International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Assessing the Efficacy of Parenteral Iron Therapy in Treating Pregnancy Anemia of Mild to Moderate Severity: A Clinical Study
Lalitha Umesh
Background: Anemia is a clinical condition characterized by the decreased number of red blood cells or their capacity to carry oxygen needed for physiologic functions. Hemoglobin (Hb) value less than 2 standard deviations less than the median value for healthy subjects matched for pregnancy status, smoking, altitude, gender, and age. Anemia is commonly seen in pregnancy where intravenous iron has proven to be highly effective as a treatment even in cases where oral iron seems ineffective. Aim: The present study was conducted to assess the efficacy of parenteral iron therapy in treating pregnancy anemia of mild to moderate severity Materials and Methods: The present study included 120 pregnant females having confirmed diagnoses of iron deficiency anemia. All the included subjects were given 100mg mebendazole in a dose twice daily along with anti-helminthic therapy for 3 days duration. Also, during the therapy, folic acid was given to all the subjects. Stool examination for cyst and ova, culture, microscopy, and routine urine examination, Renal function test (RFT), and kidney function test (KFT) was done for all the subjects. Results: The results of the present study showed that significant changes were seen in various hematologic parameters from baseline to follow-up. The study results also showed that mean hemoglobin values increased significantly from 7.28 gm to 11.28 gm from baseline to 8 weeks. Similar results were seen for MCV, reticulocyte counts, serum ferritin, TIBC, and serum iron. Conclusion: The present study concludes that parenteral iron therapy is an efficacious treatment modality for moderate to severe pregnancy anemia with significant improvement of various parameters over time, and hence, should be considered for managing iron deficiency anemia of pregnancy.

2. Diagnosis of Appendicitis – Role of CT Scan in Ultrasound Negative Patients
Keerthi Bharathi P, Deepthi Tippani
Background: Acute appendicitis ranks among the most frequent causes of acute abdominal emergencies, making accurate diagnosis and timely surgery essential. Ultrasonography (US) and computed tomography (CT) are pivotal in achieving accurate diagnoses for this condition. This study aimed to evaluate the accuracy of CT in identifying appendicitis in ultrasound-negative cases and to assess the efficacy of CT in identifying complications of appendicitis. Methods: The study included patients aged 15 – 50 years, who were admitted to the surgical emergency ward with clinical symptoms suggestive of acute inflammation, such as right iliac fossa pain, fever, and vomiting. A total of fifty patients were selected as the study sample. Detailed clinical history was recorded using the prescribed proforma. Informed consent was obtained from all participating patients, and the study protocol was approved by the institutional ethical committee. Among the participants, 32 patients with either negative ultrasound findings or equivocal results underwent CT examination to obtain further diagnostic information. Results: The examination of the position of the appendix on CT scan showed 78% of cases having retrocaecal appendix followed by the pelvic position in 14%, pre, and post-ileal in 6% of cases, and the rest in 2% of cases. The existence of free fluid was in 18% of cases, mesenteric lymphadenitis in 26% of cases, and normal appearance in 56% of cases. In this study, 38% of the study group has appendicitis, diagnosed by Computed Tomography. The age group 20-24 years has a higher incidence of acute appendicitis. Shows 6% of patients among the study population with free fluid in the Right iliac fossa show appendicular perforation/abscess. Conclusion: CT plays a more precise role in diagnosing appendicitis, especially in cases where ultrasound results are negative. Although the role of ultrasound cannot be underrated as being non-invasive, having a quick acquisition time, being relatively cost-effective, and most importantly, not requiring the use of ionized contrast agents or oral preparation, thus eliminating radiation exposure. The CT scan can as a second-line investigation with higher significant sensitivity, specificity, positive predictive value, and negative predictive value.

3. Correlation of Clinico-Histopathological and Dermoscopic Diagnosis of Leprosy Patients
Mohit Naik, Anand Saraswat, Delux Godghate, Amar Surjushe
Background: Mycobacterium leprae causes a chronic, infectious illness known as leprosy. Histological observations as well as peripheral slit-skin smear staining confirm the clinical diagnosis. This granulomatous disease can be diagnosed and patients can be classified based on their immunological along with clinical response using dermoscopy. This study was conducted to determine the connection among clinico-histopathological and dermoscopic diagnoses of leprosy patients, as well as to assess the significance of dermoscopy in the diagnosis of leprosy. Method: Seventy leprosy patients participated in the investigation. A comprehensive history, complete general physical as well as local examination, skin biopsy, and dermatoscopy were performed. There was a correlation between its findings with clinical and histopathological observations. Results: The incidence is highest among those aged 21 to 40 (51.4%), with a male preponderance of 60%. The average duration of illness for the plurality of patients (45.7%) was less than six months. The most prevalent complaint was patches of hypopigmented epidermis. Clinically, there were more multibacillary cases (51.4%). Histopathologically, the higher numbers of patients were Lepromatous (37.1%) and Tuberculoid type (25.7%). Maximum Clinico-histopathological correlation was seen between Multibacillary Leprosy and LL type (75.76%) and between Pauci-bacillary Leprosy and TT type (54.05%). Maximum, Dermatoscopic-histopathological correlation was found between Lepromatous Pole and LL type (72.22%) and between Tuberculoid Pole and TT type (52.94%). Also, highly significant correlation was seen between clinical and Dermatoscopic diagnosis. Conclusion: Dermoscopy is unquestionably a useful diagnostic instrument for leprosy and lepra reactions. Although dermoscopy alone may not be able to diagnose atypical leprosy lesions, dermoscopy as a diagnostic tool has enormous potential for the early detection of leprosy.

4. Comparing Pulmonary Function in Apparently Healthy Females Exposed to Biomass Fuel Combustion versus Clean Fuel Combustion
Ashish Kumar Jain, Rajesh Kharadee, Ashutosh Chaturvedi, Satendra Mishra
Background: Indoor air pollution resulting from biomass fuel combustion is a significant public health concern in many developing countries, particularly for women who are often primary cooks and caregivers. Exposure to biomass smoke has been associated with adverse respiratory effects, but studies comparing pulmonary function in apparently healthy females exposed to biomass versus clean fuel combustion are limited. Understanding the impact of different fuel types on pulmonary function in this vulnerable population is crucial for designing effective interventions to reduce indoor air pollution and improve respiratory health outcomes. Aim and Objective: The objective of this study was to compare pulmonary function in apparently healthy females exposed to biomass fuel combustion versus clean fuel combustion. Materials and Methods: A cross-sectional study was conducted among 68 apparently healthy females aged 18 to 65 years residing in [Study Area]. Participants were recruited from community health centers, local organizations, and through word of mouth. Pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR), were performed using a calibrated spirometer following American Thoracic Society (ATS) guidelines. Participants were categorized into two groups based on the type of cooking fuel they used: biomass fuel combustion group (n=34) and clean fuel combustion group (n=34). Exposure to fuel combustion was assessed through structured questionnaires, gathering information on cooking habits, fuel types, cooking duration, and kitchen ventilation. Indoor air quality monitoring was also performed in a subset of households to measure PM, CO, and VOC levels. Results: The mean age of participants in both groups was similar (p > 0.05). The biomass fuel combustion group showed lower mean values of FVC, FEV1, and PEFR compared to the clean fuel combustion group (p < 0.05). Multiple linear regression analysis indicated that exposure to biomass fuel combustion was associated with a decline in pulmonary function, independent of potential confounders. Conclusion: This study provides evidence of impaired pulmonary function in apparently healthy females exposed to biomass fuel combustion compared to those using clean fuel combustion. These findings underscore the importance of promoting the use of clean fuels to reduce indoor air pollution and its associated adverse health effects. Further longitudinal studies are warranted to investigate the long-term effects of biomass fuel exposure on respiratory health.

5. Incidence of COVID-19 Positivity with RT PCR in All Pediatric Patients Admitted in a Tertiary Care Teaching Hospital Located in Tribal District of Telangana
Yalla Thirumal Reddy,  Hemalatha Addi, K . Srinivas
Corona Virus disease (2019) is an illness caused by severe acute respiratory syndrome coronavirus [SARS-COV-2]. In India and throughout the world fewer cases of covid 19 have been reported in children than in adults. This study is to investigate Pediatric COVID-19 incidence with RT PCR for early diagnosis and Treat-ment. Total 7590 children were tested with RTPCR. 2.75% children were RTPCR test positive. To gain a bet-ter understanding of children’s COVID-19 infection outcome, more detailed information on clinical outcomes needs to be further elucidated.

6. Case Series of Responders to Sofosbuvir Plus Velpatasvir Based Combination Therapy for Hepatitis C in Chronic Kidney Disease Who are on Maintenance Hemodialysis
Pramod G R, Kishan S Vishwamitra, Kamalesh T N, Yeshavanth G
Hepatitis C Virus (HCV) infection is a major infection worldwide, with 12.5 million people infected in India alone. In hemodialysis undergoing CKD population in specific, the prevalence of HCV is 4.3 – 45 %. It leads to accelerating decline of renal and liver functions causing higher mortality in hemodialysis patients. WHO recommends use of pan-genotypic, direct-acting anti-virals for the treatment of HCV. Sofosbuvir, in combination with other antivirals, led to a significant paradigm change in the treatment of HCV. Sofosbuvir is metabolized in the liver into an active metabolite which is not detected in circulation and an inactive metabolite that is excreted renally. Sofosbuvir and Velpatasvir combination of drugs was given to 10 HCV positive patients with CKD and on hemodialysis for 12 weeks. Viral load, after the completion of the treatment, were undetectable in all the patients. Sofosbuvir-Velpatasvir combination was demonstrated effective and safe in hemodialysis undergoing HCV patients.

7. A Cross-Sectional Study on Physical Activity among Medical Students and Interns in Southern India
Sindhu. B.M., Rashmi. B.M., Abhinandan. S. Kumbar
Background: India is facing increase in non-communicable diseases. Low physical activity is an important modifiable risk factor for the same. The doctors’ own physical activity practices influence their clinical attitudes towards physical activity. Healthy lifestyle of medical students can facilitate the formation of healthy physicians who is more likely to give effective preventive health education to their patients. Objectives: To assess the prevalence and levels of physical activity among medical students and interns and its determinants. Materials and Methods: A cross-sectional study was conducted among undergraduate students and interns of Basaveshwara Medical College, Chitradurga. Proforma included GPAQ for physical activity measurement. Data was entered in Microsoft excel spreadsheets and analysed using SPSS.v.20. Results: 95 students participated in the study.63.2% belonged to normal BMI.91.6% did walking, followed by moderate and vigorous physical activity (75.8% and 61.1% respectively). Median for walking was highest (60 min/week), followed by that for moderate (20 min/week) and last for vigorous activity (10 min/week).40% students spent < 450 METs physical activity per week. Conclusion and Recommendations: More than one third of the students had lesser levels of physical activity. Low physical activity being an important factor for non-communicable diseases, it has to be addressed at the earliest.

8. Prospective Study of Benign Breast disease in Females of South Karnataka
Anant Kumar N
Background: Benign breast diseases (BBD) consist of various groups of disorders, including developmental abnormalities, epithelial and stromal proliferation, inflammatory lesions, and neoplasms. It creates a phobic state of maligned tumours in adult females. Hence, histopathological analysis is mandatory. Method: 340 adults female aged between 20 to 60 years with BBD were studied. Routine blood examination, radiological investigation, USG/mammography, pathological investigation, and FNAC/HPE discharge were also carried out if necessary. Different supplies of BBDs were noted. Results: 42 (12.3) Breast abscesses, 9 (2.6%) cold abscesses, 11 (3.23%) cyclical mastalgia, 12 (3.52%) duct papilloma, 4 (1.17%) duct papilloma +fibroadema, 123 (36.11%) fibradenoma, 25 (7.3%) fibroadenosis, 5 (1.47%) galactocele, 108 (31.7%) mastaliga, 4 (1.7%) recurrent fibroadenom adenom adenoma, 2 (0.5%) tubercular lesion. Conclusion: In the present pragmatic study, It is concluded that most of the BBD can be managed with medication, but in resistant cases, surgery is unavoidable, and in certain cases, the clinician has to wait and watch the outcome of treatment.

9. Prophylactic Intramuscular Mephentermine for Reduction of Spinal Anaesthesia – Induced Hypotension in Elderly Patients Undergoing Hip Fracture Surgery, is it Effective: A Randomised Double Blind Placebo – Controlled Clinical Trial
Yadav Ansika1, Naithani Udita, Jain Shweta, Ahamed Riyaz, Gakkhar Vandana, Saxena Gaurav
Background: Spinal anesthesia – induced hypotension (SAIH) can be minimized by prophylactic intramuscular (IM) injection of mephentermine but it has not been investigated much in elderly. We aimed this study to evaluate the efficacy of prophylactic IM injection of mephentermine to prevent SAIH in elderly patients undergoing hip fracture surgery in spinal anesthesia. Material & Methods: This randomized double blind controlled study included 130 patients ageing >60 years of both sex, American Society of Anesthesiologists grade I or II undergoing hip fracture surgery under spinal anesthesia. Patients were divided into two groups: Group M received IM mephentermine 1ml (30mg) and Group C received IM normal saline 1ml immediately after subarachnoid block and hemodynamic variables were continuously monitored. Primary outcome measured was incidence of hypotension (mean arterial pressure < 20% from baseline), secondary outcomes were rescue vasopressor requirement, hemodynamic stability and adverse effects. Results: Hypotension was observed in 21 (32.3%) patients in Group M which was significantly less as compared to 37 (59.9%) patients in Group C, P = 0.0478. Cumulative episodes of hypotension were also significantly less in Group M (28 episodes) than in Group C (84 episodes), P = 0.038. Intra-operative vasopressor (mephentermine) requirement was significantly less in Group M as compared to Group C both in terms of number of doses (28 versus 93, P = 0.027) and dose in mg (168 versus 558, P=0.000). Conclusion: Prophylactic use of intramuscular mephentermine is effective in reducing post-spinal hypotension and intra-operative rescue vasopressor requirement in elderly hip fracture surgery patients.

10. The Role of Collagen Tympanoplasty for the Management of Traumatic Perforations
Puja Ghosh, Andrew Thomas Kurian, Rashmika Rajendran, Muthukumar Tharumaraj
Introduction: Traumatic perforation of the tympanic membrane is common presentation in the ENT out-patient departments. The variety of treatment options ranges from just regular follow up without any intervention to immediate surgical intervention. Collagens are the amplest proteins of the body and are major components of connective tissue. The objective of this study is to compare the closure rates of traumatic perforations larger than 25% of the tympanic membrane with office-based repair with collagen sheets against spontaneous closure of the traumatic perforation. Materials and Methods: A randomised control trial was done in the department of ENT from a tertiary care hospital, between August 2021 and December 2022. All the patients were examined and diagnosed by the same surgeon to exclude examiner’s bias. Demographic data, mechanism of injury, characteristics of the perforation and pure tone audiogram was recorded for each patient at first presentation. Patients aged between 20 and 50 years of age, who were having a traumatic perforation involving more than one quadrant with conductive hearing loss of not more than 45dB were chosen as study participants and were included in the study. Patients selected were randomly divided into two groups – Group A (cases) and Group B (controls) by simple random sampling (using lottery method). The patients in Group A underwent an office based myringoplasty. The patients in Group B were subjected to routine otoscopy and were advised water precautions. Results: Sixty-eight patients with traumatic perforation of the tympanic membrane who presented to the emergency department and our out-patient department were included. 58 patients (85.3%) had moderate sized perforations involving 2 quadrants of the tympanic membrane and 10 patients (14.7%) had large sized perforations involving 3 quadrants of the tympani membrane. After 6 months the perforation healed in a total 60 patients (88.2%), a higher rate of healing was seen in the cases group (32 patients – 94.1%) than the controls group (28 patients – 82.4%) in the controls group. Among the patients with large perforations in the study all the 5 patients in the cases group had successfully healed perforations while only 2 out of the patients in the controls group had healed perforations. Conclusion: From the above study we conclude that perforations involving less than 50% of the tympanic membrane were found to have similar closure rates even with conservative management; collagen tympanoplasty in these cases does not show any significant improvement. But in cases with traumatic perforation involving more than 50% of the tympanic membrane, the closure rates are higher with collagen tympanoplasty.

11. Variation of Alkaline Phosphatase Activity in Fallopian Tube: A Semiquantitative Histochemical Assessment in Clinical Perspective
Virendra Kumar, Niyati Airan, Anil Kumar Dwivedi, Geetika Mohan, Aditi Srivastava
Introduction: Body proteins perform a number of functions, of which the most remarkable and specialized function is their ability to act as biological catalysts. Catalytic proteins called enzymes, stimulate the rate of several reactions in the body without themselves getting consumed in the process. Enzymes are highly selective as biocatalysts. A catalyst increases the rate of reaction without altering its equilibrium position and without changing itself The alkaline phosphatases (ALP) are a group of enzymes that hydrolyses the organic phosphates at alkaline Ph. They are present in most tissues but are in particularly high concentration in intestinal epithelial cells, kidney tubules, bones (osteoblasts), liver and placenta. In adult plasma ALP is derived mainly from bone and liver in approximately equal proportions. Increased osteoblastic activity increases the level of plasma ALP, it may be physiological as seen in children. The total activity is about 2.5 times more than the normal upper limit in adults. In adults it is 40-125 IU/L. during pregnancy, plasma ALP level rises due to contribution of placental isoenzymes. The fallopian tube is the vital organ of female reproductive system, which acts as a conduit to give passage to ova from ovary to uterus. The fallopian tube undergoes histochemical variations with oestrus cycle. Aim: To study the phasial and segmental variation of ALP activity in rabbit’s fallopian tube and to correlate the anatomy, physiology and Biochemistry of fallopian tube which may be useful to understand the different anomalies/ pathologies or problems related to female reproductive system. Materials and Methods: The cross-sectional study was done on 50 Rabbit’s fallopian tube at SNMC Agra from June 1976 – June 1979. The fallopian tubes of both sides were taken by the section and cut into segments from medial to lateral end viz intramural, isthmus, ampulla and infundibulum. The phases of oestrus cycle i.e. Pro-oestrus, oestrus, meta-oestrus and dioestrus were decided by cytological observation of a papaniculus stained vaginal smear. ALP activity was observed in various phases of sexual cycle and of different segments of fallopian tube by the Gomori’s calcium cobalt method (after Gomori, Pears 1946). One way analysis of variance (ANOVA) was applied for the analysis of data. Results: The ALP activity was higher in pro-oestrus (4.33+0.25), oestrus (4.08+0.25) and low in meta-oestrus (3.25+0.25) and dioestrus (2.08+0.25) of oestrus cycle. The activity was seen higher in infundibulum (4.25+0.31) ampulla (3.92+0.31) and low in Isthmus (3.00+0.31) Intramural (2.58+0.31). The maximum difference 1.7 was noticed between infundibulum and intramural segments (p<0.0001). a maximum difference (2.25) in pro-oestrus was noticed between pro-oestrus and dioestrus (p<0.0001). Conclusion: The oestrogenic phase of the sexual cycle has higher enzymatic activity whereas in luteal phase it was low. The infundibulum and ampulla show higher activity. It suggests these segments are more functionally active as compared to intramural and isthmus segments of fallopian tube.

12. Surgical outcome following Facial Mohs Micrographic Surgery and its Reconstruction
Manish Jain, Saurabh Garg, Priyanshi Gupta
The recent advancement in the treatment of cutaneous malignancy has seen Mohs Micrographic surgery being the preferred treatment with meticulous reconstruction keeping in mind the principle of facial aesthetics. The challenge lies in patient dissection and assessment of all margins to be negative. Reconstruction depends upon the size, location, and patient preference. The aim of our study is to assess the surgical outcome of Mohs Micrographic surgery performed for cutaneous neoplasms located in facial region along with their reconstruction along with possible relationship between patient characteristics, techniques performed and multidisciplinary approach. All the patients were prospectively followed and their data collected who underwent Mohs Micrographic surgery and reconstruction in our institute between 2021-2023. Patient characteristics, tumour pathology, surgical specifics, reconstructive modalities, and surgical outcomes were analysed. A total of 82 patients were included, predominantly light skinned, Indians (83%) and males (52%) with a mean age of 56 ± 11.3 years. Tumour pathology was predominantly Basal cell carcinoma in 73% of all cases. The nasal aesthetic unit was most commonly affected (44%). Local advancement flaps and different types of flaps were used in 60% and 24% of reconstructions, respectively. Complications were observed in 6% of cases and recurrence in 3% of cases. In depth understanding of facial aesthetics is of paramount significance in providing a good cosmetic outcome with lower complication rates involving multidisciplinary team like plastic surgeons and pathologists when dealing with cutaneous neoplasms especially over facial region.

13. Prevalence of Poor Body Image among Medical Students, It’s Effect on Their Life and Self-Esteem and Impact of Educational Intervention on Their Perception
Rijul Ranjan, Chhavi Kiran Gupta, Manish Garg, Bhavya Khattri
Introduction: Body image is a multidimensional construct involving self-perception on size and body shape, surrounded by the sensations and immediate experiences, also involving a subjective component that refers to individual satisfaction with body size. Aims/Objectives: (1) To Assess the Body Image perception. (2) To understand that a negative body image can lead to Self-Destructive Behaviours and Health/Psychological Problems. (3) To highlight strategies for improving body image and self-esteem. Methodology: The Interventional study was conducted from January 2023 – March 2023. The study was planned and conducted among undergraduate medical students of Subharti Medical College, Meerut. Result: The student’s participants reported that they were knowledgeable about poor image and body shaming practices.

14. Assessment of Antenatal Depression and Its Associated Risk Factors in Pregnant Women: A Tertiary Care Hospital Study
Neha Ninama, Hardikkumar Yagnik, Nilesh R. Prajapati, Arpit Jani
Introduction: Antenatal depression (AND) is a significant mental health concern that affects both pregnant women and their offspring. Studies have reported varying prevalence rates of AND in different regions of India. Objective: Assess the prevalence of prenatal depression and its risk variables in pregnant Indian women. Methods: The current investigation was conducted in a tertiary care that provides prenatal and postnatal care. The study comprised 630 pregnant women who went to the antenatal clinic for prenatal examinations using the consecutive sampling method. The Edinburgh Postnatal Depression Scale (EPDS) was utilised to determine the possibility of depression. To investigate the relationships between prenatal depression and various socioeconomic, obstetric, and medical characteristics, the chi-square test was used. Results: Among 154 depressed pregnant women, the highest number (37.7%) in the 25-29 years group (26.6%), followed by 37.7% in the 25-29 years group, and 18.8% in the 30-34 years group. Age shows a significant association with depression (p<0.05). Additionally, 42.2% of depressed pregnant women experienced health problems during pregnancy, while 31.1% of non-depressed women had health issues, indicating a statistically significant association (p<0.05). Other factors like education, occupation, family income, and spouse’s alcoholism did not show significant associations with depression. Conclusions: This study focuses on antenatal depression among pregnant women, revealing its prevalence and highlighting two significant risk factors: age and the presence of health issues during pregnancy. Early screening and intervention for antenatal depression are deemed vital to minimize its adverse impact on both maternal and child health.

15. Risk Factors Impacting the Results of Treating Intertrochanteric Fractures in Older Patients with Dynamic Hip Screws
Manthan Soni, Haresh Chaudhary
Background and Aim: Dynamic hip screw fixation is the most popular treatment option among the many fixation techniques for intertrochanteric fractures. In a tertiary care hospital in India, the current study was done to assess the risk factors that will have an impact on how intertrochanteric fractures treated with dynamic hip screw fixation turn out. Material and Methods: This was an observational research carried out over the course of a year by the orthopaedics department at the medical college and hospital in India. Fractures were classed in accordance with Evans’ radiological classification of intertrochanteric fractures. Fractures were additionally classified using the AO/OTA system. On the basis of one of the following radiographic parameters, operation was deemed “failed”. At six months, the Harris hip score was used to evaluate the functional outcomes. Results: 100 patients in total, mostly men, were included in the trial. Based on the established radiological criteria, 22 of the 100 recruited patients (or 22%) were judged to have “failed” surgical results. When comparing the patient factors, it was discovered that the “failed fracture” subgroup’s mean age was substantially higher than the “united fracture” subgroup’s (p 0.05). According to AO/OTA categorization, a significantly higher proportion of cases in the “failed fracture” category were found to fall into Evans’ classes IV and V as well as the A3 class. (p<0.05). Conclusion: The result of intertrochanteric fractures treated with dynamic hip screws was influenced by patient characteristics such older age and obesity, intertrochanteric unstable fractures as indicated by Evans’ classes IV and V, and A3 class based on AO/OTA classification. Still a good implant for most intertrochanteric fractures is the sliding hip screw.

16. Comparison of SIRIRAJ Stroke Score with Computerized Tomography in Ascertaining Type among 50 cases of Cerebrovascular Stroke Patients
Jayantilal Lalji Sathavara, Mohini Datraniya, Dileep Gamit
Background: Timely diagnosis is especially important in ischemic stroke, because early thrombolytic therapy and anti-platelet drugs not only improve the functional outcome but also reduce mortality and recurrent strokes. Vast majority of patients do not have access to brain imaging. Therefore, the clinical criteria for distinguishing between ischemic and hemorrhagic stroke has been emphasized. Objectives: Present study is done with following objectives. To determine the accuracy of the Sirriraj stroke score in differentiating the ischemic from the hemorrhagic strokes and to find the sensitivity, specificity and positive and the negative predictive values of this scoring system in stroke patients. Material and Methods: Present Cross-sectional study included 50 cases of stroke of adult patients. The study includes patient’s age, sex, duration of symptoms before presentation, and whether the patient is a known diabetic or hypertensive. In addition, the first record blood pressure from onset of the stroke, consciousness level, presence of atheroma marker, and the presence of headache or vomiting within 2 hours of onset were documented. The presence or absence of clinical variables in the Siriraj stroke score was matched against the stroke types as confirmed by CT scan. Sensitivity, specificity, positive predictive value and negative predictive value were calculated using standard methods. Results: Clinical parameters such as diastolic blood pressure (>90 mmHg) were in 27 (54%) patients, systolic blood pressure (>140 mm hg) were in 40 (80%) patients. From the risk factor wise of distribution, Stroke Patients ware highly associated with hypertension 27(54%), others were related to Diabetes Mellitus. Comparison of CT scan and Siriraj score it was found that Score<-1waspresentin (60%) patients where ischemic stroke (52%) and hemorrhagic stroke (8%); -1to+1 was in (18%) patients where ischemic stroke (10%) and hemorrhagic stroke (8%) in each; and > +1 was in (22%) patients where ischemic stroke (6%) and hemorrhagic stroke (16%). The Sensitivity – 76.47%; Specificity – 75.00% was found in Ischemic stroke while Hemorrhagic stroke have Sensitivity -50.00%; Specificity–91.18%. Conclusion: Based on clinical variables with using Siriraj Stroke Score, a high degree of accuracy in detecting both types of strokes where CT scan is not available immediately. However, there is a low sensitivity in diagnosing hemorrhagic strokes and higher sensitivity in diagnosing ischemic strokes.

17. A Clinical Study of Risk Factors and Outcomes of Surgical Site Infection at a Tertiary Care Teaching Hospital
Mitul K. Patel, Pallav S. Mehta, Rahil M. Vahora, Parth A. Kansagara
Background and Aim: Surgical site infection (SSI) is disastrous in orthopedic practice as it is difficult to rid the bone and joint of the infection. Objectives of the study were: to study surgical site infection and its risk factor and outcome, to determine risk factors for surgical site infection and to determine outcomes for surgical site infection. Material and Methods: Present Observational study was conducted in 50 Adult patients operated in orthopedic department of C.U. Shah Medical College and Hospital developed surgical site infection. After determine SSI by signs of inflammation (redness, swelling, local rise in temperature, fever, quality of discharge) short history was taken and physical examination was conducted on each patient. All of the preoperative factors, intraopertaive factors and post operative factors related to SSI present in the patient were noted down in the data sheet. Postoperatively swab was sent for culture and sensitivity test in every case with discharge from the wound of surgical site infection. Results: Out of 50 patients, 34 (68 %) were male and 16 (32%) were female. In relation to addiction, it was observed that 31(62%) patients had addiction history and 19 (38%) patients had no addiction history. Out of 50 patient’s organisms were isolated from 30(60%) patient and no organism was isolated from 20(40%) patients. Among those 30 patients E. coli was isolated in 15 patients. Out of 50 patient developed SSI 36 (72%) patients were cured with conservative management 10 (20%) patients were complicated are treated with thorough surgical debridement, 4 (8%) patients had undergone septic shock and other SSI related complications and dead. Conclusion: Various host factors like Male gender, Lower socio economic class, smoking and other addiction like alcohol and tobacco chewing, hyperglycemia, malnutrition, obesity, hypertension, etc coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, type of operation and experience of operating surgeon greatly contribute to occurrences of SSI.

18. Effect of Recurrent Laryngeal Nerve Identification Technique on RLN   Paralysis and Hypoparathyroidism in Thyroidectomy
S. Naresh Kumar, Devender, Gopi Sandeep Raj
Background: The RLN innervates the abductor and adductor muscles responsible for vocal cord movement, while the external branch of the superior laryngeal nerve EBSLN innervates the cricothyroid muscle, which controls vocal cord tension. Both nerves, located in proximity to the thyroid, are susceptible to damage during thyroidectomy. The current study aim is to investigate the correlation between two techniques for identifying the recurrent laryngeal nerve during thyroidectomy, namely superior-inferior and inferior-superior, and the occurrence of postoperative RLN paralysis. Methods: In this prospective study, we enrolled all patients who underwent thyroid surgery at both the Department of General Surgery & ENT in Gandhi Hospital, Secunderabad. The study population consisted of 60 patients who underwent surgery for various thyroid disorders within the specified timeframe. Patients with multinodular goiter, uninodular goiter, thyroid cancer, thyroiditis, and recurrent goiter were included in the study. Results: Symptomatic hypocalcemia was observed in 4 patients out of operated cases,1 case in group I and 2 cases in group 2. One in which RLN was not identified. Out of these patients in 3 cases total serum calcium level was lower than 8.2mg/dl. As a result, RLN palsy was only seen in group 2 i.e., inferior-superior technique, and the incidence of hypocalcemia was 4 cases out of which 2 cases were in group 2.In the group of patients with symptomatic hypocalcemia, the average level of i-PTH 1 hr after surgery was 12.33pg/ml, and the average level of serum calcium after 24 hr was 7.53 mg/dl. Conclusion: Among these techniques, the superior-inferior approach demonstrates the lowest incidence of RLN injury, as evidenced by the absence of RLN injury in our study. Therefore, we recommend the use of the superior-inferior technique for RLN identification during thyroidectomy. Furthermore, the superior-inferior technique proves effective in preventing postoperative hypoparathyroidism. Estimating intact parathyroid hormone (i-PTH) levels one hour after surgery emerges as a reliable predictor of hypocalcemia following total thyroidectomy.

19. Comparison of Efficacy and Safety of Azilsartan with Telmisartan in Patients with Hypertension
Uddesheya Kumar, Prabhat Ranjan, Dinesh Kumar
Background: A sustained systolic blood pressure of more than 140 mm Hg or a sustained diastolic blood pressure of more than 90 mm Hg is considered to be hypertension. Heart disease and stroke, the two leading causes of mortality worldwide, can be caused by chronic hypertension. Compared to ACE inhibitors, angiotensin receptor blockers have the capacity to completely suppress angiotensin. They are more selective angiotensin blockers. The purpose of this study was to compare the safety and effectiveness of Telmisartan to the more recent ARB Azilsartan. Methods: This Prospective, randomized open labelled parallel study was carried out at Department of Pharmacology and patients collected from outpatient and inpatient Department of Medicine, Jannayak Karpoori Thakur Medical College and Hopital, Madhepura, Bihar from March 2022 to August 2022. Participants in the trial had a blood pressure of ≥ 140/90 mmHg and had recently been diagnosed with stage I-II essential hypertension of either sex and were between the ages of 18 and 65. Pregnant women, history of drug or alcohol misuse, cardiac arrhythmias, severe hypertension >180/110 mm Hg, hypersensitivity to ARBs, secondary hypertension with any other origin, and severe hypertension were eliminated. Patients who agreed to participate in the trial were split into two groups at random and given azilsartan in group 1 and telmisartan in group 2, respectively. After starting treatment, a blood pressure of <140/90 mm Hg was considered the point of control. Results: Two groups of 102 patients were randomly assigned. Azilsartan was administered to 52 individuals in group 1 of whom two were lost to follow-up. Six of the 50 patients in group 2 who got telmisartan were unfollowable. At 6 hours, 15 days, 1 month, and 3 months, there was no discernible difference between the two medications in either the mean systolic or diastolic blood pressure. Significantly, telmisartan reduced mean diastolic blood pressure more than azilsartan over the course of 24 hours. In the azilsartan group, 3% of patients experienced adverse symptoms linked to hypotension, but 8% of patients in the telmisartan group did. Conclusion: Azilsartan is a blood pressure-lowering medication with similar safety and effectiveness to telmisartan.

20. Exploring the Interplay between Lipid Profile, Endothelial Dysfunction, and Disease Activity in Early Rheumatoid Arthritis Patients
Shubham Mishra, Aditi Rajan, Anubhav Shukla, Chiranjib Mishra
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation and damage. Recent research has highlighted potential links between lipid profile alterations, endothelial dysfunction, and disease activity in RA. However, the relationships between these factors, particularly in the context of early RA, remain poorly understood. Aim and Objective: This study aimed to investigate the association between lipid profile alterations, endothelial dysfunction, and disease activity in patients with early RA compared to age and sex-matched healthy controls. Materials and Methods: A cross-sectional study was conducted involving 60 patients with early RA and 60 age and sex-matched healthy controls. Lipid profiles, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), were assessed using standard enzymatic assays. Endothelial function was evaluated using flow-mediated dilation (FMD) of the brachial artery before and after reactive hyperemia induced by cuff occlusion. Disease activity in RA patients was determined using the Disease Activity Score in 28 joints (DAS28), which includes clinical and laboratory assessments. Results: Patients with early RA exhibited significant alterations in their lipid profiles compared to healthy controls. Specifically, RA patients had elevated levels of LDL-C (p < 0.001) and TG (p = 0.012), along with decreased levels of HDL-C (p = 0.007). Endothelial dysfunction, as indicated by impaired FMD (p < 0.001), was observed in the RA group. Disease activity, assessed by DAS28, positively correlated with LDL-C levels (r = 0.453, p = 0.001) and negatively correlated with HDL-C levels (r = -0.317, p = 0.021) in RA patients. Linear regression analysis adjusting for potential confounders confirmed independent associations between disease activity and both LDL-C (β = 0.363, p = 0.005) and HDL-C (β = -0.281, p = 0.032) levels. Conclusion: This study provides novel insights into the relationships between lipid profile alterations, endothelial dysfunction, and disease activity in patients with early RA. The findings suggest that lipid abnormalities and endothelial dysfunction may contribute to the pathogenesis of early RA and underscore the importance of managing both disease activity and lipid metabolism in optimizing patient outcomes. Further research is warranted to elucidate the mechanistic underpinnings of these associations and explore potential therapeutic interventions targeting lipid metabolism and endothelial dysfunction in early RA.

21. Head-To-Head Comparison of Acarbose and Voglibose as Add-On Therapy to Metformin in Patients with Type 2 Diabetes
Masuram Bharath Kumar, Shalini Chandra, KV Thimmaraju, M Amruth
Objective: To compare the effectiveness of Acarbose and Voglibose as add-on therapy to Metformin monotherapy in patients with type 2 diabetes mellitus. Methods: A prospective, non-random, open-label study was conducted at Varun Arjun Medical &Rohilkhand Hospital involving 76 patients divided into two groups. Group I received Metformin with Acarbose, and Group II received Metformin with Voglibose for three months. Glycemic parameters (HbA1c, FBS, PPBS) were evaluated at baseline and after three months. Medication adherence was calculated using the Morisky Medication Adherence Scale-8 (MMAS-8). The primary outcome was reduced HbA1c levels and secondary outcomes included changes in FBS and PPBS and medication adherence. Results: Both groups significantly reduced HbA1c, FBS, and PPBS levels (p<0.0001). Adding Acarbose to Metformin therapy showed slightly better effectiveness in reducing FBS and PPBS than adding Voglibose. Medication adherence was comparable in both groups. Conclusion: Acarbose and Voglibose, as add-on therapies to Metformin, showed significant effectiveness in glycemic control with a good adherence profile. Acarbose exhibited a slightly superior reduction in FBS and PPBS compared to Voglibose. Further randomised controlled studies are needed to validate these findings.

22. Correlation of Liver Function Test and Severity in Dengue Patients
Saradva B, Gupta P, Shrimali L, Shah M
Introduction: Dengue Viral infection (caused by Flaviviridae group) has recently seen a spurt affecting multiorgan. Most of the cases are asymptomatic, while few patients present with fulminant symptoms. Aim: To assess association of liver function test and severity in Dengue. Material and Methods: This prospective observational study was conducted in Geetanjali Medical College at tertiary care hospital of southern Rajasthan from June 2020 to November 2021 after institutional ethics committee approval. In this study, all dengue positive cases based on positive ELISA test, NS1 antigen, IgM and IgG were included and cases diagnosed with malaria, liver cirrhosis, viral hepatitis, enteric fever and patients taking hepatotoxic drugs were excluded. Diseases which can derange Liver function test (LFT) were also excluded. Liver function was evaluated for all patients and its association with dengue severity and patient’s clinical outcomes were assessed. Results: This study showed that serum bilirubin levels were elevated in dengue fever patients. Out of 157 patients, mean total bilirubin of the patients was 1.56 ± 0.17, 1.56 ± 0.16 and 3.59 ± 0.83 mg/dl in the DF (Dengue fever), DHF (dengue hemorrhagic fever) and DSS (dengue shock syndrome) group respectively. Total of 140 patients (91.5%) had raised AST (Aspartate transaminase) levels (> 40 U/L). DF group had 89 patients (87.3%) with raised AST (mean AST 154.17± 44.73), where all patients of DHF 37 patients (100%) (mean AST 355.87± 8.26) and DSS 14 patients (100%) (mean AST 814.79.17± 36.65) had raised AST level (p value < 0.01). Likewise, 137 patients (89.5%) had raised ALT (Alanine transaminase) levels (> 40 U/L). DF group had 86 patients (84.3%) (Mean AST 91.7± 22.41) with raised ALT, where all patients of DHF 37 patients (100%) (Mean AST 136.6± 6.76) and DSS 14 patients (100%) (Mean AST 368.86± 13.63) had raised AST level. Conclusion: We conclude the rising levels of AST and ALT are associated with DHF and DSS severity and hence a baseline liver function test should be done in every dengue patient.

23. A Comparative Study of Radiological and Surgical Findings of Mucormycosis in Post-COVID Patients
Priyanka Ramkrishna Bhagat, Anuj Kansara, Hiren Doshi, Meeta Bathla, Karnadev Solanki
Mucormycosis is the most invasive form of paranasal fungal infection caused by Mucor which is an ordinarily saprophytic, but can becomes an aggressive pathogen under the conditions appropriate for it. Methods: In this study of Mucormycosis of Nose and PNS, 97 cases were studied at Tertiary care hospital over period of 6 months. Patients were assessed for age, gender, predisposing factors, symptoms and signs, site of extension with help of CT scan and MRI and nasal endoscopy, site of surgical debridement and prognosis. Results: The commonest predisposing condition for the disease is extensive use of steroids followed by diabetes mellitus. Mucopurulent discharge was found in 71 cases. On Endoscopic examination, majority patients showed Black crust in 41 cases, 69 cases out of 97 showed KOH positivity and 77 cases out of 97 showed Histopathological positivity. Maxillary sinuses were involved in 97 cases, Ethmoid sinuses in 97 cases and Sphenoid sinuses in 97 cases as per radiological investigations but on surgical exploration 76 patients had maxillary sinuses, 62 patients had ethmoid sinuses and 57 patients had sphenoid sinuses diseased. Conclusions: With increasing rate of mucormycosis in post covid patients it is utmost important to diagnose and treat this deadly disease early. The recent technology of radiological investigations is boon for the earliest diagnosis and proper planning for surgical intervention.

24. Qualitative Analysis of Barriers of Immunization among Mothers of 12-23 Months Children in Rural Areas of Area Nuh
Bhupesh Gupta, Varsha Gupta, Aseem Garg, Anshu Mittal
Introduction: Immunizations are usually considered as the most fruitful public health intervention employed today. apart from the vaccine availability the accessibility of vaccines, it is predictable that nearly 3 million children die annually throughout the world by vaccine-preventable diseases. Despite the government’s best efforts, immunisation rates in the district of Nuh were significantly lower than the remainder of Haryana. Various national immunization surveys conducted from time to time had shown sub-optimal vaccination coverage in Mewat (Nuh) district. This qualitative study was expected to identify the barriers to achieve full immunization of 12-23 months children in a timely manner as perceived by mothers in rural areas of Nuh district. Material and Methods: Focus group discussions (FGDs) took place among mothers of 12-23 months children to tackle the region’s obstacles to child immunisation. Participants were chosen by purposive sampling. The note-taker recorded their observations and insights from the FGDs in writing and also photographed each session for later transcription. When the primary sources were translated into English, the researchers went back and clarified some of the claims. Results: Majority of mothers did not get all vaccines for their children because of fear of adverse events following immunization. Other barriers to achieve full immunization were that mothers did not know the importance of immunization and did not get their child all vaccines because of sickness of child. It was also found that mothers did not get their child all vaccines because of non-availability of anyone to take child for immunization. The study found that mothers did not get their child all vaccines because of no support of family. Because according to them, immunization is not good for health of child. Fishbone diagram was used to group barriers of immunization as perceived by mothers in rural areas of district Nuh, Haryana. The sources of variance were traced back to their respective groups throughout the fishbone diagram. Conclusion: In rural areas, vaccination rates were generally high, but there were still pockets of under-coverage that needed to be addressed through improved methods of information and education dissemination (IEC) and interpersonal contact.

25. Prospective Clinical Study on Intraarticular Corticosteroids Injection, Manipulation under Anesthesia, and Hydraulic Capsular Distension with Supervised Physical Therapy for Frozen Shoulder Management
Naveen Gupta, Amit Thakur, Dixit Gautam
Background: Frozen shoulder, also known as adhesive capsulitis, is a painful condition characterized by shoulder pain and restricted range of motion. It is a common musculoskeletal problem, with a higher prevalence in individuals with diabetes. Various treatment approaches have been used to manage frozen shoulder, but the optimal management remains debated due to conflicting reports on treatment efficacy. Methods: This prospective clinical study aimed to evaluate the effectiveness of three treatment modalities, namely Intraarticular Corticosteroid Injection, Manipulation under Anesthesia, and Hydraulic Capsular Distension, combined with Supervised Physical Therapy, in managing frozen shoulder. The study was conducted as a hospital-based, randomized, and comparative trial with a sample size of 26 subjects in each treatment group. Patients were assessed over a 12-week study duration, and pain scores, abduction range of motion, and Shoulder Pain and Disability Scores (SPADI) were recorded at various time points. Results: This study compares three treatments for shoulder pain. Intraarticular Steroids showed the best pain relief and function, followed by Hydraulic Distension and Manipulation under Anaesthesia. Group C experienced more complications. Conclusion: The Intraarticular Steroid treatment (Group A) showed promising results in terms of pain relief and shoulder function. Hydraulic Distension (Group B) and Manipulation under Anaesthesia (Group C) also demonstrated improvements, but not as significant as Group A. Understanding these findings can aid clinicians in making informed treatment decisions for patients with shoulder pain and disability.

26. Bacteriological Profile and Antibiogram of Gram Positive Nosocomial Isolates from Intensive Care Units with Special Reference to High Level Aminoglycoside Resistance in Enterococcus Species in a Tertiary Care Hospital of North Karnataka, India
Zarrin Afroz, Basavaraj C. Metri, Faisal Nasim Gilani
Introduction: Nosocomial infection is an important factor in determining clinical outcomes among patients admitted in intensive care units. Previous studies on nosocomial infections in ICUs found that respiratory tract infections, blood stream infections, urinary tract infections and soft tissue infections are the common nosocomial infections in ICUs. These infections are more commonly caused by Gram negative isolates followed by Staphylococcus aureus, CONS and Enterococcus species. These organisms isolated are highly resistant to antibiotics. Presence of high level aminoglycoside resistance in these Enterococcus isolates makes the treatment combination of cell wall inhibitor and aminoglycoside ineffective. Early recognition of bacteria and appropriate antimicrobial therapy are essential for control of infection, preventing the morbidity and improving the quality of life. Objectives: To find out the profile of Gram positive bacteria causing nosocomial infection in patients admitted in intensive care units. To know the antibiotic susceptibility pattern of Gram positive nosocomial isolates and determining High level aminoglycoside resistance (HLAR) among Enterococcus species isolated. Materials and Methods: A total of 192 samples were taken from various clinical specimens. The organisms were identified by gram staining, cultural characteristics and a battery of biochemical tests. Drug susceptibility was performed on the isolates by Kirby Bauer’s disk diffusion method. HLAR producing Enterococcus species were detected by high level gentamicin and streptomycin discs. Results: A total of 202 organisms were isolated from 192 various clinical samples. Respiratory tract infection 76( 39.6%) was the most common infection in Intensive care units .The number of Gram positive isolates was 60 (29.7% ) .142 (70.3%) Gram negative organisms were isolated. The most common Gram positive cocci was Staphylococcus aureus 34 ( 16.8%). Highest occurrence of nosocomial infections was observed in CCU 52( 27.1% ) followed by ICCU 48 ( 25%). Among Gram positive cocci minumum resistance was seen against vancomycin (6.7%) followed by linezolid (10%) and cotrimoxazole (26.6%). HLAR was seen in 100% of the Enterococcus species. Conclusion: This study shows that Gram positive bacteria cause severe infections in intensive care units. The most common isolates among Gram positive organisms were S.aureus CONS and Enterococcus species. The isolates were resistant to most of the drugs. For Gram positive cocci the most effective antibiotics were vancomycin followed by linezolid and cotrimoxazole. High level aminoglycoside resistance (HLAR) was seen in all the Enterococcus species isolated .Appropriate antibiotic utilization in Intensive Care Units is essential not only in ensuring an optimal outcome but also in the prevention of multidrug resistant bacteria.

27. Prevalence Risk Factors for Dry Eye Syndrome among Type 2 Diabetes Mellitus Patients
Vandana Batham, Priyansh Agarwal, Tejendra Singh
Background: Type 2 diabetes mellitus is a complex condition characterized by elevated blood sugar levels due to impaired insulin secretion or insulin resistance. Ocular complications associated with diabetes, such as diabetic retinopathy and other corneal abnormalities, can have severe consequences, including vision loss. Dry eye disease is a prevalent condition among diabetic patients, with approximately 50% experiencing its symptoms. This study aims to determine the prevalence of dry eye in patients with type 2 diabetes and explore its association with diabetes duration and glycemic control. Methods: This prospective cross-sectional study conducted at a tertiary hospital in North India aimed to investigate dry eye disorder in patients with type 2 Diabetes Mellitus. A total of 400 consecutive patients were included, meeting specific criteria and excluding certain conditions and medication use. The study involved interviews, demographic data collection, medical history review, general and systemic examinations, ocular examinations, and diagnostic tests. Statistical analysis was performed using SPSS software, and a p-value of less than 0.05 was considered statistically significant. Results: The study included 384 patients, with a mean age of 61.32 years. The majority of participants were male (71.1%), and the average duration of diabetes mellitus was 10.23 years. The prevalence of dry eye based on the Dry Eye Workshop dry eye severity level grading system was 16.9% for mild dry eye and 2.1% for moderate dry eye. The study found a significant association between the duration of diabetes and dry eye, with a higher prevalence observed in patients with longer diabetes duration. Similarly, the severity of retinopathy was significantly associated with dry eye, with higher rates observed in patients with more severe retinopathy. Conclusion: In conclusion, our study strongly supports the existence of a significant association between diabetes mellitus and dry eye. Early diagnosis, timely treatment, and effective management of diabetes are vital in improving patient outcomes and enhancing their overall ocular health and well-being.

28. Introduction of Flipped Classroom among Medical Undergraduates in Pharmacology
Madhulika Peter Samuel, Dinesh Kumar Badyal, Gagandeep Kwatra
Background: The flipped classroom is not new but now become popular teaching learning method. FCR is student-centered as compared to lectured base classroom which is teacher centered. The flipped classroom has some disadvantages also like technology related problems, and lack of motivation. But advantages are always outweighing disadvantages of FCR. In spite flipped classroom is another innovative teaching modality for medical students, there are very few studies regarding flipped classroom teaching method especially in India. Hence, this study was planned to introduce flipped classroom among medical undergraduates in Pharmacology and as well to assess the students and faculty’s perception regarding flipped classroom. Methods: This prospective educational study was conducted in Pharmacology department at tertiary care hospital, among students of new M.B.B.S. batch. There were two main activities among students, first was pre-class activities followed by in class activities. At the end of topics being selected, feedback questionnaire form (pre-validated and pretested) was provided to all students as well to faculty to know about their perception and attitude towards flipped classroom including demographic characteristics. There was separate feedback questionnaire form for faculty and for residents. The collected data was entered in the MS excel sheet. The data was analysed using SPSS version 21.0. The findings were expressed as percentage, and frequency. Results: The perception of faculty regarding flipped classroom (FCR) was assessed in the study and it was observed that 60.0% of faculty were having neutral response regarding feasibility of the FCR. None of faculty were in agreement for the FCR as the preferred method of teaching or choosing FCR as teaching method. Although 36.5% and 39.7% of students agreed for FCR for upcoming classes and for selected topic respectively, but only 22.2% students agreed to prefer FCR as teaching method and 23.8% agreed that it time consuming teaching method. Conclusion: Students have responded favorably to implementation, feeling more involved and active in the learning process. We were unable to show that the assessment results had improved. Flipped learning will be expanded to other subject modules at our institution.

29. To Compare the Efficacy and Safety of Umbilical Vein Oxytocin Infusion and Intramuscular Oxytocin Administration in Management of Third Stage of Labour
Richa Sharma, Supriya Gupta, Ritu Bassi
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality globally, particularly in resource-limited settings. The third stage of labor, encompassing the delivery of the placenta, is a critical period for managing PPH. Oxytocin, a commonly used uterotonic drug, plays a pivotal role in preventing PPH. However, optimal dosages and administration routes for oxytocin remain uncertain. Intraumbilical vein oxytocin injection has emerged as a potential noninvasive method for reducing blood loss and addressing complications like retained placenta. This study aims to evaluate the efficacy and safety of intraumbilical vein oxytocin injection in shortening the third stage of labor and preventing excessive bleeding. Methods: This prospective randomized case-control study involved 220 pregnant women in labor admitted to the Department of Obstetrics and Gynecology at the Government Multispecialty Hospital. Participants meeting specific criteria were allocated to either Group I or Group II using sealed opaque envelopes. Group I received 10 IU of oxytocin diluted in 18 ml of normal saline via the umbilical vein, while Group II received 10 IU of oxytocin intramuscularly at the delivery of the baby’s anterior shoulder. Exclusion criteria were applied to certain medical conditions. Vaginal delivery was conducted, and blood loss was measured using a kidney tray and pre-weighted pads. Pulse rate, blood pressure, temperature, and side effects were recorded. The primary outcomes assessed were blood loss, incidence of PPH, duration of the third stage of labor, and manual removal of the placenta. Statistical analysis was performed using appropriate tests and software. Results: The age distribution, gestational age, gravida, and parity were similar between Group I and Group II. The duration of the third stage of labor showed no significant differences between the two groups, with the most common duration being 5 minutes. The mean duration was 4.57 minutes in Group I and 5.082 minutes in Group II. Interventions and outcomes related to delivery, including episiotomy, tears, intact perineum, mode of placental delivery, and blood loss, were comparable between the groups. There were no cases of severe blood loss (PPH) in either group. These findings indicate similar outcomes in terms of delivery measures and associated interventions. Conclusion: From these observations, it was concluded that intraumbilical oxytocin injection in the third stage of labor is comparable to intramuscular oxytocin injection in the active management of the third stage of labor. Intraumbilical vein oxytocin is considered safe, simple, inexpensive, and noninvasive. Therefore, it can be used as an alternative to the traditional method of intravenous oxytocin infusion in the management of the third stage of labor.

30. Assessment of Risk Factors and Clinical Features in Young Patients with Myocardial Infarction: A Cross-Sectional Study
Ravi Ranjan Kumar Raman, Vikash Kumar, Md. Shahid, Sumit Kumar
Background: The change in life style is one of the important risk factors for development of obesity, along with its consequences such as development of metabolic syndrome, hypertension and diabetes mellitus, and coronary artery disease. Aims and Objectives: The aims of this study were to study the risk factors and clinical profiles of young patients with acute myocardial infarction. Materials and Methods: The present cross-sectional study was conducted on Ninety (young patients (<45 years of age) admitted to the emergency department of the internal medicine and diagnosed with MI. The diagnosis of MI was done primarily on the basis of an electrocardiogram (ECG). For statistical analysis, and data interpretation, Microsoft Excel 15 and SSPS22.0 software was used, and P<0.05 was taken as statistically significant. Result: The present study consists of 90 patients. Out of these, there were 70  males and 20 females with a M: F ratio being 3.5:1. The overall mean age of young patients with MI in this study was found to be 36.90±4.86 years. The analysis of risk factors for showed that body mass index was 30.93 Kg/m2. 58.89% patients were active smokers, whereas 41.11%patients had no history of smoking. In 20% patients both parents had history of CAD, whereas in 42.22% patients, one parent had history of CAD. Hypertension and DM was present in 54.44% and 35.55% respectively. Dyslipidaemia was the most common risk factor in the present study was in 75.56% patients. The majority of patients had STEMI, accounting for 67.78% of the total, while the rest 32.22% suffered from NSTEMI. Conclusion: In present study, Acute MI in people less than 45 years of age is almost exclusively seen in men, and ST elevation MI is the main presentation. Smoking, hypertension, Diabetes Mellitus, low HDL, high triglycerides, and raised LPa are major risk factors. Anterior wall MI is more common, and in hospitals admitting patients, mortality is low.

