International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. A Randomized Placebo-Controlled Study to Evaluate the Efficacy of Nebulized Dexmedetomidine Premedication for Attenuation of Hemodynamic Stress Response during Laparoscopic Cholecystectomy under General Anesthesia
Naveen Kumar, Udita Naithani, Riyaz K Ahamed, Surendra Kumar Sethi, Isha Garg, Pratibha Yadav
Background: Intravenous dexmedetomidine is frequently used as an adjuvant in anaesthesia to provide hemodynamic stability during laparoscopic cholecystectomy; however, the role of nebulized dexmedetomidine for the same is not yet investigated. We aimed this study to determine the effect of nebulized dexmedetomidine administered as a premedication in attenuating the hemodynamic response during laparoscopic cholecystectomy as the primary objective while its effect on sevoflurane requirement, recovery profile and side effects as secondary objectives. Materials and Methods: This prospective, randomized, placebo-controlled study included 60 patients of American Society of Anaesthesiologists (ASA) I and II aged 18-60 years of both gender undergoing laparoscopic cholecystectomy. They were randomized into two groups of 30 each to receive either nebulization with dexmedetomidine (1 mcg/kg in 5ml normal saline) in Group D and 5ml normal saline in Group C, administered 15 min before induction of general anaesthesia. Hemodynamic variables, sevoflurane requirement, Ramsay sedation score (RSS) and Modified Aldrete score were recorded preoperatively, and compared with t-test or chi-square test with P<0.05 as statistically significant. Results: Mean arterial pressure and heart rate were significantly less in Group D as compared to Group C following intubation, pneumoperitoneum, surgery and extubation, P<0.05. Mean sevoflurane requirement (volume %) was significantly less in Group D (1.24±0.29%) as compared to Group C (2.69±0.28%), P=0.001, showing 53% reduction in Group D. Both groups were comparable regarding RSS scores, extubation time and recovery time, (P>0.05). Conclusion: Administration of nebulized dexmedetomidine (1µg/kg) before induction provides hemodynamic stability and reduces sevoflurane requirement during laparoscopic cholecystectomy without any delay in recovery or side effects.

2. Correlation of T3, T4 and TSH Levels with Diastolic Blood Pressure in Premenopausal Women with Altered Thyroid Hormone Status
Santosh Madhao Kayande, Urjita Zingade, Sheetal Madhav Munde, Anupam Suhas Khare
Introduction: Hypothyroid or Hyperthyroid state affects all the physiological systems including the cardiovascular system. Among all adverse changes, diastolic blood pressure can also be affected in patients with thyroid disorders. Objectives: The present study was carried out find out correlation of T3, T4 and TSH levels with diastolic blood pressure in premenopausal women with altered thyroid hormone status Materials and Methods: The present study was carried out in 90 female subjects in the age group of 30 to 45. Diagnosis of hypothyroidism and hyperthyroidism was based on both clinical and biochemical criteria. Subjects were divided in euthyroid, hypothyroid and hyperthyroid groups with each group containing 30 subjects. Resting diastolic blood pressure was measured in all the groups. Results: A negative linear correlation of total T3 and total T4 hormone level with resting diastolic blood pressure (p<0.001) was observed. A positive linear correlation of total TSH hormone level with resting diastolic blood pressure (p<0.001) was noted. Conclusion: Thyroid hormone directly or indirectly decreases peripheral resistance by dilating the arterioles. As T3 and T4 levels increase and as TSH levels decrease, resting diastolic blood pressure goes on decreasing linearly. On the other hand, as T3 and T4 levels decrease and as TSH levels increase, resting diastolic blood pressure goes on increasing linearly. Hence thyroid hormone concentration should be kept within normal limits by appropriate therapeutic measures so as to prevent ill effects of resultant deranged diastolic blood pressure.

3. Evaluation of Serum C-Reactive Protein in Patients with Sepsis
Amitav Mohanty, Ganitya Bhusan Bhuyan
Introduction: According to the definition of sepsis, it is “a life-threatening condition of organ dysfunction brought on by an abnormal host response to infection.” The acute stage of the protein known as C-reactive protein (CRP) is made in the liver. TNF-, IL-1, and IL-6 promote its production. It is heightened during an inflammatory immunological response, particularly when there is a bacterial infection. After the sickness has abated, the CRP levels rise and return to reference ranges more quickly. Method: After ruling out exclusion criteria, patients who presented to the general medicine department, ER, or intensive care unit and met the Sepsis-3 criteria were taken with informed permission. The patients’ medical records were mined for demographic, clinical, and laboratory information. The Mispa i2 machine was used to determine the serum C-reactive protein. The anti-human Creactive protein-coated latex fragments agglutinate when exposed to serum C-reactive protein (CRP). Turbidimetry can be used to measure the agglutination of the latex particles, which is proportional to the CRP concentrations. Result:  We have 46 patients to explore the function of serum PCT and CRP in the identification and prognosis of sepsis patients. Serum CRP (mg/L) (Day 0) in the case group had a mean (SD) of 39.91 (28.32). The control group’s mean (SD) for serum CRP (mg/L) on Day 0 was 5.61 (4.86). Conclusion:  We came to the conclusion from our study that CRP might be regarded as dependable biomarkers for the precise diagnosis of sepsis patients. d Early detection of sepsis can be aided by CRP, which could speed the start of proper therapy with antibiotics and other factors, thereby improving the sepsis’s unfavourable prognosis. Therefore, it is possible to regard CRP as reliable prognostic indicators in sepsis.

4. Serum Procalcitonin Evaluation in Sepsis Patients
Amitav Mohanty, Ganitya Bhusan Bhuyan
Introduction: In the medical condition known as sepsis, the immune system works overtime to fight infection by releasing chemicals into the blood that cause widespread inflammation. The prohormone precursor of calcitonin known as procalcitonin (PCT) is largely synthesised in the C-cells of the thyroid gland and to a lesser extent in the neuroendocrine tissue of other organs like the lungs and intestines. Method: In Bhubaneswar, Odisha’s Apollo Hospitals (Tertiary Care Centre), a study was undertaken on patients in general medicine, emergency care, and intensive care units. It is situated in the eastern coastline region of Odisha’s capital city. The iCHROMA II equipment was used for the serum procalcitonin assay. Result:  To investigate the role of serum PCT in the identification and prognosis of sepsis patients, we have 92 individuals. In the case group, Serum Procalcitonin (ng/mL) (Day 0) had a mean (SD) of 6.21 (5.43). In the control group, Serum Procalcitonin (ng/mL) (Day 0) had a mean (SD) of 0.37 (0.39). Conclusion:  One of the top causes of death in the globe is sepsis. To reduce morbidity and death in sepsis, early detection and prompt treatments are essential. The gold standard for diagnosing sepsis is microbiological culture, however it takes time and is not widely available. Serum PCT and CRP, two easily accessible biomarkers, have drawn a lot of interest in previous investigations. In this research, we assessed the roles of CRP and procalcitonin in the diagnosis and prognosis of sepsis patients.

5. Correlation between Clinical Seizure Type with Aetiology, Electroencephalogram and Neuroimaging in Infants and Children Aged 1 Month -14 Years
Deepak Kumar Behera, Gobinda Hembram, Nibedita Pradhan
Objective: To find out etiology, determine the frequency of abnormal EEG and neuroimaging in infants and children aged 1 months-14 years. Methods: In this cross-sectional observational study, children between 1 month and 14 years of age admitted to Sriram Chandra Bhanj Medical College and Hospital, Cuttack complaining of seizures were observed from December 2020- December 2022. Results: Out of 210 patients 137 had abnormal EEG, of whom only 42.5% also had abnormal CT scan and the majority 52.5% had normal CT. However out of 38 cases with normal EEG recording 28% had abnormal CT scan. There is a statistically significant relationship between EEG recording and CT scan findings (p=0.045). Conclusion: Based on our findings we recommend EEG and Neuroimaging only in all children with abnormal history, clinical examinations, endemicity of tuberculosis and persistent altered sensorium or focal deficits following an epileptic fit.

6. Significance of Serum Procalcitonin and C-Reactive Protein in Septic Shock Patients
Amitav Mohanty, Ganitya Bhusan Bhuyan
Aim: The aim of this study was to investigate and evaluate the clinical significance of C-reactive protein (CRP) and serum procalcitonin (PCT) in patients with septic shock. Method: Seventy-two patients with septic shock were divided two groups based on treatment outcomes- mortality (n = 42) and survival (n = 102) groups. As a control group, 40 sepsis patients without septic shock were selected. PCT, CRP, and SOFA scores were evaluated within twenty-four hours of admission. Results: The mortality group had highest PCT, CRP, and SOFA scores, followed by survival and control groups. In determining the prognosis of patients with septic shock, the sensitivity and specificity of PCT were 67.9% and 46.5%, while those of CRP were 83.3% and 81%. Conclusion: CRP and PCT levels may indicate a patient’s prognosis.

7. Evaluation of the Diagnostic Role of Transvaginal Ultrasound Measurements of Endometrial Thickness among Postmenopausal Women
Preksha Gupta, Shubha Srivastava, Pomila Sachdev
Introduction: Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity without an obvious intervening cause and is confirmed only after 12 consecutive months of amenorrhea. Endometrial atrophy is the most common cause of postmenopausal bleeding, accounting for 60 – 80 % of the cases. Asymptomatic endometrial thickening is defined as endometrium ≥ 5 mm thick on ultrasonographic examination in postmenopausal women who have no complaints of bleeding. Transvaginal ultrasonography is routinely performed as part of a pelvic sonogram in postmenopausal women, and images of the endometrium, including a measurement of the endometrial thickness (ET) are frequently obtained. Materials and Methods: This is a prospective study conducted among all Postmenopausal Women attending Gynecology OPD in The Department of Obstetrics and Gynecology Kasturba Hospital, BHEL Bhopal. Women who reported at least 12 months of amenorrhea after the age of 40 yrs. provided that the amenorrhea was not explained by medication or disease. All asymptomatic postmenopausal women having endometrial thickness >/= 5mm. Transvaginal sonography; the measurement of the endometrium is made at its maximal thickness on a midline sagittal image of the uterus obtained by transvaginal ultrasound. It is a bilayer measurement combining the width of both the anterior and the posterior layers of the endometrium. It has been suggested that the normal endometrial thickness in a postmenopausal woman is 5 mm. Results: Out of 100 patients, 17% of the women had an Irregular menstrual cycle in the past. Out of 100 patients, 14% of the women had increased menstrual flow. Out of 100 patients, 20% of the women had dysmenorrhea. Distribution of Per speculum showed that the majority of the women had cervix flushed with vagina and vagina healthy (43%) followed by cervix and vagina – healthy (33 %) whereas 15 % had cervix – hypertrophied and vagina – healthy. The Majority of the patients had endometrium thickness (mm) of 9 mm (23%) followed by 8 mm (22%) and 10 mm (14%). In the majority of the patient’s atrophy (62 %) was observed, 19% had an endometrial polyp, 10% had hyperplastic hysteroscopy. In 2% of women ca endometrium diagnosed and 19% of the women endometrial polyp was diagnosed, 16% had endometrial hyperplasia without atypia and 1% of patients had endometrial hyperplasia with atypia. Conclusion: The results of our study highlight the need for routine use of transvaginal ultrasound as a screening test for endometrial cancer. We should consider the rising incidence of endometrial cancer, and the requirement for more and larger prospective trials with surrogate criteria for thickened endometrial stripe in postmenopausal women in TVS for both symptomatic and asymptomatic women.

