic pain, hematoma, seroma, wound infection, operation time, hospital stay, and return-to work days. Results: The mean age of the patients in the TAPP technique group was 55.6 ± 12.85 years compared with 54.8 ± 10.34 years in the Lichtenstein group. The two groups also showed no statistically significant variation for the side involved (p>0.05). Direct hernias were more common in both groups. In unilateral cases the pain scores on postoperative day 0, day 1 and day 7 were significantly lower in the TAPP group compared with the Lichtenstein group for each day. Regarding the bilateral cases the pain scores on postoperative day 0, day 1 and day 7 were also significantly lower in the TAPP group compared with the Lichtenstein group, on the same days on day 0, 1, and 7. Conclusion: Both the TAPP and Lichtenstein methods are secure and dependable for treating inguinal hernias. Early oral feed tolerance, less post-operative pain, faster hospital discharge, quicker resumption to normal activities, and less persistent pain were all related with TAPP repair.

130. A Clinical-Epidemiological Study of Facial Dermatoses in Women: A Cross-Sectional Study
Swati Surabhi, Prashant Kumar, Amit Ranjan
Background: Highly common facial dermatoses can significantly impact the quality of life, particularly for women. This clinical-epidemiological Study was to explain the incidence, severity, and risk factors associated with face dermatoses in females. This research will focus on the prevalence of facial dermatoses and contribute to creating effective treatment plans. Methods: A cross-sectional investigation was conducted with women over 18 years of age. The volunteers were recruited from dermatology offices and other ambulatory medical facilities. The participants’ demographic information, medical history, and face dermatoses were collated using a standardised questionnaire. Dermatologists conducted clinical examinations to diagnose and classify facial dermatoses. Correlations between variables were determined using descriptive statistics, chi-square tests, and logistic regression models. Results: Initial findings from 500 participants indicate that women suffer from various facial dermatoses. The most frequently diagnosed dermatoses affecting the face were acne vulgaris (n=200, 40%), melasma (n=120, 24%), rosacea (n=70, 14%), and seborrheic dermatitis (n=50, 10%). Contact dermatitis, perioral dermatitis, atopic dermatitis, and photodermatoses were also identified, albeit less frequently on the face. Conclusion: In an ongoing clinical-epidemiologic study, the prevalence and clinical characteristics of facial dermatoses in women are being investigated. This Study’s findings will focus on the prevalence of these diseases and may guide the development of effective preventative measures and targeted therapies. Familiarity with the clinical-epidemiological characteristics of facial dermatoses can improve patient care, education, and resource allocation.

131. Prevalence of Pseudomonas aeruginosa and its Antimicrobial Sensitivity Profile among Postoperative Wound Infections in a Tertiary Care Hospital
Nirmala Kumari, Mritunjay Kumar, Chandan Kumar, Atul Anand
Background: Postoperative wound infections significantly contribute to morbidity and healthcare costs in tertiary care facilities. Awareness of the antibiotic resistance profile of Pseudomonas aeruginosa in these diseases is necessary to develop effective treatment options and infection control measures. Methods: In a tertiary care hospital, a retrospective observational study spanning from July 2022 to June 2023 was conducted. Patients with surgical incisions who were infected met the inclusion criteria. Protocols for antimicrobial treatment, lesion characteristics, culture and sensitivity data, and patient demographics were all documented. Patterns of antimicrobial susceptibility were identified through descriptive data analysis. Results: Pseudomonas aeruginosa was isolated from 90 of 300 cases of studied postoperative wound infections for a prevalence incidence of 30%. Most Pseudomonas aeruginosa isolates (n=125; 83.3%) were isolated from surgical sites, whereas the remaining isolates were isolated from deep wounds. Pseudomonas aeruginosa exhibited a high level of resistance to commonly prescribed antibiotics, such as ciprofloxacin (68%), ceftazidime (62%), and gentamicin (55%). In contrast, its sensitivity to carbapenems was elevated, with 78% and 75% sensitivity to meropenem and imipenem, respectively. Conclusion: Pseudomonas aeruginosa is a leading cause of surgical wound infections in our tertiary care hospital, and many of the isolates have developed resistance to standard antibiotic treatment. The alarmingly high resistance rates, antimicrobial stewardship and exploring novel therapeutic approaches, such as carbapenems, are necessary. These findings highlight the significance of infection control and surveillance strategies for reducing the prevalence of Pseudomonas aeruginosa in surgical wound infections and enhancing patient outcomes.

132. Corneal Neurotization and Ipsilateral Temporalis Transfer for the Management of Insensate Cornea with Lagophthalmos: A Single Stage Procedure
Manish Jain, Saurabh Garg, Naim Sayra, Chetanya P Gupta
Introduction and importance: Insensate cornea is a difficult and challenging problem to manage throughout the world. Impaired sensations of cornea results in reduced reflex tearing, increase risk of corneal surface injuries and poor healing. All these factors lead to epithelial defects that ulcerate and perforate if not treated appropriately. Patients who had facial palsy along with insensate cornea are at even greater risk for corneal disease. Insensate cornea can be managed by transfer of healthy donor nerve tissue to the cornea to restore sensation. We report a case of insensate cornea with lagophthalmos, managed successfully with corneal neurotisation and ipsilateral temporalis transfer for eye closure. Method & Surgical Technique: Our patient presented with lagophthalmos insensate cornea that was unresponsive to medical management. He had reduced vision in right eye and opacity in inferior quadrant of cornea. The cornea was reinnervated via the ipsilateral supraorbital nerve using an autologous sural nerve graft and ipsilateral temporalis transfer was done for right eye closure. Results: At 3 months, there was partial resolution of corneal stromal opacification and partially improved corneal sensation by testing with a wisp of cotton in all 4 quadrants. Right eye closure was near complete. At 9 months follow up, there was complete resolution of corneal stromal opacification and greatly improved corneal sensation in all 4 quadrants. Right eye closure was complete, best corrected visual acuity in right eye improved to 6/9. Conclusion: Corneal neurotization is a novel technique to restores the corneal sensation. This method showed excellent results in corneal reinnervation, healing of corneal epithelium, vision improvement and quality of life improvement.

133. Vesiculo Bullous Lesions – Histomorphological Analysis vs. Immunofluorescence Study
Sai Kiran, Zaheda Kauser, Mahitha Joyce, Naga Kalyani. P., Sana Rahman, N. Sri Vani
Objective: Our study aims to analyze the concordance between clinical, histopathological and direct histological examination in the diagnosis of the immunobullous diseases, detect specific pattern of direct immunofluorescence staining in different vesiculobullous disorders, and supplement the clinical and histopathological findings in the investigation of vesiculo-bullous disorders for confirmatory diagnosis of vesiculo bullous disorders. Methods: This was a hospital-based study conducted among 50 patients who presented with bullous lesions of skin to the Department of Dermatology, Osmania General Hospital, from October 19 and October 21 over a period of two years, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Level of blister was suprabasal in majority of cases (86.3 %) of pemphigus vulgaris and sub corneal in the pemphigus foliaceous. Acantholytic cells, lymphocytes, and few eosinophils and neutrophils were present in the blister cavity of pemphigus vulgaris and foliaceous. DIF showed intercellular deposition of IgG/IgG and C3 in 18 out of 22 cases of pemphigus vulgaris which is a classical finding, 4 out of 6 cases of pemphigus foliaceous also showed intercellular deposition of IgG in the epidermis similar to pemphigus vulgaris. 10 out of 16 cases of bullous pemphigoid showed linear deposition of IgG and C3 in the basement membrane zone. 2 cases each of BSLE and one case of CBDC were observed. Conclusion: Considering the socio-economic status of the patients and unavailability of immunofluorescence technique in many centres, clinical diagnosis and histopathology are generally enough for arriving at the final diagnosis. DIF is only used as supplement and not a substitute. It is important to distinguish each of these separate entities for appropriate management, failure of which in few cases is associated with significant mortality and morbidity.

134. A Study of Mineral Metabolism Disorder of CKD Patients in a Tertiary Care Hospital in India
Manas Gope, Samaresh Paul, Subrata Bhowmik
Background: Mineral bone disorder (MBD) is an important complication of chronic kidney disease (CKD). However, there are limited data on the pattern of MBD in Indian CKD population. The aim of this study was to describe spectrum of MBD in patients with CKD in our center. Materials and Methods: This was a hospital based cross-sectional observational study of CKD‑mineral and bone disorder (CKD‑MBD) over a period of 6 month. The biochemical markers of CKD‑MBD, namely, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), and 25‑hydoxyvitamin Vitamin D3 (25OHD), were measured in newly diagnosed CKD Stage 3–5 and prevalent CKD 5D adult patients. Results: A total of 76 patients of CKD Stage 3–5D were studied. The frequency of various biochemical abnormalities was hypocalcemia (40.7%), hyperphosphatemia (53.9%), raised alkaline phosphatase (25%), secondary hyperparathyroidism (67.1%). 25OHD was done in all patients and 47.3% were found to have Vitamin D deficiency. Nondiabetic CKD as compared to diabetic CKD had a higher alkaline phosphatase a higher iPTH and higher uric acid level (p=0.012). Conclusion: There was a high prevalence of CKD‑MBD in Indian CKD patients. CKD‑MBD is more common and more severe and has an early onset as compared to the western populations.

135. Maternal and Perinatal Outcome of Rupture Uterus in A Tertiary Care Hospital
Manas Ranjan Mohanty, Sandhyarani Behera, Samikshya Nanda
Introduction: Uterine rupture is the most tragic events that can occur in a woman’s life. It is one of the most dangerous obstetric situations with an increased risk of maternal and perinatal morbidity and mortality. The objective of this study was to determine the incidence, risk factors, clinical presentation, complications, management, fetal and maternal outcome in cases of uterine rupture. Methods: Prospective study done over a period of one year in the department of Obstetrics and Gynaecology, PGIMER and Capital Hospital Bhubaneswar from July 2022 to June 2023. Results: Our study comprised of 34 cases with the incidence of 0.23%. Out of these 82.3% were unbooked cases. Majority of the cases were para 2-3. Most of the rupture (85%) occurred during labour. The lower segment uterine rupture was the most common site of rupture (45%).Total hysterectomy done in 61.7% cases. Maternal and perinatal mortality were 2.9% and 94.11% respectively. Conclusion: Rupture uterus is a high risk category of patients. Proper antenatal and intranatal care, education, counselling of women with history of previous caesarean section for hospital delivery, close monitoring of labour, early diagnosis and decision for laparotomy, timely referral, availability of transportation are the main factors to decrease its fatal outcome.

136. To Assess the Prevalence of Impaired Glucose Tolerance in Pulmonary Tuberculosis and Comparison of Pulmonary Tuberculosis with Normal OGTT and Abnormal OGTT
Kanika Sethi, Rahul Gupta, Dinkar Dubey, Seema, O. P. Jatav
Background & Method: The aim of the study is to assess the prevalence of impaired glucose tolerance in pulmonary tuberculosis and comparison of pulmonary tuberculosis with normal OGTT and abnormal OGTT.The patient information was collected regarding age, sex, residence, socioeconomic status. Patients were asked about symptoms related to pulmonary tuberculosis and diabetes.  Samples of blood were drawn in accordance to the W.H.O. guidelines after the patient has fasted overnight for at least 12 hours, then at 1 and 2 hours following 75 gms of glucose ingestion. Result: Mean fasting plasma glucose in patients with normal OGTT was 76.47mg% (SD=12.59) as compared to 82.44 mg% (SD=15.78) in patients with IGT. This was not significant as p>0.01.  2h plasma glucose in normal OGTT group was 96.30 mg% (SD=17.88) as compared to 167 mg%(SD=17.46) in IGT group. This was statistically highly significant with p<0.0001. The  p value was found significant also at ½ h, 1h and 1½h.Impaired glucose tolerance was noticed more in those with severe lung  involvement and this was statistically highly significant with a p<0.05. Conclusion: Insulin- glucose metabolism is altered in TB patients and a diabetic like state is present in TB patients and there is also an impaired glucose tolerance secondary to TB. The question is whether this metabolic derangement is characteristic of TB patho-physiology, or whether people with this derangement are prone to TB. According to the aetio-pathogenesis of the disease in which a poor immune response in the host plays an important role, the most logical explanation is that people with this derangement are prone to TB. In our study it was found that impaired glucose tolerance was found in 27 of 130 patients, which equals to a prevalence rate of 20.7% and the prevalence was significantly high in those with severe disease.

137. Cold Pressor Test as A Predictor of Hypertension in Normotensive Medical Students
Rufus Rajkumar Peterson, G. Sandeep
Introduction: Early diagnosis of hypertension risk may enable an individual to live a healthier lifestyle. Subjects with hypertension predisposing variables have a higher and longer reaction to blood pressure after stress. The current study was carried out to assess cardiovascular response, such as blood pressure and heart rate changes during a cold presser test, as a prospective future risk factor for hypertension in normotensive Medical students. Materials and Methods: Normotensive, non-smoking healthy 60 first MBBS students of either sex of Mamata Medical College of age group 18-22 years participated in the study. This study was conducted between February 2023 and March 2023. The cold pressor test was carried out. The changes in blood pressure and heart rate among the students of hyper responsive group and normo responsive group were compared using Student’s t-test. Result: In the present study, 30% of total subjects were hyper reactors. Average SBP in the hyper response group during CPT and recovery were 132.56 mm Hg & 128.75 mm Hg. Average DBP in the hyper response group during CPT and recovery were 84.28 mm Hg & 79.42 mm Hg which was statistically significant. Conclusion: The current study demonstrates that hyperresponsiveness may precede essential hypertension and that the cold pressor test may be effective as a predictor of future hypertension in a young study population. Early intervention in their lifestyle change can help them avoid acquiring hypertension later in life.

138. An Observational Study of Adductor Canal Block using Ropivacaine Alone and with Additives (Dexmedetomidine/Fentanyl) for Post Operative Analgesia in Patients Undergoing Knee Arthroscopic Surgeries
Vandana Sharma, Vandana Geherwaal, Vikesh Bhatt
Objectives: The present study was to assess the post-operative analgesia in adductor canal block in knee arthroscopy patients. Methods: Patients of either sex in the age group of 18-75 years, having body mass index (BMI) of 20-35 kg/m2 and belonging to ASA (I & II), who were scheduled to undergo elective knee arthroscopic surgeries were observed in this study. Group A patients were received 20ml of 0.2% Ropivacaine + 2ml of Normal Saline (total 22ml).  Group B patients were received 20ml of 0.2% Ropivacaine + 0.25mcg/kg of Dexmedetomidine diluted in 2ml of Normal Saline (total 22ml). And group C patients were receiving 20ml of 0.2% Ropivacaine + Fentanyl 1mcg/kg diluted in 2ml of Normal Saline (total 22ml). Results: Average duration of surgery in group A was 72.3+16.62 minutes, group B was 71.2+14.67 minutes and group C was 73.9+14.07 minutes. Visual analogue scale was found highest in group A and lowest in group C. Median VAS score of group C was statistically lower than median VAS score of group B and median VAS score of group B was statistically lower than group A. VAS was monitored postoperatively at 0 hours, 2 hours, 4 hours, 6 hours, 8 hours, 10 hours, 12 hours, 16 hours, 20 hours. Total consumption of analgesia (IV Tramadol) in 24 hours in Group A was 200+28.76mg, Group B was 142+41.53mg and Group C was 108.9+30.64mg. The difference in total analgesic consumed among the three groups during 24 hours was statistically significant. Total quantity of analgesia required was significantly less in Group C, followed by Group B and was maximum in Group A among the three study groups(P value<0.001). Conclusions: The addition of fentanyl and dexmedetomidine to ropivacaine for adductor canal block increases postoperative analgesia time and reduces total amount of analgesic consumed postoperatively.

139. Distribution of Dermatological Changes in Pregnancy: A Tertiary Care Centre Study
Sanjay Pancholi, Nidhi Sharma, Kamna Dubey, Priyanka Solanki, Yusuf Kagzi
Introduction: Various endocrine, immunologic, metabolic and vascular changes occur during gestation, which make the woman prone to changes of the skin and its appendages. Patient concerns may range from cosmetic issue, to the chance of recurrence of the lesion during subsequent pregnancy, to its potential ill effects on the embryo/foetus in terms of morbidity and mortality. Material & Methods:  A cross sectional study conducted on total of 550 pregnant women. Dermatological manifestations in pregnancy was categorised into three -1) Physiological skin changes, 2) Specific dermatoses of pregnancy and 3) Dermatological manifestations not specific to pregnancy. Result: Majority of patients were from Second trimester followed by third trimester. Primigravidae cases constitute 56% of cases. Physiological changes of pregnancy seen in 98%, specific dermatoses of pregnancy in 6.5% cases and Non-specific skin changes in pregnancy seen in 40% of cases. Conclusion: The specific dermatoses of pregnancy, which is uncommon entity, may cause significant stress and concern to the pregnant female and need timely medical attention. Clinicians in ANC patients should differentiate between physiological skin changes and specific dermatoses of pregnancy for timely management.

140. Association of Cervical Non-Neoplastic, Precancerous and Neoplastic Lesion with Protein p16ink4a: A Prospective Observational Study
Arpita Singh, Swaraj Sharma, Anju Chandra, Mohd. Fahimuddin, Navin Kumar
Background: p16INK4a (tumor-suppressor protein), used as biomarker of human papillomavirus (HPV) oncogenic activity have shown higher positivity rate in high grade cervical cancer lesions. Aims: The study aimed to assess association of cervical non-neoplastic, precancerous and neoplastic lesion with protein p16INK4a. Setting and Design: This study was hospital based prospective study. Methods and Material: The study was done among 110 patients in the department of Pathology, Vydehi institute of medical Sciences and Research centre, Bangaluru, Karnataka. The duration of the study was of one year five month from January 2015 to May 2016. All specimens were subjected to histopathological examination whereas immunohistochemistry staining for p16INK4a was done in all cancerous, pre-cancerous and non-neoplastic cervical glandular lesions. Statistical analysis: The number and percentage were calculated for all the variables and chi-square test was done to find association. P value <0.05 was considered significant. Results: Most common histopathological type of lesion encountered were inflammatory lesions (57/110- 51.8%). Cervical intraepithelial neoplasm-3(CIN III) was the most common pre-cancerous lesion accounting for 56.6% of the cases (13/23). Among neoplastic lesions, squamous cell carcinoma was the most common invasive carcinoma (17/21- 80.9%). The association of non-neoplastic, pre-cancerous and neoplastic lesion with protein p16INK4a was found to be statistically significant. Conclusion: p16INK4a expression was significantly higher in neoplastic lesions. p16INK4a staining intensity increases from sporadic to diffuse as disease severity progress from cervical intraepithelial neoplasm-1(CIN I) to neoplastic lesions.

141. Comparison of Outcomes of Proximal Femoral Nailing and Bipolar Hemiarthroplasty Techniques in Intertrochanteric Femur Fracture Treatment
Mohammad Rafi Shaik, Veer Abhishek Goud, Srikanth Nara, Srikanth Palthi
Introduction: Intertrochanteric femur fractures are among the most common fractures. Because of mankind’s increasing longevity, the occurrence of these fractures is also increasing. The fourth generation of intramedullary nails, such as gamma nails or proximal femoral nails, are used to treat these fractures. We examined early outcomes and complications in patients with intertrochanteric femur fractures who underwent proximal femoral nailing (PFN) and bipolar hemiarthroplasty (BPH) at a tertiary care hospital. Materials and Methods: The current prospective study was carried out during a two-year period at Dr. Patnam Mahender Reddy Medical College. Our study comprised patients with intertrochanteric fractures who came to our hospital. The study comprised patients over the age of 60 with intertrochanteric fractures. Patients were separated into two groups: those who had bipolar hemiarthroplasty (BPH) and those who had proximal femoral nail (PFN). The functional outcome of both groups was assessed using the Harris Hip scale and various parameters were compared. Result: All the patients were elderly. The most common age group was 71-80 years, the average age for arthroplasty was 77.3   years and PFN was 75.8 years. Females were predominantly affected in both cases. In the BPH group, the right side was involved in 9 (36%) patients and the left side in 11 (64%) patients, and in the PFN group, the right side was in 8(40%) patients and the left side was in 12(60%) patients. Domestic fall accounted for the most common mode of injury in both BPH (85%) and PFN (80%) groups. The average amount of blood lost in BPH cases was 516.66 ml. The average amount of blood lost in PFN cases was 187.33 ml which was statistically significant. The average duration of surgery was 81.4 minutes for the BPH Group, and the average duration of surgery for the PFN Group was 77.58 minutes. The mean Harris hip score at the end of one year for the BPH group was 80.84 and for the PFN group was 74.3. Conclusion: When compared to Bipolar hemiarthroplasty, PFN provides the advantage of shorter surgical time, less blood loss, and shorter hospital stay with no difference in functional outcome.

142. A Study on Association of Early Onset Neonatal Septicemia and Maternal Vaginal Microflora at a Tertiary Care Center in Bihar
Atul Anand, Chandan Kumar, Kumari Jyotsna, Nirmala Kumari
Background: Early Onset Neonatal Septicemia (EONS) is a high neonate mortality and morbidity rate. Learning more about the association between maternal vaginal microbiota and EONS can aid in identifying risk factors and developing preventative measures. This study aimed to investigate the relationship between vaginal microbiota and EONS in a Bihar tertiary care setting. Methods: The institution of tertiary care conducted a retrospective cohort analysis. 250 women diagnosed with EONS from July 2022 to June 2023 and their offspring participated in the study. The microbiota of the maternal vagina was determined using vaginal samples, and EONS was diagnosed using clinical and analytical indicators. The correlation between maternal vaginal microbiota and EONS was analyzed using statistical analyses and software. Results: Approximately 250 mothers and their infants took part in the study. In the vaginal microflora of mothers, Escherichia coli, Streptococcus agalactiae, and Staphylococcus aureus were identified. There was a statistically significant difference (p <0.05) in the prevalence of specific bacteria between mothers whose neonates’ developed EONS and those whose infants did not. The vaginal microbiota of mothers whose neonates were diagnosed with EONS contained Escherichia coli in most cases (45%). Streptococcus agalactiae (30%) and Staphylococcus aureus (25%) were also discovered to be prevalent bacteria. Escherichia coli was also associated with an increase in the incidence of EONS (odds ratio = 2.5, 95% confidence interval: 1.2-5.4, p = 0.02). Conclusion: According to this study, Escherichia coli, Streptococcus agalactiae, and Staphylococcus aureus are significantly linked to early-onset neonatal septicemia at the tertiary care center in Bihar. These findings highlight the necessity of detecting and treating maternal colonization with these organisms to reduce the risk of EONS in infants. Implementing therapies aimed at preventing and managing maternal vaginal microbiota colonization may result in improved newborn health outcomes and reduced EONS burden.

143. Prevalence of Osteoporosis in Adult Populations Visiting A Tertiary Care Hospital in Central India: An Observational Cross-Sectional Study
Vardhan Ladiwala, Sushil Mankar
Introduction: According to WHO, Osteoporosis is defined as a “disease characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”. It is a condition of multifactorial etiology. Worldwide, it is estimated that 1 in 3 women above the age of 50 will experience osteoporotic fractures, as well as 1 in 5 men. Around 50 million people in India are either osteoporotic (T-score lower than-2.5) or have low bone mass (T-score between-1.0 and-2.5). Materials and Methods: A total of 325 adult patients visiting the OPD of Lata Mangeshkar Hospital, Digdoh were screened using an Ultrasound Densitometer scan done at the wrist. Patients were segregated on the basis of age primarily with 40 years being the mean. They were given a questionnaire which included 6 factors that had a correlation with osteoporosis- namely menopause, age, smoking, alcohol consumption and diabetes. Results were analysed and categorised based on age groups and various causative factors. They were graded as follows: A T score from -1.1 to -2.5 as osteopenic, A T score More than -2.5 as osteoporotic. Results: Out of our patient base of around 325 patients, around 201 were osteopenic (61%), around 62 were osteoporotic (19%). Age above 40 years, smoking, and menopause and alcohol consumption showed significance in relation to the occurrence of osteoporosis/osteopenia. Out of the 34 patients who consumed alcohol, 9% of patients had osteoporosis and 82% had osteopenia. 50.5% of menopausal women s had osteoporosis. 86% of smokers developing the condition and its precursor.

144. Lackness in Identifying Severe Acute Malnutrition by Using Mid Upper Arm Circumference as Stand Alone Marker
Thenmozhi M., Vasanth T.M., Kanimozhi K.
Objective: To identify severe acute malnutrition by using mid upper arm circumference alone as per WHO cut offs. Methods: Cross sectional study conducted at Institute of Child Health and Hospital for children and ICDS centres, Chennai district for the period of one year from 2020 to 2021. Results: Among 1432 screened children 531 babies found to be severe acute malnutrition as per WHO Z Scoring. Among them 154 have less than 11.5 cms. It found to have low sensitivity of 28.63% and specificity of 99.78%. The positive predictive value was 98.7% and the negative predictive value was 70.34%, with an accuracy of 73.39%. Conclusion: MUAC alone cannot be taken as indicator of severe acute malnutrition, 29%SAM only can be identified by MUAC in this study. The sensitivity of mid upper arm circumference can be improved by increasing cut –off values.

145. Spectrum of Infections and Antibiotic Susceptibility Pattern of Pseudomonas aeruginosa in a Tertiary Care Hospital
Jayanta Debnath, Anup Saha, Swarupa Chakma, Nabaneet Majumder, Sourabh Das
Background : Pseudomonas aeruginosa can cause serious nosocomial and community acquired infections with limited therapeutic options due to their intrinsic resistance to several antibiotics and rapid development of multiple drug resistance mechanisms. This study aims to determine the infections caused by Pseudomonas aeruginosa and analyze the antibiotic susceptibility pattern to establish the current therapeutic options. Materials and Methods: The study was conducted on 166 strains of Pseudomonas aeruginosa isolated from various clinical samples. Isolation and confirmation of the organism in culture was performed using standard microbiological techniques. The antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method. Results: The predominant infections caused by Pseudomonas aeruginosa included Pneumonia (52.4%) followed by Urinary tract infection (28.9%). All isolates were sensitive to Colistin. Other effective antibiotics against Pseudomonas aeruginosa were Imipenem (80.7%), Meropenem (78.9%), Piperacillin tazobactum (77.7%) and Netilmicin (72.9%). The isolates were mostly resistant to fluoroquinolones and Antipseudomonal Cephalosporins. Multidrug resistance were observed in 34.3% isolates. Conclusion: Lower respiratory tract infection and urinary tract infection were the common infections caused by Pseudomonas aeruginosa. Piperacillin tazobactum and/or Netilmicin may be considered for empirical treatment of suspected infection. Use of carbapenems and colistin may be restricted to multidrug resistant strains causing serious infections and those resistant to all other classes of antibiotics. Definitive treatment should be based on the culture and sensitivity test results only.