31. Left Ventricular Diastolic Dysfunction in type 2 Diabetes Mellitus: A Cross Sectional Study
Amulya Visweswar, Uday Girijakanth, Prashanth N C
Introduction: Patients with diabetes have a two to four fold increase in the risk of coronary artery disease (CAD). Patients with diabetes have an absolute risk of CAD death more than three times higher than that in the non-diabetic cohort even after adjustment for established risk factors. Aim: to study left ventricular diastolic dysfunction in asymptomatic normotensive patients with Type II Diabetes Mellitus. Method: This was a prospective cross sectional study where diabetic patients attending the out patient department and admitted to various wards of Dr. B. R. Ambedkar Medical College and hospital, K. G. Holli. Bengaluru, were selected randomly for enrollment into the study after consideration of inclusion and exclusion criteria. Results: Among 41 patients with 1 – 5 yrs duration of diabetes, 34 had normal filling pattern, whereas among 28 patients with > 10 yrs duration of diabetes all patients had diastolic dysfunction. (p<0.001). Conclusion: Diastolic dysfunction was observed in 54% among 100 subjects out of these 43% had impaired relaxation and 11% had pseudo normal filling.

32. Evaluation of Gray Zone Breast Lesions Along with Cyto-Histological Correlation
Ritu Sarkar, Poulami Dey, Manoj Kumar Deka, Biman Jyoti Deori, Arindam Das
Background: Breast cancer has recently surpassed cervical cancer as the most frequent malignancy in Indian women. In order to distinguish between benign and malignant breast lesions, FNAC is a very safe, minimally invasive, and quick diagnostic technique. The National Cancer Institute (NCI) has developed a thorough and consistent system in 1996 for classifying FNAC breast lesions into five groups for the diagnosis as follows: inadequate – C1, benign – C2, atypical, probably benign – C3,  suspicious, favours malignancy – C4, and malignant – C5. ]. C3 and C4 are gray lesions that are difficult to interpret for a specific diagnosis. Aims and Objectives: The objective of this study is to evaluate the significance of FNAC in the C3 and C4 category diagnosis and to compare it to histopathological diagnosis. Materials and Methods: A retrospective study was carried out in the Department of Pathology of Silchar Medical College and Hospital, from 1 September 2020 to September 2022. A total of 312 cases were studied, and those that fell into the C3 and C4 categories were selected for further investigation and later histopathological results were compared. Results: Out of 312 cases which were studied, C3 and C4 categories constituted 18 (5.7%) and 24 (7.69%) cases respectively. Histopathological diagnosis was available in 9 cases of C3 (50%) and 16 cases of C4 (66.66%). Among C3 category, 7/9 cases in which histopathological examination was available showed benign lesions (77.77%) and 2/9 cases were malignant (22.22%). Among C4 category, 2/16 cases available for histopathological examination showed benign lesions (12.5%) and 14/16 cases turned out to be malignant (87.5%). Between the C3and C4 categories, there was a statistically significant difference between benign and malignant lesions (p <0.001). Conclusion: Thus, FNAC of breast is a simple, safe, quick, and affordable diagnostic modality that is crucial in the detection of grey zone breast lesions. However, it is important that clinicians understand the limitations of FNAC. There was a statistically significant difference in benign & malignant diagnosis for these categories in our study, and so C3 and C4 categories should still be continued with.

33. Comparison of Norepinephrine and Phenylephrine Boluses for the Treatment of Hypotension during Spinal Anaesthesia for Caesarean Section
Pankaj Verma, Sheela Ekka, BimalKrushna Panda, Siddhanta Choudhury, Neha Padhi, Abhilash Dash
Background and Aims: Hypotension is common despite adequate fluid loading following spinal anaesthesia for caesarean section. Phenylephrine is presently the drug of choice to treat spinal hypotension following caesarean section. Recently, norepinephrine is being proposed as a substitute to phenylephrine boluses. The aim of the study was to compare the effectiveness of bolus doses of norepinephrine with phenylephrine to treat hypotension following spinal anesthesia for caesarean section. Methods: 100 patients undergoing elective caesarean section under spinal anaesthesia were randomly assigned into two groups. Group PE patients received phenylephrine 50 µg as an IV bolus and group NE received 4 µg of norepinephrine as IV bolus to treat hypotension following spinal anesthesia. The primary objective of the study was to compare the number of bolus doses of norepinephrine or phenylephrine needed to treat hypotension following spinal anesthesia. The secondary objectives were to compare the incidence of bradycardia, nausea and vomiting in mother and foetal outcomes. Results: The number of boluses of vasopressors required to treat hypotension was significantly lower in group NE (Group NE=1.36±0.563, Group PE=2.00±0.699, p-value=0.000). The frequency of bradycardia was high in group PE, and this difference was also statistically significant (Group NE=2 (4%), Group PE=11 (22%) p-value=0.015). Maternal complications such as nausea and vomiting and shivering were comparable between the groups. The fetal parameters were also comparable between both the groups. Conclusion: Intermittent boluses of norepinephrine are effective in the management of hypotension following spinal anesthesia for caesarean section. The fetal outcomes were comparable in both the groups. Norepinephrine boluses can be considered as a better alternative to phenylephrine boluses.

34. Analysis and Importance of Hard Water Compositions for Potential Housing of Zebrafish as Research Model
Murugan, Sunil, Vishal Babu
Background and Aim: Now a day the zebrafish has become an important research model for the study of many diseases and drug discovery due to convenience and less expense. Analysis of composition of hard water is paramount importance because of it play a vital role in cellular and molecular level activities and may give negative impacts on the results of research studies. So it is necessary to check and maintain the concentration of basic water parameters for good research purpose and it maybe varying between the places. So we aim to identify and draw attention to factors likely to affect their welfare of maintaining laboratory zebrafish. Methods: All the bioassays were conducted with zebrafish maintained water sample. The parameters were assayed as per the Indian Standard methods of sampling and test for waste water by (IS 3025 (part60)-2008 (Reaffirmed 2013), mean ± S.E. error bar in percentage compared with acceptable range. Results:  In the result, there were observed that significant fall in the concentrations of chloride, sulphate, iron calcium and significant rise in alkalinity, total hardness in the collected tap water when compared with the acceptable range. Conclusions: Our results gave additional information, importance of concentration of basic hard water parameters to provide the best potential housing of zebrafish for research purpose.

35. Lung Lesions: Correlation of its Histopathology with Immunohistochemistry
Ayesha Farheen, Mohammed Abdus Samee, Sneha Sheelwanth
The anatomical and histological features oblige the Lungs to be most susceptible to invasions. Lung lesions are common due to exposure to various risk factors. A few of them are pollution, smoking, human immunodeficiency virus (HIV), infections, tuberculosis, and malnutrition. An increasing trend in cases of lung cancer is being seen in India. Lung biopsy is a simple, relatively safe, rapid and reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. We wanted to study the histopathological pattern of lung lesions along with its distribution with regard to age, sex, and site. Methods: This is an observational study conducted at the Department of Pathology, ESIC Medical College, Kalaburagi from January 2020 to December 2022. Material for the study consisted of all the biopsies submitted for histopathological and immunohistochemical study. Results: 164 cases were included in the study, out of which 104 cases (63.41%) were malignant, 10 cases (6.10%) were of inflammatory origin and 50 cases (30.49%) showed no evidence of malignancy. Male to Female ratio was 3:1. Most common age group was 51 to 60 years (31.71%). Most common histological type of malignancy was adenocarcinoma (36.54%), followed by squamous cell carcinoma (30.77%). Conclusions: Lung biopsy is reliable with high accuracy for diagnosis and subtyping of lung lesions. Immunohistochemistry is an important complimentary tool for routine diagnosis of lung cancers.

36. A Comparison of Three Different Doses of Gabapentin for Attenuation of the Hemodynamic Response to Laryngoscopy and Tracheal Intubation in General Anaesthesia
Garima Gaurav, Kumar Akash, Sushil Kumar
Background and Objectives: Endotracheal intubation is the gold standard for airway management. It is the mostly important measure taken during induction of general anesthesia (GA) to safeguard the airway from gastric content aspiration and to provide positive pressure ventilation. To evaluate and compare the effects of different doses of gabapentin on haemodynamic response to laryngoscopy and endotracheal intubation. To find the safe and adequate dosage of gabapentin required to suppress the haemodynamic responses during laryngoscopy and endotracheal intubation. Methods: This prospective study was conducted at operation theatres of different surgical discipline in Darbhanga Medical College and Hospital, Laheriasarai, Bihar during the period of January 2018-June 2019. Conclusion: A single oral dose of Gabapentin 600 mg or 900 mg given one hour before induction of GA can significantly attenuate the pressor responses associated with laryngoscopy and tracheal intubation.

37. Complication of Phototherapy with Special Reference to its Effect on Serum Calcium in Neonatal Hyperbilirubinemia
Rakesh Kumar, Satish Kumar
Background and Objectives: Jaundice is common and, in most instances, a benign condition in the newborn. Jaundice is defined as a yellow discoloration of skin, mucous membrane and sclera that is produced by the accumulation of bilirubin in the tissues and interstitial spaces. Prevalence of phototherapy induced hypocalcaemia among neonates. To estimate and compare the serum calcium concentration in neonatal hyperbilirubinemia. Materials and Methods: Prospective Hospital based Analytical Longitudinal Cohort study. Department of paediatrics, Kurji Holy Family Hospital, Patna, Bihar a tertiary care referral hospital. Study duration of Two years. Kurji Holy Family Hospital is a 300 bedded hospital. It provides 24 hours emergency services, managed by a team of consultants, registrar, DNB students, house surgeons and trained nurses. Apart from these, there is round the clock laboratory, blood bank, Radiological facility, NICU, PICU. Conclusion: jaundiced neonates who undergone phototherapy the number of neonates developing hypocalcemia i,e. Serum calcium level< 7 mg/dl at 48 hour of phototherapy increase i,e. 78(74.28%). This observation is statistically significant (p-value=0.00).

38. Eosinopenia and Nucleated Red Blood Cells as Diagnostic Markers in Neonatal Sepsis and in Predicting Morbidity and Mortality in Neonatal Intensive Care Unit
Satish Kumar, Rakesh Kumar
Background and Objectives: Neonatal sepsis is a clinical syndrome consisting of bacteremia with systemic signs and symptoms of infection accompanied by evidence of the bacterial growth in blood cultures, urine or cerebrospinal fluid, in the first four weeks o/f life. Neonatal sepsis is frequent and important cause of morbidity and mortality particularly in the developing countries like India and accounts for early-half of all neonatal death in our country. To evaluate the diagnostic efficacy of eosinopenia in neonatal sepsis and to determine the value of eosinopenia and nucleated red blood cells in predicting morbidity and mortality in NICU. Methodology: A prospective comparative study done in Neonatal intensive care unit of GMCH Purnea. 254 neonates admitted to neonatal intensive care unit with a clinical suspicion of sepsis were included in the study. All neonates fulfilling the inclusion criteria were included as study subjects after obtaining detailed informed consent from the parents. Conclusion:  As an inexpensive, easily available test to diagnose sepsis on ICU admission, eosinopenia and nucleated red blood cells offer a moderate degree of certainty in diagnosis of neonatal sepsis and can be used as an adjuvant test along with the other currently available septic markers.

39. Aerobic Bacterial and Fungal Profile of Chronic Suppurative Otitis Media and its Antibiotic Susceptibility Patter
Vinita Prasad, Shilpa Singh, Saroj Kumari, Shabbir Azad, R.S. Prasad
Background and Objectives: Chronic suppurative otitis media is defined as chronic inflammation of middle ear and mastoid cavity that presents with recurrent ear discharge of more than three months duration through a perforated tympanic membrane. CSOM is a major health problem in developing countries causing serious local damage and threatening complications. To isolate and to identify aerobic bacteria from Chronic suppurative Otitis media cases, to study antibiotic susceptibility pattern of isolated aerobes and facultative anaerobes, to isolate and identify fungi causing CSOM and to study the antifungal susceptibility pattern of isolated Candida species. Materials and Methods: This study was conducted at the Department of Microbiology, at DMCH, Darbhanga. A total of 500 patients with clinical diagnosis of CSOM from the Department of ENT were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs processed by standard microbiological techniques. Conclusion: Chronic suppurative otitis media is a major health problem in our setup causing serious local damage and threatening complications. Pseudomonas aeruginosa followed by Staphylococcus aureus are the most common bacterial isolates causing CSOM.

40. A Study on Middle Ear Risk Indices in the Postoperative Outcome Following Tympanoplasty
M Hemanth Rao, K Gokul Kumar, S Prasanna Laxmi
Background: A persistent inflammation of the middle ear and mastoid cavity known as chronic suppurative otitis media (CSOM) manifests as recurrent ear discharges or otorrhoea through a tympanic perforation. The distinguishing characteristics of CSOM from other types of chronic otitis media are persistent tympanic perforation and middle ear drainage. To evaluate MERI Score for the degree of AB gap closure and uptake of graft following tympanoplasty procedures in the study group. To assess the closure of perforations using Belluci criteria. Methods: Based on the inclusion and exclusion criteria n=60 patients were prospectively enrolled for the study based on the convenient sampling technique. The following procedure was adopted for all participants. Detailed history taking followed by Clinical examination including General physical examination, Ear Nose, and Throat examination, and systemic examination. The following investigations were performed preoperatively on all patients Nasal endoscopy, X-Ray PNS, Water’s view, and Belluci criteria to assess the degree of otorrhea, Pure tone audiometry, and air-bone gap. Results: In the present study, among n=65 operated ears n=12 ears had ossicular necrosis. Ossicular necrosed (N=12) patients underwent type III tympanoplasty and the remaining patients (N=53) underwent type I tympanoplasty. In type1 tympanoplasty, Graft acceptance was observed in n=51 patients (96.22%) In type III tympanoplasty, Graft acceptance was observed in only N=1 patient (8.33%) The graft acceptance was significantly affected by the presence of ossicular necrosis. The Hearing assessment is done for graft accepted patients. Conclusion: In the present study the lower MERI risk categories were found to be associated with significantly better outcomes following the tympanoplasty in terms of both reduction of the A-B gap and Graft acceptance. Also, the presence of middle ear granulations and positive Belluci criteria were found to be significantly associated with the success of tympanoplasty in terms of graft acceptance.

41. Effect of Thoracocentesis on Spirometry, ABG Values and 6 Min Walk Test in Symptomatic Patients with Moderate and Massive Pleural Effusions
Manoranjan Dash, Swetapadma Pradhan, Nrusingha Ch. Dash, Somya Sucharita Panda, Jyoti Patnaik
Introduction: Pleural effusion is characterised by abnormal accumulation of fluid in pleural space secondary to local or systemic diseases. This clinical condition causes changes in respiratory mechanics with reduction in static and dynamic lung function. Impact of thoracocentesis on various physiological parameters of respiratory system including spirometric variables, arterial blood gases, mechanical properties and respiratory muscle function. Aims and Objectives: To determine the effect of thoracocentesis on spirometry, exercise tolerance and ABG values in patients with moderate to massive pleural effusions and comparing pre and post thoracocentesis value. Material and Methods: This is a prospective observational study accepted by the Institutional Ethics Committee of this tertiary medical college & hospital. Inclusion Criteria: Symptomatic patients of > 18 years age admitted to chest and TB ward diagnosed with pleural effusions – moderate and massive by chest radiology. Exclusion Criteria: Asymptomatic, not giving consent and    having mild effusions, encysted effusions, effusions with hydropneumothorax other comorbidity that causes dyspnea and exercise intolerance. Spirometry, ABG and 6MWT done before and after thoracocentesis. Results: Total of 71 patients included. Mean values of pre and post thoracocentesis FEV1 were 1.17±0.49 and 1.29±0.51 l respectively. Mean values of pre and post thoracocentesis FVC were 1.27±0.53 and 1.42±0.60 l respectively showing the improvement in both FEV1 and FVC to be statistically significant. PaO2 increased significantly 6 hrs after therapeutic aspiration. Mean values of PaO2 pre and post-thoracocentesis were 71.54±10.37 and 72.86±11.20 mmHg respectively with p value of 0.015. 6MWD also increase 6 hrs post thoracocentesis. Mean 6MWD pre and post thoracocentesis were 487±102.32m and 513±105.93m respectively. Post therapeutic aspiration 6MWD increased from 89% to 94% of predicted 6MWD of all patients with p value of 0.001 showing the improvement to be statistically significant. Conclusion: Therapeutic thoracocentesis is highly effective in providing modest improvement in FeV1, FVC and PaO2 in patients with large volume effusion and there is significant improvement in 6MWD. The benefits of fluid removal are more evident in situations of exertion, where it allows patients to go back to their daily routine activities.

42. Co-Infection of Herpes Family among HIV-I Positive Cases in Jaipur, Rajasthan
Ashish Kumar Panda, Nitya Vyas, Pankaj Kumar Sharma, Jitendra Panda
Acquired Immunodeficiency Syndrome (AIDS) is a medical condition caused by the Human Immunodeficiency Virus (HIV). The first recognized cases of AIDS were reported in the early 1980s, primarily among gay men in the United States. Coinfection of herpes family viruses, especially Herpes simplex virus (HSV) and Cytomegalovirus (CMV), is relatively common among HIV-1 positive individuals. HIV weakens the immune system, making individuals more susceptible to opportunistic infections, including infections caused by herpes viruses. In this study Total 150 HIV Positive patients were enrolled. Co-infection & Synergic effect of Herpesviridae viruses in HIV-1 Positive cases were correlated with CD-4 Count and HIV viral load. Total 8(5.33%) cases of multiple coinfections were found among 150 HIV-1 positive patients. It showed that due to poor immunity these multiple coinfections of herpes family was found among such cases.

43. A Prospective Study on the Prevalence of Foreign Bodies in Nasopharyngeal and Oropharyngeal Pathways in Subjects Reporting to the ENT Department
Barun Kumar Bhattacharjee, Paromita Patra, Sk. Ramiz Islam
Background: Foreign bodies in the oropharyngeal and nasopharyngeal pathways can have fatal impacts and are commonly seen in routine medical practice. Aim: The present study aimed to assess the prevalence of foreign bodies in nasopharyngeal and oropharyngeal pathways in subjects reporting to the ENT (Ear, Nose, and Throat) Department of an Institute. Methods: The present prospective study assessed 100 subjects from both genders who presented to the Outpatient Department of ENT with foreign body obstruction in oropharyngeal or nasopharyngeal pathways. Results: More prevalence of foreign bodies was seen in male subjects compared to females from lower to middle-income groups and urban populations. The majority of the foreign bodies in the oropharyngeal pathway were single in number. Majority of the cases presented in the acute period with the most common foreign body being fish bone. Child subjects showed excessive salivation, food refusal, and excessive crying, whereas, adults with nasopharyngeal foreign bodies presented with dysphagia. Following treatment, the hospital stay duration was 24-48 hours. Conclusion: The study concludes that oropharyngeal and nasopharyngeal foreign bodies are more commonly seen in adult males from the middle age group and urban population compared to females with the most commonly obstructed being chicken bone and fish bones.

44. Diphtheria Revisited: An Interesting Case Report from India
Anoushka Sahai, Pooja Shriwastav, Kartik Narkhede, Ashwinikumar Gaikwad, Hetal Marfatia
Background: Diphtheria, caused by Corynebacterium diphtheriae, remains a significant concern in developing nations like India, where vaccination efforts encounter obstacles. This study presents a critical case of diphtheria-induced airway obstruction in an 8-year-old Indian girl, emphasizing the importance of early detection and management in resource-constrained contexts. Case Presentation: At a Western Indian tertiary care hospital, an 8-year-old girl exhibited sudden breathlessness, mouth breathing, and midline neck swelling, along with four days of rhinitis. Clinical evaluation revealed respiratory distress, 98% oxygen saturation on high-flow oxygen due to inadequate room air oxygenation, and evident dyspnea. Bilateral grade 4 tonsillar hypertrophy, characterized by a unique white membrane enveloping the tonsils, and Bull’s neck-like lymphadenopathy supported the diagnosis. Failed intubation led to an urgent tracheostomy. Corynebacterium diphtheriae infection was confirmed through lab analysis, prompting immediate antitoxin therapy and antibiotics, with vigilant monitoring and supportive care. Conclusion: This case underscores the intricacies of diagnosing and managing diphtheria-induced airway obstruction, particularly in resource-limited areas like India. The need for a tracheostomy due to failed intubation highlights the urgency of timely intervention in constrained medical environments. With diphtheria persisting as a threat in India due to vaccination challenges, early diagnosis, prompt treatment, and effective airway management are crucial. The study emphasizes the necessity of robust vaccination programs and healthcare systems to prevent resurgences of fatal infections like diphtheria.

45. Functional Outcome of Patients with Compound Fractures Managed by Primary Fixation with Plate and Nail
Yogesh K, Sanjeev MN, Dr. Mahantesh
Background: Participating in sports has a positive influence in many areas. It supports positive mental health and improves social skills along with promoting physical health. Participating in sports develops healthy living habits that provide physical benefits such as developing coordination, physical fitness, and strength. Sports and Exercise reduces the levels of stress hormones in our body. At the same time, physical activity stimulates production of endorphins. These are natural mood lifters that can help keep stress and depression at bay and in this way, sports add up to the happiness too. Objectives: This Study Aims to assess the effect of participation in sports on the self-esteem and happiness of medical students, and to identify healthy habits developed due to participation in sports among medical college students. Materials and Methods: This cross–sectional study was conducted between June to November 2022 among 206 randomly selected medical students of age 18 to 26 years of various medical colleges of Central India in Indore District who gave consent, using a pre-designed, pre-tested, semi-structured questionnaire. The questionnaire was constructed based on two scales (Rosenberg self-esteem scale and Subjective happiness scale) for measuring self-esteem and happiness respectively. Data entered in Microsoft excel have been analysed by using SPSS software25.0 (trial version). Results: In this study 43.2%participants were Males and 56.8% were Females. Among them 49.5% belonged to 20-21 years age and mean age (in years) of participants was 20.89 with S.D. (Standard Deviation) of 1.57. Majority (69.4%) of the participants used to play sports while 30.6% did not play sports. Among those who were playing sports, 44% used to play badminton and 74.1% spent <1 hour/day on sports. 97.9% felt refreshed after playing sports and 97.2% opined that sports have effect on self-esteem and happiness of a person. Mean Subjective Happiness Scale (SHS) Score of participants, those who played sports was 4.823 ± 0.69 (S.D.). Mean SHS Score of participants those who did not play sports was 3.26 ± 0.63 (S.D.). Mean Rosenberg Self-Esteem (RSE) Score of participants those who played sports was 27.00 ± 3.15 (S.D.). Mean RSE Score of participants those who did not play sports was 23.65 ± 2.82 (S.D.). Conclusion: Subjective happiness scale score and Rosenberg self-esteem score were found to be greater among those who played sports compared to those who did not play sports and both were statistically significant (p<0.05).

46. To Study the Ocular Manifestations of Rheumatoid Arthritis
Happy Kaur, Manpreet Kour
Methods: 100 rheumatoid arthritis patients who attended the ophthalmology outpatient department underwent a detailed ocular examination using slit lamp biomicroscopy and ophthalmoscopy. The tear function of all the patients was assessed using Schirmer’s test, tear film break-up time and ocular surface staining. Results: 38 out of the 100 patients studied had ocular manifestations typical of rheumatoid arthritis. Dry eye was the most common manifestation (81.6%). Of the patients, 70% was females (70 patients). The mean duration of rheumatoid arthritis in patients with ocular manifestations was 5.4±2.7 years and without ocular manifestations was 2.1±1.6years. 7.9 percent of the patients had episcleritis (3 patients). Scleritis was present in 2.7% of the patients (onepatients). Peripheral ulcerative keratitis was present in one patient (2.7%).  Anterior uveitis was present in two patients (5.3%). Eighty-five percent (85 patients) had bilateral manifestations 15% (15 patients) had unilateral manifestations. Conclusion: Ocular manifestations are a significant part of the extra-articular manifestation of rheumatoid arthritis. Dry eye was the most common ocular manifestation.

47. Analysis of Factors Pertaining to Intrauterine Fetal Death at Tertiary Care Centre
Bonela Sandhya, Uriti Sujatha Patnaik, Chimpiri Sudhakar, Kotala Sugunasree
Introduction: Intrauterine fetal death (IUFD) is unpredictable aspect during regular antenatal checkup. Early assessment and timely intervention can reduce the incidence of IUFD. Aim: The aim of this current study is to know incidence of intra-uterine fetal death, etiology or risk factors for antepartum and intrapartum fetal deaths (IUFD) and their management strategies. Method: A retrospective observational study was carried out in Government Hospital, Kurnool Medical College between March 2021 to March 2022. Total 100 cases of IUFD were included in this study. Results: Majority study subjects were at age of 21 years and most of them are primigravida who are unbooked cases belonging to lower socioeconomic class and many of them were past dated pregnancies. 22% study subjects were having previous history of IUFD/stillbirths. 50% of the study subjects had maternal cause of IUFD, among those pregnancy induced hypertension (32%) followed by gestational diabetes mellitus (GDM) and 40% had foetal causes and 10% were of undetermined cause. Majority of IUFD fetus were male and weighed between 1.5 to 2 kg birth weights. Conclusion: Majority of subjects was primies, unbooked, lower socioeconomic class and postdated pregnancy suggesting these are the risk factors for IUFD. IUFD can be prevented by providing patient and community health education for regular antenatal care regarding warning signs during antenatal, hospital delivery, and early hospital visit.

48. Expression of PD-L1 (Programmed Cell Death Ligand-1) in Oral Squamous Cell Carcinoma: A Potential Immunomodulator Tool for Management
Mayank Kumar Singh, Jitendra Singh Yadav, Sufia Ahmad Khan, Shalini Baghel
Background: Oral squamous cell carcinoma (OSCC) is a common malignancy with increasing incidence and mortality. Now it is important to take step to improve therapeutic strategies for the patients affected by OSCC. In the advent of immunotherapy, Anti PD-L1 seems to be effective in the treatment of many malignancies. Objectives: To demonstrate the expression of Programmed Cell Death Ligand-1 (PD-L1) in Oral squamous cell Carcinoma (OSCC) by means of immunohistochemistry (IHC). Material and Method: In this study, immunohistochemical staining in 25 Cases of OSCC was done by Ventana PD-L1(SP263) Rabbit monoclonal primary antibody and expression of PD-L1 was assessed as per FDA approved criteria. Only membranous staining on tumor cells was considered positive. For statistical analysis, SPSS software version 23 was used. Result: In this study, PD-L1 was expressed in 23 Cases out of 25 Cases (92%)of OSCC. Expression was negative in only 2 cases of OSCC. We also found that expression was high in Cases of Alveolar ridge and Buccal Mucosa and low in the lesions of tongue. Conclusion: Our study supports that PD-L1 which is an immunomodulator is significantly expressed and play role in Oral squamous cell carcinoma. Anti PD-L1 immunotherapy in patients of OSCC could be a new direction in the treatment of oral cancers.

49. Thyroidal Hormonal Variations: A Neglected Entity in Type II Diabetes Mellitus
Bhagyamma Sollapurappa Narayanaswamy, Padmaja Pujari, Venkateswarulu. K., Sreenivasulu Uppara, T Durga, P V Srinivasa Kumar
Introduction: The co-existence of thyroid dysfunction in type 2 diabetes mellitus patients will worsen the macrovascular and microvascular complications, morbidity, mortality, and quality of life. Over the years it has been evident that there exists regards a strong relationship between thyroid and diabetes. The incidence of thyroid diseases differs in different diabetic population. Thyroid through its hormones exert a great influence on various organs in the body. Similarly insulin also plays a major role in various cellular metabolic activities. Hence, a deficiency or excess of the thyroid hormones are thought to alter the functional integrity of insulin. Aim and Objective: The objective of this study was to determine the prevalence of thyroid dysfunction among patients with Type 2 diabetes. Methods: This Hospital based prospective cross sectional study was conducted from May 2022- May 2023. A total of 100 patients with type-2 diabetes who regularly attend the outpatient Endocrinology Department, GGH Ananthapuramu. A detailed history and examination was done after getting informed consent. Blood samples were collected and sent to the laboratory for the evaluation of thyroid profile. Results: Thyroid dysfunction was found in 36%of the patients with Type 2 DM. Among 100 patients the prevalence of subclinical hypothyroidism was 18 %, primary hypothyroidism was 10 %, clinical hyperthyroidism 16 %.and 64 are in euthyroid state. Conclusion: Thyroid Hormone testing is usually neglected in Type 2 Diabetes mellitus. Unidentified Thyroid Dysfunction will have impact on microvascular and macrovascular complications of Type 2DM. Thus, Routine Screening of Thyroid is advised in all patients of type 2 DM to reduce the morbidity and mortality.

50. Knowledge, attitude and practice towards COVID-19 Vaccination acceptance in Tamilnadu: Cross-sectional study
Dheepa. N, A.V. Mathivadhana, Bagavathiammal Periyasamy, K.C. Subha, Sasikala Gunasekaran, Panneerselvam Periasamy
Background: Vaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. Getting people vaccinated is the only long-term solution to the current COVID-19 crisis. In India currently two vaccines namely covaxine and covidshield are used against COVID-19. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in India. Ason: 05Jun2021, 08:00IST: 77, 83, 926 people got vaccinated as per sources, i.e 10% of Tamilnadu population. So, this study aimed to investigate general public Knowledge, attitudes, Perceptions, and acceptance towards COVID-19 vaccinations in Tamilnadu. Methods: The survey was conducted using a semi-structured and self-reported questionnaire by using Google Forms and a shareable link was generated and disseminated publicly on various social media outlets containing informed consent along with six sections (Demographic Details, Knowledge, Attitudes, Perceptions and acceptance towards COVID-19 vaccinations). The correlation between knowledge, attitude and perceptions score was analysed using Karl Pearson correlation method. Results: An exploratory and anonymous population-based e-survey was conducted among 440 general individuals (44.79% male, 55.21% Female; mean age 31.33+12.34 years; age range=18-62 years) of different districts in Tamilnadu. Among the study population 68.63% (302 out of 440) said they are willing to take the vaccine while 21.59% (95 out of 440) said they were not willing to take the vaccine and remaining 9.77% (43 out of 440) had not yet decided about it. Similar results got for encouraging family/friends/relatives to get vaccinated. 59.54% of participants feel COVID-19 vaccine may have side effects and 40.54% doesn’t think so. 63.63% participants were willing to pay for their vaccine. Overall, 59.54% participants agreed, 27.95% participants disagreed and 12.5% participants undecided with “It is not possible to reduce the incidence of COVID-19 without vaccination. Our study shows public having 59.30%, 63.17% & 61.33% knowledge; attitude and perception score respectively calculated using mean difference with 95% CI and proportion with 95% CI. Conclusions: The possibility of controlling the COVID-19 pandemic depends on vaccine uptake and acceptance of the COVID-19 vaccine. When it comes to executing vaccination programmes, developing strategies and systematic interventions are required by public health authorities to reduce the levels of vaccines hesitancy and improve their acceptance.

51. A Rare Case Report of Anterior Atlantoclival Assimilation and Posterior Assimilation of Posterior Arch with Posterior Elements of C2 Vertebra
P.V.S. Abhishek, Adimulam Josthsna, Ponugoti Spoorthi
Craniovertebral junction anomaly or variant is an uncommon condition. The craniovertebral junction includes the occiput, atlas, axis, and supporting ligaments. We are reporting a case of 42-year-old female patient presented with occipital headache associated with tingling and numbness radiating to neck since 1 week following head trauma. Plain CT Brain imaging revealed normal brain parenchyma and an incidental finding of anterior fusion of anterior arch with clivus and posterior fusion of posterior arch with posterior elements of C2 vertebra along with increase in atlantoaxial interval with posterior subluxation of dens with resultant stenosis of foramen magnum causing cervicomedullary junction compression. This may be a first such case reported in our literature.

52. Efficacy of Dexmedetomidine and Ketamine as Adjuvant to Epidural Bupivacaine in Gynaecological Pelvic Surgeries: An Observational Study
Biswajit Sutradhar, Subhash Ranjan Das, Anand Jadhao, Swapan Debbarma
Background: Epidural anesthesia is commonly used for surgical anesthesia and postoperative analgesia. It provides superior pain relief compared to spinal anesthesia and offers segmental blockade for better hemodynamic stability. However, large volumes of local anesthetic can lead to hemodynamic fluctuations. To address this, adjuvants like dexmedetomidine and preservative-free ketamine are used in epidural anesthesia. This study aims to assess the effects of bupivacaine with dexmedetomidine and bupivacaine with preservative-free ketamine in gynecological surgeries under epidural anesthesia, focusing on stable hemodynamics and prolonged analgesia. Methods: This single-blinded cross-sectional observational study was conducted for one and a half years at Agartala Government Medical College and G.B.P. Hospital. The study included patients undergoing gynecological pelvic surgeries, with ASA physical status I & II, aged 20 to 60 years, and height 145 to 165 centimeters. Exclusion criteria were applied. Ethical approval and written informed consent were obtained. Patients were randomized into two groups: Group BK (Bupivacaine + Ketamine) and Group BD (Bupivacaine + Dexmedetomidine). The technique involved pre-anesthetic check-up, drug administration, hemodynamic monitoring, and assessment of outcomes. Statistical analysis used SPSS software version 19.0. Results: In this study, a total of 60 gynecological cases undergoing pelvic surgeries were included, divided into two groups of 30 each. The mean age of participants was 51.10 ± 6.90 years, with no significant difference between the groups. Baseline characteristics such as religion, ASA grade, and diagnosis were comparable between the groups. The onset of sensory and motor block was faster in the BD group, with significantly longer duration of motor block and analgesia compared to the BK group. Side effects and hemodynamic parameters did not differ significantly between the groups, except for blood pressure, which showed variations at different time intervals. Sedation scores were consistently higher in the BD group. Conclusion: Our study findings support that the addition of epidural dexmedetomidine to bupivacaine as an adjuvant yielded several advantages compared to ketamine. Specifically, dexmedetomidine led to a quicker onset of sensory and motor blockade, as well as a longer duration of both types of blockades.

53. A Prospective Study Comparing the Outcome of Dynamic Hip Screw and Proximal Femoral Nail in the Treatment of Intertrochanteric Fractures of Femur
Tarun Solanki, Avneet Singh Shishodia, Maneesh Kumar Maurya
Introduction: Fractures involving upper end of femur through and in between both trochanters with or without extension into upper femoral shaft’ are intertrochanteric fractures, according to the definition. It is generally recognised that the risk of intertrochanteric fractures rises with ageing. Intertrochanteric fracture incidence varies from nation to nation. According to Gulberg et al.1, there will be 2.6 million hip fractures worldwide by 2025 and 4.5 million by 2050. Asia accounted for 26% of all hip fractures in 1990, but this percentage is expected to increase to 37% in 2025 and 45% in 2050. Although the cause is unknown, there is hope that the risk of hip fractures has started to decline in some parts of the world. The intramedullary hip screw was thought to be preferable for fixing intertrochanteric fractures for the aforementioned causes. However, there is disagreement over which implant should be used in unstable fractures, with emphasis on old age and osteoporotic bone. Our study was aimed at comparing the Outcome of Dynamic Hip Screw and Proximal Femoral Nail in the Treatment of Intertrochanteric Fractures of Femur. Methodology: The clinical methodology for the study consists of 92 cases of intertrochanteric fractures of femur that meet the inclusion criteria and exclusion criteria, admitted to between November 2019 and July 2021. Study was started after obtaining institutional ethics committee clearance. Patients over the age of years with closed intertrochanteric fractures lasting less than three weeks and who could walk before the fracture meet the inclusion criteria. Malignancy, neurological, psychiatric, and co-morbid diseases such uncontrolled diabetes, uncontrolled hypertension, hyperthyroidism, and individuals with active hip joint infections are all excluded from the study. The majority of participants (56.52%) in the PFN group achieved good results, according to the results. In the DHS group, 43.48% of the individuals achieved favourable results. Result: In Group DHS, the mean six-week score was 33.42 3.13 and in Group PFN, it was 33.22 2.5. Between the two groups, there wasn’t a very noticeable difference in the mean six-week comparison. The mean score throughout the course of 12 weeks in Group DHS was 53.55 2.39 and in Group PFN it was 64.16 5.79. The mean comparison of the two groups after 12 weeks showed a significant difference. The mean score after 24 weeks was 85.26 6.43 out of 100 for Group PFN and 82.3 6.58 out of 100 for Group DHS. The mean 24 weeks comparison between the two groups revealed a sizable difference. Group DHS’s mean HHS score was 85.3 7.54 out of 100. The average HHS for the PFN group was 87.26 6.32 out of 100. The mean HHS (/100) comparison between the two groups showed a significant difference.

54. Measurement of Subaxial Cervical Vertebral Height using Computed Tomography (CT) and its Implications for the Optimization of Anterior Cervical Plate (ACP) Fixation
Maneesh Kumar Maurya, Tarun Solanki
Background: Anterior cervical plate (ACP) fixation is a commonly employed surgical technique for stabilizing the subaxial cervical spine and promoting fusion in patients with cervical spine pathologies. Achieving proper stability and alignment is crucial for successful fusion and restoration of spinal function. Accurate measurement of subaxial cervical vertebral height is essential for selecting the appropriate size and shape of the anterior cervical plate. Traditional manual measurement methods are subjective and prone to errors. Computed tomography (CT) imaging has emerged as a reliable tool for assessing cervical vertebral dimensions. This research aims to investigate the use of CT for measuring subaxial cervical vertebral height and its implications for optimizing the selection and placement of anterior cervical plates, ultimately improving surgical outcomes and patient satisfaction. Methods: This retrospective observational study investigated subaxial cervical vertebral height using computed tomography (CT) for optimizing anterior cervical plate (ACP) fixation. The study included patients who underwent ACP fixation for subaxial cervical spine pathologies between January 2018 and December 2022. Data including patient demographic information, clinical history, and radiographic data were collected from electronic medical records. Subaxial cervical vertebral height was measured using specialized software on CT images, and measurements were compared to commercially available ACP dimensions. Descriptive statistics and appropriate statistical methods were used for data analysis. Ethical guidelines were followed and patient privacy was maintained. Results: A total of 100 patients (62 males, 38 females) participated in the study, with cervical disc herniation being the most common pathology (52%). The mean heights of subaxial cervical vertebrae ranged from 11.6 mm (C5) to 14.1 mm (C7), with an overall mean of 13.2 mm. Analysis of available anterior cervical plates showed mean lengths of 12-16 mm, mean widths of 10-14 mm, and mean thicknesses of 2-4 mm. The majority of patients (87%) required plates with specific dimensions (length: 12-14 mm, width: 10-12 mm, thickness: 2-3 mm). A significant correlation was found between vertebral height and plate height (r = 0.63, p < 0.001), but no significant correlations were observed for plate width or thickness. Conclusion: Our study highlights the importance of precise subaxial vertebral height measurements obtained through CT imaging for optimizing anterior cervical plate placement. The individualized approach to implant selection based on accurate measurements can enhance surgical outcomes and reduce the risk of complications.

55. Hypoalbuminemia is An Important Risk Factor for Surgical Wound Healing: A Retrospective Study in a Tertiary Health Care
Abinasha Mohapatra, Sudarsan Sethy, Himansu Shekhar Mishra, Ruhi Dwivedi, Mahendra Mohan Panda
Introduction: This retrospective study used serum albumin as the only indicator of nutritional status for patients who are admitted for elective or emergency surgery. Serum albumin level is affected by insulin, thyroid hormones, inflammatory cytokines, hypermetabolism, malabsorption, intravascular volume overload. If the deficit factors could be identified and corrected in pre-operative period, the chances of wound healing related complications (like wound infection, wound dehiscence,and anastomotic leak) will be reduced. Aim: To study effect of serum albumin level in wound healing and related complications like wound infection, wound dehiscence and anastomotic leak. Materials and Methods: The study is conducted in surgery department, V.S.S. institute of medical science and research, Sambalpur, Odisha. A total of 150 patients were studied over a period of 12 months and were evaluated for serum albumin and the wound related complications. Results: Hypoalbuminemics are more prone to develop wound related complications than normoalbuminemics. Conclusion:  Serum albumin levels can be considered to be one of the best predictors for the wound related complications.

56. Retrospective Clinical Study of Acute Appendicitis in COVID-19 Pandemic: A Study of 100 Cases
Abinasha Mohapatra, Sunil Sahu, Himansu Shekhar Mishra
Background: Acute appendicitis is having around 7% probability of occurrence over one’s lifetime. Acute appendicitis is a common gastro-intestinal disease affecting 5.7–57 per 1lakh individual each year with the highest incidence in children and adolescents. Acute appendicitis is the most common reason for emergency abdominal surgery and must be distinguished from other causes of abdominal pain. Aim and Objective: To compare the clinical presentation, grade of presentation and post-operative complication of acute appendicitis before (July 2019- February 2020) and during (March 2020 – October 2020) the COVID-19 pandemic. Method: Based on clinical and radiological features, cases divided into 2-groups [ pre-pandemic group (group-1) i.e. having 65 cases, and pandemic group (group-2) i.e. having 35 cases] and 5- grades [Grade-1 (Probable appendicitis), Grade-2 (Appendicitis), Grade-3 (Appendicular perforation), Grade-4 (Appendicular abscess), Grade-5 (Complicated appendicitis / appendicular mass). Results:  Out of 100 cases enrolled, 65 and 35 cases belong to pre-pandemic period and pandemic period respectively. Higher grades, post-operative complications were more common in pandemic period. Conclusion: This pandemic period affects diagnosis, treatment protocol, and increases post-operative complications, which may be due to delayed presentation in casualty department resulting delayed diagnosis and advanced stage of the disease.

57. Management and Outcome of Different Sized Duodenal Perforations: A Retrospective Study of 100 Cases in a Tertiary Health Care, Odisha
Abinasha Mohapatra, Kishan Bhoi, Himansu Shekhar Mishra
Background: Multifactorial etiologies are responsible for duodenal perforations, having mortality rate ranges from 1.3%-20%. Although the size of a duodenal perforation is an important measure in determining the outcome, a review of literature failed to reveal, any accepted definition of either small, large, or giant perforation. Aim and Objectives: This retrospective study represents our experience with the management and outcome of different sized duodenal perforations over a period of one year (between May 2022 to May 2023). Materials and Methods: In recent study, where 100 patients were enrolled, analyzed as per the division into three groups as per size of perforations- Group-A (small, having < 1cm diameter), Group-B (large, having 1cm-3cms diameter), and Group-C (giant, having > 3cms diameter). Results: Group-B and Group-C (accounts 27% of patients) were associated with longer hospital stay, higher leak rates, increased morbidity and mortality. Conclusion: The Cellan-Jones omental patch is simple, can be done in a relatively short time, and remains dependable even for the closure of large sized perforations (i.e. perforations up to 3 cms size). Perforation > 3 cms size are hazardous, where omentopexy may be unsafe, and other option may be thought to be necessary.

58. Maternal and Fetal Outcomes of Pre-Eclampsia in A Tertiary Care Centre
Maryam Deshmukh, Kalpana Sukalkar, Ajit Patil, Ishwari Patil, Sakshi Anarase, Gargi Kalyankar, Jeetendra Singh
Introduction: Preeclampsia is a multi-organ system disorder of pregnancy and is responsible for a significant rate of maternal and perinatal morbidity and mortality worldwide, occurring after 20 weeks of gestation. Aims and Objectives: The aim and objective of this study is to study and evaluate pregnancy outcomes in patients with pre-eclampsia on the basis of mode of delivery, term at which delivery occurs, maternal outcome, and fetal outcome of the newborn. Materials & Methods: It is a prospective study, carried out on 200 pregnant women admitted with severe pre-eclampsia at a tertiary care referral unit. Detailed history and examination were carried out. Investigations like complete hemogram, liver function tests, renal function tests, coagulation profile, LDH, and fundus examination were done. The maternal and fetal outcomes were then noted down. Result: It was found that the leading maternal complication of pre-eclampsia was PPH which contributed to about 34%, followed by abruptio placentae (15%), renal dysfunction (7%), pulmonary edema (10%), pulmonary embolism (2%), HELLP syndrome (2%), DIC (1%) and eclampsia(0.5%). Maternal mortality was 8%. Perinatal complications included low birth weight in 75%, 60% had preterm delivery, 59% of babies had birth asphyxia and 30% were stillborn. Conclusion: There is very high maternal and perinatal morbidity and mortality and 90% of patients had no antenatal care and belonged to a lower socio-economic class. Good antenatal care could have prevented severe pre-eclampsia to a large extent. It is important to create awareness about the importance of antenatal check-ups.

59. A Very Rare Case Report of Septo Optic Dysplasia with Incidental Association of Kallman’s Syndrome
PVS Abhishek, Ponugoti Spoorthi, Adimulam Josthsna
Septo-optic dysplasia with Kallmann’s syndrome is a rare condition which includes, visual abnormalities/vision loss, hypogonadotropic hypogonadism, anosmia/hyposmia. We report a case of 12-year old boy with complete vision loss and a poor sense of smell since childhood. Radiological imaging revealed bilateral hypoplastic optic nerves, chiasma and tracts, absent left olfactory bulb and olfactory gyrus, small pituitary gland. He was referred by his primary physician for evaluation.

60. Comparative Study of Oral Tranexamic Acid and Topical Tranexamic Acid in Patients with Melasma
Lokesh Chawala, Shailesh Kumar
Background: Melasma is one of the most common causes of hyperpigmentation and is a prevalent cosmetic concern for patients. Aim: To evaluate and compare the therapeutic effectiveness of topical and oral tranexamic acid for the treatment of melasma. Materials and Methods: A total of 50 patients who presented to dermatology OPD with melasma were divided into two groups, namely A and B. Group A patients were treated with oral tranexamic acid 250 mg twice daily, and patients in Group B were treated with topical 5% tranexamic acid with follow-up every 4 weeks until 3 months. Results: Among the oral treatment and topical patient groups, a statistically significant difference in the mean percentage of reduction in MASI score from baseline was observed at 12 weeks. Conclusion: Oral tranexamic acid gave a more promising result when compared to topical tranexamic acid.

61. Comparison of ORIF and Percutaneous Fixation of Scaphoid Fractures in Maharashtra Population
Vinod Chandrashekaran Nair, Omkar Rohidas Shinde, Swaroop Solunke, Satyam Jawa
Background: Fractures of the distal radius, including scaphoid bone, are the most common among orthopaedic injuries and impose a significant financial burden on patients; hence, early union of fractures is a clinical challenge for orthopaedic surgeons. Method: 30 Scaphoids with fractures were treated and studied. The radiographs were taken from different perspectives. The screw fractures were treated with Herbert screws. The injuries were graded as per Herbert and Fisher’s classification. All the factures were first tried for percutaneous fixation using the volar approach. If adequate reduction was not achieved, then opt for ORIF and bone grafting through a volar approach, with a minimum follow-up of up to 12 months. Results: Out of 30 scaphoid fractures, 20 belonged to the right wrist and 10 to the left wrist. As per Heart Bean: 13 B2, 14=A2, 3-C. Per cutaneous fixation, 15 (26.6%) had excellent results. In Orif – 8 (26.6%) patients had excellent results, 5 (16.6%) had good results, and 2 (6.6%) had fair results. Various motions or movements, like wrist flexion, wrist extension, Mean range motion, mean grip strength score, activity score, and mean MMWS score Per cutaneous has increased score and motions as compared to ORIF. Conclusion: In the present pragmatic study, it is concluded that, percutaneous fixation technique in scaphoid fractures is an ideal method to treat, because fractures unite early and return to normal functional activity with less complications than ORIF.

62. A Cross-sectional Study to assess the Participation in sports and its effect on the Self-esteem and Happiness among medical students of Indore District
Muhammed Riyas S, Deepa Raghunath, Sanjeev Kumar Dwivedi, Pragati Gautam, Shivam Dixit
Background: Participating in sports has a positive influence in many areas. It supports positive mental health and improves social skills along with promoting physical health. Participating in sports develops healthy living habits that provide physical benefits such as developing coordination, physical fitness, and strength. Sports and Exercise reduces the levels of stress hormones in our body. At the same time, physical activity stimulates production of endorphins. These are natural mood lifters that can help keep stress and depression at bay and in this way, sports add up to the happiness too. Objectives: This Study Aims to assess the effect of participation in sports on the self-esteem and happiness of medical students, and to identify healthy habits developed due to participation in sports among medical college students. Materials and Methods: This cross–sectional study was conducted between June to November 2022 among 206 randomly selected medical students of age 18 to 26 years of various medical colleges of Central India in Indore District who gave consent, using a pre-designed, pre-tested, semi-structured questionnaire. The questionnaire was constructed based on two scales (Rosenberg self-esteem scale and Subjective happiness scale) for measuring self-esteem and happiness respectively. Data entered in Microsoft excel have been analysed by using SPSS software25.0 (trial version). Results: In this study 43.2%participants were Males and 56.8% were Females. Among them 49.5% belonged to 20-21 years age and mean age (in years) of participants was 20.89 with S.D. (Standard Deviation) of 1.57. Majority (69.4%) of the participants used to play sports while 30.6% did not play sports. Among those who were playing sports, 44% used to play badminton and 74.1% spent <1 hour/day on sports. 97.9% felt refreshed after playing sports and 97.2% opined that sports have effect on self-esteem and happiness of a person. Mean Subjective Happiness Scale (SHS) Score of participants, those who played sports was 4.823 ± 0.69 (S.D.). Mean SHS Score of participants those who did not play sports was 3.26 ± 0.63 (S.D.). Mean Rosenberg Self-Esteem (RSE) Score of participants those who played sports was 27.00 ± 3.15 (S.D.). Mean RSE Score of participants those who did not play sports was 23.65 ± 2.82 (S.D.). Conclusion: Subjective happiness scale score and Rosenberg self-esteem score were found to be greater among those who played sports compared to those who did not play sports and both were statistically significant (p<0.05).

63. Retrospective Study of Etiology of Chronic Liver Disease in Northeastern India, Sikkim
Tsella Lachungpa, Karma Doma Bhutia, Sangey Chhophel Lamtha
Introduction: Liver diseases can result from a spectrum of etiologies such as alcoholic liver disease (ALD), nonalcoholic fatty liver disease (NAFLD), viral infections like hepatitis B virus [HBV] or hepatitis C virus [HCV], autoimmune liver disease and drug-induced liver injury (DILI). Reports of etiologic assessment of CLD published in the past 25 years indicates that hepatitis B, hepatitis C and ALD are the leading causes of liver disease in India. Aim and Objectives: To assess various etiology of chronic liver disease. Material and Methods: This present study was carried out to find out the various etiology of chronic liver disease prevailing in the state of Sikkim, a Himalayan northeastern state of India. Patients data of chronic liver disease admitted in the department of gastroenterology, Sir Thutop Namgyal Memorial Hospital, Sochakgang, a tertiary care referral centre in the state of Sikkim from December 2022 till January 2023 was collected in the form of age, sex, alcohol intake duration more than 80gm per day for more than 10 years, liver function test, kidney function test, blood sugar, prothrombin time with international normalised ratio (INR), hepatitis B serology, hepatitis C serology. Result: 94.1% study subjects were alcoholic, 1.1% study subjects were had autoimmune liver disease, 1.7% study subjects had wilsons disease, 0.8% study subjects had idiopathic liver disease, whereas 0.6% subject each had hepatitis B, IG G4, NASH induced cirrhosis, and primary biliary cirrhosis. Conclusions: Alcoholic liver disease was the most common cause of chronic liver disease in Sikkim. This can be prevented by healthy lifestyle changes and changing the drinking alcohol habits.

64. A Comparative Study between Dynamic Hip Screw and Proximal Femoral Nailing in the Management of Intertrochanteric Fractures of the Femur: A Hospital-Based Prospective Study
Asif Ahmad Khan, Sanjay Kumar, Ram Nandan Suman, Kumar Anshuman
Background: The incidence of hip fractures has been increasing due to higher life expectancy and a rising incidence of motor vehicle accidents. Approximately half of the hip fractures in the elderly are intertrochanteric fractures. Aims and Objectives: The present study was done to evaluate and compare the clinical and radiological outcomes of patients treated by PFN and DHS for intertrochanteric fractures of the femur. Methods and Materials: The present prospective study was conducted on 60 patients with stable intertrochantric femur fractures attending out-patient departments at a tertiary centre. The institutional ethical committee granted ethical approval. Results: In this study, the ratio of men to women was 2:1. We observed that low-velocity trauma, such as falls, caused frequent fractures, i.e., 86.67% of injuries were due to low velocity trauma and 13.33% were due to high velocity trauma, with the right side (66.67%) being the most common involvement. Conclusion: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes; however, the PFN has a better functional outcome with an unstable fracture.