8. Comparative Evaluation of Septoplasty versus Septoplasty with Functional Endoscopic Sinus Surgery (FESS) in 50 Cases of Chronic Maxillary Sinusitis: A Retrospective Cohort Study
Gopal Kumar Jha, Prashant Kumar
Background: Surgery is often necessary to treat chronic maxillary sinusitis (CMS), a prevalent sinonasal condition. This retrospective study aimed to evaluate the efficacy of Septoplasty versus Septoplasty combined with Functional Endoscopic Sinus Surgery (FESS) in the Treatment of CMS. Methods: We looked back at 50 CMS instances, splitting patients into two groups: those who underwent Septoplasty only (n=25) and those who experienced Septoplasty plus FESS (n=25). Patients’ demographics, symptoms, CMS recurrence rates, and quality of life were assessed. Results: Significant symptom alleviation, minimal recurrence rates of CMS, and substantial patient-reported improvements were seen following both surgical methods. There were no discernible differences between the two groups. Eighty per cent and eighty-two per cent of patients in the Septoplasty and Septoplasty with FESS groups experienced an improvement in face pain and nasal congestion, respectively. Both the overall and recurrence rates for CMS were 16%. Both groups reported delighted patients. Conclusion: When FESS is unnecessary due to individual patient characteristics, this study implies that Septoplasty alone may be a viable therapy option for CMS. It is essential to make treatment selections individually, considering patient preferences and symptom patterns. This strategy can improve clinical practice by raising patient satisfaction, quality of life, and general well-being. More study is required to confirm these results and provide helpful guidance for CMS administration.

9. Clinical Evaluation of Inguinodynia Following Inguinal Hernioplasty
Santosh Kumar¹, Om Prakash Kumar², Prem Prakash³, Anunay Kumar
Background: Surgical repair of an inguinal hernia, in which abdominal contents protrude through the inguinal canal, is a standard medical procedure. Persistent or recurrent pain in the inguinal region after surgery, known as inguinodynia, can be problematic for patients and doctors to manage. This research aims to examine inguinodynia after inguinal hernioplasty procedures and the factors contributing to its development. Methods: 200 patients who had inguinal hernioplasty at Bihar Hospital were included in a retrospective study. Electronic health records were mined for demographic and clinical information, such as patient characteristics, surgical methods, mesh types, and pain ratings. The incidence of inguinodynia was studied through various surgical procedures using logistic regression analysis. Results: Forty (20%) of the 200 patients reported inguinodynia during the postoperative checkup. Although there was a trend in the direction expected, no statistically significant relationships were found between the various surgical procedures and inguinodynia. Inguinodynia was most common after TAPP repairs (37.5%), then TEP (25%), Lichtenstein (25%), and stress (12.5%). In a non-significant trend, logistic regression analysis favours some methods. Conclusion: This research explains why some patients get inguinodynia after having an inguinal hernia repaired. The observed trends suggest that the surgical method may affect inguinodynia rates, but statistical significance was not reached. These results have implications for postoperative pain treatment, preoperative counselling, and clinical decision-making. More study with more significant cohorts is needed to validate these results and further understand this complexity.

10. The Impact of Maternal Obesity on Pregnancy Complications and Neonatal Outcomes
Priyanka, Deepali, Sweta Bharti
Background: Over 15% of pregnant women around the world are obese, making it a major health issue on a global scale. This is a major public health concern linked to numerous negative outcomes for the mother and the newborn. Maternal obesity increases the likelihood of complications, such as Type 2 Diabetes Mellitus (Gestational Diabetes Mellitus (GDM)), hypertensive problems in pregnancy, premature birth, macrosomia, and neonatal morbidity. Healthcare practitioners can better assist obese pregnant women by implementing tailored interventions if they fully grasp the mechanisms beneath these connections. Methods: This retrospective study included 200 expectant mothers who gave birth at the Bihar General Hospital between January and December 2022. Maternal characteristics, obstetric difficulties, and neonatal outcomes were extracted from medical records and databases. Obese mothers were identified using pregnancy-specific BMI cutoffs, and statistical analyses were conducted to search for associations between maternal weight and adverse pregnancy and baby outcomes. Results: Hypertensive disorders during pregnancy (20% vs 5% in non-obese) and macrosomia (15.0% vs 2.0% in non-obese) were also substantially linked with maternal obesity with increased risk of GDM (32.0% vs 8.0% in non-obese). The greater rate of preterm birth in the group of obese mothers (18.0% vs. 12.0% in the non-obese) was not statistically significant. A higher percentage of babies born to obese mothers were admitted to a Neonatal Intensive Care Unit (NICU) (25.0 vs 10.0%). Conclusion: Obese mothers had increased pregnancy complications and lower baby outcomes. The findings emphasise early risk assessment and personalised therapy for overweight or obese pregnant women. Nutritional guidance, fitness regimes, and other lifestyle changes are needed to manage pregnancy weight gain and reduce risk. Healthcare providers can improve expectant mothers’ and newborns’ health by raising awareness and adopting measures to lower maternal obesity concerns. Understanding maternal obesity’s effects is essential for healthier babies and better futures. Future studies should examine potential remedies and the long-term effects of maternal obesity on children to improve evidence-based guidance and public health initiatives.

11. Ultrasonography and Pregnancy Outcome in Threatened Abortion: A Prospective Observational Study
Swati Sharan, Pratulya Nandan
Background: In the early phases of pregnancy, pregnant women who experience vaginal bleeding should be highly concerned about a condition known as threatened abortion. To provide the best patient treatment, it is essential to predict the outcome of a pregnancy and select the most appropriate management strategies. This prospective observational study aimed to obtain a deeper understanding of the predictive value of ultrasonography and its implications for the medical treatment of impending abortion. Method: Between April 2022 and March 2023, 100 pregnant women in their first trimester who exhibited warning signs of an impending abortion were recruited for the study. Using ultrasound, we examined the heart of the foetus, the extent of the cervical canal, and a few other aspects of the gestational sac. In addition, documentation indicating the presence of additional information, such as subchorionic hematoma, was discovered. To keep track of how the pregnancy progressed, repeated examinations were performed. Results: 65% of the study’s participants were able to carry their pregnancies to term, while 35% had miscarriages for unknown reasons. The ultrasonogram results were able to predict the outcome of the pregnancy accurately. Specifically, the formation of a visible gestational sac and the presence of foetal heart activity were substantially associated with an increased likelihood of a healthy pregnancy continuation. This relationship was robust. In contrast, researchers discovered that women with a shorter cervical length or a subchorionic hematoma had a substantially elevated risk of miscarriage. These results demonstrate the utility of ultrasonography as a method for predicting the outcomes of pregnancies at risk of being terminated due to complications associated with the threat of abortion. Conclusion: This prospective observational study demonstrates the usefulness of ultrasonography in assessing pregnancy progression and identifying cases of imminent abortion. Taking ultrasound findings into account when making clinical decisions can enhance patient counselling, management strategies, and care for pregnant patients. Additional research is required to determine whether or not early intervention with ultrasonographic indicators improves the outcomes of high-risk pregnancies.

12. A Hospital Based Comparative Study to Evaluate the Efficacy of Methotrexate V/S Dapsone/ASST for Treatment of Chronic Urticaria: A Retrospective Cohort Study
Swati Surabhi, Prashant Kumar, Abhishek Kumar Jha, Vikas Shankar
Background: Treatment of chronic urticaria is difficult in the clinic, since it often does not react to standard antihistamines. This retrospective study compares the efficacy and safety of Methotrexate with Dapsone/ASST (Dapsone combined with Autologous Serum Skin Test) for the treatment of chronic urticaria. Methods: 180 patients with chronic urticaria who received treatment with Methotrexate (n = 90) or Dapsone/ASST (n = 90) within January 1, 2022 and December 31, 2022 were the subject of a retrospective review of their electronic medical records. Changes in the Urticaria Activity Score (UAS), safety profiles, time-to-response, and duration of response were used to evaluate efficacy. Results: The UAS was drastically diminished by methotrexate and Dapsone/ASST. The Methotrexate group saw a decrease of -6.2 ± 3.1, whereas the Dapsone/ASST group saw a decrease of -6.5 ± 3.0. Comparing the two groups, there was no discernible trend (p = 0.324). Haematological, hepatic, and pulmonary adverse events were similar in the Methotrexate and Dapsone/ASST groups. The Methotrexate group had a higher treatment discontinuation rate due to side effects, although this difference was not statistically significant (p = 0.212). The median time to response for Methotrexate was 20 days, and for Dapsone/ASST was 18 days, according to Kaplan-Meier survival analysis. After ceasing treatment, the Methotrexate group had a median response time of 9 months and the Dapsone/ASST group 10 months. In a logistic regression analysis, age and baseline sickness severity were significant determinants of therapeutic response (p < 0.05). Conclusion: When treating chronic urticaria, both Methotrexate and Dapsone/ASST are viable alternatives with similar success rates. Individual patient features and treatment side effect profiles should be considered while making this decision. Methotrexate’s benefits may be worth the price. Future research should further investigate long-term outcomes and individualised treatment techniques to improve chronic urticaria management.

13. Cutaneous Manifestations among COVID-19 Patients Admitted to a COVID Hospital: A Retrospective Analysis
Swati Surabhi, Prashant Kumar, Babli Kumari, Abhishek Kumar Jha, Vikas Shankar
Since the emergence of the COVID-19 pandemic, various cutaneous manifestations have been reported among infected individuals. Understanding these dermatological symptoms is crucial for early recognition, diagnosis, and appropriate management. This retrospective study investigated the prevalence and types of cutaneous manifestations observed among COVID-19 patients admitted to a designated COVID hospital in Bihar, India. Medical records of COVID-19 patients admitted to the COVID hospital between August 2022 and July were retrospectively reviewed. Patients with documented cutaneous manifestations during their hospitalization were included in the study. Data on patient demographics, clinical characteristics, and dermatological findings were collected and analysed. This study included 500 patients with moderate-to-severe COVID-19, where more than half were aged >60 years, and 48% exhibited severe cutaneous manifestations, with erythematous rash (38%) being the most common symptom, while vesicular lesions were associated with severe COVID-19, and erythematous rash and urticaria with mild-to-moderate disease, and post-COVID-19 skin complications were reported in 15% of recovered patients, with post-inflammatory hyperpigmentation (7%) and pruritus (5%) being the most common. This retrospective study sheds light on the occurrence of cutaneous manifestations in COVID-19 patients admitted to a COVID hospital in Bihar, India. Early recognition of these dermatological signs is crucial for timely diagnosis and appropriate management. Further research is warranted to investigate the underlying mechanisms and potential implications of these cutaneous symptoms in the context of COVID-19.

14. Psoriasis & Psychiatric Morbidity: A Profile from a Tertiary Hospital in North India
Swati Surabhi, Prashant Kumar, Babli Kumari, Abhishek Kumar Jha, Vikas Shankar
Background: Psoriasis, a chronic inflammatory skin disease, is a significant global burden that negatively impacts individuals’ physical and mental health. The connection between psoriasis and psychiatric illness has grown more of a concern, particularly in North India, where climate and genetics could affect disease prevalence. This study seeks to better understand the mental health issues experienced by psoriasis patients in North India and to identify any correlations between the skin condition’s severity and emotional distress. Methods: 200 people participated in a cross-sectional survey at a tertiary care facility in Northern India. This study used structured interviews and validated questionnaires to assess variables including psoriasis severity using the Psoriasis Area and Severity Index; PASI and psychiatric morbidity using the Hospital Anxiety and Depression Scale; HADS). Statistical analyses were conducted to identify relationships between the derived demographic and clinical data. Results: According to the study’s findings, the psychological problem was prevalent among psoriasis patients in Northern India. The prevalence of anxiety was 22.5% (HADS score 8), while depression was 17.7%. The severity of psoriasis, as measured by PASI scores, was associated with higher psychological morbidity. The fact that 10% of the participants reported both anxiety and depression simultaneously demonstrates the complexity of their mental health needs. Conclusion: The findings emphasise the significance of integrated care that addresses both the dermatological and mental health aspects associated with psoriasis and the significant psychological impact of psoriasis in North India. This study improves our understanding of psoriasis and psychiatric morbidity, and highlights individualised care’s importance. In the meantime, clinicians should adopt an integrated approach to improving patient outcomes incomplete the completion of additional research on this complex relationship.