146. Comparative Effectiveness of Knee Arthroscopy Versus Intra-Articular Platelet Rich Plasma Injection for Osteoarthritis of the Knee: A Randomized Study
Neeraj Agarwal, Amisha Agarwal Ostwal
Objective: The objective of this randomized study was to compare the efficacy of osteoarthritis knee arthroscopy and intra-articular platelet-rich plasma (PRP) injection in the treatment of osteoarthritis of the knee. Methods: Forty patients diagnosed with osteoarthritis of the knee were randomly assigned to two treatment groups: arthroscopy (n=20) and PRP injection (n=20). The arthroscopy group underwent a minimally invasive surgical procedure to remove damaged cartilage and smooth joint surfaces, while the PRP group received intra-articular injections of autologous platelet-rich plasma. Pain scores, functional outcome measures, and radiographic evaluations were recorded at baseline and at 3 months, 6 months, and 12 months post-treatment. Results: Both treatment groups improved pain scores and functional outcomes over the study. The arthroscopy group had a mean VAS pain reduction of 45% (± 10.5) at three months, while the PRP group had 38% (± 9.7). This difference was insignificant (p=0.14). At 6 months, arthroscopy reduced pain by 58% (± 12.3) and PRP by 51% (± 11.2) (p=0.26). The arthroscopy group had a mean pain reduction of 62% (± 13.8) at 12 months, while the PRP group had 56% (± 12.4) (p=0.35). Both groups improved functional outcome measures at each follow-up. At 3 months, the arthroscopy group had a greater knee ROM increase (38° ± 8.2) than the PRP group (30° ± 7.6) (p=0.04). At 6 and 12 months, knee ROM did not differ significantly between groups (p>0.05). Radiographs showed no significant differences in joint space narrowing or cartilage thickness between treatment groups at any time (p>0.05). Conclusion: Both osteoarthritis knee arthroscopy and intra-articular platelet-rich plasma injection were found to be effective treatment options for osteoarthritis of the knee. While arthroscopy demonstrated a greater improvement in knee range of motion at 3 months, no significant differences were observed between the two groups in terms of pain reduction, functional outcome measures, or radiographic evaluations at any other time points. These findings suggest that PRP injection could be a viable alternative to arthroscopy in selected patients, considering its non-invasiveness and potential for fewer complications. Further studies with larger sample sizes are warranted to confirm these results and investigate long-term outcomes.

147. Know the Correlations of Various Risk Factors with Acute Myocardial Infarction and its Angiographic Profile in Young Adults’ Patients
Jitendra Satpute, Sandeep Kumar Jain, Balwant Singh Patle, Vishal Rastogi
Background: Acute myocardial infarction (AMI), commonly known as heart attack, is a critical cardiovascular event associated with significant morbidity and mortality. Traditionally considered a disease of older individuals, AMI is increasingly affecting young adults, raising concerns about its epidemiology, risk factors, and angiographic characteristics in this age group. Recent shifts in lifestyle, dietary habits, and environmental factors may be contributing to this phenomenon. Despite this emerging trend, there is limited research comprehensively exploring the correlations between various risk factors and the angiographic profile of AMI specifically in young adult patients. This study seeks to bridge this knowledge gap by conducting a thorough analysis of risk factors and angiographic findings in young adults diagnosed with AMI, providing essential insights that can inform preventive strategies and improve clinical management for this unique patient population. Aim and Objective: This study aimed to investigate the correlations between various risk factors and the occurrence of acute myocardial infarction (AMI) in young adult patients, while also assessing the angiographic profile of AMI cases in this specific population. Materials and Methods: An analysis was conducted on a cohort of young adult patients (age range: 18-40 years) diagnosed with AMI. Data from medical records, angiographic reports, and risk factor assessments were collected for each patient. Risk factors assessed included smoking status, family history of cardiovascular diseases, hypertension, dyslipidemia, diabetes mellitus, obesity, sedentary lifestyle, and substance abuse. Angiographic profiles were evaluated to determine the extent and severity of coronary artery involvement. Results: A total of 89 young adult patients with AMI were included in the study. Among the assessed risk factors, smoking status emerged as the most prevalent risk factor, followed by family history of cardiovascular diseases and sedentary lifestyle. Conclusion: This study sheds light on the correlations between various risk factors and AMI occurrence in young adult patients. The findings suggest that smoking, family history of cardiovascular diseases, and sedentary lifestyle may significantly contribute to the incidence of AMI in this age group. Furthermore, the angiographic profile of AMI cases in young adults provides valuable insights into the nature of coronary artery involvement in this population.

148. A Comparative Study of Prevalence of Hypertension among Tobacco Consumers in Adults of Rural and Urban Field Practice Area of a Private Medical College and Hospital, Bangalore
Krithika T T, Balwant Singh Patle, Sandeep Jain, Vidya G S
Background: According to WHO, tobacco kills more than 1 million people each year in India, accounting for 9.5% of all deaths. The death toll is increasing, as the estimated 1 million tobacco-related deaths in India in 2018 compares to about 930,000 adult deaths in 2010. Smokeless tobacco has made a resurgence in the United States and other developed nations since the 1970s. Because of vigorous efforts toward increasing awareness of the adverse effects of tobacco, smoking has declined consistently over the last 30 years; paradoxically, the use of “snuff” and smokeless tobacco has greatly increased. Aim and Objective: To estimate the Prevalence of Hypertension and the risk factors associated among Tobacco consumers in adults of the Rural and Urban field practice area of RajaRajeswari Medical College and Hospital (RRMCH), Bangalore. Materials and Methods: A Cross Sectional study was conducted on 675 Rural subjects (18 years and above) and 500 Urban subjects (18 years and above) during January 2019 to June 2020 through multistage sampling method. The participants were interviewed using a pretested structured standard questionnaire to obtain data on Tobacco consumption, Demographic data, Dietary history, medical history in adults. The data was collected and compiled in MS Excel and analyzed by using SPSS software version 24.0. Results: In this study it is observed that In the Urban study subjects, the association between Tobacco and Hypertension consumption was significant with Chi-square (X2) =  11.1; DF = 2; p = < 0.05. Conclusion: We should note that tobacco smoking is also one of the main preventable causes of hypertension and myocardial infarction. The long-term effects of smokeless tobacco use on blood pressure levels seem to differ depending on the user’s age and level of physical activity and on the amount of different forms of tobacco used.

149. Bacteriological Profile of Urinary Tract Infection in Paediatric Age group along with their Antimicrobial Susceptibility Pattern
Gopal Koli, Govind Ninama, Kunjal Vaja, Bithika Duttaroy
This study was conducted in Microbiology Department, government medical college, Baroda, Gujarat between January 2022 to December 2022.clean catch, midstream and suprapubic aspiration of urine sample were inoculated on CLED agar and incubated The significant growth of pathogenic bacteria were subjected to antibiotic susceptibility testing. Drug Susceptibility test was done by Kirby -bauer disc diffusion test. Result was determined as per CLSI guidelines. Result: A total of 644 urine sample were obtained from pediatric patients suspected having Urinary tract infection. Significant Growth was observed in 208(32%) sample. Male to female ratio was 1:1.Gram negative isolates were 188(90.38%),of which Escherichia coli      112(53.85%) being the predominant pathogen, followed by Klebsiella spp. 66 (31.73%). Gram positive isolates constituted 20(9.61%) among them Coagulative negative Staphylococcus, 01(0.48%) were isolated. Escherichia coli showed highest resistance to Nalidixic acid (91.96 %), followed by Cefotaxime (88.39%), Cefuroxime (49.11 %). E.coli showed least resistance to Fosfomycin(5.35%%). Conclusion: E.coli is major  cause for Urinary tract infection in paediatric age group. Suspected case should be treated with fosfomycin as its higher sensitivity against most pathogens.

150. Seroprevalence of Dengue at a Tertiary Care Hospital, Vadodara Gujarat
Gopal Koli, Kunjal Vaja, Govind Ninama, Bithika Duttaroy
Background: Dengue is one of the most serious mosquito borne viral infection mainly affecting tropical and subtropical countries of the world. In absence of specific treatment and vaccine for dengue fever (DF); vector control is the only method by which the spread of dengue can be prevented. Aims & Objective: This study was conducted to report the prevalence of Dengue virus infection in Department of Microbiology, Medical College Baroda, Vadodara, Gujarat, India. Material and Methods: Study was performed at a Department of Microbiology, Medical College Baroda, Vadodara from Jan2022toDec 2022. Patients attending SSGH Hospital & Medical College Baroda,  for suspected dengue were tested. Blood samples collected in plain tubes were tested for dengue IgM antibodies and NS1 antigen by Dengue IgM capture enzyme linked immune sorbent assay and Dengue Early ELISA respectively. The laboratory records were analyzed for demographic features and seasonal variations. Descriptive statistics were  used. Data were expressed in proportions. Results: Out of total 8204 serum samples tested, 927 were found positive for dengue virus infection. 60% positive samples were of male patients and 82% positive samples were from 18 to 35 years age group (Adult population) . Seasonal trend showed a gradual increase in dengue positives started from August with a peak in October (37%). Conclusion: Dengue has established its transmission in urban and semi-urban areas of Vadodara, Gujarat with predominantly affecting males and active adult population. Virus activity is high during monsoon and post monsoon period which coincides with increased vector breeding. This study thus emphasizes the need for continuous epidemiological surveillance for the timely formulation and implementation of effective dengue control programme.

151. Morphometric Study of the Lateral Ventricles of Brain by Imaging Using Computerized Tomography
Jesin Elsa Jose, Manju Madhavan C., Girija Kumari K
Introduction: The human brain has four connected ventricles which form the ventricular system of brain – two lateral ventricles, a third ventricle and a fourth ventricle. Knowing the normal measurements of the cerebral ventricles in the living human has great significance in diagnosing and monitoring several pathologies. The aim of the present study is to determine the average dimensions and variations of the different parts of the normal lateral ventricles of brain by imaging using Computerized tomography. Materials and Methods: The study was conducted by the Department of Anatomy in association with the Department of Radiodiagnosis, Government Medical College, Thiruvananthapuram. A total of 200 CT brain of individuals which included 100 males and 100 females, in the age group 10 – 90 years, with normal radiological findings, were taken for the study. Results: The measurements of the different parts of the lateral ventricle, except inferior horn, were more in males compared to females and more on the left side than right side. Measurements of the inferior horn showed that the transverse diameter was more in females than males on both the sides. Height of inferior horn was found to be 0.23 mm more on the right side in males and 0.12 mm more on the right side in females. Conclusion: From the present study, the different parts of the left lateral ventricle was found to be larger than the right side in both genders. The size of the ventricular system was seen to be varying with age, that is, it increased with an increase in age. This study has defined the morphometric measurements of the different parts of the lateral ventricles of brain by CT scans in South Kerala population. This can be useful to many clinicians and would aid in the diagnosis and management of many neurological conditions.

152. Functional Outcome of Dorsolumbar Fractures Treated with Short Segment Stabilization Including Fractured Vertebra: A Prospective Observational Study
T.C. Premkumar, S. Rajasekaran, M.F. Mohamed Rifan
Spinal fractures are the major cause of disability in adult population. They are common due to high frequency of motor vehicle accidents and occupational injuries. The mortality rate following spinal injuries is 7%. The aim of the study is to assess the functional and radiological outcome of fractures of dorsolumbar spine treated with short segment posterior stabilization with fractured body pedicle screw fixation. Methods: Dorsolumbar fractures with intact pedicle on the fractured segment with Load sharing classification score of equal or less than 5, Loss of vertebral height less than 50%, khyposis angle more than 20 degrees and neurological involvement are included in the study. Patient with multiple level fractures and pathological fractures are excluded from the study. AO classification and Denis classification were used. Load sharing score is used in Decision Making For Fracture Body Screw Fixation. Results: L1 is the most common fracture involved followed by D12. AO distraction types and Denis burst types are the most common types. Among the 30 patients, 5 patient had complete neurological deficit, 15 patients had incomplete deficit and 10 patients without neurological deficit. None of the patient developed loss of correction in the follow up period. Outcome using Ronald Morris questionnaire was excellent in 65.2% cases good in 24.3% cases and poor in 10.5% cases. Conclusion: To conclude short segment posterior stabilization with fractured body screw fixation provides better biomechanical stability when compared with conventional short segment stabilization.

153. Comparative Study of Efficacy of Bupivacaine with or without Clonidine in Ultrasound Guided Ankle Block in Patients Undergoing Foot Surgeries
Chandru C, Sudhakar D S, Sivaprasath S, Prem Kumar K G
Lower limb surgical procedures can be performed under General anaesthesia, Sub arachnoid blockade and Peripheral nerve blockade. Peripheral nerve blocks are widely accepted as the gold standard for ambulatory limb surgeries. The advantage of operating under regional anaesthesia can outweigh the hazards of general anaesthesia. The aim of this study is to compare the efficacy of Bupivacaine with or without Clonidine in Ultrasound guided ankle block in patients undergoing foot surgeries. Study Design: Many adjuvants have been tried to enhance the analgesic efficacy of local anaesthetics in peripheral nerve block. From previous studies, it was noted that α2 agonists added to local anaesthetics had produced prolonged analgesia in ankle block. Hence, in our study, we have compared a group of patients who received 0.25% Inj.Bupivacaine alone with the other group of patients who received the combination of 0.25% Inj.Bupivacaine and Inj.Clonidine. Onset of sensory blockade of each nerve, hemodynamic characteristics, duration of post- operative analgesia and time for first rescue analgesia were observed. SPSS 26 Version was used for descriptive, analytic and comparative statistics. Result: There was no statistically significant difference in onset of sensory blockade in both the groups. The duration of post-operative analgesia and the time to first rescue analgesia were prolonged in clonidine group. Conclusion: The results showed that clonidine had prolonged the duration of post-operative analgesia and the time to first rescue analgesia when added to bupivacaine in ankle block in patients underwent foot surgeries.

154. To Determine Whether the Depth of Invasion is a Reliable Parameter for Predicting Regional Lymph Node Metastasis in Cases of Oral Squamous Cell Carcinomas
Vasa Labdhi, Vaghela Hiren, Jawarkar Ashish, Hiryur Premnath
Objective: To determine the relationship between depth of invasion and neck node metastasis in squamous cell carcinoma of the oral cavity. Material and Methods: This was a cross-sectional retrospective study. Histopathology reports from patients who underwent neck dissection and oral squamous cell carcinoma surgery were analyzed. A total of 60 cases were studied. In each example, the depth of invasion was measured microscopically up to the point of maximum invasion. Histologically, the lymph nodes were checked for the existence of metastatic cells. Results: This study showed no statistical significance between depth of invasion and regional lymph node metastasis (p > 0.05). Conclusion: Depth of invasion might be an essential criterion for staging and determining the further management, but it is not a predictor for lymph node metastasis. According to our study, further research on this matter is advisable.

155. Study of Swine Origin Influenza A H1N1 Virus Infection in Maharashtra Population: A Prospective Approach
Shirish Dnyandeo Chavan, Nitin S. Chitte
Background: The influenza pandemic occurred when a novel influenza virus with surface antigen hemagglutination (HA) and/or neuramidase (NA), to which the majority of humans have little or no pre-existing immunity, emerged in humans and was able to be transmitted efficiently from person to person. Method: 40 patients above 18 years of age who presented RT-PCR positives were studied. The hematalogical exami-nations included CBC, Hb%, S-creatinine, SGOT, SGPT, PH, and arterial blood gases Fi02 and Pa02. A chest x-ray with blood and urine cultures were also studied to confirm the severity of the H1N1 infection. Results: Clinical manifestation revealed 38 (95%) cough and fever, 25 (62.5%) had fever, and 23 (57.5%) had tachy-cardia and tachypnoea on auscultation. 12 (32.5%) had breathlessness; 9 (32.5%) had a sore throat; 19 (22.5%) had bodyaches; 3 (7.5%) had vomiting; 5 (12.5%) had diarrhoea; and 33 (82.5%) were fatigued. Co-morbidity was 8 (20%) type-II DM, 7 (17.5%) CKD, and 3 (7.5%) immune suppressed. Radiological observations showed that 18 (4.5%) had pneumonia, 13 (32.5%) had respiratory failure, 6 (15%) had ARDS, 10 (20%) patients were admitted to the ICU, 30 (75%) were non-ICU and non-invasive mechanical ventilation, and laboratory findings were 6 (15%) anaemic, 12 (30%) had leucopenia, 4 (10%) had thrombocytopenia, 8 (20%) had renal dysfunction, and 8 (20%) had reduced levels of SGPT. Elevated PH, Fio2, and Pio2 were observed in ICU-admitted positive patients and mortality cases were 11 (27.5%). Conclusion: A present pragmatic study of swine-origin influenza A H1N1 virus infection is pandemic, causes severe illness, and causes complications in patients with co-morbidities like type II DM, CKD, and immune suppressive patients. Hence, the present study will be helpful for clinicians to treat such patients efficiently to avoid morbidity and mortalities.

156. Study of Malignant Breast Tumours in Women of Telangana
S. Rama Devi, R. Ranjana
Background: Breast tumours create panic in patients and whole family members because the majority of breast tu-mours are diagnosed as malignant; hence, early and proper diagnosis can prevent morbidity and mortality; hence, an ideal diagnosis is mandatory in females of every age group. Method: 430 women aged between 20 and 60 years who were histo-pathologically diagnosed were studied immune histologically. ER, PR, and HER parameters were analysed to evaluate the grades of malignant tumours. Results: Out of 430 malignant breast tumours, 310 (72.09%) were IDC, followed by 24 (5.58%) mucinous CA, 16 (3.72%) papillary CA, and 16 (3.72%) malignant stromal tumours, which were signature findings. 166 (38.6%) were grade-I IDC, 154 (35.8%) grade-II, 77 (17.9%) grade-III, and 33 (7.67%) were un-graded tumour grading v/s ER and PR had a significant p value (p<0.001). Conclusion: The present pragmatic studies show a significant correlation between tumours and ER, and PR positive status is a valuable biomarker as it indicates prognostic information for an ideal therapeutic decision.

157. Assessment of Left Ventricular Function after Elective Percutaneous Coronary Intervention in Patients with Coronary Artery Disease with Compromised LV Function
Pawan Sarda, Shoaib Mehboob, Ankur Kumar, Anil Baroopal, Rohit Mathur
Objective: The objective of this study was to evaluate the extent of improvement in left ventricular (LV) function following elective percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD) with compromised LV function. Methods: A total of 104 patients with CAD with compromised LV function were enrolled in this prospective study. Baseline characteristics, including LV ejection fraction (LVEF) and LV diastolic dysfunction (LVDD) grades, were recorded. All patients underwent elective PCI within a specific timeframe following the index event. Follow-up assessments were conducted at 3- and 6-months post-PCI to evaluate changes in LVEF and LVDD grades. Data analysis included descriptive statistics and comparison of mean values. Results: The majority of patients underwent PCI on the Left Anterior Descending artery (LAD) (44.23%), followed by the Right Coronary Artery (RCA) (24.03%) and the Left Circumflex artery (LCX) (15.38%). In Group 1 (LVEF <30%), significant improvement in LVEF was observed from baseline (23.5%) to 3 months (30.5%) and 6 months (32.16%). In Group 2 (LVEF 30-40%), LVEF improved from baseline (33.7%) to 3 months (40.2%) and 6 months (42.16%). The prevalence of LVDD decreased over time, with improvements observed in LVDD grades. The timing of intervention showed a positive correlation with the degree of LV function improvement. Conclusion: Elective PCI in patients with CAD and compromised LV function leads to significant improvements in LVEF and LVDD. Patients with severe LV systolic dysfunction showed substantial improvement within the initial 3 months, while those with moderate dysfunction displayed continued improvement over 6 months. Early intervention from the index event was associated with greater improvement in LV function. These findings emphasize the benefits of timely elective PCI in optimizing LV function and warrant consideration in clinical decision-making.

158. Prospective Study of Surgical Site Infections in the Department of General Surgery at Government General Hospital, Srikakulam, Andhra Pradesh
M. C. Venkateswarlu, P. Ashok, M. Ravichandra
Introduction: Surgical site infection is a common post-operative problem causing significant post-operative morbidity and mortality, prolonged indoor stay and adds between 10% and 20% to hospital cost. In India, rate of surgical site infections in various set-ups had been reported to be 4.2-21%. Current study aimed to record the incidence of surgical site infection in present set up in both elective and emergency cases and to assess the possible risk factors and analyse the measures to prevent surgical site infection. Material and Methods: The present prospective study was conducted in the Government General Hospital, Department of General Surgery, Government Medical College, Srikakulam, from 1July 2022 to June 2023 to determine the incidence of surgical site infections and to assess the risk factors associated with the surgical site infections. Samples were processed for microbial flora and antibiotic sensitivity. Results: Incidence of surgical site infections in present study was 13%. In elective surgeries it was 7.1% while in emergency surgeries it was 26.7%. Incidence was higher in patients with diabetes, smokers and obese patients. Highest incidence was present in dirty wounds. Incidence was lower in patients who have shorter pre operative hospital stay and underwent surgery for shorter duration. In most of the cases surgical site infections occurred on post-operative day 7. Patients with SSI had longer mean duration of hospital stay as compared to those who did not have SSI. Staphylococcus aureus was the most common organism isolated followed by E. Coli. Conclusion: We reported a significant association of SSI with type of procedure (open and emergency), diabetes, obesity, smoking, duration of preoperative hospital stays, ASA physical grade, duration of surgery, duration of drains and type of wound according to wound classification.

159. Analyse the Efficacy of Pipelle Biopsy in Diagnosing the Causes of Abnormal Uterine Bleeding – Endometrial Disease
Sonal Kulshreshtha, Niharika Pandey, Megha Bandil, Vaishali Singh
Introduction: Abnormal uterine bleeding (AUB) is a common condition affecting a significant number of women. It is crucial to identify the underlying causes of AUB, particularly endometrial disorders, as they can lead to serious complications. Endometrial sampling, such as the Pipelle biopsy, is a widely used and effective diagnostic tool for evaluating AUB. Objective: The objective of this study was to analyze the efficacy of Pipelle biopsy in diagnosing the causes of abnormal uterine bleeding, specifically endometrial disease. Materials and Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynecology, Kamla Raja Hospital, Gwalior (M.P.). The study included 100 women aged over 30 years or presenting with postmenopausal bleeding. The Pipelle biopsy procedure was performed, and clinical features, ultrasound findings, and histopathology results were analyzed. Results: The study participants were divided into age groups, with the highest number of individuals experiencing abnormal uterine bleeding in the 40-49 years age group. Obesity was found to be associated with a higher risk of abnormal uterine bleeding. Pipelle biopsy findings revealed that proliferative endometrium was prevalent in obese participants, while secretory endometrium was more common among overweight participants. Obesity was identified as a risk factor for various endometrial pathologies. Conclusion: This study highlights the importance of age and body mass index (BMI) in the evaluation of abnormal uterine bleeding. Pipelle biopsy was effective in diagnosing endometrial diseases associated with AUB. The findings emphasize the need for considering age and BMI when assessing the causes of abnormal uterine bleeding and highlight the role of Pipelle biopsy as a valuable diagnostic tool in gynecological practice.

160. Paravertebral Block versus Sub Arachnoid Block for Inguinal Hernia Repair: A Tertiary Care Experience
Lakshmi Deepthi Davuluru
Background: This study aimed to assess the effectiveness and safety of unilateral paravertebral block (PVB) as the primary anesthetic technique for inguinal hernia repair, as it is currently not widely utilized even by experienced practitioners. The study sought to compare PVB with subarachnoid block (SAB) anesthesia for these procedures, both of which can be employed alongside general, regional, and peripheral nerve block anesthesia to ensure satisfactory anesthetic conditions during surgery. Methods: Patients were selected from elective inguinal hernia surgeries in our hospital. Group I Paravertebral block (20 patients) received ipsilateral Paravertebral block from T10 to L2, where 5ml of bupivacaine (0.5%) with 1:400,000 epinephrine was administered at each segment. On the other hand, Group II (20 patients) received a Subarachnoid block with 12.5ml of hyperbaric bupivacaine (0.5%). Results: The Visual analog scale was evaluated in the two groups of patients at different intervals of time as depicted in Table 3. The mean overall values of group I paravertebral block have a reduced range over a time period as compared to group II Subarachnoid block and were found to be statistically significant. Rescue Tramadol was administered only after 24 hours in both types of blocks. When we compared the total rescue analgesic used in the two groups, it was notably lower in group I as compared to group II although this difference did not reach statistical significance, as indicated by a P-value of 0.411. Conclusion: Paravertebral block can be considered a superior and safe alternative to unilateral spinal anesthesia for inguinal hernia repair. It offers advantages such as unilateral and segmental anesthesia, extended postoperative pain relief, early ambulation, stable intraoperative hemodynamics, and minimal side effects.

161. Prolonged QTC Interval as an Indicator of Cardiac Autonomic Neuropathy in Diabetes Mellitus Patients
Bhuvaneswari T, Suresh Kumar Sukumaran, Padmasini Baskaran, Ashok SampathKumar
Introduction: Due to its high risk of cardiac arrhythmias and sudden death from silent myocardial ischaemia, CAN is a significant source of morbidity and mortality in diabetes individuals. Numerous studies have shown that the electrocardiogram’s corrected QT interval (QTc) prolongation is a specific, quick, and reliable way to identify cardiac autonomic neuropathy. The objective of the current study was to assess the relationship between the QTc interval and diabetic cardiac autonomic neuropathy. Material and Methods: Between April 2020 and March 2021, 60 patients with type 2 diabetes mellitus who met the inclusion and exclusion criteria were studied. The patients underwent five cardiovascular autonomic function tests as described by Ewing et al, and they were classified according to Ewing’s criteria. The QTc interval was computed using Bazett’s formula. Results: Out of 60 type2 Diabetic patients, CAN was found in 35 (58.3%) patients. Early CAN was seen in 54.3%, Definite CAN in 28.6%, and Severe CAN in 17.1% patients. Patients with CAN had a mean QTc458 ± 12.8 ms, whereas patients without CAN had a mean QTc407 ± 11.8 ms which was statistically significant (p<0.05). Conclusion: Early detection of CAN aids in the prevention of cardiovascular disease-related mortality and morbidity.  In diabetic patients, the prolonged QTc interval is a relatively simple, fast, and reliable indicator for identifying CAN.

162. A Cross Sectional Study of Clinical Spectrum and Diagnostic Efficacy of Dermoscopy in Scalp Dermatoses at A Tertiary Care Centre in Southern Rajasthan
Arushi Jain, Sanjay Meena, Kapil Vyas, Kalpana Gupta
Introduction: In human society, hair and scalp now play an important role in appearance and sexual signalling; original functional roles of protection and heat conservation are secondary and changes in the appearance of skin and hair affect self-esteem and confidence in social settings. Aims: To study the various clinical patterns and dermoscopic findings of scalp dermatoses in adults. Settings and Design: An observational cross-sectional study. Methods and Material: The study was undertaken from 1st January 2019 to 1st June 2020. All adult patients reporting to the Outpatient Department of Dermatology, Venereology and Leprosy, Geetanjali Medical College and Hospital, Udaipur were evaluated for entry into the study and patients having scalp lesions were enrolled. A detailed history of all such patients was taken including general status of the patient, systemic diseases, medication used, precipitating factors such as sunlight, alcohol, smoking, drugs and trauma. Complete clinical and a thorough scalp examination along with dermoscopy was performed. Results: On studying the demographic profile of the patients with respect to the gender we found that out of 350 subjects, female and male comprised of 61.1% and 38.9% of the subjects respectively. Maximum subjects were in the second decade of the life with a mean age 35±10 years.14% followed by 31-40 years (22.86%). Most common scalp lesion was seborrheic capitis 131(37.4%) followed by psoriasis (83)23.7%. Telogen Effluvium, Androgenetic Alopecia and Alopecia Areata was found among 30(8.6%), 29 (8.3%) and27 (7.7%) of the subjects respectively. In dermoscopy findings among the study subjects most common findung is yellow scales with arborizing vessels in 119(34%) patients followed by red dots with silvery scales in 84(24%) and others findings are yellow dots, miniaturised hairs with single hair in follicular ostium, excalamation mark, yellow crusting, cerebreform pattern, peripilar casts, hypopigmented patches, broken hairs, nits, frogspawn appearance were observed. Conclusions: This study emphasizes the fact that many of the common dermatoses can significantly involve the scalp and can have overlapping symptoms and presentation making the diagnosis difficult and dermoscopy is helpful for making diagnosis.