65. A Comparison of Humeral Interlocking Nail and Compression Plating in Fracture of Shaft of Humerus at a Tertiary Centre
Sanjay Kumar, Asif Ahmad Khan, Kumar Anshuman, Ram Nandan Suman
Background: Humeral shaft fractures make up about 3% of all fractures. In the majority of series of humeral shaft fractures treated with closed reduction or open reduction and internal fixation, good to outstanding results have been documented. Aims and Objectives: The present study was conducted to compare humeral interlocking nails and compression plating in patients with fractures of the shaft of the humerus. Materials and Methods: 74 cases of shaft of the humerus fracture in both genders were divided into 2 groups. Each group consisted of 37 patients. Group I underwent internal fixation by humeral interlocking nail, and group II underwent internal fixation by dynamic compression plating, with or without bone grafting. Parameters such as mode of injury, range of elbow joint movements, and complications were recorded. Results: Group I had 20 males and 17 females, and Group II had 18 males and 19 females. The modes of injury were RTA in 28 in group I and 25 in group II; falls in 5 in group I and 7 in group II; and violence in 4 in group I and 5 in group II. The difference was significant (P< 0.05). The range of movement pre-operatively in group I was 8–128 degrees and in group II was 4–130 degrees, and post-operatively in group I was 4–134 degrees and in group II was 5–130 degrees. The difference was non-significant (P> 0.05). Complications were shortening seen in 3 in group I and 4 in group II; non-union in 2 in group I and 1 in group II; superficial infection in 1 in group I and 2 in group II; deep infection in 1 in group I and 2 in group II; and implant failure in 1 in group II. The difference was non-significant (P> 0.05). Conclusion: Dynamic compression plating was found to be a superior method of stabilising diaphyseal fractures of the humerus. Dynamic plating resulted in lesser union time, fewer complications, and a better range of motion.

66. An Assessment of the Outcome of Early and Delayed Repair of Bile Duct Injuries at a Tertiary Centre
Mohamed Ashraf Ali, Md. Quamar Zubair, Md Mazharul Haque, A.K. Jha Suman
Background: Bile duct injuries refer to damage or trauma that occurs to the bile ducts, which are tubes that carry bile from the liver to the gallbladder and intestines. The present study compared the outcomes of early and delayed repair of bile duct injuries. Materials and Methods: 70 patients with bile duct injuries in the age range of 18–60 years of both genders were divided into 2 groups of 35 each. Group I was an early repair group, and Group II was a delayed repair group. Parameters such as the amount of time since the index procedure, operative parameters, the classification of the injury and procedural factors, and the postoperative course, including 30-day readmission and 90-day mortality, were noted. Results: Group I had 18 males and 17 females, and Group II had 20 males and 15 females. The aetiology was abdominal trauma in 27 and 19, cholecystectomy in 3 and 10, and non-biliary abdominal procedures in 5 and 6 in groups I and II, respectively. Strasburg-Bismuth classification showed A in 1 and 2, B in 2 and 3, C in 7 and 2, D in 6 and 3, E1 in 5 and 6, E2 in 4 and 4, E3 in 5 and 5, E4 in 3 and 3, E5 in 2 and 4, and X in 0 and 3 in groups I and II, respectively. Hospital length of stay was 7.2 days in group I and 8.2 days in group II; 30 days of re-admission were seen in 4 and 5, and 90 days of mortality were seen in 2 in group I and 1 in group II. Preoperative PTC catheter placement was seen in 0 and 14, and preoperative percutaneous transabdominal drain placement was seen in 0 and 11 in groups I and II, respectively. A significant difference was observed (P< 0.05). Conclusion: Early repair was found to be better as compared to delayed repair of bile duct injuries. Hospital length of stay, 30 days of re-admission, preoperative PTC catheter placement, and preoperative percutaneous transabdominal drain placement.

67. Assessment of Drug Utilisation in Cardiovascular Disease Patients at a Tertiary Centre
Ashish Ranjan, Pankaj Kumar Singh, Deepak Kumar
Background: Cardiovascular diseases are a group of disorders that affect the heart and blood vessels. Globally, CVD is a leading cause of morbidity and mortality. Cardiovascular diseases are responsible for 1.5 million deaths in India annually. Hypertension is linked to 57% of all stroke deaths and 24% of all coronary event deaths. Aims and Objectives: The present study was conducted to assess drug utilisation in patients with cardiovascular diseases. Material and Methods: A prospective observational study was consists of 102 patients of both genders admitted to OPD of Medicine department. Parameters include the typical number of drugs prescribed per prescription, the percentage of drugs prescribed using their generic names, the percentage of prescriptions containing antibiotics, the percentage of prescriptions containing injections, and the percentage of drugs prescribed from the essential drug list. Results: The average number of drugs prescribed per prescription (≤3) was seen in 15%, the percentage of drugs prescribed by generic name (100%) in 23%, the percentage of prescriptions with an antibiotic prescribed (≤30%) in 35%, the percentage of prescriptions with an injection prescribed (≤10%) in 96%, and the percentage of drugs prescribed from the national EDL (100%) in 98%. Cardiovascular drugs prescribed were diuretics in 61%, statins in 75%, thrombolytic in 14%, ACE inhibitors in 72%, antiplatelet in 87%, anticoagulants in 58%, beta blockers in 43%, and calcium channel blockers in 8%. The difference was significant (P< 0.05). Conclusion: The authors found that commonly prescribed cardiovascular drugs were antiplatelet, anticoagulants, thrombolytic, ACE inhibitors, beta blockers, diuretics, and statins.

68. Assessment of the Incidence of Head Injuries at a Tertiary Centre
Sajal Kumar, Ritesh Kumar Singh, Dhirendra Kumar Chaudhary, Rajeev Ranjan
Background: In the world, particularly among young people, head injuries are a major public health and socioeconomic problem that leads to death and disability. Aims and Objectives: The present study was conducted to assess the incidence of head injuries. Materials & Methods: The present study comprised 80 victims of head injuries of both genders at the department of Forensic Medicine and Toxicology. The criteria for exclusion were decomposed bodies, unknown natural diseases, admitted cases, and fatalities due to other body parts. The results thus obtained were subjected to statistical analysis. P values less than 0.05 were considered significant results. Results: The type of incidence was motorcyclist in 23 (most common), two-wheeler in 21, car or bus in 19, and pedestrian in 17. The type of meningeal haemorrhage was subdural in 43 cases, subarachnoid in 17 cases, and epidural and subdural in 20 cases. The site of fracture was frontal in 32 (most common), parietal in 26, temporal in 13, and occipital in 9 (least common) cases. Conclusion: Maximum cases were seen in age group 21-40 among motor cyclists.

69. Assessment of Variation in Spirometric Parameters among Type 2 Diabetes Mellitus Patients and their Association with Glycemic Control at a Tertiary Centre
Vikash Kumar, Ravi Ranjan Kumar Raman, Md. Shahid, Sumit Kumar
Background: A major public health problem is diabetes mellitus (DM). According to the World Health Organisation, India will be the diabetes capital of the world by the year 2025. Aims and Objectives: The goals of the present study are to use spirometry to measure pulmonary function in Type 2 diabetic mellitus patients and to find out the correlation of the pulmonary function test variables with Glycemic control. Methods and Materials: The present cross-sectional prospective study was done on 90 (Ninety) Type 2 Diabetes mellitus patients and non-diabetic patients, selected randomly from patients attending general medicine outpatient department of Government Medical College and Hospital, Bettiah, Bihar, India. Patients with diabetes mellitus were classified as study group 1 (45 patients), whereas those without diabetes were classified as control group 2(45 patients). Results: The mean age of the study group with Diabetes Mellitus was 48.57 years, and the control group was found to be 47.62 years, and the p value was found to be insignificant (p >0.05). The mean BMI among the study group with Diabetes Mellitus was 27.58 kg/m2, and the control group was found to be 26.91 kg/m2, which was also found to be not statistically significant. There is a significant (p<0.05) decrease in Pulmonary function test parameters (FVC, FEV1, PEFR, FEF 25–75%) and diffusion capacity (DLCO), whereas FEV1/FVC is significantly increased in cases compared to controls. Applying an ANOVA test between three groups according to HBA1c level shows that there is a significant decrease in FVC and DLCO and a significant increase in FEV1/FVC in those groups with HBA1c levels >7%. Conclusion: The present study shows significant changes in FVC%, FEV1/FVC%, and DLCO% in Type-2 diabetes patients, and they have been correlated with poor glycemic control.

70. Prescribing Pattern of Antidiabetic Drugs in Type II Diabetes Mellitus Patients at a Tertiary Centre
Pankaj Kumar Singh, Ashish Ranjan, Zaki Anwar Zaman
Background: Type 2 diabetes, also known as adult-onset diabetes or non-insulin-dependent diabetes, is a chronic metabolic disorder that affects how your body uses insulin to regulate blood sugar (glucose) levels. Aims and Objectives: The present study was conducted to assess prescribing pattern of antidiabetic drugs in type II diabetes mellitus patients. Materials & Methods: 120 type II diabetes mellitus patients of both genders were included. Parameters such as duration of diabetes, family history of diabetes, prescribed antidiabetic drugs, associated medications and comorbid conditions were recorded. Results: Out of 120 patients, 70 were men and 50 were women. Prescription pattern was monotherapy: oral in 30%, monotherapy: injectable in 54%, two drug combination in 41%, three drug combination in 25%, four drug combination in 23%, five drug combination in 67% and six drug combination in 64%. The difference was non- significant (P> 0.05). Comorbidities found were dyslipidaemia in 34%, hypertension in 40%, hypothyroidism in 12% and CAD in 15%. The difference was significant (P< 0.05). Conclusion: The antidiabetic medicine prescribing trend was shifting towards combination therapy. Most common drugs prescribed were metformin, glimepiride, pioglitazone, miglitol, pioglitazone+ metformin, glimepiride+ metformin and pioglitazone+ glimepiride.

71.  Role of Vitamin D as an Add-on Therapy to Oral Hypoglycemic Drugs in the Management of Type-2 Diabetic Patients
Sunil Kumar, Hitendra Kumar Verma, Rajnish Kumar, Sarbil Kumari, Yogesh Krishna Sahay
Background: New cases of Type 2 DM are increasing worldwide in every nation, with 80% of affected people living in developing countries. Therefore, Type 2 DM has become a very serious public health problem with a huge socio-economic burden for each country, but developing countries like India bear the highest burden. Aims and Objectives: The aim of the study was to evaluate the role of vitamin D as an add-on to oral hypoglycemic drugs in the treatment of Type 2 diabetic patients. Method and Materials: The present case-control study was conducted on 80 (Eighty) Type 2 Diabetes mellitus patients attending the OPD of General Medicine in collaboration with the Department of Physiology and Department of Biochemistry, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. The patients are divided into two groups- a control group (n = 40) of Type 2 Diabetic patients on oral hypoglycemic drugs without vitamin D supplementation and a study group (n = 40) of Type 2 Diabetic patients on oral hypoglycaemic drugs with vitamin D supplementation. Results: The mean age of the patients was 42.17±9.50 years in the control group and 46.39±9.93 years in the study group. Vitamin D supplementation shows improvement in glycaemic parameters like FBS, PPBS, and HbA1c values over a 3 months period. Conclusion: The present study indicating that Vitamin D supplementation improves glycemic control, thereby delaying the progression and consequently the complications of Type 2 DM in patients with Vitamin D deficiency.

72. The Study of the Association between Glycated Haemoglobin and Lipid Profile in Type 2 Diabetes Mellitus at a Tertiary Care Centre: A Retrospective Cross-Sectional Study
Nitesh Kumar, Mukesh Kumar, Asha Singh, S.M. Inamul Haque
Background: Type 2 diabetes mellitus patients are prone to diabetic dyslipidemia, which puts them at risk of developing macrovascular (stroke, peripheral vascular disease, and coronary artery disease and microvascular (nephropathy, neuropathy, and retinopathy) diseases. Aims and Objectives: In the present study, we find the association between HbA1c and the lipid profile in patients with T2DM. Materials and Methods: The present retrospective cross-sectional study was carried out on 90 Eastern Indian diabetic patients at the Pharmacology Department in collaboration with the Medicine Department at Nalanda Medical College and Hospital, Patna, Bihar. Result: The mean age of the female participants was 60.73±13.91 years and male participants was 56.83±12.54 years. The participants’ basic characteristics were analyzed and compared according to gender. The females had significantly higher values for BMI, HbA1c, TC, HDL-C, LDL-C, TG, FBS and PPBS compared to the males. Conclusion: In the present study, a significant positive relationship was found between HbA1c and triglycerides (TGs) while no significant associations were found with age, BMI, TC, LDL-C, HDL-C, or FBS  levels.

73. The Study of the Efficacy of Metformin in Rheumatoid Arthritis and its Effect on Serum C-Reactive Protein at a Tertiary Centre
Mrityunjay Kumar, Asha Singh, Navin Kumar, S.M. Inamul Haque
Background: The prevalence rate of Rheumatoid arthritis (RA) is around 0.4 percent to 1.1 percent globally. There is no reliable statistical data available in India. More research is required in this area. Metformin has been shown in preclinical studies to have anti-arthritis and anti-inflammatory effects through a number of mechanisms, including the inhibition of osteoclast gene expression, the suppression of IL-17-producing Th17 cells, the up-regulation of Treg cells, and the reduction of pro-inflammatory cytokine production. Aims and Objectives: To determine the Efficacy of Metformin in Rheumatoid Arthritis and its impact on serum C-Reactive Protein. Materials and Methods: This was a prospective, randomised, single-blinded, controlled study carried out on 70 Eastern Indian RA patients. Results: The mean age of the participants was 49.78±8.64 years, where 43 (71.6%) of them were obese (body mass index (BMI) ≥ 30 kg/m2) and 15 (25%) were overweight (25 ≤BMI≤ 29.9). The identified comorbidities in the study groups were hypertension, dyslipidemia, and ischemic heart disease, where 16 (45.71%) of participants had hypertension, 5 (14.28%) had dyslipidemia, and 2 (5.71%) had ischemic heart disease. Conclusion: Use of metformin in Rheumatoid Arthritis as an adjuvant is highly advisable because metformin enhances quality of life after one year of treatment.

74. To Compare the Minimally Invasive Plate Osteosynthesis (MIPO) with Hybrid External Fixation in the Treatment of Proximal Tibial Fracture
Asif Ahmad Khan, Sanjay Kumar, Ram Nandan Suman, Kumar Anshuman
Background: Proximal tibial fractures can result from various causes, including direct impact or force to the knee or upper shin area, such as from a fall, sports injury, or car accident. The present study compared hybrid external fixation and MIPO in the management of proximal tibial fractures. Materials and Methods: 80 cases of proximal tibia fracture of both genders were divided into 2 groups of 40 each. Group I patients were treated with hybrid external fixation, and group II patients with MIPO. Parameters such as operative time, blood loss, hospital stay, healing time, etc. were recorded. Results: Group I had 18 males and 22 females, and Group II had 20 males and 20 females. The aetiology of fractures was road traffic accident (RTA) in 26 in group I and 30 in group II; fall in 10 in group I and 7 in group II; and violence in 4 in group I and 3 in group II. The difference was non-significant (P> 0.05). The mean operative time was 91.2 minutes in group I and 112.6 minutes in group II; blood loss was 128.6 ml and 204.2 ml; healing time was 8.4 weeks and 16.2 weeks; time of recovery to work was 10.6 days and 32.5 days; and hospital stay was 10.1 days and 22.4 days in groups I and II, respectively. The difference was significant (P< 0.05). Conclusion: In the treatment of proximal tibia fractures, hybrid external fixation has been demonstrated to be superior to MIPO. The mean operative time, blood loss, healing time, time of recovery to work, and hospital stay were relatively less with hybrid external fixation as compared to MIPO.

75. To Investigate the Impact of Metformin, Voglibose as Individual Interventions, and their Combination on Body Mass Index (BMI) among Non-Diabetic Obese Individuals of Estern Indian Region
Hitendra Kumar Verma, Dayanand Prasad, Sunil Kumar, Sarbil Kumari
Background: Obesity has become a prevalent issue on a global scale and is linked to various chronic ailments such as osteoarthritis, obstructive sleep apnea, gallstones, fatty liver disease, reproductive and gastrointestinal cancers, dyslipidemia, hypertension, type 2 diabetes, heart failure, coronary artery disease, and stroke. Lifestyle modifications, including dietary and exercise interventions, play a crucial role in the prevention and management of obesity. Aim: To investigate the impact of metformin, voglibose as individual interventions, and their combination on body mass index (BMI) among non-diabetic obese individuals of Indian descent. Materials and Methods: The present case-control study was conducted on 90 (Ninety) patients attending the OPD of General Medicine in collaboration with the Department of Physiology at Bhagawan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, following the necessary approval from the institutional ethical review board. The participants were categorised into three distinct groups, labelled as Group 1, Group 2, and Group 3. Each group consisted of a total of 30 individuals who volunteered for the study. Group I was administered with Tab Metformin 500 mg, Group II was administered with Tab Voglibose 0.3 mg and Group III with Tab Metformin (500 mg) + Tab Voglibose (0.3 mg). Results: The inter-group comparison between the Voglibose group (27.49±2.88) and the Metformin group (27.11±2.11) was conducted using an unpaired t-test. The results indicated that there was no statistically significant difference in BMI between the two groups (p = 0.22). There was a statistically significant difference in BMI between the Metformin group (27.11±2.11) and the combination group in the inter-group comparison. The combination of Voglibose and Metformin yielded a mean value of 21.99±2.39, as determined through the application of an unpaired t-test. This analysis revealed a statistically significant result, with a p-value of less than 0.0001. The inter-group comparison between the Voglibose group (mean BMI: 27.49±2.88) and the combination group (Voglibose + Metformin) (mean BMI: 21.99±2.39) revealed a significant statistical difference in BMI. Conclusion: In conclusion, the current study suggests that Metformin should be considered as the preferred choice for managing BMI and type-2 Diabetes Mellitus due to its demonstrated efficacy and safety profile compared to other available anti-diabetic drugs.

76. Peritonsillar Infiltration of Epinephrine in Reduction of Blood Loss in Tonsillectomy
Puja Ghosh, Vasanth Kumar Gunasekaran, Andrew Thomas Kurian, Muthukumar Tharumaraj
Background: Tonsillectomy is one of the most performed surgeries in the field of otorhinolaryngology. Despite being commonest and simplest one the operating surgeon is always keen to its high risk of complication i.e., intra & post-operative haemorrhage which may even lead to shock & death. A variety of hemostatic agents & specialized surgical techniques have been used to reduce intra & post-operative bleeding. The effects of most of the substances and techniques have been just primarily on clinical impression because of paucity of prospective studies. Keeping these things in mind this randomized prospective study of peritonsillar infiltration of epinephrine in maintaining hemostasis in tonsillectomy is undertaken. Methods: Patients with tonsillar hypertrophy undergoing tonsillectomy under general anesthesia in tertiary hospital in Chennai were studied for a period of two years. They were assessed clinically and all basic investigation was done. Informed written consent was obtained from the patients. Left sided tonsillectomies were chosen for peritonsillar infiltration of epinephrine and the right side were chosen as the control group, automatically making patients their own controls thus eliminating other potential influencing physiological factors. The amount of blood loss in both the group was calculated. Result: The mean age of patients undergoing the study was 20.96 ± SD years. In this study 34% were male and 66% were female. The patients had different grades of tonsils. Unpaired student ‘t’ test shows P value = 2.58 which is less than 0.005 level of significance. This shows there is a significant difference between group C and group T. This indicates there is a remarkable reduction in blood loss in group T. Conclusion: Peritonsillar infiltration of epinephrine helps in reduction of intraoperative blood loss.

77. A Study of Hormonal Receptors in Patients of Carcinoma Breast and Its Prognostic Importance
Avinash Kumar, Nirmal Kumar Sinha, Kritika Jha
Background: A growing body of research highlights the significance of HER-2 expression, young age, ER, PR, and PR status in breast cancer patients. Patients and methods: In this analytical cross-sectional analysis of 105 breast cancer patients who underwent surgery between October 2019 and September 2021. Age, size, hormone receptor status, HER-2 expression, and P53 expression were all examined as potential indicators of lymph node involvement. Results: Positive progesterone receptor status and being under 40 years old are directly correlated (P <0.05). Additionally, young women’s tumours were more likely to be large and in advanced stages than older women’s tumours (P <0.05). Furthermore, HER-2 overexpression was more common in patients with negative progesterone receptor status (P<0.05). The likelihood of lymph node metastasis varied between hormone receptor statuses, although these changes were not statistically significant. Conclusion: It is probable that higher stage and larger size breast cancer in younger women is connected to positive progesterone receptor status, despite the fact that tumours with negative progesterone receptor status were more likely to have HER-2 overexpression.

78. Comparative Study of MRI Fistulogram and X-Ray Fistulography with Operative Findings: in Fistula in Ano
Avinash Kumar, Nirmal Kumar Sinha, Alok Kumar
Background: By contrasting their results with intraoperative data, the current study has attempted to assess the efficacy and diagnostic accuracy of MRI fistulogram over X-ray fistulography. Methods: The Nalanda Medical College and Hospital in Patna, Bihar, undertook a hospital-based prospective study with 60 patients to compare the results of an MRI fistulogram and an X-ray fistulogram with the operative finding of a fistula in ano. The following two groups of 30 patients each were used in the investigation. 30 cases from Group A received an MRI fistulogram. Group B: X-ray fistulography was performed in 30 cases. Its results were compared to the operation’s overall conclusions. Results: When we compared the intra-operative MRI fistulogram findings to the intra-operative findings, we discovered that 23 patients had inter-sphincteric fistulous tracts as opposed to 22 patients. The sensitivity of MRI with intraoperative findings was nearly 100% with a significant association in the remaining findings. The X-ray fistulogram’s sensitivity and specificity for a fistula in ano were relatively low. Conclusions: The findings have been statistically significant in demonstrating that an MRI fistulogram is a better diagnostic tool than an X-ray fistulogram.

79. Study of Post-Menopausal Bleeding in Women At ANMMCH, Gaya, Bihar
Sandhya Kumari, Ranjana Kumari, Lata Shukla Dwivedy
Background: One of the most frequent reasons for referral to gynecological care is postmenopausal bleeding (PMB), mostly because of suspicions of an underlying endometrial cancer. The purpose of this study is to assess the relationship between patient characteristics and endometrial histological diagnosis, as well as the relationship between endometrial thickness (ET) and histopathological diagnosis in PMB-affected women. Methods: The characteristics findings of 67 PMB patients’ pelvic examinations were documented. Endometrial biopsy (EMB) and transvaginal sonography were used to evaluate all of the women. Results: Endometrial adenocarcinoma (EAC) patients had a significantly longer PMB time than other patients, at 22.3 days on average. EAC sufferers have been observed to have greater body mass indices than other patients. Conclusion: We suggest that all patients with PMB should be examined for EMB because nearly 4.5% of patients with PMB had EAC. Obese patients and those with persistent PMB should receive special attention.

80. Study of Primary and Secondary Infertility in Women with Hypothyroidism and Hyperprolactinemia
Sandhya Kumari, Vijay Kumar, Lata Shukla Dwivedy
Background: India is not the only country with infertility issues. Infertility is thought to be a result of altered thyroid and prolactin levels. The goal of the study was to determine whether women with primary and secondary infertility had elevated levels of prolactin and serum thyroid hormones. Methods: The participants included both primary and secondary infertile women. Age-matched, fertile women served as the control group. Age, height, and weight anthropometric data were noted. On the second day of the follicular phase of the menstrual cycle, an overnight fasting blood sample was taken. By using an enzyme-linked immunosorbent assay (ELISA), the levels of serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were assessed. A radioimmunoassay was used to determine the serum prolactin (PRL). Results: 150 women in all were enrolled in the trial. Out of 150 women, 50 experienced primary infertility, 50 secondary infertility, and 50 were fertile women of a similar age who served as the control group. Both infertility groups had significantly higher mean TSH levels than women who were fertile. In terms of thyroid function, hypothyroidism was seen in 24% and 28% of women with primary and secondary infertility, respectively. In the primary and secondary infertility groups, elevated serum prolactin levels were seen in 42.9% and 50% of hypothyroid patients, respectively. Conclusion: The study has highlighted the significance of measuring both serum TSH and prolactin in infertility by showing a high prevalence of hypothyroidism with elevated serum prolactin levels among infertile females.

81. A Study of Comparison of Serum Lipid Profile of Women with Pregnancy Induced Hypertension and Normal Pregnancy
Sandhya Kumari, Sushma Sinha, Lata Shukla Dwivedy
Background: One of the main causes of fetomaternal morbidity is pregnancy-induced hypertension. Studies have indicated that early-stage PIH patients have altered serum lipid metabolism, which may aid in predicting PIH. The study’s objective was to examine the levels of serum lipids in women with naturally occurring pregnancy and hypertension. Methods: From August 2021 to July 2022, the study was carried out at the Department of Obstetrics and Gynecology, ANNMCH, Gaya, Bihar. In each group, 40 women were chosen after exclusion and inclusion criteria were applied. A thorough history and clinical examination were followed by a routine investigation, lipid profile assessment, and data analysis. Results: Serum lipid level in the PIH group was significantly higher compared to normal group. Women with PIH had significantly higher values of total cholesterol (348mg/dl, SD±45), Triglycerides (368 mg/dl, SD ±39), LDL (201 mg/dl, SD±17)and VLDL (107 mg/dl, SD±11) as compared to normotensive pregnant women, total cholesterol (135mg/dl, SD±8.7), Triglycerides (120mg/dl, SD ±20), LDL(83 mg/dl, SD ±4.7)and VLDL(26mg/dl, SD±5) with p value of 0.0001. However HDL level is found to be significantly higher (p value<0.05) in normal group (61 mg/dl, SD 2.81) as compared to PIH group (34.3 mg/dl, SD ±4.3). Conclusion: In conclusion, compared to pregnant women with normotensive blood pressure, women with PIH have greater levels of total cholesterol, triglycerides, LDL, VLDL, and low HDL. Early identification of PIH may benefit from prenatal testing for serum lipid levels.

82. Evaluation of Functional Outcome of Pre-Contoured Olecranon Locking Plate in Fractures of the Olecranon
Upendra Kumar, Shiwendu Kumar Tiwari, Barun Golwara, Rajeev Rajak
Background: ‘Pre-contoured Olecranon Locking Plate’ provides rigid internal fixation allowing vigorous early mobilization at the elbow, especially in comminuted fractures of the olecranon. It shows an excellent rate of radiological union. Present study aims to evaluate the functional outcome of precontoured olecranon locking plate for fractures of the olecranon. Methods: This prospective study was done at Orthopedic emergency and the Out-Patient Department of Govt. Medical College and Hospital, Bettiah, Bihar from February 2019 to January 2020. The study was performed on thirty one skeletally mature patients with displaced fractures of the olecranon. Open reduction and internal fixation of displaced olecranon fracture of ulna with pre contoured olecranon locking plate. Patients were assessed by measuring the range of motion and Mayo Elbow Performance Score (MEPS) and index (MEPI). Serial radiographs were reviewed preoperatively for fracture classification and associated fractures, immediately postoperatively, and at the time of final review for adequacy and maintenance of reduction, evidence of union and arthritis. Results: At 1 year of follow up the mean flexion of elbow was 123.70 (range 90-1300), while the mean extension was 5.640 (range 0-300). The MEPS index showed 1 patient having fair result, 6 patients having good results and 24 patients having excellent results. None of the patients had poor results. The mean MEPS were 90.65. All patients showed full radiological union. Conclusions: Pre-contoured olecranon locking plate to be more effective with a lower rate of symptomatic hardware and subsequent implant removal than tension band wiring.

83. Fracture of Talar Body Treated by Open Reduction and C.C. Screw Fixation
Shiwendu Kumar Tiwari, Upendra Kumar, Barun Golwara, Rajeev Rajak
Background: Due to their rarity and frequent consequences, talar body fractures provide a significant challenge to surgeons. The purpose of this study was to report the mid-term outcomes of displaced talar body fractures fixed internally. Methods: From July 2020 to December 2021, this retrospective study was carried out at the Department of Orthopaedics, GMCH, Bettiah and Bihar. Retrospective analysis was performed on a total of 18 patients with talar body fractures (12 Male, 6 Female, mean age 31.0). Results: The fractures were divided into crush fractures (2), coronal fractures (10), and sagittal fractures (6). Two individuals also had concomitant talar neck fractures, while six patients suffered open fractures. Follow-up lasted an average of 26 months (from 18 to 43). Four patients had exceptional function, six had good function, four had fair function, and five had poor function based on the American Orthopaedic Foot & Ankle Society’s (AOFAS) ankle-hind foot score. Two superficial wound infections, one partial wound dehiscence, one case of skin necrosis, and one deep infection were among the early sequelae. Other issues included avascular necrosis in seven cases, delayed union in one, and malunion in one patient. Conclusion: Talar injuries can severely disable a person and impair their ability to move their foot and ankle, thus they are significant. Less favorable outcomes are linked to talar body crush fractures, those connected to open wounds, and talar neck fractures.

84. A Comparison of Effects of Ketamine-Propofol vs Ketamine-Dexmedetomidine Combinations in Pediatric Patients Undergoing Short Surgical Procedures
Jayshri Prajapati, Rekha Bayer, Hiren Patel
Background: The anaesthetic agent used during the short surgical procedures in pediatric patients should be hemodynamically safe and should provide adequate analgesia, sedation and with minimal or no side effects. This study aimed to evaluate the efficacy of ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for pediatric patients undergoing short surgical procedures. Methods: This prospective observational study was carried out in 80 pediatric patients who were scheduled for elective short surgical procedures at tertiary care teaching hospital of Gujarat All the patients were randomized in to two groups (40 each) using computer generated random numbers. Group KP received Inj. Ketamine 1 mg/kg + Inj. Propofol 1 mg/kg and Group KD received Inj. Ketamine 1 mg/kg+ Inj. Dexmedetomidine 0.5 mcg/kg slowly over 5 minutes. Hemodynamic parameters like heart rate, systolic, diastolic, mean blood pressure (SBP, DBP, MBP), SpO2 and complications were compared in both the groups. Results: Both SBP, DBP and MBP were significantly less in patients receiving ketamine-propofol compared to those who received ketamine-dexmedetomidine after 5 min and thereafter. (p<0.05) Post operative SBP values were significantly low in ketamine propofol groups. There was no significant change in DBP and MBP in both groups postoperatively. Conclusion: This study concluded that Ketamine-Dexmedetomidine combination provide better hemodynamic stability with fewer complications than Ketamine-Propofol group. So, Ketamine-Dexmedetomidine combination considered to be good and safe for pediatric patients undergoing short surgical procedures.

85. Narrative as a Powerful Tool in Medical Education
Aprajita Raizada, Jignesh Kumar L. Patel, Shruthy KM, Ramnath Takiar, Vishwas Johri
Background: “Narrative” refers to the use of storytelling techniques and personal narratives. It involves presenting medical concepts, experiences and scenarios in a narrative format to engage learners on an emotional and intellectual level. This study aimed to evaluate the effectiveness of narrative as a tool for teaching first year MBBS students and to know the feedback about narrative from faculty and students. Methods: This study was conducted in Anatomy department of American International Institute of Medical Sciences, Udaipur from May 2022-July 2022 in 120 first year students and five faculties. Mammary gland and venous drainage of lower limb was taught through narratives. ANOVA test was used for assessment and feedback was taken from faculty and students using questionnaire. Results: Students scored better in the assessment who were taught using narrative as a teaching mode. The results were statistically significant. Conclusion: The study concluded that narrative is a useful tool for learning in basic medical sciences.

86. Comparative Study Between Plating and Titanium Elastic Nailing System in Mid-Clavicular Fractures
Vinod Chandrashekaran Nair, Satyam Jawa, Swaroop Solunke, Omkar Rohidas Shinde
Background: Fracture of the clavicle is one of the most common bony injuries. The clavicle lacks a medullary cavity and is late to heal. Hence, proper technique is mandatory to heal the fracture as soon as possible. Hence, it has become a challenge for orthopaedic surgeons. Method: Out of 30 patients with clavicle fractures, 15 were treated with TENS and 15 with plating. Routine blood examination (CBC), an ECG, radiological study was carried out, and general anaesthesia was given. Results: Mean blood loss, timing for surgery, and size of wound were quite low in the nailing technique as compared to the plating technique, and the p value was highly significant (p<0.00). Surgical complications were also the least common with nailing techniques. The rate of union was 100% in both techniques. The mean dash square rate in the 1st, 2nd, and 6th months was highly significant in nail technique (p<0.001). Conclusion: Both techniques have 100% union of fracture and are equally effective in treating displaced mid-clavicular fractures. But due to the fewest post-surgical complications, TENS is preferred over the plating technique.

87. Exploring the Interplay between Asthma Control and Children’s Quality of Life: A Comprehensive Investigation
Suryendru Kumar, Vijay Kumar, Kumar Sanjeev
Aim: This study aims to investigate the relationship between asthma control and the quality of life in children diagnosed with asthma. Materials and Methods: A sample of 50 pediatric patients with confirmed asthma was included in the study. The participants’ ages ranged from 5 to 12 years, with an equal distribution of gender. Asthma control was assessed using the Asthma Control Test (ACT) questionnaire, and the quality of life was measured using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Results: The results of the study revealed a significant correlation between asthma control and quality of life in children with asthma (Pearson’s correlation coefficient, r = 0.68, p < 0.001). Higher levels of asthma control were associated with better quality of life scores. The mean ACT score was 19.5 (±3.2), indicating moderate asthma control, while the mean PAQLQ score was 6.8 (±1.5), suggesting a moderate impact on the quality of life. Furthermore, subgroup analysis based on age showed that younger children (5-8 years) had a stronger correlation between asthma control and quality of life (r = 0.74, p < 0.001) compared to older children (9-12 years, r = 0.55, p < 0.05). Additionally, patients with well-controlled asthma (ACT score ≥ 20) demonstrated significantly higher quality of life scores (PAQLQ score = 7.4 ± 1.2) compared to those with poorly controlled asthma (ACT score < 20, PAQLQ score = 5.9 ± 1.6, p < 0.01). Conclusion: In conclusion, this study highlights a positive association between asthma control and the quality of life in pediatric patients with asthma. Effective asthma management and control strategies can potentially lead to improved quality of life outcomes, particularly in younger children. These findings emphasize the importance of holistic care approaches that address both medical management and quality of life aspects in pediatric asthma patients. Further research with larger and diverse populations is warranted to validate and generalize these findings.

88. Promoting Inclusion in Clinical Trials: A Rapid Review of the Literature and Recommendations for Action
Saroj Chopde
Clinical trials play a critical role in advancing medical knowledge and improving patient care. However, the lack of diverse representation in these trials has been a persistent concern, limiting the generalizability of findings and potentially perpetuating health disparities. This rapid literature review aims to explore the current state of inclusion in clinical trials and provide actionable recommendations for promoting greater diversity and inclusivity.
Through an extensive search and analysis of relevant literature, we examined the underrepresentation of various populations, including ethnic minorities, women, the elderly, and individuals with comorbidities. We identified multiple factors influencing underrepresentation, such as socioeconomic barriers, cultural biases, historical mistrust, and language challenges. These barriers hinder participation and restrict the inclusivity of clinical trial cohorts.
To address these challenges, successful inclusion strategies were reviewed, including culturally sensitive recruitment approaches and community engagement initiatives. Ethical considerations surrounding informed consent and protection of vulnerable populations were also highlighted.
Additionally, the review explored the existing regulatory landscape and policy implications concerning diversity in clinical trials. We propose several recommendations to enhance inclusion, such as implementing diversity quotas, increasing funding for targeted recruitment efforts, and establishing inclusive trial protocols. These measures can help researchers, institutions, and policymakers promote diversity in clinical trials effectively.

In conclusion, promoting inclusion in clinical trials is imperative for achieving equitable healthcare outcomes and reducing health disparities. By adopting the recommended strategies and policies, researchers and policymakers can create a more inclusive landscape in clinical research, leading to more accurate and relevant findings that benefit all members of society. Continued efforts in this direction are essential for building a future of healthcare that truly represents the diverse needs of the global population.

89. A Cross-Sectional Study on COVID-19 Vaccine Acceptance and Hesitancy Among Rural Population of Chengalpattu District, Tamil Nadu
Rajeshkannan Sivakumar, Raja T.K., M. Buvnesh Kumar
Background: The global healthcare landscape has been reshaped by the emergence of COVID-19, necessitating efforts to contain its impact worldwide. India, a heavily populated nation, faced significant COVID-19 burden, prompting comprehensive strategies and vaccination campaigns. This study focuses on vaccine acceptance and hesitancy within India’s rural population, aiming to understand factors influencing attitudes toward vaccination. Methods: This three-month cross-sectional study (June-August 2021) at a tertiary care hospital’s Department of General Medicine investigated COVID-19 vaccine acceptance and hesitancy in Chengalpattu’s rural population. Ethical clearance was obtained, and a sample of 400 participants from 10 villages was selected using multi-stage stratified random sampling. Trained interviewers collected data using a culturally validated questionnaire, and SPSS 20.0 was used for analysis, including descriptive statistics, chi-square tests, and T-tests (p<0.05). Results: The study’s demographic analysis revealed 66.5% male and 33.5% female participants, with a mean age of 37.26 years. Vaccine acceptance among participants was observed in 73.2%, while 26.8% expressed vaccine hesitancy. Factors contributing to vaccine acceptance as 14.0% attributed it to advice from family/peers, 35.2% to healthcare worker (HCW) or leaders’ recommendations, and 41.0% to awareness from social media/news.  Males showed higher acceptance (75.1%) compared to females (24.9%, p<0.0001). Religion displayed significant differences, with vaccine acceptance highest among Hindus (79.4%) and lower among Muslims (6.1%) and others (4.8%, p=0.004). Conclusion: Strategies focusing on accurate information dissemination, community engagement, and addressing socio-demographic disparities are crucial in ensuring equitable vaccine coverage.

90. Assessing the Characteristics of Postoperative Pain and its Quality of Management among Patients Underwent Surgery: A Cross-Sectional Study from North Wales, UK
Asna Zehra Naqvi, Umair Hassan, Wasif Raza, Nik Abdullah, Rajeev Ranjan
Background: Quality pain management (QPM) focuses on patient-centered, safe, effective, timely, efficient, and equitable care, aiming to reduce pain severity, provide relief, minimize functional interference, and ensure satisfaction. Despite improvement efforts and guidelines, pain prevalence in hospitals remains high (48%-88% in the past 24 hours), negatively impacting well-being and increasing costs. Encouraging patient involvement yields positive outcomes in acute and chronic pain scenarios. This study examines pain experienced by surgical patients three days post-operation and evaluates pain management quality. Methods: A cross-sectional study conducted at a tertiary care hospital in North Wales, UK for one year among 261 surgical patients who underwent elective procedures.  A validated questionnaire, Strategic and Clinical Quality Indicators Postoperative Pain (SCQIPP), comprising three subscales (pain management, nursing intervention, and environment) with 14 items, was utilized. Participants rated each item on a 5-point Likert-type scale. Descriptive statistics summarized participant demographics, pain intensity scores, and satisfaction levels using means, standard deviations, frequencies, and percentages. Results: Tingling was the most commonly experienced sensation, reported by 83.5% of patients. Pulsating pain was also prevalent, reported by 61.7% of patients. The most frequently reported factor was movement, with 84.7% of patients experiencing increased pain when moving. Loss of the painkiller’s effect was also a significant factor, reported by 33.3% of patients. The mean score for pain management was 14.01±1.34, indicating the participants’ satisfaction with pain management. The mean score for nursing/staff intervention was 26.91±2.34, reflecting positive perceptions of the assistance provided by healthcare professionals. Overall, the total mean score for the SCQIPP questionnaire was 48.96±4.08, suggesting a generally high level of satisfaction with pain management, nursing intervention, and the environment. Conclusion: This study identified areas for improvement in postoperative pain management, emphasizing patient-centered care. Active patient participation, individualized approaches, and effective communication are crucial for enhancing care quality. Findings stress the importance of prioritizing patient preferences, shared decision-making, and comprehensive education to optimize pain management, improve experiences, and enhance outcomes.

91. Clinical, Bacteriological and Radiological Study of Community Acquired Pneumonia (CAP)
Falguni Makwana, Divyang Makwana, Dhruvil Kaila, Subhagini Srivastava, Kamlesh Desai, Janki Pandya
Pneumonia that develops outside the hospital is considered community acquired Pneumonia (CAP) and is the highest cause of mortality among infectious diseases. The objective of the study is to know Clinical presentation, the prevalence of causative microorganism and to study the Radiological profile of the patients with community acquired pneumonia. This was a prospective study of 100 patients admitted in tertiary care hospital during the period from August 2019 to August 2021. Patients with age more than 12 years and having clinical features like fever (temperature more than 37.8 degree Celsius), cough (less than 4 weeks), production of purulent sputum, chest pain and difficulty in breathing and having Radiological evidence of pneumonia were included in the study. The patients in this study were of more than 12 years. In this study, older age group (>50 year) is more prone to Pneuomnia. The incidence of CAP was most common in males (64%) compared to females(36%). Cough, Fever, Expectoration, Pleuritic chest pain and Dyspnea are common signs present in Community acquired Pneumonia wherease Altered sensorium and Hemoptysis are observed in only few patients. Smoking and COPD are more common associated risk factors. Mortality is less in Community Acquired Pneumonia. Outcome in Community Acquired Pneumonia is good when it is presented and treated timely and accordingly. Most of the patients recovered without any complication except in patients with COPD, symptoms were not completely reduced and were advised for follow-up.

92. Study of Serum Calcium Level in Schizophrenic Patients and it’s Association with Stage of Disease
Santosh Kumari Sharma, Seerat Sachdeva, Puneet Kumar, Sanjay Bhatt
Objectives: Schizophrenia is a mental disorder having positive and negative symptoms and imbalance in the element composition of the human body may have important role in the pathogenesis or progression of this disease. The study is aimed to evaluate the concentration of calcium in Rajasthan population and its correlation with PANSS score. Methods: This study was done in Department of Biochemistry and Psychiatric Centre, SMS Medical College, Jaipur (Rajasthan).150 controls and 150 patients were enrolled in this study. The concentration of serum calcium in 300 individuals was determined by fully automated analyzer. Results: Mean serum Ca level of case group was found statistically significant (p=0.000) when compared with controls. In acute cases of schizophrenia mean Calcium level was 9.01 ± 0.48 mg/dl while it was 8.85 ± 0.37 mg/dl in chronic cases. This difference was found significant (p = 0.028) when unpaired t-test was applied. Conclusion: Thus we detected a significant imbalance in the distribution of calcium in Rajasthan population and the data obtained provide evidence that in chronic schizophrenia serum calcium is decreased significantly when compared to acute schizophrenic patients.

93. Spectrum of Periorbital Dermatoses in Central India: Unique Observations
Sanskriti Chauhan, Rochit Singhal, Vivek Choudhary, Shyam G Rathoriya, Pallavi Phadnis
Background: Periorbital dermatoses are the dermatological manifestations involving area around the eyes. Although these are commonly encountered conditions but sometimes it becomes challenging to diagnose them due to similar clinical presentation and worrisome for the patients since this area is cosmetically very important. Aim: To study clinical pattern and to determine frequency and distribution of periorbital dermatoses in patients presenting in dermatology outpatient department at tertiary care centre. Methods: This was a hospital based observational descriptive study carried out among 300 patients with skin lesions affecting periorbital region irrespective of their age & gender attending Dermatology outpatient department between January 2021 to June 2022. Results: Periorbital pigmentary disorders were the most common periorbital dermatoses seen in 74 (24.66%) cases and periorbital skin tumours in 67 (22.33%) cases, followed by periorbital infections in 48 (16%), periorbital dermatitis in 38 (12.6%) and disorder of pilosebaceous and sweat gland in 16 (5.3%) cases. Conclusion: Most frequent condition encountered in this study was perorbital pigmentary disorders, which was distinctive observation compared to contemporaneous researches which describe periorbital skin tumors to be commonest entity. Our study may help clinician to enhance their understanding about patterns of periorbital dermatoses in central India and thus to focus on availability and execution of various medicinal and procedural modalities targeted to deliver best possible therapeutic and cosmetic outcome.   

94. Eosinophil Counts and Serum IGE Levels as Biomarkers for Assessing Atopic Dermatitis Severity: A Comprehensive Investigation
Mani Shankar, Babli Kumari, Upendra Prasad Sahu
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by pruritic and eczematous lesions. It is associated with aberrant immune responses and often coexists with other allergic diseases. Recent research has focused on understanding the role of eosinophils and immunoglobulin E (IgE) in the pathogenesis of AD. This study aimed to investigate the correlation between the severity of AD, absolute eosinophil counts in peripheral blood, and serum IgE levels. A total of 200 AD patients were enrolled in this cross-sectional study, with varying degrees of disease severity, as assessed using established clinical scoring systems such as the Scoring Atopic Dermatitis (SCORAD) index. Peripheral blood samples were collected from all participants, and absolute eosinophil counts were determined using automated hematology analyzers. Additionally, serum IgE levels were measured using enzyme-linked immunosorbent assays (ELISA). The results revealed a positive correlation between the severity of AD and both absolute eosinophil counts (r = 0.67, p < 0.001) and serum IgE levels (r = 0.54, p < 0.001). This suggests that eosinophils and IgE play a significant role in the disease’s progression. Further subgroup analysis based on disease severity revealed a more pronounced increase in eosinophil counts and serum IgE levels in moderate to severe AD cases compared to mild AD cases. These findings suggest that eosinophil and IgE levels could potentially serve as biomarkers to distinguish AD severity levels. To determine the predictive value of eosinophil counts and IgE levels in AD, a receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) for eosinophil counts was 0.82 (95% confidence interval: 0.76–0.88), while the AUC for serum IgE levels was 0.74 (95% confidence interval: 0.67–0.81). These AUC values indicate that both eosinophil counts and serum IgE levels have moderate diagnostic accuracy in predicting AD severity. Combining these biomarkers may improve diagnostic accuracy further. In addition to correlational analysis, we investigated the potential mechanisms underlying the observed relationship between eosinophil counts, IgE levels, and AD severity. Eosinophils are known to release pro-inflammatory cytokines and chemokines that exacerbate AD’s inflammatory response, while IgE is central to allergic sensitization. The interaction between IgE and eosinophils may amplify the inflammatory cascade in AD, promoting disease severity. In conclusion, our study demonstrates a significant correlation between the severity of atopic dermatitis, absolute eosinophil counts in peripheral blood, and serum IgE levels. These findings support the notion that eosinophils and IgE contribute to AD pathogenesis and progression. Furthermore, eosinophil counts and IgE levels may serve as potential biomarkers for assessing AD severity, helping clinicians make informed treatment decisions. However, further prospective studies are warranted to establish causation and to explore the therapeutic implications of targeting eosinophils and IgE in the management of atopic dermatitis.

95. A Study on Estimation of Time since Death by Post Mortem Examination of Electrolyte Changes in Vitrous Humor
Mohan Gushinge, Lovekumar Bhagora, Viras Patel, Vanraj Parmar, Sonal H Govindwar, Tejas C Patel
Introduction: Estimating PMI is crucial in forensic science for solving cases and identifying bodies. Electrolyte changes in the vitreous humor, including K+, Na+, and Ca+, offer potential markers for PMI determination due to predictable postmortem alterations. This study delves into the estimation of time since death by investigating the electrolyte changes in the vitreous humor, aiming to contribute to the advancement of forensic science and the accuracy of PMI determination. Material and Method: This cross-sectional study was conducted between April 2021 and March 2022, with 100 subjects. Cases with specific conditions were excluded. Vitreous humor samples were collected and analyzed for electrolytes using an automated analyzer. Time since death (TSD) was estimated using the Sturner and Gantner formula, and correlations between PMIs were analyzed using SPSS software. The study was carried out at NAMO Medical Education & Research Institute and Shri Vinoba Bhave Civil Hospital, U.T. of Dadra & Nagar Haveli and Daman & Diu. The time of death data was obtained from police files, hospital records, or eyewitness accounts and cross-referenced with postmortem alterations for validation. Results: In the results, we found moderate and statistically significant correlations between potassium (K+) levels and eye locations, with R values approximately 0.455 for Rt eye, 0.436 for Lt eye, and 0.554 for Both eye. For calcium (Ca+), the correlations were moderate and significant, with R values around 0.280 for Rt eye, 0.298 for Lt eye, and 0.523 for Both eye. However, correlations for sodium (Na+) levels were relatively low and not statistically significant, with R values of approximately 0.026 for Rt eye, 0.024 for Lt eye, and 0.031 for Both eye. Conclusion: In conclusion, potassium and calcium levels showed significant correlations with eye locations, suggesting their potential as markers for postmortem interval estimation. Sodium levels did not exhibit strong associations. Comprehensive approaches are vital for accurate time of death determination.

96. Assessment of Renal Cell Carcinoma Subtypes using Multidetector      Computed Tomography
Diddi Vamshi Kiran
Background: Renal cell carcinoma (RCC) is the second most common urologic neoplasm, after prostate cancer in men and bladder cancer in women. The prevalence of RCC has been increasing in recent years. This is likely due to several factors, including changes in diet and lifestyle, as well as increased awareness of the disease. Our study aims to recognize diverse demographic attributes among RCC patients, examine varied characteristics of subtypes using multidetector computed tomography (MDCT), and ascertain the distinguishing traits among these subtypes. Methods: This study included 25 patients who had undergone pre-operative CT scans at our institution. The scans were performed according to our renal mass protocol, which includes four phases: unenhanced, corticomedullary, nephrographic, and excretory. All patients had a confirmed pathological diagnosis of a specific subtype of renal cell carcinoma (RCC). Results: This study identified four distinct subtypes of renal cell carcinomas (RCCs): clear cell RCC (CRCC), papillary RCC (PRCC), Xp 11.2 translocation-TFE3 carcinoma (TRCC), and chromophobe RCC (ChRCC). CRCC was the most common subtype, followed by PRCC. The majority of tumors were small (≤200 cc) and had smooth margins. They showed varied enhancement patterns and signs of cystic degeneration. A small portion of the tumors displayed calcifications. The tumor enhancement ratio was above 0.3. The density of solid tumor areas in CECT scans was high and closely resembled the attenuation values of the renal cortex. In contrast, papillary, chromophobe, and TRCC types had relatively lower attenuation. Conclusion: This study found that tumor attenuation is the most important differentiating feature between different subtypes of renal cell carcinoma (RCC). However, other parameters assessed by multi-detector computed tomography (MDCT) such as size at presentation, heterogeneity, tumor spread, and tumor/aorta enhancement ratio can also help to distinguish between different subtypes of RCC.

97. Prevalence of Binge Eating Behaviour in Patients with Psychotic Disorders Admitted in A Tertiary Care Hospital
Rahul Rakesh, Monika Kumari
Background and Objectives: Binge eating (BE) is characterized by “eating, in a discreet period of time, usually within 2 hours an amount of food which is larger than what most people would consume under similar circumstances.” Eating disorders and psychotic disorders may present together and has been researched in both affective and non-affective psychosis. Detailed surveys are not available from the Indian context regarding the same. The objectives of this study were to assess the prevalence of binge eating behaviours in patients with psychosis admitted in a tertiary care hospital. Secondary aims were to ascertain the psychiatric comorbidity in them, to analyse the stress levels and coping strategies employed and lastly to note the patient’s attributions to weight gain. Methods: This is a hospital based cross-sectional study. The target population was in-patients diagnosed with psychotic disorders. The study duration of two Years. A total of 101 patients included. The patients were interviewed, socio-demographic data, clinical details noted, QEWP, Binge Eating Scale, PSS and Brief COPE administered. Conclusion: Hence it is vital for clinicians to look into it for better therapeutic outcome and to prevent comorbid conditions like obesity. Stress levels and coping strategies are important factors that influence treatment and recovery and need to be addressed.

98. Analysis of the Maternal Etio Pathological Factors in Intra Uterine Foetal Demise after 20 Weeks of Gestation in A Tertiary Care Centre
Swati, Rajni Priyanka, Geeta Sinha, Juhi
Background and Objectives: The present study was done to determine the total number of antepartum and intrapartum fetal deaths; to know the probable etiology and management of the same, and to study the role of antenatal care in prevention of IUFD. Methods: Prospective study was undertaken and 73 cases were studied, at PMCH Patna. All the cases of IUFD attending antenatal clinic, studied. (May 2018 – Feb 2019). Results: The fetal death rate was 35.09/1000 births. Major causes of IUFD were PE and eclampsia (32.88%) and abruptio placenta (20.55%). Majority were term gestations (30.13%) and birth weight <2.0 kg (28.76%). Risk of IUFD was significantly less in booked patients than in un booked patients. Conclusion: Present study showed that majority of IUDs was preventable. Pre-eclampsia and abruption which are the major causes of IUD can be reduced by improving the socio- economic status of people, proper antenatal care and timely admission of the patient, thorough monitoring and timely intervention.