15. Retrospective Study of Pregnancy Outcome in Twin Pregnancy with One Fetal Demise
Sadhana Kumari R, Shanti Snehlata, Raj Rani Chaudhary
Aims and Objectives: To study pregnancy outcomes in women with twin pregnancies with one fetal demise from a period of March 2022 to February 2023. Materials and Method: It is a prospective study at Nalanda medical college and hospital, Patna. Total number of pregnant women with twin pregnancies with one fetal demise was taken in this study. Both live and dead fetuses were followed up till term and their pregnancy outcomes were studied. Results: Out of 2477 pregnant patients; 152 had twin pregnancies. Out of this, 8 had twin pregnancies with one fetal demise. Out of these 8 patients, in 4 patients, demise was detected in first trimester.1 patient came in second trimester. Rest 3 patients came in third trimester for their first visit. Of the 4 patients who reported fetal demise in first trimester, all patients delivered healthy babies compared to those who came in other trimesters. Out of these 4 patients who reported in third and second trimesters, 1 patient delivered premature baby, 2 patients had i.u.g.r. baby and 1 patient developed preeclamptic symptoms. Discussions: The incidence of single fetal death in twin pregnancies is reported to be as high as 2.5 to 6% compared to 0.3% to 0.6% in singleton pregnancies. Intrauterine single death can occur at any gestational age. If this happens in first trimester of pregnancy, surviving twin will most likely develop without further consequences. However, if fetal death occurs after mid-gestation, this is associated with increased rate of preterm labor, iugr, preeclampsia, and perinatal mortality.

16. Radiological and Functional Outcome of ACL Repair with Internal Brace Augmentation: A Retrospective Study
Sudip Daniel Minz, Rakesh Choudhary
Background: The Anterior Cruciate Ligament (ACL) is commonly injured and can be quite debilitating, frequently requiring surgery for a full recovery. Traditional ACL reconstruction procedures, while effective, have limitations that have prompted the search for new solutions. Utilising an internal brace for strengthening an ACL that has been previously repaired is a promising new advancement in the field. By evaluating the radiological and functional outcomes of ACL restoration retrospectively using Internal Brace Augmentation (IBA), this study contributes to the demand for more effective treatment options. Methods: Retrospective research was conducted on 200 patients who underwent ACL surgery; 100 received IBA, and 100 underwent Traditional ACL Repair. Researchers examined population characteristics, diagnostic results, and functional assessments. Statistical tests were utilised to determine the differences between the two categories. Results: The results indicate that IBA is associated with numerous positive outcomes. Graft integrity (p = 0.027), graft rupture rate (p = 0.011), and complication rate (p = 0.046) were all significantly higher in the IBA group compared to the Traditional ACL Repair group. According to the IKDC Subjective Knee Evaluation, those who had IBA showed a greater increase in knee range of motion (p = 0.031) and a higher rate of returning to pre-injury activity levels. Conclusion: The potential advantages of IBA as a companion to ACL surgery are shown by this analysis of past patients. As a result of IBA, radiographic quality has increased, difficulties have decreased, and functional outcomes have gotten better. Significant implications for clinical practise are suggested by these results, which imply that IBA is a therapy option for ACL injuries and has the potential to improve patient outcomes and quality of life. Verifying these findings and refining IBA’s use to ACL restoration operations will require further study and future investigations.

17. A Prospective Study of Management and Outcome of Intertrochanteric Fractures Using Trochanteric Femoral Nail (TFN)
Prashantha, Prakash N, Anoop H S, Karthika Hathwar K.S., Sanjeev MN
Introduction: Fractures around the trochanteric area of the femur are among the most frequent fractures encountered in orthopedics and also among the most distressing injuries of the elderly. A burgeoning population and increased life expectancy have resulted in a rise in these types of fractures. Several implants have been designed for the treatment of these fractures. In this study, we analyze the functional and radiological outcome of intertrochanteric fractures managed with Trochanteric Femoral Nail. Materials and Methods: This is a prospective study. 30 patients with intertrochanteric fractures treated by Trochanteric Femoral Nail, from November 2019 to November 2021 were included in the study. We analyzed these 30 patients for functional and radiological outcome and complications. The criteria for the assessment of efficiency of surgical technique included duration of surgery, number of intraoperative complications, and blood loss. Clinical assessment includes postoperative walking ability, hip and knee function, duration for fracture union, and implant bone interaction by modified Harris Hip Score. Results: The fracture union rate was 93% and the average union time was 14 weeks. According to modified Harris Hip Score, overall, 7% of patients had excellent results, 47% of patients had good results, 33% of patients had fair results and only 13% of patients had poor results. Conclusion: The result of our study shows that Trochanteric Femoral nail is an effective device for fixation of inter trochanteric fractures of femur with good functional and radiological outcomes. We conclude that the TFN is a highly accepted minimally invasive implant for fixation of intertrochanteric fractures, but careful surgical technique and selection of the patients should further reduce its complication rates.

18. Mobile Device Use for Calming and Emotional Reactivity and Executive Functioning in Young Children
Rajesh Singh, Amrita Chauhan, Ashish Saraswat, Sachin Singh Yadav
Background: Young children are frequently engaged or soothed by mobile devices, although it is unknown whether this practice affects a child’s development. Objectives: To investigate the long-term, reciprocal relationships between young children’s executive functioning (EF) and emotional reactivity and the frequency that parents report utilizing mobile devices to soothe them. Methods: This prospective study used a convenience sample of English-speaking parents with typically developing children between the ages of 3 and 6. The study was carried out from August 2022 to January 2023. Parents regularly use mobile devices to comfort upset children (3-point Likert scale). Checklist for Adolescent Behavior At each wave, the child’s emotional reactivity was assessed using the Emotional Reactivity Subscale, and executive function (EF) was assessed using the Behavior Rating Inventory (BRI) of Executive Function-Preschool Version Global Executive Composite. The Child Behavior Questionnaire-Very Short Form surgency score and median split were used to generate structural equation models to examine the cross-lagged associations between the use of calming tools, EF, and emotional reactivity. Results: The crude OR for frequent users compared to non-regular users among 500 eligible children was 1.85 (95% CI [1.252.74], p =.002) for regular users (Crude model in Table 5). For regular users, the IPTW-OR for executive functioning was 1.82 (95% CI [1.152.87], p =.009). In contrast to higher emotional reactivity, increased device use for calming among boys was not significantly correlated with higher emotional reactivity (r [standardized regression coefficient] = 0.20; 95% CI, 0.10-0.30). The use of calming devices was linked to increased emotional reactivity in children with high temperamental surgency, whereas higher emotional reactivity was linked to increased calming device use. Conclusions: The findings of this study suggest that the frequent use of mobile devices for calming young children may displace their opportunities for learning emotion-regulation strategies over time; therefore, pediatric health care professionals may wish to encourage alternate calming approaches.

19. Obstetrical Outcome of COVID-19 Positive Pregnant Women in A COVID Dedicated Hospital in Bihar
Shanti Snehlata, Puja Verma, Usha Kumari
Background: During the COVID-19 pandemic (2020 -2021) our hospital was Covid dedicated tertiary care center. COVID-19-positive pregnant women and women in immediate post-partum period were admitted in LRE. Covid positive pregnant women were referred from other hospital for appropriate management. Aims & Objective: The aim is to study the effect of Covid-19 infection in pregnant women with regards to maternal and perinatal outcome. The ultimate aim is to use this knowledge in the management of COVID-19-positive pregnant women for better maternal and perinatal outcome. Material and Method: Covid-positive pregnant women and women in post-partum period admitted in the labour room emergency from May 2020 to June 2021 were included in the study. The study parameters included chief complaint, gestational age, mode of delivery, abortion, operative intervention, maternal or perinatal complication etc. Results: In my study 29 pregnant women and one woman on 5th post-op after LSCS were admitted in LRE during the study period. Two patients had incomplete abortion (6- 8 weeks). Almost 96% women were delivered by LSCS. All the neonates were COVID-19-negative on the first day of delivery. There was one maternal death and one perinatal death. Conclusion: Majority (almost 93%) of Covid positive cases are either asymptomatic or has mild symptoms. Maximum (96%) cases are delivered by LSCS. There is no Tran’s placental transmission. Spontaneous abortion may occur in early pregnancy due to COVID-19.

20. Comparison of 0.25% Bupivacaine and Dexmedetomidine Versus 0.25% Bupivacaine in Caudal Epidural Block in Terms of Motor Blockade and Post-Operative Analgesia in Children Undergoing Infraumbilical Surgeries
Pooja, Brajesh Kaushal, RP Kaushal, Palak Sharma, Sweyta Shrivastava
Background: This hospital-based observational study aimed to assess the impact of adding dexmedetomidine to bupivacaine in caudal epidural block (CEB) on the duration of postoperative analgesia and motor recovery in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: A total of 60 pediatric patients (2-10 years old) undergoing elective infraumbilical surgeries were randomly assigned to two groups: Group A (n=30) received 0.25% bupivacaine, while Group B (n=30) received 0.25% bupivacaine with dexmedetomidine. The duration of postoperative caudal analgesia was recorded in both groups. Motor recovery time was assessed, and Mann-Whitney U tests were conducted to analyse the data. Results: The addition of dexmedetomidine significantly prolonged the duration of postoperative caudal analgesia in Group B (8.80 ± 0.92 hours) compared to Group A (4.03 ± 0.85 hours) with a highly significant p-value of 0.001. Moreover, the Mann-Whitney U test revealed a highly significant p-value of 0.0001, indicating a considerable delay in full motor recovery in Group B (4.17 ± 0.64 hours) compared to Group A (2.83 ± 0.68 hours). Conclusion: This study demonstrates that the addition of dexmedetomidine to bupivacaine in caudal epidural block for pediatric patients undergoing infraumbilical surgeries significantly prolongs postoperative analgesia while delaying motor recovery. These findings offer valuable insights for optimizing anaesthesia techniques in this patient population.

21. Clinico – Epidemilogycal Feature of Gallbladder Cancer in a Tertiary Care Hospital of Guwahati City: A Hospital Base Case Control Study
Mousumi Krishnatreya, Rohit Kumar Sinha, Anjana Moyee Saikia
Background: Gallbladder cancer is the most common carcinoma of the biliary tree with very poor prognosis as it is one of the most highly malignant tumours. Various risk factors have been suggested for gallbladder cancer in medical literature but still there is lot to be known. gallstones, female gender, obesity, older age, ethnicity and geography, porcelatin gallbladder, choledochal cysts, gallbladder polyps, industrial and environmental chemicals. GBC is very common in India particularly in the North- Eastern and northern parts of the country where it surpasses, other high incidence areas of the world, due to some yet unknown reasons. Few studies had been conducted in the past regarding Gall-Bladder cancer in the North-Eastern region This study will attempt to throw light on some factors related to gall bladder cancer with the objectives of 1)To access the clinical profile of Gall-bladder cancer in tertiary care hospitals in Guwahati city 2) To know some of the epidemiological factor related to gallbladder cancer patients diagnosed in tertiary care hospitals in Guwahati city except age and sex which were matched in this study. Materials and Methods: This is a Hospital based case control study done in The Gauhati Medical College and Hospital of Guwahati, Assam from August 2020 to July 2021. A sample size of 200 cases and 200 controls was taken. For the purpose of collection of data from cases, Gauhati Medical College and Hospital was visited. and cases of GBC who met the inclusion criteria were identified from case sheets of the surgery ward and interviewed subsequently. For the purpose of collection of data from controls GMCH was visited. Patients who met inclusion criteria were identified through case sheets and interviewed and examined after taking consent. The controls were selected after matching for age and sex. Results: Most common presenting clinical features among gallbladder cancer patients were pain abdomen (87%) and jaundice (34%). Association between family history of GBC and gallbladder cancer was found to be statistically significant. Association between tobacco (chewed) consumption and gallbladder cancer was found to be statistically significant. Ever users had 1.6 times more chances of developing GBC in comparison to never users. Association between family history of GBC and gallbladder cancer was found to be statistically insignificant. It is found that persons who were hypertensive had 1.7 times more chances of developing GBC in comparison to non-hypertensive persons. Association between physical activity and gallbladder cancer was found to be statistically significant. Thus, more physical activity had a protective role in GBC. Conclusion: Gall bladder cancer shows association with family history of GBC, Smoking, Tobacco and Alcohol Consumption. It also shows that hypertension and physical activity is also associated with gall bladder cancer.