163. A Cross-Sectional Study of Clinical and Etiological Profile of Non-Tubercular Lower Respiratory Tract Infections in Patients with Diabetes Mellitus
Banerjee Pabitra, Ghosh Bijan Kumar, Mitra Subhra
Introduction: Diabetes Mellitus is a major and increasing public health clinical problem. Non-Tubercular Lower Respiratory Tract Infections in Diabetes Mellitus are often misdiagnosed. The present study was therefore conducted to assess the occurrence of Lower Respiratory Tract Infections in Diabetes Mellitus patients and also to impart an effective treatment to those patients. Aims and Objectives: To determine the clinical profile, pathological, and radiological findings of patients of non-tubercular Lower Respiratory Tract Infection (LRTI) in Diabetes Mellitus. Materials and Methods: It was an institution based cross-sectional observational study of 50 patients admitted in the IPD of respiratory medicine, CNMCH, Kolkata(W.B) fulfilling the inclusion and exclusion criteria, from the period between February 2020 to August 2021. Results and Analysis: In our study it was found that males were affected more with LRTIs having DM. The HbA1C level was between 7-10 (%) for most of the patients (68%) and 62% patients had diabetes mellitus for more than 5 yrs. It was also found that 78% patients had cough, 84% had fever. In our study it was found that Klebsiella sp. was the most frequently isolated organism (14%) in sputum samples. 48% patients had lower lobe involvement, 36% patients had consolidation, the final diagnosis being community acquired pneumonia (CAP) of bacterial origin in 34% cases and 14% had COVID pneumonia. Conclusion: Patients with Diabetes mellitus have indeed a very high chance of having non-tubercular lower respiratory tract infections, of both bacterial and viral aetiology and associated morbidity. Klebsiella sp. being the most frequently isolated organism. Bilateral lower lobes of lung are most commonly affected in LRTIs with DM.

164. Stigma and Depression in Patients Suffering from HIV/AIDS
Prashant M Mangla, Chirag K Barot
Introduction: Patients living with HIV/AIDS (PLWHA) are a vulnerable group who are often subjected to discrimination, stigma and have poor social support. This can lead to or worsen depression, resulting in worse health outcome in such population. The aim was to measure the HIV related stigma, severity of depression and their correlation in PLWHA. Materials and Methods: This was an observational cross-sectional study conducted on 100 PLWHA coming to Anti-Retroviral Therapy (ART) Centre of a tertiary care hospital. A semi-structured questionnaire was used for interviewing the patients. HIV related stigma was measured with Berger HIV Stigma Scale and Patient Health Questionnaire – 9 (PHQ-9) was used to screen for and measure severity of depression. Results: 50% of patients scored in moderate range and 50% in severe range of Berger HIV Stigma Scale. Overall HIV related stigma score was high, with mean of 121 and standard deviation 2.11. 39% of the patients screened positive for depression. Mean PHQ-9 score was 7.68 with standard deviation 5.48. There was a positive correlation between overall HIV related stigma and depression (0.457), with highest correlation for negative self-image domain (0.566). Conclusion: PLWHA experience high level of stigma and there is increased prevalence of depression in them. Early diagnosis and treatment of depression is warranted in order to help both the treating physicians and patients in maintaining compliance, improving prognosis and quality of life of such patients.

165. Correlation of Clinical Features and Nerve Conduction Study in Patients of Diabetic Neuropathy
Patel Ravikumar Natvarlal, Abhishek Vashisth, Sanjana Sharma
Background: Nerve conduction studies (NCS) can document the characteristics of the neuropathy (e.g., axonal, demyelinating) and the localization (eg, mononeuropathy versus radiculopathy or distal neuropathy) and, possibly, the severity and even prognosis for morbidity. Aims: The present study was conducted to study the type of neuropathy and correlation between the symptoms of diabetic neuropathy with nerve conduction studies. Material and Methods: It was a hospital based cross-sectional study conducted over a period of one year from January 2017 to December 2018 in department of medicine in collaboration with department of neurology of a tertiary care hospital in Gujrat, India. 50 Diabetic patients age more than 30 years with symptoms of neuropathy were included in the study. Results: Distal symmetrical sensorimotor polyrdiculoneuropathy was the most common neuropathy seen. Autonomic neuropathy, radiculoplexus neuropathy and mononeuropathy were relatively less common. Conclusion: Earlier diagnosis and treatment of diabetes mellitus could have prevented this complication of diabetes mellitus. Hence regular screening for diabetes mellitus should be carried out in the general population especially in people above the age of forty having family history of diabetes mellitus.

166. Perspective Study of Cervical PAP Smears in Females of Telangana
Ranjana. R, S. Rama Devi
Background: The PAP smear cytology technique test is cost-effective, fast, and acceptable for every patient to get diagnosed with various genital infections, including CA of the cervix. Method: 300 females aged between 20 to 80 years with pathology in the cervix of the uterus were studied. Cervical smears were prepared by using a disposable Ayre’s spatula fixed in 95% alcohol, stained by conventional PAP techniques, and interpreted according to the guidelines of the 2001 Bethesda system. Results: Cervical PAP smear and cervical Biopsy histopathological studies had 106 (35.3%) chronic cervicitis in ASSUS, 6 (2%) chronic cervicitis in LSIL, 12 (4%) reportive changes, 16 (5.33%) chronic clervicitis, 16 (5.33%) micro INV Ca, 8 (2.66%) CIN, in the HSIL study, 66 (22%) SSC, and 4 (1.33%) adenocarcinoma in the 330 PAP smear study. Conclusion: The PAP smear is a tool for screening of cervical intra epithelial lesion. It will be useful to Obstetrics and gynecologist, oncologist to treat efficiently to avoid morbidity and mortality in such patients.

167. Resection-Arthrodesis of Knee Joint for Aggressive Giant Cell Tumor of Bone by Intramedullary Nailing with Bone Grafting and Ilizarov Technique for Treatment of Complications Like Post-Operative Infection
Mankar S, Golhar A, Assudani A
Introduction: A benign aggressive tumor of the bone is known as Giant cell tumor (GCT) which occurs in patients aged around 20 to 40 years with slight preponderance in females. Most commonly it occurs at distal femur, proximal tibia and distal radius. Therefore, in this study outcomes of the patients with aggressive GCTs of the bone surrounding the knee joint along with patients having deep post-operative infection who were treated with ilizarov technique are reported. Method: An observational retrospective study involving database that was scanned from 1993 to 2021 to identify the patients who underwent resection arthrodesis in aggressive giant cell tumor was done. Twenty six patients were found who were treated with resection and arthrodesis involving 17 female patients and 9 male patients. Results: 21 out of 26 patients had proximal union, or AD, and were able to bear full weight within 6 to 10 months. After removal of the implant and infected bone grafts with the IT, five patients with profound infection were treated as patients of infectious non-union with bone defect. Four out five such patients united completely achieving bony AD at knee joint. One patient had non-union and shortening of more than 2.5 cm. The functional assessment performed using a modified version of the Musculoskeletal Tumor Society (MTS) system, demonstrated range of functional score between 20 to 26 out of 30. The five patients treated with IT were evaluated with Association for the study and application of methods of ilizarov (ASAMI) scoring system and also with modified system of MTS. Conclusion: The present study concludes that healing rate was better in patients who underwent knee joint resection and AD. Additionally, the post-operative infection rate was very less as compared to other studies.

168. Outcomes of Infected Non-Union of Femur Treated with Ilizarov Method and Limb Reconstruction System: Retrospective Case Study Series
Mankar S, Assudani A, Sakhare R
Introduction: Several surgical techniques are documented for treating Non-union (NU) of long bone. Due to numerous coexisting complications, infected NU of the femur is prevalent. All of these challenges can be resolved with the Ilizarov Method (IM) as it is reliable, versatile and effective in management of NU of long bones hence, this study was carried out to understand outcome of IM in central Indian population. Method: A retrospective observational study was commenced by scanning the database after January 1998 to January 2022 for identifying the patients who had infected NU of femur with shorting paley type B and were treated by Ilizarov method means. Results: The IM of ring fixator was used in eight patients and Limb Reconstruction System (LRS) was used in three patients. Bone union was achieved in 90.9% of patients. A mean bone gap of 6.7 cm, mean external fixator (EF) time of 8.981 months and mean EF index of 1.479 months/cm was observed. The complications mainly involved significant shortening, stiffness of knee, refracture and remenant NU (9%). When patient outcomes using Association for the study and application of methods of ilizarov (ASAMI) scoring system were evaluated the bone results were excellent in 9 patients (81.81%) and poor in 2 patients (18.18%) whereas, functional results were excellent in 2 patients (18.18%), good in 7 patients (63.63%), and poor in 2 patients (18.18%) in the present study. Conclusion: IM and LRS are good salvage procedures for infected NU of femur. Therefore, as long as the limb is functional, sufficiently innervated, and the patient is motivated to the psychological and financial requirements of this treatment, limb salvage is favoured.

169. Study the Level of Glycosylated Haemoglobin in Lower Limb Diabetic Ulcer in Tertiary Care Hospital
Rahul Sontode, Satish Bhasale, Manohar Kadam
Background: Diabetic patients are at increased risk for developing foot ulcers, which, if left untreated, can lead to neuropathy and vascular insufficiency, both of which can have devastating effects on the patient’s quality of life. Objective: To study relationship between HbA1c levels and lower limb diabetic ulcer. Methodology: The present prospective study was carried out at Department of Surgery of tertiary care centre during November 2021 to October 2022. A total of 50 patients with diagnosed type II DM and diagnosed diabetic foot ulcers were included in the study. Data was collected at presentation using proper history, thorough examination of patient, limb and ulcer, HbA1c assessment as well as duplex arterial sonography of lower limb. Grading of ulcer was done by Wagner Classification. Results: The mean age among the distribution of cases was 56.29 ±10.92 years with male dominance. (64%) The maximum numbers of cases had Grade 3 diabetic ulcer (42%) The relation of grade of diabetic foot ulcer and HbA1c shows HbA1c has a linear relationship with the grades of Wagner classification of diabetic foot. Conclusion: The HbA1c can be used as a screening tool in the high-risk diabetic patients for the diabetic foot to predict its occurrence.

170. The Role of Biomarkers in Diagnosis and Risk Stratification for COVID-19 Deterioration, Death
Prabhjot Kaur, Sukhraj Kaur, Sukhwinder Singh, Arti Gupta
A Retrospective observational study was done to identify role of laboratory biomarkers in diagnosis and risk stratification for COVID-19 deterioration, death in a tertiary care hospital. A total of 70 COVID-19 patients were included in the study after having applied inclusion and exclusion criteria. Two groups were made survival (40) and non-survival (30). Maximum number of non–survival were in the age group of 66-75 years (33.33%). This study investigate role of Laboratory biomarkers- LDH, Ferritin, D Dimer, PCT, IL6, Urea, Creatinine, SGOT, SGPT that were significantly raised in non-survival COVID-19 patients. Assessing and monitoring the laboratory biomarkers of LDH, FERRITIN, DDIMER, PCT, IL6, UREA, CREATININE, SGOT, SGPT at the earliest stage of the disease could have considerable role in halting disease progression and death.

171. Insights of Medical Students and Faculty on e-learning Biochemistry in MBBS during COVID-19 Pandemic
Murugan S, Vishal Babu GN, Deepak KS
Background: Studying Biochemistry is most important in MBBS course because of its play a vital role in diagnosis and treatment of human diseases. Due to covid-19, all institutions instructed the students to go to their houses and all classes were shifted to online learning mode. In order to fulfil the educational needs of the medical students, teachers adopted using online teaching platforms.  Previous published articles showed the positive and negative perception of online learning medical subjects but not in any particular subjects. So, this study was done to determine the strength and weakness of online learning of biochemistry among the medical students and faculties. Methods: After getting approval from the Institutional Research Committee, the study was carried out among the undergraduate MBBS students and faculty members. Study was based on MCQ based questionnaire and distributed to both students, faculty members and was asked to answer with a single most appropriate response and any suggestion if present. Results: Totally 175 medical students and 20 faculty members participated in questionnaire survey. A majority of students opined that the lectures class were informative, interesting, but 90% of the students and faculty felt was not effective (p<0.005) and expecting offline class. Many problems such as technical issues, no interaction with faculties and friends, unable to clarify the doubts, not satisfied with practical class (p<0.001) and more involvement in social media activities during online class was seen by students. So, they were having additional stress on their examination results and future is maybe affected. Conclusion: From the study it was observed that majority of the students and faculties had negative perception and felt that e-learning of biochemistry subject was not useful.

172. Prevalence of Pulmonary Hypertension in Patients of Chronic Kidney Disease in Western Rajasthan: A Cross Sectional Study
Jitendra Falodia
Chronic kidney disease (CKD) includes a spectrum of pathophysiologic processes associated with abnormal kidney function and progressive decline in glomerular filtration rate (GFR). Hospital based cross-sectional study was conducted on 100 diagnosed cases of CKD (according to different stages based on GFR) and age more than 18 years. All data collected and analyzed by SPSS software. Prevalence of pulmonary hypertension in CKD patients was 15.00%.46.67% patients were mild, 40.00% patients were moderate and 13.33% patients were in severe pulmonary hypertension group.  The association between pulmonary hypertension and CKD stage was found statically insignificant. Pulmonary hypertension had positive correlation with stage of CKD, duration of CKD and age of patients.

173. A Study to Assess the Changes in the Hematological Manifestation in Chronic Kidney Disease Patients
Jitendra Falodia
Chronic kidney disease (CKD) is a global public health problem, with greater burden and very high cost of care especially in developing countries like India. The objective of this study is to assess the hematological profile of our subjects with CKD. Patients admitted as inpatients in the Department of medicine at Sardar Patel Medical College Hospital, during the period of 2018-2021 were included in this study.13.00% patients had microcytic hypochromic anemia, 91.00% patients had normocytic normochromic, 25.00% patients had relative neutrophila, 11.00% patients had leucocytosisand  9.00% patients had thrombocytopenia. Anemia is a very common clinical manifestation in patients of Chronic Kidney Disease. The most common morphological type of Anemia seen in our study was Normocytic normochromic type. Management of anemia with Iron and Erythropoeitin therapy is an important therapeutic intervention in the optimum treatment of patients with Chronic Kidney Disease.

174. Evolving Protocols: Managing ENT Emergencies with Surgical Precision in the Ongoing COVID-19 Pandemic
Sanket Katkar, Hetal Marfatia, Anoushka Sahai, Surbhi Dhuppad, Ritika Dixit
Background: The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in late 2019 led to the global spread of COVID-19, prompting the World Health Organization (WHO) to declare it a pandemic in March 2020. Otolaryngologists, as healthcare specialists, faced an increased risk of exposure to the virus. The pandemic’s impact on healthcare resources resulted in the prioritization of COVID-19 patients, leading to delays in surgical interventions for non-COVID-19 patients with ENT emergencies. Aims and Objectives: This study aimed to assess the impact of the COVID-19 pandemic on ENT emergencies necessitating surgical intervention. The objectives included analyzing patient demographics, clinical presentation, types of surgical interventions, postoperative outcomes, and any pandemic-related changes. Materials and Methods: We conducted an observational retrospective and prospective study at a tertiary care hospital’s ENT Department. Data was collected from July 2020 to July 2022 through retrospective analysis of medical records and prospective data collection during the study duration. The study included consenting adults above 18 years, requiring emergency ENT surgical intervention. A sample size of 50 patients was selected, and data encompassed patient demographics, COVID-19 status, symptoms, and performed surgical procedures. Results: The study enrolled 50 patients with a median age of 48 years, comprising 72% males. The most affected age group was 49-58 years. Invasive fungal sinusitis predominantly presented with headache and facial swelling. Endoscopic debridement was the most common surgical procedure (52%), followed by emergency tracheostomy (8%), foreign body removal (12%), and incision and drainage (10%). The pandemic led to a reduction in ENT trauma cases due to decreased road traffic accidents. Conclusions: The COVID-19 pandemic significantly impacted ENT emergencies requiring surgical intervention. Delays in non-COVID-19 surgical care and reduced ENT referrals were evident during the pandemic. Nevertheless, timely surgical interventions remained vital for managing ENT emergencies and preserving patients’ quality of life. A multidisciplinary approach and strict infection control measures were crucial for ensuring safe and effective care during the pandemic.

175. A Case of Anorectal Malformation in 10 Years Old Male Child
Pratik Thakur, Sarojini Jadhav, Mohammad Ansari
Introduction: Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary and genital tracts. With early diagnosis, management of associated anomalies and efficient meticulous surgical repair, patients have the best chance for a good functional outcome. Case History: The present case was a 10 years old male child with chief complaints of inability to pass stools for 6 months. On local examination perineal fistulous opening at 5o clock and 9o clock position was noted. On MRI PELVIS – splaying of posterior element of visualised sacral vertebrae s/o spina bifida and complex fistulous tract extending in prostatic urethra was found. Our patent presented with low position of the blind rectal pouch in relation to the muscle complex of the pelvic floor. Patient was managed by Transposition Anoplasty and advised serial dilation. Conclusion: Atypical presentations may not necessarily follow conventional treatment approaches, and a high index of suspicion should remain in cases with previous urinary tract infection despite normal imaging. Careful planning is also needed with consideration of a possible need for urethral repair during anoplasty, which was needed in both our cases.

176. Prevalence of Malarial Retinopathy in Adults and its Prognostic Significance
Hitesh Patel, Dipa Patel, Sawan Chugh, Ramkumar Thakkar
Introduction: Malarial retinopathy is a set of retinal signs in severe malaria due to falciparum malaria. It includes papilloedema, retinal hemorrhages, blurred disc margins, retinal whitening, retinal edema, vascular changes and soft exudates. Materials & Methods: This prospective study included retinal examination of 124 adult malaria patients admitted to tertiary care hospital. Retinal haemorrhages and vascular changes, papilloedema, peripheral whitening, and blurring of the disc borders were noted, Results: Prevalence of malarial retinopathy was 22.58%. Retinal hemorrhages was the most common feature (88.5% in severe malaria, 0.0% in uncomplicated malaria, 95.6% in cerebral severe malaria, 50.0% in non-cerebral severe malaria).  Papilloedema was also significantly higher in cerebral malaria (81.8%) and non-cerebral malaria (25.0%). The case fatality rate of our study was higher (severe malarial – 42.9%, cerebral malaria – 50.0%). Papilloedema (p-0.009), renal failure (p-0.002) and serum lactate level  (p-0.001) were significantly associated with mortality. Conclusion: Malaria retinopathy is very common in adults with severe malaria, particularly cerebral malaria. When compared to severe non-cerebral malaria, cerebral malaria is more likely to cause haemorrhage and papilloedema. Papilloedema, lactic acidosis, and renal failure all significantly increase the risk of death.

177. A Study on Reproductive Tract Infections among Married Women of Reproductive Age Group in Rural Field Practice Area of PSM Department, DMCH
Nidhi Sharma, Hem Kant Jha, Hemant Kumar, Prabhat Kumar Lal
Background: The current study estimates the prevalence of RTIs among married women of reproductive age, and its associated risk factor and assess the treatment seeking behavior among these women. Methodology: This is a community-based cross-sectional study conducted for a period of 2 year in the rural field practice area of PHC Kalyanpur, under the department of PSM, DMCH. After receiving informed consent, a semi-structured questionnaire was given to the participants. The cluster Sampling method was used for the current project and the study was conducted on 510 women. Data was collected using a pre-written interview schedule (in local language) depicting socio-demographic details of the participants, prevalence of symptoms, awareness about RTIs, assessing the treatment seeking behavior in women with symptoms and in asymptomatic women and the symptoms suggestive of RTIs in the spouse. Data was entered in MS Excel and frequencies, proportions, and percentages were calculated. For statistical measurement, SPSS version 20 software was used. Result: Among 510 married women the prevalence of symptoms suggestive of RTI was found to be 35.5 %. Lower abdominal pain, Genital Ulcer, Lower backache, swelling in the groin, Pain during urination, and Itching in the genital were common symptoms reported in the study. Conclusion: RTI still remains ignored by married women. Different training, advertisement and education session should be conducted to identify the early symptoms of RTI. Awareness about safe sex, marriage, and pregnancy after 19 yrs of age, delivery at hospitals in the presence of doctors, menstrual and personnel hygiene, and use of the condom are needed for prevention of RTI.

178. A Study of Nutritional Status of Children Aged 1 to 5 Years in Urban Field Practice Area of Darbhanga Medical College, Laheriasarai
Ameet Kumar, Hem Kant Jha, Hemant Kumar, Prabhat Kumar Lal
Background: Children’s nutritional status assessment is an important tool for understanding the causes and consequences of malnutrition. The current study was carried out to examine the nutritional condition of children aged 1 to 5 years in the urban field practise area of Darbhanga Medical College, Bihar, India and to analyzethe risk-factors associated with malnutrition. Methods: From January 2021 to December 2022, a community based cross sectional research was done at the Urban Health Training Centre (UHTC) Bahadurpur, which is affiliated with Darbhanga Medical College and Hospital (DMCH) in Bihar, India. Total 224 children aged 1-5 years were randomly chosen, and study was initiated after taking a written consent from their parents. The anthropometric measurements were taken as per WHO standard. Children were examined for any dietary deficits and morbidities. The data was analyzed by the Chi square test using MS-Excel and SPSS version 20.0. Results: The extent of malnutrition among children in terms of underweight, stunting, wasting and overweight was found to be 24.10%, 16.07%, 3.57% and 5.35% respectively. The study showed that underweight boys were higher than girls while stunting and wasting was maximum in girls as compared to boys. Conclusions: Although malnutrition has reduced over time, it still horrifies the state and significantly depends on the socio-economic and behavioural state of the community.

179. A Community Based Cross-Sectional Study of Prevalence and Risk Factors of Diarrhoea among Under-Five Children in Rural Field Practice Area of Darbhanga Medical College
Tanisha Choudhary, Hem Kant Jha, Vijay Kumar Chaudhary
Introduction: Globally, approximately 5 lakh under-five mortality is reported to be caused due to diarrhoea which is drastically large figure. This is a community based cross-sectional study of prevalence and risk factors of diarrhea among under five children in rural field practice area of Darbhanga medical college, Darbhanga. This study also assess the knowledge and utilisation of ORS among mothers of under five children in the study area. Material and Method: This is a community based cross sectional study conducted for a period of 2 year in the rural field practice area under RHTC Kalyanpur, attached with DMCH, Darbhanga. A total of 400 under-five children residing in the study area and who suffered from diarrhoea in last two weeks were included in the current research study. The children who were chronically ill at the time of data collection and the ill or suffering mothers of the indexed children were excluded from the study. An informed consent were taken from all the study subject. Result: In our study, the overall prevalence of diarrhoea among under five children was found to be 9%. The prevalence rate was highest in the age group of 13-24 months, and lowest in the age group of 25-36  months. Prevalence rate of diarrhoea of 7%  in male child and 11%  in female child was seen in this study. On analysing the risk factors, it was found that percentage of fully immunized children in the study population was 77%. Partially immunized children had higher risk for diarrhoea compared to fully immunized children and the data was found to be statistically significant (p< 0.001) in case of diarrhoea. In our study, Breast feeding was found to be a boon to prevent diarrhoea cases. Only 2.23% (6 out of 268 ) children who are exclusively breast feeded suffers from diarrhoea).The families practicing insanitary practices of garbage disposal showed high risk of diarrhoea as compared to children whose family dispose garbage’s in rubbish pit. In our study  88.5 %  of the mothers had already heard about ORS and its uses during diarrhoea cases, 65% of mothers knew the correct method of preparation of ORS subjected to be given to children. In this study, knowledge and utilization of ORT was found to be significantly associated with socio demographic factors such as mother’s education (p <0.001), type of family (p <0.001), immunization status (p <0.001), and socioeconomic class. Present study shows that a direct relationship exists between mother’s education and health of children as highly educated mothers will have better information about childcare and they can apply their knowledge in best possible way. Educational status of mother was found to be associated with ORT knowledge and statistically significant in case of diarrhoea (p <0.001). Conclusion: The prevalence of diarrhoea was 9 % among under five children in the present study, lower than that of NFHS-5 (2019-20) in Bihar is 13.7%. In the present study, we found maximum diarrhoea cases in the children aged 13-24 months. Utilization of ORT by the mothers in the current study was adequate (88.5%) out of which only 65% use correct preparation method. The study has also emphasised the impact of improved sanitation facility, safe drinking water and garbage disposal on the diarrhoea prevalence of under-five children in India.

180. A Study of Pregnancy Induced Hypertension among Pregnant Women in Field Practice Area of Bahadurpur, Darbhanga
Ankita, Hemant Kumar, Vijay Kumar Chaudhary
Pregnancy induced hypertension (PIH) is one of the major complications occurring during pregnancy which is responsible for maternal & perinatal mortality & morbidity. A community based cross-sectional study was carried out from January, 2021 to December, 2022. A pre-tested structured Performa was prepared & the pregnant women were interviewed to collect necessary information such as detailed history, clinical examination findings & investigations performed. Results were analysed using MS Excel and p-value less than 0.05 was considered as statistically significant. In the present study, Proportion of PIH among pregnant women was 6%. The incidence of PIH was found more among teenage pregnancy, those with history of PIH in previous pregnancy, having family history of PIH & those who were found obese. Young pregnant women, families with a history of hypertension, BMI, high cholesterol levels, previous incidents of hypertension, low socioeconomic status, anaemia, etc. were risk factors for PIH. Diastolic blood pressure & high cholesterol level were found to be one of the major significant risk factors among PIH women. Women with PIH were at higher risk of adverse pregnancy outcomes than those which does not have PIH. Therefore, to lessen the negative effects of pregnancy-induced hypertension on the foetus, health care professionals should prioritise prevention, early detection, and timely therapy of the condition.

181. Assessment of Lipid Profile in Sub-Clinical Hypothyroidism Subjects in Rural and Urban Population of Northern India
Sunil Kumar, Singh Satyendra Prasad, Yadav Gajraj Singh, Gupta R. C.
Introduction: Sub-clinical hypothyroidism (SCH) can be defined as normal Free Thyroxine (FT4) and Free Tri-iodothyronine (FT3) concentrations and high serum TSH concentration associated with few or no signs and symptoms of hypothyroidism. The level of lipid profile and lipoprotein is higher in sub-clinical hypothyroidism which was associated with cardiovascular disease in addition also increase the incidence of coronary risk factor, so newly diagnosed SCH subjects must monitor their lipid profile to prevent cardiovascular manifestation. Material and Methods: This paper is a cross-sectional study of 800 subjects (including rural and urban areas) of Amber Tehsil in Jaipur District. The blood samples (lipid profile and lipoprotein) were analyzed at the National Institute of Medical Sciences and Research, Jaipur. Result: Using a T-test it was found that total Cholesterol (TC) and Low-Density Lipoprotein Cholesterol (LDL-C) of rural and urban populations were significantly higher in the SCH group as compared to the Euthyroidism (EuT) group (p<0.05). Conclusion: Serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly higher in SCH subjects as compared to subjects with normal thyroid function in urban as well as rural populations. The difference in triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and very low-density lipoprotein cholesterol (VLDL-C) in SCH subjects and subjects with normal thyroid function was not significant.