99. Prevalence of Cardiac Manifestations of COVID-19 at a Tertiary Centre in Western Rajasthan
Pawan Sarda, Ankur Kumar, Shoaib Mehboob, Rohit Mathur, Anil Baroopal
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to global healthcare systems, with the respiratory system being predominantly affected. However, emerging evidence suggests that COVID-19 can also lead to various cardiovascular complications. This retrospective study aims to investigate the prevalence of cardiac manifestations in COVID-19 patients and its association with disease severity. Methods: We conducted a retrospective analysis of medical records from 350 patients admitted with COVID-19 infection at a tertiary care hospital between June 2020 and July 2022. Patients were categorized into severe and non-severe groups based on clinical, lab parameters. Various cardiac manifestations, including heart failure, arrhythmias, myocarditis, acute coronary syndrome (ACS), and pulmonary embolism, were evaluated. Results: Our findings revealed a clear correlation between the severity of COVID-19 and the prevalence of cardiovascular complications. Heart failure was observed in 7.4% of patients, with a significantly higher incidence rate in the severe COVID-19 group (10.9% versus 2.7% in non-severe group, p < 0.01). Similarly, the overall incidence of cardiac arrhythmias was 7.1%, with a higher prevalence in the severe COVID-19 group (10.5% versus 2.7% in non-severe group, p < 0.01). Myocarditis and ACS were reported in 6.6% and 10.3% of patients, respectively, with significantly higher rates in severe COVID-19 cases (p < 0.01). Additionally, pulmonary embolism was identified in 1.4% of patients, predominantly in the severe COVID-19 group (p < 0.01). Conclusion: Our study provides valuable insights into the diverse cardiac complications associated with COVID-19. The findings underscore the importance of vigilance among clinicians to recognize and manage these manifestations, particularly in severe cases. By understanding the impact of COVID-19 on cardiovascular health, healthcare providers can take proactive measures to optimize patient outcomes. Further research is needed to explore the underlying mechanisms and develop targeted interventions for these cardiac complications.

100. Prevalence of Fungal Infections in MDR-TB Patients in Jodhpur (Western Rajasthan)
Khandelwal Dheeraj Kumar, Kulshrestha Smita, Gupta Ritu
Introduction: Fungal infections are a leading cause of morbidity and mortality in immunocompromised patients especially in Tuberculosis patients. Early identification of these fungal infections can be the cornerstone in the treatment of MDR TB patients. Aim of Study: To find out prevalence of associated fungal infections in MDR TB patient. Material & Method: The study was conducted on 100 MDR-TB patients and the results were compared with 50 sputum samples collected from subjects other than tuberculosis patients. Microscopy and culture examination was done for each collected sample. Discussion: Among 41 Candida positive in MDR-tuberculosis patients, the highest percentage was present for Candida albicans in both the group studied. Prevalence of non albicans Candida species (68.9%) was much higher than Candida albicans (31.71%) in MDR tuberculosis patients while a reverse relationship was observed in subjects other than tuberculosis.
Conclusion: Fungal infections are increasing day by day in MDR- tuberculosis patients. MDR-Tb patients are at high risk of acquiring non Candida albicans infections. So early detection of these fungal infections can help in increase survival rate, improve life style and can decrease the mortality rate in these patients.

101. Functional and Radiological Outcome of K Wire Fixation in Pediatric Supracondylar Humerus Fracture
Parag Tank, Mitesh J Mer, Tejas Vadhera, Aliasgar Umatiya, Meet Prajapati, Chirag Amin
Background and Aim: The therapy of displaced supracondylar humerus fractures in children is frequently difficult. The doctor caring for these patients encounters management pitfalls often and on a consistent basis, particularly when it comes to displaced supracondylar fractures. This study compares and contrasts the effectiveness of the two pinning methods for children with humeral supracondylar fractures. Material and Methods: The present study was done for the period of one year, in the Department of orthopedics with the association of the department of paediatrics, in the medical college and associated hospital. The included patients were divided in group A and group B. Each group consisted of 20 patients, total of 40 patients were included in study. The fracture of patients in group A was fixed with two laterals cross Kirschner wires configuration and fracture of patients in Group B was fixed with mediolateral cross Kirschner wires con-figuration. Range of motion, carrying angle and presence of neurological deficits were measured and were rated as poor, fair, good and excellent on the basis of the patient’s evaluation. Results: All of the fractures were type III Gartlands, affecting 16 patients on the right side and 24 patients on the left. There were no significant differences (p> 0.05) between groups with regard to any of these variables except 4 cases in group B had iatrogenic ulnar nerve palsy which needed pin removal which recovered subsequently. Conclusion: Closed reduction and percutaneous criss-cross K-wire fixation are effective treatments for displaced supracondylar humeral fractures. With the exception of ulnar nerve damage, neither group experienced any serious complications. The functional outcome appears to be the same in both groups. Although technically difficult, it is essential to perform this method with fluoroscopy assistance.

102. A Retrospective Study of Haematological Laboratory Parameter in Thrombocytopenia in Tertiary Care Hospital
Koteswari Muthe, V Aruna Kumari, Victor Paul, B Krishna Murthy, Durga Prasad
Introduction: It is very important to identify the cause of Thrombocytopenia, where it is due to hyper destruction or hypo production of platelets as it will ultimately have an impact on the management of the patient. Mean platelet volume (MPV) and the platelet distribution width (PDW), can be used as screening test for the differentiating both types of thrombocytopenia and may help in avoiding or delaying the irrelevant invasive procedures like Bone-marrow aspiration (BMA). The detailed knowledge must be acquired from patients, who have been suffering from the Thrombocytopenia. The etiological differences are of importance in the assessment and management of Thrombocytopenia. Aim: To study the association of Thrombocytopenia with different haematological parameters and its prevalence in different age groups. A study of 604 cases was conducted to evaluate the association of different haematological parameters with Thrombocytopenia, during a period from January 2020 to December 2022. Thrombocytopenia defined as low platelets, is attributed to variety of haematological and pathological disorders. During the evaluation of Thrombocytopenic patients, it is very important to identify the cause of Thrombocytopenia Material& Methods: A complete hemogram and laboratory profile of a total case of 604 patients was carried out in each case of Thrombocytopenia. The EDTA samples were analysed after proper mixing in automated cell counter, Horiba, Tripad to obtain Complete Hemogram. Peripheral smear examination was done, stained with Leishman stain and examined under microscopy to confirm the platelet count and status of other blood cell lines [Red blood cells &White blood cells]. Results: Total 604 cases of Thrombocytopenia were studied from Jan.2020 to Dec.2022 in tertiary care hospital (RIMS), Govt. Medical College, Ongole, males:316 and females:288. Mild Thrombocytopenia-129, males:78 and females:51.Moderate Thrombocytopenia-199, males:113 and females:86. Severe Thrombocytopenia-276, males:125 and females:151. Thrombocytopenia with Anemia-284(47%), pancytopenia-124(20.5%), bicytopenia-169(27.98%), leucopenia-41(6.8%) and leucocytosis-50(8.3%) and isolated Thrombocytopenia-162(26.8%). Conclusion: Thrombocytopenia is not a disease but is a diagnosis. Smear examination is very necessary in each case of Thrombocytopenia as it virtually rule out infectious cause, pseudo thrombocytopenia and leukemia and be able to triage life – threatening from serious cause. Detailed examination and the laboratory tests should be done, which are related to etiology.

103. A Prospective Study of the Effect of Prolene Mesh Prosthesis on Testicular Perfusion in Individuals Undergoing Lichensteins Repair of Inguinal Hernia
Om Prakash Kumar, Santosh Kumar, Mukesh Kumar, Shubham Kumar
Introduction: The Tension Free Mesh Repair by Lichtenstein is an easy, safe, and efficient operation with very low recurrence rates. It is widely established that perimesh fibrosis and direct mesh contact with inguinal canal vessels may negatively affect testicular flow. The majority of clinical and experimental investigations demonstrate that using mesh during hernioplasty is a risk-free operation for patients. The purpose of the study is to assess how prolene mesh affects individuals having Lichtenstein’s mesh repair on their testicles. Methodology: In patients having Lichtenstein’s hernia repair, the effect of prolene mesh on testicular volume and perfusion is assessed in this study. 50 patients who had been hospitalised to the general surgery department at IGIMS Patna with inguinal hernias were included in the study, which was done between March 2021 and December 2022. Results: In our study, the majority of patients who received Lichtenstein’s hernia surgery recovered postoperatively without any complications. The most frequent complications seen were seroma development and surgical site infection. In our investigation, testicular blood flow parameters and testicular volume measures taken preoperatively and postoperatively showed no statistically significant alterations. Conclusion: The testicular perfusion and size are unaffected by the Lichenstein hernia repair procedure. If testicular perfusion is negatively impacted, data from clinical and experimental studies may be available. Because of the abundant artery supply and collateral capacity, it would be challenging to affect testicular perfusion following hernia surgery. By minimising dissection, leaving distal indirect hernia sacs, and keeping the cremasteric muscle fibres, the incidence of testicular atrophy was decreased. The greatest outcomes could derive from careful surgical dissection, reconstruction, and use of appropriate prosthetic material.

104. To Study the Outcome of Neutrophil to Lymphocyte Ratio as A Marker of Disease Severity in Chronic Obstructive Pulmonary Disease
Yash Devgan, Sanjiv Maheshwari , Yadram Yadav, Kavin Kumar, Anil Sankol, Gaurav Arora
Background: Neutrophil to lymphocyte ratio (NLR) is an effortless and basic parameter that is readily obtained from the simplest and easy obtainable complete blood count, even in peripheral hospitals. One of the inflammatory markers in COPD is NLR and also has its relationship between many diseases like, cardiovascular disease, kidney disease, etc. Methods: Patients with Chronic Obstructive Pulmonary Disease attending OPD and casualty, Department of Medicine, JLN Medical College, Ajmer, Rajasthan was included in the study, based on the inclusion and exclusion criteria. The study was done after getting informed signed consent from the patients participated in the same. Results: In the present study the mean value of 2.03±0.47 in the gold of group in mild. the mean value of 2.58±1.05, in the gold of group in moderate. the mean value of 4.29±1.19 in the gold of group in severe. the mean value of 5.08±0.86, in the gold of group in very severe. The P value – 0.001 is significant. Conclusion: Neutrophil lymphocyte ratio is a blood parameter which is easily obtained, and is significantly raised in acute exacerbations of COPD, based on its severity of exacerbation. Those who had more the ratio of NLR indicates more severe the disease. The prognosis and survival rate will be poor in high NLR ratio patients and these patients can be picked up early with the simple investigation.

105. Incidence and Clinicopathological Assessment of Endometrial Carcinoma and their Precursor Lesions in a Tertiary Care Hospital
Amudhavalli Singaram, Prathipa Krishnamurthy, Rama Krishnaswamy, Babiya Infant Arockiasamy
Introduction: Endometrial cancer is the commonest gynaecologic malignancy in developed countries. Hyperplasia of endometrium with atypia carries increased risk of 29% of transforming to malignancy. There is morphological overlap between atypical hyperplasia and well differentiated carcinoma making their histological differentiation, a diagnostic problem especially in curetting specimens. This distinction has clinical significance and this study is aimed to observe the incidence, distribution and clinicopathological profile of endometrial hyperplasias and endometrial carcinoma in patients who attended Institute of Social Obstetrics & Govt. Kasturba Gandhi Hospital for Women and Children, Madras Medical College for a period of 3 years. Materials And Methods: Total of 7229 cases were received for histopathological examination of these cases 3554 were endometrium specimens. 186 cases accounts for hyperplasias and malignancies of Endometrium. Among 186 cases of Endometrial hyperplasias and carcinomas, 135 cases were hyperplasias, 51 cases were malignancies. Observation and Results: Hyperplasia of Endometrium showed a peak incidence in the age group of 41 to 50 years. Carcinoma endometrium had a peak incidence age group of 51-60 years of the 135 cases of hyperplasia, 12 cases were hyperplasia with atypia. Among the 51 cases of malignancy, majority are typical endometrioid type(36 cases-70.58%), 14 were villoglandular variant(14 cases- 27.45%), 1 case was carcinosarcoma (1.96%) Of the 51 cases, majority of the cases presented in grade 1and stage I. Conclusion: To conclude the incidence of endometrial carcinoma was lower in this study compared to western population.

106. Exploring the Interplay Between Dermatoglyphics: An In-Depth Investigation of the Relationship Between Fingerprints and Lip Prints for Personal Identification
Deepak Chaturvedi, Manveer Singh, Priyanka Chahal
Introduction: The study of dermatoglyphics, encompassing fingerprint and lip print patterns, has significant implications for personal identification in forensic science and biometrics. While fingerprints have been widely used for this purpose, lip prints remain a relatively unexplored area, presenting the potential for complementing existing identification methodologies. Materials and Methods: A diverse sample of individuals, encompassing various genders and age groups, was examined using non-invasive imaging techniques to capture high-resolution images of fingerprints and lip prints. Statistical analyses were employed to identify correlations between specific dermatoglyphic features. Results: Results from a gender-based analysis demonstrated consistent trends between males and females, with slight differences in overall patterns. Furthermore, a correlation analysis across age groups highlighted stronger associations in the younger demographic (18-30 years) indicates potential age-related influences. Conclusion: Dermatoglyphics, Fingerprint, Lip Print, Personal Identification, Correlation Analysis.

107. To Assess Stratification for Cardiovascular Risk Factor through Cardio Pulmonary Exercise Testing in Young Indian Patients with Cardiac Risk
Satendra Mishra, Sunil Yadav, J. K. Bhargava, Rajesh Kharadee, Vikas Patel
Background: Cardiovascular risk factors are increasingly prevalent in young Indian adults, contributing to the burden of cardiovascular diseases (CVDs). Cardiopulmonary exercise testing (CPET) holds potential as a tool for risk stratification in this population. Aim and Objective: To assess the associations between exercise parameters and demographic/physiological factors in young Indian patients with cardiac risk factors. Materials and Methods: A prospective cross-sectional study was conducted on 30 young Indian patients (18-40 years) with cardiac risk factors. Demographic data, clinical characteristics, and exercise parameters (VO₂max, BR, AT, OUES) were assessed. Pearson correlation coefficients were calculated to investigate associations between exercise parameters and demographic/physiological factors, including age, height, weight, BMI, and systolic blood pressure. Results: Among the participants, 66.67% were males, and 33.33% were females. VO₂max negatively correlated with advancing age (r = -0.624, p < 0.001). BR showed a positive correlation with height (r = 0.434, p < 0.05). AT exhibited negative correlations with weight (r = -0.450, p < 0.05) and BMI (r = -0.493, p < 0.05). OUES positively correlated with height (r = 0.464, p < 0.05). VO₂max positively correlated with systolic blood pressure (r = -0.380, p < 0.05). Conclusion: In young Indian patients with cardiac risk factors, advancing age negatively impacted VO₂max, while height positively influenced BR and OUES. Weight, BMI, and systolic blood pressure were associated with AT and VO₂max. These findings shed light on the intricate interplay between exercise parameters and demographic/physiological factors, offering insights for risk stratification and tailored interventions in this high-risk population.

108. A Study of Non Cicatrial Diffuse Hair Loss in Female at Tertiary Care Center
Snehal V. Chaudhari, Shivani Patel, Twinkle Patel
Introduction: Hair loss is a common concern for women, affecting their self-esteem and quality of life. Understanding the factors behind non-cicatricial diffuse hair loss is crucial for effective management. Materials and Methods: In this study, we examined 50 female participants with hair loss. We collected data on Demographics, Medical history, and conducted various investigations to analyze potential contributing factors. This helped us gain insights into the patterns and causes of non-cicatricial diffuse hair loss in females. Results: The study included 50 participants with non-cicatricial diffuse hair loss. Most were in the 18-25 age group (52%), with various occupations. Hair fall was the predominant complaint (100%), with itching (32%), visible thinning (24%), and lack of volume (18%) also noted. Hair loss duration varied, with 54% experiencing it for less than 6 months. Medical history revealed factors like diabetes (4%), thyroid dysfunction (8%), and stress (14%). Laboratory findings indicated abnormal Hb levels (38%) and low Vitamin B12 (18%). Daily hair loss ranged from 300 to 600 hairs. Diagnoses included Chronic Telogen Effluvium (42%), Acute Telogen Effluvium (28%), and Female Pattern Hair Loss (30%). Conclusion: Non-cicatricial diffuse hair loss affects women across ages. Factors like hormonal imbalances, nutrition, genetics, and environment contribute. Our study highlights varied patterns, including Chronic Telogen Effluvium, Acute Telogen Effluvium, and Female Pattern Hair Loss. Addressing factors like anemia, thyroid dysfunction, and nutritional deficiencies is crucial for effective management.

109. A Study of Cutaneous Manifestations in HIV Infected Patients in A Tertiary Care Centre
Nithin Babu VH
Background and Aim: Several cutaneous conditions may be seen in human immunodeficiency virus infection during the course of HIV infection atypical and unusual manifestations can be seen. The varied spectrum of cutaneous manifestations in HIV patients where studied with this objective in mind. Methods: All HIV positive patients attending the MGMC & RI Hospital between December 2011 to June 2013 were included in the study. The patients were included in the study through the following channels. Results: In our study we found that among the 55 HIV positive patients included in the study, 50 patients had cutaneous lesions. Majority of the patients (46%) belonged to the 31-40 years age group, the youngest was 17 years old and the oldest was aged 59 years. There were 19 female and 31 male patients. Among these patients 37(67.3%) had infectious dermatoses and 31(56.4%) cases were having non-infectious dermatoses. Among the patients having infectious dermatoses, 19(34.5%) had fungal infections, 18(32.7%) had viral infections, 5(9.1%) had bacterial infections and 1(1.8%) had parasitic infections. Conclusion: In our study we come across high prevalence (91%) of skin and mucocutaneous diseases in HIV patients. Various patterns of skin manifestations were observed in our study, including seborrheic dermatitis, tinea corporis and pruritic popular eruption. Treatment of this skin manifestation would be incomplete without adequate treatment of HIV itself.

110. Role of Magnetic Resonance Imaging (MRI) in Anorectal Fistula
Gajanan Dhansing Chavhan
Introduction: The following study has discussed anal fistulas being best evaluated preoperatively with MRI. It helps diagnose, characterise, and monitor disease, treatment, and therapy. Furthermore, MRI accurately visualises fistulous tracts, buried abscesses, and their closeness to internal and external sphincters. It guides surgical planning and lowers recurrence rates. Higher MRI grades are connected with poorer patient outcomes. Even, anal fistulas are assessed using T2-weighted and post-gadolinium T1-weighted imaging. Aims and Objectives: The purpose of this investigation is to analyse and determine the best course of treatment for anorectal fistulas using magnetic resonance imaging (MRI). Methods: MRI’s accuracy in identifying fistula-in-ano was examined in this retrospective investigation at the University Medical Centre. MRI data from January 2021–January 2022 surgical patients were analysed. Written informed permission was acquired, and the ethics committee approved the study procedure. Radiologists assessed MRI scans, using surgical records as a reference. MRI data were compared to surgical observations to determine MRI’s accuracy in recognising primary and secondary tracts, abscesses, and opening locations. Results: Table 1 shows fistula kinds’ external opening-anal margin distances. Table 2 compares Parks-classified main tract classifications from MRI and surgery. MRI and surgery agree on secondary tract locations in Table 3. Table 4 compares T2W TSE with post-contrast FS T1W TSE fistula characterization. T2W TSE performed well for internal openings and secondary tracts. Post-contrast FS T1W TSE diagnosed abscesses well with better sensitivity but lower specificity. Conclusion: This study has concluded that MRI is statistically efficient in characterization and mapping fistula-in-ano and can contribute significantly in surgical prognosis.

111. A Cross-Sectional Study on the Frequency of Dry Eyes in Hyperthyroidism Patients
Sharmistha Behera, Sasmita Sahu, Pramod Kumar Sharma, Deepak Jyoti Mohanty, Arati Biswal
Background: Dry eye is the most prevalent cause of ocular irritation in patients with thyroid diseases. This study sought to determine the prevalence of dry eye syndrome in hyperthyroidism patients. Methods: This cross-sectional study was conducted on 100 patients diagnosed with hyperthyroidism by Dept. of Ophthalmology, VSSIMSAR, Burla, Odisha during the study period over 2 years from December 2020 to November 2022. Results: Out of 100 patients, highest number of patients [42 (42%)] were seen in the age group of 36 and the gender group of 58 (58%) males. Highest frequencies of dry eyes 62 (62%) were seen for severely decreased tear breakup time for both the right eye and left eye. Conclusion: The frequency of dry eye disorder was found to be extremely high in the case of hyperthyroidism patients.

112. Study of Serum Homocysteine Level and C-Reactive Protein Level in Coronary Artery Disease Patients
Daulat Singh Meena, Ashish Kumar Agarwal
To assess the difference in serum homocysteine and C-Reactive protein level in coronary artery disease patients and normal controls. This Cross-sectional duty was conducted on 200 subjects were studied. This included 100 patients with confirmed CAD and 100 healthy age matched subjects as controls. The blood sample of controls as well as study groups were withdrawn and analysed for serum homocysteine.  The serum homocysteine level of CAD patients mean value 62.23±13.36 µmol/l was highly significantly elevated (p=0.0001) then control group which had mean value 9.36±3.02µmol/l. This study show that the serum homocysteine level are significantly elevated in CAD patients compare to controls.

113. To Estimation of Lipoprotein (A) Levels in Patients of Acute Coronary Syndrome
Daulat Singh Meena, Ashish Kumar Agarwal
High levels of lipoprotein(a) [Lp(a)] are associated with increased risk of acute coronary syndrome (ACS). Hospital based cross-sectional study. Was conducted on 100 patients with acute coronary acute coronary syndrome (ACS). The serum lipo-protein(A) level was measure and ECG was done at the time of admission and repeated as necessary. Lp (a) was measure by agglutination. Lipo-a was lipo-a was 52.33±12.06 mg/dl. The association between age and lipo-protein a level was found statistically significant. The association between sex and lipo-protein a level was found statistically Insignificant. Lp(a) seems to be an independent risk factor for acute coronary syndrome (ACS), and high Lp(a) levels increased the risk for acute coronary syndrome (ACS).

114. Assessment of Acute Abdomen Cases Coming to Tertiary Care Hospital
K Ashok
The term acute abdomen designates symptoms and signs of intraabdominal diseases usually treated best by surgical operation. Many diseases, some of which do not require surgical treatment, produce abdominal pain, so the evaluation of patients with abdominal pain must be methodical and careful. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation. The present study was done in 100 patients presenting with acute abdominal pain in Tertiary care teaching Hospital. All 100 patients were managed surgically. Some patients were managed conservatively but were not included in study. Maximum cases were of Acute appendicitis 48%. Colonic perforation and bowel obstruction were 16% cases each. Most surgeries done  were of Appendicectomy and Exploratory laparotomy. Acute abdomen is often a surgical emergency and a challenge to any surgeon. Rigorous approach to diagnose is mandatory.

115. An Observational Study on Fractures around the Elbow in the Pediatric Age Group
Deependra Sonkar, Neeraj Patidar, Vinod Kumar Rawat, Vijendra Parmar
Background: Fractures around the elbow constitute a common injury in the pediatric population, with varying degrees of severity and potential long-term consequences. The intricate anatomy and dynamic growth patterns of the pediatric elbow present unique challenges in diagnosis, classification, and management. Despite its clinical significance, there remains a need for comprehensive observational studies examining the prevalence, distribution, mechanisms, and outcomes of such fractures to inform evidence-based approaches to treatment and rehabilitation in this age group. Aim and Objective: This original research article aims to investigate the prevalence, patterns, mechanisms, and outcomes of fractures occurring around the elbow in the pediatric age group, utilizing a sample size of 226 participants. Materials and Methods: A prospective observational study was conducted over a defined period, involving pediatric patients aged 0-14 years who presented with elbow fractures. Clinical, radiological, and demographic data were collected and analyzed. Fracture patterns were categorized according to specific anatomical locations and mechanisms of injury. Results: The study comprised 226 participants with confirmed elbow fractures. The most common fracture site was the supracondylar region (69%), followed by the lateral condyle (17.3%) and the medial condyle (6.2%). Mechanisms of injury varied, with falls being the predominant cause (96.4%), followed and road traffic accident (3.6%). Supracondylar type of fracture was significantly higher in all age group less than 5 years, 6-10 years and 11-14 years. Similarly, lateral and medial condyle fracture was more common with 11-14 years and 6-10 years (p=0.001). Association between type of fracture and gender distribution was not significant in our study (p>0.05). However, numerically Supracondylar fracture was higher in male children as compared to female children, probably pertaining to more vigourous playful activities of boy children. Conclusion: This observational study sheds light on the prevalence, distribution, and outcomes of elbow fractures in the pediatric age group. The findings emphasize the significance of falls as the primary cause of fractures and underscore the importance of prompt and accurate diagnosis and appropriate management strategies. These insights contribute to a better understanding of pediatric elbow fractures and aid in refining clinical approaches to enhance patient outcomes.

116. Effect of Increased Body Mass Index (BMI) on Pulmonary Function Tests: A Pilot Study
Nirmal D Malhotra, Falak Saiyad, Huma Saiyad, Shaista Saiyad
Introduction: Obesity is a prevalent has been associated with various health complications. However, studies on its effects on the respiratory system are very less. Medical students are more prone to stress and which can lead to overweight or obesity. This study aimed to investigate the impact of body mass index (BMI) on pulmonary function tests (PFTs) among medical students. Aims and Objectives: The main aim of study to observed association between BMI and lung functions. Materials and Methods: A cross-sectional study conducted among medical students at Smt. N.H.L. Municipal Medical College. Total 30 participants were included in the study. Anthropometric and spirometry parameters, such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate measured using a computerized spirometer. Statistical analysis performed using Graph-pad Software. Results: FVC, FEV1, PEFR, FEV1/FVC values are reduced in obese compared to normal subjects. Reduction in FEV1/FVC was statistically significant. Conclusion: People with high BMI are prone to respiratory disorders. Hence, preventive measures should be taken for healthy lifestyle to avoid obesity.

117. A Comparative Study on Body Temperature Measurement Technique: Mercury Thermometer vs Digital Thermometer
Sanket Mathukiya, Jitendra Patel, Swati Mahajan, Aalisha U. Dodhiya
Introduction: The body temperature is one of vital parameter and common method to measuring is oral body temperature with help of clinical thermometer. Clinically two types of thermometers being used to measure body temperature, one is mercury thermometer and second one is digital thermometer. In current study is comparison made between two techniques. Aims and Objectives: The aim of the study was to compare the Body temperature measured using two different thermometers: mercury thermometer vs. digital thermometer & to correlate the Body temperature measured using these two instruments. Material and Method: After taking informed consent of the subject, oral body temperature of the subjects measured. 132 subjects participated in the study. Three readings were taken with the both the instrument (mercury thermometer and digital thermometer) of every subject and then the average of three reading was taken. The obtained data was analyzed using appropriate statistical software. Result: The data obtained analyzed as follows:  The mean value of the body temperature measured using mercury thermometer and digital thermometer is (97.32±0.9) and (97.99±0.57) respectively and the p value is <0.001.  The correlation coefficient (r2) of body temperature measured using mercury and digital thermometer is 0.47 and the p value is <0.001. Conclusion: From the above study, we can conclude that there was significant difference found in both techniques. Here, a difference obtained in body temperature measured using two different instruments (Mercury thermometer and Digital thermometer). This shows that there are chances of variation in body temperature measured using different technique.

118. A Clinical Study on the Incidence, Clinical Course and Prognosis of Community-Acquired Pneumonia in Children below 05 Years in Deficiency of Vitamin D, Serum Zinc, Ig G, Ig M and Serum Iron
Bijumon AV, Niyas Ahammed K, Soumya Jose, Nileena Paul
Background: Community Acquired Pneumonia (CAP) accounts for mortality of less than five years children all over the World. Immunity among them is disrupted by malnutrition and deficiency of Vitamin D, Zinc and Iron which play vital role. This prospective study was aimed at understanding the relation between serum levels of these three elements in under five children suffering from Acquired Pneumonia (CAP). Aim of the Study: To correlate the serum levels of Vitamin D, Zinc and Iron and the severity of Community acquired Pneumonias in the children aged below 5 years. Materials: A clinical and laboratory based study was conducted KMCT, Kozhikode in the department of pediatrics with 57 children in the study group and 55 children in the control group aged below 05 years. Children diagnosed with CAP and severe CAP was included in the study group. British Thoracic Society (BTS) criteria were considered to classify the grading of CAP in this study. Mild to moderate: Children with temperature less than 38.5 °C, respiratory rate less than 50 breaths/min, and mild breathlessness. Severe cases: Children who had temperature less than 38.5 °C, respiratory rate more than 50 breaths/min, and severe degree of difficulty in breathing showing nasal flaring, cyanosis, and tachycardia. Biochemical investigations included serum calcium, phosphate, alkaline phosphatase, vitamin D3 levels, Serum zinc level, Albumin globulin ratio and Iron using conventional and high-performance liquid chromatography (HPLC). Immunological tests to estimate total IgG and Ig E levels were conducted. Results: The CAP group of 57 children and the control group of 55 healthy children had 34: 24 and 35:20 male to female ratio. The mean ages were 03.45±0.85 and 03.80± 0.34 years in the CAP and control groups respectively. There was no statistical significant difference between the two groups in regards to their age, gender and type of feeding. (P values ˃ 0.05) There was a statistical significance between the CAP children and control group children in terms of these levels of serum Vit.D and serum Zinc, (p value less than 0.05). Inadequate Vit. D, Zinc and TIBC values were noted in relation to the severity of the CAP. Conclusions: Adequate dietary Zinc, vitamin D and Iron are protective in nature to the children below 05 years in preventing infection with community-acquired pneumonia. But the study showed no correlation between adequate serum iron levels and CAP. Watchful supplements of zinc, vitamin D, and iron helped to develop the immune system in children which prevents CAP.

119. GATA3 Immunohistochemistry Expression in Differentiating Metastatic Lesions of Bladder from Urothelial Carcinomas of Bladder and its Significance in Different Grades of Urothelial Carcinoma
Harshaa Maheshwari, S.R. Negi, Nitesh Samriya
Introduction: Urothelial carcinoma is most common type of bladder cancer. Immunohistochemical analysis of urothelial carcinoma is important in the identification of the site of origin of metastatic lesions of unknown primary. Aim: to explore GATA binding protein 3, a zinc finger transcription factor, immunohistochemistry expression in urothelial carcinomas of the bladder and in metastatic lesions of the bladder. Methods: It is an observational study where 40 cases of Urothelial carcinoma along with 10 cases of each high Gleason score prostate adenocarcinoma, colon adenocarcinoma, cervix squamous cell carcinoma, and renal cell carcinoma were included. All the cases were histopathologically evaluated and immunohistochemically stained for GATA binding protein 3. Only nuclear positivity was considered as positive. The immunoreactivity score for GATA expression was calculated based on the staining intensity as well as percentage. The statistical analysis was done P value <0.05 was considered significant. Results: GATA3 expression was seen in 85% of the cases of urothelial carcinoma mostly with moderate to strong positivity whereas none of high gleason score prostate adenocarcinoma, colon adenocarcinoma, cervix squamous cell carcinoma, and renal cell carcinoma were GATA3 positive. GATA3 expression significantly correlated with histological grade and muscle invasion with a weaker or negative expression in high‑grade muscle invasive tumor as compared to low‑grade. Significantly weaker expression of GATA3 was found in cases with severe nuclear pleomorphism and mitosis >10/10 hpf. Conclusion: The study concluded that GATA3 immunohistochemistry expression helps in differentiating metastatic lesions of the bladder like high gleason score prostate adenocarcinoma, colon adenocarcinoma, cervix squamous cell carcinoma, and renal cell carcinoma from urothelial carcinomas of the bladder, thereby facilitating the diagnosis, treatment, and management of these cases.

120. A Study to Assess MRI in Evaluation of Knee Injuries as Compared to Clinical Examination
Kamal Nayan Gangey
Introduction: Knee joint trauma is a significant cause of morbidity, especially among young and active individuals, including athletes, military recruits, and trained warriors. The advancement of minimally invasive surgical treatments has increased the importance of imaging techniques for knee joint evaluation. Magnetic resonance imaging (MRI) is commonly used techniques for assessing knee joint injuries. Aim and Objectives: Assess the MRI appearances of ligaments and meniscal tears in cases of knee injury and to correlate the MRI findings of knee injury with clinical observations. Material and Methods: The present cross sectional study is a comparative study conducted in the Department of Radio diagnosis, SRMS Bareilly during the period from June 2022 to May 2023 after taking permission from ethical committee and informed consent from the patients. Patients presenting with knee joint injuries were included. Patients meeting with the inclusion criteria will undergo clinical examination, knee examination and subsequently MR Imaging. Results: On MRI 52 study subjects had ACL tear positive in which only 52 study subjects were positive clinically. Whereas 18 subjects shows tear on clinical test in MRI negative study subjects. The sensitivity of clinical test to detect ACL tear was 96.15%, specificity was 62.5%, PPV was 73.53% and NPV was 93.75%. On MRI 43 study subjects had PCL tear positive in which all 40 study subjects were positive clinically. The sensitivity of clinical test to diagnose PCL was93.02%, specificity was 91.23%, ppv was 89.58 and NPV was 94.54%. Conclusions: In the present study, the sensitivity of clinical tests for diagnosing ACL tear was 96.15%, indicating a high accuracy in detecting this specific ligament injury. For PCL tear, the clinical tests showed a sensitivity of 93.02%, suggesting a reliable ability to identify PCL injuries. MCL tear had a sensitivity of 80.0% on clinical tests, indicating a good diagnostic performance for this ligament tear.

121. Pattern of Adverse Drug Reaction and Medication Use in Neonatal Care Units in a Tertiary Care Hospital: A Longitudinal Observational Study
Gaurav Mittal, Rishika Agarwal, Amarjeeth Raja
Background: Adverse drug reactions (ADRs) pose significant risks to neonatal patients in healthcare settings and contribute to healthcare burden globally. This longitudinal observational study aimed to investigate the pattern of ADRs and medication use in neonatal care units within a tertiary care hospital, shedding light on prevalence, causality, severity, and implicated drug classes associated with ADRs. Methods: The study was conducted in the neonatal care units of a tertiary care hospital. Data were collected prospectively, and demographic characteristics, causality, severity, and implicated drug classes were recorded for neonates experiencing ADRs. Causality was assessed using standardized scales, and severity was graded using established criteria. Medication use data were collected for all neonates included in the study. Results: The study included 220 neonates with ADRs. Maculopapular rash (18.2%), diarrhea (13.6%), and hypotension (11.4%) were the most common ADRs observed. Antibiotics were the leading causative drug class (36.4%), followed by anticonvulsants (22.7%) and analgesics (13.6%). The majority of ADRs were categorized as “probable” in causality (63.6%) and “moderate” in severity (68.2%). Antibiotics demonstrated significant associations with both “moderate” and “severe” ADRs (p < 0.001). Conclusion: This present study underscores the significance of ADR monitoring in neonatal care units. Antibiotics were the most frequently implicated drug class, warranting cautious prescribing practices. The study highlights the importance of continuous monitoring and reporting of ADRs in neonatal populations to enhance drug safety and optimize patient outcomes.

122. Etiological Spectrum of Blindness in Patients Attending Visual Disability Assessment Clinic for Blindness Certificate in a Tertiary Care Centre in Tamil Nadu
Chitra Govindan
Background: Blindness is a major health problem as well as social and economic problem in developing countries like India. Blindness in all forms confers serious morbidity to those affected. The aim was to study the causes of blindness in patients attending visual disability assessment clinic. Methods: A prospective hospital based study of total of 110 patients of all age groups attending Government Dharmapuri Medical College Hospital for blindness certificates during the period between November 2022 to January 2023 were included. All the patients underwent complete ophthalmological evaluation and information was gathered regarding their demographic profile and nature of ocular disorder whether primary or secondary and laterality. Patients with unilateral as well as bilateral total blindness were included in the study. Blindness was defined according to World Health Organization Criteria. Results: Out of 110 blind patients, males above 50years were more commonly affected, unilateral involvement more than bilateral and the most common cause was corneal disorders particularly corneal opacity. Conclusion: In our study, corneal disorders were the major cause of blindness in the patients. Legal blindness is a term defined to determine those who are eligible to receive disability benefits, tax exemption, transport concessions and other eligible monetary benefits.

123. A Prospective Observational Study on Maternal and Perinatal Complications Associated with Urinary Tract Infections in Pregnancy at A Tertiary Care Hospital
Ipsita Mohanty, Sushreesmita Mohanty, Sikruti Mohanty, Pulak Ranjan Panda
Background: Urinary tract infection is the most common bacterial infection during pregnancy and is associated with several maternal and perinatal complications. Aim: To describe the maternal and perinatal complications in pregnant women with UTI. Methods: A prospective observational study was undertaken at Hitech medical college and Hospital, Bhubaneswar from January 2021 to December 2022. The presence of risk factors, the causative organisms and the adverse maternal and perinatal outcomes like preterm labour, amnionitis, maternal anemia, low birth weight along with perinatal morbidity and mortality were tabulated. The results were analysed and was expressed in proportions and percentages. Results: Majority of the pregnant women who had UTI were multiparous (54.66%) belonging to the low(46%) and medium SES(40%). 64.66% were between the age group of 21 to 30 years. The highest incidence of infection was seen during the first trimester that is 59.6%. 26% of the patients had preterm and 2.3% had anaemia. Most common organism isolated was E.coli (72.6%). Conclusion: Our study concludes that routine screening for urinary tract infection in pregnant woman should be a part of routine antenatal care to reduce the associated adverse maternal and fetal outcomes.

124. To Study the Radiological Features of Pulmonary Manifestations in HIV Infected Patient
Rahul Gupta, Seema, Sumit Khatri, Kanika Sethi
Background & Method: The aim of the study is to study the radiological features of pulmonary manifestations in HIV infected patient. Result: In our study chest  X Ray findings of patients who have  HIV with Tuberculosis showed a mix pattern that is different to Tuberculosis cases who do not have HIV (TB cases without HIV) as we know the commonest findings of TB cases without HIV are cavietry lesions and upper zone pathological findings while in our study we found that a few cases have cavitatory lesions and upper zone findings also not common. 5 cases have lower zone findings, 5 cases have upper zone findings, 1 case has middle zone findings, 2 cases have upper middle zone findings, 7 cases have findings in middle and lower zone while 9 patients of  HIV with TB have normal chest X-ray. Radiological findings of our study showed that 15 cases out of 49 have pleural effusion i.e. 30.6% of total cases. Conclusion: In our study most common findings are diffuse lesions either unilateral or bilateral 20 cases out of 49 cases of TB with HIV showed diffuse features (11 b/l and 9u/l) and this is 40% of all cases. In our study total 15 cases out of 49 have pleural effusion (30.6% of total cases) and there is not any significant correlation between pleural effusion and CD4 counts. At the CD4 count <200 the chest radiographic pictures showed media sternal lymphodenopathy (61.4%), mid and lower zone involvement 86.7%, B/L lung involvement (50%), miliary and disseminated pattern (49.9%). The patients who had CD4 count >200 showed cavitary and upper zone lesions in their chest radiographs.

124. Investigation of Primary and Secondary Infertility through Different Hormonal Assays
Manas Ranjan Behera, Pramoda Kumar Sahoo, Bharati Mishra
Background: Infertility is a global public health issue that affects roughly 10% to 15% of couples trying to conceive during the reproductive age. This study was designed to investigate primary and secondary infertility through different hormonal assays. Methods: In this cross-sectional study, out of 160 cases, 104 cases of infertile females were evaluated. Demographic characteristics and various medical factors were used to determine primary and secondary infertility. Infertility cases were also studied through ultrasonography investigation and various biochemical parameters, including estimating the levels of LH, FSH, prolactin and thyroid hormones. Results: The primary and secondary infertility rates were 80.76% and 19.24%, respectively. Maximum cases (42.3%) of infertility were in the age group of 21-25 yrs. Among the causes of primary and secondary infertility in this study, 46.2% of cases had PCOS, 19.2% had tubal block and 7.7% had hypothyroidism. The present study showed no menstrual abnormalities in 28.9% of cases. In 45.2% of cases, oligomenorrhoea cycle was observed. Among these 70% had PCOS and 19% had hypothyroidism cases with an oligomenorrhoea cycle. Ultrasonography investigation showed normal and abnormal pelvic findings in 51% and 49% of cases, respectively. Identification of various hormone levels in primary and secondary infertility cases showed increased level of serum LH in 29.8% of cases. Of 48 PCOS cases, 28 (58.3%) cases were observed with increased serum LH levels. Conclusion: Primary and secondary infertility were caused by the interaction of numerous demographic and medical variables in the current investigation. The study found that younger individuals had a higher rate of infertility. The main cause of infertility was PCOS with elevated serum LH levels, hypothyroidism, and hyperprolactinemia.

125. Incidentally Discovered Gall Bladder Carcinomas on Routine Histopathology Following Laparoscopic Cholecystectomy
Meenakshi Pathak, Nimisha Gupta, Sunit Pathak
Background: Gall bladder carcinoma accounts for 98% of all the gall bladder malignancies and it is the fifth most common malignancy of the gastrointestinal tract worldwide. Most incidental gall bladder cancers are detected only after pathological examination of the excised surgical specimens. This study was aimed at detecting the incidence of gall bladder carcinomas which were diagnosed incidentally on histopathological examination of gall bladders which were sent for gall stone disease and cholecystitis in our center and the need for routine versus selective histopathological examination of cholecystectomy specimens. Material & Methods: We retrospectively reviewed 1709 cholecystectomy specimens sent for histopathology in the pathology department after cholecystectomy in the study period from March 2015 to October 2021. Clinical details including clinical presentation, preoperative ultrasound (USG) findings, laboratory data, and surgical procedures as well as outcome and macroscopic features were retrieved. Results: We identified 16 cases of incidental gall bladder cancer (IGBC), consisting of 12 women and 4 men ranging in age from 34 to 75 (60.5 ± 13.2, years with female preponderance) after pathological study of 1709 resected gall bladders. Mean gallbladder thickness in these cases was 0.8±0.5 cm, and 96% cases of IGBC were associated with cholelithiasis. No correlation was seen between the age of patient and gallbladder thickness. Final diagnosis of IGBC was made on microscopical examination of gall bladder with tumor cells infiltrating the lamina propria in two cases (pT1a), muscularis propria in 10 cases (pT1b), and serosa in the remaining 4cases (pT2). Conclusions: The rate of incidental gallbladder carcinoma in our study was 1.06%. This strategy of increased early intervention adds to the advantage of higher chances of gallbladder cancer detection in early stages, and thus better prognosis. IGBC is a clinical disguise which often escapes the radiological diagnosis and comes as pathological surprise. Histopathological examination of cholecystectomy specimens remains the gold standard for the detection of this occult, yet rigorous malignancy and assessment of the depth of invasion in IGBC and further management.

126. A Study of asymmetry in fingerprints in Lucknow, India
Devendra Pal Singh
Background: Fingerprints are widely acknowledged as the most dependable and robust parameter for individual identification in various medical and academic contexts. The current study was conducted to investigate the distribution of fingerprint patterns among individuals of male and female genders, as well as to examine the asymmetry in the Bihar region. Methods: The present descriptive cross-sectional study was carried out at the Department of Anatomy, integral institute of medical science and research Lucknow, India, spanning from July 2020 to September 2020. A total of 196 participants between the ages of 18 and 60 were included in the study. The fingerprints of all ten digits were collected and examined to assess the distribution pattern and scrutinised for potential gender disparities. A simple random sampling technique was employed, and the sample size was determined based on a prevalence rate of 50%. The acquired data were processed and evaluated utilising Microsoft Excel software in order to derive the outcomes. Results: The research findings revealed that loops exhibited the most prevalent occurrence, with a frequency of 1033 instances, accounting for 52.71% of the observed patterns. Whorls followed closely behind, with a count of 537 occurrences (27.38%), while arches also exhibited a frequency of 537 (27.38%). Additionally, a composite pattern was identified in 300 instances, representing 15.28% of the total patterns observed. The study findings revealed a higher prevalence of radial loops among the male participants, accounting for 397 individuals (5.54%) out of the total male population. Conversely, the female participants exhibited a greater occurrence of ulnar loops, with 636 individuals (96.38%) out of the total female population. In the study, it was observed that males exhibited a higher prevalence of concentric whorls, accounting for 245 individuals (52.03%). Conversely, females displayed a greater occurrence of spiral whorls, with 292 individuals (53.27%). Conclusion: For standard authenticity of the sexual dimorphism, fingerprint patterns, can also be considered for gender identification purposes.

127. Investigation of Primary and Secondary Infertility through Different Hormonal Assays
Manas Ranjan Behera, Pramoda Kumar Sahoo, Bharati Mishra
Background: Infertility is a global public health issue that affects roughly 10% to 15% of couples trying to conceive during the reproductive age. This study was designed to investigate primary and secondary infertility through different hormonal assays. Methods: In this cross-sectional study, out of 160 cases, 104 cases of infertile females were evaluated. Demographic characteristics and various medical factors were used to determine primary and secondary infertility. Infertility cases were also studied through ultrasonography investigation and various biochemical parameters, including estimating the levels of LH, FSH, prolactin and thyroid hormones. Results: The primary and secondary infertility rates were 80.76% and 19.24%, respectively. Maximum cases (42.3%) of infertility were in the age group of 21-25 yrs. Among the causes of primary and secondary infertility in this study, 46.2% of cases had PCOS, 19.2% had tubal block and 7.7% had hypothyroidism. The present study showed no menstrual abnormalities in 28.9% of cases. In 45.2% of cases, oligomenorrhoea cycle was observed. Among these 70% had PCOS and 19% had hypothyroidism cases with an oligomenorrhoea cycle. Ultrasonography investigation showed normal and abnormal pelvic findings in 51% and 49% of cases, respectively. Identification of various hormone levels in primary and secondary infertility cases showed increased level of serum LH in 29.8% of cases. Of 48 PCOS cases, 28 (58.3%) cases were observed with increased serum LH levels. Conclusion: Primary and secondary infertility were caused by the interaction of numerous demographic and medical variables in the current investigation. The study found that younger individuals had a higher rate of infertility. The main cause of infertility was PCOS with elevated serum LH levels, hypothyroidism, and hyperprolactinemia.

128. Understanding the Barriers in Seeking Dental Care among Children in the Mixed Dentition Stage at a Tertiary Care Hospital in Western Tamil Nadu, India: A Mixed-Methods Study
S. Sriram Balaji, S. Sivanandam, Umakanthan, G.M. Sharavavan, K. Rajendran, S. Jeevithan, Ramesh Rathinamoorthy
Introduction: The early years of a child’s life are crucial for establishing healthy oral habits and preventing dental issues that can have long-lasting effects into adulthood. Neglecting oral health during childhood can lead to various dental problems, such as tooth decay, gum disease, and misalignment, which can impact overall health and well-being. Despite the significance of dental care for children, several barriers hinder parents and guardians from seeking appropriate dental services for their children. To address this concern, we conducted a study aimed at identifying the barriers in seeking dental care for children during the mixed dentition stage attending a tertiary care hospital in western Tamil Nadu, India. Objective: The objective of this study was to identify the common barriers which prevented the children of mixed dentition stage to seek dental care. Materials and Methods: This cross-sectional study was done among 250 children of mixed dentition stage who attended Paediatric Outpatient Department (OPD) of KMCHIHSR, Coimbatore, Western Tamil Nadu, India, between June 2023 to July 2023. A structured questionnaire was used to collect data. Results: When assessed for the barriers to seek dental care, 21.1% did not visit the doctor due to anxiety. 53.3% did not perceive the need to visit a doctor. 15.9% mentioned they did not have accessibility to visit the doctor. 6.9% mentioned financial constraint was the main reason for not seeking dental care. Conclusion: The barriers to children’s access to dental care are complex and multifaceted, impacting their oral health and overall well-being. Addressing these barriers requires a concerted effort from various stakeholders. Initiatives should focus on increasing the availability of dental care providers in underserved areas, implementing school-based dental health programs, and conducting community outreach efforts.

129. To Study the Normal and Abnormal Pattern of Endometrial Lining of Uterus through Ultrasonography in Women of Reproductive Age Group in Area around North Bihar
Kumari Suman, Madhu Kumari, Priyamvada, Birendra Kumar Sinha
Background and Objectives: Ultrasonography is the first imaging modality used to demonstrate gynaecological anatomy and to evaluate physiological and pathological changes. to study the normal and abnormal pattern of endometrial lining of uterus through ultrasonography in women of reproductive age group. Material and Methods: This is a cross-sectional study of 100 women of reproductive age group carried out during the period of November 2018 to September 2020 attending Department of Radiology, Sri Krishna Medical College and Hospital, Muzaffarpur. Conclusion: This study showed that during reproductive age, most of the women have normal endometrial thickness depending upon their menstrual phase. 12% of the patients had endometritis. Inadequate aseptic precautions, low socioeconomic condition and emergency cesarean section might be responsible for such higher incidence.

130. Histological Study of Fetal Spleen at Different Gestational Ages
Madhu Kumari, Priyamvada, Kumari Suman, Birendra Kumar Sinha
Background and Objectives: The spleen is a largest collection of lymphoid tissue with peculiar anatomical and physiological features. Spleen plays an important role in fetal hematopoiesis and immunomodulation. The aim of the study is to perform detailed histological analysis of human fetal splenic specimens of various gestational ages and compare the findings with earlier studies. The aim of the study is to perform detailed histological analysis of human fetal splenic specimens of various gestational ages and compare the findings with earlier studies. Material and Methods: The present study included   40   fetal cadaveric spleen and morphometric features i.e., weight was measured and the sections of the spleen were stained with Haematoxylin and Eosin stain and were observed under compound light microscope. Results:  Study the histology of spleens of prenatal group showed the well-defined red pulp, venous sinusoids and diffusely spread lymphocytes at 18 weeks of gestation and the organization of lymphoid follicles was noticed at 24-28 weeks. At 32 weeks well defined white pulp was observed and the microscopic architecture of the spleen was similar to the histology of adult spleen. Conclusion: A detailed knowledge of splenic morphometric dimensions, Histological  is crucial in deciphering the role of spleen in fetal development and fetal wellbeing.

131. Cadaveric Study on Variations in the Branching Pattern of Arch of Aorta
Priyamvada, Madhu Kumari, Kumari Suman, Birendra Kumar Sinha
Background and Objectives: The most common branching pattern of the aortic arch in humans comprises of three great vessels, during the routine dissection for 1st MBBS we encountered variations in the branches of arch of aorta, so the study was conducted to know the percentage and common type of variations. Material and Methods: The study was performed on thirty hearts, among the 30 hearts 28 were adult formalin preserved cadavers and two were pre-dissected separate hearts with the aortic arches en-bloc. The sex and age of the cadavers were not assessed in the study. A study was conducted. The purpose of the study was to measure the percent of variation in the branching pattern of an arch of aorta. The most common branching pattern of the aortic arch in humans comprises of three great vessels; first, the brachiocephalic trunk, then the left common carotid artery and finally the subclavian artery. In the present study the most common aortic arch branching pattern was found in 86.67%, additional artery that is four branches were observed in 10% of the cases and two arteries from the arch of aorta, were noted in 3.33% of the case studied. Results: In the present study, the most common aortic arch branching pattern was found in 26 (86.67%) of 30 specimens. In this pattern the three major branches that are brachiocephalic trunk, left common carotid artery, and left subclavian artery originated independently from the arch of aorta. The variations in aortic arch regarding its branching pattern were observed in the remaining 4 (13.33%) hearts.   Conclusion: Different branching patterns of the arch of aorta observed in this study and these can assist surgeons in performing safe and effective surgeries in the superior mediastinum.

132. Cadaveric Morphometric Study of the First Cervical Vertebra
Priyamvada, Kumari Suman, Madhu Kumari, Birendra Kumar Sinha
Background: The atlas (first cervical vertebra) has undergone many structural modifications. It is critically located and close to the ‘life centres’. For this study, one hundred dried intact human atlas vertebrae from the Indian population were measured using a digital Vernier calliper that provides accurate resolution up to 0.01 mm. The distance between the tips of the transverse process, the outer and the inner distance between the foramen transversaria and various diameters of vertebral foramen were measured. The mean width of the measured atlases was 69.37 mm. The mean distance between the lateral margins of foramen transversaria was 55.66 mm and the inner distance was 45.93 mm. The mean thickness of vertebral artery grooves was 3.72 + 1.06 mm. The observations made in the present study may help in improving understanding of various bony dimensions while operating close to important structures like nerve roots and the vertebral artery. Material and Methods: One hundred dried human atlases of unknown sex, obtained from the Department of Anatomy PMCH Patna. and Included Other medical colleges were studied. All samples were drawn from the Indian population. Atlases with pathological features were excluded from the study. The following parameters were measured for each atlas using a vermier caliper. Conclusion- studied one hundred dried first cervical vertebra deriving from the Indian population to give us the opportunity to analyse metrical data.

133. Radiological Observation of Congenital Uterine Anomalies and Their Impact on Fertility
Madhu Kumari, Kumari Suman, Priyamvada, Birendra Kumar Sinha
Background and Objectives: Uterus is responsible for most of the vital steps in process of reproduction like sperm migration embryo implantation, fetal nourishment, development growth and birth of baby. Congenital uterine anomalies affect some or all of these uterine functions required for successful pregnancy. Observation of congenital uterine anomalies and their on fertility. Material and Methods: It is a descriptive observational study. The study was conducted in out Patient department of Obstetrics and Gynecology, Patna medical college, Bihar. On patients come for cyclical pian abdomen, lump in abdomen, menstrual problem, problem in conception, recurrent miscarriage, antenatal postnatal complication and diagnosed to have reproductive system abnormalities in aforesaid institution were selected as study population. These patients usually come from Patna as well as all districts of Bihar. Conclusion: The of fertility concern and reproductive system anomalies is of great concern with the advent of newer and sophisticated diagnostic tools and increased patient awareness. Every gynaecologist and obstetrician should have adequate knowledge about occurrence corrective treatment to increase fertility outcome, possible complication in such pregnancies and their proper management to successfully save the lives of mother and fetus.