22. Study of Anxiety and Depression in COPD (Chronic Obstructive Pulmonary Disorder) Patients of Maharashtra
Ravindra Bhumanna Narod, Balaji G Tuppekar, Priya Venkatrao Kaurwad
Background: The mechanism of depression and anxiety in COPD is still not completely understood. The biological mechanism between COPD and mental illness has to be evaluated. Method: 95 patients aged between 40-70 years with COPD in depression and anxiety was studied. They were subjected to a detailed clinical examination, and COPD was diagnosed as per GOLD guide lines with a post-bronchodilator fEv1/FEV<70 nMRC score. Spirometric study, psychological assessment by the HAM-D method, and anxiety assessment by the MADRS method. Results: 44 (46.3%) had anxiety, and 51 (53.6%) had depression. In a comparative study of no depression, respiratory and psychiatric parameters had a highly significant p value (p<0.001). Conclusion: COPD patients with co-morbid anxiety and repression experience more acute exacerbations and need pulmonary rehabilitation. Management of anxiety and depression in COPD will reduce readmissions and mortality.

23. Study of Anxiety and Depression in COPD (Chronic Obstructive Pulmonary Disorder) Patients of Maharashtra
Santosh S Ankalagi, Amarpali K S, Spandana S
Background: C-reactive protein (CRP) is the most extensively studied acute-phase reactant so far in predicting infection. This study was done to evaluate the role of CRP in prediction of clinical outcome in case of PPROM. Methods: This is a prospective study among 100 pregnant women with PPROM admitted in the department of Obstetrics and Gynecology in Karnataka institute of Medical Sciences & Hospital, Hubballi from December 2019 to May 2021. Pregnant women with PPROM aged more than 18 years with singleton pregnancy and gestational age between 28 to 36 weeks are included. Informed written consent was obtained before collecting the data and examination. Case was evaluated by asking the history, clinical examination, blood grouping and Rh typing was sent. Nitrazine test, fern test, CBC, CRP, Vaginal and cervical swab was sent for culture, urine routine, urine culture and sensitivity was also sent. The information collected was entered in Microsoft Excel and analysed using SPSS 22 software. Chi square test was used to test the association between the variables. Statistical significance was set at 0.05% level of significance (p < 0.05). Results: There were total 100 PPROM woman enrolled for the study. Majority were in the age group of 21-25 years (50%). PPROM was most common among unbooked (75%) cases and among primigravida (56%). Among primi gravida females, 78.57% delivered vaginally after induction and among multigravida the rate of vaginal delivery was 59.09%. Among primi gravida females, 62.5% delivered vaginally after induction and among multigravida the rate of vaginal delivery was 79.55%. After PROM 55.36% of women delivered within 12-24 hrs in primi gravida, whereas 36.36% of women delivered within 12-24 hrs in multi gravida. Mean duration was 23.52hrs with SD of 20.01hrs. Maternal CRP was positive among 46% cases and cord blood was positive for CRP in 39% cases. Maternal morbidity was significant (30%). No maternal mortality in the study. Most common fetal morbidity was sepsis (14%) followed by birth asphyxia (4%). Conclusion: By educating the women to have regular antenatal care, recognise genital tract infections early, treat appropriately and report at the earliest opportunity, the difficulties associated with PPROM might be lessened. For the purpose of predicting PPROM and averting future problems, CRP can be employed as a diagnostic measure.

24. A Case Series of Acute Limb Ischemia and its Management-Institutional Experience at a Tertiary Care Center
Mailabbai Mohammed Affan, K Prathap, B Riaz, G Vinayagam
Acute limb ischemia (ALI) represents one of the toughest challenges encountered by the surgeons. It occurs because of sudden deterioration of blood supply to the limb. Acute limb ischemia is a spectrum of disease, it starts with Class 1 Ischemia and progresses to develop Gangrene. This is a retrospective study of patients who were diagnosed to have ALI and treated at our hospital from October 2022 to June 2023. A total of 17 patients were diagnosed to have acute limb ischemia. Out of 17 patients 9 were males 8 were females. Among them 8 patients (47%) had upper limb ischemia and 9 patients (53%) had lower limb ischemia. Among the 8 upper limb ischemia patients, 5 (62%) were males and 3 were (38%) females. 4 patients (50%) were diagnosed with Class 1 ischemia, 3 patients (38%) with Class 2B and 1 patient (12%) with Class 3. With regards to the etiology of ischemia, 1 patient (11%) had thrombotic cause, probably due to hypercoagulable status and 7 patients (77%) had an embolic cause. Out of 9 lower limb ischemia cases, 3 patients (33%) had saddle embolism and all of them underwent bilateral transfemoralembolectomy. Overall, out of the 17 patients who presented with acute limb ischemia, limb salvage rate was 76% (13 patients), Amputation rate was 11% (2 patients) and Mortality rate was 11% (2 patients).. Earlier diagnosis and treatment are a must for limb salvage. The Rutherford Classification should be used to identify all ALI patients, and early intervention should be started for a better prognosis. Earlier the diagnosis, better the prognosis.

25. Comparison between the Efficacy of Preprocedural Ultrasound-Guided Paramedian Approach & Conventional Landmark Guided Paramedian Approach in an Obese Patient
Seema Singh, Parli Raghavan Ravi, Anushree Mishra, Abhishek Mishra
Background: The use of ultrasound imaging techniques in regional anaesthesia is rapidly becoming an area of increasing interest. It represents one of the largest changes that the field of regional anaesthesia has seen.  Earlier electrical stimulation or paraesthesia, both of which relied on surface landmark identification, was used for regional anaesthesia. However, landmark techniques have limitations; variations in anatomy and nerve physiology as well as equipment accuracy, have had an effect on success rates and complications. The introduction of ultrasound may go some way towards changing this. Aim: To evaluate the efficacy of two modalities of spinal anaesthesia preprocedural ultrasound-guided paramedian approach and conventional landmark-guided paramedian approach in an obese patient undergoing lower abdomen, perenial and lower limb surgeries. Methods and Materials: The study was a randomized single blinded controlled study. A total of 80 subjects were included in the final study, with 40 subjects in each of the study groups. Group 1 (US group) participants received Preprocedural USG guided paramedian spinal anaesthesia and Group 2 (LM group) received landmark-guided Conventional midline spinal anaesthesia. Following variables were compared between the two groups, number of attempts, number of passes, time taken for identifying landmark (sec), time for a successful lumbar puncture (sec), number of attempts, number of passes, time taken for performing successful lumbar puncture defined as the time taken from insertion of the introducer needle to completion of the injection. Results: Among the people in landmark (LM) group, the median number of passes was 5.50 (IQR 4 to 7) and it was 4 (IQR 3 to 4) in people with ultrasound-guided (US) spinal anaesthesia. The difference in the number of passes between the group was statistically significant (P Value <0.001). Among the people in landmark (LM) group, the median time for identifying space was 38.19 sec (IQR 25.05 to 57.95) and it was 78.35 sec (IQR 60.20, 90.67) in ultrasound-guided (US) group. The difference in the identifying space (sec) between groups was statistically significant (P Value <0.001). Among landmark (LM) group, 2 (5%) people were converted to GA. Among the ultrasound-guided (US) group, 3 (7.5%) people were converted to GA. Among the people with landmark (LM), the median spinal injection was 88.31 sec (IQR 51.74 to 120.19) and it was 64.32 sec (IQR 51.46 to 88.31) in people with ultrasound-guided (US). The difference in the time for a successful lumbar puncture (sec)between the group was statistically significant (P Value 0.048). Conclusion: Ultrasonography can be a useful adjunct to safe spinal anaesthesia and also it facilitates the performance of spinal anaesthesia in the non-obstetric patient population with difficult anatomic landmarks, like obese patients.

26. An Assessment of Knowledge, Attitude and Practices in a Defined Rural and Urban Population Influencing the Immunization Status of Children
Anjali Singh Kanwar, Avyact Agrawal, Ravishankar Uikey
Background: Individuals who encounter obstacles in obtaining immunization services are at a heightened risk of developing morbidities associated with vaccine-preventable illnesses. The spectrum of variables that may hinder immunization programmes and their health benefits includes affordability, accessibility, lack of knowledge, and other constraining elements. Aims and Objectives: The present study aimed to assess the factors influencing the immunization status of children under five years in a defined rural and urban population and to evaluate the impact of National Immunization Schedule and assess the progress made in the areas studied. Materials and Methods: The study was conducted as an OPD based cross sectional survey on children aged one month to sixty months in defined urban and rural areas from 01 March 2021 to 31 August 2022 where 608 children were randomly taken from the study areas which was the Department of Pediatrics Tertiary health care center, a community health center and Primary Health Centre belonging to central India. Our data were collected from the parents of the children coming to the study area. The immunization status of these children was analysed and the cause for partial immunization was studied. Data was analysed by using statistical software SPSS version 21. The chi-square test was used to compare various determinants. A p-value <0.05 was considered significant. Results: The difference in fully and partially immunized status of children belonging to the rural and urban area was found to be statistically significant (p = 0.001). The association between immunization status with type of family and socioeconomic status was found statistically significant (p< 0.001). It was seen that among fully immunized children, highest proportion 50% was seen among children who were of birth order more than 2 and were residing in urban areas (p<0.05). In both rural and urban areas, household problems were the main reason for vaccine hesitancy. It was observed that 43.3% in rural and 22.8% in urban have delayed vaccination. The distribution of caregivers according to knowledge, attitude and practices regarding immunization was found to be statistically significant. Conclusion: The importance of parental education in improving child health and the socioeconomic status of the family were found to be significant determinants of incomplete immunization. Coverage of optional vaccines was found to be very low in comparison with routine vaccines. From this study, policymakers and social workers can target young pregnant women to increase female education. These findings emphasize the need for regular monitoring and evaluation of immunization coverage to achieve the benefits of vaccination in all strata of society.

27. Retrospective Study of Proximal Coated vs Fully Coated Femoral Stem Used in Uncemented THR
Vikas Kumar, Vivekanand Kumar, Masuraj Atal Bihari Mandal, Neeraj Kumar Chaudhary
Background: A total hip replacement (THR) operation is often performed when the hip joint becomes damaged. Uncemented THR patients still face a clinical problem when deciding between proximally coated and completely coated femoral stems. This study will compare the short-term and long-term clinical and radiological outcomes of these two stem types. Methods: In retrospective cohort research, 240 patients with uncemented THR with either proximally coated or coated femoral stems were included. Radiographic data, clinical outcomes, and patient demographics were all examined. Multivariate regression, survival analysis using Kaplan-Meier plots, and t-tests were among the statistical methods used. Results: Short-term clinical outcomes were significantly better for proximally coated stems compared to fully covered stems, with patients reporting significantly less pain after surgery (Mean SD: 2.7 ±1.1 vs. 3.1 ±1.2, p <0.05) and higher Harris Hip Scores (Mean± SD: 92.5 ±6.2 vs. 89.2± 5.8, p <0.001). The radiographic success rates and implant survival were equivalent between the two groups. Subgroup analysis showed that patients under 60 with proximally coated stems experienced more significant pain reduction. The results of the sensitivity study backed up the original conclusions. Conclusion: Consistent with the previous data, proximally coated femoral stems provide short-term benefits in pain reduction and functional outcomes in uncemented THR. The two stem types have similar long-term radiographic results and implant survival rates. When deciding on a stem design, surgeons should consider the individual patient.