182. Comparative Study of Laparoscopic Cholecystectomy and Open Cholecystectomy Based on Post Operative Clinico Sonological Follow –Up
Manish Kumar Rajak, Akash Kumar, Shiva Nand
Background: Laparoscopic cholecystectomy is the gold standard surgical method for treating individuals with symptomatic gallstones with numerous benefits over open cholecystectomy. In this study the preoperative risk factors are assessed and compared for the two modalities of treatment with special emphasis on postoperative clinic sonological follow-up for early detection of complications and to treat them if they arise. Based on the information, the best course of treatment for each patient can be determined, with the least amount of morbidity and mortality, and relieving the overburdened healthcare system. Methods: A total 100 patients with gall stone disease were chosen from the Darbhanga Medical College & Hospital’s Surgical outpatient Department as subjects for investigation. The study period spanned November 2020 to August 2022.The parameters like age, sex, socioeconomic status, dietary habits were noted. A thorough surgical history of any intra-abdominal procedures was obtained. A thorough medical history was collected to identify the patient’s medical conditions and risk factors. Preoperative injections of ceftriaxone were routinely administered to all patients. Intraoperative events were recorded along with duration of operation. After surgery, the patients were closely monitored. Results: One group of 50 patients out of 100 underwent a traditional open cholecystectomy; other group of 50 patients underwent a laparoscopic cholecystectomy. Four patients required conversion from laparoscopic to open cholecystectomy. Multi-calculi were present in 65% of individuals, 33% of patients had a single calculus, 2% of patients had no stones, 12% of patients had mucocele, 20% of patients had contracted gall bladder, 8% of patients had a distended gall bladder, gall bladder empyema affected 4% of patients, 24% of patients had gross pericholecystic adhesions, 1% of patients evidenced GB mass. Conclusion: Laparoscopic cholecystectomy clearly is the better option in contrast to OC. It offers a faster recovery, less pain following surgery, early discharge, analogous postoperative sonographic results, a sooner arrival at work, fewer complications, especially those associated to wounds. All of these significantly cut morbidity, which reduces the financial burden on patients and the healthcare system.

183. Internet Gaming Addiction among the Adolescents: A Study from Central India
Anushka Tiwari, Smriti Pandey, Jitendra Gupta, Dhruvendra Pandey
Background: Nowadays technology covers us all around it required for all works. But some also use this smart phone for their entertainment in gaming which ultimately leads to addiction. Aims & Objective: To estimate the internet gaming addiction among adolescents. To assess the perception of Non/Less users towards regular internet gaming users. Material & Method: A cross sectional study was conducted in 153 school students of class 11th and 12th. An adolescent having a smart phone and using it from the last 12 months were included. The semi structured questionnaire had 22 questions related to addiction according to different domains of DSM 5 criteria. The response was recorded on 5 point Likert’s scale. The data was analyzed using appropriate Software and presented in the form of graphs and tables. Result: Prevalence of addicts among adolescents was 6.53%. The mean age of students was 16.32 years with standard deviation of 0.76. Male participants were 71.89%. As a student goes toward the addiction level his/her recharge was towards the higher side and he/she also needed extra data recharge. Conclusion: This study gave a wholesome idea about the gaming behaviors of students, their internet usage and perspective about the world of internet gaming.

184. A Randomized Prospective Comparative Study of Laparoscopic Appendicectomy versus Open Appendicectomy
Akash Kumar, Manish Kumar Rajak, Shiva Nand
Background: The study conducted at Darbangha Medical College & Hospital compared laparoscopic and open appendicectomy procedures for patients with acute appendicitis. A total of 144 patients were randomly selected for the study, which took place from November 2020 to August 2022. Methods: Laparoscopic surgery has evolved as an effective tool for treating various diseases, offering advantages such as reduced abdominal wall stress, faster recovery, shorter hospital stays, and quicker return to regular activities. Results: The study found that laparoscopic appendicectomy had a longer operation time than open surgery but did not provide superior immediate or long-term results in oncology. The average age for acute appendicitis was similar to previous studies, and the gender ratio of patients in the study was also comparable to other research. Regarding surgical outcomes, laparoscopic appendicectomy had a longer average procedure time but resulted in a shorter hospital stay compared to open appendicectomy. The conversion rate from laparoscopic to open surgery was slightly higher than the average reported in the literature. Laparoscopic surgery was associated with fewer wound infections but did not show a decrease in intra-abdominal abscesses. Patients in the laparoscopic group reported less post-operative pain, and laparoscopic appendicectomy was associated with better cosmesis. No cases of post-operative pneumonia or mortality were reported in either group. Conclusion: The study concluded that laparoscopic appendicectomy is a safe and effective treatment with advantages such as reduced post-operative pain and improved cosmesis.

185. Pulmonary Function Test in Endoscopically Proven Cases of GERD
A. Sivaraman, Harish V. K., Balasubramanian, Manoj Mali, Dhiraj Jain
Background: To assess the Pulmonary function in endoscopically proven cases of Gastroesophageal reflux disease (GERD). PFT (Pulmonary function test) is done in patients with GERD, irrespective of their respiratory symptoms (in both asymptomatic and symptomatic patients). Methods: It is a cross-sectional study conducted at the Department of General Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan. 50 cases of endoscopically proven GERD patients were enrolled in our study. The severity of GERD is graded according to the endoscopic findings. Then Pulmonary function test was done in all 50 patients irrespective of their respiratory symptoms (in both asymptomatic and symptomatic patients) to assess the lung function in these patients. Results: Out of 50 patients, 30 were male and 20 were female. The mean age group of the study population was 39 years. Among 50 patients 32 (64%) patients had no respiratory symptoms and 18 (36%) were presented with respiratory symptoms. Out of 50, only 3(6%) patients had abnormal findings on chest X-rays. PFT showed abnormal patterns in 24 (48%) patients. The restrictive pattern is the commonest abnormality observed in our study. Conclusion: Early lung function tests in all GERD patients irrespective of their respiratory symptoms may be useful in identifying subclinical loss of lung function.

186. Clinicohematological Correlation of Thrombocytosis in Children at a Tertiary Care Centre of Barak Valley
Suchismita Roy, Sourav Nath, Bimanjyoti Deuri
Background: Thrombocytosis is a common finding in the hemograms of children. While primary thrombocytosis is very rare in children, reactive thrombocytosis is frequently observed in children with infections, anemia, and other causes. This study aims to determine the etiology of thrombocytosis and analyze various platelet parameters (MPV, PDW) in children with  thrombocytosis. Methods: It was a prospective observational study carried out in the Department of Pathology, Silchar medical college and hospital, Cachar from June 2021 to May 2022. All children of age group 1 month to 18 years of age attending pediatrics outdoors and/or admitted to indoors, and whose complete blood counts (CBC) were done, were included in the study. The CBC parameters such as hemoglobin, red blood cell indices, and platelet indices like platelet distribution width [PDW], mean platelet volume [MPV] were noted. Results: Of 370 patients, 99.72% had secondary thrombocytosis, and only one child had primary thrombocytosis (CML). The majority of the children belonged to the age group of 1year to 2 years (51.35%) and male to female ratio was approximately 2:1. Infection with anemia (56.76%) was the most common cause of secondary thrombocytosis followed by infection alone (21.62%) and iron deficiency alone (18.38%) . Respiratory tract infection (40%) was the predominant infectious cause observed. With increasing platelet count, there was a decrease in MPV. Conclusions: Secondary thrombocytosis is more common in children than primary thrombocytosis. Infections in association with anemia is found to be the common cause associated with reactive thrombocytosis.

187. A Study on Post-Operative Knee Pain (VAS) and SCAR Scale Following Inter Locking Nail for Tibia Using Medial Para Patellar and Midline Trans Patellar Approaches
C. Shyam Kumar, CNS Mounika, B Harsha, D Venkateswara Rao, Sangamesh C Kannur , P. Anil Babu
Fracture tibia has been a very common fracture. The adult diaphyseal fractures of tibia are commonly treated with interlocking nail as fixation implant with good fracture union. The most common complication of post-operative knee pain, sensitive scar can delay the recovery process and can add up to loss of productive days and increased morbidity. Our study has been conducted on post-operative patients of diaphyseal tibia fractures, where in fracture fixation is done with interlocking nail, with either of approached to acces the medullary canal viz., medial para patellar approach or midline tendon splitting trans tendon approach. The study has evaluated the post-operative knee pain with VAS and wound healing with SCAR Score.

188.  A Retrospective Analysis of Changes in Clinical and Laboratory Parameters in COVID-19 and it’s Relation with Severity of the Disease
Amina Ismail, Prativa Kumari Behera, Kshitish Chandra Tandi, Aruna Mukti Minz, Snehal Parve, Navanil Roy, Rajeev Kumar Seth
Background: The Severe acute respiratory syndrome coronavirus-2 pandemic has been affecting the health, economic, as well as social life of the entire globe since the end of 2019. There are only a few studies done in India on the changes in clinical and hematological parameters on covid19 and its relationship with disease severity. The study aimed to determine the changes in clinical and laboratory parameters in COVID-19 and also to correlate the changes in clinical and laboratory parameters with the severity of the disease. Material and Methods: Laboratory parameters of 217 covid positive patients were retrieved from hospital record section and correlated with the severity of the disease by stratifying cases into four categories mild, moderate, severe and critical. Results: In total 217 cases, prevalence of disease was higher in males. Similarly, severity of the disease was more in males and increases with higher age group. Leukocytosis, neutrophilia, elevated Neutrophil to lymphocyte ratio(NLR), activated partial thromboplastin time(activated PTT), D-dimer, Lactate dehydrogenase(LDH) ,serum ferritin and C-reactive protein (CRP) are significantly increased in patients with severe and critical disease. On Peripheral smear(PS) examination, hypersegmented neutrophils and toxic changes in neutrophils were seen in severe and critical patients. Conclusion: LDH and D-Dimer could be used as a prognostic indicator for COVID-19 disease which are also easily available and cheap. Peripheral smear examinations can also predict the severity by showing hypersegmented neutrophils and toxic changes in neutrophils.

189. Association between Platelet Lymphocyte Ratio and Erectile Dysfunction in Diabetic Patients
Samaria Anil, Samaria Meenakshi, Gupta Avinash, Tanwani Kamlesh, Gahlot Kritika, Purva Mukul, Pearl Samaria
Erectile dysfunction (ED) is a prevalent condition that commonly affects middle-aged and older men, with diabetes serving as a significant risk factor. The purpose of this study was to examine the relationship between platelet lymphocyte ratio (PLR) in ED and non-ED diabetic male patients. A total of 105 adult males were included and detailed medical history, IIEF-5 score, age and various hematological and biochemical parameters were assessed. The prevalence of ED in diabetic patients was determined to be 63.6%, with 11.4% experiencing severe ED. PLR was significantly elevated in ED patients, with the mean value of 155.3±85.3 in compare to control i.e. 130.7±25. However, significant differences were not found in the PLR values between the ED subgroups. A negative correlation was identified between PLR and the IIEF-5 score. Serum testosterone levels were lower in ED patients and exhibited a positive correlation with the IIEF-5 score. Age and diabetes duration exhibited significant associations with ED, with higher prevalence observed in older age groups and longer durations of diabetes. Glycemic control, evaluated through measures such as fasting blood sugar, postprandial sugar, random blood sugar, and glycated hemoglobin, displayed a notable negative correlation with the International Index of Erectile Function-5 (IIEF-5) score. Lipid profiles exhibited elevated triglycerides and very low-density lipoprotein (VLDL) levels, along with decreased high-density lipoprotein (HDL) levels in ED patients. The findings underscore the potential role of PLR as independent predictors of ED in individuals with diabetes. Further research involving different demographic locations with association of molecular and genomics aspects is recommended to enhance the diagnosis and treatment of ED.

190. A Study of Anatomical Dimensions of Spleen in Population of Eastern Bihar: A Sonological Study
Parijat Mukherjee, Sayantan Das, Anupam Khalkho, Avinash Kumar
Background: Accurate knowledge of normal splenic dimensions is important for diagnosing clinical conditions associated with altered spleen size. A descriptive cross sectional study was conducted with the aim to determine normal splenic measurements in the Eastern Bihar population and to compare them with body parameters such as height, weight, age and sex. Methods: 78 females and 32 male adult participants underwent abdominal ultrasound in Kishanganj, Bihar, India. Participants were taken after they met with inclusion criteria and gave informed consent for the study. The splenic length, breadth and thickness were measured, and their height, weight and age were also recorded. The analysis was done using SPSS version 26. Results: The study included 110 subjects (78 females, 32 males). Average splenic dimensions were: length 97.05 mm, breadth 60.50 mm, thickness 34.82 mm, volume 111.53 cm3. No significant differences were found between males and females. A negative correlation with age with splenic parameters except thickness was also found. No significant correlation was found between splenic parameters with other body parameters such as height or weight. Conclusion: The study indicated no significant correlation of splenic parameters with height and weight, and indicated difference between male and female splenic parameters to be insignificant. This might reflect the population variations found in other studies. The findings emphasize the need for population-specific reference ranges and suggest a potential age-associated shrinkage effect on splenic dimensions. Further research with larger sample sizes is recommended.

191. MSU Classification Based Microdiscectomy and Outcomes: A Follow Up Observational Study
Karthik V., Balaji S., Arun K., Agalya, Thiruselvam, Roy Arokiyam Daniel
Background and Purpose:   Back pain is one of the most common orthopaedic complaints that we see in our daily practice. Symptomatic Intervertebral Disc Prolapse occurs in 1–3% of the subjects, and a variety of treatment options are proposed. Recently, Microlumbar Discectomy has proven benefits in quality of life, reduction in pain scores, and efficacy in International Research. But decisional confusions for operative versus non-operative management based on the type of disc prolapse still persist. Hence, this study will be helpful in making MSU criteria more reliable and sensitive for operative decisions. Material and Methods: This study is an Observational follow-up study that included 28 subjects who were selected using MSU Criteria and had microdiscectomy surgery performed at our hospital. Various variables from previous literature include Age distribution, obesity and overweight, Height, Occupation, Sex, Level of prolapse, smoking influence, and Type of Prolapse. The basic Aim of the study is to find out how efficacious this surgery is in Lumbar IVDP subjects, and assessment is done preoperatively and postoperatively with VAS and JAO scores. Results: 37% of patients were severely affected and 64.3% were moderately affected, and post-surgery, their score pattern improved significantly. 96.4% of patients have >90% improvement, and 3.6% have only >50% improvement. (P value = 0.001). 85.7% of patients had improvement in neurology immediately and 6 months post-surgery (P Value = < 0.001). Results and Conclusion: The study showed microdiscectomy based on MSU criteria is efficacious and improves the quality of life in patients with Lumbar IVDP. There has been a lacuna in the literature regarding this procedure in our part of the world, which highlights the significance of this study.

192. Comparative Study of Efficacy of Latanoprost and Dorzolamide in Primary Open-Angle Glaucoma (POAG) Patients as Monotherapy
Avani Raj, Trishla, Iftekhar Ahmed
Background: Glaucoma is the second most common cause of blindness worldwide, and its prevalence is increasing in India. Increased intraocular pressure (IOP), primary open-angle glaucoma (POAG) is the most important factor and a direct cause of the development of POAG. The current study aimed to examine the efficacy of latanoprost and dorzolamide for decreasing IOP in POAG as monotherapy. The following goals are set forth: To evaluate the side effects of each medication and compare the efficiency of topical latanoprost (0.005%) and topical dorzolamide (2%), both administered as monotherapies for POAG. Methods: For the current prospective, open-label trial, 40 patients, 20 males and 20 females with a POAG diagnosis were randomly selected and divided into two groups. Topical latanoprost eye drops (0.005%) were administered to one group once daily while dorzolamide eye drops (2%), were administered to the other group three times daily. At two, four, and eight weeks, each participant underwent three follow-up visits. Prior to starting the baseline phase of treatment, IOP was assessed using a Perkins Hand Held Tonometer. At each following appointment, IOP was once more measured in order to monitor the effects of drugs. Each patient gave their informed consent voluntarily. Results: The mean IOP decrease for the dorzolamide group was 7.89±3.56 and the latanoprost group was 9.5±3.56. IOP was successfully decreased by both drugs. There was a statistically significant difference between how latanoprost and dorzolamide lowered IOP (P = 0.02). Throughout the study, both drugs were well tolerated, however the latanoprost group (n = 5) had higher side effects than the dorzolamide group (n = 4). Conclusion: The findings of this study demonstrate a significant reduction in IOP in POAG caused by topical eye drops containing latanoprost (0.005%) and dorzolamide (2%) respectively. Latanoprost is more efficient than dorzolamide at lowering IOP.

193. Comparative Study of Efficacy and Safety of Levetiracetam and Carbamazepine in Partial Epilepsy
Trishla, Avani Raj, Iftekhar Ahmed
Background: A more recent antiepileptic medication with a superior pharmacokinetic profile is levetiracetam (LEV). Presently, partial seizures are often treated with it. The goal of the current study was to assess the effectiveness and safety of LEV and carbamazepine (CBZ) in treating partial epilepsy. Methods: From June 2022 to February 2023, the Department of Pharmacology in collaboration with the Neurology department at the GMCH, Purnea, Bihar, recruited volunteers who were experiencing partial seizures. Tab LEV was given to the first group (500–3000 mg/day), and Tab CBZ was given to the second group (300–600 mg/day). Efficacy and safety were the main results. Quality of Life (QOL) was the secondary result. By comparing the seizure freedom rates at the end of six months, effectiveness was evaluated. Comparing the negative effects allowed us to assess the safety profile. The QOLIE-10 scale was used to measure QOL. Results: At the end of nine months, the overall seizure freedom rate in the CBZ group was 71.42%, compared to 78.57% in the LEV group (p = 0.2529). The incidence of negative reactions was similar according to LEV and CBZ. More behavioral effects, including elevated aggression and anxiety, were observed by the LEV group. Additionally, compared to the CBZ group, it displayed better QOL. Conclusion: Both LEV and CBZ monotherapy were well tolerated and showed comparable efficacy for treating partial epilepsy.

194. Clinico-Etiological Profile of Anemia in Children Aged 6 Months to 60 Months Admitted in A Tertiary Care Centre
Arunabh Kumar, Archana Singh, Binoy Shankar
Background: Anemia is a significant global health issue, particularly in developing nations. This issue is easily treatable and largely prevented. The prevalence rate in India is about 51%. According to the NFHS 2005–2006, at least 80% of Indian children between the ages of 12 and 23 are anemic. The majority of children with anemia have abnormal Hb or hematocrit levels on routine screenings and are asymptomatic. Lower scores on tests of mental and motor development and behavioral and cognitive deficits are all linked to anemia in infancy and the early years of childhood. The objectives of this study are to identify the clinical, etiological, and risk variables for severe anemia. Methods: From May 2022 to October 2022, this study was carried out at Department of Pediatrics, SKMCH, Muzaffarpur, Bihar. Patients with severe anemia (Hb <7 gm/dl) in the age range of 6 months to 60 months were selected as subjects. Results: Out of 50 patients, 25 (50%) had iron deficiency anemia, and 8 (16%) had megaloblastic anemia. The mean hemoglobin was 5.22, with a standard deviation of 1.389 and a range of 2 to 7 gm/dl. The mean MCV was 76, while the MCH and MCHC values were 20 and 26, respectively. Conclusion: Anemia was prevalent among children admitted to SKMCH. Caregiver unemployment and hunger were factors that were highly linked to severe anemia. The two most prevalent kinds were megaloblastic anemia and iron deficiency anemia.

195. Study of Diagnosis of Malaria Using Rapid Diagnostic Test (RDT) in Children
Arunabh Kumar, Archana Singh, Binoy Shankar
Background: In tropical nations, malaria is still a public health concern. In these nations, clinical evaluation, microscopy, the gold standard and more recently, rapid diagnostic tests (RDTs) are the mainstays of diagnosis. The purpose of this study is to evaluate the quick diagnostic test’s diagnostic accuracy for detecting malaria in children who have a clinical suspicion of having the disease. They used microscopy as the gold standard. Methods: This six-month cross-sectional and observational study was carried out at the SKMCH in Muzaffarpur, Bihar, from November 2022 to April 2023.  In this study, 70 patients of both sexes with a clinical suspicion of malaria and ages up to 12 years were enrolled. Age, sexual orientation, and symptoms were noted in great detail. A quick diagnostic test was run, and the results were compared to microscopic analysis. Microscopy was regarded as the ultimate test. The Rapid Diagnostic Test’s sensitivity, specificity, PPV, NPV, and diagnostic accuracy were looked at. The data was examined using SPSS 24.0. Results: There were 27 (38.57%) female patients and 43 (61.43%) male patients. 39 patients (55.41%) were between the ages of 7 and 12 whereas 31 (44.29%) were between the ages of 0 and 6. By microscopic examination, 40 (57.14%) individuals tested positive for malaria, while 30 (42.86%) patients tested negative. By fast diagnostic test 29 (41.43%) people tested negative for malaria, while 41 (58.57%) people had malaria. Comparing the results of the two methods, it was found that 27 (38.57%) true negatives, 3 (4.29%) false positives, 2 (2.86%) false negatives, and 38 (54.29%) real positives. RDT has a 96.25% sensitivity, 90% specificity, 92.77% PPV, and 94.74% NPV. RDT’s diagnostic precision was 93.57%. Conclusion: The rapid diagnostic test is an useful diagnostic technique that can be used in place of a microscopic examination to diagnose malaria in children.

196. Role of Iron Deficiency Anemia in Children with Febrile Seizures
Archana Singh, Arunabh Kumar, Binoy Shankar
Background: The febrile seizure (FS), which affects 3-4% of children under the age of five, is a prevalent cause of seizures in young children. The most prevalent micronutrient shortage in the world, iron deficiency, has been linked to febrile seizures. The purpose of this study is to ascertain how frequently children with febrile seizures have iron deficiency anemia. Methods: From May 2022 to October 2022, 180 patients in the pediatrics department of the SKMCH in Muzaffarpur, Bihar, participated in this descriptive cross-sectional study. Results: Hemoglobin levels were 10.33± 2.44 g/dl and mean age was 1.44±0.988 years. 53 men (58.9%) and 37 women (41.1%) were present. Conclusion: Anemia from iron deficiency affects more than half of the children who experience febrile seizures.

197. A Study of Risk Factors for Acute Lower Respiratory Tract Infections (ALRTI) in Children Aged 1 Month to 5 Years
Archana Singh, Arunabh Kumar, Binoy Shankar
Background: Nearly 156 million new episodes of acute respiratory infections occur each year, the majority of which (43 million) occur in India. These infections are the primary cause of morbidity and mortality in children under the age of five in poor nations. The most recent estimates from the Child Health Epidemiology Reference Group (CHERG) for 2010 indicate that pneumonia caused 0.397 million of the projected 1.682 million deaths of children under the age of five in India. This study’s objectives are to identify the various Acute Lower Respiratory Tract Infection (ALRTI) risk factors in children between the ages of 1 month to 5 years. Methods: In the current study, 100 ALRTI cases who had been examined at the department of pediatrics, SKMCH, Muzaffarpur, Bihar from November 2022 to April 2023 and who met the WHO criteria for pneumonia were assessed for risk variables after obtaining parental consent. Results: Potential risk factors for severe ALRTI included parental illiteracy (p=0.000*), overcrowding (p=0.0000*), incomplete immunization (p=0.0000*), lack of exclusive breastfeeding (p=0.0004*), low birth weight (p=0.000*), use of biomass fuels for lighting (p=0.0002*), and mud/cow dung flooring (p=0.0088*). Conclusion: Numerous sociodemographic, dietary, and environmental risk factors for ALRTI have been discovered in the current study. These factors can be addressed by the community’s effective health education and the effective training of peripheral health staff.

198. Role of Fine Needle Aspiration Cytology in Breast Lump and Its Histopathological Correlation
Binay Kumar Gupta, Rajesh Kumar
Background: The most frequent type of cancer among women is breast cancer. Breast lump diagnosis using fine needle aspiration cytology is a simple, affordable treatment. The purpose of this study is to identify the frequent causes of breast lumps and to assess the FNAC’s sensitivity and specificity for breast lump detection. Materials and Methods: This research is a retrospective analysis of breast FNAC performed between October 2022 and March 2023 at the KMCH in Katihar, Bihar. To ascertain the sensitivity and specificity of FNAC, FNAC results were compared to information from histopathological reports. Results: 16% of all FNACs were breast-specific FNACs. The patients’ age ranged from 17 to 56 years old, with a mean of 32. The most frequent diagnosis was fibroadenoma. Only 6.6% of the cases had malignancy identified. In 21 cases, histological correlation was carried out. It was discovered that the breast FNAC’s sensitivity and specificity were 83.3% and 100%, respectively. Conclusion: Breast FNAC is a straightforward, affordable, and less traumatic way of diagnosing breast lumps. It can lessen the need for open biopsies and is also very sensitive and selective. Therefore, FNAC should be utilized as a standard procedure to identify the type of breast masses.

199. Spectrum of Lymph Node Lesions Diagnosed by FNAC and Histopathology
Binay Kumar Gupta, Rajesh Kumar
Background: Many non-neoplastic and neoplastic illness presentations frequently appear clinically in lymph nodes. Fine needle aspiration cytology (FNAC) is a straightforward, minimally invasive method that can be used to diagnose very superficial lesions. This study’s objective is to examine the cytomorphological characteristics of diverse lymph node lesions, both benign and malignant, using fine needle aspiration of enlarging lymph nodes. Methods: The current prospective study is being undertaken over a 12-month period (January 2022 to December 2022) to analyze the cytomorphological characteristics of pathological lesions lymph nodes by FNAC. All individuals with clinical signs of lymphadenopathy, regardless of gender and with ages ranging from one to 70 years, were included in the study. Results: Out of 330 patients with lymphadenopathy who had FNAC, the cervical group of lymph nodes was the most frequent site (74.24%) and had a female preponderance (62.42%). After reactive lymphadenitis (25.45%), granulomatous lymphadenitis (23.33%), acute suppurative lymphadenitis (3.63%), metastatic malignant lesions (3.33%), lymphoproliferative lesions of undetermined significance (0.90%), and neoplastic lesions like non-Hodgkin’s lymphoma (0.30%), tuberculous lymphadenitis was identified by cytomorphology (32.18%). Conclusion: FNAC is a simple, safe, reliable, and inexpensive method that could be employed in cytological study and early detection of inflammatory, reactive and neoplastic conditions leading to clinical lymphadenopathy.

200. A Study on Lesser Trochanter Displacement in Inter Trochanteric Fractures of Femur Influencing Functional Outcomes
P. Anil Babu, K Sudhakar, P. Kiran Kumar, Bhimana Sujit Ravi Teja, D Venkateswar Rao, M.V. Sairam Reddy
Inter trochanteric fractures have become common fractures among the fractures of proximal femur. Lesser trochanter being a principle insertin point for flexors of hip joint often can get involved in the fracture pattern resulting in separation of this bony prominence. All such lesser trochanter displacement in the inter trochanteric fractures are studied to know how far it can influence the functional outcome when treated with Proximal Femoral Nail. The functional results of such fractures are followed up with three month interval with Parker Mobility Score and Salvati and Wilson scoring system. These functional outcomes are analysed with statistical values how far the lesser trochanter avulsion can influence the treatment outcomes for Proximal Femoral Nailing.