134. Study of Outcomes and Surgical Approach in Swelling of Salivary Gland
Kumari Rashmi, Vivekanand, Md. Sarfaraz Alam
Background: Salivary gland tumours are rare tumours and majority of these are benign and about 20% are malignant. The incidence of salivary gland cancers ranges from 0.5 to 2 per 100,000 in different parts of the world. Salivary gland swellings in the parotid or submandibular glands usually present as an enlarging mass and may be associated with neurological symptoms like facial nerve paralysis or pain. Minor salivary gland tumours present as a submucosal intraoral mass which subsequently ulcerates. Acute inflammatory conditions generally can be diagnosed by history and physical examination alone, whereas chronic inflammatory diseases and granulomatous disorders require supplemental diagnostic information including lab tests, imaging studies and biopsy. FNAC of salivary gland tumours is advantageous to both the patient and the clinician because of its immediate results, accuracy, lack of complications and economy. Appropriate therapeutic management may be planned earlier, whether it is local excision for a benign neoplasm, radical surgery for a malignant one or any other alternate treatment. Material and Methods: All patients admitted to surgical wards due to obstructions of the salivary duct and neoplasia were included in the study. Demographic data from all the patients were collected, also they were evaluated for clinical examination, routine laboratory investigations and specific investigations. After evaluation of the swellings by clinical examination and by specific investigations, a surgical plan was formulated. The final decision was taken by the operative surgeon. Conclusion: Salivary gland tumors occur more commonly in the parotid gland, most often benign, pleomorphic adenoma constitute majority of all neoplasm. Surgery is the main modality of treatment in salivary gland sialolithiasis. Most commonly done surgery is excision of submandibular salivary gland & superficial parotidectomy and also for salivary gland tumors. Awareness and early referral is necessary, as prognosis is good if treated early.

135. Study and Review of the Variation in the Pattern of Circle of Willis in Human Brain
Kumari Suman, Priyamvada, Madhu Kumari, Birendra Kumar Sinha
Background and Objectives: Circle of willis is the arterial anastomosis at the base of the brain which is also reffered as circulus arteriosus cerebri. Variation in circle of Willis is known to cause grave disorders like cerebrovascular disorders, subarachnoid haemorrhage, cerebral aneurysm and schizophrenia. The objectives of the present study are to study the formation and branching pattern of circle of Willis and also to study the distribution of variations. Materials & Methods: The study was conducted on 50 adult brain specimens. Each brain was removed in one piece by dissection and the circle of Willis was observed for its formation, pattern and variations. Results: Among the 50 specimens studied, 28 cases (56%) had a normal pattern of circle of Willis and variations were observed in the remaining 22 cases (44%). More number of variations was observed on the right side than on the left side. The most common variation observed was hypoplastic posterior communicating artery (7 cases, 31.8%). Posterior communicating artery was found to be the most variable vessel while middle cerebral artery was the least variable vessel.

136. Evaluation of Colonic Interposition and Lesions of Esophagus- Prospective and Retrospective Study
Kumari Rashmi, Vivekanand, Md. Sarfaraz Alam
Background and Objectives: Restoration of gastrointestinal tract continuity after destruction or removal of the esophagus may be accomplished by several methods, one of these being interposition of a segment of colon. Material and Methods: The Retrospective and prospective will be conducted in the Department of Surgery at PMCH Patna. Study duration of Two Years. The above table shows the distribution of patients according to presenting complains. 1 (3.3%) patient presented with liquid dysphagia, 23 (76.7%) patients presented with solid and liquid dysphagia and 6 (20.0%) patients presented with solid dysphagia. Majority of the patients had solid and liquid dysphagia. the distribution of patients according to diagnosis. 6 (20.0%) patients had carcinoma esophagus and 24 (80.0%) patients had esophageal strictures. Majority of the patients had esophageal strictures. Comparison of wound site infection. At 2 weeks, 2 (6.7%) patients had wound site infection, which was still present at 1 month and decreased to 1 (3.3%) at 3 months. After 3 months, none of the patients had wound site infection. Conclusion: The colon interposition is an alternative option for esophageal reconstruction when the stomach is unavailable the quality of life after colonic transposition compared at postoperative 1 month and 2 year using specially designed QOL questionnaire for coloplasty patients. Our disease specific questionnaire performs well in relation to previously published study which was used same questionnaire asses the quality of life. in post-coloplasty patients According to the selected colon graft (left or Right) route of reconstruction, direction of graft various surgical procedures can be considered for colonic reconstruction in present study left colic artery based left colonic graft is used. Regardless of the situation, blood supply of colon graft directly affect the outcome of the surgery.

137. A Forensic Study on Fingerprint Comparison Between Lucknow and Raebareli Population in India
Devendra Pal Singh
Background and Objectives: Restoration of gastrointestinal tract continuity after destruction or removal of the esophagus may be accomplished by several methods, one of these being interposition of a segment of colon. Material and Methods: The Retrospective and prospective will be conducted in the Department of Surgery at PMCH Patna. Study duration of Two Years. The above table shows the distribution of patients according to presenting complains. 1 (3.3%) patient presented with liquid dysphagia, 23 (76.7%) patients presented with solid and liquid dysphagia and 6 (20.0%) patients presented with solid dysphagia. Majority of the patients had solid and liquid dysphagia. the distribution of patients according to diagnosis. 6 (20.0%) patients had carcinoma esophagus and 24 (80.0%) patients had esophageal strictures. Majority of the patients had esophageal strictures. Comparison of wound site infection. At 2 weeks, 2 (6.7%) patients had wound site infection, which was still present at 1 month and decreased to 1 (3.3%) at 3 months. After 3 months, none of the patients had wound site infection. Conclusion: The colon interposition is an alternative option for esophageal reconstruction when the stomach is unavailable the quality of life after colonic transposition compared at postoperative 1 month and 2 year using specially designed QOL questionnaire for coloplasty patients. Our disease specific questionnaire performs well in relation to previously published study which was used same questionnaire asses the quality of life. in post-coloplasty patients According to the selected colon graft (left or Right) route of reconstruction, direction of graft various surgical procedures can be considered for colonic reconstruction in present study left colic artery based left colonic graft is used. Regardless of the situation, blood supply of colon graft directly affect the outcome of the surgery.

138. Retracted

139. Comparison of Airway Response and Early Versus Late Recovery Profile During Sevoflurane and Desflurane Administration Via Laryngeal Mask Airway for Maintenance of Anaesthesia
Santushti Vijay, Deepa Yadav, Aakriti Jaiswal, Sonal Shrivastava
Objective: The aim of our study was comparison of airway response and early versus late recovery profile during Sevoflurane and Desflurane administration via laryngeal mask airway for maintenance of anaesthesia. Methods: Prospective randomized controlled study, 56 ASA grade I or II patient, aged 19 – 60 years who were posted for minor surgical procedures were enrolled in the study from June 2015 to May 2016. Patients were divided in two groups– Desflurane – group D and – Sevoflurane – group S. Heart rate, Systolic blood pressure, Diastolic blood pressure, Oxygen Saturation, Respiratory rate were measured intraoperatively till the end of surgery (max 120 minutes). Incidence of respiratory events –coughing, breath holding and laryngospasm were recorded intraoperatively as well as in post operative period till the patient has achieved modified Aldrete score of 10. Results: All the demographic characteristics, ASA grading, baseline vital parameters were comparable in both the groups. There was no statistical difference in the mean arterial systolic blood pressure between the two groups. No significant difference is observed in respiratory rate at induction, intraoperatively and postoperatively among both the groups. There was no statistical difference after induction up to the end of the procedure in SpO2 between the groups. 1 patient had single emergent cough episode whereas 3 patients had multiple coughing episode at the time of emergence in Desflurane group. The time taken to open the eyes, to obey the verbal commands, the time taken for orientation and to achieve Modified Aldrete score 10 was shorter in the group which received Desflurane. The time taken to sit, to first oral intake, the time taken for standing and ambulate unassisted was again shorter in the group which received Desflurane than the group which received Sevoflurane which is statistically significant ( P value < 0.001). Conclusion: The emergence (eye opening, obey the verbal commands, orientation and Modified Aldrete score 10) from anaesthesia was faster following the administration of Desflurane compared to Sevoflurane. In the group which received Desflurane, the Aldrete score was higher on arrival at the time of emergence, and at 10 minutes of arrival in the ICU. The time taken to reach an Aldrete score of 9 was lower in the group which received Desflurane. Recovery in PACU (post anaesthesia care unit) – (sit, first oral intake, standing and ambulate unassisted) was faster following the administration of Desflurane compared to Sevoflurane.

140. Identifying Acute Appendicitis in Pediatric Patients using the Pediatric Appendicitis Scores in Subjects Visiting the Emergency Department with Acute Abdominal Pain
Vinayak J Shenage, Swati Jain, Shreeja D Nayak, Saurabh Borgaonkar, Girish R Shakuntal
Background: Acute appendicitis is one of the most common causes of acute abdominal pain in pediatric patients and needs immediate surgical management. It is usually assessed with PAS (pediatric appendicitis scores) to minimize radiation exposure in pediatric patients. The literature data is conflicting concerning the accuracy of PAS in assessing acute appendicitis in child subjects. Aim: The present study aimed to assess the diagnostic accuracy of PAS (pediatric appendicitis scores) in diagnosing acute appendicitis in pediatric patients visiting the emergency department with acute abdominal pain. Methods: The present study retrospectively assessed the institutional data of children in the age range of 4 years to 18 years having the clinical suspicion of acute appendicitis and presenting to the pediatric emergency department. Negative predictive value, positive predictive value, specificity, and sensitivity were used to assess the diagnostic accuracy of pediatric appendicitis scores. Results: in 52 child subjects, the mean age was 10.7±3.3 years. There were 75% (n=39) male and 25% female subjects. Moderate to high PAS scores of ≥4 was seen in 90.38% (n=47) cases and biopsy-proven appendicitis was reported in 98.07% (n=51) cases. The likelihood ratio for high, equivocal, and low-risk pediatric appendicitis scores was 2.51, 2.15, and 0.12 respectively. The positive predictive value, specificity, and sensitivity for equivocal PAS were 98.7%, 80%, and 96.6% respectively in the prediction of acute appendicitis. Conclusion: The present study concludes that pediatric appendicitis scores have high diagnostic accuracy in the prediction of acute appendicitis in pediatric patients visiting the emergency department with acute abdominal pain.

141. To Study the Different Infectious Etiology of Acute Febrile Encephalopathy in Children
Mahendra Kumar Pandey, Akshay Shukla, Swaroop Anand, Raghuveer Siddeshwar Anantpur
Background & Method: The aim of the study is to study the different infectious etiology of acute febrile encephalopathy in children. This is prospective study of the patients of age group 2 months to 12 years with acute febrile encephalopathy during of period of one year. All patients admitted with a clinical diagnosis of AFE were included if they satisfied the inclusion criteria. A total of sixty subjects were analyzed. Result: A male predominance was noted with ratio of 1.5:1. Conclusion: Our study in subjects of acute febrile encephalopathy has shown that viral encephalitis as the most common presentation followed by cerebral malaria. A male predominance was noted with ratio of 1.5:1.The majority of our patients made a complete recovery and a minor number of patients were also left with neurologic sequela. The cause for maximum morbidity was seen in patients with acute viral encephalitis, followed by pyogenic meningitis.

142. A Study on the Alternative Supportive Care Adopted By Breast Cancer Patients and Its Association with Socio-Demographic Characteristics: A Cross-Sectional Study in a Tertiary Care Centre, Gujrat
Akash Patel, Badal C. Bhandarkar, Tanvi Vyas, Kinner Patel, Arjun Kumar H. Jakasania
Background: The incidence of breast cancer is rising rapidly and risk factors associated with it. Medical and surgical methods are available to cure Breast cancer however; many patients turn to alternative supportive care before reaching to hospital or after experiencing the side effect of conventional breast cancer treatment. Objective: To study the various alternatives supportive cares adopted by breast cancer patients and its association with socio-demographical & patients characteristics in a tertiary care centre, Gujrat. Methodology: This was hospital based Cross-Sectional Study in the tertiary care cancer and research institute situated in Central Gujarat. 215 breast cancer patients were included in the study using Convenient Sampling method from the pool of patient visiting hospital for treatment over a year. Results: No evidence was found statistically significantly related to any addiction, occupational radiation or opportunistic infection among them. 82% patients suffer from various Co-morbid conditions like Hypertension, Diabetes etc. Among the study population 74(34.4%) breast cancer female adapted/ tried alternative supportive care. Conclusions: Nearly half of the patients were 41 to 50 years old and nearly 50% was illiterate. Co-morbid conditions like Hypertension, Diabetes etc. Less than 1/4th of patients do have family history of breast cancer among their near ones.

143. Incidence of Mesh Infection in Inguinal Hernia Surgery in Bidar Institute of Medical Sciences
Manjunath, Shrikant
Background: Mesh infection is considered as disturbing complication of sterile inguinal hernia surgery. This study was conducted to evaluate short-long term outcomes ensuring mesh infection treatment in inguinal hernia surgery. Methods: This study is single-cantered retrospective study that involves all those patients who had incidence of mesh infection in inguinal hernia surgery. Study has been conducted in one year from January 2022 to January 2023. Characteristics of mesh infection, demographics of patients, surgery features, microbiology, follow-up data and short-long term outcomes were studied. Results: Total 100 patients (10 women, 90 men with mean age of 13-82 and BMI of 24.6 were selected for the incidence of mesh infection. Almost 60 patients undergo complete infected mesh removal and 50 patients undergo partial removal. In 10 patients minor wound infection has been developed during short-term follow-up. Similarly, 30 patients had developed seromas and almost 4 patients had developed hematomas. 10 months of mean follow-up has also been conducted in which almost 5 patients had developed hernia recurrence, 22 patients had developed recurrent infection needed reoperation in the partial removal of mesh and 2 patients had developed chronic pain. Conclusion: The result of mesh infection after inguinal hernia repair treated with mesh removal is satisfactory. Systematic individualized treatment by experienced professionals based on the patient’s previous repair technique, implanted mesh, and physical condition is recommended.

144. Clinical Profile and Outcome of Newborns with Hypoxic Ischemic Encephalopathy in a Teaching Hospital of Bihar
Amrit Raj, Nupur Kumari, Alka Singh
Introduction: Perinatal asphyxia is a serious condition in neonatology which has a significant effect on neonatal morbidity and mortality. It affects the neurological and intellectual development of the infant. Hypoxia refers to a decrease in oxygen supply to cells or organs, while ischemia is insufficient blood flow to maintain normal function. Hypoxic-ischemic encephalopathy (HIE) is a condition that can cause permanent damage to the central nervous system. It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to study the clinical profile and, immediate outcome of perinatal asphyxia in Nalanda Medical College and Hospital, Patna, Bihar, India. Methods: It was a prospective case controlled study involving 80 neonates as case and 45 as control fulfilling the inclusion criteria conducted during June 2022 to May 2023. Inclusion criteria included new-borns with: a) APGAR score equal to or less than seven at five minutes, b) requirement of more than one minute of positive pressure ventilation. Results: Out of total 125 neonatal intensive care unit (NICU) admissions, 80 (64%) cases were of perinatal asphyxia, 56 inborn and 24 referred cases. The rest 45 babies served as controls. Of those 80 cases, HIE stage I had good outcome with survival rate of 95% and HIE stage III had poor outcome with survival rate of only 30%. Mean urinary output was less in cases as compared to controls. Out of 80 asphyxiated babies 33 developed acute renal failure (ARF) of which predominant type was oliguric type ARF. Out of 33, 10 babies died ( 8 oliguric and 2 non-oliguric renal failure). Conclusion: Acute renal failure was common in asphyxiated babies its incidence being 41% and incidence of ARF increases with severity of asphyxia. Majority of ARF cases were of oliguric type thus showing correlation between asphyxia and type of renal failure.

145. A Study to Observe the Effects of Addition of Intrathecal Magnesium Sulfate to Bupivacaine for Spinal Anesthesia in Cesarean Section
Nirali H Prajapati, Priyanka Chaudhari, Sujata R Chaudhary, Richa Gupta
Background and Aim: Spinal anaesthesia is widely used for caesarean section. Magnesium parenterally has been utilized for intraoperative and postoperative analgesia on an empirical basis for a long time. The present study was designed to examine whether addition of intrathecal magnesium sulphate would enhance the analgesic efficacy of intrathecal bupivacaine in patients undergoing caesarean section. Material and Methods: The present analysis was done in the department of gynaecology in association with the department of anaesthesiology, in the medical college and associated hospital. A total of 80 pregnant women with mild PIH and were scheduled for elective caesarean section were included in the study. They include patients were divided into three groups randomly as follows: Group A: Control group comprised of 40 patients, the patients were administered with 0.5% 2cc (10mg) Bupivacaine + 0.6cc normal saline and Group B: Test group patients comprised of 40 patients, the patients were administered with MgSO4 group, 0.5% 2cc Bupivacaine +0.5cc Fentanyl along with 0.1cc 50% (50mg) MgSO4. The onset of sensory blockade, motor blockade, upper level of analgesia, intensity of motor block, two segment regression time, APGAR Score, Postoperative analgesia duration and hemodynamic parameters at 1, 5, 15 minutes were observed. Results: The mean time to achieve T10 sensory level in group B was found to be 3.20 ± 0.20 min and in group A that is control group was found to be 2.1 ± 0.90 min and the difference was found to be statistically significant. Onset of motor block was prolonged in group B (6.16 ± 0.06 min) as compared to group A. Total duration of sensory block was more in group B, which was found to be 200.5 ± 11.22 min and that was when compared to group A (160.5 ± 16.36) min it was found to be significantly higher in group B. Conclusion: Non-opioid medication magnesium sulphate can be used as an adjuvant with bupivacaine intrathecally to prolong postoperative analgesia without causing any additional side effects. The patient will benefit from this for post-operative analgesia.

146. The Role of Autologous Platelet Rich Plasma in Treatment of Chronic Non Healing Diabetic Foot Ulcers
D. Vidhyabharathi, L. Surendran, P. Sumathi
Introduction: Chronic ulcers are a major health problem worldwide and have great impact at personal, professional and social levels, with high cost in terms of human and material resources. Application of autologous Platelet Rich Plasma (PRP) has been a major breakthrough for the treatment of non-healing and diabetic foot ulcers, as it is an easy and cost-effective method, and provides the necessary growth factors that enhance tissue healing. To study the role of effectiveness of autologous platelet rich plasma in healing of chronic ulcers. Also to study the percentage of reduction of area of the ulcer. Methods: Patients admitted in surgery ward for chronic ulcer were studied. Individuals with systemic disease or history of anticoagulant, immunosuppressive, pregnant women, patients with severe cardiovascular disorder, bleeding disorder and anemia were excluded. Detailed history, clinical examination and lab investigations were taken and analyzed. Autologous platelet rich plasma was prepared from the patients and was applied to the ulcer and regular dressings were done. Wound area was calculated. The treatment outcome was defined as a percentage change of the area, which was calculated as initial measurement minus assessment day measurement divided by initial measurement. Conclusion: 50 cases were studied. Various factors like age group, gender, etiology of the ulcer, percentage change of area of the ulcer is calculated and found that autologous platelet rich plasma is effective in healing of chronic ulcers. The mean percentage area of reduction of ulcer in the study is 79.33%, which is a very significant reduction in the area of the ulcer.

147. An Examination of the Link between Maternal Serum Zinc Levels and Fetal Congenital Malformations at a Tertiary Care Hospital in the Erode District
R. Sathya, A. Gayathri, R. Renju, Revathi. A, Panneerselvam Periasamy
Background: Pregnant women frequently experience zinc insufficiency, particularly during the third trimester. However, there is inadequate information on the relationship between zinc deficiency and congenital abnormalities in Indian population. Therefore, the purpose of this study was to ascertain whether serious congenital abnormalities in babies are related to maternal serum zinc insufficiency. Methods: This descriptive, case–control study involved mothers of 50 neonates with congenital anomalies on serum zinc levels of mothers who gave birth to babies with clinically apparent congenital malformations was undertaken at Government erode medical College Hospital, Perundurai during the period 2022-2023. During the same period, serum zinc was measured in 50 mothers who had delivered normal new-borns without congenital malformations (control group). Results: Study group and control group, majority of the patients were in the 21.25 and 26-30 yrs age groups Mothers. In the study group 60% of babies were males and 40% of babies were females. In the control group 52% of babies were males and 48% of babies were females. The mean serum zinc level in the study group was 44.95 µg/dl (SD 14.4). Mean serum zinc level in the control group was 86.43 µg/dl (SD 7.88). There is statistically significant difference in the zinc level between the two groups (P value < 0.001). In study group mean serum zinc level in primi 50.64 (SD 13.2) multi 40.46 (SD 14.84). In control group primi 85.33 (SD 7.6) multi 87.44 (SD 8.09). The lowest value of maternal serum zinc was found with hydrocephalus (20.1 µg/dl) and highest value 78.82 with polydactyl. Conclusions: This study throws light on the fact that lower maternal serum zinc levels may be an associated factor in the pathogenesis of congenital malformations, especially of the central nervous system. Low zinc levels during conception or during early embryogenesis may operate as a cause of congenital malformations. Hence zinc supplementation may be started in early pregnancy or preconceptional period as prophylaxis.

148. Intrathecal Morphine versus Fascia Iliaca Compartment Block for Post Operative Pain Control in Femur Fracture: A Randomised Controlled Prospective Study
Madhusmita Patro, Swastika Swaro, Sushree Das, Prerna Biswal, Namrata Narayan, Nupur Moda
Background: Fracture femur leads to considerable pre and post-operative pain which is one of the most common medical causes of delayed recovery and discharge [1]. Optimal pain control not only decrease complications but also facilitates faster recovery during the immediate postoperative period. Fascia iliaca compartment block (FICB) is a regional block of lumbar plexus which is an alternative to central neural block and can provide adequate unilateral analgesia with fewer adverse effects. Hence we conducted the study to compare the efficacy of FICB to that of Intrathecal Morphine administration in fracture femur cases with regards to the duration of analgesia, patient satisfaction and side effect profiles. Material and Method: The study is a prospective, randomized, double blinded study. 80 patients were divided into 2 groups. Group ITM (Group A) received 0.5% Bupivacaine (heavy) with 150 mcg of morphine as an adjuvant after CSF aspiration, then patient was made to lie in supine position. Group FICB (Group B) -patients received spinal anaesthesia with 3ml of 0.5% Bupivacaine (heavy) and later facia iliaca block was given with USG guidance after confirmation of correct needle position, with 20ml of 0.5% Bupivacaine and 20ml of 2% xylocaine with adrenaline. Patients were monitored for post-operative pain scores, tramadol consumption, vital parameters including heart rate, blood pressure, oxygen saturation and adverse effects like nausea vomiting, itching, respiratory depression and sedation at 1,2,4,6,12 and 24 hrs. Results: The mean NRS score at 1,2 and 4 hours were not statistically significant and had nearly equal NRS score. However at 6, 12 and 24 hour the mean NRS score was statistically significant and lower in group A than in Group B. The mean time to first rescue analgesia in Group A was 18.75±1.81 hrs and in Group B 10.53±1.54 hrs (p=0.000) which was statistically significant. The overall patient satisfaction score at 12 hours and 24 hours postoperatively was found to be considerably higher in Group B than in Group A (p=0.000). Conclusion: Intrathecal morphine in spinal anaesthesia provided prolonged duration of analgesia up to 24 hours as compared to USG guided (FICB) fascia iliaca compartment block in patients undergoing femur fracture surgery with few side effects.

149. Comparative Study between Staplers V/S Subcuticuticular Suture for Wound Closure after Thyroidectomy
Aditya Gargava, Priyanka Verma, Amrita Shukla, Ashish Upadhyay
Aim: To Compare Staplers vs subcuticular suture methods for wound closure after thyroidectomy. Material & Methods: The Study was randomised Prospective conducted on 90 patients by the Department of Otorhinolaryngology ABVGMC Vidisha M.P. from January 2022 to July 2023. Total 90 patients was randomly allocated into two groups with 45 patients in each groups, both groups went into thyroidectomy followed by use of staplers in one group & another one subcuticular suture for skin closure. Drain was placed in all cases. Patients were given IV antibiotics for 7-10 days followed by removal sutures and staplers. Results: Postoperative pain score at discharge was least in subcuticular group followed by stapler group, though statistically there was no difference. Cosmetically subcuticular group shows excellent result as compare to stapler group. Mean time for closure of skin was less in stapler group. Conclusion: The choice of material for wound closure will depends on the surgeon’s preferences. However this study shows that subcuticular suturing method were more acceptable method for wound closure.

150. A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy with or without Stent Placement: A Prospective Study on 50 Cases at Tertiary Centre
Priyanka Verma, Aditya Gargava, Nikhila Yadav, Yogendra Narwariya
Objectives: Comparison of the surgical outcome of Endoscopic Endonasal Dacryocystorhinostomy (DCR) with stent & without stent. Results were evaluated objectively. Material & Methods: A Prospective categorical study included 50 adults between age group 18-60 years with epiphora, randomly divided into two groups. (Group A) DCR with stent & (Group B) DCR without stent. Results: Surgical result of the success rate were statistically insignificant between the two groups furthermore the use of stents was found to be associated with complications mainly granulation tissue formation. Conclusion: Endoscopic Endonasal DCR without stent placement is the treatment of choice in chronic dacryocystorhinostomy because DCR with stent causes persistently discomfort and complications.

151. Endoscopic Sinus Surgery for Sinonasal Polyposis: A Comparative Study Microdebrider Assisted Fess V/S Conventional Fess
Priyanka Verma, Aditya Gargava, Meenakshi Garg, Ashish Upadhyay
Objective: To study & compare the benefits of microdebrider- assisted FESS VS conventional FESS in terms of subjective as well as objective improvement in symptoms of nasal polyposis. Material & Methods: This study involves total 150 patients with bilateral nasal polyp scheduled to undergo FESS. The patients were randomized into two groups: Group A- Conventional FESS and Group B- Microdebrider-assisted FESS. Results: In our Study male found to be predominant with age distribution of the patients ranged from 13 to 50 years. Conclusion: we can achieve good postoperative results in both groups provided a well skilled & trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal trauma & regular follow up.

152. To Compare the Efficacy of Topical Platelets Rich Plasma (PRP) in Myringoplasty
Priyanka Verma, Aditya Gargava, Yogendre Narvaria, Ashish Upadhyay
Aim: To analyse the use of autologous platelets rich plasma (PRP) in myringoplasty so as to improve graft uptake & beneficial on hearing. Objective: To compare graft uptake percentage & hearing improvement between conventional myringoplasty & myringoplasty using PRP. Methodology: Total 50 patients diagnosed with COM (inactive mucosal type) randomly divided into case &control with 25 patients in each group. Case (myringoplasty using PRP) & control myringoplasty without PRP. Postoperative graft uptake status & pre-post-operative PTA were performed in all the patients & outcome was compared. Results: 25 patients in each group. 2 patients in case study & 4 in control group had residual perforation, i.e 92% & 84% graft uptake in case & control group respectively. Results were better in cases that underwent myringoplasty with PRP. Hearing improvement (>10db) were seen 84% in case group & 72% in control group. Conclusion: The study shows definite clinical benefit using PRP. PRP can be routinely use in surgical field, as it can be easily prepared has minimal or no side effects.

153. Comparison of Causes of Infective and Non-Infective Epistaxis in Andhra Population
Pradeep Devineni, Akkineni Sivaram
Background: Epistaxis is a quite common otolarangyngological emergency, affecting 60% of people in their lifetime globally, but 6% require medical attention because it may be due to infection or trauma. Method: 50 patients with epistaxis aged between 10 to 55 years old were studied, serum electrolytes, Urea, Creatinine, Urine routine examination, Blood group, Coagulation profile, and CT PNS were done, if there was a need in selected patients to rule out neoplasms of the nose, PNS, and nasopharynx. Moreover, a chest-x-ray, ECG was performed for the fitness procedure required for general anaesthesia. Results: In the clinical manifestations, 17 (34%) were idiopathic, 10 (20%) were trauma, 7 (14%) were rhinitis, 8 (16%) were HTN/Atherosclerosis, 1 (2%) were tumours, 1 (2%) were iatrogenic, 2 (4%) were foreign bodies, 1 (2%) were blood dyscrasia (Dianz manns thrombo-haemophilia), 1 (2%) were congenital heart disease, 2 (4%) were Out of 50 patients, 33 (66%) had infective epistaxis and 17 (34%) had non-infective epistaxis. 30 (60%) had infective bleeding, and 20 (40%) had non-infective bleeding. Conclusion: In the present pragmatic study, it is concluded that, infectious epistaxis and infective bleeding epistaxis are comparatively more common than non-infective epistaxis; hence, epistaxis patients must approach ENT surgeon to prevent further complications as infection may spread to the meninges and brain.

154. Study of Nerve Conduction Velocity in Type-2 Diabetic Patients with Neuropathy in Tamil Nadu Population
Prathusha Nerella, Namanandi Ashwini, Alekhya Vempati
Background: Neuropathy in Type -2 diabetic patients mainly causes sensory symptoms and signs of nerve dysfunction which are more subjective. Hence, a neuro-physiological study has to be done to study the pathophysiology, severity and prognosis of neuropathy in these patients. Method: 95 patients diagnosed with Type-2 DM of duration more than 1 year to more than five years were studied. Electro-physiological tests were done for measuring NCV and SNAP of median, peroneal and sural nerves. These tests were carried out using the EMG/NCV/EP ALERON 202 channel machine. Results: In each nerve, NCV and SNAP values were higher in newly diagnosed patients and diabetic patients of 1 year duration and quite less in those diagnosed with more than 5 years duration. Conclusion: The present parameters of NCV and SNAP will help the physician, endocrinologist, and neurophysician predict the prognosis of nerve dysfunction in Type -2 Diabetes patients and treat them efficiently to avoid mortality and morbidity among those patients.

155. Comparison of Three Doses of Tramadol as Adjuvant to Bupivacaine for Caudal Analgesia in Paediatric Hypospadias Repair Surgery
Yogesh Kumar Aggarwal, Neelu Sharma, Rajkumar Harshwal, Jitendra Kumar Yadav, Hemant Singh Rajawat, Subrat Agarwal
Introduction: Bupivacaine is a commonly used long acting, local anaesthetic agent for Caudal epidural block in paediatric population for providing post-operative analgesia. However use of bupivacaine as a single shot administration provides post-operative analgesia for a shorter duration. This study aimed to compare different dose of tramadol, as an adjunct to bupivacaine caudal epidural block in children undergoing elective hypospadiasis repair surgery. Material and Methods: This hospital based, randomized, double blind, controlled clinical study included 80 male pediatric patients between 2 years to 8 years of age, with ASA I or II undergoing elective hypospadias repair surgery (Urethroplasty). Patients were randomized to 4 groups (N=20) – Group B (1ml/kg 0.25% bupivacaine), Group BT1 (bupivacaine with 1mg/kg tramadol), Group BT2 (bupivacaine with 1.5mg/kg tramadol) and Group BT3 (bupivacaine with 2mg/kg tramadol) by caudal block. Duration of analgesia was defined as the time from administration of block till the time, the Objective pain score (OPS) reached 4 or the child complained of pain. Results: The duration of analgesia was significantly longer in group BT3 (705.8 min) as compared to Group BT2 (632.65 min), BT1 (474.05 min) and B group (236.10 min). Additional analgesic requirement in 24 hours showed dose dependent reduction with tramadol. No significant difference was seen in motor blockage or sedation score among the study groups. Post operative OPS score was significantly lower with increasing dose of tramadol. No significant difference was seen in incidence of vomiting or hemodynamic parameters. Conclusion: Tramadol showed dose dependent prolongation of duration of analgesia in pediatric hypospadiasis surgery, without any increase in incidence of adverse effects.

156. Association of Diabetes Mellitus with Hypertension, in Rural Population in Meerut, Uttar Pradesh, India
Rijul R, Girjesh Y
Background: Diabetes is the serious public health problem in all the countries but majorly in developing countries. The prevalence of diabetes is showing an upward trend in most countries. The prevalence of diabetes is rapidly rising in rural population. Also there is paucity of data regarding Diabetes Mellitus in rural Meerut. Aims & Objective: To study the prevalence of Diabetes Mellitus and associated factors with Diabetes Mellitus. Material & Method: A cross-sectional study was done by taking the prevalence of diabetes mellitus 13% in persons age 30 years & above by various studies & relative precision 20% the sample size come out to be 642, total subjects studied were 700 for uniform coverage in villages selected by systematic random sampling, fasting blood sugar was done to estimate the prevalence of diabetes. Rest of the information was collected on Predesigned and pretested questionnaire. Results: the prevalence of diabetes were found to be 11.7% in persons aged 30 years & above in rural population of Meerut. The prevalence of diabetes was found to be significantly associated with hypertension, coronary heart disease, and dietary habits, fat consumed. Conclusions: The diabetes mellitus is a significant health problem after 40 years of age in rural population.

157. A Cross Sectional Study on Health Profile of Fishing Community in Andaman and Nicobar Islands
Deepak Kumar, Sharmendra Singh, Akhilesh Kumar Singh, Mohd. Amir Ansari
Background and Aim: Fishing is a dangerous occupation, in which fishermen are exposed to health risks both on and offshore. Due to the unique geography and demography of the Andaman and Nicobar islands, there is a lack of in-depth understanding of health issues affecting people associated with fishing in the island. Hence, present study was done to understand health profile of fishermen and demographic factors associated with it. Materials and Methods: A cross-sectional study was conducted among 150 fishermen of Junglighat fishing colony, South Andaman district. The per-designed and per-validated questionnaire was used for collecting data about the health profile of fishermen. Descriptive statistics and Chi-square/Fisher Exact test were used for statistical analysis. Results: The behavioral risk factors like use of tobacco products, alcohol were present in 28.6 % and 28.0% fishermen respectively whereas 82.6% fishermen had exposure to intense sunlight, 37.3% had exposure to loud noise. NCDs like overweight/obesity (50.7%), hypertension (28%), diabetes (18%) were quite prevalent among fishermen. Eye diseases and skin diseases were also prevalent among fishermen. Fishermen (90.7%) mainly preferred nearby tertiary care government hospital for seeking treatment of their illness. Conclusions: The fishermen face various challenges and risks for good health. The common health problems found among fishermen were hypertension, obesity, diabetes, injuries, skin and eye diseases. Fishermen should be provided health education for adoption of healthy lifestyle to prevent NCDs. Fishermen should be provided health safety devices along with training to prevent various occupational hazards.

158. To Study the Level of Serum Cholesterol after the Surgical Stress
Chandrakala Dutt, R. D. Dutt, Tarushi Dutt, Jayendra Arya
Introduction: Stress in the Biological sense is the interaction between damage & defense. Anything that causes stress endangers life unless it is counteracted by adequate adoptive response. Conversely anything endangers life causes stress and adaptive responses. Adaptability and resistance to stress are fundamental requisites for life and very vital organ and function participate in them. Aims: To assess the preoperative value of serum cholesterol in different elective surgical operations. Methodology: This study was done in surgical department of J.A. Group of Hospitals from May 2019 to April 2021. In study 40 normal subjects were taken for serum cholesterol estimation. Serum cholesterol was estimated in 100 patients who were taken for various surgeries in respect of age, sex, and social status. The patients were categorized under three groups, group A – patient who underwent operation lasting for 1/2 an hour or less, group B – those with operations lasting between half an hour to 1½ hour, group C – operations lasting for more than 1½ hour. Results: Serum cholesterol value in normal healthy individuals was ranged from 124 to 240. Serum cholesterol level falls to its maximum on the first postoperative day in all cases of group A, B and C except 3 cases in group C in which maximum fall was observed on 3rd postoperative day. Conclusion: The more the surgical stress slower was the recovery.

159. Prescription Auditing at a Tertiary Care Teaching Hospital of Western Odisha: A Cross-Sectional Study
Khushbu Agrawal, Sachchidanand Pandey, Bhabagrahi Rath
Prescription audit is one of the important tools to assess drug utilisation and rationality of prescription which can facilitate improvement in the quality of health care provided. Irrational prescribing is a global problem and in developing country like India, inappropriate use of drugs can lead to ill-effects on health and health-care expenditure. To promote rational drug use, standard policies on use of drugs must be set and this can be done only when the current prescription practices are audited. This cross-sectional study was carried out over a period of three months (June 2017 to Aug 2017) in various outpatient departments of our teaching hospital. 900 prescriptions were selected randomly and analysed using WHO prescribing indicators and Odisha state ‘Niramaya’ guidelines. Total drug prescribed were 3471. Average number of drugs per prescription was 3.8. 77.4% of total drugs were prescribed by generic name. 62.8% of prescription had an antibiotic prescribed among which 6.8% of prescriptions had two or more antibiotics. The number of injectable prescribed was 9% in this study. 74.6% of drugs were from EDL. 63.8% of drugs were dispensed from our free-drug dispensing hospital pharmacy (Niramaya) counters and 32.6% of drugs were purchased from outside. 88.8% of prescriptions had the diagnosis of the disease and 95.8% of prescriptions were complete in terms of drugs having required strength, dose, frequency, and route of administration. Only 0.4 % of prescriptions had the full name of the prescriber. Positive aspects were significant use of drugs in generic names (77.4%), satisfactory usage of drugs from EDL (74.6%), high rates of prescriptions with diagnosis mentioned (88.8%) and also completeness of prescriptions as regards the mention of strength, dose, frequency and route of administration (95.8%). However, the negative aspects that need improvement are polytherapy (3.8 drugs per prescription) and high prescription of antibiotics (62.8%).

160. Leflunomide versus Methotrexate and Hydroxychloroquine Combination Therapy in Rheumatoid Arthritis: A Prospective Study on Effectiveness and Quality of Life
Acharya Tonima, Pandey Sachchidanand, Tripathy Sagnika, Rath Bhabagrahi
Introduction: Several newer drugs are available for rheumatoid arthritis including leflunomide (LEF). Comparative studies of treatment with LEF (against methotrexate) report a better quality of life. With this background we have conducted this study to evaluate and compare the effectiveness of drugs leflunomide (LEF) with combination therapy of methotrexate (MTX) and hydroxychloroquine (HCQS) in treatment of patients suffering with rheumatoid arthritis (RA). Methodology: This was a prospective, observational and comparative study in the Department of Medicine, VIMSAR, Burla. Patients diagnosed with RA as per ACR-EULAR criteria aged >14yrs were conventionally sampled to receive leflunomide (20mg/day P.O) or a combination of methotrexate and hydroxychloroquine (7.5 mg/week P.O and 200 mg/day P.O respectively) with folate supplementation for 12weeks. The EULAR criteria of improvement according to DAS28 score was considered as primary efficacy variable. Baseline and end of study values were evaluated. The total study period was of 2 years. Results: When DAS28 was compared between the two groups it was insignificant at baseline, 6 weeks and 12 weeks with a P-value 0.47, 0.91 and 0.86 respectively suggesting that both the groups were comparable throughout the study. Statistical analysis: The data were analysed with Chi-square test, unpaired-t test and one way ANOVA. Values were expressed as numbers, percentages and mean ± SD. ANOVA was used to analyse the variables within the group and unpaired-t test to find the difference between the two groups. Conclusion: LEF was found to have equal efficacy as the combination of MTX+HCQS in reducing DAS28 score with similar safety profile during our study and so may be considered as an initial therapy in active RA.

161. Profile of Acute Encephalitis Syndrome and Japanese Encephalitis in Dibrugarh District of Assam, India
Dutta R K, Mahanta B, Mahanta T G
Background: Acute encephalitis syndrome (AES) and JE is a significant public health problem in India and around the world. The name Acute Encephalitis Syndrome (AES) is used by the National Vector Borne Disease Control Programme to facilitate diagnosis and surveillance. This study was an attempt to determine the status and trends of AES and JE in Dibrugarh, Assam. Methods: IDSP routinely collects and analyses disease data from a number of reporting units. The data for the study was obtained from the IDSP section of the District Health Service in Dibrugarh, Assam. Results: There was a mixed pattern in encephalitis cases during the research period. The number of AES deaths was found to be highest in 2013 (17.7% of total cases), followed by 2017 (14.9%), 2012, 2014, and 2018, and lowest in 2010 (7.3%). The average annual AES and JE CFRs were 17.6% and 26.2%, which is in accordance with global fatality rate of 20 to 30%. Among the patients with AES, 36.2% were found positive for JE. The most commonly affected age group is 31-60 years for both AES and JE, closely followed by the age group of 16-30 years. Among the AES‑affected patients 60.3% were males and 39.6% were females. Conclusion: The study showed a high JE positivity amongst AES cases but with a declining trend over the years. It also highlighted on the association of JE with different parameters such as age, sex etc. Japanese encephalitis continued to occur in this part of India, although at lower levels as compared to high-endemic regions. The national programme activities including surveillance, management and vaccination need to positively consider strengthening efforts for monitoring and consider evaluating the need for the expansion of vaccination to new areas that reported cases recently.

162. Morphometric Measurements of Lateral Femoral Cutaneous Nerve and it’s Clinical Significance
Aparna Vedapriya, Shabana Sultana, K. Sangeetha, Amrutha Roopa Ramagalla
Introduction: The lateral aspect of the thigh is supplied by the lateral femoral cutaneous nerve (L2–3). This arises directly from the lumbar plexus and enters the thigh usually by passing deep to the inguinal ligament. Occasionally, the nerve pierces the ligament and may then be pressed upon by it with resultant pain and anaesthesia over the upper outer thigh (meralgia paraesthetica). This is relieved by dividing the deeper fasciculus of the inguinal ligament where the nerve passes over it. (Clinical Anatomy sunny books Harold Ellis). Aim: The aim of the study was to determine the anatomical course of the lateral femoral cutaneous nerve (LFCN) and measurement of the trunk from inguinal ligament to its branches in relation to certain anatomic landmarks in human cadavers. Methods: This study was performed on 50 thighs from 25 cadavers with no detectable malformations in the Department of Anatomy, Government Medical College, Siddipet, Telangana State, India by dissection method. The LFCN position was evaluated according to its relation to the anterior superior iliac spine and its distance from the Sartorius were measured along the inguinal ligament (IL). The anatomical data were collected and analysed. Results: Out of 25 human cadavers, the trunk measurement was ranging from 1cm to 5 cm below inguinal ligament and the measurement of trunk in the right and left limb were different in the same cadaver. In none of the cadavers it was piercing the inguinal ligament. Conclusion: The anatomical variations of the LFCN has been viewed with meticulous care while dissecting the cadavers. The results of this study on the morphological features and variations of the LFCN in human cadavers provide understanding of its variability for further studies in the region. The purpose of this study was to evaluate the outcome of surgical decompression of the LFCN for the treatment of persistent MP with preservation of sensation along the distribution of the LFCN and conserving this nerve for various surgical procedures like anterior approach of hip replacement surgery etc.

163. Clinical Profile of Secondary Glaucoma in Tertiary Care Centre in Western Odisha
Kanhei Charan Tudu, Bikash Ranjan Nayak, Pramod Kumar Sharma, Sharmistha Behera
Background: Secondary glaucoma is caused by underlying systemic or ocular disorders. The purpose of this investigation was to examine the clinical profile of patients with secondary glaucoma and the different management strategies for these secondary glaucomas in a hospital in western Odisha. Methods: This two-year cross-sectional observational study was conducted between October 2020 and November 2022. After receiving informed consent, 57 cases of secondary glaucoma affecting outpatients were included in the study. Evaluation consisted of BCVA, IOP, slit lamp examination, gonioscopy, and medical management. Results: Seventeen percent of the 322 patients diagnosed with glaucoma or suspected of having glaucoma had secondary glaucoma. The most prevalent cause was lens-induced glaucoma (25 cases, 43%), followed by post-traumatic glaucoma (10 cases, 18%), pseudophakic (6 cases, 11%), aphakic (5), steroid-induced (4), uveitic (4), and neovascular glaucoma (3 cases, 5%). Conclusion: The causes of secondary glaucoma are diverse, and the majority of patients present late with impaired vision, elevated intraocular pressure, and even glaucomatous optic atrophy. In order to prevent secondary glaucoma-related blindness, it is essential to identify and address the causes promptly.

164. Management of Secondary Glaucoma in Tertiary Care Centre in Western Odisha
Kanhei Charan Tudu, Pramod Kumar Sharma, Bikash Ranjan Nayak, Sharmistha Behera
Background: Glaucoma’s characterized by secondary angle closure differ from glaucomas characterised by primary angle closure (PACG). In contrast to primary angle closure glaucoma, secondary angle closure glaucoma is characterised by identifiable contributory factors for angle closure and obstruction of aqueous flow, which are typically unaffected by iridotomy. Each type of secondary angle closure glaucoma is managed differently; therefore, diagnosing the underlying cause is essential for its effective treatment. This study’s objective was to assess the significance of these management plans. Methods: This investigation was conducted between March 2021 and April 2023 at the Department of Ophthalmology, VSSIMSAR, Burla, Sambalpur, Odisha. All patients who visited the glaucoma clinic were enrolled in this investigation, their glaucoma was classified, and the appropriate treatment was initiated to achieve the 15 mmHg target pressure. Findings: 212 patients were examined in total. The number of male patients was greater than that of female patients by 66.04 percent. Among secondary glaucomas, inflammatory glaucomas were the most prevalent, constituting 28.30% of all cases. The age cohort between 51 and 60 years represented 28.30% of all primary glaucoma cases. Oral and intravenous hyperosmotic drugs were administered, along with topical B blockers, miotics, sympathomimetic, prostaglandin analogues, hyperosmotic drugs and steroids. Trabeculectomy was the most prevalent surgical option for controlling intraocular pressure. Yag laser iridotomies were also performed when necessary. Control of intraocular pressure and visual outcome is quite satisfactory following treatment. Conclusion: The most prevalent cause of secondary glaucoma is inflammatory glaucoma. They could be effectively managed if they were timely. In addition to steroids, medical antiglaucoma therapy serves an important role in the treatment of glaucoma. Trabeculectomy is highly efficacious in cases of resistance.

165. A Comparative Study of Surgical Outcome in Patients of Perforation Peritonitis with or Without Preoperative Drain Insertion
Shourabh Sinha, Amandeep Singh, Arzoo, Sudhir Khichi, Haramritpal Kaur, Navkiran Kaur, Sunandan Singla
Background: The aim of this study was to assess the role of primary peritoneal drainage (PPD) in patients of perforation peritonitis, who were unfit for general anaesthesia (GA) prior to exploratory laparotomy and definitive procedure. Furthermore to evaluate its role in patient survival and complication prevention. Method: It is a prospective comparative study done on 60 patients with confirmed diagnosis of perforation peritonitis at tertiary care hospital. Patients were divided into two groups of 30 each as per inclusion and exclusion criteria. Study group was subjected to PPD under local anaesthesia. Result: In the present study the average age of patients was 39.1 years. The male to female ratio was 4.5:1. The most affected site was ileum (42%). Postoperative complications like SSI, wound dehiscence, drain site infection with the use of PPD was though lesser as compared to without PPD, but it was statistically insignificant. Overall mortality rate was 27%, whereas with PPD it was 13% and 20% without it. Post-operative hospital stay was more or less the same in both the groups. Conclusion: Use of PPD under LA in patients of perforation peritonitis is a low cost intervention not requiring higher degree of surgical expertise. It can be used prior to definitive exploratory laparotomy for hemodynamic stabilization and resuscitation of sick patients who would not tolerate GA. Though use of PPD is not a definitive alternative to standard surgical procedure but it provides surgeon with a prospect to stabilize critically ill patient by draining the toxic fluid. Its can find extensive applicability resource deficient country.

166. Outcome Analysis of Spreader Graft Vs Autospreader Flaps in Patients with Deviated Nose Undergoing Open Septorhinoplasty
Anandita Das
Introduction: The spreader graft is a valuable tool in any rhinoplasty surgeon’s armamentarium. There are innumerable studies, demonstrating its value in the restoration of nasal dorsal aesthetics, helping in the maintaining of patency of the internal nasal valve, and also maintaining the straightened position of the corrected dorsal cartilaginous septum in crooked noses. This study compares the insertion of spreader grafts vs auto spreader flaps in patients undergoing open septorhinoplasty. Objective: To compare the efficacy of mid- vault reconstruction technique (spreader graft vs autospreader flap) in open septorhinoplasty cases done for crooked nose. Design: A prospective observational study of patients undergoing septorhinoplasty, whose mid vault was reconstructed using (1) spreader grafts, or (2) auto spreader flaps. Preoperative and postoperative results were evaluated using a detailed questionnaire and diagnostic nasal endoscopy. Results: Ten patients completed preoperative and postoperative evaluation. No complications occurred in any of the patients. 7 patients were inserted with spreader grafts while only 3 patients were treated with autospreader flaps. In terms of aesthetic and functional outcomes in the first category, 5 and 6 patients were highly satisfied, 1 and nil was partially satisfied and 1 and 1 patients were not satisfied respectively. For the second category 1 and 2 patients were highly satisfied, nil and nil patients were partially satisfied and nil and 1 patients were not satisfied respectively. Conclusions: Midvault reconstruction using the spreader graft or auto spreader flaps helps prevent postoperative nasal obstruction. On comparing both these techniques it was seen that there was no significant difference in the aesthetic and functional outcome.

167. To Study the Association of Abnormal Fetal Rate Patterns and Meconium Stained Liquor with Umbilical Cord Artery Ph at Birth and its Clinical Application in Obstetric Unit
Neelam Toshniwal, Sushma Mogri, Sushil Gupta, Akshay Toshniwal
Introduction: Umbilical cord artery blood pH analysis provides important information about newborn’s biochemical status prior to delivery. Aims and Objectives: To evaluate association between abnormal fetal heart rate patterns (FHR) and meconium stained liquor (MSL) with umbilical cord artery blood pH at birth and its clinical application in obstetric unit. Material and Method: The observational prospective study, carried out in the Department of Obstetrics and Gynaecology, Geetanjali medical college and hospital, Udaipur for 1 Year. The study was conducted in 150 terms parturient, who were diagnosed clinically to have non-reassuring fetal status in labor and were considered for vaginal delivery or for emergency caesarean section for the same reason. Non-reassuring fetal status was diagnosed clinically by presence of MSL (thick/thin) and by abnormal FHR patterns classified as Normal CTG (cardiotocography)/Suspicious CTG/Pathological CTG. Immediately after delivery, umbilical cord artery blood sample was sent for pH analysis. Neonatal outcome in terms of weight of new-born, Apgar score at 1 and 5 minutes, NICU admission, duration of stay in NICU, perinatal outcome were recorded. Thereafter, study of association of all these factors was done accordingly. Statistical testing performed by SPSS 24.0 by using independent student t-test. Results: Presence of thin MSL and suspicious CTG were not significantly associated with fetal acidosis and poor neonatal outcome. Only thick MSL and FHR showing pathological CTG that fetus had significant association with acidosis (Umbilical cord artery blood pH < 7.20). Conclusion: Umbilical cord artery blood pH can be considered as the most sensitive parameter to diagnose fetal asphyxia. This may help in providing appropriate care to the new-born at birth and in preventing as well as decreasing neonatal morbidity and mortality. In addition, normal umbilical cord blood pH results can usually provide a defense against a suggestion that an infant had an intrapartum hypoxic-ischemic event.

168. A Comparison between Two Radiation Dose Regimes of Whole Brain Radiation with Temozolomide in a Resource Constraints Setting: A Real World Experience
Ghosh S., Das A., Chowdhury K.B.
Background: Brain metastasis is considered as one of the worst prognostic factors of any carcinoma. Treatment aims at symptom palliation and intra cerebral disease control. Despite the introduction of SRS, neurosurgery, FSRT, whole brain radiation still remains the most practiced treatment. For ineligible patients for advanced treatments, higher dose WBRT is often discussed along with chemotherapy. Methods: In this study two separate radiotherapy regimes (Standard 30 Gy in 10Fr vs Protracted 40 Gy in 20 Fr) along with Temozolomide have been compared in terms of Efficacy and Survival in a resource constrained setting. Results: Irrespective of radiation dose used, no added advantage of a protracted regime was found in terms of survival (p=0.837), however it achieves better objective response rate. In terms of 6 months follow up there was no incidence in PS1 whereas only 31 % patients with PS 2 survived at the end of 6 months. Similarly, 70% patients with “some response” in MRI survived compared to only 14.5% with “stable intracranial disease” (p=0.002). Conclusion: Despite of no survival advantage, higher dose regime with Temozolomide is a safe and efficacious option and may be more suitable to carefully selected performance status 1 patients. Multi institutional study with more number of patients can give insights about using higher dose regime.

169. A Prospective Study of Feto-Maternal Outcome in PPROM Patients in a Tertiary Care Center
Amarpali K. Shivanna, Priya S. Raju, Divya S.
Background: Preterm premature rupture of membranes (PPROM) is when the foetal membranes spontaneously rupture before 37 weeks of gestation. 3% of pregnancies result in PPROM. This research examines the feto-maternal outcome in women who experienced preterm premature rupture of membranes (PPROM) between 28 and 36 weeks+6 days of pregnancy. Materials and Methods: This prospective study was conducted between January 2022 to December 2022 involving 120 singleton pregnancies between 28wks and 36week+6days gestation with PPROM. Detailed history of the patient and examination was done. Each patient was monitored until birth, and the fetomaternal result was documented. Results: The incidence of PPROM in this study is 5.74%. 56.66% belongs to the age group of 19-25yrs and 72.5% are in the gestational age of 34 to 36wks+6days. 68.33% has normal vaginal delivery and rest has undergone lower segment caesarean section(LSCS) and most common indications for LSCS are fetal distress and failure to progress. While analysing the maternal morbidity 1.66% has chorioamnionitis and abruption of placenta and 3.33% has febrile illness. Patient with chorioamninitis are followed with CRP and TLC. The fetal survival is 100% at >32wks of gestation. There is 34.16% NICU admission rate and fetal mortality is 0.83%. conservative treatment with prophylactic antibiotics, steroids and magnesium sulphate(MgSO4) has reduced the feto maternal morbidity and mortality. Conclusion: Prophylactic antibiotics, steroids, and MgSO4 are effective conservative treatments that lower fetal-maternal morbidity and mortality. However, the early indication of chorioamnionitis should prompt consideration of pregnancy termination.