28. An Institutional Based Retrospective Study to Compare the Gait, Trendelenburg Test and Functional Outcome between Lateral and Posterior Approaches for Primary Total Hip Arthroplasty (THA)
Rajnish Kumar, Mahesh Prasad
Background: When a patient’s hip joint is damaged, a Total Hip Arthroplasty (THA) is frequently required. Whether a posterior or lateral surgical approach is preferable has been discussed. This retrospective study was conducted between 1st January 2022 and 31st December 2022 to compare the lateral and posterior approaches to THA regarding postoperative gait patterns, Trendelenburg test results, and functional recovery in 200 patients. Methods: Two hundred patients were analysed, with the first group being studied using a lateral technique and the second group being studied using a posterior approach. Patients had preoperative, postoperative, and 12-month assessments of gait, Trendelenburg, and functional outcomes. There was a statistical comparison of the two procedures. Results: The mean BMI for the posterior approach group was 29,1, while the mean BMI for the lateral approach group was 28.6. After surgery and rehabilitation, gait performance analysis suggested a distinct advantage for the posterior approach. One year after surgery, the posterior group’s stride length was 97.4 centimetres, while the lateral group’s was 94.2. The reduction of stance time during the gait cycle confirms the gait efficacy of the posterior approach. Postoperatively, both groups possessed fewer positive Trendelenburg tests, indicating enhanced hip abductor function. One year after surgery, only 7% of posterior and 11% of lateral patients had positive Trendelenburg tests. The functional outcomes of the Harris Hip Score improved in both groups over time, but the posterior group consistently outperformed the anterior group. One year after surgery, posterior approach patients had a greater Hip Health Score than lateral approach patients, showing superior hip health and function. Conclusion: This study shows that compared to the lateral method, the posterior technique for THA improves gait, hip muscle function, and hip health more generally. These findings illustrate the importance of considering the patient’s outcomes and quality of life while selecting a surgical technique for THA.

29. Functional Outcome of the FNS (Femoral Neck System) in Fracture Neck of Femur in Young Patient: A Retrospective Cohort Study
Neeraj Kumar Chaudhary, Masuraj Atal Bihari Mandal, Vivekanand Kumar, Vikas Kumar
Background: Functional limitations after a femoral neck fracture are often permanent, even in young patients. Preserving femoral head vascularity and facilitating healing are two areas where the Femoral Neck System (FNS) has shown promise. However, research in this population is still in its infancy. Method: In this retrospective cohort analysis, 175 young patients with FNS-treated femoral neck fractures were analysed. We looked at things like age, gender, kind of fracture, mechanism of injury, frequency of FNS use, and quality of life after fracture. Subgroup analyses and paired t-tests were part of the statistical analysis. Result: The study included 175 young patients with femoral neck fractures, split evenly between males and females. The majority of fractures occurred in the sub-capital region (46.9%), and these breaks were typically brought on by collisions with vehicles (36.6%), falls from a great height (30.3%), and sports (33.1%). The FNS was used in surgical procedures for about 69% of patients. Range of motion, pain ratings, and quality of life all increased significantly after surgery, proving the efficacy of the FNS in improving functional outcomes for this population. Conclusion: Specifically, our results highlight the importance of FNS in conserving vascularity and enhancing functional outcomes following femoral neck fractures in young patients. Long-term effects and cost-effectiveness in this population need more study.

30. A Comparative Study of Different Rehabilitation Protocols for Patients Undergoing Anterior Cruciate Ligament (ACL) Reconstruction: Retrospective Cohort Study
Rajnish Kumar, Mahesh Prasad
Background:  Disabling injuries in the Anterior Cruciate Ligament (ACL) are common musculoskeletal injury that frequently necessitates surgical intervention to restore knee joint stability. There is still some controversy about the best rehabilitation plan after surgery. This research aimed to evaluate and contrast many postoperative rehabilitation strategies for ACL restoration. Methods: Over the course of 24 months, 200 patients between the ages of 18 and 45 who were scheduled to have primary ACL reconstruction participated in prospective cohort research. The four treatment groups to which patients were randomly assigned were accelerated, Traditional, Neuromuscular Training and Combined Protocols. Return to sport was measured with patient-reported outcomes (Knee Injury and Osteoarthritis Outcome Score, KOOS) at numerous postoperative periods up to 12 months. Chi-square tests and repeated-measures Analysis of variance,(ANOVA) were among the statistical methods used. Results: Time-dependent return to sport and patient-reported KOOS ratings were measured. The groups improved knee function similarly with time. The Neuromuscular Training Protocol group had the highest 12-month success rate (78%), however, this was not statistically significant. Over 12 months, all rehabilitation techniques improved knee function and return to sport for all individuals. Individualized treatment is the goal. Conclusion: This research demonstrates that after ACL reconstruction surgery, different rehabilitation procedures lead to similar gains in knee function and rates of return to sport over 12 months. Patients’ unique traits and preferences should guide the selection of a protocol. These results support the hypothesis that patient-centred care is essential for the best possible outcomes following ACL reconstruction.

31. Comparative Study for Functional Outcome of Arthroscopic Bankart Lesion Repair Using Knotted Vs Knotless Technique: A Retrospective Cohort Study
Masuraj Atal Bihari Mandal, Vikas Kumar, Neeraj Kumar Chaudhary, Vivekanand Kumar
Background: Bankart lesions are a leading cause of shoulder instability, and arthroscopic procedures have been developed to treat them. This retrospective analysis compares and contrasts the clinical consequences and cost effectiveness of knotted versus knotless methods for arthroscopic Bankart lesion repair. Methods: A cohort of 120 patients undergoing arthroscopic repair was analysed. Demographics, primary and secondary outcome measures, including postoperative stability, range of motion, and patient-reported outcomes, were assessed. Comparative statistical analysis was conducted to evaluate differences between the techniques. Results: Postoperative stability was significantly higher (90%) with the knotted Technique than with the knotless method (80%; p=0.048). Range of motion (p=0.076) and patient-reported outcomes (p=0.212) showed no statistically significant differences. When comparing the two groups, those who used the knotted approach had a decreased recurrence rate (8.3% vs. 20%; p=0.024). Conclusion: With the knotted Technique giving higher stability but the knotless Technique providing identical patient-reported results and range of motion, making an individualised decision between the two is essential. More extensive prospective trials should be the focus of future research to inform technique selection better and investigate sustainability and cost-effectiveness over the long run.

32. Evaluation of Functional and Radiological Outcome of Distal Femoral Fracture Fixation Treated with Locking Plate
Rajnish Kumar, Mahesh Prasad
Background: Because of complex anatomy and high morbidity risk, distal femoral fractures present significant challenges for orthopaedic surgeons. Optimal radiological and functional outcomes following these fractures receive increasing attention. Methods: This retrospective cohort study evaluated functional and radiological results from locking plate fixation for distal femoral fractures. A varied group of 200 participants from a hospital in Bihar, India included. Functional outcomes were evaluated using a range of motion measurements and knee function ratings, whereas radiological outcomes included union status and implant placement. The statistical analysis consisted of descriptive statistics and relevant significance tests. Results: According to the study, functional outcomes following locking plate fixation were substantially better than anticipated. There were important improvements in the range of motion, KOOS Pain Score, and KOOS Function Score. Besides a high union rate (92%) and accurate positioning of 88% of implants, radiographs revealed a high union rate of 92%. Conclusion: In addition to positive radiological outcomes, locking plate fixation for distal femoral fractures improves patient mobility, pain alleviation, and overall well-being. The study emphasises this intervention’s positive influence on patient recovery and its therapeutic value. Regardless of its limitations, the study offers new research possibilities for determining the optimal treatment for distal femoral fractures.

33. MID Term Follow-Up for Functional Outcome of Mobile Bearing vs Fixed Bearing Knee Arthroplasty: A Retrospective Cohort Study
Vivekanand Kumar, Neeraj Kumar Chaudhary, Vikas Kumar, Masuraj Atal Bihari Mandal
Background: Joint deterioration in the knee is a common reason for surgical intervention, and knee arthroplasty provides significant pain reduction and functional improvement. Whether a mobile and fixed-bearing knee arthroplasty is preferable in the long run is a topic of ongoing discussion. Methods: We looked back at the data of 350 individuals who had knee arthroplasty done and compared the functional outcomes between those who had movable bearings and those who had fixed directions. After a median of 2 years, we measured pain reduction, knee range of motion, and multiple practical scores (such as the Knee Society Score, Oxford Knee Score, and SF-36). Results: The demographics of the two groups were similar enough to be considered equivalent. The average pain rating on a 0–10 scale among patients who used movable Bearing was 2.1±1.0. The average pain rating for fixed-bearing patients was (2.4 ±1.2) on the visual analogue scale. There was no statistically important difference in variety of motion, functional scores, or quality of life assessments between patients with primary or revision mobile bearing knee arthroplasty and those with direct or edit fixed bearing knee arthroplasty (p = 0.034). Conclusion: Functional outcomes were similar between mobile and fixed-bearing knee arthroplasty at the midpoint of the follow-up period. Each patient is unique, and so is the surgical situation in which one of these procedures must be chosen. More in-depth evaluation of these results requires additional research over extended periods and randomised controlled trials.

34. The Impact of Obesity on the Outcomes of Total Knee Arthroplasty: A Retrospective Analysis
Rajnish Kumar, Mahesh Prasad
Background: Considering into account the effect of obesity on TKA (Total Knee Arthroplasty) results is becoming increasingly relevant due to the rising prevalence of obesity and the increasing demand for TKA treatments. The goal of this retrospective study was to determine that there was a connection between obesity and the occurrence of complications, postoperative pain, length of hospital stay, and functional outcomes following TKA. Methods: Bihar Central Hospital treated 200 patients who need total knee replacement. Participants were classified as either obese (BMI 30 kg/m2) or non-obese (BMI 30 kg/m2). Hospital records were scoured for information on patient demographics, surgical procedures, and outcomes. Several statistical methods were used to investigate the correlation between obesity and TKA outcomes. These methods included descriptive statistics, chi-square tests, t-tests, analysis of variance, and regression analysis. Results: Patients who carried more had a higher risk of experiencing surgical complications (p = 0.037), more severe pain after surgery (p 0.001), a longer recovery period (p = 0.012), and poorer functional outcomes (p 0.05). Conclusion: This study demonstrates the large influence of obesity on TKA outcomes and emphasises the significance of adjusting strategies to address surgical complications, pain, and postoperative rehabilitation for obese patients. Preoperative counselling for TKA patients must emphasise the value of weight management in improving results. The mechanisms linking obesity and TKA outcomes need more investigation.

35. Comparison of Efficacy & Safety of Intravaginal Misoprostol Tablet and Intracervical Dinoprostone Gel for Induction of Labour in Unfavourable Cervix in Term Pregnancy: A Randomised Control Trial
Shahla Yazdani Abraham, Deepak Patil
Background: Induction of labour is a commonly performed obstetrical procedure for which numerous methods are adapted and intracervical dinoprostone and intravaginal misoprostol are the most frequently used techniques. This study aimed to compare the safety and efficacy intravaginal misoprostol tablet and intracervical dinoprostone gel for induction of labour at term. Methods: The present study was conducted in a tertiary care hospital in New Delhi among pregnant females with singleton pregnancy at term requiring induction of labour for various indications. The study subjects were enrolled in group A (misoprostol group) were administered 25 mcg of misoprostol every 4th hourly to a maximum of 5 doses and in group B (dinoprostone) study subjects were administered 0.5 mg of dinoprostone every 6th hourly to a maximum of 4 doses. Results: A total of 50 cases were enrolled in both the study groups. The baseline parameters among both the study groups were comparable. Nearly two-third of study subjects in misoprostol group delivered within first 12 hours and only 12% had delivered in first 12 hours in dinoprostone group. Requirement of oxytocin augmentation of labour was nearly similar in both the study with 18% of cases in misoprostol group and 16% cases in dinoprostone group requiring it. Conclusion: Low dose vaginal misoprostol is associated with a lower incidence of uterine tachysystole and a lower caesarean delivery rate.