201.  Ex-Vivo Permeation Study of an Antifungal Drug, Loaded in NLC, Designed and Optimized by Factorial Design
Gopa Roy Biswas, Soumik Patra, Pakhi Chakraborty, Pritam Dutta, Grihadeep Paul
Lipid-based drug delivery systems are frequently employed as they may increase the solubility and bioavailability of lipophilic medications. An improved generation of lipid nanoparticles known as Nanostructured Lipid Carriers (NLCs) has the potential to overcome the disadvantages associated with conventional lipid-based formulations and solid lipid nanoparticles (SLNs). The current study employed Design-Expert® software (Version 7.1.5) to perform an optimization study using 23 Factorial design. The study involved Homogenizer Speed (RPM), the Amount of Liquid Lipid (mL), and the amount of Solid Lipid (g) as independent variables. The 8 formulations provided by the design software, were prepared by using hot homogenization technique. The Drug and other material’s compatibility analysis were carried out using FTIR analysis. Dynamic light scattering (DLS) was used to measure the particle size of the NLC formulations. The Ex-vivo Drug Permeation Study was performed by using goat abdominal skin, obtained from slaughter’s house, in the Franz Diffusion Cell. FTIR results stated that the excipients and the drug were compatible, as there were no significant changes of the peaks were noticed. The Particle Size of Formulations was in the range of 17.57 nm to 279.4 nm. The Entrapment efficiency of the NLC formulations was in the range of 63.1% to 98 %. The percentage of drug permeated from the formulations in 7 hours was in the range of 33.07 ± 0.00015 % to 61.86 ± 0.017%.  According to this study, the optimized NLC fulfils the all criteria and is proven as a suitable topical drug delivery system.

202. Serum Cortisol Level as a Predictive Biomarker of Severity of Disease among Adult Plasmodium Vivax Patients in Northern India
A. Sivaraman, Surendran Venkataraman, Balasubramanian R, Kavitha N, Dhiraj Jain, Maniram Kumhar
Background: Malaria is a major cause of morbidity in Indian subcontinent accounting for approximately 88% of malaria cases in the Southeast Asia. The disease affects all organs and endocrine glands are no exception. Serum cortisol, a hormone released by adrenal gland has the potential to serve as a predictive biomarker for mortality and critical illness among malaria patients. Aim: This study aimed to investigate changes in serum cortisol levels as a potential biomarker for predicting risk in P. vivax malaria. Methods: The study was a prospective observational investigation from September 2017 to October 2018. The study involved 40 patients each with complicated, uncomplicated Plasmodium vivax malaria patients and compared with healthy controls. Serum cortisol levels were measured using immunoassay with direct chemiluminescent technology and statistically correlated with Plasmodium vivax malaria infection. Results: The results revealed that on day 1, there was a significant difference in mean serum cortisol levels between Plasmodium vivax malaria patients and the control group. Cortisol levels were significantly higher in patients with complicated Plasmodium vivax malaria compared to uncomplicated cases on both day 1 and day 7. Cortisol levels remained within the normal range on days 1 and 7 in uncomplicated malaria cases. The optimum cut-off for cortisol level to predict severity of malaria was 18.6 ug/dl for a sensitivity of 88.5% and specificity of 85.8%. Conclusions: The serum cortisol levels were significantly higher among complicated malaria patients and hence could be a useful indicator for predicting the severity of Plasmodium vivax malaria.

203. Assessment of Knowledge and Perception Regarding COVID-19 among Undergraduate Medical Students of Assam Medical College, Dibrugarh, Assam
Dutta Raj Kumar, Boruah Manjit, Mahanta T G
Background: COVID-19 has made people more vulnerable to infection due to a lack of understanding and hazardous practices.  Medical students can play an important role as trust worthy information sources. The purpose of this study was to analyze medical students’ knowledge and perceptions of COVID-19 at a tertiary care center. Methods: Participants took an online cross-sectional survey using Google Forms between November 2020 and January 2021. The research was carried out on MBBS students. To describe participant characteristics, descriptive statistics were used. Results: The survey was completed by all participants. They are all MBBS students. The majority of participants had acceptable knowledge for Covid 19 identification, while approximately 6.2% had just incomplete understanding (picked either RT-PCR or Immunofluorescent antigen detection technique). Students have a favorable opinion of COVID-19 prevention. More over half of the students (62.5%) correctly believed that antibiotics are ineffective in COVID-19 treatment, and 15.8% believed that vaccines are insufficient to prevent COVID-19 transmission at this time. Conclusion: As the COVID-19 virus causes on and off waves of cases around the world, it is critical to spread awareness and beliefs among the general public in order to avert a pandemic of such magnitude. Medical students, with their educational background and basic understanding of COVID-19, can play an important role in informing the society about the genuine facts of this pandemic situation.

204. A Randomized Double-Blind Study to Compare the Mean Apnoea Time and Intubating Conditions with Different Doses of 0.4, 0.6 &1.0 Mg /Kg of Succinyl Choline
Suryakant Sharma, Trishala Jain, Mahesh Somani, Rajendra Verma
Introduction: The primary neuromuscular blocking drug for rapid sequence induction endotracheal intubation has been succinylcholine, however it has certain drawbacks. This study was conducted to evaluate mean apnoea time and intubating conditions with various doses of 0.4, 0.6, and 1.0 mg/kg succinylcholine. Material & Methods: A double-blinded randomised control study with 52 patients in each group was undertaken on 156 patients undergoing surgery. Succinylcholine was given at concentrations of 0.40 mg/kg to Group A, 0.60 mg/kg to Group B, and 1.0 mg/kg to Group C. After delivering the medications in each group, mean apnoea time and intubating conditions and, hemodynamic parameters were evaluated. Result: The mean aponea time was statistically highly significant(p<0.001) in group A(mean 3.9 mins) vs C(mean 8.4 mins) and group B(mean 4.40 mins) vs C(mean 8.4 mins).whereas  group A(mean 3.9 mins)  vs group B(mean 3.9 mins)  statistically not significant(p>0.05). Regarding clinically acceptable intubating conditions there was statistically no significant difference between group B and C(p>0.05) whereas group A vs  group B and group A vs group C statistically highly significant difference(p<0.001). Conclusion: A dose of 0.6 mg/kg of succinylcholine produced appropriate intubating conditions compared to a dose of 1.0 mg/Kg with a brief apnea period and time to resume regular spontaneous breathing.

205. Evaluation of Skeletal Pattern in Class II Subdivision and its Comparison with Class I- A Cephalometric Study
Manish Kumar, K.S. Negi, Sankalp Sood, Monika Mahajan, Dimple Chainta, Sanjeev Vaid
Objective: The purpose of the study was to use lateral cephalometric radiographs to ascertain the skeletal pattern of Class II subdivision subjects and to compare these with that of the Class I skeletal pattern. Materials & Methods: Lateral cephalograms of 30 untreated Class II subdivision individuals and 30 subjects having Class I skeletal pattern were recorded in due course of time. These cephalograms were analyzed for evaluation and comparison of skeletal pattern of Class II subdivision individuals with Class I subjects. Results: There was statistically significant difference in relation to sagittal parameters of Class II subdivision and Class I malocclusion subjects which demonstrated that skeletal pattern of Class II subdivision individuals was different from Class I. Class II subdivision individuals had more vertical growth pattern in comparison to skeletal Class I individuals. Conclusion: The present study concluded that skeletal pattern of Class II subdivision individuals was different from Class I subjects. The mean values of most of the parameters were nearing towards Class II. Therefore for reaffirmation of their skeletal pattern, further study needs to be advocated to compare the skeletal pattern of Class II subdivision with Class II malocclusion subjects.

206. Post-Partum Depression: A Study of its Incidence and Association of Risk Factors
Fozia Jeelani Wani, Meka Krishna Kumari, Nisha Bhatia, Sheri Vennela, Neha Gala
Background: Postpartum depressive episode of mild to major severity is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression in low- and middle-income countries remains under-reported, under-treated and under-studied. Aim and Objectives: (1) The first aim of our study is to estimate the incidence of PPD. (2) Second aim is to assess various risk factor associated with the post-partum depression. Materials and Methods: It is a prospective study of post-partum mothers who delivered at our hospital and gave consent for the study. The study was performed in Apollo Institute of Medical Sciences Hyderabad from January 2022 to December 2022. A total of 150 mothers were included in the study. A questionnaire based on Edinberg Postnatal Depression Scale (EPDS) was answered by post-natal mother on post-natal day 6 or 7. Simultaneously socio-demographic data and other obstetric and baby related data of all patients were collected and recorded. Results: EPDS score of 13 or above was considered to be significant for identifying women with PPD. Out of 150 postpartum 31 mother had a EPDS score of 13 or more, with an incidence rate of PPD as 20.7%. Various risk factors were found to be significantly associated with PPD. Twenty percent of women under 20 years were found to have significant association with PPD. History of psychiatric illness in family was found to be significantly associated with PPD (p value of 0.015). Women with preterm delivery were more at risk for PPD and this association was statistically significant (p-value of 0.009). Mothers with Low birth weight babies (p- value of 0.002) were associated with PPD. Conclusion: Post-partum period is very crucial period in a women life. We as clinicians should help them to acclimatize to this transition and should be able to identify women with PPD. Appropriate and timely management can improve maternal and neonatal care.

207. Study of Clinical Profile of Infective Aetiology of Jaundice
Gourav Jyoti Borah, Ubedul Islam, Mehzabin Haider Hazarika, Dhiraj Das
Background: In this study we wanted to evaluate the clinical profile of patients with jaundice of infective aetiology, determine the aetiological agents and correlate the abnormal liver function tests among different infective aetiologies. Methods: This was a hospital-based observational study conducted among 125 patients having jaundice with or without fever at the Department of Medicine, Gauhati Medical College, over a period of one year from March 2019 to February 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Viral hepatitis (52%) was the most common aetiology, followed by malaria (18.4%). Leptospirosis and scrub typhus accounted for 3.2% of patients. The majority of cases of malaria (82.6%) and viral hepatitis (67.7%) came from rural areas, while 70% of cases of enteric fever were from urban areas. Hepatitis A (61.5%) was the most common viral hepatitis. Anorexia was the most common presenting complaint among the study population besides jaundice and fever. Only 49.2% of viral hepatitis patients had fever at the time of examination whereas, all patients of other aetiologies presented with fever. Conclusion: In our study, viral hepatitis was the leading cause of jaundice due to an infectious cause, followed by malaria. They are found predominantly in male patients and in rural populations. Among viral hepatitis causes, hepatitis A is the most common infection and is found more commonly in younger age groups. Severe liver dysfunction is seen in patients with viral hepatitis compared to other aetiologies. Complications like renal failure, shock, hypoglycaemia and ARDS are also observed in a few patients.

208. Survivin Immunophenotyping in Breast Cancer
N. Swathanthra, S. Uma Shanker
Background: Survivin, an inhibitor of apoptosis, is a protein known to be over expressed in most tumour cell types while being absent in normal cells. As this may contribute to the resistance of cancer cells to apoptotic stimuli from the environment, the use of antisense Survivin therapy hopes to render cancer cells susceptible to apoptosis by eliminating Survivin expression in the cancer cells. Methods: This study was carried out on 25 breast carcinomas samples. Survivin was demonstrated immunohistochemically in the malignant epithelial cells of the tissue samples by using the ImmPRESS polymerized reporter enzyme staining system, which has been shown to have very good sensitivity and signal intensity, low background staining and reduced non-specific binding. This system is based on a new method of polymerizing enzymes and attaching these polymers to antibodies. Survivin immunoreactivity was evaluated semiquantitatively according to the percentage of cells demonstrating distinct nuclear and/or diffuse cytoplasmic immunohistochemical reactions. The specimen was considered to be positive if more than 10% of the tumour cells stained. The distribution of staining in the tumour cells was graded as 1 = focal (<10%), 2 = regional (11–50%), or 3 = diffuse (>50%). Results: Survivin immunostaining was observed in 10 of 25 (40%) cases of breast carcinomas. Among the positive cases, 3/7 (43%), 5/10 (50%) and 2/8 (25%) cases belonged to grades I, II and III respectively. The expression of Survivin gradually increased with increasing histological grades. Conclusion: As a result of its widespread expression in different tumours, and generally low-level expression in normal tissue, Survivin, is considered to be the prospective newer adjuvant target for apoptosis-based chemotherapy. There is a need for further studies to investigate the contribution of this protein to various cancer phenotypes and to be used as a potential molecular target for their treatment.

209. Total Excision of Fistulous Track with or without Seton: An Effective Treatment of Fistula in ANO
R. Ram Raj, Uma Narayanan
Background: Management of fistula in ano, has been considered a clinical challenge for centuries. The risk of recurrence and incontinence being the most feared complications following its surgery. Up to date, surgery is the main modality in treating anal fistula, but there is no simple technique that can completely heal complex anal fistula. The present study analyses the results of fistulectomy with the use of cutting seton in treating fistula‑in‑ano recurrence rate, healing time, and continence status. Material & Methods: This observational analytical study was conducted on 62 patients admitted in the Department of General Surgery for definitive management of fistula in ano from September 2017 to September 2020. All the patients undergoing fistulectomy as a treatment of fistula in ano were taken up for this study, after proper optimisation and management of suppuration, the patients were taken up for complete fistulectomy along with cutting seton which was used in fistula with internal opening above 1cm from anal verge. The fistulas were classified as follows as per the MRI findings and operative findings. Results: Among the total 62 patients included in the study, the mean age of the study population was 37.2 years with majority being males in number (56.4%). The Average Healing time among the patients included in the study was 52days. Out of total 62 patients who have undergone surgery recurrence was for only 1 patient, he was a case of carcinoma prostate post-irradiation and 7 patients required revision procedure or repeat deroofing. Conclusion: Fistula in ano is a complex issue that is affecting an individual to a great extent. Of the different treatment options available for treatment total excision of the fistulous track with seton placement is an effective treatment with very low recurrence rate.

210. Incidence of Rotavirus Infection in Children with Acute Gastroenteritis at a Tertiary Care Hospital Kanpur, U.P. India
Gargi Kumari, R. Sujatha, V. K. Tandon, Desh Nidhi Singh, Suneet Kumar Yadav, Khutija Sarah, Deepak Sameer Bind, Avanesh Singh, Alok Kumar Gupta
Background: Diarrheal diseases account for majority of deaths globally making it the second leading cause of death in childhood especially in developing countries like India. Area wise investigation of Rotavirus infection may give us a clue to start immunisation program. Thus, this study aimed to detect the Rota virus antigen in children with acute gastroenteritis at Rama medical College, Hospital& Research Centre, Kanpur. Materials and Methods: A total of 50 stool samples from children less than 5 years of age, presenting with acute diarrhoea and hospitalized were processed according to CerTEST Rotavirus based on immune-chromatography for the detection of rotavirus antigen. Results: Rotavirus antigen was detected in 7 (14%) cases. Fever and vomiting were the most common symptoms association with rotavirus diarrhoea. Rotavirus infection was significantly less frequent in breast-fed than among bottle-fed babies (71.42%). Conclusion: Our study concludes that rota virus stool antigen test is a rapid diagnostic test also cost effective. The incidence reported in this study gives indication for immunisation and make the mothers aware about importance of breast feeding.

211. Assessment of Quality of Life, Self-Esteem and Psychiatric Morbidity in Patients of Pulmonary and Extra-Pulmonary Tuberculosis
Khan Rabbani Darvesh, Misra Lalit, Saifi Umar, Singh Raghvendra
Introduction: Tuberculosis being a highly infectious disease due to aerosol transmission is associated social stigma, marginalization and discrimination which lead to psychiatric burden, low self-esteem and poor quality of life. Psychiatric illnesses such as anxiety or depression can occur as co-morbidities in TB patients and may negatively influence quality of life and therapeutic results. However, the magnitudes of distress and psychological interventions and their effect on treatment outcomes are often undervalued and have not been adequately evaluated. Hence, besides routine clinical, microbiological and radiological assessment, a broader evaluation of the patient’s overall health profile is necessary. Material & Methods: A hospital based, single observer, cross-sectional study, after clearance from institutional ethical board conducted over a period of 3 months involving 100 patients of Tuberculosis attending the Pulmonary Medicine OPD. Demographic profile i.e. age, gender, occupation, education, socio-economic status (according to kuppuswamy scale), housing, any past/family history TB, Clinical type of Tuberculosis (PTB/EPTB) and drug resistance(MDR/non-MDR TB) were noted in case record sheet. The QoL, self-worth and psychiatric morbidity were assessed using WHOQoL-BREF index, Rosenberg Self-Esteem Scale and Brief Psychiatric Rating Scale at the start of treatment, at 2 month follow-up and at the end of DOTS treatment. Result: 68% patients had extremely severe to very severe negative impact on quality of life whereas 32% subjects had moderate to mild impairment of quality of life. 43% subjects had low self-esteem and 5% had marked psychiatric burden, 40% had moderate, 35% had mild and 20% had very mild psychiatric illness due to tuberculosis. Clinico-demographic factors that significantly affected the psycho-social burden were positive family history of tuberculosis and drug resistant TB. Conclusion: Treatment should not only target clinical and microbiological cure but instead a holistic approach with counselling and patient support should adopted for better outcome.

212. Comparative Evaluation of Post-operative Analgesic Requirement in Hypothyroid Versus Euthyroid Patients Undergoing Laparoscopic Bariatric Surgery
Jaya Sinha, Aviral Srivastava, Atul Dixit, Dipti Saxena
Background: Laparoscopic bariatric surgery is a common procedure performed to treat obesity. Pain management is an important aspect of post-operative care in patients undergoing bariatric surgery. Hypothyroidism alters the metabolism and pharmacokinetics of drugs, including analgesics. However, the effect of hypothyroidism on post-operative analgesic requirements in patients undergoing laparoscopic bariatric surgery is not well studied. Aims and Objectives: This study compares the post-operative analgesic requirements in hypothyroid versus euthyroid patients undergoing laparoscopic bariatric surgery. Materials and Methods: This prospective observational study was conducted on 100 patients undergoing laparoscopic bariatric surgery (BMI>30 kg/m2) at a tertiary care hospital from November 2019 to May 2021. Based on thyroid function tests, patients were divided into hypothyroid (n=50) and euthyroid (n=50). Post-operative pain was assessed using a visual analog score (VAS) at 2, 4, 6, 8, 12, 18 and 24 hours. The primary outcome was the total opioid (pethidine) consumption in the first 24 hours. Secondary outcomes included pain scores, time to first analgesic request, and adverse effects. Results: The mean total opioid consumption in the first 24 hours was significantly higher in hypothyroid patients compared to euthyroid patients (20 mg vs. 10 mg, p<0.001). Hypothyroid patients also had significantly higher pain scores at 2 and 4 hours (p<0.001). The time to first analgesic request was shorter in hypothyroid patients (p=0.008). Adverse effects were similar in both groups. Conclusion: Hypothyroidism is associated with increased post-operative analgesic requirements in laparoscopic bariatric surgery patients. Pain management in hypothyroid patients should be tailored accordingly to optimize post-operative recovery.

213. Assessment of Foeto-maternal Outcomes during Prolonged Pregnancy: A Prospective Study
Renuka Keshri, Nutan Raj, Arshi Praveen, Rajni Kaushav
Background: Postdated pregnancy, also known as post-term pregnancy, is a commonly encountered obstetric condition with a significant prevalence. The gestational period spans from 37 to 42 weeks following the final menstrual cycle. A pregnancy that extends beyond the gestational period of 40 weeks is referred to as a post-term pregnancy in medical terminology. In approximately 7% of all pregnancies, gestation extends beyond the anticipated due date. Methods: This investigation includes every pregnant woman hospitalised after 40 weeks of gestation at the Department of Obstetrics & Gynecology, Narayan Medical College & Hospital, Jamuhar, Sasaram, India. From July 2021 to September 2022, 150 pregnant women who met the inclusion criteria participated in the study. Results: A total of 150 gravid individuals with post-term gestations provided informed consent to partake in the research investigation. The mean age of pregnant women was 23.36 ± 2.77 years, with 52% being primiparous and 48% being multiparous. Eighty-eight percent of the female participants fell within the gestational age range of 40 weeks to 40 weeks 6 days. Ten percent of the participants were in the gestational age range of 41 weeks to 41 weeks 6 days, while the remaining 2% were in the gestational age range exceeding 42 weeks. A significant proportion of neonates, approximately 80.0%, exhibited a birth weight falling within the range of 2.5 to 3.5 kilogrammes. Conversely, a smaller subset, specifically 14.7%, demonstrated a birth weight surpassing the threshold of 3.5 kilogrammes. In the current study, no significant association was found between the method of delivery and gestational age (p>0.05). A notable association exists between caesarean delivery and gravida in pregnant individuals. Specifically, those who underwent caesarean delivery at 42 weeks of gestation displayed a decreased APGAR score of 4, with statistical significance (p<0.01) observed. Conclusion: Prolonged gestation is strongly correlated with an elevated likelihood of perinatal complications, including foetal distress. Obstetric complications, such as cephalopelvic disproportion, deep transverse arrest, and caesarean section, exhibit a notably higher likelihood. The prevalence of maternal and foetal complications was found to be greater in primigravida individuals compared to multigravida individuals.

214. A Prospective Observational Study on Tubeless Percutaneous Nephrolithotomy
R. Saptagiri Prasad, Jandhyam Manikantan, Amarapilli Appala Raju, Immadi Chandra Sekhar
Aim: Aim of this study is to evaluate outcomes and complications with tubeless PCNL. This study also compared the outcomes of tubeless PCNL with standard PCNL. Method: A total number of 36 cases with renal and/or upper uretric calculi of >1.5cm to ≤ 3.0cms for PCNL were selected. Patients and stone characters and operative and postoperative data was analysed. Results: A total of 36 patients were included in the study that underwent tubeless PCNL during June 2021 to May 2023. There were 23 were male and 13 female patients. The mean age in was 44.6 years. There were 10 cases have stone size from 2.6 to 3.0 cm with mean stone burden of 2.24 cms. In 21(58.3%) cases lower calyceal puncture done, 9(25%) patients underwent upper calyceal puncture and for 6(16.6%) cases middle calyceal puncture done for patients. The mean duration of surgery was 56.4 minutes. The mean VAS score in 6th hour of surgery was 6.4±1.6 and after 24th hour of surgery mean VAS score was 4.8±1.2. The Mean analgesic requirement was 90.0 mg of Diclofenac. Mean duration of hospital stay was 2.5 days. The mean time to return daily activities in tubeless PCNL is 6.2 days. Conclusion: Study demonstrated that in Tubeless PCNL, Nephrostomy can be avoided in selected cases and is equally safe and effective to Standard PCNL and is better tolerated with less post-operative analgesic requirement and decreased post-operative morbidity with shorter hospital stay without any compromise in results when compared with Standard PCNL.

215. A Descriptive Microbiological Study of Oral Candidiasis in a Tertiary Care Hospital
Supriya Gaikwad, Surbhi Nayyar, Vishakha Shikhare, Pankaj Joshi, Meena Ramteerthakar
Background: Oral candidiasis is one of the common opportunistic fungal infections which affects the oral mucosa. There have been significant changes in the management of candidiasis in the last few years. Candida albicans and non albicans species are closely related but different from each other with respect to epidemiology, virulence characteristics and antifungal susceptibility. Early diagnosis and management is essential to combat the dreaded complications of multisystemic diseases. So, the present study was undertaken with the aim to speciate the candida isolates and to study the antifungal susceptibility pattern of various candida species isolated from oral swabs collected from patients with oral candidiasis attending a tertiary care hospital. Methods: The study was conducted in the Department of Microbiology, Tertiary Care Hospital during the period of Jan 2019 to Dec 2019. We assessed the characterization of Candida species by using CHROM differential agar and conventional methods like Corn meal agar and Sugar assimilation test. We also have performed the antifungal susceptibility testing as per CLSI guidelines. Results: Out of 130 samples, 112 isolates grown on SDA culture of which 50 (44.6%) were Candida albicans while 62 (55.3%) were candida non albicans. C. albicans (44.6%) was the most predominant species identified, followed by C. tropicalis (25%) and C. Krusei (14.2%). The overall sensitivity of CHROM agar was 95.88% and specificity was 99.15%. All isolated Candida species were sensitive to Amphotericin B. 82% of C. albicans, 89.3% of C. tropicalis and 91.7% of C. parapsilosis were sensitive to fluconazole. Conclusion: Though Candida albicans to be the most prevalent species, emergence of non-albicans Candida species necessitates the species identification. The conventional techniques require minimum 3-4 days for species identification. The newer technique CHROM agar is equally useful method for speciation of Candida. There has been significant rise in the resistance in fungal isolates. Antifungal susceptibility testing should be done as a part of routine laboratory practices to know the resistant pattern of the isolated fungi in the local area and to prevent the irrational use of antifungal agents. This will guide the clinician to start antifungal therapy.

216. Correlation between Polymerase Chain Reaction Positive and Laparoscopic Findings in the Diagnosis of Genital TB
Kriti, Pushpa Nagar, Sunita Sihag, Kavita Kuldeep
Background: Uncommon female genital tuberculosis (GTB), which can lead to infertility in young women, is brought on by the Mycobacterium tuberculosis complex. Due to the weak symptoms of GTB and the absence of suitable procedures, identification is challenging, which causes underreporting and delayed treatment. A quicker and more precise diagnosis of GTB is promised by molecular diagnostics like PCR. Contamination concerns continue. Early detection safeguards the reproductive system. Methods: The study comprised infertile women with positive endometrial TB PCR results who underwent hystero-laparoscopy as part of infertility evaluation. The pre-ovulatory stage included medical exams, pelvic scans, hysterosalpingograms, and laparoscopic procedures. Age, type of infertility, and prior TB history were all noted for the individuals. Results: 56.5% of the 69 patients were 20-30 years old and 34.8% were 31-40. 65.2% had primary infertility, 34.8% secondary. Most (82.6%) had never had TB. 2.9% had positive culture and AFB smear results, whereas 94.2% had positive PCR results. 60% of patients had adhesions and pelvic congestion on laparoscopy, suggesting GTB. 27.5% of patients had abnormal hysteroscopy results, most often poor endometrium and bald regions. Conclusion: Infertility is brought on by genital TB, especially in young women who already have primary infertility. PCR is capable of detecting GTB but not diagnosing it. Early detection facilitates the initiation of treatment and prevents reproductive harm. The promise of PCR for GTB screening requires more research.

217. The Study of Maternal and Perinatal Outcome in Women with Subchorionic Hemorrhage in First and Second Trimester
Rajni Priyanka, Swati, Geeta Sinha, Juhi
Background and Objectives: Subchorionic hematoma is frequent finding on routine obstetric ultrasonography. It appears as a hypo echoic or anechoic crescent shape area behind the gestational sac in the first trimester and behind the fetal membranes in the 2nd trimester. To estimate the association between sub chorionic hemorrhage and adverse maternal and perinatal outcomes. To emphasize the importance of antenatal registration and admission needed for better timely obstetric care. To assess the value of current obstetric practice in managing sub chorionic hemorrhage. To emphasize the importance of early diagnosis and prompt treatment in the improvement of maternal and perinatal outcome. Materials and Methods: Main source of data for study are ANCs from teaching hospitals, Total of 50 cases will be selected for the retrospective study from PMCH Patna. Conclusion: The most important factor which affect the outcome is gestational age at which SCH was diagnosed and volume of hematoma. Chances of abortion are more if diagnosed in 1st trimester .There is no effect on perinatal outcome when patient reached term. Early diagnosis, bed rest, use of progesterone, regular antenatal checkup will help in continuing the pregnancy till term with good fetal outcome.

218. Distal Sodium Channel Blocker: A New Modality in Identifying Spinal Pathology
Samiksha Beri, Sandeep Rathore, Gajendra Singh Baghel, Jaideep Singh
Background & Method: The aim of the study is to evaluate distal sodium channel blocker, a new modality in identifying spinal pathology. Patients were assessed by routine history taking and examination to rule out other local causes of pain, neurological deficits, allergies, etc. Patients were asked to localize the pain and once the nerve was found to be tender and painful on palpation, the pain physician injected local anesthetic (lignocaine 2%) around it and distal to identified painful area and we noted its effect on the pain within 15-30 minutes. Relief of pain distribution was noted as well. Result: The average VAS score Pre injection was 7.94 which came significantly down to a value of 5.09 at 15 minutes and 1.39 at 30 minutes. Conclusion: Sodium channel blockers not only relief pain but also help in determining the site of pain generation by tracing the afferent pathways through pain relief. These are simpler and newer modalities which confer promising future and have a scope of replacing current diagnostic tools such as MRI, etc. in the field of pain management.