170. Comparison of Simultaneous Bilateral versus Unilateral Total Knee Replacement on Pain Levels and Functional Recovery
Bharath M., Yogananda Gali Hanumaih, Hariprasad K.A., Avinash G.C.
Introduction: In patients with advanced knee osteoarthritis, total knee replacement is a frequent surgical surgery to reduce pain, restore function, and enhance quality of life. The goal of the current research was to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function. Material & Methods: The current study included sixty patients who had total knee replacements (30 bilateral and 30 unilateral). The subjects were hospitalized for a period of five to seven days. Similar inpatient and outpatient physiotherapy sessions were given to group members. The lower extremity functional scale and the visual analogue scale were used, respectively, to measure pain severity at baseline, day 7, and day 30 postoperatively. The data were examined using repeated measures analysis of variance. Results: At 30 days after surgery, both groups demonstrated a statistically significant decrease in pain intensity and an improvement in functional capacity (p< 0.001). However, at 30 days after surgery, there was no statistically significant difference between bilateral and unilateral total knee replacements in terms of pain relief and improvement in functional ability  (p > 0.05). Conclusion: The use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis is suggested since its costs and rehabilitation process could be lessened compared to staged bilateral total knee replacement. Simultaneous bilateral total knee replacement was associated with a similar reduction in pain intensity and recovery of function compared to unilateral total knee replacement.

171. A Study of Functional Outcome of Acromioclavicular Joint Reconstruction with Double Button Fixation System
Avinash G. C., Bharath M., Yogananda Gali Hanumaih, Hariprasad K.A.
Background: This study was conducted to evaluate the double-button fixation system in the management of Rockwood type III, IV, V and VI acute acromioclavicular joint dislocations. Methods: This was a hospital-based prospective study conducted among 30 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation at the Department of Orthopaedics at Mandya Institute of Medical Sciences, Mandya, over a period of 18 months from January 2019 to June 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean age of patients was 40.6 years. Males comprised 97.7% and females were 3.3%, showing a male preponderance. The involvement of the right side (60%) was higher than the left (40%). The mode of injury in 11 patients was RTA (36.7%), and 19 patients sustained injuries due to falls (63.3%). The majority (73.3%) belongs to Rockwood type 5. Significant differences were observed between pre-operative and post-operative DASH scores and constant shoulder scores. Conclusion: According to the results, the double-button fixation system for acute acromioclavicular joint dislocation provides a stable reduction of the acromioclavicular joint with a very good functional outcome and a pain-free full range of shoulder movement with minimal intraoperative and post-operative complications.

172. A Study on the Reduction of Postoperative Sore Throat and Hoarseness of Voice on Endotracheal Tube Cuff Lubrication with Betamethasone Gel and Lidocaine Jelly
Harishankar, Dhanya R., Neetha C.
Background: This study was conducted to evaluate and compare the efficiency of lubricating the endotracheal tube cuff with 0.05% betamethasone gel and 2% lignocaine gel in reducing the incidence of commonly occurring complications following endotracheal intubation for general anaesthesia. Methods: This was a hospital-based prospective observational study conducted among 122 patients who had undergone elective surgeries at the Department of Anaesthesia at Government Medical College Hospital, Super Speciality Theatres, Thiruvananthapuram, for a period of one year, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The overall incidence of postoperative sore throat was significantly lower in the betamethasone group with 33 patients (54.1%) when compared to the lignocaine group with 50 patients (82%). The incidence of no sore throat, mild, moderate, and severe postoperative sore throat at 1 hour after extubation in betamethasone group was 47.5%, 45.9%, 6.6% and 0% respectively, compared to lignocaine group, which was 18%, 50.8%, 23.0% and 5% respectively. The incidence of no sore throat, mild, moderate, and severe postoperative sore throat at 6 hours after extubation in betamethasone group was 78.3%, 2%, 1.7% and 0% respectively compared to lignocaine group which was 32.8%, 54.1%, 6.6% and 6.6% respectively. The incidence of no sore throat, mild, moderate, and severe postoperative sore throat at 24 hours after extubation in betamethasone group was 77.0%, 21.3%, 1.6% and 0% respectively compared to lignocaine group was 36.1%, 49.2%, 8.2% and 6.6% respectively. The incidence of sore throat was lower in the betamethasone group than in the lignocaine group at intervals of 1, 6, and 24 hours post extubation, which was statistically significant. The incidence of no HOV, grade 1 HOV, grade 2 HOV, and grade 3 HOV in betamethasone group was 47.5%, 49.2%, 3.3% and 0% respectively compared to lignocaine group which was 26.2%, 44.3%, 26.2% and 3.3% respectively, which was statistically significant. Conclusion: Application of betamethasone gel preoperatively on the endotracheal tube cuff in elective surgeries under general anaesthesia significantly decreases postoperative sore throat in comparison to the application of  lignocaine gel on the endotracheal tube cuff.

173. Study of Epistaxis with Regard to Demographic Distribution, Duration, Volume and Associated Symptoms in a Tertiary Care Teaching Hospital
Hazna Hameed, Hiran Ramanan
Background: Epistaxis is one of the most common emergencies that otorhinolaryngologists see in the out-patient department as well as in casualties. Epistaxis is any bleeding from the nose. The incidence of epistaxis in the general population is difficult to ascertain, as most people experience it at some point in time. It occurs more commonly in males than females. Rare in infants, children suffer much more frequently than adults. It can be unilateral or bilateral, with a number of factors playing a role like age, sex, occupation, anatomical, pathological and climatic conditions, etc. Methods: The study was conducted in the Department of ENT, VIMS, Bellary, during the period from December 2014 to May 2016. The prospective study included 75 patients attending the department of ENT and also patients referred from other departments of VIMS Hospital, Bellary. A written informed consent was obtained from all the patients who were included in the study. Results: In our study, epistaxis was more common in males in the age group of more than 40 years, with 41.2% suffering from trauma, followed by hypertension as the second most common cause. Bilateral bleeding was more common than unilateral bleeding. Anterior epistaxis was more common than posterior epistaxis, with Little’s area being the most common bleeding site. The majority, 89%, presented with acute bleeding, which lasted for 1-2 days in most of the patients. The majority of patients (46.7%) showed scanty bleeding, 41.3% had moderate bleeding, and only 12% had profuse bleeding. The frequency of epistaxis was 3-5 episodes per day in most of the patients (42.7%), followed by 1-2 episodes in 32%. The most common associated symptom was nasal obstruction (53%), followed by fever (16%). Conclusion: The study showed that epistaxis was more common in older males. Bilateral anterior epistaxis was more common, with Little’s area being the most common bleeding site. The presentation was acute, with scanty bleeding that lasted for 1-2 days in most patients, with a frequency of 3-5 episodes per day. Nasal obstruction and fever were the common associated symptoms.

174. Aetiology and Management of Epistaxis: A Study from a Tertiary Care Hospital in North Karnataka
Hiran Ramanan, Hazna Hameed
Background: Epistaxis is one of the most common emergencies that otorhinolaryngologists see in the out-patient department as well as in casualties. Causes of epistaxis can range from a simple self-limiting condition to a more sinister malignant lesion that needs a radical approach. Epistaxis can be managed medically, with nasal packing or surgically, depending on the situation and cause of bleeding. Methods: The study was conducted in the Department of ENT, VIMS, Ballari, during the period from December 2014 to May 2016. The prospective study included 75 patients attending the department of ENT and also patients referred from other departments of VIMS Hospital, Ballari. Once the diagnosis was made, they were managed medically (conservatively), with anterior or posterior nasal packing and if needed, surgically, and the patients were followed up for a period of 6 months. The collected data was tabulated and subjected to statistical analysis. Results: In our study, epistaxis was more common in males in the age group of more than 40 years, with 41.2% suffering from trauma, followed by hypertension as the second most common case. 40% of the patients needed combined modalities, including medical, anterior nasal packing and surgical management, 29% were managed medically. 18.6% required anterior nasal packing along with pharmacotherapy, 12% got controlled only when both anterior and posterior nasal packing were done. 97.3% of the patients had no recurrence on follow up for 6 months. Conclusion: The study shows that epistaxis is more common in trauma patients, followed by hypertension with the combined modality of medical, anterior nasal packing and surgical management being the most effective mode of management with minimum recurrence.

175. A Clinical Study on Complications and Visual Outcomes of Sphincterotomy In Poorly Dilating Pupils in SICS
Lipika Panda, Doris Benita T.
Background: Cataract is the leading cause of blindness in India accounting for 62% of avoidable blindness in the country. India has a high prevalence of cataract due to various factors, including a large aging population, limited access to healthcare and inadequate eye care infrastructure. The aim of the study is to evaluate intraoperative and postoperative complication and visual outcome of sphincterotomy in poorly dilating pupils in small incision cataract surgery. Method: A Study was done between January 2023 to June 2023 which included patients with poorly dilating pupils (< 6 mm) after pharmacological dilation underwent sphincterotomy in small incision cataract surgery by the same surgeon. Intraoperative postoperative complications were studied. Patients were reviewed up to 6 weeks postoperatively and visual outcome was studied. Result: Total 56 eyes with poorly dilating pupils underwent small incision cataract surgery. Sphincterotomy was done intraoperatively. Our study shows that 56 (10.9%) had poorly dilated pupils (<6 mm ) after pharmacologically dilated with tropicamide phenylephrine 0.5% eye drop. Our study shows 27 (48 %) patients associated with pseudoexfoliation. Intraoperative complications were zonular dialysis (1 eye), posterior capsular tear (1 eye). Postoperative complications were corneal oedema 3 (5.3%), anterior chamber reaction 2 (3.5%), retained cortex 2 (3.5%), atonic pupil 10 (17.8 %). 91% of patients had best corrected visual acuity more than  6/18. Conclusion: There are various methods described to make pupils wider during surgery like iris suture, healon 5, iris hook, mechanical stretching and ring expander. But these are cost-effective. Our study was done to evaluate efficacy and safety of sphincterotomy. This study on 56 eyes shows that sphincterotomy is a safe, easy-to-perform and cost effective method to obtain adequate pupil size during small incision cataract surgery.

176. Epicardial Fat Thickness Assessment by Echocardiography and its Association with Severity of CAD by Coronary Angiogram in a Tertiary Care Hospital, India
Mukesh Jaiswal, S. Suresh Kumar, S. Karthikeyan, T. Munusamy
Background:  The term “Epicardial adipose tissue” (EAT) refers to the visceral fat that surrounds the heart and is easily assessed in the clinic using conventional transthoracic echocardiography. EAT can release free fatty acids close to coronary arteries, especially in people with coronary artery disease, which disrupts vascular homeostasis and endothelial function. The goal of this study was to determine the EFT cut-off echocardiographic EFT and CAD severity. Material and Methods:  This cross-sectional study was conducted at Department of Cardiology, KAPV medical college, Trichy. 250 study participants with CAD were included in this study. A semi-structured questionnaire is used to collect the demographic details and routine clinical examination, evaluation of risk factor profile, and anthropometric variables were also done. Epicardial fat thickness was measured Routine clinical examination, evaluation of risk factor profile, and anthropometric variables were also done. Epicardial fat thickness was measured by transthoracic echocardiography. Data analysis was done using SPSS and continuous variables and categorical variables were interpreted using frequencies (mean±SD) and proportions (%). Statistical differences between groups for categorical data will analyses using the Chi-squared test. Results:  This study was conducted among 250 patients with coronary artery disease to assess epicardial adipose tissue thickness and its association with CAG reports. The mean age of participants was 54.632±9.98 years and one-third of the population included in this study were male participants in which the male and female ratio was 3:1. In this study, the study population was presented with Diabetes (48.4%), Hypertension (35.2%), current smoker (34.4%), BMI ≥ 25 (64.8%) and Dyslipidemia. 15 patients (6%) had EATT more than 6mm. The mean EATT thickness was 3.1084±1.609 mm ranging from 0.6 mm – 8.10 mm and there was significant association of EATT with CAD with P value<0.01. The patients with triple vessel disease had higher EATT mean values than others and the p-value was found to be statistically significant. Conclusion: In this study, patients with CAD had considerably higher EFT measured by transthoracic echocardiography than non-CAD. EFT may therefore be helpful in predicting the severity of CAD.

177. Association of Ametropia in Children with the Refractive Status of Their Parents: A Case Control Study
Nimi R., Nishi R.S., Anitha S.
Background: Refractive error is the condition in which incident parallel rays of light do not come to a focus upon the retina. It is one of the important causes of treatable visual impairment among children. Most of the refractive errors are potentially correctable with spectacles which is relatively an inexpensive modality of treatment. Aim of the study is to find out whether there is any association between the refractive status of children and their parents. Methods: A case-control study was conducted in 2018-2019.232 cases and 208 controls were included in the study. Cycloplegic refraction was done with or without post mydriatic test. Parental refraction was also assessed. Results: A total of 440 children were included in the study;232 cases and 208 controls. Among the cases 41.3% were males and 58.6% were females. 43.8% were males and 56.2% were females among the control group. In 30.6% children with unilateral refractive errors, only single parent had refractive error.(p value-0.005) and in 5.6% ,both parents had refractive errors.(p value 0.013).Both were statistically significant. Parents of 31.7% of cases with refractive errors in both eyes had unilateral refractive error (p value-0.011) and 5.5% had refractive error in both eyes (p value-0.011).Both were statistically significant. Among the control group, 1.9% had refractive errors in both the parents; whereas 20.2% has refractive error in a single parent. The parents of 61.5% cases had refractive errors. This was found to be statistically significant( p value – 0.005).In 30.6% children with unilateral refractive error, only single parent had refractive error(p value-0.005) and 5.6% both parents had refractive errors(p value-0.031%) which were found to be significant. In 31.7% of children with refractive error in both the eyes, only one parent had refractive error p value-(0.011) and 5.5% had refractive error in both the parents(p value-0.011).Both were found to be significant. Conclusion: The results of the present study shows a strong association between the refractive status of children and their parents. This points towards the importance of regular screening of children of ametropic parents for the development of any refractive error as they grow.

178. Determining Efficacy of Single Agent Sclerotherapy in Two Sessions for Early Symptomatic Haemorrhoidal Disease: A Tertiary Centre Study
Pranoy Ghosh, Subir Kumar Majumdar, Kunal Sanyal, Subhendu Bikas Saha
Background: Hemorrhoids or piles are bundles of vascular structure composed of arterio-venous channels and connective tissue of anal canal. Usually these vascular piles work as venous cushions, which play an important role in continence. In symptomatic patients, non-response to conservative therapy can be managed by various procedures like sclerotherapy. Objective: Injection sclerotherapy, the oldest technique, still being used for the management of symptomatic haemorrhoids. Patients with grade I and II haemorrhoids were treated with 3% Polidocanol and their symptoms were compared pre and post-procedure to assess the efficacy as well as complications and long term outcome. Material & Methods: Total of 100 patients with symptomatic grade I and II haemorrhoids were randomly selected for this prospective observational study for one and half year. Sclerotherapy (ST) was performed on OPD basis on two separate sessions at an interval of one month sclerotherapy session 1 and 2 (ST1 and ST2) and patients were asked for four sessions of follow-up at three, six, twelve and eighteen months. Recurrence of symptoms was noted and analyzed using standard statistical tool. Results: Fifty five percent patients were female. Mean age was 50.13years (28-74; SD ± 9.85). Most patients belonged to upper middle socioeconomic status (45%). Improper dietary habit and obesity were common risk factors. No complications were noted during the procedure. Symptomatic relief was observed in 92.1% with bleeding and 96.1% with mucosal prolapse at the end of 18 months of follow-up. Multiple sclerotherapies in our study revealed excellent cure rate and low recurrence rate although it was not found so effective on symptoms like mucoid discharge and altered bowel habit. Conclusion: Sclerotherapy with 3% Polidocanol injection is safe, painless, patient-compliant and minimally invasive OPD based procedure with high cure rate though this procedure needs multiple therapies to combat recurrence and repeated follow-up.

179. Comparative Evaluation of the Stereoacuity in Subjects Having Emmetropia, Isometropia, and Anisometropia
Vikrant Sharma, Nandita Chaturvedi, Dinesh Kumar Sahu, Shrishti Mishra
Background: Stereoacuity is the discrimination of differences in depth based on binocular disparity, and is a measure of stereopsis, Impairment in stereopsis can negatively affect the day-to-day activity in child subjects. Aim: The present clinical study was aimed to comparatively evaluate the stereoacuity in subjects having emmetropia, isometropia, and anisometropia. Methods: The study assessed 702 subjects of age 5-15 years divided into three groups emmetropes with 250 subjects, isometropes with 250 subjects, and anisometropes with 202 subjects respectively. Ambylopic eyes were 78 and 129 respectively among isometropes and anisometropes, Titmus stereo test was used to measure the stereoacuity comprising of a combination of contour targets. Results: The study had 357 males and 345 females. In anisometropes, a significant decrease in stereoacuity was seen compared to emmetropes and isometropes. In ambylopes, the stereoacuity was worse. In the majority of subjects with anisometropia of <3.0, a fair stereoacuity was seen. With an increase in anisometropia degree to >3.0 D, a gradual deterioration in stereoacuity was seen. In severe anisometropia of >6.0 D, a marked decrease in stereoacuity was seen. Reduced stereoacuity was seen in anisometropia of ≥2.12 D. In anisometropes, stereoacuity was poorest in myopia followed by myopia with astigmatism, hypermetropia with astigmatism, and hypermetropia. Conclusion: The study concludes that stereoacuity is the poorest in anisometropes compared to emmetropes and isometropes. A greater reduction in stereoacuity is seen in ambylopes compared to non-amblyopes. With an increase in the degree of anisometropia, stereoacuity is decreased. In anisometropes, worse stereoacuity is seen in myopes compared to hypermetropes.

180. Femoral Nerve Block versus Intravenous Fentanyl in Adult Patients with Proximal Femur Fracture: A Comparative Cross-Sectional Study
Archana Sengar, Priya Majumdar, Manish Shivani, Chandra Shekhar Mishra, Sumit Bhargava
Background: Femoral fractures are linked to elevated mortality rates and reduced functionality. This study aimed at comparing the pain-relieving impacts of Femoral Nerve Block (FNB) with intravenous (IVF) fentanyl before positioning for a spinal block in individuals with femur fractures. Material and Methods: This was a single centre, hospital, inpatient-based comparative, cross-sectional study conducted over a period of 18 months by enrolling a total of 60 patients. FNB group were given Femoral Nerve Block with 10 ml of 0.5% bupivacaine and IVF group were given intravenous fentanyl 1 microgram/kg. Results: Overall, there were 23 (38.3%) female and 37 (61%) male participants (p = 0.426). The mean time from procedure completion to completing spinal anaesthesia given FNB and IVF was 9.9 minutes and 11.1 minutes, respectively (p-value < 0.001). The median pain score among the participant given IVF (VAS = 3.5) was higher than participants given FNB (VAS = 2) (p= 0.034). A higher proportion of participants given FNB rated their experience as either satisfactory and/or very satisfactory than those given IVF (p = 0.049). A higher proportion of anaesthesiologists rated their experience as either satisfactory and/or very satisfactory while inducing SA for participants given FNB (p = 0.642). Conclusion: Femoral Nerve Block (FNB) proved to be a successful and secure approach for preparing femur fracture patients for a spinal block, especially those undergoing spinal anesthesia while in a seated position. The implementation of femoral nerve block can lead to a decrease in pain intensity and a reduced requirement for additional pain relief. Additionally, fewer negative effects on the body are linked to this approach, and the procedure itself does not present higher inherent risks.

181. Age Related Dyslipidemia in Type 2 Diabetes Mellitus Patients: A Hospital Based Prospective Study
Shashi Kant Verma, Jugnu Kishore, Sushil Kumar
Objectives: The present study was to evaluate the lipid profile and to establish the relation between serums lipid profile of type 2 Diabetes mellitus patients in different age group and it was also evaluate the effect of duration of diabetes mellitus on lipid profile. Methods: A total of 80 subjects were enrolled in this study. The patients were divided into two major groups, one group comprising 40 patients in old age group (DDO) with diabetes and dyslipidemia were included and second group 40 comprised of old age non –diabetic but dyslipidemic patients (NDDO). The diagnosis of diabetes mellitus was based on World Health Organization (WHO) criteria. All the biochemical estimations were done by using RFCL kit on the micro lab -300 Semi Auto- analyser. Results: FBS and PPBS were significantly higher in DDO group as compared to NDDO group (p<0.0001). Mean TC level of DDO and NDDO group was 319.645±38.765 and 335.332±42.887 respectively, but it was not statistically significant (p=0.0901). Mean HDL of DDO and NDDO group was 30.732±3.612 and 34.675±4.321 respectively and it was statistically significant differences (p<0.0001). Mean LDL of DDO and NDDO group was 218.657±38.241 and 226.689±43.223, but it was not statistically significant (p=0.3814). Mean VLDL of DDO and NDDO group was 80.342±5.123 and 72.881±7.665 respectively, and it was statistically significant differences (p<0.0001). Mean TG of DDO and NDDO group was 361.721±39.476 and 363.788±31.445 respectively, but it was not statistically significant (p=0.7963). Conclusions: disturbances of lipid profile are more common in old age diabetic patients. Increasing age and diabetic state, both are the most common factors which affect the lipid profile.

182. Correlation between Microalbuminuria and Coronary Artery Diseases (CAD) In Type-2 Diabetes Mellitus, a Study in a Tertiary Care Hospital in Western India
Pawan Kumar Gangwal, Vivek Gupta, Kusum Khoiwal, Ranjita Bansal
Introduction: Diabetes mellitus, a multi-systemic metabolic disorder, is one of the leading causes of mortality and morbidity worldwide. Coronary heart disease is the main cause of premature death in type-2 diabetes. Early diagnosis of Microalbuminuria with a direct correlation with intima-medial thickening will predict the degree of atherosclerosis, as atherosclerosis is the major cause of mortality and morbidity in these patients. Aim & Objective: To determine the correlation between Microalbuminuria and Coronary Artery Disease (CAD) in type -2 Diabetes Mellitus patients. To study statistical significance of various parameters in our study population. Materials & Methods: The present study include total three hundred patients in the Department of Medicine, National Institute of Medical Science and Research, Jaipur, Rajasthan a tertiary care hospital from June 2022 to May 2023. Biochemical and clinical risk factors assessed for Diabetes Mallitus and coronary artery disease. Microalbuminuria is defined as excretion of albumin in urine in the range of 20 to 200μg/min. (30-300mg/day). Results: Case group are Type -2 Diabetes Mellitus with Microalbuminuria and control group are Type 2 Diabetes Mellitus without Microalbuminuria. The mean age in the case and control group for males were 58.01 and 58.10 years respectively, while for females the values were 57.66 and 56.55 years respectively. The mean age±SD of all subjects of the case and control group were 57.9±8.18 and 57.39±7.75 years respectively. There is a significant association between Age and CAD in both case and control group (x2=33.64, P <0.001 HS). CAD+ patients are Highly Significant higher (P<.001) in more than 50 years age group in comparison to less than 50 years age group (x²= 23.66 P <0.001 HS). In >50 year age group CAD patients are highly Significant higher in case group in comparison to control (x² = 29.84 P <0.001). CAD + Cases are Highly Significantly higher in males in comparison to females (x²=41.45, P<0.001 HS). CAD in males are Highly Significantly higher in case group in comparison to control. (x²=35.67 P <0.001). In case group 90.65% of male and in control group 50% male had CAD. In case group 46.15% of female and in control group 28.81% of female had CAD. Conclusions: There is an association between age and CAD in both microalbuminuric and nonmicroalbuminuric Diabetes Mellitus patients but more in microalbuminuric Diabetes Mellitus case. Risk of CAD is higher in both sexes in microalbuminuric Diabetes Mellitus subjects as compared to nonmicroalbuminuric Diabetes Mellitus patients. Microalbuminuria showed a positive correlation with coronary artery disease (CAD) in type -2 Diabetes Mellitus subjects. In type -2 Diabetes Mellitus an association of Microalbuminuria had a more significant association with CAD as compared to subjects of type 2 Diabetes Mellitus without Microalbuminuria.

183. Predictors of Adverse Outcome Early After ICU Stay
Rahul Kumar Joshi, Divankur Khanna, Amandeep Kaur
Objective: In order to mitigate potential complications and minimise the financial burden associated with an extended hospitalisation, medical practitioners often face the critical decision of determining the appropriate timing for discharging patients from the intensive care unit (ICU) environment. The primary aim of the present study was to ascertain potential risk factors associated with adverse outcomes in the immediate aftermath of intensive care unit (ICU) discharge or readmission. Methods: Based on the patients’ readmission status (Group A), mortality within 72 hours of ICU discharge (Group B), or absence of readmission or mortality within 72 hours (Group C), a total of 135 patients who were discharged from the intensive care unit (ICU) were categorised into three distinct outcome groups. Results: In contrast to the cohort that achieved a favourable outcome subsequent to their discharge from the Intensive Care Unit (ICU), individuals who experienced readmission to the ICU exhibited significantly prolonged durations of hospitalisation in a general ward prior to their initial discharge. Patients who expired shortly after being discharged received vasopressor support without epinephrine for significantly extended durations and exhibited markedly more severe illnesses on the day of discharge. Individuals who experienced prolonged hospitalisation and received vasopressor therapy exhibited an increased susceptibility to early post-discharge mortality or readmission to the intensive care unit (ICU). Conclusion: Patients who exhibit an extended length of hospitalisation and require vasopressor support are more susceptible to ICU readmission or mortality shortly after being discharged.

184. The Association of Vitamin D Levels in Children with Alopecia Areata
Mani Shankar, Babli Kumari, Upendra Prasad Sahu
Alopecia areata, an autoimmune disorder characterized by hair loss in localized areas, has prompted increased interest in exploring potential contributing factors, including the role of vitamin D. This research delves into the intricate relationship between vitamin D levels in children and alopecia areata, shedding light on existing research, potential mechanisms, and clinical implications. Vitamin D is renowned for its crucial role in maintaining bone health and calcium regulation. Recent studies have highlighted its additional function in immune modulation and anti-inflammatory actions, making it an intriguing candidate for investigating its influence on autoimmune conditions like alopecia areata. Numerous investigations have sought to establish the link between vitamin D levels and alopecia areata. Some studies suggest that individuals affected by alopecia areata often exhibit lower levels of vitamin D compared to healthy counterparts. This has sparked inquiry into whether insufficient vitamin D levels might play a role in the onset or exacerbation of the condition. Several mechanisms have been postulated to explain how vitamin D could impact the development of alopecia areata. The immunomodulatory effects of vitamin D encompass the regulation of T-cell function and suppression of pro-inflammatory cytokines. Given the autoimmune nature of alopecia areata, where immune cells target hair follicles, it is plausible that vitamin D may exert influence on this immune response. The implications of understanding the vitamin D-alopecia areata relationship are significant. If substantiated, it could open new avenues for therapeutic interventions. Combining vitamin D supplementation with established treatments may form a comprehensive approach to managing alopecia areata in children. However, it’s important to consider the limitations of the current research landscape, which includes variations in study methodologies, population demographics, and underlying health conditions. The dynamic interplay between vitamin D and alopecia areata introduces exciting prospects for future research and treatment strategies. Potential clinical applications underscore the need for rigorous clinical trials and longitudinal studies to establish the causative link between vitamin D levels and the progression of alopecia areata. Moreover, exploring genetic factors and individual variability may offer a more comprehensive understanding of the intricate web of interactions underlying this condition. This research also delves into the concept of holistic approaches to alopecia areata management. Integrating vitamin D supplementation with existing treatment modalities holds promise for achieving more robust and sustainable outcomes. Recognizing the importance of personalized treatment plans, tailored to each patient’s unique needs, can usher in a new era of precision medicine for children with alopecia areata. Thus, investigation into the association between vitamin D levels and alopecia areata in children is a field of study that was conducted in department of paediatrics RIMS Ranchi bridges bone health, immune function, and autoimmune disorders. While the current body of research reveals intriguing findings, further exploration is warranted to establish the causal link and unlock the potential therapeutic benefits. By considering the complexity of the immune system and individual patient factors, we can hope to advance our understanding and treatment of this enigmatic condition.

185. Stapedial Otosclerosis and Evaluation of Small Fenestra Stapedotomy
Sreejith M K, Sunil Kumar K P, Binchu P Babu
Background: Otosclerosis is a non-infective slowly progressive disease of unknown aetiology primarily involving the otic capsule where the normal enchondral bone is replaced with spongy vascular bone causing ankylosis of footplate of stapes resulting in acquired conductive or mixed deafness in adults. Small fenestra stapedotomy with prosthesis is the most accepted form of present treatment to overcome the deafness. Aims and Objectives: To study the clinical and audiological findings of stapedial otosclerosis and to study the outcome and complications of small fenestra stapedotomy in a cohort of 55 patients during February 2019 to July 2020. Methods: A cohort study was conducted between February 2019 and July 2020 on 55 consecutive patients diagnosed with stapedial otosclerosis who underwent small fenestra stapedotomy at the Department of ENT, Government Medical College, Kozhikode, a tertiary care centre. Patients were followed up for a minimum period of 3 months. 4 patients lost follow up during the study period. Results: A total of 55 patients were considered for the study, there were 36 females and 19 males. The age of patients varied from 17-60 years and the mean age was 33 years. Majority of patients were in 3rd and 4thdecades (83.6%). Hearing loss was the most common symptom reported by all the patients. Other associated symptoms were tinnitus (56.3%) and vertigo (21.8%). Majority of the patients (94.5%) presented within 8 years after the onset of symptoms. 83.6% patients had bilateral symptoms. 12.7% patients had family history of similar disease. Most of the patients had normal tympanic membrane. Majority of the patients (89.1%) had moderate to moderately severe hearing loss. 92.7% of the patients were having air-bone gap between 31dB- 50dB. Majority of patients (54.5%) had a type A tympanogram. Most common type of otosclerotic foci found during stapedotomy was anterior focus type (54.5%) and least common was posterior focus type. A piston length ranging from 4.25mm to 4.5mm was used intra operatively. Facial nerve abnormality was the commonest (10.9%) complicating factor found intra-operatively. Vertigo was the most common complaint of patients postoperatively. There was significant improvement in the A-B gap 3 months after surgery, with 76.4 % patients having an A-B gap of less than 10 dB and rest of them had it between 11dB and 20dB. Conclusion: The result supports the role of small fenestra stapedotomy with maximal effectiveness and least complications. Mean post-operative A-B gap 3 months following surgery was 8.47 dB, which substantiates that small fenestra stapedotomy is an ideal procedure for correcting the conductive component of hearing loss in otosclerosis.

186. The Influence of Inflammation on HBA1C Levels and Insulin Resistance in Prediabetes: Insights from Inflammatory Biomarkers
Ikshita Sabharwal, Amisha Bawa, Sukhraj Kaur
This study aimed to investigate changes in inflammatory markers, including Interlekin-6 (IL-6) and Tumour Necrosis Factor-alpha (TNF-α), and triglyceride levels in individuals with prediabetes and their potential correlations. A total of 50 subjects, classified as prediabetic cases and controls, were selected based on their glycosylated haemoglobin (HbA1c) levels. The study found elevated levels of TNF-α and triglycerides in prediabetic individuals compared to healthy controls. Additionally, positive correlations were observed between HbA1c, TNF-α and IL-6, indicating the influence of inflammation on HbA1c levels and progression towards insulin resistance. Gender differences were also observed, with lower IL-6 levels in females and stronger positive correlations between IL-6 and HbA1c in males, and TNF-α and HbA1c levels in females. These findings highlight the importance of identifying biomarkers and early interventions in prediabetes to prevent diabetes and associated complications. Monitoring pro-inflammatory markers can aid in risk stratification,  predicting complications, and tailoring therapy according to factors such as gender and age, leading to improved healthcare outcomes.

187. Comparison of Two Different Doses of Clonidine Hydrochloride as An Adjuvant to Epidural Bupivacaine for Post-Operative Analgesia
Shatrughan Kumar, Shailesh Kumar
Objective: This study aimed to compare the block characteristics and hemodynamic or adverse effects of combining two distinct doses of clonidine with epidural Bupivacaine as an adjuvant for infraumbilical surgeries. This study sought to compare sensory and motor block onset factors between two groups. Methods: This was an interventional, prospective, double-blind, parallel group, randomised clinical study involving patients undergoing elective lower abdominal and lower limb surgeries. During the 2022-2023 academic year, this investigation was conducted at the Patna Medical College and Hospital, Patna. Results: In our study, the mean onset time for the sensory block was 8.17 ± 1.5 minutes in group A and 7.43 ± 1.01 minutes in group B. In group A, the mean time to onset of motor block was 19.55 ± 1.5 minutes, while in group B, it was 17.17 ± 1.37 minutes. In our study, the mean duration of sensory analgesia in group A was 351.10 ± 20.38 minutes, while in group B it was 372.32 ± 21.54 minutes, indicating a highly significant extension of analgesia duration in group B compared to group A. Conclusion: During the intraoperative period, both concentrations of clonidine (60µg and 75µg) administered via the epidural route with 0.5% Bupivacaine provide effective analgesia. However, in the postoperative period, 75µg clonidine with 0.5% Bupivacaine provides longer-lasting analgesia than 60µg clonidine, without a significant increase in adverse effects or alteration of the hemodynamic profile.

188. Measurement of Peripapillary Retinal Nerve Fiber Layer Thickness in Myopia Using OCT
Radhakanta Bhoi, Sushant Kumar Pujahari
A total of 50 eyes of 25 healthy subjects, comprising 20 eyes with moderate to high myopia (spherical equivalent [SE] >-3.00 D) and 30 eyes with low myopia (SE between -0.50 D and -3.00 D), were analyzed in this cross-sectional study. Total average and mean quadrant RNFL thicknesses were measured by Stratus OCT and associations between RNFL measurements and spherical equivalent refraction were evaluated by linear regression analysis. The RNFL measurements were significantly lower in the moderate to high myopia group compared with those of the low myopia group. Significant correlations were evident between RNFL measurements and the spherical equivalent. The average RNFL thickness decreased with increasing negative refractive power ( P = 0.000). Out of 50 eyes 13 were classified as below normal limits and 15 as borderline with reference to the normative database of the RNFL thickness. The most frequently abnormal sector was at the nasal quadrant, where 36% of myopic eyes were below normal limits. There was a decrease in the average RNFL thickness as the refractive error became more myopic. So a careful interpretation of RNFL measurements, especially the nasal quadrant, should be done among myopic subjects to avoid mislabeling them as glaucoma suspects.

189. Study of the Relationship Between Microalbuminuria and the Target Organ Damage in Patients of Essential Hypertension
Aaruni Rahul, Shailesh Kumar
Background: It has long been understood that in people with hypertension, a crucial amount of urine albumin excretion serves as a trustworthy predictor of cardiovascular events. Very few studies have been conducted to date demonstrating a link between microalbuminuria and target organ damage in patients with essential hypertension, with the exception of cardiovascular events. We investigated the prevalence of microalbuminuria in patients with essential hypertension and its relationship to organ injury. Methods: A total of 120 patients with essential hypertension were examined. Analysis was done on the frequency of urine albumin excretion and its connection to target organ damage such as stroke, retinopathy, and left ventricular hypertrophy. Urinary albumin excretion was assessed using turbidimetry, and the presence of microalbuminuria was assessed using the urine albumin to creatinine ratio. Results: Microalbuminuria was discovered to be prevalent in 57.5% of the patients. The target organ was harmed in 82.5% (99 patients) of the cases, and microalbuminuria was also present in 82.82% of these situations (p<0.05). Patients with longer histories and more severe types of hypertensions, elevated body mass indices, and dyslipidemia were more likely to have these conditions. Conclusions: Examining microalbuminuria is a critical diagnostic for identifying the severity of target organ damage in hypertensive patients. With ideal hypertension management, weight control, and maintenance of normal lipid levels, the risk of microalbuminuria is reduced.

190. Study of Relationship between Acute Ischemic Non-embolic Stroke and Serum Uric Acid
Aaruni Rahul, Shailesh Kumar
Background: Impact of high level of uric acid on stroke is still controversial. We conducted this study to investigate the relationship between acute ischemic non-embolic stroke and serum levels of uric acid. The goal was to look into the connection between serum uric acid and acute ischemic non-embolic stroke. Methods: Present study was conducted at Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, New Delhi, treated 100 patients who had their first acute ischemic stroke ever. Blood samples were taken and CT scans were done within 24 hours of the stroke’s onset. To conduct a 2D ECHO and a biochemical analysis, blood samples were given. It was also determined whether the people had any extra risk factors like hypertension, diabetes, a bad lipid profile, smoking, and intoxication. Results: There were 32 women and 68 men among the 100 patients. Uric acid levels in 49% of participants were higher than 8 mg/dl. 53% of them had hypertension, and 35% of them had diabetes. 21% of people consumed alcohol, and 24% of people smoked. Conclusion: According to this study, there is a strong link between high uric acid levels and a greater chance of having an acute ischemic stroke. Lowering blood uric acid levels might be considered one of the stroke prevention techniques for treating high risk groups.

191. Prevalence of Anemia in Type 2 Diabetes Mellitus and its Association with Vitamin B12 Deficiency
Namita Kumari, Mahesh Prasad
Background: The world’s diabetes epicenter is in India nearly 21% of the total new diabetes cases every year are from India, which already has highest number of cases in any country. Since many years ago, vitamin B12 deficiency has been recognized as a significant adverse effect in diabetic patients on metformin for longer than 5 to 10 years. The purpose of this study was to identify the prevalence of anemia in people with type 2 diabetes mellitus (T2DM) and its relationship to vitamin B12 insufficiency brought on by metformin treatment. Methods: The study comprised 100 males and females with type 2 diabetes mellitus (T2DM). All participants provided blood in tubes without anticoagulant for measurements of Hba1c and Fasting blood glucose. By using automated cell counters, hemoglobin and mean corpuscular volume (MCV) were assessed. Only individuals who presented with macrocytic anemia had their levels of vitamin B12 measured. Results: Out of 100 patients, 57 were vegetarians. In this study’s participant population, anemia was prevalent in 33 (33.0%). A diagnosis of Normocytic Normochromic Anemia was given to 6, Microcytic Hypochromic Anemia to 11, Macrocytic Anemia to 13, and Dimorphic Anemia to 3 (6.98%) individuals. Vitamin B12 levels were checked in these 16 patients who had macrocytic and dimorphic anemia at the time of testing. For 12 patients, the vitamin B12 level was less than 200 pg/ml, whereas for the remaining 4 patients, it was more than 200 pg/ml. On Metformin were 63 individuals. Conclusion: Our findings imply that treating anemia may play a significant role in preventing other diabetic complications, and as a result, we advise that routine hematological testing and annual testing for Vitamin B12 deficiency be included in the criteria for treating T2DM.

192. Clinicopathological Spectrum of Fungal Infections in a Tertiary Care Centre of Bihar
Namita Kumari, Mahesh Prasad
Background: Fungal lesions are frequent in immunocompromised patients, including those with diabetes, cancer patients receiving chemotherapy or radiation, HIV positive people, and transplant recipients. Although tissue culture is the preferred method for identifying fungi, histopathology analysis provides a more accurate picture of tissue invasion. Methods: This study covered 47 cases over a 6-months period. This study examined the histological spectrum of fungal infections, their distribution by age, sex, and site of involvement, and their morphology in our hospital’s setting. Results: Aspergillosis is most prevalent fungus in this investigation, and the majority of patients of this condition manifested as ganglion and dermoid cysts. The foot was the most typical site. Conclusion: We aimed to identify the etiological diagnosis of fungal infections in histopathological specimens acquired in our department in this investigation.

193. Application of Scoring System in FNAC of Thyroid Lesions
Namita Kumari, Mahesh Prasad
Background: Giving thyroid lesions’ cytology/FNA results a score can provide crucial details about their neoplastic or non-neoplastic status. The goal of the current study was to classify thyroid lesions on aspirates according to established cytological criteria and evaluate them based on numerous parameters. The two cytological classification systems (Cytological score and Standard technique) were compared during histopathology. Methods: A cytological score and classification were given to 49 cases of thyroid lesions having a preoperative cytologic diagnosis. The association between the cytologic score and the histology was established using the Spearman correlation coefficient after statistical analysis and comparison of the histopathology diagnoses were conducted. To determine the importance of each cytological score, regression analysis was used. Results: The amount of colloid, nuclear characteristics, and background pattern were found to be the most significant cytologic features by multivariate analysis. Compared to the traditional cyto categorization with histopathology, there was a higher degree of correlation between the scoring techniques on cytology and histopathology. The ratings awarded to the cytologic and histopathologic specimens showed a strong relationship (p <0.001) with one another. Conclusion: Since histology and categorization systems have a close link, thyroid lesions can be evaluated using a cytological scoring approach.

194. Study of Cases of Pregnancy with Jaundice in a Tertiary Care Hospital
Snehalata, Priyanka Gahlout, Abha Rani Sinha
Background: As a high-risk pregnancy with a poor prognosis for both the mother and the fetus, jaundice in pregnancy presents both the hepatologist and the obstetrician with an interesting and pressing challenge. The purpose of this study is to assess the prevalence, underlying causes, and fetomaternal outcome of jaundice during pregnancy in a tertiary care setting. Methods: The study included all antenatal patients with jaundice who were admitted to the Department of Obstetrics and Gynecology at the SKMCH, Muzaffarpur, Bihar, between May 2022 and April 2023. Results: In the current study, the incidence of jaundice during pregnancy was determined to be 0.65%. Viral hepatitis was the most frequent cause of jaundice. Patients with abnormal liver enzyme levels and patients in the age range of 25 to 29 who were primigravidas and from lower socioeconomic backgrounds most frequently presented with yellowish discoloration of the sclera and/or urine. DIC and PPH were two of the most frequently occurring causes of morbidity. The primary factors contributing to perinatal outcome and morbidity were neonatal hyperbilirubinemia, perinatal death, meconium-tainted liquor, and fetal discomfort. Both maternal and perinatal death rates were 21% and 23%, respectively. Conclusion: Pregnancy-related jaundice produces negative fetal and maternal outcomes. Increased health consciousness, education, routine antenatal care, and early referrals can lead to early jaundice in pregnancy diagnosis and treatment, lowering fetal and mother morbidity and mortality.

195. Estimation of C-reactive Protein (CRP), Serum Uric Acid (UA) and LDH in Women with Preeclampsia
Snehalata, Puja Sinha, Abha Sinha
Background: Several markers have been proposed for pre-eclampsia using different systems. The level of CRP reflects the extent of endothelial cell damage. One of the causes of preeclampsia’s onset or progression is endothelial cell damage. Serum LDH levels can be used to gauge the severity of the condition during pre-eclampsia due to the degree of cellular death. The circulating xanthine oxidase activity and oxidative stress generation are reflected in the serum uric acid levels. The purpose of this study was to determine the relationship between blood LDH, uric acid, and C-reactive protein and the severity of pre-eclampsia. Methods: Preeclamptic and eclamptic prenatal patients (n=150) in the study group and normotensive pregnant women (n=50) in the control group had their serum levels of CRP, LDH, and uric acid measured. For statistical analysis, chi-square tests and student t-tests were employed. Results: In comparison to the control group, where the mean CRP value was 1.20±4.37 mg/L, the study group mean CRP value was 24.80±24.70 mg/L (p = 0.001). When compared to the control group, the study group mean serum uric acid level was considerably higher (6.16±3.39 mg/dl) (p=0.001) than the control group (3.09±0.53 mg/dl). Additionally, the mean LDH in the study group was substantially greater than the control group (p=0.001), 698.95±624.08 U/L versus 301.24±124.59 U/L. Conclusion: Monitoring of CRP, LDH, and uric acid can aid in determining the severity and course of the disease as well as aid in avoiding difficulties for the mother. An indirect risk factor for placental vasculopathy, which precedes clinical preeclampsia, is an elevated serum CRP level in preeclampsia.

196. Correlation between Various Inflammatory Markers, Serum Triglyceride Levels and Glycosylated Hemoglobin in Type II Diabetes Mellitus: A Case Control Study in an Indian Tertiary Care Setting
Arushi Sekhri, Sukhraj Kaur
The present study aims to assess the various biochemical parameters between 25 clinically diagnosed type 2 diabetics and 25 controls. We had divided the diabetics into 3 groups (on the basis of their serum glycosylated hemoglobin (HbA1c) levels) and also made a gender-based analysis of each group, to find the correlation between serum interleukin-6 (IL-6), tumor necrosis factor (TNF-alpha) and triglyceride levels (TG) with glycosylated hemoglobin (HbA1c). IL-6 showed a positive correlation with glycosylated hemoglobin in group 1,2 and a negative correlation in group 3. TNF-alpha showed a negative correlation in group 1 and a positive correlation with glycosylated hemoglobin in group 2 and 3. Serum triglycerides showed a negative correlation with glycosylated hemoglobin in all the three groups. The current study showed that diabetes is a state of inflammation and there exists an imbalance between the inflammatory markers and an overall higher serum triglyceride level in diabetics as compared to the normal controls. However, we stress on the need of further studies with regards to measurements of inflammatory markers to come across a specific coherent pattern between the rise/fall of the cytokines as the disease progresses, to consider anti-inflammatory drugs as potential therapies to decrease the progression of diabetes mellitus and the measurement of these markers to quantify risks in diabetic patients.

197. Role of CT scan in Management of Blunt Abdominal Injury: An Observational Study in a Tertiary Health Care Centre
Abinasha Mohapatra, Himansu Shekhar Mishra, Subrat Kumar Pradhan, Kishan Bhoi
Background and Objectives: Evaluating patients who have sustained blunt abdominal injuries remains one of the most challenging and resource –intensives aspects of acute trauma care. Missed intra-abdominal injuries continue to cause preventable deaths. Objective is to assess efficacy of CT scan (computed tomography as accurate diagnostic tool for blunt abdominal injuries patients. Methods: 96 cases of blunt abdominal injury admitted in VIMSAR, Medical College, Burla, Sambalpur during the period of October 2021 to October 2022 were included in my study after taking informed consent. All these patients were thoroughly investigated. CT Scan was done for all heamodynamically stable patients. Recorded data included age, sex, types of organ injuries and scan results. Organ injuries were grading using the OIS (Organ Injury Scale) guidelines. Results: The study comprised of 96 patients having blunt abdominal injuries. Majority of patients were in age group of 20-39 years male. The most common injury were splenic (40%), liver (23%) and hemoperitoneum (55%).95% (92 patients) were positive for abdominal injury and 5% (4 patients) were negative. The CT findings of hemoperitoneum and/or solid organ injury were confirmed in the 17 cases taken up for surgery rest conservatively managed. Conclusions: In this study CT scan was 100% sensitive in diagnosis of blunt abdominal injuries. A negative CT scan discourage unnecessary urgent abdominal exploration.

198. Surgical Site Infections Before and During COVID-19 Pandemic: A Comparative Clinico-Pathological and Bacteriological Study of 100 Cases Each in a Tertiary Health Care
Abinasha Mohapatra, Pravash Chandra Sahu, Subrat Kumar Pradhan, Himansu Shekhar Mishra, Ramakanta Mohanty5, Rohan Kumar Sahu
Background: Post-operative wound infection rate varies from 1 – 9%, depending on several factors like microbial pathogenicity, host defenses (age, sex, nutrition, immunity, antibiotics use), local environment factors, razor use for hair removal before surgery and surgical techniques. Aim and Objective: This cross sectional study was done to find out the incidence of SSIs and factors influencing its development, types of common bacterial pathogen causing SSIs and their sensitivity in post-operative period before (i.e. July 2019 – February 2020) and during( i.e. March 2020 – October 2020) COVID-19 Pandemic period in Department of General Surgery, Veer SurendraSai Institute of Medical Science And Research ( VIMSAR ), Burla, Sambalpur, Odisha. Methods and Material: Patients enrolled in this study were divided into 2- groups of 100 cases each. (A) Pre-pandemic group (Group-1). (B) Pandemic group (Group-2), were reviewed during our sixteen months study period to know the incidence of SSIs and factors influencing SSIs. Parameters studied were patient’s age, BMI, blood sugar profile, haemoglobin, bacteriological profile, type and duration of surgery, antibiotics prophylaxis, duration of pre-op stay, and antibiotic sensitivity pattern of the cultured organism. Results: Overall SSIs incidence rate in Pre-pandemic and Pandemic period were 26% and 36% respectively. The higher incidence of SSIs in in this study was multifactorial. Staphylococcus aureus and E. coli remain the major culprit in SSIs in Pre-pandemic and Pandemic period respectively. Conclusions: Overall SSIs incidence rate in Pandemic period was higher than Pre-pandemic period, which may be due to delayed presentation in casualty department resulting delayed diagnosis and advanced stage of the disease. So, identification of common pathogens and use of specific antibiotics after institutional SSI surveillance is required for controlling post-op wound infections.

199. Evaluation of Primary Immunization Coverage of Under 5 Years Children Under Universal Immunization Program in a Rural Area of Khordha District, Odisha: A Cross-Sectional Study
Abinasha Mohapatra, Himansu Shekhar Mishra, Kishan Bhoi
Background: A cross sectional study was undertaken to assess immunisation status of under five children attending OPD of Balakati CHC, Bhubaneswar from August 2018 to December 2018. Though there is steady rise in immunization coverage due to increased accessibility of health care facilities, the average level remains far less than the desired. Methodology: A total number of 206 children aged 0-5 years were included in the study after implementing the exclusion criterias. Data was analysed by SPSS version 17, Microsoft excel 2010. Result- Immunisation coverage for BCG, DPT1 were maximum (100%), and least for measles (94%). There is no gender discrimination in the immunization coverage for children. Conclusion: Primary reasons behind partial immunization were inter current illness and fear of adverse effect following immunization. State routine immunization monitoring system needs to be gear up (i.e. regular health education sessions, regular reminders, and removal of misconceptions prevailing among people) for effective 100% immunization coverage.

200. Assessment of Nutritional Status of Under Five Children Attending OPD at a Community Health Centre, Khorda Odisha
Abinasha Mohapatra, Kishan Bhoi, Himansu Shekhar Mishra
Background: The problems of malnutrition among under five children can be us to conclude the necessity for nutritional care, surveillance, or appropriate intervention of nutritional programme in a community. The objective of present study was to assess the nutritional status of under five children attending at OPD of Balakati CHC and to evaluate the relationship of same with variables like literacy,income of parents, birth order, child sex, birth weight, and breast feeding. Methods: A total of 206 children aged 0-5 years were included in study after implementing the exclusion criterias. Results: Out of 206 children, majority were male children 106(51.46%). Positive correlation was observed between the nutritional status of children with educational and employment status of parents, increasing birth weight and family income. Increasing birth order has a negative influence on nutritional status of child. Breast fed babies (Exclusively breast fed for 6 months with appropriate complementary feeds thereafter) have better nutritional status.

201. An Observational Study to Assess the Prevalence of Vitamin D Deficiency in Indian Women
Swati Sharan, Pratulya Nandan
Background: People all over the world suffer from vitamin D deficiency, which can have severe consequences for their bones as well as their overall health. The purpose of this observational study was to assess deficiencies in vitamin D among Indian women by looking at their eating habits, level of outdoor activity, and vitamin D intake from food sources. Methods: Bihar women between the ages of 18 and 65 from all around the country participated in a cross-sectional survey. The researchers measured the participants’ serum levels of 25-hydroxyvitamin D (25(OH)D) and also collected information about the individuals’ diet, activity level, and sun exposure through a questionnaire. The study of the data used both descriptive and inferential statistical techniques. Results: A thousand individuals from around India participated in the study. Participants’ average age was 35.7 (standard deviation = 8.2). Serum levels of 25(OH)D below 20 ng/mL were discovered to be diagnostic of vitamin D deficiency, which was shown to affect 62% of the population. Serum 25(OH)D levels averaged 18.5 ng/mL (SD = 6.2). Vitamin D status was strongly linked with sun exposure, vitamin D-rich food intake, and vitamin D supplement (p 0.05). Conclusion: This study shows widespread vitamin D insufficiency among Indian women. Factors including limited sun exposure and poor diet exacerbate this epidemic. These findings highlight the importance of public health campaigns and interventions that encourage sun exposure, fortify foods with vitamin D, and provide proper supplementation to raise vitamin D levels in this population. Treating vitamin D insufficiency in Indian women could boost their bone health and general well-being.

202. Emergence of Non-Albicans Candida Species in Neonatal Candidemia
Abha Gupta, Nidhi Sharma, Amit Gupta, Abhishek Sharma
Aim: Therefore, following study was conducted to know the occurrence of candidemia in our region, among suspected septicemic patients. Materials and Methods: This prospective study was conducted between December and April 2017 in the Departments of Microbiology and Paediatrics of tertiary care hospital in central, India. From a total 110 neonates admitted to NICU with clinical suspicion of septicaemia. Blood samples were collected in blood culture bottle and incubated at 37C .then subculture done on blood agar and Mc conkey agar and Sabouraud’s dextrose agar with chloramphenicol (0.05%) and incubated at 37C. Only those which yielded pure growth of candida spp. were included in the study. Preliminary identification was done by colony morphology on SDA, chromogenic medium, growth at 45C, germ tube test, chlamydospore formation and was confirmed by carbohydrate fermentation test. Candidemia was defiend as the presence of at least one positive blood culture containing pure growth of candida spp. With supportive clinical feature. Results: Total 110 neonates included in the study, 65(59%) were females and 45(41%) were males. Candida albicans responsible for 67% cases while NAC species responsible for 33% cases with12% cases by C. tropicalis, 10% cases by C.parapsillosis, 5% by C. gullermondii, 4% by C. krusei, 2% by C.kefyr. Among the risk factors observed for candedimia prematurity and LBW, indwelling catheters are commonest followed by broad spectrum antibiotic use, TPN prolonged hyperalimentation. Various clinical presentations also seen in candidemia. Conclusion: Candidemia in neonates is an ominous prognostic sign and is an important entity in our hospital. Preventive measures such as use of filters for parenteral nutrition, prophylactic antifungal use, and a restrictive policy of antibiotic use to decrease Candida colonization/ infection rates should be implemented to reduce the morbidity and mortality associated with these infections.