36. Post-Operative Analgesia for Laparoscopic Cholecystectomy Converted to Open Cholecystectomy with Surgically Placed Subcostal Transversus Abdominis Plane Catheter Infusion: A Case Series
Sandhya M K, Kiran Kumar, Sudham R Shetty, Soujan Chowta
Subcostal Transversus abdominis plane block is an abdominal fascial plane block that targets the nerve fibres between the transversus abdominis and internal oblique, Transversus abdominis and the posterior rectus sheath just below the costal border. Subcostal TAP block can be used for postoperative pain relief in supraumbilical surgeries like open cholecystectomy. We present a case series of 4 cases where Subcostal TAP catheter infusion was used to for postoperative pain management in patients posted for laparoscopic cholecystectomy converted to open cholecystectomy in between the surgery. TAP catheter was surgically placed after dissecting the layer of the anterior abdominal wall in the transversus abdominis plane. The point of entry of needle for catheter placement was lateral to the linae semilunaris. A bolus dose of 20 millilitres of Bupivacaine 0.125% followed by infusion at the rate of five to eight ml/hr was started after placement of the catheter. All patients had good pain relief; the catheter was removed after forty-eight hours. None of our patients developed any catheter related complications.

37. Evaluation of Intertrochanteric Hip Fractures in the Elderly Treated by PFNA2
Nitin Kumar, Makhan Lal, Dilip Kumar Singh, Sashikant Joshi
In the elderly population, intertrochanteric hip fractures pose a significant clinical challenge due to the high incidence, morbidity, and mortality associated with them. This study aims to evaluate the efficacy and safety of treating intertrochanteric hip fractures in the elderly using the Proximal Femoral Nail Antirotation-2 (PFNA2) technique. We conducted a prospective analysis involving 100 elderly patients, aged 65 and above, who underwent surgery for intertrochanteric hip fractures using the PFNA2 fixation method. The primary endpoints assessed were functional recovery, evaluated by the Harris Hip Score (HHS), and fracture union rate within a follow-up period of 12 months. Our results indicate a high rate of fracture union, with an average time of 12 weeks post-surgery and satisfactory functional outcomes with a mean HHS of 80. Complications such as implant failure, screw cut-out and post-operative infection were minimal, affecting less than 5% of the patient cohort. Importantly, the mortality rate was also low, suggesting that the PFNA2 technique may offer a reliable and safe alternative for managing this type of fracture in the elderly.

38. Clinical Outcomes after Closed Humerus Interlocking Nail in Shaft of Humerus Fractures
Nitin Kumar, Dilip Kumar Singh, Soman Chatterjee
This study delves into the intricate landscape of clinical outcomes resulting from the closed humerus interlocking nail procedure for fractures of the humerus shaft. Through a meticulously structured exploration that encompasses patient demographics, surgical techniques, data analysis, and interpretive discussions, this research illuminates the multifaceted impacts of the procedure on patient recovery. Quantitative analysis of outcome measures, comparison across different age groups, and contextualization within existing literature contribute to a comprehensive understanding of the procedure’s efficacy. The thematic journey within the chapters navigates through the themes of precision, stability, holistic care, transformative healing, and temporal continuity, sculpting a vivid portrayal of the patient’s journey through recovery. Acknowledging the inherent limitations of any research endeavor, this study invites further exploration to continually enrich the medical discourse. The clinical implications of this research extend beyond academia, shaping the landscape of healthcare practice by informing treatment decisions, influencing patient care, and advancing the trajectory of medical knowledge. This research delves into the realm of clinical outcomes following the closed humerus interlocking nail procedure for shaft of Humerus fractures. Through a comprehensive investigation encompassing patient demographics, surgical techniques, data analysis, and interpretation, this study sheds light on the multifaceted impacts of the procedure on patient recovery. The quantitative analysis of outcome measures, comparison across age groups and alignment with existing literature contribute to a holistic understanding of the procedure’s efficacy. The thematic exploration within the chapters weaves a narrative that encompasses precision, stability, holistic care, transformative healing, and temporal continuity, painting a vivid picture of the patient’s journey towards recovery. Recognizing the inherent limitations of any research endeavor, this study invites further exploration to continuously enrich the medical discourse. Beyond academia, the clinical implications of this research extend their reach, shaping the landscape of healthcare practice by informing treatment decisions, influencing patient care, and advancing the trajectory of medical knowledge.

39. Propofol Induced Pain: Comparison of Efficacy of Pre-Treatment with Paracetamol and Lidocaine
Hemani Ahuja, Jithin J Cherian
Background and Objectives: Propofol is one of the most commonly used agent for induction of anaesthesia due to its rapid onset, short duration of action and favourable side effects profile.[1-2] But despite these favourable properties, the pain caused during injection of propofol is one of the most excruciating pain that patient recalls during perioperative period. None of the interventions alleviate this pain completely. So we aimed to investigate the effect of i.v Paracetamol pre-treatment on propofol induced pain and to compare it with lidocaine. Materials and Methods: This Prospective, randomized, double blind study was conducted on 300 patients aged 20-60 years, American Society of Anaesthesiologists (ASA) physical status 1 and 2 undergoing surgeries under general anaesthesia. The patients were allocated to two groups. In Group L- Patients were pre-treated with 0.5mg/kg of lidocaine diluted to 20ml and in Group P- Patients were pre-treated with 2mg/kg of paracetamol diluted to 20ml before administering propofol. Results: The incidence of pain on injection of propofol in i.v. Paracetamol (Group P) and lidocaïne (Group L) groups were 89.3%, 34.7% respectively(p < 0.001). Group L had better analgesia than Group P for all the VRS values (p<0.001). Chi-square test was used for statistical analysis. Differences were considered to be significant at p<0.05. Conclusions: We concluded that i.v. Paracetamol is not as effective as lidocaine on propofol associated pain.

40. Clinical Profile of Intractable Epilepsy in Children
A. Maheswari, P. Sankara Narayanan
Introduction: Intractable epilepsies constitute a small but a significant proportion of all epilepsies in childhood. In majority of the children epilepsy remains a mild disorder with 60-80% remitting spontaneously or with treatment.. A prompt diagnosis of refractoriness is of paramount importance for consideration of other therapies such as surgery. Early surgical intervention when successful might also prevent or reverse psychosocial consequences and cognitive impairment of uncontrolled seizures during critical periods of development. Based on this aim of our research work is to study the clinical profile of intractable seizures and also to determine the clinical predictors of intractable seizures. Material & Methodology: Thus study was done as a prospective case control study, for a period of one in a tertiary care teaching hospital in children with intractable seizures aged 1-12 years among both sexes, By case definition Intractable epilepsy is when seizures continue to occur despite maximally itolerated doses of more than two antiepileptics, occurrence of an average of one seizure per month for 18 months with no more than a 3 month seizure free period during these 18 months. Epileptic children who had good control of seizures for the past 1½ Yrs were taken as control and compared. A detailed history was obtained from the parents. History regarding seizure, no of AED, frequency of seizures was obtained. Clinical examination was performed for all the cases. Results and Conclusions: The following factors were found to be significantly associated with Intractable Epilepsy in our study Age of onset < 1 year, Status epilepticus, Neonatal seizures, Myoclonic seizures, Birth asphyxia, Developmental delay, Abnormal neurological examination, Abnormal EEG, Abnormal MRI scan , Abnormal findings on EEG and MRI must be identified early and referred to a specialist for optimization of pharmacotherapy, considering early surgery in selective cases and trial of the newer modalities of treatment. Conclusion: Early identification is also important for parental counselling regarding the nature of the disease and importance of compliance to medications. In our study the commonest cause of Intractable Epilepsy was perinatal asphyxia. Perinatal asphyxia can be prevented by good nutrition during pregnancy, regular antenatal check-ups with detection of high risk pregnancy, promoting hospital deliveries and prompt resuscitation of new-born when required.

41. Clinical, Microbiological Presentation of Children with Acute CNS Infection
A. Maheswari, P. Sankara Narayanan
Introduction: Meningitis is a common tropical infection which causes significant morbidity and mortality in children. Vaccination is available now-a-days for Haemophilus influenza and pneumococcus which are the common infection causing meningitis. Profile of acute Central Nervous System (CNS) infection in children varies with time to time as it depends on the organism, age, seasonal period, outbreaks, immunization and place. Based on this aim of our study is to evaluate the clinical, microbiological, radiological profile and outcome of children with acute CNS infection in a tertiary care teaching hospital. Materials and Methods: This prospective observational study was done in the Department of Pediatrics, Tirunelveli Medical College for a period of one year. Total 50 children from one month to 12 years with features of acute CNS infection were included in the study. Clinical features, Cerebrospinal Fluid (CSF) and serology findings, Computed Tomography (CT) scan findings and outcome were taken for analysis. Results: During the study period, 50 children were diagnosed with acute CNS infection. A total of 37 (74%) children were less than 3 years and 31 (62%) male children were commonly affected. Fever, seizures and altered sensorium were the common symptoms. Status epilepticus 40 (87%), shock 18 (36%), respiratory distress 16 (32%) were common findings. In CSF, elevated cell count, reduced sugar, elevated protein were seen in 21 (42%), 14 (28%) and 27 (54%), respectively. Pneumococcus, Japanese Encephalitis (JE), dengue, herpes, and scrub typhus were the common etiological agents for CNS infection. CT brain was abnormal in 8 (16%) children. Nine children died (18%) and rest 41 (82%) recovered. Conclusion: In our study most of children were in 3 months to 3 years of age and predominantly male. Status epilepticus is most common seizure presentation. In electrolytes, hyponatremia was present in 12 cases and hypernatremia in 2 cases. Hypokalemia was seen in 7 cases and hyperkalemia was not seen in any case. CSF analysis was done and mostly were neutrophil predominant, followed by lymphocyte predominant. CT Brain was evaluated and findings like thalamic hypodensities, hydrocephalus, subdural hemorrhage and ganglionic hypodensities. Hence proper evaluation and knowing various clinico-etiological summary helps in management of children manifesting with acute CNS infection.

42. A Prospective Study on Expression of Human Leukocyte Antigen 1 in Cancer Cervix Patients
R. Padmavathi, R. Kousalya, C. Ezhilarasi
Introduction: Cervix is the most common site in the female genital tract which is exposed to viral and bacterial infections. Also it is the target for carcinogenic agents leading to invasive cancer. The local tissue immune status may play a role in cancer cervix. Routine cytological PAP smear screening, early diagnosis and curative treatment had reduced the mortality of cancer cervix. The aim of our study is to examine the expression of HLA 1 in various types of carcinoma cervix and to correlate them according to their grades of malignancy. Methods: We chose the hysterectomy and small cervical biopsy tissues of cervical cancer and then detected the expression of HLA 1 using SP immunohistochemistry. The association of the HLA 1 expression with the clinicopathologic profiles of the patients was analyzed. Results: The positive staining of HLA class 1 antigen in well differentiated carcinoma is 7 out of 24 SCC cases and the negative staining of HLA class 1 in poorly differentiated form of SCC is 5 out of 24 cases. Conclusion: The expression of HLA 1 are down regulated in poorly differentiated carcinomas and it is more efficiently expressed in well differentiated forms which indicates that there is a good prognosis in well differentiated carcinomas because of HLA 1expression.