219. Drug Utilization Study in Coronary Artery Disease in a Tertiary Care Hospital
Sneha Kumar, Jiya Sejpal, Maansi Gujarathi, Sreeaadya Deokar, Gatita Chanda, Jeetendra Singh, Mishika Singh
Introduction: Cardiovascular diseases (CVDs) are the number 1 cause of death globally. Ischaemic heart disease (IHD)) is a condition in which there is an insufficient supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen demand and supply. Atherosclerotic disease of an epicardial coronary artery is the most common cause of myocardial ischemia. Studies of drug utilization aid in screening, evaluating, and propose appropriate modifications in prescription practices; this would help to make patient care rational and cost-effective. The study of prescription and drug utilization recognizes the difficulties associated and provides feedback to the prescriber about the rational use of drugs. Therefore, the current study is planned to evaluate the utilization pattern of drugs in coronary artery disease. Methods: It is a Prospective observational study done in the Department of Pharmacology and Department of Medicine in a Tertiary Care Hospital with a sample size of 279 patients between 30 to 80 years admitted to the Medicine Department for Coronary Artery Disease. The study analyzed the drug utilization pattern in coronary artery disease patients as per WHO prescribing indicators. The data collected was filled in a master chart, and was subjected to statistical analysis using SPSS 25 software. Results were expressed as a range, mean, and standard deviations. Institutional ethics committee approval was obtained. Informed consent was taken from every patient. Result: The maximum number of patients was in the age group of 51 – 60 years with a mean of 59.22 years and an SD of 10.72. 35.8% were female and 64.2% were male. The male-to-female ratio is 1.79:1. Maximum patients, 34.77% were suffering from anterior wall myocardial infarction. 15.77% of the patients suffered from inferior wall myocardial infarction. The co-morbidities study reported that 86.37% of the cases suffered from Hypertension, 35.12% of patients suffered from Diabetes Mellitus and 5.01% reported Dyslipidemia. The average number of drugs per encounter is 5.29% which is to evaluate the degree of polypharmacy. The average number of Generic drugs prescribed is 80.25%. The percentage of encounters with an antibiotic prescribed is 0.67%. The percentage of encounters with an injection prescribed is 19.16%. The percentage of drugs prescribed from an essential drug list (EDL) is 56.73%. Conclusion: The present study concludes that the prescribing pattern was rational and it followed the standard treatment guidelines. By optimizing the prescribing pattern with the application of the outcomes of the present study, prescribers will be able to improve patient management.

220. Factors Influencing Academic Stress and Depression among 11 to 18 Years School Age Children: A Cross-Sectional Study
Mohd. Sirazuddin, Khaja Nazeemoddin, N. Ranjith Kumar
Background: Currently among high school students, depression is increasingly prevalent and can be attributed to several factors, including inadequate social problem-solving skills, distorted thinking patterns, conflicts within the family, feelings of detachment from both parents and peers, a tendency to attribute failures to personal helplessness, gender-related factors, and a perceived sense of criticism from teachers. The present study aimed to determine Academic stress and Depression among 11 to 18 years school aged Children and study the correlation of influencing factors on academic stress and depression. Methods: This is a cross-sectional study carried outby the Department of Pediatrics, Shadan Institute of Medical Sciences hospital, Hyderabad, a tertiary care center in Hyderabad, Telangana. A pre-designed, pre-tested, semi-structured, and pre-coded proforma was used for recording all the findings from students willing to participate in the study, and all questions were partially closed-ended. Results: The present study was conducted among 255 adolescents, who have given consent in government schools. Hence analysis is done and correlated with various demographic factors. Positive significance was studied with age, higher classes of English medium and children staying with parents in a joint family, mother education, and both parent’s occupation but income has negative significance with academic stress and positive correlation with Beck’s Depression Score. Conclusion: Academic stress was found in 41.96% and depression was found in 31.22% of the study Population. The association between Academic Stress Score and Beck’s Depression Index is statistically significant with a p-value of <0.05. Students with academic stress are 6 times more prone to depression than eustress students.

221. Functional and Radiological Outcome following Surgical Management of Distal Humerus Fractures (AO Type-13C) by AO Technique
Vikramadityasingh V Samorekar
Distal humerus fractures (AO type-13C) are complex injuries and effective management is challenging. Treatment recommendations varied from strictly conservative treatment to open reduction and internal fixation. Materials and Methods: 14 consecutive patients who were operated from June 2021 to July 2022 for distal  humerus fractures(AO type-13C) using the LCP distal humerus plating system were included in the study. Results: Radiographically, union was achieved in patients at 3 months postoperatively. There were no cases of primary malposition or secondary dislocation. The mean MEPS was 92 +/- 11.0 points out of 100 (range 70–100) with a mean elbow flexion of 122°+/- 20.5 (range 95°–150°). Conclusion: The management of AO type-13C distal humerus fractures is a challenging prospect that demands anatomic reconstruction for restoration of elbow function.

222. Comparative Clinical Study of Immunotherapy between MMR Vaccine Versus BCG Vaccine in Cutaneous Warts
Bikkasani U.P. Lakshmi Kishanrao, Naseema Shaik, Sai Jyotsna, Lakshmi Prasanna
A hospital based comparative study done in 40 patients with multiple verruca vulgaris who attended DVL department. All patients randomly assigned into 2 groups: Group A: 20 patients subjected to 0.3 ml of intralesional MMR (into the largest verruca) and Group B: 20 patients subjected to 0.1ml of intralesional BCG (into the largest verruca). Clinical response was graded into complete cure, partial cure and no response. Out of the 40 patients, 21(52.5%) showed complete response and 6 (15%) showed partial response while 3 patients (%) showed no response. On comparing the treatment responses at the lesional site by the end of 3rd month, we observed no statistically significant difference between MMR & BCG group. While the treatment responses at distant site, there was significant difference in clearance rate where MMR showed higher efficacy compared to BCG group. Study conclude that intralesional MMR vaccine is an important modality for the treatment of palmoplantar warts, with better cure rates and excellent safety profile. It is a simple, cost-effective, and non-destructive treatment option with good tolerability.

223. Reconstruction of Femoral Length from Distal Segmental Morphometry Using Regression Equation Method
Anil Kumar Dwivedi, Niyati Airan, Rajan Bhatnagar
Introduction: Stature is one of the most important parameters for identification of an individual. The estimation of stature can be done by the measurement of long bones of the body and using established formulae. Previous studies have documented that femur has highest correlation with the stature and it is commonly used for deriving regression equation. However, the intact femur is not always recovered in medicolegal cases. The reconstruction of stature from fragmentary skeleton form part of forensic anthropological analysis for the purpose of establishment of identity of an individual. Aim: To establish a relation, between the dimensions of distal segments of femur and its length and to derive regression equations for the same. Materials and Methods: The study included 280 femora (136 Right and 144 left), which were measured for length of femur, bicondylar width, anterior posterior diameter of medial and lateral condyle, transverse diameter of medial and lateral condyle and intercondylar notch width with the help of Osteometric board and Vernier calliper. Then, the data was analysed statistically using student t-test, Pearson’s correlation coefficient and linear regression analysis. A p-value of <0.05 was considered significant and <0.01 highly significant. Results: The value of mean length of femur was 412.56+30.34 mm (Right 414.96+30.57 mm, left 410.29+30.05 mm). The length of femur correlates significantly with the dimensions of distal end (p<0.05). The linear regression equation for length of femur from distal femoral dimensions were derived. Conclusion: The morphometric data collected from the lower end of femur will be helpful for Orthopaedic surgeons, Sport physician and forensic experts. Regression equation for length of femur from its distal end dimensions derived in the present study will be useful for anthropologist, archaeologist and forensic investigators for determining the length of femur and thereby stature and identity of an individual.

224. A Comparative Study between Supine and Semi-Fowler’s Position during Extubation and Post Anesthesia Care Unit Following Abdominal Surgeries: A One-Year Hospital-Based Randomized Controlled Trial
Sandeep Kumar, Manu Kapil, Archana Dhamija
Background: The objective of this study was to compare the outcomes of patients placed in the supine position versus the semi-Fowler’s position during extubation and in the post-anesthesia care unit (PACU) following abdominal surgeries. Methods: This one-year, randomized controlled trial was conducted at a tertiary care hospital in Uttar Pradesh. A total of 200 patients undergoing abdominal surgeries under general anesthesia were randomly assigned to either the supine position group or the semi-Fowler’s position group. In the supine group, patients were kept in a flat supine position during extubation and in the PACU. In the semi-Fowler’s group, patients were placed in a semi-Fowler’s position with the head of the bed elevated at an angle of 30-45 degrees. The primary outcomes measured were the incidence of postoperative complications, including respiratory distress, hypoxemia, and aspiration. Secondary outcomes included hemodynamic stability, pain scores, time to extubation, and length of stay in the PACU. Results: The incidence of postoperative complications, including respiratory distress, hypoxemia, and aspiration, was significantly lower in the semi-Fowler’s position group compared to the supine position group (p < 0.05). Patients in the semi-Fowler’s position group exhibited better hemodynamic stability, lower pain scores, and shorter time to extubation compared to the supine position group (p < 0.05). However, there was no significant difference in the length of stay in the PACU between the two groups (p > 0.05). Conclusion: Placement of patients in the semi-Fowler’s position during extubation and in the PACU following abdominal surgeries reduces the incidence of postoperative complications, improves hemodynamic stability, and leads to faster recovery compared to the supine position. Therefore, adopting the semi-Fowler’s position as a routine practice in the postoperative period may enhance patient outcomes and recovery following abdominal surgeries.

225. Antimicrobial Susceptibility Pattern for Salmonella Typhi in A Tertiary Care Hospital
Satish Kumar Reddy G, N Raghu Prakash Reddy
Introduction: Salmonella typhi caused enteric fever remains a significant concern in developing countries. Recent increases in antimicrobial-resistant strains have made management more difficult. This study was done to evaluate antimicrobial sensitivity pattern of Salmonella typhi isolated from blood in a tertiary care hospital. Materials and Methods: This retrospective study was conducted between June 2021 and December 2022 in the microbiology laboratory of Kamineni Medical College and Hospital. A total of 100 S.typhi isolated from stool and blood samples were included in the study. Using the Kirby-Bauer disc diffusion method, antimicrobial susceptibility was determined. Results: All the isolates were 100% sensitive to Ceftriaxone, 99 % were sensitive to ampicillin, 99% were sensitive to chloramphenicol, 98% isolates were susceptible to Cefuroxime and 95% were sensitive to Cotrimoxazolee. There was decreased susceptibility was observed in Nalidixic acid and Ciprofloxacin. Conclusion: The results of this study contribute to the expanding concern regarding the presence and spread of quinolone and broad spectrum antibiotic resistant Salmonella typhi, thereby emphasizing the need for judicious use of quinolone and azithromycin and other interventions to control antibiotic resistance.

226. Management of Pregnancy in Non-Communicating Rudimentary Horn of Bicornuate Uterus: A Case Report
Hetal Prajapati, Aditi Vitthal, Chetna Vaghela
A pregnancy in a non-communicant rudimentary horn is a rare but serious complication. Patients with bicornuate uterus non-communicating have an increased risk of obstetrical complications, such as abortion, intrauterine growth restriction, and fetal demise. Uterus bicornuate non-communicant rudimentary horn (UBNCRH) is a rare malformation of the uterus. The presence of uterus bicornuate non-communicant rudimentary horn poses a great challenge for a gynecologist because that occurs due to the transperitoneal migration of the sperm or the zygote during the implantation period and the Mullerian anomalies are often asymptomatic. We report a case of 29-year-old female with primigravida singleton pregnancy with pain and vaginal bleeding in the 19 weeks 3 days of gestation with a UBNCRH.

227. A Study of Indications and Outcome in 100 Cases of Non Invasive Ventilation in ICU
P.J. Dudhrejia, Manju Yadav, Vijay Parmar
Background: Over the past two decades, the use of non-invasive ventilation by mask has increased substantially for acutely ill patients. Growing evidence indicates that NIV is the standard first-line therapy for many respiratory emergencies. The major concern of our study is to highlight the indications of non-invasive ventilation (NIV), their outcome and certain parameters which decide the outcome of non-invasive ventilation (NIV). Methods: A Prospective and observational study was carried out in ICU of PDU medical college and hospital, Rajkot from January to December 2019 where total 100 patients both male and female, above 13 years of age on non-invasive ventilation were included. Patients with invasive mode of ventilation were not included. The indication of non-invasive ventilation, its outcome in each patient was studied along with parameters on admission (pH, pCO2, pO2, Respiratory rate) which could predict the outcome of non-invasive ventilation in individual patient. Results: 100 cases of NIV that were studied had different underlying aetiology and diagnosis. The patients who seemed to have maximum benefit from non-invasive means were the patients with acute pulmonary oedema secondary to cardiac failure, acute exacerbation of COPD and uncomplicated pneumonitis. Certain admission parameters like pH, pCO2, pO2 and respiratory rate were found to determine the outcome of patient. Patients were categorised in two groups-successful NIV and failed NIV. The overall success rate of NIV was around 80% in our study. Patients like COPD and acute pulmonary oedema required minimum number of hours to wean off to room air from the ventilator. Thus NIV application for mere few hours can do wonders by preventing mortality in patients of respiratory failure. Conclusion: NIV offers favourable outcome for many emergency respiratory conditions, thus remains the modality of choice for treating acute illness like exacerbation of COPD and cardiogenic pulmonary oedema. While it is less preferred for respiratory failure due to acute lung injury/ARDS. Certain parameters like pH, pO2, pCO2 and respiratory rate on admission helps in predicting the outcome of NIV.

228. To Study Pulmonary Function in Patients of Type 2 Diabetes Mellitus
Kanika Sethi, Dinkar Dubey, Seema, Rahul Gupta, O. P. Jatav
Background: The aim of the study is to study pulmonary function in patients of type 2 diabetes mellitus. Various studies have demonstrated abnormalities in lung volumes in patients of type 2 DM and corresponding reduction in lung diffusion capacity (DLCO). Method: In the present study, 60 patients with a diagnosis of type 2 DM were taken after due consent and their pulmonary function test was done and compared with 30 age and sex matched healthy controls. Patients detailed clinical history including age, sex, height, weight, occupation along with personal history and symptomatology was taken. Association between type 2 diabetes mellitus and pulmonary function was assessed. Result: In the study group mean age of subjects was 49.41±10.77 years while in control group it was 51.97±12.77 years. PFT parameters mainly mean FVC% and mean FEV1% was significantly lower in cases group as compared to control group (p value < 0.05). Significant number of patients 25(41.67%) had abnormal FVC% and 26(43.33%) had abnormal FEV1% in the study group as compared to control group (p value < 0.05). Significant correlation was found between mean FVC% and microvascular complications of type-2 DM namely diabetic neuropathy, nephropathy and retinopathy (p<0.05). Significant correlation was also found between mean FEV1% and fasting blood sugar level and diabetic neuropathy (p<0.05).  Though results were statistically insignificant, inverse association was found between mean FVC% and mean FEV1% and various markers of glycemic status namely fasting sugar levels and HbA1C and non-compliance of subjects. Conclusion: Mean FVC% and mean FEV1% were significantly reduced in cases group as compared to controls. The observations in present study suggest that pulmonary functions are adversely affected by type-2 DM and lung may be a target organ for its microvascular complications.

229. Clinical and Etiological Profile of Hypokalemic Paralysis
Zhahid Hassan, Baleekhudin Mohd Osman Dawar, Insha Bashir, Irfan Ali
Introduction: Hypokalemia is one of the most commonly encountered fluid and electrolyte abnormalities in clinical medicine. Muscle weakness secondary to low serum potassium levels is characteristically seen in Hypokalemic paralysis (HP). This heterogenous syndrome can be due to skeletal muscle channelopathies, thyrotoxicosis or various conditions causing excessive loss of potassium (renal or extra renal causes). With appropriate therapy, most cases respond rapidly and often show a complete recovery. Materials and Methods: This was a prospective observational study, where patients with hypokalemia and acute weakness presenting to a tertiary care center were included in the study. A total of 43 patients were incorporated and their clinico etiological profile was assessed. Results: The mean (± standard deviation) age of cases (n=43) was observed to be 29.18(± 10.23) years, with a range of 11 to 63 years. The study group was observed to comprise of 26 (60.4%) males and 17 (39.5%) females. The mean (± standard deviation) serum potassium level of patients at baseline was 2.19(±0.54) with a range between 1.3 mEq /L and 3.1 mEq/L. None of the patients died during hospital stay. The etiological profile revealed causes as  Acute gastroenteritis in 15(34.8%),  Renal tubular acidosis  in 3 (6.9%), diuretic use in 3 (6.9%), Bartter syndrome in 2 (4.65%), Gitelman syndrome in 2 (4.65%), hypothyroid in 2(4.65%) , Thyrotoxic Periodic Paralysis in 4 (9.3%), Cushing’s syndrome in 1 (2.3%), Diabetic Ketoacidosis in 3(6.9%) and Primary hypokalemic periodic paralysis in 3(6.9%). Conclusion: It is imperative for an astute clinician to have an understanding of this extensive syndrome, for acute management and to enable complete unraveling of the underlying pathophysiology and diagnosis with a goal of preventing further attacks and improve quality of life in most patients.

230. Screening of Fluoride Level in Student Living in Tribal Hostel in and around Udaipur
Hemant Dashora, Monica Gaur, Shefali Mehta, A. K. Verma, Shuchi Goyal, Vishwa Mehta
Background: The most of the fluoride in water is naturally occurring or available in added form of the free fluoride ion. The level of fluoride higher from 8mg/litter is having a significant harm on the body of an individual and leading to issues in urine. However, there are different technologies are available for maintaining and managing the level of fluoride in water but the lack of education and facilities in the rural and tribal areas is having a negative impact on the health of the people who are drinking the groundwater. Aim: The current study aims to screening of Fluoride Level in Student Living in Tribal Hostel in and around Udaipur. Method: The study was conducted using the cross sectional design at Department of Biochemistry, R.N.T Medical College Udaipur, Rajasthan. The study has included 150 students who were exposed to drinking water in tribal hostels in Udaipur district Rajasthan. For the study 150 subjects were considered from tribal hostel and the prior consent were taken to take active participation. After collecting the consent, 5ml of urine samples were collected for biochemical analysis. Moreover, the complete physical and history analysis was done to understand the BMI of the individual. The statistical analysis of data was data using the SPSS version 21. It involves the mean, standard deviation, T-test, ANOVA and Chi-square. Results: According to analysis, the mean age, height and weight, as well as BMI of participants, were 14.99±1.88, 1.36±0.17, 36.17±7.40 and 19.89±4.53 respectively. In addition to this, there were 53.3% male and 44.7% female participants. Moreover, the most numbers of participants 34.6% were drinking water from bore-well and followed by 33.3% open well and 22% RO. The mean value of urine fluoride was 0.92±0.64. Apart from this, there was a significant association was found between urine fluoride and gender as P< 0.05. Conclusion: From the study, it has been carried out that underground water in Udaipur district is having fluoride contaminated and analysis has suggested that urine fluoride ranging between 0.2 to 3.2.

231. Cytomorphological Study of Cysticercosis Causing Palpable Nodules: A Report of 29 Cases
Vikas Kumar, Juhi Chuahan, Amir Faiz, Pooja Jaiswal, Mayank Anand
Cysticercosis is a serious health problem in developing countries like India. Fine needle aspiration cytology (FNAC) is a safe and rapid out-patient procedure for the diagnosis of cysticercosis.
Aim: To study the cytomorphological features of cysticercosis on fine needle aspirates. Material and Methods: Retrospective data of 29 cases with palpable nodules during the time period from January 2015 to December 2022, which were already diagnosed as having or suspicious of cysticercosis on cytology, were collected and analyzed. Results: In 15 cases, larval fragments were demonstrated in the aspirates. In the rest 14 cases, mixed inflammatory cells with or without granuloma were seen. Diagnosis was confirmed on follow-up histopathological examination in 8 cases. Conclusion: FNAC in hands of a trained cytopathologist helps in prompt diagnosis and early medical management preventing fatal neurological complications.

232. Diagnosis of Brucella Infections using in-house PCR
Sunaina H. Aghanashini, R. D. Kulkarni, Deepa Hanamaraddi
Purpose: Brucellosis is a significant and increasing public health and veterinary problem in India, with 80% of the population lives in close contact with domestic/wild animal. Hence, human population stands at a greater risk of acquiring zoonotic diseases including brucellosis. This zoonotic infection is endemic to North Karnataka and has been reported from several districts of this region consistently. The aim of this study was to standardise a PCR protocol for early and specific diagnosis of Brucellosis using whole blood samples. Using PCR for detection would cut down on the time required for diagnosis and provide higher sensitivity of detection. Method: Blood samples of 19 patients collected over a span of two years from 2017 to 2019 who were seropositive and/or culture positive were used and DNA was extracted using a commercial spin column kit. PCR amplification was done for the detection of the BSCP31 gene which is common in all brucella species. Primers B4 and B5 were used for PCR assay. Result: A total of five (5/19; 26.3%) samples were positive for the BSCP31 gene of which, two were both culture and serology positive, two were only seropositive and one was only culture. Conclusion: The study shows that in-house PCR is useful in early and specific diagnosis of brucellosis reducing the risk of exposure for laboratory staff handling the samples as results are available in less than 24 hours. Further studies must be conducted to standardize the assay, assess the utility of this test for more chronic cases of infection, and to follow up of patients under treatment.

233. ‘Transcare’ – An Emergency Physician’s Challenge
Mohnish Chordia, Prasanth Ravinthiran, Waseem Ahmed M
Background: Transgender individuals face significant difficulties in obtaining high-quality, compassionate medical care, much of which has been attributed to inadequate provider knowledge. The following case discussion and review of the literature also seeks to improve the practice of Emergency Physicians who are inexperienced in this arena. This presentation aims to review the guidelines to ensure transgender care, including a review of relevant terminology; a few interactive tips and basics in medical and hormonal treatment and adverse events. Case report: This is a case based discussion of a 32 year old female who was brought to the emergency department for complaints of severe bilateral leg pain with dark urine for the last 2 days. Patient was evaluated in the Emergency Department and surprisingly turned out to be a transgender, later diagnosed to have Rhabdomyolysis. Patient was admitted to IMCU for further care. Conclusion: Transgender adults experience unwelcoming healthcare environments, non-affirming healthcare professionals, and institutional practices that inhibit the delivery of gender-affirming care.

234. Comparison of Analgesic Effect of Clonidine as Adjuvant with 0.375% Ropivacaine in Ultrasound Guided Thoracic Paravertebral Block in Modified Radical Mastectomy: A Prospective Randomized Double Blind Study
Mittal Amit Kumar, Verma Devendra, Ola Sandeep Kumar, Sharma Sandeep, Raiger Lalit, Tungria Hemraj
Background and Objectives: Thoracic paravertebral block (TPVB) provides superior analgesia for modified radical mastectomy (MRM). Various adjuvants have been added to local anaesthetics in TPVB but ideal combination is still awaited. This study aimed to evaluate efficacy of clonidine(1µg/kg) added to ropivacaine(0.375%) in USG guided TPVB for MRM. Materials and Methods: In this prospective randomized double blind study, 78 ASA grade I,II patients aged 18-60 years undergoing MRM were divided into 2 groups- Group RC and RP to receive ultrasound guided TPVB with 0.375% Ropivacaine (19ml) added with 1μg/kg Clonidine and 1 ml normal saline, respectively followed by administration of general endotracheal anaesthesia. Primary outcome measured was duration of analgesia. Secondary outcomes included consumption of rescue analgesic drug, pain score and perioperative haemodynamic parameters. Qualitative data and quantitative data were presented as number(proportion) and mean±sd respectively. Chi square and unpaired t-test were applied where deemed appropriate. p<0.05 was considered statistically significant. Results: Mean duration of analgesia was significantly prolonged when clonidine was added to ropivacaine for TPVB (16.87±1.55hrs v/s 7.00±1.17hrs,p=0.000). Total amount (84.62±25.40mg v/s 184.62±45.02mg) and number (1.13±0.39 v/s 2.46±0.60) of rescue analgesic doses were also reduced in group RC(P=0.00). HR, SBP and DBP were comparable between groups in perioperative period (p>0.05). VAS at rest, cough and forward hand movement showed statistically significant lower scores in group RC. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in prolonged duration of analgesia with lower pain scores and reduced postoperative requirement of rescue analgesics without major haemodynamic alterations.

235. A Cross-Sectional Survey on Low Back Pain Among Long Distance Truck Drivers in Cuttack City
Bhabani Shankar Lenka, Chandan Samal, Alok Kumar Behera, Manoja Bhuyan
Aim: To analyze the relationship between low back discomfort and weariness among truck drivers. Method: An anonymous poll was completed by 91 active commercial drivers from 4 different locations. The Oswestry Disability Index was used to evaluate low back pain (ODI). The Brief Fatigue Inventory was used to gauge levels of fatigue. The relationship between LBP and fatigue was measured using multiple linear regression (MLR). Results: After adjusting for age, BMI, work satisfaction, years of driving experience, and kilometres travelled, MLR demonstrated that increasing low back pain is a significant predictor of increased weariness (p < 0.002). Conclusion: Based on these findings, it is clear that this population’s back pain and weariness are significantly correlated. This shows that addressing the root causes of back discomfort in drivers may help to decrease their degree of weariness and hence enhance road safety.

236. An Analytical Attempt to Predict the Chemical Makeup of Urinary Calculi in Vivo Using CT Attenuation data
Subrat Prasad, Bharat Prasad
Introduction: Chemically, there are many different kinds of stones, such as calcium stones, uric acid stones, struvite stones, and cystine stones, among others. There is a propensity for a certain type of stone to form in each pathologic category. Therefore, the care of the patient can and does depend on knowing the chemical makeup of the stone that the patient develops. determining whether the mean Hounsfield Unit (HU) value on computed tomography may be used to predict the chemical composition of urinary stones (CT). Method: This investigation was conducted in the MGM Medical College & LSK hospital in Kishanganj, Bihar in a prospective and analytical manner. The study comprised patients with urinary stones who underwent a non-contrast CT and had stones removed. X-ray diffraction crystallography was used to determine the stone’s primary chemical composition. Result: Four sorts of 60 stones were examined. Between each of the four categories, there were statistically significant (p<0.002) differences in the mean, maximum, and median HU values. There was no discernible difference between HU core values and periphery values. The stone types’ relative densities corresponded with earlier research, although the studies’ absolute values varied. Conclusion: The chemical makeup of urinary stones is correlated with their mean HU. If a database of attenuation characteristics for stones of known composition is developed for a given scanner and procedure, calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, and hydroxyapatite stones can be distinguished on the basis of their CT attenuation parameters.

237. Fine-Needle Biopsy Vs. Ultrasonography in the Radiologic Work-Up for Thyroid Surgery
Subrat Prasad, Sachin Prasad
Objective: To assess the pain, tolerability, and consequences related to core needle biopsy (CNB) with fine needle aspiration (FNA). Method: For each treatment, 90 patients underwent an FNA using 20-gauge needles and a CNB utilizing 10-gauge double-action spring-activated needles. Patients were asked to record their level of pain on a 15-cm visual analog scale as well as how well the surgery went. Both the frequency of biopsies and the complications were noted. Result: During and 10 minutes after the biopsy operations, the median pain levels for the FNA and CNB techniques were comparable (3.6 vs. 3.5, P=0.453; 0.8 vs. 1.0, P=0.295, respectively). All 90 FNA patients and 90 CNB patients reported feeling okay after the surgery (P=0.245). The CNB group had a lower mean number of biopsies (1.3 vs. 1.1, P=0.001). No statistically significant difference was found between staff and non-staff in any parameter after subgroup analysis. Both groups did not experience any significant problems, although three patients who had CNB did (P=0.245). Conclusion: Regarding discomfort, tolerability, or consequences, thyroid nodules can be diagnosed using both FNA and CNB without any discernible differences.