203. To Study the Oxidative Stress & It’s Correlation with Vit B12 & Folic Acid Levels in Megaloblastic Anemia
Yisha Chandrakar, Abhishek Sharma, Anuj Jain, Nidhi Sharma
Introduction: WHO defines, megaloblastic anemia as a type of anemia characterized by the formation of unusually large, abnormal and immature red blood cells. Prevalence of megaloblastic anemia in India according to many studies ranges from 02%-40%.It has been found to have decrease antioxidant activity in anemic patient causing increase oxidative stress, leading to DNA damage and altered biomolecules. Aim:  To study the oxidative stress & it’s correlation with vitamin B12 & folic acid levels in Megaloblastic anemia. Methods: A Case Control Study was carried out from January 2023 to June 2023 by Medicine & Biochemistry department of Government Medical College, Datia(Madhya Pradesh) .100 non-pregnant female(age ranges 15-45yrs) patient having Hb<12g/dl & Megaloblastic anemia were taken as cases. Whereas 100, age and sex matched without anemia as controls. Blood sample was collected in EDTA vial for complete blood count & peripheral blood smear. Blood sample was collected in plain vial to estimate serum vitamin B12, folate & FRAP (Ferric Reducing Ability of Plasma). Serum B12 & folate estimation was done by Chemiluminiscence method & Spectrophotometric analysis was done for FRAP. Results: Serum Vitamin B12 was found to be lower among 56% of cases (113.2±189.6) compared to controls (206.7±261.9). Serum Folate was found to be lower among 25% of cases (5.7±4.1) compared to controls (7.3±4.2).Both vitamin B 12 & folic acid, found to low among 19% of cases. Serum FRAP value was found to be lower among Cases (582.7±198) compared to controls (908.1±174.2).There was a positive significant (p-value<0.05) & mild correlation of Serum FRAP value with serum Vitamin B12 and Serum Folate in Controls. In Cases the correlation was stronger with positive significance (p-value<0.05), compared to Controls. Conclusion: In our study, it may be concluded that in Megaloblastic anaemia there is serum folate and Vitamin B12 deficiency with increased oxidative stress leading to free radical generation and peroxidation of vital body molecules. Therefore in such cases, thorough biochemical analysis should be undertaken before starting with medications and there should be an antioxidant supplementation to be given.

204. Comparative Study of Pressure Control Ventilation versus Volume Control Ventilation in Pediatric ICU Patients Needing Mechanical Ventilation for Oxygenation and Airway Pressure
Chayan Sarkar, Moumita Debnath, Rajeev Ranjan
Introduction: Over three-fifths of all 2.3 million child deaths in India in 2005 were caused by five conditions: pneumonia, prematurity & low birthweight, diarrhoeal diseases, neonatal infections and birth asphyxia & birth trauma. Out of these causes pneumonia accounts for 19 percent of under-five mortality. A large percentage of these pneumonia patients require mechanical ventilation due to respiratory failure. Hence Mechanical ventilation is an important aspect of management of children in pediatric intensive care unit. There is a paucity of literature about the preferred mode of ventilation in children. Hence we planned this study to compare VCV with the current standard of care PCV. Material & Methods: The current study was in a 60 bedded pediatric ward with 10 bedded pediatric ICU and 10 bedded neonatal ICU. Randomisation was done by allocation of patients in two groups, with 65 participants in each group. one group will receive volume control ventilation and another group will receive pressure control ventilation. Patients 3 months to 12 years requiring mechanical ventilation and patient relatives giving consent for the trial were included in this study. Inability to wean from experimental strategies (e.g. nitric oxide), severe chronic respiratory disease, morbid obesity, lack of commitment to life support and less than 12 hours of ventilation were excluded from the study. Results: The mean age of patients enrolled for Group VC is 32.24 +/- 38.16 months and for group PC is 37.36 +/- 39.27 months. There was no significant difference in heart rate, systolic blood pressure, mean temperature, mean PaO2/FiO2 ratio, urine output, urea, total leucocyte count, potassium, serum sodium, serum bicarbonate, bilirubin, Glasgow coma scale, SAPS score across the two groups of patients enrolled for the study (p>0.05). The PaO2 /FiO2 ratio in VC group is significantly higher in the VC group compared to the PC group as P value is 0.001.

205. Femoral Nerve Block versus Intravenous Fentanyl in Adult Patients with Proximal Femur Fracture: A Comparative Cross-Sectional Study
Archana Sengar, Priya Majumdar, Manish Shivani, Chandra Shekhar Mishr, Sumit Bhargava
Background: Femoral fractures are linked to elevated mortality rates and reduced functionality. This study aimed at comparing the pain-relieving impacts of Femoral Nerve Block (FNB) with intravenous (IVF) fentanyl before positioning for a spinal block in individuals with femur fractures. Material and Methods: This was a single centre, hospital, inpatient-based comparative, cross-sectional study conducted over a period of 18 months by enrolling a total of 60 patients. FNB group were given Femoral Nerve Block with 10 ml of 0.5% bupivacaine and IVF group were given intravenous fentanyl 1 microgram/kg. Results: Overall, there were 23 (38.3%) female and 37 (61%) male participants (p = 0.426). The mean time from procedure completion to completing spinal anaesthesia given FNB and IVF was 9.9 minutes and 11.1 minutes, respectively (p-value < 0.001). The median pain score among the participant given IVF (VAS = 3.5) was higher than participants given FNB (VAS = 2) (p= 0.034). A higher proportion of participants given FNB rated their experience as either satisfactory and/or very satisfactory than those given IVF (p = 0.049). A higher proportion of anaesthesiologists rated their experience as either satisfactory and/or very satisfactory while inducing SA for participants given FNB (p = 0.642). Conclusion: Femoral Nerve Block (FNB) proved to be a successful and secure approach for preparing femur fracture patients for a spinal block, especially those undergoing spinal anesthesia while in a seated position. The implementation of femoral nerve block can lead to a decrease in pain intensity and a reduced requirement for additional pain relief. Additionally, fewer negative effects on the body are linked to this approach, and the procedure itself does not present higher inherent risks.

206. Socio Demographic Determinants of Abortion: A Cross Sectional Retrospective Study
Agniwesh, Dhanakar Thakur, Anil Kumar Singh, Rashmi R. Prasad, Ajay Kumar Agarwal, Sakshi Agarwal
Objectives: The present study was to investigate the socio-demographic determination of abortion and was to correlate of age, religion, community and education with abortion and parity with abortion. Methods: A total of 205 cases of abortion were enrolled in the Department of Obstetrics and Gynaecology, RMCH, Bareilly during a period from August 2019 to February 2021. Data was collected by using some questionnaire like as religion, community, education and gravida in prescribed Performa. Results: Maximum abortion 42.44%, in Hindu (42.95%) and in Muslim (37.04%)were in 26-28 years age group, maximum cases (62.93%) were from urban community, maximum cases (32.19%) in women educated up to high school, maximum cases (48.29%) in gravida 3, (46.34%) in women having two lived child. Conclusions: It is concluded that to reduce abortion rate, level of education be raised and safety of every delivered baby be secured and active family planning advices during second gravida be provided.

207. To Establish Whether Diagnosis of Flat Foot Deformity by Staheli`S Plantar Arch Index Is As Reliable As Radiological Method
Sravanthi Repalle, D. Chandra Shekhar, Spandana Thrikkovallur
Background & Method: The aim of the study is to establish whether diagnosis of flat foot deformity by Staheli`s plantar arch index is as reliable as radiological method. Detailed history was taken regarding the complaints of both foot, past history, history of injury, as well as family history. Careful clinical examination was done under guidance of expert from orthopedic/physiotherapy department and Signs were recorded. Result: Observation shows that the Average PI value is 1.29 for both feet. SD for right is 0.09 and for left is 0.08.  Minimum PI values are 1.17 and 1.16 for right and left feet. Maximum PI value for right and left foot is 1.91 and 1.47 respectively.  Correlation between radiological angle (TFM angle) and plantar arch index PI is significant for  both the sides with correlation value 0.31 for right side and 0.46 for left side and p value p<0.05 for both the side. Conclusion: Correlation between radiological diagnosis and foot print methods was established. Study concluded that there is significant correlation between PI and TFM angle (P<0.05). Hence we can conclude that for diagnostic tool foot print method is as effective as radiological method.

208. Thyroid Dysfunction & Lipid Abnormalities in Patients with Cholelithiasis
Divyang Patel, Vinaykumar Hariyani, Vishal Balat, Vasantpuri Gosai, Nishitkumar Devalia
Introduction: Disturbances in lipid metabolism that occur during hypothyroidism, particularly cholesterol pathway, changes the rate of bile excretion and lead to the formation of gall stones. The current study was conducted to find association between hypothyroidism and CBD stones. Materials & Methods: This prospective study included 100 patients with CBD stones who underwent ERCP and 100 healthy individu­als in the control group. Thyroid profile, lipid profile and symptom of hypothyroidism were evaluated in all patients. Results: Lipid profile (Cholesterol, TG, HDL and LDL) was deranged in case group as compared to control group. Mean serum TSH levels among case group (7.79 ± 3.23 μIU/ml) was significantly higher than control group (3.14 ± 1.23 μIU/ml, p – 0.001). Sub clinical hypothrodism was noted higher in case group (12.0%) than control group (4.0%, p -0.02). Conclusion: Thyroid dysfunction and deranged lipid profile are more com­mon among patients with CBD stones. Therefore, we recommend checking for the lipid profile and TSH level in every patient with gallstones.

209. Pregnancy Outcome in HIV-Positive Pregnant Women at Tertiary Care Center
Mandeep Kaur, Parneet Kaur, Anju Gupta, Tarvinderjit Khurana, Gurdip Kaur, Satinder Pal Kaur
Introduction: The Human Immunodeficiency Virus remains a major public health issue in developing countries and it has great impact on pregnant mothers and birth outcomes. Thus, it is very important to identify, estimate CD4 count and treat all pregnant women with HIV infection to reduce mother to child transmission, morbidity and mortality. Aims and Objectives: To study pregnancy outcomes, prevalence of co-infections and ART practices in HIV positive pregnant women at tertiary care centre. Material and Methods: The study was a prospective observational study conducted in Department of Obstetrics and Gynaecology, Government Medical College and Rajendra Hospital, Patiala for a period of one and a half years. All the pregnant females presenting with HIV positive status or diagnosed as HIV positive in our Gynaecology Department for were taken up for study. All women were followed till delivery for development of any complications. Maternal and fetal outcome was noted. The data was collected and analysed statistically. Result: During the study period70 subjects with HIV positive status were enrolled for study. Complications in pregnant women including anemia (p-value -0.0001), preterm labour (p-value -0.044) and gestational diabetes mellitus (p -value – 0.0338) were significantly more in the study group as compared to the control group. Neonatal outcomes in HIV positive mothers included fetal growth retardation (p-value -0.00036), low birth weight (p-value -0.0012) and NICU admissions (p-value -0.00036). Major risk factor for mother was positive status of the husband (82.8%). Other risk factors included the previous history of unsterile nasal or ear piercing (11.4%), IM/IV injections from RMP in village (14.3%) and blood transfusion (17.1%). Coinfections like HCV (p-value -0.0062) and Candidiasis (p-value – 0.0026) were prevalent in the study group as compared to controls. Conclusion: The accumulated data shows a positive correlation between HIV infection and anemia, preterm labour, GDM, LBW, NICU admissions and coinfections like HCV and candidiasis as compared to controls. It was observed that with increasing awareness, pregnant females had started ART pre-pregnancy and in 1st trimester. In our study, ART was taken for more than 24 weeks by majority of the subjects, which is in accordance with NACO guidelines for the prevention of MTCT.

210. Effectiveness of Fentanyl Nasal Pack in Post OP Pain Assessment Following Functional Endoscopic Sinus Surgery
Shivani V Lashkari, Ketan J Pipaliya, Ronak B Ramanuj
Introduction: In the realm of postoperative pain management following functional endoscopic sinus surgery (FESS), our study delves into a novel avenue by examining the effectiveness of fentanyl nasal packing. FESS, a common procedure for sinus and nasal conditions, often involves discomfort and pain during the recovery phase. To address this issue, our research explores the potential of fentanyl, an opioid medication, administered through nasal packing to alleviate postoperative pain. Through a comprehensive evaluation, we aim to contribute valuable insights into tailored pain relief solutions for patients undergoing FESS. Material and Methods: We enrolled 60 ASA I and II patients, aged 18 to 65, scheduled for elective FESS. Exclusion criteria included certain medical conditions and recent drug use. Anesthesia induction used propofol and rocuronium, followed by fentanyl for analgesia and sevoflurane for maintenance. Bilateral polyvinyl alcohol sponges were applied at surgery’s end. Group F received fentanyl-soaked packing, Group NS got normal saline. Postoperative analgesia included paracetamol and dexketoprofen. Pain assessment utilized VAS at intervals up to 24 hours post-surgery. Data analysis involved SPSS 20.0 software, using appropriate tests for comparison. Results: Baseline characteristics between Group F (Fentanyl) and Group NS (Normal Saline) were similar, showing no significant differences in age, gender, ASA physical status, or surgical duration. Preoperative pain scores were also comparable in both groups. Throughout the postoperative period, pain scores assessed using the Visual Analog Scale (VAS) were consistently lower in Group F compared to Group NS. At 1 hour post-surgery, the mean pain score in Group F was 3.5 (± 1.2), while in Group NS, it was 5.2 (± 1.6). This trend continued at subsequent time intervals: 2, 4, 8, 12, and 24 hours postoperatively, as well as during nasal tampon removal. No significant complications were observed in either group. Conclusion: In summary, our study demonstrates that fentanyl nasal packing effectively reduces postoperative pain after functional endoscopic sinus surgery (FESS). This personalized pain relief approach holds promise for improved outcomes in FESS patients.

211. Study of Various Laboratory Parameters in Leprosy and Lepra Reaction Cases at A Tertiary Care Centre
Devanshi Solanki, Mitali Bhikhubhai Rathod, Jaymala Solanki, Siddharth Parmar
Introduction: Leprosy is a chronic mycobacterial disease caused by Mycobacterium leprae with more than 2,00,000 new cases reported every year from more than 120 countries.3 Leprosy is endemic in tropical countries, and more prevalent in developing countries. In year 2020 in Gujarat total new cases detected was 4081, ANCDR was 5.77 and prevalence rate was 0.36 with percentage MB cases were 57%. Early detection and treatment are key for prevention of leprosy associated disabilities and deformities and also prevention of leprosy in community. Materials and Methods: This prospective study was carried out at tertiary care hospital. Study design – Cross sectional analytical. Study duration- July 2021 to October 2022. Results: In present study all clinically diagnosed cases of leprosy and lepra reactions during July 2021 to October 2022 that presented to our OPD and satisfied the inclusion and exclusion criteria were enrolled. Considering leprosy prevalence of 0.57 / 10,000 in year 2019-20 calculated sample size was 54 but we enrolled total 64 patients in present study. Conclusion: Total 64 patients were included in the study, out of which 17 (26.5%) were patients with reaction. Mean age in this study were 33.73 years. Majority of the patients were male. Male to female ratio was 3.26. Most of the patients belonged to 20 to 40 years age group.

212. Clinical Profile of Sleep Apnoea Syndrome in the Tertiary Care Centre
Jyoshna Pratty, Lalam Harsha Kiran, Appalanaidu Rongali, Viritha Pandu
Objectives: Our study aimed to prospectively assess the effectiveness of clinical parameters in individuals who snore, predict the presence of obstructive sleep apnoea (OSA), and determine the priority for overnight polysomnography (OPS) in patients. Study design: A cohort of individuals characterized by loud habitual snoring, along with the presence of one additional symptom indicative of obstructive sleeps apnoea (OSA), was enrolled in this study. The participants underwent comprehensive overnight polysomnography, which involved monitoring 10 physiological channels. The diagnosis of obstructive sleep apnoea (OSA) was made in accordance with the criteria set forth by the American Academy of Sleep Medicine. In the study, significant associations between parameters and obstructive sleep apnoea (OSA) were identified, and subsequently, independent predictors were determined through statistical analysis. Results: A total of 180 patients were enrolled in the study. Of 180 individuals, 142 were diagnosed with obstructive sleep apnoea (OSA). The independent predictors of OSA were assessed, taking into account the age, sex, and neck circumference of the participants. Among these predictors, neck circumference exhibited the highest predictive value in determining the presence of OSA. The age and neck circumference thresholds for predicting OSA were established at 50 years and 15.5 inches, respectively. Based on the predictors mentioned above, a decision model was developed to prioritize individuals who experienced symptoms of snoring and are awaiting an operative procedure. Conclusion: Our study findings indicate that individuals with a neck circumference greater than 15.5 inches, aged above 50 years, and of male sex exhibited an independent association with an increased risk of OSA within our study cohort.

213. Computed Tomography Evaluation of Traumatic Brain Injury with Clinical Correlation (GCS Score)
Prasad Sunil K, Thakur Madhurjya K, Mahela Sangita
The health scenario in India has changed immensely in the last few decades. Among the present health problems, injuries due to urbanization, motorization, and human behavioural changes form a major bulk of the problems. This study aims to assess the pattern of CT findings in the head injury patients with possible traumatic brain injury and correlate the CT findings with the Glasgow coma scale score of the patient. The present study is a hospital-based cross-sectional analytical study that was carried out in the department of Radiodiagnosis, FAAMCH, Barpeta, Assam for a period of 1 year. GCS score of the patient was recorded at the time of presentation and grading of craniocerebral trauma was done based on GCS score. The patients were scanned by Philips MX 16-slice CT machine. The most common mode of TBI in our study was RTA, followed by physical assault and self-falls. Based on GCS, 62.4% of the study population in our study was in the mild TBI group, 16.3% patients were in the moderate TBI group and 21.2 % in severe TBI group. Positive CT findings were noted in 202 out of total 306 cases i.e., 66% of total cases. The most common intracranial lesion was contusion haemorrhage seen in 24.5% cases followed by SDH in 22.5% cases, SAH in 21.2% cases and EDH in 17%. In our present study a very strong, positive correlation was noted between extra-axial haemorrhages, three or more findings with GCS score (TBI groups).  NECT brain gives us a vivid picture regarding the pattern of injury with appropriate location and size of lesion. The NECT brain findings correlated well with the severity of head injury clinically assessed by GCS Score, particularly in patients with more than one finding. NECT brain can be used as a tool.

214. A Comparative Study Between CT scan and Endoscopic Examination in Chronic Sino Nasal Disease
Badal Kumar, Vivek Kumar
Introduction: Chronic rhinosinusitis is a highly prevalent disease with significant effects on productivity and quality of life. Endoscopy and CT scan have revolutionised the diagnosis and treatment of chronic sinonasal diseases. Aim: The purpose of this study was to compare the diagnostic endoscopic and CT findings of sinus disease patients. Methods: From March 2021 to November 2022, cases were selected from the outdoor, indoor, and emergency departments of the ENT department at Patna Medical College and Hospital. The research methodology included a comprehensive history, clinical examination, investigation, and management. This study included 50 patients who were selected using a basic random sampling technique. Results: In this study, the most prevalent symptoms among patients were nasal obstruction (80%) and headache (70%). In the current 50 cases, DNE identifies septal deviation in 27 cases while CT identifies septal deviation in 30 cases. In 21 (42%) cases, the uncinate process is attached to the lamina papyracea on the right and left sides in both DNE and CT. Conclusion: CT scan has a greater advantage than DNE in detecting anatomical variations and determining the condition of the sinus cavity and the severity of sinus disease. When conditions such as middle meatal secretions, mucosal condition, and lesions are being evaluated, DNE may be a superior diagnostic modality than CT scan.

215. A Comparative Study on the Efficacy of TOTASEP Disinfectant in a Newly Built Operation Theatre Versus to an Already Existing Well-Functioning Operation Theatre: A Prospective Cross Sectional Analytical Study
Subashini. P, Sumetha Suga. D, M. Ramakumar, Dhanapal Nandini, V. Natarajan, B. Ananthi
Introduction: Disinfection and infection control protocol implementation is a continuous process in healthcare setups. Strict and stringent disinfectant protocol must be followed in high risk areas like ICU and in OT theaters. Hospital set ups can face many hurdles in implementing the protocol and maintaining its quality throughout the healthcare setups. In our study we throw light upon differences and difficulties faced while fumigating, an already existing OT theater compared to the newly built OT theater, along with the disinfectant potency.
Materials and Methods:
Study design: Analytical study. Study place: ACS medical college and hospital and Sri Lalithambigai Medical College and Hospital, Chennai. Period of Study: January 2022 to December 2022. As per the Hospital infection guidelines and disinfectant policy designed based on our hospital setup, the protocol was followed. Pre fogging OT theater environment samples, post fogging environment samples, and post deep cleaning environment samples were analyzed. Results: the results were interpreted and comparative analysis was done by using SPSS software 2023 version. The results showed that disinfectants used in an established OT set up showed more sensitivity than the newly built OT. The disinfectant analysed was TOTASEP. There was not much difference with the specificity between the two OT setups. There was a need for usage of additional disinfectant in case of newly built OT theater due to the micro debris and dust deposits from the construction works. Conclusion: We came to know that Totasep was more efficient in a well-established OT set up compared to the newly built. The major factor included were as newly built theater cleaning must be done frequently due to the deposition of the debris, cement dust, AC vent deposits. The other factor that we noticed was insect’s infestations and pest control must be followed more vigorously. Frequent visitors for plumbing works, leaks, bolt or screw tightening will happen in a newly built setup. After each and every visit required through cleaning of the setup. Totasep alone cannot be used as a single disinfectant, additional disinfectant must also be used in a newly built hospital OT, to avoid the above mentioned factors and frequent exposure of the same disinfectants may also lead to resistant in the insects and pest which was in the area.

216. To Study the Prevalence of Obesity and Its Correlation with Cardiovascular Risk Factors
Chhaya Rani Shevra, Himanshu Kumar, Albail Singh Yadav, Mayank Singh
Obesity is not a lethal disease in and of itself but is a significant risk factor associated with a range of serious non-communicable diseases and conditions. Overweight and obesity is considered as an intermediate risk factor for major chronic conditions including heart disease, stroke, cancer, chronic respiratory diseases and diabetes. Aims and Objectives: This study was undertaken to study the prevalence of obesity and find out its correlation with BMI, hypertension and lipid profile. Settings and Design: A prospective study in a tertiary referral centre. Material and Methods: The present study was a prospective study, a total of 100 cases were analysed. Their anthropometric indices, BMI, waist circumference, hip circumference, waist hip ratio, systolic and diastolic blood pressure were measured, and lipid profile was investigated in central pathology laboratory. Statistical Analysis: All statistical analysis was done by using excel software and SPSS (V.22) statistical software. p<0.05 was considered significant. Results: BMI is positively correlated with total cholesterol, serum triglycerides, serum lipoprotein and blood pressure and negatively correlated with HDL. Conclusion: early and immediate interventional measures like increase in physical activity healthy lifestyles and regular surveillance are required to prevent obesity and various complications like CVDs.

217. Retrospective Study of Medicolegal Aspects of Trauma Cases in Orthopaedics
Showket Rashid, OBAID Nisar, Jabreel Muzaffar, Khalid Quyoom
Background and Aim: Victim of injuries presenting to a hospital is a medico-legal issue. With the tremendous metamorphosis in the healthcare sector, incidents of lawsuits against orthopaedic surgeons and hospitals, in the name of medical negligence is on the rise. Unfortunately, regardless of the complexity of the injury, the expectations from the patients as per the outcome of the treatment are also high. Present study aimed to investigate the cases of medical complaints in orthopaedic patients who had been involved in a traumatic accident. Material and Methods: In this descriptive-analytical study, all litigations were studied. Present study was done at Govt. Medical College Baramulla from May 2020 to April 2021. During the next step, the trauma orthopedic claims were included for more detailed reviews. Demographic data including gender, age, occupation, delineation of geographic areas, comorbidities, history of previous psychiatric disease, and cause of injury were collected. Results: The most common injuries were at the hand, thigh, elbow, and forearm, respectively. Likewise, the most common alleged complication was malunion or non-union, and the least was attributed to neurological insufficiencies and surgical site infection, respectively. According to the forensic reviews, in 40% of the cases, the main problem that led to the complaint was the inappropriate or insufficient explanation to the patient. In 60%, there was a problem with the surgery (P ≤ 0.05). Conclusion: In orthopaedics, if medico-legal cases are considered as a disease, poor results are its chief symptom. Today’s patients insist that medical products and services should be provided without risk. To avoid malpractice lawsuits careful clinical appraisal, good clinical judgment, impeccable surgical technique, good surgeon-patient relationship, and well documented records are essential.

218. Epidemiology and Histomorphological Presentations of Salivary Gland Neoplasms
C. Aruna Mutharasi, L. Muthumani, N.S. Subbulakshmi
Introduction: Intertrochanteric fractures are rising due to longer life expectancies, especially in Asia. Lag screws and intramedullary (IM) nailing have shown promising outcomes. New design improvements have overcome prior challenges. Surgeon expertise and local criteria determine implant choice. The research found statistically significant regional differences in Medicare enrollees’ “intramedullary (IM)” nail use. Aim and Objectives: This study examines intramedullary nail fixing for intertrochanteric femur fractures. Method: 53 patients with intertrochanteric fracture from four high-volume clinics were included. Participants must be 60 or older and healthy enough to stroll around their areas. The procedure used an InterTAN nail and was on schedule. Lag screws supplied anatomical alignment and compression after fluoroscopically assisted reduction. After surgery, antibiotics and heparin helped with weight bearing. Non-institutional orthopedists judged bony union as a callus crossing two cortices. Result: Table 1 shows preoperative findings: mean age 76.7 years (SD 8.9), 20 men, 33 women. BMD hip T-score -2.6 (SD 1.0), spine T-score -2.8 (SD 1.3). In Table 2, the surgery lasted 76.8 min (SD 29.9), blood loss was 184.5 ml (SD 97.9), and 1.3 blood units were transfused. Good 74, acceptable 17, bad 9. TAD 14.9 mm (SD 2.9), bone union 17.9 weeks (SD 7.9). Table 3 shows surgical complications, emphasising caution. Conclusion: In conclusion, treatment with IM nails and lag screws for Asian patients with intertrochanteric fractures is effective. Correctly selecting patients and putting in screws is essential. Further investigation is recommended.

219. Identifying Risk Factors for Readmission to the Neonatal ICU After Discharge
Anshuman, Vinay Kumar Yadav, Shashi Prabha
Background: The frequent readmission of newborns to the Neonatal Intensive Care Unit (NICU) after their initial discharge creates challenges with neonatal care and resource allocation. This study aims to identify and investigate the reasons for early NICU readmissions within 30 days of the initial discharge. Methods: A retrospective examination of 200 neonatal patients at IGIMS, Patna, Bihar was conducted. Collecting population characteristics, medical records, and post-discharge contact information. The method of logistic regression was used to examine associations between risk factors. Results: Low birth weight (OR = 2.65, 95% CI = 1.83 – 3.87), NICU problems (OR = 3.21, 95% CI = 2.17 – 4.75) and a lack of post-discharge medical visits (OR = 1.92, 95% CI = 1.24 – 2.98) were also significant risk factors for readmission. There was a greater chance for mothers younger than 25 (OR = 1.48, 95% CI = 0.96-2.28, p = 0.078). Conclusion: The findings emphasise the importance of thorough discharge and post-discharge follow-up planning, particularly for premature and difficult-to-deliver newborns. Adapting interventions based on recognised risk factors can reduce readmission rates and enhance neonatal care outcomes.

220. Study on the Outcomes of Intertrochanteric Femur Shaft Fracture Managed by Proximal femoral Nail
Kamaleshkumar A Patel, Keyur Rajendrakumar Shah
Introduction: Intertrochanteric fractures are rising due to longer life expectancies, especially in Asia. Lag screws and proximal femoral nailing have shown promising outcomes. New design improvements have overcome prior challenges. Surgeon expertise and local criteria determine implant choice. The research found statistically significant regional differences in Medicare enrollees’ “proximal femoral nail use. Aim and Objectives: This study examines proximal femoral nail fixing for intertrochanteric femur fractures. Method: 53 patients with intertrochanteric fracture from four high-volume clinics were included. Participants must be 60 or older and healthy enough to stroll around their areas. The procedure used an InterTAN nail and was on schedule. Lag screws supplied anatomical alignment and compression after fluoroscopically assisted reduction. After surgery, antibiotics and heparin helped with weight bearing. Non-institutional orthopedists judged bony union as a callus crossing two cortices. Result: Table 1 shows preoperative findings: mean age 76.7 years (SD 8.9), 20 men, 33 women. BMD hip T-score -2.6 (SD 1.0), spine T-score -2.8 (SD 1.3). In Table 2, the surgery lasted 76.8 min (SD 29.9), blood loss was 184.5 ml (SD 97.9), and 1.3 blood units were transfused. Good 74, acceptable 17, bad 9. TAD 14.9 mm (SD 2.9), bone union 17.9 weeks (SD 7.9). Table 3 shows surgical complications, emphasising caution. Conclusion: In conclusion, treatment with IM nails and lag screws for Asian patients with intertrochanteric fractures is effective. Correctly selecting patients and putting in screws is essential. Further investigation is recommended.

221. Study on the Functional Outcome of the Distal End of Radius Fractures Treated with Buttress Plating
Keyur Rajendrakumar Shah, Kamaleshkumar A Patel
Introduction: This following study examines distal radius fracture care, the most common upper extremity injury in the US. More than 300,000 fractures occur annually. Volar buttress plating is a popular method for treating unstable fractures due to its longevity and stability. Both Kirschner-wire and locking plates have pros and cons. The effects of the 2.7-mm volar locking plate have not been extensively studied despite multiple plating operations. Distal radial fracture treatment in the elderly is poorly researched. Aims and Objectives: This study aims to evaluate the functional results associated with buttress-plated distal radius fractures. Method: This prospective Study includes 65 patients aged 18–70 with buttress-plated distal radius fractures. The study used Gyaneswar et al.’s sample size (n = 4pq / d^2) to get 90% satisfactory-excellent results. Comorbidities, >3-week injuries, poor tissues, complicated fractures excluded. Frykman’s categorization used demographic, injury, and radiograph data from surveys. The orthopaedic surgeon uses traditional procedures and Lindstrom’s grading for post-op evaluation for ≥3 months. Result: A study used buttress plating to treat 65 distal radius fracture patients aged 18–70. The sample size of Gyaneswar et al.’s study was 90% to reach a satisfactory-excellent result. Comorbidities, injuries lasting more than three weeks, poor tissue quality, and severe fractures are eliminated. Post-operative grading was assessed by Lindstrom. Joint stiffness and infection were reported in Table 4. Conclusion: In conclusion, buttress plate fixation for distal radius fractures had a positive effect, consistent with other studies that were better constructed.

222. Anatomy of the Greater Palatine Foramen and Canal and their Clinical Significance in Relation to the Greater Palatine Artery
Rahul Prakash Kharate, Bhakti R Kharate
Introduction: The purpose of this research was to pinpoint the “greater palatine foramen (GPF)” in India with respect to other maxillary anatomical landmarks. Textbooks often identify the GPF as being between certain teeth or positioned opposite the last molar. The goal of this study was to offer a more precise location for GPF in the maxilla. Aim and Objectives: This study investigates the greater palatine foramen’s anatomy and clinical significance to the artery. Method: The objective of this study was to examine the spatial location of the greater palatine foramen in relation to specific anatomical features in both male and female skulls. A study was conducted on a sample of 100 adult skulls from Gujarat, India, comprising 59 males, 40 females, and 1 undetermined specimen. Distances between the foramen and significant landmarks were determined by employing Vernier callipers to get measurements. A quantitative assessment was conducted to evaluate morphological variances and gender-related differences. Result: In male and female skulls, Table 1 shows the millimetre distances between the larger palatine foramen and the median palatine suture. In Table 2, the foramen’s distances from the posterior hard palate are comparable. Table 3 categorises foramen locations in relation to maxillary molars and shows M3 prevalence in males (88.13%) and females (92.5%). The opening directions in Table 4 show a vertical orientation. Three women and three men participated in the study. Conclusion: The larger palatine foramen was found near the third molar in 87.5% of skulls. This is relevant to trigeminal nerve block and anaesthesia.

223. Evaluation of Bone Density and Nutritional Status in Children with Cerebral Palsy
Nayan J Patel, Sagar V Hansalia
Background: Children with cerebral palsy (CP) face numerous challenges, among which bone health and nutritional status are of significant concern. As bone fragility and malnutrition may affect their overall quality of life, this study aimed to evaluate the bone density and nutritional status of children diagnosed with CP. Methods: A cross-sectional study involving 142 children with CP, aged between 2-18 years, was conducted. Dual-energy X-ray absorptiometry (DXA) was utilized to measure bone mineral density (BMD). Nutritional status was assessed using anthropometric measurements, dietary recalls, and biochemical markers. Results: A significant proportion of the children exhibited below-average bone density for their age. Additionally, a notable number presented signs of malnutrition, with micronutrient deficiencies being prevalent. A correlation was found between reduced bone density and poor nutritional status, emphasizing the need for comprehensive nutrition and bone health interventions in this population. Conclusions: Children with cerebral palsy are at heightened risk for compromised bone health and nutritional deficiencies. Tailored intervention strategies focusing on improving bone density and nutritional intake can greatly enhance the quality of life and long-term outcomes for these children.

224. A Comparative Study between Standard Oral Iron Tablets Versus Single Dose Intravenous Iron Sucrose in Post-Partum Anaemic Women Attending A Tertiary Care Hospital in Tripura
Debbarma B, Chakrabarti SB, Rakshit AK, Saha(Ray) M, Shil A
Background: Postpartum anaemia is one of the under-appreciated global maternal health burden. There are various comorbidities found relating to postpartum anaemia such as fatigue, depression, impaired cognition. Postpartum anaemia can impact on both maternal-child bonding & neonatal care. Most women with postpartum anaemia have antepartum iron deficiency. Oral or intravenous iron is choice of correcting anaemia with various side effects. The current study had been taken to compare the effectiveness of oral iron tablet & intravenous iron sucrose. Result: Mean haemoglobin level was found to be increased more significantly from baseline to post 6 weeks therapy in both the groups: 1. Group A from 9% (baseline) to 10.58% (after 6 weeks) and 2. Group B from 8.5% (baseline) to 10.50% (after 6 weeks). The mean changes both in between the group and within the group were also found to be significant. However, it was observed that the mean changes were more in group A (2.091 ± 0.8121) who were treated with IV iron sucrose than group B (1.442 ± 0.7354) who were treated with oral iron folic acid tablets. Conclusion: The haemoglobin concentration at 6 weeks postpartum was higher in women who received intravenous iron compared to oral iron therapy. The current findings suggest that intravenous iron can be considered as a viable option for postpartum anaemia over oral iron concerning rise in hemoglobin level & risk of side effects.

225. Seroprevalence among Blood Donors Using Comparison of ELISA and Rapid Screening Methods at a Tertiary Care Hospital
Akshitha Dave, Tejaswi Chada
Introduction: Transfusion of blood and blood components, a special modality of patient management is known to save millions of lives worldwide to reduce morbidity and mortality. Transfusion department plays an important role to screen, monitor and control infections transmitted by blood transfusion. The objective of blood screening is to detect markers of infection in order to provide safe blood and blood components for clinical use. Materials and Methods: 3000 donations were screened for viral markers namely HIV 1and 2, HBV, HCV by ELISA and Rapid testing methods. Results: 35 out of 3000 donors are HBV positive (1.16%), 7 cases of HIV positive (0.23%), 2 cases positive for HCV among 3000 donors (0.06%) are noted by ELISA method. 5 out of 3000 donors (0.16%) are reactive for HIV, 29 (0.96%) are reactive for HBV, 2 (0.06%) reactive for HCV by rapid method. 5 out of 7 donors (71.4%) are reactive for HIV by rapid screening method. Conclusion: Screening of donated blood with higher generation sensitive ELISA kits and avoiding Rapid screening methods can help to identify reactive donors accurately. The higher number of false negative results by Rapid tests is of concern to blood safety, hence should not be used routinely in Blood Centre for screening of blood donors.

226. Ultra-Low Dose CT Chest for Screening of COVID-19 Patients: Evaluation of Diagnostic Performance and Radiation Dose Reduction
Prabhakaran A.V., Sathiyabama Dhinakaran, Laavanya Sree. B, Praveen.V, Panneerselvam Periasamy, Arbind Kumar Choudhary
As COVID-19 cases surge in Tamil Nadu, proactive measures to manage and curb its spread are of paramount importance. The conventional RT-PCR testing method, while reliable, comes with a significant time lag of at least 8 hours for obtaining results. Swift screening methods are essential to enable prompt quarantine measures and early detection of positive cases. Drawing inspiration from experiences in Wuhan, China, and Seoul, South Korea, where CT chest scans were employed for rapid and effective patient assessment, this study aims to explore the potential of ultra-low-dose CT chest scans as an innovative screening tool for COVID-19 in the context of Tamil Nadu. While existing literature showcases the use of CT chest scans for screening purposes, the application of low-dose CT in this specific context remains largely unexplored. This study postulates that ultra-low-dose CT chest scans could serve as an efficient, time-sensitive screening tool with a substantial reduction in radiation exposure to patients. The primary objectives of this research are twofold: firstly, to develop a methodology that minimizes radiation exposure while preserving the necessary diagnostic information for accurate imaging assessments, and secondly, to assess the diagnostic performance of ultra-low-dose chest CT scans in detecting COVID-19 pneumonia. By achieving these objectives, this study not only contributes to the growing body of knowledge regarding COVID-19 screening techniques but also presents a potential solution to expedite case identification and subsequent interventions in Tamil Nadu. The findings of this research could hold significant implications for public health, aiding in the early identification and containment of COVID-19 outbreaks.

227. Study of Feto-Maternal Outcome in Pregnancy with Advanced Maternal Age
Rajal Vidyutkumar Thaker, Shyamabahen Bipinbhai Baranda, Vaishali Parimal Panchal, Gautam Chandubhai Gavaniya, Dhruvi Ashok Dadhania, Antala Kartikey
Background: Advanced maternal age (AMA) is generally defined as pregnancy in women aged 35 years or older. Studies of pregnancies in older women from higher-income countries have shown higher maternal and perinatal morbidities. The objective of this study was to estimate the proportion of pregnancy with advanced maternal age and its demographic details, causes and feto-maternal outcome. Methods: This retrospective observational study was carried out from 1st June 2018 to 31st May 2021. Results: The proportion of pregnancies with advanced maternal age was 1.9%. Majority of the patients, 232 (69.6%) were in the age group of 35-36 years, 309 (92.8%) were coming from urban lower-middle class, 212 (63.7%) were uneducated and 303 (91%) were gravida 2 or more, 287 (86.2%) had desire for more children. Abortion, Vaginal delivery and LSCS were 23 (6.9%), 152 (45.6%) and 121 (36.3%) respectively. Anemia and hypertensive disorders were present in 77(23.1%) and in 49(14.7%) respectively. Live births were 256 (92.4%) and NICU admissions were required in 75 (29.3%). Conclusion: Pregnancy with advanced maternal age was associated with elevated risks for feto-maternal complications. Majority of patients were uneducated and from lower socio-economic class who were desirous for more children. Education of girl child, women empowerment and awareness about various methods of contraception must be promoted. Increased maternal and fetal surveillance along with multidisciplinary approach can ensure better maternal and perinatal outcome.

228. Evaluation of Prognostic Value of Magnetic Resonance Imaging in Acute and Chronic Spinal Trauma
P.V. S. Abhishek, Mudunuri Lakshmi Deepthi, Sai Charitha. G
Introduction: Spinal trauma is commonly seen in RTA cases, sport injuries, assaults etc. MRI is an excellent diagnostic modality for evaluation of spinal trauma. Aims and Objectives: To evaluate role of MRI as a patient’s non-invasive diagnostic tool in acute and chronic spinal trauma and comparison of these findings with patient’s neurological status and clinical outcome. Materials and Methods: This was descriptive study with 85 cases carried out over a period of 10 months in the Department of Radiodiagnosis, CAIMS, and Karimnagar. Results: In present study, the total number of patients was 85 and the male to female ratio was 3:1, age ranged between 11 to 80. Cervical spine is the most commonly involved. RTA and fall from height are the most common causes of spinal injury. Cord compression and hemorrhage are most common type seen whereas cord edema has better prognosis. Cord transection and hemorrhage had worst neurological outcome. Conclusion: MRI is the modality of choice for evaluation of spinal trauma. MRI is the only tool available for depicting the changes within the cord, ligaments and paraspinal soft tissues which helps in the management of the patients and in predicting the prognosis of recovery.

229. A Comparison of Anesthetic Efficacy Between 4% Articaine with 1:1,00,000 Adrenaline and 2% Lidocaine with 1:1,00,000 Adrenaline for Extraction of Mandibular Posterior Teeth: A Randomized Controlled Trial
Anil Kumar Karanam
Background of the study: Articaine is an amide local anesthetic that differs from other agents of its group due to the presence of thiophene ring instead of a benzene ring. Many studies claim that articaine is superior to lignocaine. Objective: The present study has been designed to study the anesthetic efficacy of 4% Articaine with 1:1,00,000 Adrenaline in comparison with 2% Lidocaine with 1:1,00,000 Adrenaline administered to Nerve Block in 100 patients who needs extraction of mandibular posterior teeth. Materials & Methods: This prospective, randomized single-blinded clinical trial included 100 patients needing extraction of either first or second molars. The onset of anesthetic action (both subjective & Objective), intraoperative anesthetic efficacy was measured using the modified Wong Baker Faces pain scale, total duration of anesthetic action and any re-anesthesia or additional anesthetic requirement was evaluated. Results: The mean time of onset of anesthetic action – subjective symptoms for Articaine – 2.08 min (SD-0.11) and for Lignocaine – 4.05 min (SD-0.32) & for objective symptoms for Articiane is 2.87 min (SD-0.3) and for Lignocaine is 4.84 min (SD-0.29). The Intraoperative Anesthetic efficacy with Articaine group was 1.06 (SD-1.15) and with Lignocaine group was 1.36 (SD-1.24). The mean total duration of Anaesthesia for Articaine group was 209.55 min (SD-7.14) and for Lignocaine group was 173.92 min (SD-10.42). Conclusion: 4% Articaine showed better pharmacological performance than 2% lignocaine, particularly the onset of anesthetic effect and duration of anesthetic action.

230. Examination of the Hormonal Relationship of Thyroid Lesions through Fine Needle Aspiration Cytology
Vipul Kavar, Shamim Sheikh, Dharti Kanani, Kajari Gohil
Background and Objectives: Thyroid gland is superficial, highly accessible in position and an ideal tissue for fine needle aspiration cytology (FNAC). FNAC in conjunction with hormonal assay is a very effective procedure in evaluation of thyroid swellings of differing biologic significance pre operatively. Present study was done with following objective: To assess the level of T3, T4 and TSH in various thyroid lesions, to evaluate role of thyroid hormone profile (T3, T4, &amp; TSH) in different thyroid lesions and to assess the sensitivity, specificity and diagnostic accuracy of FNAC as an initial diagnostic modality for thyroid lesions. Material and Methods: The 160 cases of apparent thyroid lesions from tertiary care centre were selected in present study. The case history with relevant clinical signs and symptoms of the patient and provisional diagnosis given by the clinician referred to cytopathology section of Pathology department for FNAC. Thyroid hormonal estimation of patient had been done by ELISA method in Biochemistry department and thyroid hormonal assay data was collected. Diagnostic accuracy was calculated by using sensitivity and specificity. Results: Amongst various thyroid lesions, majority of cases were nonneoplastic (92.5%). Among non- neoplastic condition, colloid goitre was most commonly occurring lesion followed by adenomatous goitre. The role of thyroid hormone profile is significant for thyroiditis, primary hyperthyroidism and granulomatous thyroiditis. Amongst neoplastic lesion of thyroid, majority of cases (66.6%) were euthyroid. Thyroid hormonal assessment by ELISA technique is sufficiently sensitive to separate the serum T3, T4 and TSH values in hyperthyroidism and hypothyroidism from subclinical or nonthyroidal illness. Conclusion: FNAC is widely recognised as the preferred initial diagnostic method for evaluating thyroid swellings due to its notable specificity and accuracy. The Fine Needle Aspiration Cytology (FNAC) technique is a straightforward, reliable, economical, and minimally intrusive diagnostic method employed to evaluate patients with thyroid nodules prior to surgery. Histopathological evaluation is the sole definitive approach to exclude the presence of malignancy.

231. Results of Arthroscopic Rotator Cuff Repair Vs Mini Open Rotator Cuff Repair: Study of 50 Cases
Haresh Fatesinh Chaudhary, Manthan Soni
Background and Aim: Rotator cuff tears have long been known to produce discomfort and impairment. The method of treating rotator cuff tears has changed throughout the years, moving from an open operation to a mini-open technique to an all-arthroscopic approach. This study compared the results of individuals who had rotator cuff repairs utilising mini-open versus all arthroscopic methods on a similar patient population. Material and Methods: The results of 50 patients who underwent arthroscopic and mini-open rotator cuff surgeries were compared in the current study. All preoperative and postoperative clinical and physical evaluations were completed, and the following information was collected: Demographics, the Simple Shoulder Test, the UCLA Rating Scale, the Visual Analogue Pain Assessment (VAS), and the Preoperative SF12 Assessment are the first five variables. Each patient’s outcome was evaluated using the modified ASES score. Results: Patients in the arthroscopic group had an average initial modified ASES score of 41, which increased to an average final score of 86 (P0.05). The average initial score for patients in the mini-open group was 51, while the average final score was 91 (P 0.05). The modified ASES ratings at preoperative and postoperative time points did not substantially differ between groups. Overall, shoulder pain, shoulder function as assessed by the UCLA Shoulder Form and the Simple Shoulder test, all significantly improved from pre-operative status. Conclusion: Patients who failed nonoperative treatment both had their function enhanced by mini-open and arthroscopic rotator cuff surgery, but there was no difference between the groups. Both methods worked well on individuals who had tears ranging in size from 1 cm2 to 12 cm2. The patient, physical therapist, and surgeon will work together to a great extent to determine the patient’s pleasure and outcome as the field of orthopaedics, particularly rotator cuff repair, continues to embrace new technologies.

232. Retracted

233. A Prospective Study to Correlate the Changes between Retinal Nerve Fiber Layer Thickness and Cupping of Disc Using Optical Coherence Tomography and Visual Field Changes Using Perimetry in Primary Open Angle Glaucoma Patients
Vishakhabahen Dabhi, Nilesh Parekh, Billav Rojasara
Introduction: Glaucoma, a leading cause of global irreversible blindness, includes Primary Open Angle Glaucoma (POAG), characterized by optic nerve damage and visual field loss. This study aims to correlate RNFL thickness, disc cupping, and visual field changes to enhance early glaucoma detection and management. Objective: To investigate correlations between RNFL thickness, disc cupping, and visual field changes in primary open-angle glaucoma. Methods: A cohort of 40 POAG patients was analysed. RNFLT was measured using OCT, while optic disc cupping was quantified through the vertical cup-to-disc ratio (VCDR). Perimetry was performed to assess visual field changes. Statistical analyses were conducted to determine correlations between variables. Results: Out of40 POAG patients, mean right eye RNFL thickness was 79.98 μm (SD = 11.548 μm) and left eye RNFL thickness was 79.15 μm (SD = 13.917 μm). Mean right eye VCDR was 0.735 (SD = 0.1027), and left eye VCDR was 0.747 (SD = 0.0784). Strong correlations were observed between RNFLT and VCDR in both eyes (p<0.05). IOP and VCDR also showed associations, with higher IOP values linked to larger VCDR values (p<0.05). Perimetric analysis revealed prevalent early defects. Significant correlations were found between perimetric changes and both RNFLT and VCDR in both eyes (p<0.05). Conclusions: This study establishes significant correlations between RNFLT, optic disc cupping, and visual field changes in primary open-angle glaucoma, underscoring their clinical relevance and potential for improved management.

234. An Autopsy Study of Histomorphological Changes in Heart: A 3-Year Study at A Tertiary Care Hospital, Government Medical College, Kadapa
V Nagesh Kumar, K Divija, G Sobha Rani, B Sridhar Reddy
Introduction and Objectives: Sudden cardiac deaths related to cardiovascular diseases accounts for nearly 50% of sudden deaths, most of which are caused by coronary artery disease. Incidence of ishemic heart disease in India has increased to about 10%, with more advanced lesions at younger age than in other ethnic groups. Aim of the present study is to identify various histo-morphological lesions in coronaries, aorta and heart. Material & Methods: This is a retrospective study over a period of 3 years from August 2020 to July 2023. A total number of 266 autopsy specimens were received in the department of pathology, GMC, Kadapa, out of which 110 heart specimens were received. 23 heart specimens were autolysed which were excluded and the remaining 87 were included in the study. Results & Conclusion: 87 heart specimens with preserved morphology were included in the study. The most common morphological change in heart was left ventricular hypertrophy (LVH). The pathological lesions in coronaries were seen in 49 cases (56%) with maximum lesions observed in LAD – 19 cases (39%). Coronary atherosclerosis was further graded according to Modified AHA classification based on histo-morphological description. To conclude our study highlights the importance of histopathological autopsies of heart which can provide important clues that aid in concluding the cause of sudden deaths and also provides estimation of undiagnosed cases and assessment of prevalence of atherosclerosis.

235. Evaluating and Reporting the Incidence, Prevalence and Provoking Factors to Admit in Emergency Medicine Department of a Tertiary Care Teaching Hospital: A Prospective Observational Study
Radhika Rani Chandra, Rama Rao Nadendla, Rama Rao N.V., Mannava Mithra Vindhya Sai Meghana, Yarramreddy Krishnaveni, Burri Shekinah Angelin, Shaik Baji Rahamtulla
Background: Emergency Department (ED) is a primary contact for medical care in critical cases. The core purpose of acute medical care is to stabilize the patient suffering with a life threatening (or) limb threatening injury or illness. There are numerous provoking factors to seek admission in ED like Social factors (smoking, alcohol, drug abuse, economic status, occupation); Psychological factors (suicidal thoughts, stress, anxiety, depression, isolation and intellectual disability); Genetic factors and Dietary factors. On an average, the incidence of emergency cases is 47 per 100 visits to a tertiary care teaching hospital. Aim: To evaluate and report the Incidence, Prevalence and Provoking factors to admit in Emergency Department of a tertiary care teaching hospital: A Prospective Observational Study. Methodology: A Prospective observational study was carried out in Emergency Department, Government General Hospital, Guntur for a period of 6 months i.e., 1st September 2022 to 28th February 2023 after obtaining approval from Institutional Ethics Committee. The patients were screened based on inclusion and exclusion criteria. Patients who satisfy criteria were included in the study after obtaining informed consent. The data was collected in designed data collection forms. The patient demographics, past history, provoking factors, MLC and non-MLC cases were taken and assessment of incidence, prevalence was done. Results: Majority of the patients were found Non-medico legal cases (71.4%) compared to Medico legal cases (28.6%). Incidence of Inflammatory/Infectious disease (38.2%) is more and the Prevalence is also high for Inflammatory/Infectious disease (49%) (P=<0.00001). Most of the accidents were seen in those using a 2- wheeler (81.73 %) than those using a 4- wheeler (16.12 %), 3- wheeler (2.15 %), most accidents occurred in patients whose driving speed limit is > 50 kmph (76.93 %) compared to those whose driving speed limit is < 50 kmph (23.07 %).Majority of them have no helmet (94.7 %) and the others have a helmet (5.3 %).We also Witnessed that the mortality was high in vascular diseases (40 %) followed by those in inflammatory/infectious (37.5 %) then in traumatic cases (20 %) and the least in neoplastic (2.5 %). Conclusion: From our study we conclude that patients of age group 36-45 were shown higher prevalence of admission in the ED in both MLC and non-MLC. Recurrent diseases have the high prevalence rate compare to the non-recurrent diseases. Non-communicable diseases have the high prevalence rate compare to the communicable diseases. On tabulation of results for speed of vehicle and helmet, speed >50Kmph has shown high prevalence rate and no helmet usage has shown high prevalence rate. The option for Ambulance and First-aid was low. Life saving techniques like CPR has lower utilization compare to dialysis. Our study concludes that by counseling the patient about dietary factors, life style modifications and measures to prevent Road Traffic Accidents (RTA) and poisonings which are contributing to admit in ED could help the patient in improving the patient’s health status and reduces the occurrence of RTA and poisonings. We also have seen the pivotal role of awareness of First- aid and Ambulance among the patients regarding to quality of life.