43. Comparative Study between Liquid Based Cytology and Conventional Smear in FNA Samples of Breast Lesions
R. Kousalya, R. Padmavathi, Abu Arshad A
Introduction: Breast lesions are the most common lesions in women ranging from inflammatory lesions to malignant conditions. Fine-needle aspiration cytology is a safe and cost-effective, first line diagnostic tool in diagnosing breast lumps. FNAC helps in reducing the number of unnecessary surgeries in benign breast lesions. Materials and Methods: This is prospective study includes 98 women patients and 2 male patients who are attending the FNA OP. Two samples were collected. One for CS preparation and other for LBC preparation. The following cytological parameters are compared. Cellularity, background material (blood, necrosis), informative background, monolayering, nuclear and cytoplasmic details. Results: Cellularity in both the preparation showed moderate to high. In LBC preparation this is due to centrifugation of the collected sample. Clean background in LBC preparation. In CS method, there is bloody background which obscures the presence of the cells. Informative background is reduced or lost in LBC method. Whereas in CS method informative background is present. Monolayering is more in LBC method. Overlapping of cells is more common in CS preparation. Nuclear and cytoplasmic details are equally comparable in both the LBC and CS preparation. Conclusion: Fine needle aspiration method is a safer and cost-effective method for the diagnosis of breast lesions. Liquid based cytology of breast aspirates provides a better cellular preservation, less cellular overlapping and elimination of obscuring background when compared to that of Conventional smears. With continuous experience Liquid based cytology may become the main FNA diagnostic method in future.

44. Drug Prescription Trends in Neonatal Intensive Care Unit (NICU) at a Tertiary Care Private Teaching Hospital in Central India
Ranjeet Kumar, Sarju Zilate, Chittaranjan Naik, Kiran Akhade
Context: Neonatal intensive care units (NICUs) treat critically ill or premature newborns. A variety of medications are used in neonatal intensive care units. Lack of knowledge about these drugs and unethical marketing of these drugs lead to irrational prescriptions in clinical practice. Aims: To determine drug prescribing trends in NICU at a tertiary care private teaching hospital. Settings and Design: A retrospective observational study was conducted in a NICU of teaching hospital during the period of 1st January 2021 to 31st December 2021. Methods and Material: All new-born admitted to the NICU during the study period are included in this study. Demographic information, delivery details, the purpose of admission, final diagnosis, and medication prescribed was collected from case sheets. As per the WHO-ATC classification system, prescribed drugs are divided into different categories based on their effects on different organs and system. Statistical analysis used: The data collected was entered in Excel and analyzed with the help of SPSS ver 2020. Descriptive statistics were used in the form of percentages and proportions were used to express the results. Results: Total 657 neonates admitted in NICU during the study period. 54.2% were males and 45.8% were females. Total number of drugs prescribed was 2484 and average number of drugs per neonate was 3.78. Low birth weight (2.5 kg) and preterm birth (37 weeks) were significantly more exposed to drugs. Neonatal sepsis was the most common morbid condition observed (39.3%), followed by birth asphyxia (12.7%) and neonatal jaundices (11.4%). In the majority of cases, antibiotics were prescribed to neonates, and among antibiotics, ampicillin was the most commonly prescribed medicine. Conclusions: Periodic surveys should be conducted over time in order to facilitate rational drug use in neonates due to their immature bodies and to avoid adverse drug reactions in neonates.

45. Elucidation of Dermatophyte from a Tertiary Care Teaching Hospital through Currently Available Methods
Debasmita Behera, Chinmoy Raj, Kanishka Uthansingh
Aim: To detect the typical dermatophyte that causes a fungal infection through traditional microscopic (KOH) and cultural techniques. Methods: Patients with T. corporis, T. cruris, T. ungium, T. pedis, and T. barbae, aged 6 to 70 years, were included in this prospective study, which was conducted over a year. Microscopic analysis of skin and nail samples taken from the patient’s body revealed the presence of dermatophytes. To observe under a microscope, cotton blue and KOH concentrations of 10–30% were both utilized. For statistical analysis, the SPPS version 20 was used to analyze the elucidated data. Result: A total of 156 patients, who visited the Department of Skin and VD, KIMS Hospital, Bhubaneswar, were enrolled in the study. It was observed that a fraction of 59% of individuals were positive through direct the application of KOH, whereas a fraction of 52% of individuals were positive through cultural method. Interestingly few of those direct positives did not belong to the positive patients during the culture method. A maximum of T. mentagrophytes with a frequency percentage of 28% were observed during the study. Conclusion: Trichophyton rubrum infections are prevalent in patients with tinea corporis. Then T.violaceum, T.tonsurans, and T.mentagrophytes infection occurs. Patients between the ages of 21-30 had the highest infection rate. The severity of elderly people between the ages of 61 to 70 years increases if the diagnosis and treatment are delayed.

46. Evaluation of Dry Swab Direct RTPCR Method for Detection of SARS-Cov2 in a Tertiary Care Hospital
Gayathri Devi Thanigaimani, Srikanth Kodam, Vijay David Raj Ranjit, Nanthini Devi P, Kalyani M, Surapaneni Krishna Mohan, Sujin Padmanaban
Introduction: The ongoing SARS-CoV-2 pandemic has led to shortages of laboratory-based testing kits and reagents worldwide and manufacturers have developed simple testing strategies for easy use and convenience. The Dry Swab-based Direct RT-PCR is a simple and quick method for SARS-COV2 detection which has been developed by Meril Diagnostics Pvt. Ltd. This method is a simple variation of the existing RT-PCR testing, making the extraction step easy and can expedite the testing capacity and reduces the turnaround time. Objectives: The aim of this study was to assess the diagnostic accuracy (sensitivity, specificity, positive predictive value and negative predictive value) of Meril extraction-free dry swab kit and compare its diagnostic performance with the usual RTPCR testing aided with extraction process using swabs collected in viral transport medium. Materials and Methods: This is a cross sectional (facility-based study) conducted at a tertiary care hospital in South India. The nasopharyngeal or oropharyngeal dry swab was taken under aseptic precautions, kept in a sterile collection tube and sent to the laboratory for further testing. The dry swab was processed as per the manufacturer’s instructions and proceeded with RTPCR testing as per the PCR kit protocol. The same individual’s VTM swab samples were also processed using the extraction kit and then proceeded with RTPCR protocol and the comparisons between the two test methods were done. Results: Among the 133 patients who were included in the study, RT-PCR testing with conventional extraction was positive for 19 individuals, with a prevalence of 14.29% and negative for 114 patients (85.71%). The Meril extraction free dry swab kit test was positive for 21 patients (15.79%) and negative for individuals112 (84.21%). The comparison analysis shows a Sensitivity of 94.7%, Specificity 97.4%Positive Predictive Value 85.7% And Negative Predictive Value 99.1%. Area under the Curve (AUC) indicates that the dry swab kit was able to distinguish between true positive and true negative very efficiently. Conclusion: Nasopharyngeal and oropharyngeal swabs stored in dry collection tubes area robust and inexpensive method for SARS-CoV-2 testing. The efficiency is almost equal to RTPCR testing. It can be deployed for large scale testing considering the advantages.

47. Post Traumatic Dorso-Ulnar Hamato-Fifth Metacarpal Dislocation: A Case Series
Addis, Gulrukh H.
Pure hamato-fifth metacarpal dislocation is an uncommon injury. Direct trauma to the hand is the leading cause of dislocation of the hamato-fifth metacarpal joint. It causes significant weakness of ‘grip’. Orthopaedic trauma specialists must have a high index of suspicion while examining patients presenting with trauma around the carpometacarpal region. This should be supplemented with appropriate radiological investigations. Treatment should be individualized based on reduction and stability of the fifth carpometacarpal joint. Stability of the fifth carpometacarpal joint ensures adequate support and strength while gripping objects. If inadequately treated this injury can produce arthritis of the carpometacarpal joint in the long run. In the case series reported here, we highlight the need for proper clinical examination and appropriate radiograph for diagnosing the isolated fifth carpometacarpal joint dislocation as it can be easily missed on initial presentation. This case series also highlights different approaches for treatment of this dislocation depending on the maintenance of reducibility.

48. Roles of Concurrent Chemo-Radiotherapy and Radiotherapy Alone in the Management of Malignancies of Head and Neck In a Tertiary Care Hospital
D. Niharika, Naga Chandra Sekhar Darisi, G. Kavitha, V L Anusha Konakalla
Background: Optimization of dose of radiation therapy (RT), fractionation, normal-tissue sparing, and technology has helped treating malignancies of the Head and Neck. Introduction of the combination of chemotherapy and radiotherapy has increased the tumor control and preservation of organ integrity. This study compares the final outcome of these two methods in treating the Head and neck cancers. Aim of the study: To compare the outcome of the advanced stages of Head and neck malignancies with concurrent chemo-radiation and radiation alone in terms locoregional control (tumor regression), recurrence, survival and complications. Materials: A randomized prospective study was conducted between Jan 2018 to Dec 2020 in the Department of Radiation Oncology, Viswabharathi Medical College and General Hospital, a tertiary teaching Hospital in Kurnool, Andhra Pradesh. 63 patients with advanced stages (stage III and IV) of Head and Neck Malignancies were included. Group A (33) patient with Head and Neck malignancies treated with Radiotherapy alone and Group B (30) patients treated with Concurrent chemotherapy and Radiotherapy. Patients to both the groups were allotted by a random number generated online at Patients diagnosed aged above 18 years were included. Patients of both the genders were included. Patients with histology of the tumors showing as squamous cell carcinoma were included. Patients with unresectable tumors were included. Patients with advanced stages (stage III and IV) were included. Patients with Eastern Cooperative Oncology Group (ECOG), (21), 1982 performance status between 0 and 02 were included. Results: 63 patients Head and Neck malignancies were grouped as A (33) and B (30) patients. Group A received EBRT alone and B group concurrent chemo-radiation. There were 22 (34.92%) male patients in group A and 20 (31.74%) male patients in group B and there were 11 (17.46%) female patients in group A and 10 (15.87%) female patients in group B. The mean age in group A was 56.78±4.70 years and the mean age in the group B was 54.30±5.15 years. The age and gender, ECOG status, TNM staging and gross staging of the malignant diseases observed in the patients of both the groups included in this study had no statistical significant difference. (p- Value more than 0.05). Conclusions: The advantage of Combine chemo-radiation versus Radiotherapy alone was found to be only marginal and failed to show any positive significant advantage of concurrent chemo-radiotherapy over EBRT alone. In terms of overall response rates at the end of 06 months was ranging from 85.3% to 93% in the study. The limitations to this study are relatively short follow-up and small sample size.

49. Making Decisions in Thyroid Surgeries: The Crossroad
Laghvi Kothari, Pranjal Agarwal, Kanishk Mehta
Background: Thyroid lesions are one of the most common endocrine lesions that we encounter in today’s modern practice. Due to its high prevalence it has become really important that we use as accurate modalities as we possibly can to provide the patients with better care. Aim: (1) to assess the efficacy of Fine Needle Aspiration Cytology (FNAC) in diagnosing thyroid diseases pre-operatively, (2) to enumerate the conditions where FNAC poses a challenge and (3) to establish the role of USG-guided FNAC. Method: This is a retrospective study carried out from July 2022 to August 2022 where 93 patients who underwent thyroid surgery at our institute were included. Preoperative FNAC and postoperative HPR were correlated. Results: 26% discrepancy between the cytology and histopathology was reported. The major misdiagnosed cases were malignant, followed by inflammatory conditions.

50. Poorly Differentiated Palatal Tumour: A Clinical Dilemma
Mohan Bhagchandani, Jyoti Yadav, Kanishk Mehta
Poorly differentiated malignancy is a rare pathological diagnosis that often puts the surgeon at the crossroads of treatment protocols. It not only presents as a dilemma for deciding the treatment but also adjuvant therapy and prognosis of the patient. Herein we present a case of poorly differentiated palatal tumour that was finally typed as Amelanotic Malignant Melanoma – spindle cell type. Oral melanoma is a rare malignancy with the tendency to metastasize and locally invade tissues more readily than other malignant tumors of the oral cavity, making it vital to report this case.