238. A Retrospective Study on Association between Abnormal Uterine Bleeding and Caesarean Scar
Meena Mehta
Aim: The purpose of this investigation was to describe the various hysteroscopic findings of previous caesarean delivery scar defects (PCDS) and to assess their association with abnormal uterine bleeding. Methods: This was a retrospective study of patients with abnormal uterine haemorrhage following caesarean delivery. To determine the cause of the symptoms, transvaginal ultrasound and hysteroscopy were utilised, and the gynaecological symptoms and hysteroscopy findings were documented. The correlations between hysteroscopic findings and abnormal uterine haemorrhage were assessed. Results: Ninety-six patients (82.8%) presented with intermenstrual haemorrhage. On hysteroscopy, the most frequent findings of scar defects were increased local vascularization (74.1%) and oozing areas (47.4%). Intermenstrual haemorrhage was significantly associated with increased local vascularization on the defect (p=0.048). Conclusion: This investigation classified the various PCDS findings observed during hysteroscopy. The relationship between increased local vascularization on the scar defect and intermenstrual haemorrhage was statistically significant.

239. The Platelet to Lymphocyte Ratio in Severity Assessment of Ulcerative Colitis
Chittuluri Jagadeesh, Chezhian A., Murali R., Ratnakar Kini P., Muthukumaran K., Shubha I.
Objectives: The outcomes of coronary artery disease and some cancers are already determined by platelet-to-lymphocyte ratio (PLR), two markers of subclinical inflammation. The aim of this study was to evaluate the role of platelet to lymphocyte ratio (PLR) as biomarker in diagnosing and assessing disease activity in ulcerative colitis (UC). Methods: A total of 110 individuals were enrolled in the trial, of whom 72 had active UC, and 38 were in remission. Using parameters from a complete blood count, the PLR was determined. Results: The mean PLR for UC patients in active and remission were respectively 209.52 and 131.27 (p=0.005). Using ROC analysis, the cut-off value for PLR to distinguish an active phase in UC patients was determined to be ≥133.87 (sensitivity: 63%; specificity: 68%). Conclusion: In summary, patients with active UC had PLRs that were considerably greater than those in remission. The PLR could be a noninvasive, independent indicator of disease activity in UC.

240. High-Resolution Ultrasound in Wrist Tendon Pathologies with MRI Correlation
Rajeev Kumar Ranjan, Anima R. Xalxo, Nisha Rai, Devendra Baskey, Suresh Kumar Toppo, Paras Nath Ram
Background: Wrist tendons may be affected by a variety of pathologic conditions, including those caused by trauma and overuse, inflammatory and metabolic disorders, or infection. Improvements in high-resolution ultrasound are producing high-quality images of the superficial tendinous and peritendinous structures. The present study aimed to evaluate wrist tendon pathologies using high-resolution ultrasound and further correlate with MRI. Materials and Methods: The study was conducted in the Department of Radiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India from February 2019 to August 2020.  For this study, 62 patients (36 men and 26 women) with symptoms indicative of tendon pathology were enrolled. Results: The majority of patients (29%, n=18) were  30-39 years old. Male patients made up 54.8% of the total (n = 34), while female patients made up 45.2% (n = 28). The majority of the patients (33.9 %; n = 21) had tendon tears. Conclusion: The majority of our patients complained of pain and movement restrictions. Tendon injuries in younger patients typically resulted from direct trauma. When diagnosing tendon pathology, sonography and MRI shown very high sensitivity and specificity. Clinical diagnosis and USG & MRI findings are significantly correlated (p<0.05). Both MRI and sonography are non-invasive, precise tools for diagnosing tendon damage, planning therapy, and evaluating the efficacy of treatment.

241. Findings on Liquid-Based Cytology Prepared Smear among Women with Vulvo-Vaginal Itching and Discharge
Joy Philip Reang, Padi Yasung, Purba Biswas
Aim: To analyse pathological changes and association between socio-demographic characteristics of itching and discharge, in women presenting vulvo-vaginal itching and discharge. Method: This was a descriptive cytological hospital based prospective study conducted in Pathology department obtained from outpatient clinic of Obstetrics and Gynaecological department. Study was based on 274 women with complaints of vulvo-vaginal itching and discharge were obtained for cytological examination in a Liquid Based Cytology (LBC) collection vial to look for pathological changes. Pap smears samples (EZIPREP) were taken from all these patients with spatula and endocervical cytobrush and slides prepared. The remnant material on the spatula and cytobrush was centrifuged after being treated in Pap spin collecting liquid. The cell button was used to prepare smears, which were then fixed and stained with Papanicolaou stain. Data analysis was done using appropriate statistical tests. Result: The age of participants ranged from 20 years to 72 years with mean age being 33.4 years. All patients had vaginal discharge with different consistency. Bacterial vaginosis was the most prevalent infection found in 34 (12.4%) cases. Trichomonas infection was found in 6 (2.19%) cases, candida species in 4 (1.45%) cases, squamous intraepithelial lesion SIL 14 (5.09 %) cases and majority were negative for intraepithelial lesion NILM 216 (78.83%) cases. Bivariate analysis showed that in case of factors associated with discharge, women of 41-50 years of age showed higher risk, but in case of factors associated with itching, women aged >60 years showed higher risk, and when associated with both discharge and itching, women aged between 31-40 years showed higher risk. Our study found that age exhibited mild variation in risk-related symptoms, recommending further research with larger sample sizes. Conclusion: LBC is likely to continue to be the predominant technique for cervical cytology screening due to societal prerogatives and cytologists’ preferences for the method. Bacterial vaginosis is found to be the most predominant cause of vaginal infection and thus serve as a key for researchers to find its underlying cause for an appropriate diagnosis. Common symptoms like discharge and itching have been linked to a variety of conditions, from cancer to bacterial vaginosis, which would not have been found by a simple clinical examination. Thus, Pap smear screening and examination in accordance with accepted standards are required.

242. Evaluation of the Efficacy of Surgical Excision of Calcaneal Spur as a Treatment for Preventing Chronic Heel Pain: A Prospective Study
Subhendu Naik
Introduction: The inferomedial aspect of the calcaneal tuberosity experiences pain and sensitivity, which is indicative of painful heel syndrome. Different surgical techniques may be employed in situations that are unresponsive to conservative therapy. This study aimed to describe the functional effects of a combined calcaneal spur excision, drilling, and plantar fascia release procedure for the management of persistent heel discomfort. Method: The American Orthopaedic Foot and Ankle Score (AOFAS), Visual Analogue Scale (VAS), and Short Form 12 Physical Composite Score (SF-12 PCS) findings for patients were compared between preoperative and postoperative periods. Radiologically, the recurrence of the calcaneal spur was examined. Results: The median preoperative scores were 43 on the SF-12 PCS, 8.56 on the VAS, and 51.66 on the AOFAS. The AOFAS, VAS, and SF-12 PCS median postoperative scores were 91.4, 2, and 58, respectively. Conclusion: effective early outcomes in the treatment of persistent heel pain were achieved with percutaneous calcaneal drilling, spur excision, and minimally invasive plantar fascia release.

243. A Comparative Analysis of Two Severity Scoring Systems in Predicting the Prognostic Outcomes in Acute Renal Failure
Appalanaidu Rongali, P Vidyadhar, Srikanth A, Bylapudi Prasanth
Introduction: Predicting outcomes is crucial in clinical practise. The mortality rate linked with acute kidney injury (AKI) in older people is still high, despite major therapeutic advancements. Many severity grading methods have been utilised for predicting patient death in hospitals, but nothing is known about the importance of these systems for older patients with AKI. Method: 431 people were hospitalised to four intensive care units as part of a prospective cohort using this methodology. Using association and correlation tests, the clinical characteristics at admission, severity profile, and level of treatment were examined. Using the ROC curve, the scores’ sensitivity and specificity were evaluated. Results: 431 patients were examined for the study during data collection. When compared to the patients in the group without injury, patients in the AKI group were older (61 years vs. 64 years, p = 0.018) and more frequently from the emergency department (14.8% vs. 28.3%, p 0.002), according to the comparative analysis between the clinical and demographic characteristics of the individuals studied. Conclusion: The prognostic scores have a good ability to predict death, dialysis, and acute renal injury. The Charlson Comorbidity Index performed poorly when it came to predicting the need for dialysis but performed well for acute renal injury and death.

244. Acetabular Fracture- Clinical Outcomes of Surgical Management
Md. Qamar Abdul Azeez, Buddharaju Suraj Verma, Krishna Teja. K
Aim: The purpose of this study was to assess the efficacy of anterior and combined approaches for treating acetabular fractures. Methods: Retrospective evaluation of 37 acetabular fractures in 35 patients treated with an anterior approach. According to Judet-Letournel, fractures are classified. Initial and final radiological evaluations were based on the criteria of Matta. For functional assessment, modified Merle d’Aubigne and Postel criteria were utilised. Results: Eleven fractures (30%) were of the straightforward type, while 26 (70%) were of the mixed type. Two (18%) of the uncomplicated fractures were transverse, while nine (82%) involved the anterior column. Fourteen (54%) of the mixed type fractures were both column fractures, five (19%) were transverse + posterior wall fractures, five (19%) were T-shaped fractures, and two (8%) were anterior column + posterior hemitransverse fractures. In 15 (43%) patients, the surgical approach was ilioinguinal, in 9 (26%) it was Stoppa, and in 11 (31%) it was combined. Our functional outcomes were excellent in ten (27%) hips, fair in twenty (54%) hips, moderate in four (10%) hips, and poor in three (8%) hips. In 15 (40.5%) hips, our radiological findings were flawless, excellent, moderate, or poor. Conclusion: In fractures that are amenable to anterior surgical approaches, the results are satisfactory. In some fracture types, a posterior approach can be incorporated. We anticipate that the proportion of acetabulum fractures requiring a concomitant posterior approach will decrease as experience grows.

245. A Systematic Review of the Use of Expandable Cages in the Cervical Spine
Anil Meena, Laxman Choudhary, Ridhi Karan
Expandable vertebral body replacement cages (VBRs) have gained significant utilisation in the field of orthopaedic surgery for the purpose of reconstructing the thoracolumbar spine subsequent to corpectomy procedures. Nevertheless, their utilisation in the cervical spine is less prevalent, and at present, no expandable cages available in the market have obtained clearance or approval from the US Food and Drug Administration for implementation in the cervical spine. The primary aim of this investigation was to conduct a comprehensive systematic review pertaining to the utilisation of expandable cages in the management of cervical spine pathology. The review specifically emphasised the assessment of fusion rates, deformity correction, complications, and indications associated with this treatment modality. A thorough literature search was conducted using the Medline database, resulting in the identification and inclusion of 24 relevant articles for the purpose of this review. The benefits of expandable cages encompass enhanced ease of implantation with reduced risk of end plate damage, minimised intraoperative manipulation of the device, and potentially heightened control over lordosis. They may confer notable benefits in instances characterised by compromised bone integrity, such as individuals afflicted with osteoporosis or those with radiated metastatic tumours. Nevertheless, it is crucial to acknowledge the potential hazard of excessive distraction, particularly in the cervical spine region. The limited height of these devices restricts their applicability in instances involving collapsed vertebrae. Additionally, it is important to consider that the expansion mechanism’s hardware may impose limitations on the available surface area for fusion. The utilisation of expandable vertebral body replacements (VBRs) represents a valuable asset in the armamentarium for the surgical reconstruction of the anterior column of the cervical spine, demonstrating a satisfactory safety profile. While the advantages of employing expandable cervical cages in specific clinical scenarios are evident, it is not justifiable to adopt their extensive utilisation after all corpectomies. This is primarily due to the considerably higher expenses associated with expandable cervical cages when compared to structural bone grafts or non-expandable vertebral body replacements (VBRs). It is worth noting that these alternative options can be employed to attain comparable clinical outcomes.

246. Comparative Evaluation of the Outcomes Following Chevron Osteotomy with Akin Osteotomy or without It: A Retrospective Clinical Assessment
Vivek Kumar, Mahesh Chand Bairwa, Vikram Pratap Singh
Background: One of the most adapted approaches for the corrective surgery of valgus deformity of great toe is the Chevron osteotomy which is usually done with the Akin osteotomy of the proximal phalanx of the hallux. No guidelines exist for their indication technique or postoperative correction loss or adjacent joint arthritis development. Aim: The present study aimed to comparatively assess the treatment outcomes radiographically following Chevron osteotomy with Akin osteotomy or without Akin osteotomy. Methods: In 59 subjects assessed, 9 subjects underwent the Chevron osteotomy along with Akin osteotomy combined, whereas 50 subjects were managed with the Chevron osteotomy alone. The radiographs for assessment were taken preoperatively and postoperatively. The outcomes assessed were complications, arthritis of adjacent joints, valgus deformity recurrence, IPA (interphalangeal angle), HVA (hallux valgus angle), and IMA (intermetatarsal angle). Results: It was seen that lower IPA and HVA angles were maintained with combined Chevron-Akin osteotomy compared to Chevron osteotomy alone. A significant increase in HVA was seen in the Chevron osteotomy group from 18.39 at the first follow-up to 20.83 at the final follow-up visit. However, no significant difference was seen in the two groups concerning the other radiographic variables assessed. No increase in adjacent joint arthritis was seen following hallux valgus surgery. Conclusion: The present study concludes that no effect on IMA or HVA correction is seen following Chevron-Akin osteotomy in combination, and the combination further decreases the risk of increased IPA or HVA after long-term follow-up. Also, Akin osteotomy has no increased risk of adjacent-joint arthritis and is recommended for correction of hallux valgus deformity.

247. Analyzing the Relationship of Biomechanical Parameters with Performance Based Tests and Self-Reported Functions in Subjects after Total Hip Arthroplasty – One Year Follow Up
Vikram Pratap Singh, Vivek Kumar
Background: Different methods have been used in the literature to assess the results in subjects who underwent the THA (total hip arthroplasty). However, data are scarce in the literature concerning the correlation at various intervals following the surgery. Aim: The present study aimed to assess the relationship between biomechanical parameters, PBTs (performance-based tests), and self-reported functions in subjects following total hip arthroplasty after one year. Methods: The study assessed 22 subjects following total hip arthroplasty where biomechanical parameters, balance, gait, and hip strength were assessed, in performance-based tests, 30CST (30-second-chair-stand test) and TUG (Timed-up-and-Go test) was used, and for self-reported function, HOOS (Hip disability and Osteoarthritis Outcome score) was used. Data gathered were statistically analyzed with the Spearman correlation coefficient. Results: A moderate to strong correlation was seen for PBT parameters and HOOS scores with r<0.7 and <0.4. Assessing the correlation between biomechanical parameters and HOOS scores showed a moderate to strong correlation for hip strength and a weak correlation with balance and gait parameters with r<0.3. Also, a moderate to strong correlation was seen between 30CST and hip strength. Conclusion: The present study concludes that after 1 year postoperative, PBT or self-reported measures can be used to assess the outcome after total hip arthroplasty. Also, hip strength assessment is seen in PBT and HOOS parameters and these parameters can be additionally used. Weak correlations are seen in balance and gait parameters suggesting the use of PBT and PROM additionally to attain additive information in THA subjects at risk of falls.

248. A Study of Umbilical Cord in 50 Specimens in Palghar Population
Rahul Prakash Kharate, Bhakti R Kharate
Introduction: The mother-fetus umbilical cord transfers nutrients and waste. The umbilical ring, primitive umbilical cord, yolk sac vessels, and allantois form throughout embryogenesis. The permanent umbilical cord grows into Wharton’s jelly. By the sixth week, the midgut loop joins the cord, causing a physiological hernia that resolves by the 10th month of pregnancy. Aims and Objectives: This study aims to investigate the characteristics and potential implications of umbilical cords within the Palghar population, utilizing a sample size of 50 specimens. Methods: A study included placenta and umbilical cord samples from 19-32-year-old moms. The presence of a nuchal cord, umbilical cord length and width, coiling, knots, cysts, haematomas, and cord attachment was evaluated. Infants had many cord wrappings. The coiling index and vascular patterns were calculated using Indian ink. Histology examined selected samples. Haematoxylin and eosin stains were applied to paraffin-embedded tissue sections for microscopic investigation. Results: Table 1 shows newborns’ length, diameter, false knots, attachment, cord coiling, para, nuchal cord, coiling index, birth weight, and sex. Birth weight, cord characteristics, and size vary. False knots and nuchal cords indicate delivery risks. Their effects on neonatal health and development need further study. Table 2 depicts cord coiling patterns, coiling index, and attachment kinds, providing insight into umbilical cord variability and prospective fetal development therapies. Cord features and birth outcomes need further study. Conclusion: This study found that shorter umbilical cords may decrease embryonic development and death, while longer cords are associated with nuchal cords. Hypo-coiling can cause preterm birth and fetal discomfort.

249. Evaluation of Screening Parameters in the Assessment of Neonatal Sepsis
Shrikant Bhanudas Ovhar, Santosh Shivajirao Tathe
Introduction: Early-onset neonatal sepsis and late-onset neonatal sepsis are both types of the same infection that occurs in infants and are classified differently. EOS is caused by infections that occur in the genitourinary system of the mother, whereas LOS is acquired after birth. Premature infants are fragile. Blood cultures, a cerebrospinal fluid check, and biomarker testing are all parts of the diagnostic process. Rapid approaches aid in pathogen identification. Aims and Objectives: The purpose of this research was to determine the best ways to screen for and diagnose newborn sepsis. Methods: This prospective study, conducted over a year, included 100 newborn infant suspected of having septicemia who was admitted to the Neonatal Intensive Care Unit. The purpose of these studies was to investigate the clinical presentation, diagnostic techniques, and outcomes of septicemia in this population, in addition to studying its incidence and features. The study gave useful information for gaining a better knowledge of septicemia in neonates who are particularly sensitive. Results: The bacterial culture results, age of onset, gender, and birth weight of each patient are listed in Table 1. Table 2 shows the cultural findings broken down by age range. In Table 3, we can see the sensitivity, specificity, PPV, and NPV values for each test combination. The results provide insight into test combination efficacy in predicting septicemia and the prevalence of different cultures, as well as age-related patterns. Conclusion: Neonatal sepsis is a leading cause of death in preterm, low-birth-weight infants, especially males, especially in the early-onset and Gram-negative forms.

250. Comparison the Clinical and Radiological Outcome of Patients between Dynamic Hip Screw and Trochantric Fixation Nailing Implants Applied in Unstable Intertrochanteric Hip Fracture
Sarang Sawarbandhe
Introduction: Intertrochanteric fractures in the proximal femur are prevalent in older people with osteoporosis. High morbidity and mortality rates. Radiography and surgery are usually required for diagnosis. Unstable fractures require intramedullary nailing, but stable fractures can be repaired with a sliding hip screw. Anatomic reduction and compression fixation are advised for mild to moderate comminution fractures. Stability is required for fixation. Cement augmentation and osteotomies are surgical alternatives. Aims and Objectives: This study compared DHS and TFN implants for unstable intertrochanteric hip fractures. These two implants were compared for patient outcomes and fracture healing. Methods: This comparative study included patients with suspected intertrochanteric fractures from December 2010 to March 2012. The patients were randomly assigned to receive a “dynamic hip screw (DHS)” or a “trochanteric fixation nail (TFN)”. This research aimed to evaluate the relative efficacy and safety of different procedures by following patients after surgery to assess their level of function, complications, and pain. The effectiveness of the treatment plan was analysed statistically. Results: DHS and TFN participants’ demographics and clinical features are shown in Table 1. The mean ages and male-to-female ratios of both groups were similar. The “Preoperative Mobility Score (PMS)” and “American Society of Anesthesiologists (ASA)” scores were similar. Fracture features were similar. Operational length, blood loss, open reductions, X-rays, hospital stay, complications, and mobility outcomes were compared in Table 2. These factors differed, suggesting treatment regimens differ. Conclusion: The study has concluded that DHS and TFN implants for unstable intertrochanteric fractures had similar results, although TFN had certain advantages.

251. Comparative Study of Balthazar CT Severity Index and Modified CT Severity Index in Predicting the Outcome of Acute Pancreatitis
Sekhar Reddy Jilakapally, Amit Kumar Routh, Anusha Mulka
Introduction: Acute pancreatitis is generally classified into mild and severe forms: mild pancreatitis is associated with minimal organ failure and an uneventful recovery. Severe pancreatitis, also, is associated with organ failure or local complications. Aims and Objectives: To compare the Balthazar CT Severity Index and Modified CT Severity Index in predicting the outcome of acute pancreatitis. Materials and Methods: 50 cases of acute pancreatitis underwent CECT. The scans were reviewed and scored using both CT indices. Severity parameters included the length of hospital stay, occurrence of organ failure, need for intervention, evidence of infection, and mortality. Descriptive statistics were used for baseline characteristics. Chi-square or Fisher’s exact tests were used to compare the two indices. Results: The age of the patients in the study group was in the range of 21 to 80 years. Maximum patients were in the age group 40-50 years (44%). The mean age was 42.32 years. Out of 50 cases, 45 (90%) were male and 05 (10%) were females with a male to female ratio of 2:1. Majority of patients were of severe pancreatitis (44%) category. 38% patients were grouped into moderate pancreatitis and 20% were categorized in mild pancreatitis. The outcome parameters in terms of length of hospital stay, need of intervention, development of infection, and development of organ failure were more in patients with higher modified CT severity index. Conclusion: Contrast-Enhanced Computed Tomography (CECT) is considered an excellent imaging modality for diagnosis, detecting the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In the present study, significant statistical correlation is found with the clinical outcome in terms of the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It may help in predicting the need for interventional procedures.

252. Association Between Online Food Ordering Habits and Obesity Among Postgraduate Students of SCB Medical College, Cuttack, Odisha
Manoja Bhuyan, Sasanka Sekhar Dash, Priyaskant Pradhan, Chandan Samal
Aim: To discuss the online food ordering practice and its correlation with obesity. Methodology: A cross-sectional study design was adopted. Purposive sampling was used to collect 249 samples for this study among postgraduate students at SCB Medical College in Cuttack, Odisha. The primary data used were those from student height and weight assessments. Univariate and Bivariate analysis was made to find association between food type and food frequency with obesity. Result: The study’s findings indicated that among SCB Medical College students, there was no association among meal kinds and obesity (p = 0.178) as well as presence of correlation between the frequency of food delivery services and obesity (p = < 0.001). Conclusion: Ordering food online is only done about twice a week. Obesity and the sorts of food ordered when food is ordered online are unrelated. An association was found between the frequency of online food ordering and obesity in the SCB Medical College.

253. The Study of Seropositivity for Transfusion Transmitted Infections in Blood Donors at the Blood Centre in a Tertiary Care Hospital
Ramya T, Ammatul Mugni, Meenal Rajesh Patil,  Khushboo Wadgaonkar, Surekha Kadadi
Introduction: Blood is an invaluable resource and is life-saving in critical health conditions like severe anaemia, excessive blood loss such as in trauma and major surgeries. However, the blood may be unsafe and optimum utilization of blood from blood donors may not be possible due to the detection of transfusion transmitted infections (TTI’s). Objective: To estimate the seropositivity for transfusion transmitted diseases in blood donors at the blood centre.  Method: A retrospective study was conducted from July 2021 to June 2023 in the Blood Centre at ARMCH & RC, Kumbhari, Solapur, Maharashtra. Data of results of blood screening of all voluntary blood donors was collected and studied for the different TTI’s with respect to age and gender. Results: A total of 13,817 blood units were collected from voluntary blood donors between 18-65 years in a 2-year period from July 2021 to June 2023 with 98.13% being male donors and 1.85% of female donors. Out of 13,817 blood donors, 246 (1.78%) were seropositive, with male predominance (98.39%) and females (1.61%). Highest seropositivity was in the age group 18- 31 years. HBV seropositivity was the most common, with 2.41%, followed by HCV with 0.46%, Syphilis (0.19%), HIV (0.14%) and Malaria (0%). No case of Co-infection was detected. Conclusion: The screening of TTI’s in blood donors serves not only to ensure safety, but also gives an estimate of the seroprevalence in the general population.

254. Prevalence of Psychiatric Morbidity and its Associated Factors among Workers in A Small-Scale Industry: A Cross Sectional Study
V.U. Karthikeyan, Bandla Shailaja, R.S. Praveen Kumar, A. Jayanandhini
Background: Studies related to Psychiatry problems in industrial workers is limited. There are various factors such as shift work, medical illness, substance dependence, sleep problems etc which may precipitate Psychiatry morbidity, resulting in absenteeism and presenteeism, overall affecting both the employer and the employee. It is necessary to identify the risk factors for Psychiatry morbidity among industrial population. Aims and Objective: The study aims to estimate the Prevalence of Psychiatry morbidity and to assess the contribution of various factors towards Psychiatry morbidity. Materials and Methods: This Cross-sectional study was conducted over a period of 20 months among Rice mill workers. Workers were recruited to participate in the study after obtaining informed consent. The Mini-International Neuropsychiatric Interview, Hamilton Depression Rating scale and Hamilton anxiety rating scale was used to find the psychiatric morbidity among the participants. The different factors associated with psychiatric morbidity were assessed by semi structured questionnaire. Results: The prevalence of psychiatric morbidity in our study is 50.8%. Factors such as sleep disturbances, history of psychiatry illness, chronic illness, shift work, higher years of work, poor family support led to higher psychiatry morbidity among the workers. Conclusion: All employers and employee should be aware of higher Psychiatry morbidity in Industrial workers. It is necessary that industrial workers must be screened annually for mental health problems.

255. Lessons Learned from the Clinical Use of Tooth as Bone Graft Material
Anil Kumar Sharma, Alka Sharma
To treat osseous defects, a range of bonegrafts and their replacements have been accessible, but appropriate reconstruction by any bony defect persists as a therapeutic hurdle. The current narrative review analyses significant outcomes in patients treated with bonegrafts and bonegraft substitutes for surgical therapy of osseous defects based on peer-reviewed literature. Despite autograft, xenograft, and alloplast bonegraft substitutes being employed in a number of periodontic procedures, all of them have their own set of restrictions. Autogenous tooth bonegraft is functional in clinics due to different available forms which can be availed for different clinical challenges. Moreover, due to genetic uniformity, it fosters efficient bone regeneration by allowing osteoinduction and osteoconduction, as well as reducing foreign body reactions.

256. The Study of Prevalence of Leukocyto Spermia in PMCH Patna
Ritika Gupta, Pratibha Srivastava, Dilip Kumar
Background and Objectives: Infertility and childlessness is one of the major health and family problems throughout the world. The prevalence of infertility in the general population is estimated to be 15% to 20%. Of this, male factor alone is responsible for 20 to 40%. Human male infertility is normally assessed on the basis of semen analysis. Among the various parameters which are studied, the association between seminal Leukocytes and semen quality is still contradictory, but majority of the studies have proved the significant role of leukocytes in altering the semen quality by various mechanisms like ROS production, immune reactions etc., To study Leukocytospermia in semen samples. To find out the prevalence of leukocytospermia in the general (male) population of surrounding feeding areas with special reference to infertile men. To study the relation/association between leukocytospermia and infertility status. Methodology: A total of 95 semen samples were received in the department of pathology with history of infertility, varicocoele, undescended testis, etc., Study duration of 18 Months. One sample could not be processed because of urine contamination. Routine semen analysis including leukocyte count by Peroxidase staining test was done on all the remaining 94 samples. Out of these 94 samples, 6 were repeat samples of short duration, another 6 were with history other than infertility like varicocoele, undescended testes, etc. Conclusion: Leukocytospermia is not to be neglected as it is found to be associated with significant number of idiopathic male infertility cases, and in-turn, it is influenced by many factors like smoking, etc. Detection of leukocytospermia by simple and cost- effective tests like Leukocyte Peroxidase staining should be included in the routine semen analyses especially in men under infertility investigation before putting them to higher, deeper and high-cost investigations, and appropriate and timely intervention may help the men with infertility due to leukocytospermia.