236. A Study of Prevalence and Risk Factors of Anemia in Postnatal Women
Garrepalli Saritha, Gara Bala Sreenivas, M Spoorthy Reddy
Background: Approximately two-thirds of pregnant women in developing nations are believed to experience nutritional anemia. Importantly, a significant proportion of these women were already anemic when they became pregnant, with an estimated anemia prevalence of nearly 50% among non-pregnant women in these regions. The present study aimed to determine the prevalence of anemia among postnatal women and study the risk factors associated with anemia in postnatal women. Methods: Sociodemographic data, third-trimester hemoglobin levels, and risk factors for postnatal anemia (parity, antenatal anemia, antenatal medical complications, intrapartum events, postpartum hemorrhage, mode of delivery, iron and vitamin supplementation, diet, infections, and breastfeeding) will be collected through a structured questionnaire, antenatal records, and delivery discharge summary. A 2 mL venous blood sample will be collected using established protocols. Hemoglobin levels will be estimated using a Sysmex 2-part Fully Automatic Hematology Analyzer. Results: The prevalence of postpartum anemia in this study was 52%. Women residing in urban areas had a lower likelihood of developing postpartum anemia compared to those living in rural areas. Mothers with no formal education were several times more likely to experience postpartum anemia compared to those with a formal education. Patients who underwent cesarean-section deliveries were times more likely to develop postpartum anemia than those who had vaginal deliveries. Conclusion: Overall, findings suggest that the risk of anemia in postpartum women is higher in older women, who live in rural areas, have lower educational status, have lower socioeconomic status, have more pregnancies, have low birth weight newborns, and have cesarean deliveries. Interventions to reduce the risk of anemia in postpartum women should focus on targeting these groups of women.

237. Exotic Fungi in Treated Cases of Pulmonary Tuberculosis and Treated Cases of COVID-19 with History of Pulmonary Tuberculosis: A Hidden Epidemic within Pandemic
Avighn Gupta, Pragati Aniket Manoli, Mahantesh B Nagamoti
Background: The occurrence of opportunistic mycoses among individuals undergoing treatment for tuberculosis and COVID-19 in India is notably elevated. This increased prevalence can be attributed to compromised immune systems and the administration of anti-tubercular therapy, which fosters the proliferation of fungal microorganisms. Consequently, this exacerbates the underlying health condition, potentially resulting in fatal outcomes. Methods: Post-treated cases of pulmonary tuberculosis and post-treated cases of COVID-19 with a history of pulmonary tuberculosis having respiratory symptoms visiting our teaching hospital. After getting consent from the patient, a detailed history was collected from patients by administering a structured questionnaire. The present study group is divided into Tuberculosis group (Group 1) and (Group 2) Covid 19 & TB group. Results: The total number of isolates was 19 (14 in group 1 and 5 in group 2). The most common type of isolate was Aspergillus fumigatus, with 5 isolates (3 in Group 1 and 2 in Group 2). The second most common type of isolate was Candida albicans, with 3 isolates (all in Group 1). Aspergillus fumigatus was more common in Group 2 than in Group 1. Candida albicans was more common in Group 1 than in Group 2. Aspergillus niger was found only in group 2. Conclusion: There is a high prevalence of fungal infections in treated cases of pulmonary tuberculosis and treated cases of COVID-19 with a history of Pulmonary Tuberculosis. Candida albicans and Aspergillus fumigates species are the common causative agents. These secondary fungal infections are associated with the persistence of respiratory symptoms, despite successful completion of anti-tubercular drug therapy and anti-Covid treatment.

238. A Clinical Study on Mucormycosis Done During the Covid Pandemic in the Year 2021
A. Geetha, K. Anjaneyulu, Y.M.S. Prasad, K.V. Manasa
Background: Mucormycosis is a angioinvasive fungal infection, mainly affecting patients with uncontrolled diabetes mellitus, those on chemotherapy and those who are suffering from a chronic illness. There has been a remarked increase in the incidence of Rhino-orbito-cerebral mucormycosis (ROCM) in association with the 2nd wave of COVID. Methods: The study was conducted in a tertiary care hospital. Data was collected from 200 cases of Rhino-orbito-cerebral mucormycosis which were admitted and treated in the period from June 1st to august 31st of 2021. Diagnosis was based on clinical features and histopathology of the biopsy specimen and staging was based on contrast enhanced MRI. Treatment included intravenous liposomal amphotericin B and surgical debridement of the necrotic tissue, retrobulbar amphotericin B injections as required. Results: Among the 200 patients under study 128 were male, 72 were female with the mean age being 50 yrs. All patients had history of covid with 159 of them having received oxygen inhalation and 167 of them had received systemic steroids. 174 patients were diabetic. Most of the patients belonged to stage 2 and stage 3. Conclusion: The usage of systemic steroids and uncontrolled diabetes mellitus are well known risk factors of mucormycosis, but the dramatic rise in the incidence in association with COVID probably suggests the immune compromised state caused by COVID. Early diagnosis and appropriate management are essential to control the spread of infection and decrease the morbidity and mortality associated with the disease.

239. Role of Doppler Analysis of Uterine Artery in the Assessment of Uteroplacental and Foetal Circulation
Anjali Dathan
Background: Pregnancies complicated by hypertension and intrauterine growth retardation (IUGR) experience a reduction in uteroplacental blood flow. It may be possible to predict the onset of these conditions by measuring uteroplacental blood flow early in pregnancy with colour Doppler because this decline is linked to a pathologic condition of spiral arteries that is thought to arise during placentation in the first trimester of pregnancy. This study was therefore undertaken to analyse the utilization of uterine artery Doppler imaging in the assessment of uteroplacental and foetal circulation. Methods: Serial Doppler evaluation of the uterine artery was done at 3 weeks’ interval. For patients with abnormal Doppler parameters, serial evaluation was done at 1 week and less frequent intervals depending on the severity. Doppler values of the last examination were taken for statistical measurements. The measurements of systolic/ diastolic ratio, resistance index and pulsatility index were made. Abnormal results were observed as a decrease in diastolic flow with resultant increased values of S/D, resistance index and also the characteristic persistent diastolic notch. A confidence interval was considered in S/D, resistance index and pulsatility index at different age groups by taking mean ± standard deviation. Chi – square test was applied to detect the weightage of the variable in multiple outcomes. The probability concept was directly applied to determine sensitivity, specificity and predictive values. Results: When compared to normal Doppler, higher S/D, RI and PI values were found in the abnormal Doppler. Conclusion: Doppler velocimetry of the uterine artery is one of the best prenatal tools in the earlier detection of the intrauterine growth retardation that may require additional antepartum surveillance and early obstetric intervention.

240. The Risks of Birth Defects with Conception by ART (Assisted Reproductive Technology)
Monica Singh, Rashmi Vishwakarma, Ankur Singhai, Randhir Singh
Objective To find out association between fertility status, method of conception and the risks of birth defects. Methods: This was a population-based cohort study linking ART cycles. from 1 January 2019 to 31 December 2022 that resulted in live births in 2020-2022. Non-ART siblings were identified through the birth history. Children from non-ART births were classified as being born to women who conceived with no ART treatment and were classified as being naturally conceived. Results: A total of 02 singleton children (2.04%) and 03 twin children (3.06%) had a major birth defect (chromosomal or nonchromosomal). Children conceived with ART from autologous oocytes had increased risks for nonchromosomal defects, including blastogenesis, cardiovascular, gastrointestinal and, for males only, genitourinary defects, with AORs ranging from 1.08 to 1.12; children in the autologous-fresh group also had increased risks for musculoskeletal and orofacial defects. Within the donor oocyte group, the children conceived from fresh embryos did not have increased risks in any birth defect category, whereas children conceived from thawed embryos had increased risks for nonchromosomal and blastogenesis defects. Conclusion: The risk of birth defects had two independent components: (i) method of conception and (ii) presence, type and number of birth defects.

241. Perinatal Outcomes in Children Born After Fresh or FET (Frozen Embryo Transfer) Using Donar Oocytes
Randhir Singh, Ankur Singhai, Rashmi Vishwakarma, Monica Singh
Background & Objective: To study whether children born after vitrified–thawed embryo transfers (ETs) using donated oocytes have worse perinatal outcomes when compared with fresh ET. Methods: Patients with a first singleton live birth after single blastocyst transfer were compared using multivariable regression analysis to account for potential confounding factors. The primary outcome was birth weight. Secondary outcomes were birth weight z-scores and percentiles, small/large for gestational age, gestational age at delivery, gender, prematurity (<37 weeks and <32 weeks), neonatal morbidity (Apgar scores and need for neonatal intensive care) and maternal morbidity (gestational hypertensive disorders, gestational diabetes and caesarean delivery). Results: There was no significant difference between the fresh ET and FET groups in terms of mean birth weight and birth weight z-scores, in both the unadjusted and confounder-adjusted models. However, artificial endometrial preparation was associated with a higher birth weight and birth weight z-scores when compared with a transfer in a natural cycle. Although a 1-day statistically significant difference in gestational age at birth was detected, premature birth rates (<37 weeks) did not vary significantly between groups. No other statistically significant differences were found in the remaining neonatal and maternal outcomes studies between the fresh ET and FET groups. Conclusion: No significant difference in birth weight and prematurity rates between fresh or frozen embryo transfers (FETs) in new-borns after oocyte donation was found.

242. To Study the Outcome of PFNA-2 in Intertrochanteric Fracture Femur in Elderly Patients
Mohammad Zuber, Vijendra Parmar, Rahul Jain, Neeraj Patidar
Background: Intertrochanteric fractures are increasingly common due to aging populations. Treating these fractures in elderly patients poses challenges due to osteoporosis and other risk factors. Choosing the right implant is crucial for success, and PFNA-2 is an excellent choice. These fractures occur between the greater and lesser trochanters due to direct or indirect stresses. Direct forces target the greater trochanter or femur axis, while indirect stresses involve abductor or iliopsoas muscle actions. Aim and Objectives: Objective of this study was to assess the outcome of PFNA-2 in Intertrochanteric Femur Fracture in Elderly Patients. Materials and Methods: This study was a prospective study with a sample of 20 patients with Intertrochanteric fractures of the femur. These 20 patients were treated with Proximal Femoral Nail Anti-rotation II (PFNA-II) at the Department of Orthopaedics and Traumatology, Gandhi Medical College, Bhopal. Patients were selected from among the admissions to the Orthopaedic ward and recruited into the study prospectively based on the inclusion and exclusion criteria. Results: The mean age of the patients was 69.50±11.71 years. Minimum age was 41 years and the oldest participant was 90 years old, each had right side and left side injury respectively. Majority 12(60.0%) injured from self- fall, 8(40.0%) were injured from road traffic accident. The mean operating time was 50.0 minutes. Most of the patients (55%) were operated on in 50 minutes or less. 9(45.0%) patient’s time of radiological union was 16-17 weeks. The average time taken for fracture union was 15.60±2.79 weeks. In the evaluation of the VAS scores, a significant reduction was observed at the 6 weeks, 3 months, and 6 month postoperative follow-up. The average VAS score at 1 month was 79.40±6.69, at 3 months it was 74.50±7.77 and at 6 months it was 67.70±9.48. Postoperative assessment of the patients was done using the Harris Hip Score. Good to excellent results at final follow-up in Harris Hip Score was seen in 70% of the patients, while 30% of the patients showed fair results. Conclusion: The PFNA-2 nail is a quick and straightforward implant for proximal reconstruction. Its helical blade aids in bone compaction and rotation prevention in osteoporotic trochanteric fractures, offering added advantages. With careful implantation and optimal fracture reduction, this design could lower complication rates compared to other options. For elderly osteoporotic patients, the PFNA-2 stands out as the superior choice for intertrochanteric fractures.

243. Functional Outcomes of Medial Column Augmentation in Comminuted Distal Femur Fractures: A Comparative Study
Vijendra Parmar, Amit Tandiya, Mohammad Zuber, Rahul Jain
Background: Distal femoral fractures, often caused by high-energy incidents, present challenges due to comminution and subsequent complications. Non-union of the femur, resulting from factors like severe open fractures, infections, or implant failures, leads to functional limitations and reduced quality of life. Commonly, open reduction and internal fixation (ORIF) methods are employed, utilizing various devices such as locking plates, condylar screws, blade plates, and intramedullary nails. Deformities arising from distal femur fractures demand anatomical reconstruction. Aims and Objective: The study aims to evaluate the functional outcomes of comminuted distal femur fractures treated with lateral locking compression plate fixation and medial column augmentation using either the titanium elastic nailing system or a buttress plate. Materials and Methods: Twenty patients aged 18 and above with comminuted distal femur fractures were included. Preoperative assessment involved clinical examination and radiographs. Surgical procedures comprised lateral plate fixation and medial column augmentation with either the titanium elastic nailing system or a buttress plate. Follow-up evaluations occurred at 4, 12, and 24 weeks to assess knee range of motion and radiological union. Outcome assessment utilized the Lysholme knee scoring system. Results: Most patients achieved union in under 14 weeks, with an average union time of 15.15 weeks. Knee range of motion varied from <60° to >120°. Outcomes based on the Lysholme knee scoring system revealed 35% of patients achieving excellent results, 45% achieving good results, and limited complications—55% of patients had no complications, while 15% experienced knee stiffness. Conclusion: The study underscores the efficacy of lateral locking compression plate fixation combined with medial column augmentation in managing complex comminuted distal femur fractures. This approach provides reliable fixation and favorable functional outcomes. Lateral locking compression plate fixation with medial column augmentation proves effective in treating comminuted distal femur fractures, yielding stable fixation and promising functional results.

244. Hospital-Acquired Infection and its Associated Risk Factors among Patients Admitted to a Tertiary Care Hospital at District Mahasamund, Chhattisgarh: A Longitudinal Study
Ashish Baghel, Anubha Patel, Anil Kumar Singh, Pradeep Kumar Dewangan
Background: The rates of hospital-acquired infections are rapidly increasing across the globe, especially, in developing nations including India. In the Indian scenario, the data on hospital-acquired infections is scarce in the literature. Aim: The present study aimed to assess hospital-acquired infection and its associated risk factors among patients admitted to a tertiary care hospital in the district of Mahasamund, Chhattisgarh. Methods: In 508 admitted subject’s risk factors, prevalence, and incidence were assessed throughout their stay in the hospital. In suspected subjects of hospital-acquired infection, biological specimens were taken and subjected to microbiological analysis. Laboratory and clinical data were statistically analysed. Results: The overall prevalence and incidence of hospital-acquired infection were 20% and 29% per 1000 patient days respectively. The highest and lowest incidence was seen in ICU and ophthalmology departments respectively with 208.53 and 0.96 per 1000 patient days. In surgical subjects, high risk was seen with previous hospitalization history, and in non-surgical subjects with underlying disease, mechanical ventilation, and chest tube. Hospital-acquired infection led to increased hospital mortality and prolonged stay in study subjects (6.1 more days). Conclusion: The present study concluded a high burden and poor outcomes of discharge in subjects at tertiary care hospitals in district Mahasamund. The risk factors differ between subjects who underwent surgery and did not undergo surgery. Efforts should be made to control the high burden of hospital-acquired infection to get better outcomes.

245. A Study of Management of Diaphyseal Fractures of Tibia by Closed, Reamed Interlocking Nail
Subodh Kumar, Vikas Kumar, Narendra Kumar Sinha
Background and Objectives: Many patients come to Department of Orthopaedics with tibial fractures. It is one of the common injuries occurring in adult age group. Though fracture unites with conservative treatment but associated with high morbidity. So fractures stabilization with intramedullary interlocking nail is useful to prevent morbidity. We aim to study efficacy of intramedullary interlocking nail in the treatment of closed tibial fractures. Methods: A total of 30 patients with closed tibial fractures underwent surgery for the fracture fixation with intramedullary interlocking nail in the Department of Orthopaedics, BMIMS Pawapuri. Study duration of Two Years. Patients were selected irrespective of sex. Results: Excellent results were obtained in 76.7% of cases, good results in 16.7%, fair in 10%. Complications include 6.7% of superficial infection, 6.7% of Anterior Knee pain. Conclusion: Intramedullary interlocking nail is the reliable, versatile and effective treatment for closed tibial fractures. The advantage of rapid rehabilitation and relatively few complications serves to recommend this procedure.

246. Role of Fine Needle Aspiration Cytology in Diagnosis of Thyroid Swelling
Sanjay Kumar Sahni, Deo Kumar Singh, Gluam Tabrez
Background and Objectives: Fine needle aspiration cytology is the sampling of a palpable or nonpalpable (radiological) mass by means of a fine needle with negative pressure applied by an attached syringe. It is an interventional cytological procedure and the purpose of this procedure is to obtain diagnostic material for cytological study from organs that do not shed cells spontaneously. To evaluate the efficiency and prospect of fine needle aspiration cytology of thyroid swelling in patients. To provide with a reliable, rapid and inexpensive method of diagnosis. Material and Method: The material will be collected from the patient attending the outdoor as well as admitted indoor patients of Darbhanga Medical College and Hospital, Darbhanga. The patient attending the outdoor patient department underwent a thorough clinical evaluation. Conclusion: The diagnostic yield of FNAC, in this series; was 93%. The diagnostic accuracy, in terms of detecting malignancy, was 83.34%. There was no false positive result recorded. False negative results in terms of detection of cancer were found to be 2.5%. No major complications were noted after FNAC procedure.

247. Management of Intra-Articular Calcaneal Fractures by Closed Reduction with Percutaneous Steinmann Pin
Subodh Kumar, Vikas Kumar, Narendra Kumar Sinha
Background and Objectives: Calcaneum is the most common tarsal bone to fracture and is attended by considerable morbidity. Many treatment techniques are described in literature but indications for specific techniques are vague. This study analyzes the outcome of treatment of intra articular calcaneum fractures. Methods: A Prospective study which has been carried out the BMIMS Pawapuri, Study duration of Fifteen Months. The material for the present study was collected from patients who attended and admitted in Department of Orthopedics with tongue-type intra-articular fractures of the calcaneum. 20 cases of either sex were taken up for the study. Patients were well informed about the study in all respects and informed written consent was obtained. Results: Incidence was more common in males with right and left side involvement being almost equal and no bilateral involvement. The commonest mechanism of injury was fall from height and landing on the heel. It was found to be more common in age group 30-39 years. Associated spine and lower extremity injuries were seen in 30%. There were 45% excellent, 30% good, 25% fair results and no poor results. Conclusion: The Essex-Lopresti method of closed reduction and pin fixation is a useful method for the treatment of tongue-type fracture of calcaneum.

248.  A Prospective Study- Functional and Radiological Outcome of Total Hip Replacement via Posterior Approach with Uncemented Modular Prosthesis
Vikas Kumar, Subodh Kumar, Narendra Kumar Sinha
Background and Objective: Total Hip Arthroplasty represents the greatest single advance in Modern Orthopaedic surgery. Total Hip Arthroplasty is the indication for nearly all patients with diseased hip that causes chronic discomfort and significant functional impairment. It is the definitive treatment for end stage hip arthritis and has been shown to improve quality of life in a highly cost effective manner. To assess the functional outcome, radiological outcome and quality of life scores in patients treated with Total Hip Arthroplasty using modular prosthesis via the posterior approach. Methods: 30 patients who underwent THR in BMIMS Pawapuri, for a period of 2 years who fulfilled the inclusion criteria after obtaining surgical consent. Patients were followed up at 3 weeks, 6 weeks, 3 months, 6 months interval for assessing the functional outcome and quality of life scores evaluated by Harris Hip Score (HHS) and the radiological outcome by radiography – AP view. Conclusion: Uncemented total hip replacement gives acceptable results in otherwise disabling condition of hip . Clinical assessment correlated well with radiographic appearance in the short term follow up and will require longer follow up period to prove the merits of uncemented THR. We conclude there is significant decrease in pain and disability with improvement in patient quality of life, There was significant post-operative improvement in quality of life which was evident by HHS and radiological outcomes.

249.  Study of Fasting Blood Glucose Level, C-Peptide, Insulin and Glycosalated Haemoglobin (HbA1c), In Pre-Diabetics
Deo Kumar Singh, Sanjay Kumar Sahni, Gluam Tabrez
Background and Objectives: Diabetes mellitus is the commonest endocrine disorder in population. This clinical syndrome due to either absolute or relative insulin deficiency. To correlate the level of fasting Insulin, fasting glucose level, c-peptide and HbA1c, level in prediabetic person. Suggestion to decide line of treatment as per his status of glucose, insulin, C-peptide and HbA1c particulars in pre diabetic person. Material and Methods: It is a prospective study done in the prediabetic outpatient clinic of our hospital, 50 prediabetic patients will be evaluated for fasting plasma glucose level, fasting C-peptide level, Insulin and Glycosalated haemoglobin HbA1c. Conclusion: Early screening of subjects with risk factor of pre-diabetes, C-peptide and serum insulin testing should be done in patients with poor blood glucose control to decide treatment modalities and, To create awareness about lifestyle modifications and education to Prevent obesity and encourage to physical activity.

250. Intracapsular Fracture Neck of Femur in Elderly Treated By Hemiarthroplasty: A Clinical Study
Subodh Kumar, Vikas Kumar, Narendra Kumar Sinha
Background and Objectives: The Study of fifty cases of intracapsular fracture neck of femur in elderly patients above the age of 50 years irrespective of sex treated by hemiarthroplasty using unipolar (Austin moore’s / Thompson’s ) or bipolar endoprosthesis, in the Department of Orthopedics, to study the age and sex incidence of fracture neck of femur, quality of life after hemiarthroplasty, morbidity and mortality associated with the procedure, recovery of physical, social and vocational independence, number of days of stay in hospital and associated complications. Methods: Fifty cases of fracture neck of femur in elderly patients above the age of 50 years treated by hemiarthroplasty using either unipolar or bipolar prosthesis in the Department of Orthopaedics at BMIMS Pawapuri were selected on the basis of purposive sampling or judgment sampling method. Conclusion: The poor results (11.1%) were due to moderate to marked pain in the hip or thigh after hemiarthroplasty. We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The mortality and morbidity are not high, operative procedure is simple, complications are less disabling. Early functional results are satisfactory.

251.  Clinical Study to Evaluate the Functional Outcome of Fracture of Femoral Neck with Bipolar Prosthesis
Vikas Kumar, Subodh Kumar, Narendra Kumar Sinha
Introduction: Intertrochanteric fractures are rising due to longer life expectancies, especially in Asia. Lag screws and intramedullary (IM) nailing have shown promising outcomes. New design improvements have overcome prior challenges. Surgeon expertise and local criteria determine implant choice. The research found statistically significant regional differences in Medicare enrollees’ “intramedullary (IM)” nail use. Aim and Objectives: This study examines intramedullary nail fixing for intertrochanteric femur fractures. Method: 53 patients with intertrochanteric fracture from four high-volume clinics were included. Participants must be 60 or older and healthy enough to stroll around their areas. The procedure used an InterTAN nail and was on schedule. Lag screws supplied anatomical alignment and compression after fluoroscopically assisted reduction. After surgery, antibiotics and heparin helped with weight bearing. Non-institutional orthopedists judged bony union as a callus crossing two cortices. Result: Table 1 shows preoperative findings: mean age 76.7 years (SD 8.9), 20 men, 33 women. BMD hip T-score -2.6 (SD 1.0), spine T-score -2.8 (SD 1.3). In Table 2, the surgery lasted 76.8 min (SD 29.9), blood loss was 184.5 ml (SD 97.9), and 1.3 blood units were transfused. Good 74, acceptable 17, bad 9. TAD 14.9 mm (SD 2.9), bone union 17.9 weeks (SD 7.9). Table 3 shows surgical complications, emphasising caution. Conclusion: In conclusion, treatment with IM nails and lag screws for Asian patients with intertrochanteric fractures is effective. Correctly selecting patients and putting in screws is essential. Further investigation is recommended.

252. Influence of Mastoidectomy Middle Ear Cleft Flora and Mucosal Status on Tympanic Membrane Perforation Repair
Santosh Kumar, Jitendra Kumar, Sushant Kumar
Background and Objectives: Chronic otitis media is an inflammatory process of the mucoperiosteal lining of the middle ear space and mastoid. The mucus membrane may be thickened by edema, submucosal fibrosis and infiltration with inflammatory cells. Clinical, demographic, pathological & bacteriological assessment of patients subjected to tympanic membrane perforation repair. To follow up the patient and asses the outcome of graft acceptance after tympanic membrane perforation repair. Materials and Methods: This study was conducted in the Department of ENT, Dept. of Microbiology and Pathology, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga from April 2018 to December 2019. For this purpose 145 patients who had chronic otitis media with or without ossicular chain discontinuity were studied. Conclusion: The patients were subjected to Mastoidectomy on a random basis. Mastoidectomy was done from anterior to posterior direction Attic, aditus and antrum were planned to be opened in sequential manner only up to the extent to which there was suspicion or evidence of disease. 70 patients underwent only tympanoplasty, 60 patients had tympanoplasty with mastoidectomy and l5 were revision tympanoplasty with mastoidectomy.

253. Bacteriological Study on Upper Respiratory Tract Infections
Pedapati Kasturi, Navuru Suneetha, T Jaya Chandra
Introduction: Microbial pathogens such as bacteria, virus, fungi as well as parasites can cause Upper respiratory tract infections (URTIs). With these a study was conducted to find the various bacteria responsible for URTIs and also their antimicrobial pattern. Materials and methods: Study was conducted in the department of Microbiology, GSL Medical College, from March to July 2023. Individuals clinically diagnosed with URTIs, aged >18 years, who submitted informed consent were included. Throat swab was collected from the study participants from posterior pharyngeal wall and also from the tonsils. Swabs were transferred immediately to the microbiology laboratory for the later process. Samples were inoculated immediately on sheep blood agar, chocolate agar and MacConkey agar. The inoculated plates were incubated at 37°C overnight under 5% – 10% carbon dioxide atmospheres. Results: During the study period, total 133 samples were collected, male female ratio was .9. Gender wise, 31%, 45% were culture positive (CP); statistically there was no significant difference. More CP results were identified in 28 – 59 years group, Stahylococcus aureus was predominant isolate. Conclusion: URT infections are common among female, age group 29 – 58 years is commonly prone for the infections. Stahylococcus aureus is the predominant pathogen.

254. Comparative Analysis of the Incidence of Posterior Capsule Opacification between Square Edged PMMA and Round Edged PMMA Intraocular Lens in Patients Underwent for Small Incision Cataract Surgery
Ruchi Priya, Pallavi Mishra
Introduction: “Posterior capsule opacification (PCO)” is a common long-term impact of cataract surgery induced by “residual lens epithelial cells.” PCO requires surgery to prevent vision loss. Despite advances, PCO affects millions in worldwide. “Laser posterior capsulotomy”, the principal treatment, is risky and expensive. Prevention and better “intraocular lens (IOL)” designs are needed to solve this issue. Aims and Objectives: The study has compared PCO incidence, severity, and PMMA IOLs requiring laser capsulotomy. Methods: One hundred patients at Naraina Medical College and Hospital who had posterior chamber intraocular lens implantation following manual small incision cataract surgery were included in the study. Patients were chosen for the trial based on several factors, including their interest in participating, their availability for follow-up, the absence of conditions known to affect study outcomes, and their willingness to provide informed permission after being fully briefed on the study’s methods, risks, and benefits. Results: Table 1 demonstrates ocular laterality and Group A/Group B allocation. Both groups had good BCVA results, as shown in Table 2. After one year, Group A had a higher rate of “posterior capsule opacification (PCO)” than Group B (Table 3). 12% had laser capsulotomy. Most patients did not need. These data imply PCO rates varied between the two groups and emphasise the significance of diligent follow-up and PCO management after cataract surgery. Conclusion: The incidence of PCO was found to be lower in patients who had square-edged IOLs, while Nd: YAG capsulotomy was found to be more effective with square-edged IOLs.

255. Studying the Connection between Tobacco Chewing and the Quality of Semen in Patients Undergoing Infertility Evaluation
Vanisha Dhaka, Deepali Chauhan, V. Pawar, Harpreet Kaur
Objective: The use of tobacco is one of several lifestyle choices that have an impact on male fertility. Chewing tobacco is a common addiction among Indian males. Our research’s goal was to evaluate the connection between Indian men who are habitual tobacco chewers and the quality of their sperm. Patient(s): Three categories of tobacco chewing frequency were used to classify 300 male patients having infertility evaluations: mild (3 times/day, n = 100), moderate (3–6 times/day, n = 100), and severe (>6 times/day, n = 100). Results: The mild group had considerably greater sperm concentration, percentage motility, morphology, and percentage viability than the moderate group than the severe group. Although the differences were not statistically significant, the percentage of men with azoospermia is increased with the severity of addiction. Conclusion: In our study, chewing tobacco was substantially linked to a decline in sperm quality and more deranged with increase in quantity of tobacco usage. Chewing tobacco therefore may have a negative impact on couple’s social and mental mental wellbeing. So, timely advice for quitting tobacco and couple’s counselling for fertility can help society in a better way.

256. Thoracolumbar Interfascial Plane Block Vs Caudal Epidural for Post-Operative Analgesia in Spine Surgeries: A Comparative Study
Nikitha Somanayak, Adharsh Shivanna, Deeksha R Malkhedkar, Sandhya. K
Introduction: Caudal epidural is one of the established techniques for post-operative analgesia whereas thoracolumbar interfacial plane block (TLIP) is a new technique which is still evolving and is, yet to prove its efficacy in terms of post-operative analgesia. Methods: Sixty patients aged between 18-75 years, belonging to ASA (American Society of Anaesthesiologists) I and II scheduled for elective lumbar spine surgeries under general anaesthesia were enrolled and randomly allocated into two groups of 30 each, group 1 received GA + TLIP block and group 2 received GA(General anaesthesia) + caudal epidural using 0.2% ropivacaine. Results: There was significant difference in the mean heart rate between two groups from 30 mins to post-operative 1 hr and at 12 and 24hrs post op. There was significant difference in MAP (mean aterial pressure) between two groups at 30 min intra operative period and immediately post-operative period to 24hrs, and there was significant difference in VAS (Visual analog scale) score from 2 hrs to 6 hrs and at 24hrs implying caudal epidural has better analgesia than TLIP block. Meantime of rescue analgesia in TLIP group was 13.76 hrs and caudal epidural group was 16 hrs. Conclusion: Caudal epidural has a better analgesic effect when compared to TLIP block. However, TLIP is a good adjunct with GA for post-operative analgesia in patients undergoing lumbar spine surgeries with less VAS score in the first 24 hrs.

257. Malpresentations: An Observational Study on Prevalence and Feto-Maternal Outcome in A Tertiary Care Center
Tsetan Dolma, Aakanksha Mahajan, Reema Khajuria
Background: Malpresentation is defined as when the presenting part of fetus is other than normal vertex of fetal head. Aims and Objectives: To study the prevalence of various malpresentations, mode of delivery, complications and feto-maternal outcome. Material and Methods: This hospital based prospective observational study was conducted in Department of Obstetrics and Gynaecology, SMGS Hospital, Government Medical College Jammu from 1st of November 2021 to 31st of October 2022. All the indoor patients in SMGS Hospital with malpresentations were included. Patients were observed for mode of delivery, maternal and fetal outcomes and prevalence of malpresentation calculated. Results: The prevalence of patients with malpresentations was 0.87%. Mean age was 26.5±5.04 years. There was a predominance of primigravida patients (54.9 %) and majority were term (77.2%). 92.1% had breech presentation, 3.3% had transverse lie, 2.3% had face presentation, 1.4% had brow presentation, and 0.9% had compound presentation. Out of all the patients with malpresentations, 70.2% had LSCS and 29.8% had vaginal delivery. Feto-maternal outcome was also assessed where most common complication was found to be postpartum haemorrhage (10.7 %) followed by stitch line soakage (5.6 %). We observed that 40.6% of neonates with vaginal delivery had apgar score < 7 at one minute, while only 3.3% of patient with LSCS had apgar score <7 at one minute which is statically significant(P= <0.001). 20.5% neonates needed NICU admission with neonatal mortality rate of 5.1%. Conclusion: Malpresentations require a careful obstetrical examination for diagnosis and management. Delivery should always be planned to decrease maternal and perinatal morbidity and mortality.

258. Prevalence of Anxiety and Depression among Patients with Chronic Tension Type Headache
Tushar Talhan, Ritesh Upadhyay, Chanchlesh Dehariya, Dileep Dandotiya
Background: Headache is one of the most common reason patients seek medical attention every year about 80 percent of population has a least one headache and 10 to 20 percent go to physician with headache as their primary complaint. Headaches are also a major cause of absenteeism from work and avoidance of social and personal activities. Anxiety and depression are recognized co-morbidities in patients with tension type headache but studies among patients with TTH (tension type headache), have shown variable results, hence the need for further comprehensive studies on chronic TTH. The presence of psychiatric co-morbidity in headache further complicates and makes difficult headache management and portends a poorer prognosis for headache treatment. Material and Methods: Cross sectional study was conducted among 95 patients attending outpatient department of psychiatry in medical college and hospital for 18 months from April 2015 to October 2016. Patients from psychiatric outpatient department complaining of headache in the age group 18 yrs to 60 yrs included in this study after their written consent and after applying inclusion and exclusion criteria. Subjects were recruited on a purposive basis from the OPD of Psychiatry and Medicine Department in Dr. Panjabrao deshmukh Memorial Medical College, Amravati. Recruitment was accomplished by using inclusion and exclusion criteria’s and consent was taken for the participation in the study. The recruited subjects were diagnosed for chronic tension type headache according to international classification of headache disorder (ICDH) 3rd (beta version). Results: Depressive disorder followed by anxiety disorder was most common in chronic tension type headache. The prevalence of anxiety was 16.84% in patient of CTTH and mild degree of anxiety was most common. Depression was found in 52.63% of patient of chronic tension type headache. Mild depression (68%) out of all depressive patient were most prevalent inpatient suffering from chronic tension type headache. The comorbidity (anxiety and depression) were more prevalent in unemployed/Housewife patients. Conclusion: From the our study findings, it is clearly evident from this study that, the patient with chronic tension type headache have high prevalence of depression and anxiety, the proper psychiatry screening and detail evaluation is required, so that the depression and anxiety detected in early stages and treated which further can improves the prognosis of chronic tension type headache.

259. Bacteriological Profile of CSOM and Antibiotic Susceptibility Pattern at a Tertiary Care Teaching Hospital, Udaipur, Rajasthan, India
Sudeepti Saran, Viral Chayya, Vikram Singh, Mohammad Nabil Sindhi, Rambabu Sharma
Background: CSOM (chronic suppurative otitis media) is one of the most important and common global public health problem causing hearing impairment and prevalent particularly in developing countries. Increased irrational and wide use of antibiotics, resistant in the bacterial infection of ear is common. Objectives: The main objective of the present study was to appraise the current pattern of bacterial etiology of CSOM in patients and antimicrobial susceptibility of the bacterial isolates prevalent in the hospital. Materials and Methods: A prospective observational study was carried out in 125 patients with chronic ear discharge. Sterile swabs were used to collect ear discharge and processed for gram’s stain and culture. Antibiotic susceptibility testing was performed by modified Kirby-Bauer disk diffusion method. Result: Out of 125 study patients, high prevalence was noted between age group of 21-40 years (41.6%), highest in males (62.4%) as compared to females (37.6%). Among the bacterial isolates, Pseudomonas aeruginosa (40.8%), Staphylococcus aureus (19.2%), Proteus species (6.4%), Escherichia coli (10.4%), CoNS (8%), Klebsiella species, (4.8%), and Citrobacter spp. (3.2%) was the common bacterial isolates. Staphylococcus aureus was found to be more sensitive for linezolid and vancomycin. However, the majority of gram-negative isolates showed sensitivity to carbapenems and aminoglycosides. Conclusion: Pseudomonas aeruginosa was the most common organism isolated on culture followed by staphylococcus aureus and E.coli. Aminoglycosides, vancomycin and carbapenems had the highest susceptibility rate against the bacterial isolates.

260. A Descriptive Study on Demographical, Haematological and Biochemical Profile of Weedicide Poisoning At Tertiary Health Care Centre, Chhindwara, MP
Jyoti Nagwanshi, G B Ramteke, Ritesh Upadhayay, Vikas Rangare
Background: The issue of poisoning caused by pesticides and various other chemicals used in agriculture is a significant public health concern on a global scale, particularly in developing nations. Among the many substances, weedicide like as paraquat, 2,4-D, and glyphosate have been identified as significant contributors to elevated rates of illness and death. There are limited publications on weedicide poisoning. Aims and Objective: To study the Demographical, Haematological and Biochemical Profile of Weedicide Poisoning. Materials and Methods: The present study is a retrospective observational research that includes patients who were hospitalised to CIMS Hospital Chhindwara due to weedicide poisoning between October 2019 and November 2020. The researchers gathered data on demographic characteristics, clinical presentations, haematological parameters, and biochemical markers from the patients’ medical records. Result: Total number of weedicide poisoning were 28 out of which paraquat cases were 19(67.86%), 2,4-D 7(25%) and glyphosate 2(7.14%). Outcome wise, 10 (35.74%) of them discharged, 6(21.43%) of them expired, 12(42.86%) referred to higher centre for haemodialysis/hemoperfusion and 1(3.57%) absconded. Conclusion: The ingestion of weedicide has been found to be linked to significant morbidity and fatality rates. The prompt emphasises the need of promptly identifying and implementing proactive measures to address cases of weedicide poisoning, given the absence of a targeted antidote.

261. A Prospective and Randomized Study to Compare Postoperative Analgesic Effect of Ropivacaine with or without Dexamethasone in Ultra Sound Guided Transversus Abdominis Plane Block for Patients Undergoing Lower Abdominal Surgeries
Ajay Kumar, Aditya Kumar Kejriwal, Hari Damodar Singh, Shyam Kishore Thakur, Sushil Kumar
Background: An effective abdominal field block for the transversus abdominis is ultrasound guidance. In patients undergoing lower abdominal surgeries, the intention was to ascertain the impact of adding dexamethasone to 0.375% ropivacaine on the analgesic duration of TAP block. Methods: Total 60 patients double-blinded randomised control study with 30 patients in each group was done. Group A: 20 ml total, 20 ml for each side of 0.375% ropivacaine and 1 ml of dexamethasone, 4 mg. Group B: Following lower abdominal surgery, 20 ml of 0.375% ropivacaine and 1 ml of normal saline were injected into the TAP block on each side. The primary objective is to assess the duration of postoperative analgesia provided by the block, and the secondary objectives are to compare the total amount of rescue analgesia required in the first 24 hours following surgery and any side effects from the ropivacaine in the TAP block. The intensity of the two groups’ pain was compared using scores on a numeric rating scale. Results: When compared to group B (10.69±1.79 h), group A analgesia duration was substantially longer (12.44±1.60 h) at the time of the first analgesic need, P < 0.001. In comparison to group B, group A required less total rescue analgesic ampoules after surgery (1.27±0.64 vs. 1.63±0.56 ampoule, P = 0.024) (P <0.005). At 1 hour, 2 hours, and 4 hours postoperatively, group B NRS scores for pain were significantly higher than those of group A. Conclusion: The duration of postoperative analgesia increases significantly when dexamethasone is added to ropivacaine in a TAP block.

262. Study on Clinical Profile of Liver Function Test in Patients with Dengue Infection
Dashrath Kumar Singh, Sanjay Nath Jha, Vinayanand Jha
Background: There have been numerous reports of unusual dengue infection presentations involving the liver, ranging from slight increases in aminotransferase levels to fulminant hepatitis. Methods: At the medicine department of the DMCH, Laheriasarai, Bihar, 27 cases of dengue infection that had been serologically confirmed were examined. Patients with normal levels of aminotransferase were assigned a grade of A, those with at least one enzyme elevated to less than three times the reference range were assigned a grade of B, those with at least one enzyme elevated to more than three times the reference range were assigned a grade of C, and those with elevations greater than ten times were assigned a grade of D. Results: 89% of the cases showed altered aminotransferase levels, with 22% being Grade D or acute hepatitis, 37% being Grade B, and 30% being Grade C (P< 0.001). In comparison to alanine aminotransferase (ALT), aspartate aminotransferase (AST) levels were greater (mean: 296.9 U/l and 390.7 U/l, respectively). Conclusion: A typical side effect of dengue infection is liver damage with altered aminotransferases, which is a useful marker for keeping track of these patients.

263. An Observational Study of Role of Spontaneous Cycle Follicular Monitoring in Unexplained Infertility
Sayeeda Parveen, Subhasini, Abha Rani Sinha
Background: Due to the significant prevalence of unexplained infertility, it is necessary to evaluate the utility of underutilized techniques, such as ultrasonographic follicular monitoring, endometrial alterations, and their association with hormone levels in spontaneous menstruation. Our research sought to identify the minute flaws that were to blame. Methods: It was an observational study conducted in the Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar from February 2022 to April 2023. The study comprised 50 infertile women with unknown causes. On days 2-3 after the start of menstruation, the subjects were contacted for a baseline transvaginal ultrasound to measure the endometrial thickness, antral follicular count, and hormonal profile. Up until ovulation was confirmed, follow-up ultrasonographic monitoring was performed. On the day the dominant follicle measured 18 to 20 mm, a hormonal profile was performed, and on day 21 serum progesterone levels were measured. Results: The study group average age was 26.48±3.3 years. In 66% of cases, infertility was primary, and in 34%, it was secondary. At least one, or a combination of modest abnormalities, were present in the tracked cycles of 78% of the women. The average number of antral follicles was 13.8±5.17. Only one woman had fewer than five antral follicles, and 30% of women had FSH levels over 10 IU/L and serum estradiol levels over 80 pg/ml. In 34% of the women, luteal phase defects and early LH surges were seen. Conclusion: Spontaneous cycle follicular monitoring is a helpful tool to shed light on the subtle defects that contribute to unexplained infertility, such as premature ovarian reserve depletion, defective folliculogenesis, poor oocyte quality, premature luteinization, and luteinized unruptured follicular syndrome. Thus, it appeared to be a valuable supplement to the investigative work-up of women with unexplained infertility to perform transvaginal sonographic examination of a spontaneous cycle.

264. Observational Study of Arrhythmias in Patients with Acute ST Elevated Myocardial Infarction and their In-Hospital Outcome
Jay Prakash Himanshu, P. Yugal
Background: Arrhythmia is the most frequent factor in the post-infarction phase after acute myocardial infarction (AMI), which is a leading cause of death globally. Early acute MI arrhythmia detection and therapy are important for both short- and long-term outcomes. The study objective is to assess the distribution of arrhythmias in acute STEMI patients throughout the first 48 hours of hospitalization as well as their prognosis while still in the hospital. Methods: In this study, inclusion and exclusion criteria led to the inclusion of 50 patients with acute STEMI in total. With a baseline ECG upon admission and ongoing cardiac monitoring in the CCU, the patients were monitored for the first 48 hours of their hospital stay to look for arrhythmias. In a predesigned structured data collecting sheet, the pattern of the arrhythmias throughout this time and their in-hospital outcome were documented. Result: The age ranged from 29 to 70 years, with the mean being 53.38 ± 10.22 years. 42 patients (84%) were mostly men. The majority of the patients (54%) had anterior wall myocardial infarction, including significant anterior, anterior, and antero-septal infarction. The most frequent arrhythmia seen in 36.8% of patients was sinus tachycardia alone, followed by sinus bradycardia (22.8%), ventricular tachycardia (19.3%), ventricular ectopic (12.3%), first degree AV block (5.3%), total heart block, and atrial ectopic 1.7% each. When a myocardial infarction affected the inferior wall as opposed to the anterior wall, tachyarrhythmias were more frequent. 72% of the patients in the study had favorable outcomes, with acute left ventricular failure coming in second with 10%, cardiogenic shock coming in third with 8%, and mortality coming in second with 2%. Conclusion: Sinus tachycardia was the most frequent arrhythmia found, followed by sinus bradycardia, ventricular tachycardia, ventricular ectopic, AV block, and atrial ectopic. Mortality was 2% of the population.

265. Evaluation of the Efficacy of a Single Bolus Dose of Carbetocin for Prevention of Postpartum Haemorrhage in Elective Caesarean Section under Spinal Anaesthesia
Madhu Priya, Minakshi Bajpayee, Kumari Bibha
Background: The biggest cause of maternal deaths globally is postpartum hemorrhage (PPH), which accounts for an estimated 1,40000 deaths annually. By employing “active management of the third stage of labor,” most of them can be avoided. A synthetic oxytocin analogue with a longer half-life, carbetocin was first described in 1987. The current study’s objectives were to assess carbetocin’s effectiveness in reducing intraoperative blood loss and to track its effects on hemodynamics. Methods: In this study, 120 individuals who underwent an elective caesarean delivery while under spinal anesthesia and had a gestation of at least 37 weeks were included. Two groups of patients (Group CT and Group C) were created. After the anterior shoulder was delivered, women in the carbetocin group (group CT) got an IV bolus of 100 mcg/ml of carbetocin whereas those in group C received an oxytocin infusion. The study’s parameters included mean effective blood loss, HR and MAP, as well as side effects like headache, palpitations, and nausea and vomiting. Results: Both groups showed no PPH occurrence. The average effective blood loss in groups CT and C, respectively, was 423.0±150.1 ml and 635.3 ±245.4 ml. Six patients in Group C required rescue oxytocin. The mean total dose of mephentermine was statistically lower in group CT (23.8±12. 0) than in group (56.8±8.6). Conclusion: The conventional oxytocin protocol is less efficacious and hemodynamically unstable in preventing PPH during caesarean section than a single bolus dose of carbetocin.

266. Clinical Effectiveness of Atorvastatin and Rosuvastatin in High-Risk Dyslipidemic Patients
Navin Kishore, Shashi Prakash Chandra, Navin Kumar, Asha Singh
Background: Globally, coronary heart disease (CHD) is ranked as the leading cause of death in people. It is known that a number of risk factors, including smoking, being overweight, and hyperlipidemia, are linked to CHD. In this investigation, the effectiveness of rosuvastatin and atorvastatin in decreasing cholesterol in patients at high risk for dyslipidemia was compared. Methods: 90 patients with high-risk dyslipidaemia who were identified using the international recommendations for the prevention of adult dyslipidaemia participated in this randomized, open-label study. These individuals were randomly assigned to receive either rosuvastatin (20 mg/day) or atorvastatin (20 mg/day), respectively, for a period of three months. The effectiveness of atorvastatin and rosuvastatin on the levels of LDL-C, HDL-C, total cholesterol (TC), and triglycerides (TG) was evaluated in both groups. Additionally, both group’s rates of meeting LDL-C or TC target values were evaluated. Results: In comparison to Atorvastatin, Rosuvastatin significantly reduced LDL-C (43.2% and 38.1%, p < 0.05) and TC (34.8% Vs 28.1%, p <0.05). Additionally, rosuvastatin group patients were more likely to reach the suggested goal TC and LDL-C values than atorvastatin group subjects were.

Rosuvastatin has more efficacy in lowering lipids than atorvastatin in people at high risk of hyperlipidemia.

267. A Study of Mycobacterium Tuberculosis Infection in Women with Infertility
Ashraf Shaik, Amrin, Raghu Ram Uppalapati
Introduction: Pulmonary tuberculosis is the most prevalent presentation; extra pulmonary and genital tuberculosis were the second most common presentations, with an increase in women of reproductive age. Aim: The purpose of this study was to look for mycobacterium tuberculosis in endometrial biopsy samples from infertile women. Methods: In a cross-sectional investigation, 36 infertile women aged 21-35 years were tested for mycobacterium tuberculosis infection in endometrial biopsy using PCR technology. Results: Upon PCR procedure, all cases were negative, which show that there was no genital tuberculosis infection in any of the women with infertility. Conclusion: In our investigation, genital TB did not appear to be a serious issue in women experiencing infertility.

268. Maternal Outcome in Elective Vs Emergency Caesarean Section at A Tertiary Care Center
Shalini Garg, Parneet Kaur, Balwinder Kaur, Satinder Pal Kaur, Sangeeta Aggarwal, Aarti Narula
Objective: To study the maternal outcome in elective vs emergency caesarean section at a tertiary care center. Material and Method: The study was conducted for one year. Patients irrespective of gestation age undergoing caesarean sections at our tertiary referral center were enrolled. The study was conducted after obtaining the approval of the institutional ethics committee. In this study two groups of pregnant females were studied. Group 1: Women who underwent elective caesarean section. Group 2: Women who underwent emergency caesarean section. Results: There were total 3296 deliveries during the study period. Out of total deliveries, 1306 women with singleton pregnancy underwent LSCS. There were 917(70.2%) emergency LSCS and 389(29.8%) elective LSCS. Maternal outcomes were recorded and compared between elective and emergency LSCS group. In the present study, maternal complications were seen in 41.3% of emergency LSCS as compared to 20.3% of elective LSCS. The maternal intraoperative complications were seen in 23.6% of emergency LSCS as compared to 12.3% of elective LSCS. Maternal postoperative complications were seen in 17.7% cases in emergency group as compared to 8% in elective group. Conclusion: Maternal intraoperative complications were more (23.6%) in emergency group as compared to elective group (12.3%). It was statistically significant. Maternal postoperative complications were more (17.1%) in emergency group as compared to elective group (7.7%). It was statistically significant.

269. Ewing’s Sarcoma: Outcomes in Patients with Atypical and Typical Lesions in Non-Long Bone Extremities: A Case Series
Samir Shukla, Ajay Sharma, Shivangi Pandey, Vankodoth Vamshi Nayak, Sanjay Sisodiya, Ashok Kumar Rathore
This retrospective observational study aimed to compare the characteristics and outcomes of patients with Ewing’s sarcoma presenting with atypical and typical lesions. Medical records of patients diagnosed with Ewing’s sarcoma between 2010 and 2020 at a single tertiary care centre were reviewed. Patient data, including demographics, clinical presentation, and imaging findings, were collected. Descriptive statistics were used to summarize patient characteristics, treatment modalities, and outcomes. The study included nine patients (four with atypical presentations and five with typical presentations). The atypical group had a significantly higher mean age than the typical group (34 vs. 23 years, p=0.047). Atypical presentations included a fungating mass in the area of Barrett’s oesophagus, shoulder swelling, yellowish skin discoloration with abdominal pain, and chest wall swelling. One case was an extra-skeletal Ewing’s sarcoma, while another was located in the peripapillary region and treated with ERCP and CBD stenting. Typical presentations involved pain and swelling in the long bones of the extremities. All patients underwent a combination of surgery, chemotherapy, and radiation therapy. The mean follow-up period was 12 months, with seven patients achieving complete remission and two patients with progressive disease. This study highlights the importance of considering atypical presentations of Ewing’s sarcoma and suggests that age may play a significant role in its diagnosis. Managing Ewing’s sarcoma in atypical locations may require different treatment approaches compared to bone Ewing’s sarcoma. Early diagnosis and appropriate treatment are crucial for improving outcomes in patients with Ewing’s sarcoma.

270. Characterization and detection of Linezolid resistance in clinical isolates of Enterococci in Tertiary care Hospital of Central India
Surbhi Suneja, Jaya Lalwani, Rakesh Shrivastava, Deepti Chaurasia
Introduction: The prevalence of antibiotic resistance within the Enterococcus species is on the rise. Aim: This study aimed to ascertain the occurrence of linezolid-resistance amongst the Enterococcal bacterial specimens isolated from patients. Materials and Methods: This was a single centre, hospital; laboratory based clinical cross-sectional study conducted over a period of 18 months. The Enterococcus bacteria isolated and identified from diverse samples specimen were subjected to culture and antibiotic sensitivity testing. Identification of Enterococcus species involved conventional biochemical tests and the VITEK 2 Compact system. The antimicrobial susceptibility of the isolates to a range of antibiotics was assessed using both the Kirby–Bauer disk diffusion method and the VITEK 2 Compact system to determine their minimum inhibitory concentration (MIC). Interpretation of susceptibility was based on the guidelines from the Clinical and Laboratory Standards Institute (CLSI) 2021. Results: A total of 645 Enterococcal isolates were included in the present study- 336 were isolated from male patients, while 309 were obtained from female patients. The majority of these isolates (24%) originated from patients aged between 19 and 30 years. Enterococci were predominantly isolated from urine samples (359 isolates – 55%), most frequently identified species was E. faecalis (52.1%). The highest prevalence of resistance was identified against Erythromycin (91%) across all species. A total of 18 (2.8%) isolates were resistant to Linezolid – of these Linezolid resistant Enterococci 15 (83.3%) were sensitive to vancomycin and 3 (17.7%) were resistant to both vancomycin and linezolid. Conclusion: E. faecalis is stands as the prevailing clinical species extracted from clinical samples. The rise of linezolid-resistant enterococci within hospital settings sparks concern, given its role as a final treatment option for patients afflicted by vancomycin-resistant enterococci.

271. Changes in Erythrocyte Sedimentation Rate and C – Reactive Protein After Total Hip Arthroplasty
Mohd Zabair, Gazala Abbas, Tahir Afzal, Anil Gupta, Sanjeev Gupta
The serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are the major important markers of per prosthetic joint infection. The ESR and CRP values are the important diagnostic inflammatory markers. Thus, the early and appropriate diagnosis is the most appropriate strategy to promote the functional outcomes of the orthopaedic patients. The present prospective observational study was conducted at Government Medical College and Hospital, Jammu, JKUT in the orthopaedic department with the aim to evaluate the trends of ESR and CRP in the first 3 weeks after uncomplicated THR. A total of 20 patients underwent uncomplicated THR were involved in the study. It was reported that the mean age of the patients was 55.95±8.24 years and majority of the patients were males (90%). It was found that there was a peak of ESR and CRP levels on third post-operative day, which gradually decreases on 7th, 12th and 3rd weeks after surgery. It was concluded that there was significant increase in ESR and CRP trends on third post-operative day which shows the inflammation.