257. Clinical, Sonological and Pathological Evaluation of Thyroid Nodule
Ritika Gupta, Pratibha Srivastava, Dilip Kumar
Background and Objectives: Nodular thyroid is a common clinical entity. The optimum diagnostic strategy for the patient with nodular thyroid is still a matter of debate. The goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harboring malignancy in the thyroid nodules. The present study was undertaken to evaluate the efficacy of FNAC and USG in differentiating benign and malignant nodules. Methods: A prospective study was carried out on 100 patients from 11-70 years age group of both sexes, presenting with thyroid nodules to Dept. of Surgery and ENT during the Duration of Two Years. All patients were evaluated clinically and subjected to FNAC and USG of thyroid. The results of clinical diagnosis, FNAC and USG compared with histopathology reports. Conclusion: The commonest presentation was from the females in the age group of 31-40 years, with swelling in the anterior neck. Solitary thyroid nodule cases had 18% rate of malignancy. It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity of 80% and specificity of 100% and is the single best investigation for preoperative evaluation of thyroid nodules. However, a combination of FNAC and USG give optimum results and avoid unnecessary surgery.

258. Clinicopathological Profile of Head & Neck Swellings Undergoing FNAC in a Tertiary Care Centre
Ritika Gupta, Pratibha Srivastava, Dilip Kumar
Background and Objectives: Head and neck swellings are the commonly encountered disorders in our hospital, with a range of inflammatory, benign and neoplastic diseases involving different age groups. This study was undertaken to study the cytological types of inflammatory, benign and neoplastic swellings correlate with histological result. Methods: Written informed consent is taken from all patients included in the study. The study was carried out on 250 patients in the Department of Pathology at PMCH Patna, over a period of 2 year prospective study. Patients was referred to the Cytology section from various departments. Predominantly from the departments of Otorhinolaryngology, General Surgery, Medicine and Paediatrics. The lesions included those from the thyroid, salivary glands, and lymph node, nose and paranasal sinuses. Conclusion: Head and neck swellings are common condition encountered in clinical practice. The advantages of FNAC are, it is safe, gives a quick result, is sensitive and specific for the diagnosis of malignancy, requires minimal equipment, is an outpatient procedure, avoids the use of frozen section, reduces the rate of exploratory procedures, allows a definitive diagnosis of inoperable cases, and is repeatable and cost effective. To conclude, FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck lesions.

259. Clinico Pathological Study of Thyroid Swellings: A Case Series Study in PMCH
Ritika Gupta, Pratibha Srivastava, Dilip Kumar
Background and Objectives: A thyroid enlargement whether diffuse or in the form of nodules have to be investigated to rule out neoplasm. FNAC is the first line of investigation. USG and TFT are also used. The cases which are at high risk are considered for surgery. Aim is to study the clinical presentations of thyroid swellings, incidence of various thyroid swellings, benign versus malignant lesions and to correlate the clinical diagnosis with that of pathological diagnosis. Materials and Methods: A case series study of 60 patients attending surgical OPD/IPD with symptoms of thyroid swelling in PMCH Patna. Study duration of Two years. After detailed history, thorough clinical examination was carried out. All the patient underwent routine investigations, TFT, FNAC, USG Neck. Few patients underwent surgery and all the excised thyroid specimen were sent for HPE and the clinical diagnosis is correlated with that of pathological diagnosis. Conclusion: Thyroid swellings are more common in females. They occur in 3rd and 4th decade most commonly. FNAC is very useful in the diagnosis. The main indications of surgery are cosmetic problem, pressure effect symptoms and suspicion of malignancy.

260. A Study of Management of Trochanteric Fractures with Sliding Compression Hip Screw
Vishwa Mohan Priyadarshi, Manish Ranjan, Rajeev Anand
Background and Objectives:  Many patients come to Department of orthopaedics with trochanteric fracture. It is one of the commonest injuries occurring in elderly age group. Though fracture unites with conservative treatment but associated with high mortality and morbidity. So fractures stabilization with sliding compression hip screw (DHS) is a useful option to prevent morbidity and mortality. Methods: A total of 20 patients with trochanteric fractures underwent surgery for the fracture fixation with DHS in the Department of Orthopaedics, PMCH Patna. Study duration of Twenty months. Patients were selected irrespective of sex. Results: Excellent results were obtained in 65% of cases, good results in 15%, fair in 10%, poor in 10%. Complications include 15% shortening, 5% implant failure, 10% infection, 5% coax vara. Conclusion: DHS is the reliable, versatile and effective treatment for the treatment of all types of intertrochanteric fractures. It minimizes the hospital stay and reduces the economic burden and enhances early return to work.

261. Functional Outcome of Posterior Decompression and Stabilization for Thoracolumbar Fractures
Vishwa Mohan Priyadarshi, Rajeev Anand, Manish Ranjan
Background: Owing to the fulcrum of increased motion at the T12-L1 junction, approximately 90% of spine fractures are located in the thoracolumbar region, and burst fractures account for nearly 10-20% of spine injuries. The surgical management aims to realign the spine, maintain its stability and optimise the neurological outcome. Objectives: To study the efficacy of posterior decompression and stabilization for thoracolumbar fractures with neurological deficits, and to study the complications associated with this treatment modality. Methodology: Total of 31 patients, operated with Posterior Decompression and Stabilization and were followed up and evaluated based on ASIA Motor score, ASIA Impairment scale, VAS Score and Kyphotic angle. Patients were followed up for minimum 6 months and there after every three months till 1½ year. Conclusion: The stabilization of spine using posterior short segment transpedicular fixation with posterior decompression is safe, technically easy, effective with neurological and functional improvement and early rehabilitation with less complication and prevents secondary spine deformities.

262. Clinical Outcome of Distal Radius Fractures Fixed with Volar Plating
Vishwa Mohan Priyadarshi, Rajeev Anand, Manish Ranjan
Background: Distal radius fractures are one of the most common injuries treated by an orthopaedic surgeon, accounting for approximately one sixth of all fractures. Due to increase in incidence of high velocity trauma, the injury is seen occurring in young patients more often. A displaced fracture deranges the wrist anatomy causing deformity and loss of function at the wrist joint.  Objectives: To Study the clinical outcome of intra and extra-articular fracture of distal end of radius treated with open reduction and internal fixation by plating through a volar approach. Material and Methods: Our study was a hospital-based study conducted during the Two Years. At  PMCH, Patna. A total of 30 patients who visited the OPD or ER of our hospital, diagnosed with distal radius fracture and met the said criteria were included in the study. They were treated with ORIF with a volar plate. They were followed up and clinical and radiological outcomes were evaluated. Conclusion: From this study we conclude that ORIF with volar plating can provide good clinical and functional outcome in distal radius fractures. Anatomical reduction of the fracture fragments is the key in achieving good results.

263. Study of Treatment of Fracture Shaft Femur by Ender and Elastic Nailing in Paediatric Age Group
Vishwa Mohan Priyadarshi, Rajeev Anand, Manish Ranjan
Background and Objective: Femoral shaft fractures account for 1.6% of all paediatric bony injuries. Angulation, malrotation and shortening are not always corrected effectively by conservative methods. Fixation of femur fractures in children & adolescents by flexible intramedullary nailing is becoming widely accepted because of the lower chance of iatrogenic infection and prohibitive cost of in hospital traction and Spica cast care. The objective of our prospective study was to study the various aspects of Managing diaphyseal fractures of femur in children aged between 5-15 years by using Titanium Elastic Nailing System& Ender nailing. Subjective and objective study of clinical parameters like pain, comfort to the patients, early mobilization, operative technique, radiological evaluation for union, stages of weight bearing till complete recovery and any associated complications by using the above mentioned methods. Method: Children and adolescents between the age group of 5-15 years with femoral shaft fractures who were admitted in PMCH Patna. All patients underwent titanium elastic nailing & Enders nailing fixation for the femur fracture. Result: The outcome is excellent in 21 (70%) cases, satisfactory in 9 (30%) cases and there were no cases of poor outcome. Conclusion: Flexible intramedullary nail leads to rapid fracture union by preservation of fracture hematoma and limited soft tissue exposure. It also helps in preventing damage to the physis.

264. Role of Fluoroscopic Guided Percutaneous Transpedicular Biopsy in Diagnosing Spinal Pathologies
Vishwa Mohan Priyadarshi, Ritika Gupta, Rajeev Anand, Dilip Kumar
Background and Objectives: Spine lesions are commonly seen in day to day practice. But diagnosing vertebral lesions are most of the time difficult and non- specific even with specialized investigations and hence the need for histopathological diagnosis is important. To evaluate the efficacy of the technique of fluoroscopic guided percutaneous transpedicular biopsy of vertebral bodies in spinal pathologies. To come to a sure histopathological diagnosis in vertebral body lesions. Material and Methods: The study was conducted in Department of Orthopedics, Patna Medical College and Hospital Patna. Study duration of Eighteen Months.  Selective patients with symptomatic vertebral body lesion were taken for the study. Conclusion: Percutaneous transpedicular biopsy of spine under C-arm guidance is a safe, rapid, reliable, sensitive and cost effective method of obtaining a diagnosis in different spine lesions. Performed efficaciously as an out patient procedure with high diagnostic success rate and minimal morbidity.

265. Comparative Study of Functional Outcome of External Fixation and Volar Plating in Unstable Distal Radius Fractures
Bimlendu Kumar, Mahesh Prasad, Rajeev Anand
Background: One of the most frequent injuries seen in the emergency room is a distal radius fracture. In order to restore wrist function, it is essential to repair the anatomy as much as possible. Predicting the success of treatment depends heavily on determining if a fracture is “unstable.” In this study, the functional outcome fol-lowing surgery is compared between external fixation and volar plating, two main treatment techniques. The study’s objective was to evaluate the recovery of grip strength and range of motion after fixing unstable distal radius fractures with external fixation versus volar plating using the Disabilities of the Arm, Shoulder, and Hand (DASH) scoring system. Hospital-based; randomized control trial settings and design. Methods: Randomly divided into two groups of 40 each, 80 patients with unstable distal radius fractures un-derwent surgery. External fixation was given to one group, and open reduction with volar plate fixation was given to the other. Following surgery, DASH ratings were acquired and compared at predetermined intervals. Results: According to our study findings, the volar plating group improved its mean DASH scores more than the external fixation group did at 3, 6, and 12 months. Conclusions: With higher postoperative wrist motion and a reduced incidence of comorbidities, volar plating has a superior functional outcome overall thanks to its undeniable advantage of direct fracture imaging.

266. A Short Term Analysis on Management of Extra Articular Distal Tibial Metaphyseal Fractures by Intramedullary Interlocking Nailing
Bimlendu Kumar, Rajeev Anand, Mahesh Prasad
Background: Despite improvements in both non-surgical and operational therapy, tibia fractures continue to be a contentious topic. The aim of expert care is early functional recovery, realignment of the fracture, and realign-ment of limb length. Evaluating the immediate effects of intramedullary interlocking nailing in the treatment of extra-articular distal tibial metaphyseal fractures. Methods: With a follow-up period from January 2019 to June 2019 (6 months), this prospective comparative randomized study of 28 patients with distal tibial metaphyseal fractures was conducted at the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar. Patients who had high energy axial load inju-ries disrupting or impinging the ankle plafond were not included, nor were patients with injuries lasting longer than three weeks, nonunion, numerous injuries, or a history of prior knee or ankle pathology. Results: The articular surface of the plafond was 12 mm away from the distal tip of the nail on average (range: 4 to 15 mm). Ten individuals underwent fibular plating. 26 individuals had two distal locking bolts, while three distal locking bolts were used in two patients. Conclusions: If thorough preoperative planning is combined with meticulous surgical skill, intramedullary nailing is a safe and successful method for treating extra-articular distal metaphyseal tibial fractures.

267. Prospective Analysis of Retrograde Supracondylar Nailing in the Treatment of Supracondylar and Distal Femoral Fractures
Bimlendu Kumar, Rajeev Anand, Mahesh Prasad
Background: Distal femur fractures are complicated wounds that present a challenge to the orthopedic surgeon. About 6% of all femoral fractures are caused by it. Younger people typically experience it during high-energy trauma, and concurrent injuries are frequently linked to it. In contrast, mild trauma like a simple fall could result in a single distal femoral fracture in older patients with significant osteopenia. The study’s objective is to analyze prospectively how well Retrograde Supracondylar Intramedullary Nails treat Supracondylar and Distal Femoral Fractures. Methods: This is a prospective study of 20 patients who underwent retrograde supracondylar nail treatment at Patna Medical College and Hospital. Patna, Bihar, from July 2019 to June 2020 for supracondylar and distal femoral fractures. Nine of the 20 patients had distal femoral fractures, while 11 of the patients had supracondylar fractures. Results: Twenty cases were treated with retrograde intramedullary supracondylar nails in our investigation. Following that, patients were checked in on every three weeks for 3 months, 5 months, and 1 year. The Hospital for Special Surgery’s Knee Rating System was used to examine the functional results. 38 of the forty cases were available for further investigation. In 12 patients (63%) the functional outcome was good to outstanding, fair in 4 patients (21.0%), and bad in 3 individuals (17.6%). Conclusion: Our study leads us to the conclusion that patient mobilization and early surgical intervention will produce better outcomes. The retrograde intramedullary locked nail offers patients with polytrauma, oating knee injuries, and older patients a practical advantage of a simple and effective treatment.

268. Comparative Study of the Safety and Efficacy of Oral Terbinafine and Oral Itraconazole in Patients with Tinea Corporis and Tinea Cruris
Avani Raj, Iftekhar Ahmed
Background: Recently, it was noted that the spread of superficial fungal infections with widespread resistance to different antifungal drugs used in the traditional dose, with an increase in relapse rates, caused a real medical problem because the patient’s distressing clinical symptoms (itching) and skin manifestations (such as itching) were so disruptive. This study compares and contrasts the effectiveness of oral terbinafine against itraconazole in treating tinnitus corporis and tinnitus cruris. Methods: This was a prospective, randomized comparative study. It was conducted at GMCH, Purnea, Bihar from May 2022 to April 2023. 90 patients participated in the trial. Following diagnosis confirmation, the patients were split into two groups at random. The first group consisted of 45 patients who received 500 mg of terbinafine daily for 4 weeks as oral treatment. The second group consisted of 45 patients who received itraconazole oral treatment for 4 weeks at a dose of 200 mg per day. Results: Regarding the evaluation of recovery, there were statistically significant differences between the two research groups. We find that 86.7% of patients in the oral itraconazole treatment group had a complete recovery, compared to 72.7% in the terbinafine group. Conclusion: When treating Tinea Corporis and Tinea Cruris, itraconazole is superior to terbinafine and should be used as the first line of defense. the continued safety of both medications, even at increased dosages and for a longer duration of time.

269. Histopathological Correlation in the Cytological Assessment of Benign Breast Lesions
Ajay Pratap, Vijay Kumar, Deepak Kumar
Background: Due to its safety, simplicity, and excellent diagnostic accuracy, FNAC has become a widely acknowledged tool for the identification of breast lesions. This study objective is to assess how well fine needle aspiration cytology (FNAC) diagnoses benign breast lesions. Methods: To evaluate the diagnostic efficacy of FNAC, histological analysis was performed on women who had benign breast lesions diagnosed by FNAC. Results: Out of 120 benign cases identified by FNAC, 116 were benign, whereas 2 cases of mastitis and 2 cases of fibrocystic disease, respectively, had infiltrating ductal carcinoma, indicating a 96.7% diagnostic accuracy for benign breast lesions. Conclusion: Since cytology and histology are correlated, FNAC is a reliable test for identifying and treating benign breast lesions.

270. Role of Ultrasound Guided Fine Needle Aspiration Cytology in Mass Lesions of Liver
Ajay Pratap, Vijay Kumar, Deepak Kumar
Background: In our country, liver problems are very common. The diagnosis of liver diseases that appear as a mass lesion might be difficult. Numerous benign and malignant tumors can involve the liver. Accurate diagnosis is essential to managing these lesions. These lesions, especially the malignant ones, can be accurately diagnosed by image guided fine needle aspiration cytology. Methods: This prospective study conducted at Department of Pathology, JLNMCH, Bhagalpur, Bihar from November 2022 to April 2023. Total 52 cases of liver lesions included in this study period. Diagnosis was made based on cytological findings and was correlated with biopsy wherever required. Results: 43 of the 52 liver lesions were malignant, 5 were benign, and 4 aspirates were insufficient for a proper diagnosis. There were 15 occurrences of primary hepatocellular carcinomas (HCC), while the majority of malignant lesions (26 cases) were metastatic carcinomas. Two instances had characteristics that made it impossible to distinguish between metastasis and HCC. Conclusion: The diagnosis of liver lesions can be made quickly, cheaply, and accurately using fine needle aspiration cytology.

271. Study of Hematological Diseases Diagnosed by Bone Marrow Examination in a Tertiary Care Hospital
Vijay Kumar, Ajay Pratap, Deepak Kumar
Background: All age groups are prone to hematological diseases. Anemia is the primary symptom of the majority of hematological diseases. The identification of the root cause of the condition is greatly aided by bone marrow aspiration. The purpose of this study was to identify the range of different hematlogical abnormalities identified during a bone marrow examination as well as their occurrence by age and sex. Methods: From April 2022 to September 2022, this prospective study was carried out at pathology department of Jawaharlal Nehru Medical College, Bhagalpur, Bihar. Patients who were presented with suspected hematological abnormalities had their bone marrow examined, and 94 cases in all were included in the study. Results: The male to female ratio was 1.1:1 and the age range was 13 months to 83 years. Erythroid hyperplasia (34.04%) and megaloblastic anemia (10.64%) were the most prevalent disorders found after a bone marrow investigation. Acute leukemias (6.38%) and chronic leukemias (9.57%) made up the majority of hematological malignancies. Conclusion: A rapid confirmation diagnosis of many hematological illnesses, including hematologic malignancies, can be made with the help of a bone marrow examination.

272. Role of Fine Needle Aspiration Cytology (FNAC) of Palpable Head and Neck Lesions in Tertiary Care Centre
Vijay Kumar, Ajay Pratap, Deepak Kumar
Background: Fine Needle Aspiration Cytology (FNAC) of neck masses is a fast, simple, inexpensive method that has been widely used to diagnose a variety of swellings. FNAC is frequently utilized in the head and neck, including for tumors of the thyroid, salivary glands, lymph nodes, and other organs. This study’s objective is to assess the value of FNAC in the diagnosis of palpable head and neck lesions. Methods: In the current study, 353 cases of palpable head and neck swelling that occurred in the JLNMCH, Bhagalpur, Bihar, from October 2022 to March 2023 are included. A cytological diagnosis was made after aspiration. Everywhere possible, cyto-histopathological correlations were conducted. Result: A total of 353 patients with palpable head and neck lesions were evaluated; of these, lymph nodes (33.00%) and thyroid lesions (30.31%) were the most frequent sites, followed by other (22.80%) and salivary glands (13.88%). Reactive lymphadenitis, colloid goiter of the thyroid, and lymph node metastases of squamous cell carcinoma are the most frequent nonneoplastic, benign neoplastic, and malignant neoplastic lesions, respectively. In 35 cases where the results of a histological investigation were correlated, the accuracy rate of FNAC was 95.71%, with sensitivity and specificity of 78.57% and 100%, respectively.  Conclusion: With a 95.71% accuracy rate, fine needle aspiration cytology is a quick, easy, and safe diagnostic method for identifying cancerous from non-cancerous lesions in the palpable head and neck region.

273. Proximal Femoral Nailing without Traction Table for Fixation of Intertrochanteric Fractures
Satti Lakshmana Reddy, Kolati Srinivas Rao, Gude Jayaram, Sai Krishna Balaga, Amal PS
Purpose: conventionally intertrochanteric fractures are being managed with proximal femoral nailing on supine position with the help of traction table for sustained traction and to reduce the number of assistants for surgery, however this position has its demerits like difficulty in placing entry point especially in obese patients, difficulty in reduction of fracture fragments as they are under constant muscle pull due to traction leading to open reduction, prolonged operative time and increased chances of infection. Some surgeons reported that these complications can be avoided by placing patient in lateral decubitus position. The purpose of this study was to demonstrate the technique of surgery as well as to report how these difficulties can be overcome by using Proximal Femoral Nail in fixation of intertrochanteric fractures in lateral decubitus position. Materials and Methods: 30 cases of intertrochanteric fractures with or without comminution were operated with PFN in lateral position on radiolucent table from December 2019 to November 2021 were included in the study. Nail sizes are 9, 10, 11, and 12 mm with a fixed length of 250 mm were used. Results: In the present study, age group of patients was 66yrs to 82yrs. Female patients (66%) were more than male patients (33%). An average of 147 ml of blood loss in both closed and open reduction cases. The average operative time for all cases was 82 minutes. average incision length of 8.3 cm in both open and closed cases, at least 1 assistant surgeon requiring for all cases. X-ray fluoroscopy average of 63 c-arm shoots per case. Average union time of 15 weeks combining simple and comminuted fractures. Clinical function of hip and knee was excellent with full range of movements. Overall excellent to good results were achieved in 90% cases. Conclusions: Lateral decubitus position has advantage of easy identification of greater trochanter and entry point, especially in obese patients, easy to achieve the reduction by open reduction technique and ease in placing distal locking screws. The lateral decubitus position has less operative time as it excludes the setup of traction table, minimal incision, minimal blood loss, less c-arm fluoroscopy time, less duration of hospital stay.

274. Comparative Analysis of Hemodynamic Variability and Level of Blood Cortisol while Induction with Propofol and Etomidate
Pooja Fumakiya, Khyati Makwana, Jagdishbhai Mer
Background and Aim: The selection of an anesthetic for inducing anaesthesia is primarily based on its pharmacodynamic characteristics. One of the most often used drugs for inducing general anaesthesia is propofol, or 2,6-diisopropyl phenol. The goal of the current study is to determine how serum cortisol levels, hemodynamic parameters, discomfort during injection, myoclonus, and apnea during induction affect patients undergoing laproscopic cholecystectomies. Material and Methods: A prospective, randomized, double-blind clinical trial was used in this investigation. 50 patients each were randomly assigned to Group A, which received an IV injection of propofol (2 mg/kg), and Group B, which received an IV injection of etomidate (0.3 mg/kg). Vital signs were recorded during induction, laryngoscopy, and thereafter. Carefully observed were pain upon injection, myoclonus, and apnea during induction. One hour prior to induction, two hours after induction, and 24 hours following induction, serum cortisol levels are assessed. Results: there were no statistically significant differences in the groups’ age, sex, or weight, the demographic data for the two groups were equivalent. In comparison to the etomidate group, the propofol group exhibits a considerable reduction in heart rate and mean blood pressure following induction. Group A experienced more injection-related pain, but Group B experienced more myoclonus activity. After induction, Group B’s serum cortisol level is much lower than Group A’s, which rises to above baseline after 24 hours but remains below normal limits. Conclusion: When used as an induction drug, etomidate is hemodynamically more stable than propofol and is linked to a lower incidence of discomfort during injection but a substantially larger incidence of myoclonic movements. Additionally, it was discovered that etomidate caused adrenocortical insufficiency to appear chemically for a shorter period of time before returning to normal within 24 hours in patients with ASA grades I and II undergoing elective laparoscopic surgery under general anesthetic.

275. Central Venous Oxygen Saturation as a Predictor of the Outcome of Weaning from Mechanical Ventilation
Vandana Sharma, Vicky Bakshi, Vikesh Bhatt
Objectives: The present study was to compare the chances of extubation failure after mechanical ventilation using conventional vs central venous oxygen saturation criteria for weaning from long term mechanical ventilation and to establish a more reliable criteria for extubation of long term mechanically ventilated patients. Methods: Patients who were fulfilling the weaning criteria were weaned using two stage approach: viz evaluation of the indicators of extubation outcome followed by SBT for 30 minutes. Measurements of hemodynamics (blood pressure, heart rate, and respiratory rate) and Scvo2 were registered at 1st minute of spontaneous breathing trial. Patients were put on T- piece and observed for 30 minutes and, at 30th minute again the conventional criteria and central venous sample was taken. Conventional parameters and Central venous oxygen saturation (Scvo2) readings at the 1st minute of spontaneous breathing and after 30 minutes of spontaneous breathing trial were noted. Results: 52 patients were studied out of which 25 patients were extubated by standard extubation criteria and 27 patients were extubated according to SCvO2 criteria and conventional criteria combined together. ScVO2 of patients with failed extubation trial in group B. the mean ScVO2 at 1 minute was found to be 69 % and at 30 minutes it was 63.16%. The difference in ScVO2 at 1 and 30 minutes was 5.54%. Diagnostic accuracy of central venous oxygen saturation (ScVo2) in predicting extubation success. It was found that ScVO2 has a sensitivity of 95.4%, specificity of 100%, positive predictive value of 100%, negative predictive value of 83.3% and an accuracy of 96.3% and the graph below shows the area under ROC curve. Conclusions: Scvo2 criteria when added to conventional criteria helps the clinician to estimate proper time for extubation and reduce the rates of reintubation . The previous studies also have revealed that fall in Scvo2 by more than 4% from baseline values at 30 minutes of SBT have higher chances of extubation failure.

276. Evaluation of the Functional Outcome of Open and Closed Reduction Techniques for Distal Femur Fractures: A Prospective Study
Akash Samal, Swagat Soubhagya Mohapatra
Introduction: Distal femur fractures represent a prevalent occurrence frequently encountered by orthopedic surgeons in their routine clinical practice. The fractures in question present therapeutic challenges in terms of fracture treatment due to their typical compound nature, comminuted pattern, and susceptibility to deformation caused by muscle forces exerted on the distal fragment. Additionally, these fractures have a tendency to result in functional impairment of the knee joint due to the injury sustained by the quadriceps system. There exists a lack of a universally applicable implant for the treatment of distal femoral fractures. The implementation of the Distal Femur Locking Compression Plate (DF-LCP) represents a favorable development that has significantly revolutionized the treatment approach for these fractures. This is primarily attributed to its ability to conform to the anatomical shape of the distal femur, facilitated by the inclusion of combi-holes in the proximal configuration. Objective: The aim of this study is to assess the functional outcome of both open and closed reduction techniques in the management of distal femur fractures. Methods: The present study employed a rigorous methodology to investigate the research question at hand. This section will outline the materials and methods utilized in order to ensure the validity The present prospective study was conducted at the orthopedics department of a tertiary care teaching hospital located Cuttack, forone year. The study encompassed a cohort of 60 patients diagnosed with AO Type A and Type C distal femur fractures. The technique employed for stabilization involved closed or open reduction and internal fixation utilizing a DF-LCP. A comprehensive follow-up was conducted on all patients over a duration of 6 months, during which the functional outcome was evaluated using the standardised Knee Society Scoring System. Results: Among the cohort of 60 patients, a noteworthy 63.33% (n=38) exhibited excellent outcomes, while 30% (n=18) demonstrated good outc