51. Hemodynamic Responses to Atracurium and Cisatracurium: A Comparative Analysis
Swati Nuna Jain, Nidhi V. Sardhara, Pratikkumar Jain
Introduction: Atracurium and cisatracurium are non-depolarizing neuromuscular blocking agents (NMBAs) commonly utilized in anesthesia for inducing muscle relaxation, a prerequisite for many surgical procedures. Objective: The purpose of this study was to compare the hemodynamic responses to the administration of atracurium and cisatracurium in a controlled clinical setting. Methods: A randomized, double-blind study was conducted with a total of 100 patients undergoing elective surgeries. Patients were divided into two groups: those receiving atracurium and those receiving cisatracurium. Hemodynamic parameters such as heart rate, blood pressure, and cardiac output were monitored before drug administration, immediately after, and at specified intervals up to 30 minutes post-administration. Results: Patients who received atracurium showed a significant increase in heart rate and a minor decrease in blood pressure post-administration when compared to their baseline values. Those who were administered cisatracurium demonstrated stable hemodynamic parameters with no significant alterations from baseline. The cardiac output remained largely unchanged for both groups. Conclusions: Cisatracurium appears to have a more stable hemodynamic profile as compared to atracurium in the context of the study. Clinicians should consider these findings when choosing neuromuscular blocking agents, especially in patients with cardiovascular comorbidities. Further research is recommended to validate these findings across a broader patient population.

52. Comparison of Two Supraglottic Airway Devices: I-GEL and Intubating LMA, as a Conduit for Blind Endotracheal Intubation in Patients Undergoing Elective Surgery under General Anaesthesia: Our Experience from Government Medical College Guntur, Andhra Pradesh
G. Chandra Sekhar, N. Syama Kumar, B. Praveen Naik, Boya Kumar Naidu, Anant A. Takalkar
Introduction: The most vital element in providing functional respiration is the airway. I-GEL supraglottic airway (Inter surgical Ltd., Wokingham, UK) is a relatively new device for airway management. It is made from Styrene Ethylene Butadiene Styrene and is anatomically performed to mirror the peri-laryngeal structures. It can be described as an uncuffed peri-laryngeal sealer according to Miller’s classification. Objective: To compare two supraglottic airway devices: I-GEL and Intubating LMA, as a conduit for blind endotracheal intubation in patients undergoing elective surgery under general anaesthesia. Methodology: This study was a single blind, randomized, prospective comparative study conducted in Government Medical College Guntur from January 2020 to September 2021 involving two groups i.e., Group A: I-GEL for airway management and Group B: ILMA for airway management. Results: Mean supraglottic airway device (SAD) insertion is lesser in I-GEL than that of ILMA. assessed using Student independent t-test and significant. First pass tracheal intubation success rate is more in group B than Group A and significant. There is no significant difference seen in the mean duration of successful intubation through SADs and assessed using Student independent t-test. Conclusion: We conclude that, based on the results of our study, I-GEL aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation.

53. Comparison of Different Type of Video Laryngoscope with Direct Laryngoscope for Endotracheal Intubation in Adult Patients with Difficult Airway
Aniket R Aghara, Divya Chauhan, Vatsal Patel, Saurin B. Panchal, Kamla H. Mehta
Introduction: The essential practice of anaesthesia as well as emergency and critical care medicine is airway management. Endotracheal intubation is the gold standard method for airway management because it is quick, non-surgical, and safe. It also achieves all airway management objectives, preserves airway patency, guards the lungs from aspiration, and allows leak-free breathing during mechanical ventilation. Methodology: A prospective study at a tertiary care hospital was conducted including 60 participants as per the inclusion and exclusion criteria within the weight group of 40 to 70 and ASA grade II and III. After their Consent, Randomized distribution was conducted to segregate them equally between 3 groups, to compare King Vision and Trueview PCD video laryngoscopes and direct laryngoscopy with Macintosh blade and draw results. Result: This clinical study involved 60 adult patients. They were divided into three groups using the closed envelope technique. Each group consisted of 20 patients. Group K has patients under Kingvision, Group T having Trueview, Group M having Macintosh laryngoscope. On average, Group K took 16.5s for intubation; an increase was seen with Group T and M by +7.45s and +3.3s respectively. While 95% of patients in group K were intubated in 1st attempt, the percentage dropped to 80% and 55% in group T and M respectively. External laryngeal manipulation was not required in any patient of group K, but in 33% and 66% in group T and group M respectively. Conclusion: King vision and TruView PCD video laryngoscope offer a better laryngoscopy view, higher successrate, faster intubations, minimum external maneuvers, less attempts for intubation and less hemodynamic stress response to direct laryngoscopy with Macintosh blade.

54. Studying the Association between Anemia and Neurodevelopmental Outcome in Children: A Retrospective Cohort Study
Anshuman, Vinay Kumar Yadav, Shashi Prabha
Background: The possible effects of anaemia on children’s brain growth and development are becoming more widely acknowledged as a public health issue worldwide. Within a cohort of 500 children between age group 1 and 5year, this retrospective study investigates the link between anaemia and neurodevelopmental outcomes. Methods: Anaemia was diagnosed through a comprehensive evaluation of patient records using predetermined clinical cut offs for haemoglobin and hematocrit.500 kids between the ages of 1 and 5 years were participated in the study. We checked in on the child’s cognitive abilities, motor skills, and developmental milestones during routine paediatric visits. The association between anaemia and neurodevelopmental outcomes was analysed using logistic regression, with age, gender, and socioeconomic level as independent variables. Results: The results showed that anaemia strongly correlates with neurodevelopmental outcomes. Children with anaemia performed worse on cognitive ability tests (mean Score: 92.5 ± 9.3) and motor abilities (85.1 ± 8.7) than their non-anaemic counterparts. Further, children with anaemia were more likely to be behind schedule in reaching critical developmental milestones (30.4% vs. 16.8%). These correlations persisted after controlling for potential confounding variables in a logistic regression study. Conclusion: The results of this study show strong evidence that anaemia in children increases the risk for cognitive impairment, motor skill impairment, and developmental delays. Because of its potential adverse effects on brain development, anaemia must be diagnosed and treated as early as possible. These results highlight the need for paediatric healthcare providers to manage anaemia to promote children’s healthy mental and physical growth.

55. A Comparative Study on the Hearing Outcome in Canal Wall Down and Intact Canal Wall Mastoidectomy in Chronic Suppurative Otitis Media with Special Reference to Atticoantral Disease: A Retrospective Cohort Study
Gopal Kumar Jha, Prashant Kumar
Background: Clinicians face a considerable problem when dealing with Chronic Suppurative Otitis Media (CSOM) and its variant, Atticoantral illness, due to the risk of hearing loss and recurrence of infection. There is controversy over which mastectomy technique is preferable: the Canal Wall down (CWD) or the Intact Canal Wall (ICW). Patients with CSOM and Atticoantral illness are the focus of this retrospective cohort study, which attempts to compare the hearing results of these two surgical methods. Methods: 150 patients with CWD or ICW mastectomy were analysed in depth. Electronic medical records were mined for information, including audiometric measurements, surgical procedures, and patient demographics. Hearing outcomes were evaluated using pure-tone and speech audiometry before and after surgery. Multivariate regression and independent t-tests were used for the statistical analysis. Results: The 150 patients in this retrospective cohort research had CWD or ICW mastectomy. Post- and pre-operative audiometric tests demonstrated hearing improvement in both groups. Both groups improved at 500 Hz, whereas CWD improved 44.2% and ICW 40.9%. Similar trends were detected at 1000 and 2000 Hz (CWD: 44.2%, ICW: 40.9%). CWD and ICW groups had 36.4% and 34.3% SRT increases, respectively. The groups were not significantly different before surgery. Our data suggest that CWD and ICW Mastoidectomy enhance hearing outcomes in individuals with Atticoantral disease due to Chronic Suppurative Otitis Media, with equal percentage improvements across audiometric frequencies. Conclusion: This study confirmed that CWD and ICW mastectomy helped patients with Atticoantral disease associated with CSOM. Such data can aid in surgical decision-making and underscore the importance of putting patients first.

56. Arthroscopic Management of Anterior Cruciate Ligament (ACL) Injuries: A Research of Different Arthroscopic ACL Reconstruction Techniques and their Impact on Knee Stability and Functional Outcomes: A Retrospective Cohort Study
Nitin Kumar, Soman Chatterjee, Dilip Kumar Singh
Background: Surgical Anterior Cruciate Ligament (ACL) reconstruction is often necessary to restore knee stability and function after a severe injury. This research looks into how the various arthroscopic approaches of ACL reconstruction affect long-term knee stability and function. Methods: 250 people who had ACL reconstructions were studied retrospectively. Patellar tendon autografts, hamstring tendon autografts, and allografts were available, as well as a variety of fastening techniques. Clinical tests were used to evaluate knee stability, and patient-reported measures were used to assess functional outcomes. Results: Autografts from the patellar tendon were the most popular option (45%), followed by those from the hamstrings (35%). Interference screws accomplished fifty per cent of the fixing. After surgery, patellar tendon autografts outperformed hamstring tendon autografts (p = 0.024), but both methods increased knee stability. At 12 months, patients who had received hamstring tendons as autografts had better knee function scores (87.2) than those who had received patellar tendons (84.5) or allografts (80.1) (p = 0.014). Patients who had autografts of hamstring tendons were also more likely to resume their pre-injury levels of exercise than those who had received allografts (p = 0.036). Conclusion: Knee stability and function are greatly affected by the method chosen for reconstructing the torn ACL. The surgeon and the patient must give this trade-off significant thought before making a final decision. These results have significant ramifications for improving individual patient outcomes after ACL restoration.

57. Analysis of Outcomes between Intramedullary and Extramedullary Fixation of Fracture of Radius and Ulna
Gaurav Parikh, Vipul Leuva, Ejajahmed Ansari, Avi Rangwala
Introduction: The radius and ulna are the most usually fractured upper extremity bones owing to falls on extended hands. Imaging confirms the diagnosis and children often have buckle or greenstick fractures treated by angulation. “Distal radius fractures” in adults are commonly splinted. Midshaft ulna fractures may need surgery or immobilisation. Surgery is frequently needed for many fractures. Elbow function is important with radial head fractures. Aims and Objectives: This study compares intramedullary and extramedullary forearm fracture fixation procedures. Method: This prospective study at Sheth L.G. Hospital in Ahmedabad, India, examined 18 to 65-year-olds with concurrent closed radius and ulna shaft fractures from July 2021 to May 2023. The surgery involved open reduction and dynamic compression plate or intramedullary nailing for internal fixation. Fracture union, comorbidities, and function were examined. Its rigorous methodology allowed a meaningful comparison of intramedullary and extramedullary fixation for both bone forearm fractures, providing clinical insights. Result: Table 1 lists the anterior fascial compartment’s forearm muscles’ origins, insertions, and nerve supplies. These muscles include the Pronator Quadratus, which originates from the ulna’s anterior surface and enters into the radius in Table 2. Table 3 shows primary function is forearm pronation, twisting the palm downward or posteriorly for actions like turning a doorknob or altering hand orientation. Innervated by the median nerve’s anterior interosseous branch (C8, T1). This muscle coordinates forearm and hand movements in Table 4. Conclusion: Our study found that intramedullary nail fixation for forearm fractures is comparable to plate fixation and has fewer complications.

58. Study on the Surgical Fixation Outcome and Complications of Using a Retrograde Intramedullary Nail in Fracture of the Distal Femur
Rahil Pankajkumar Shah, Anandkumar Sureshbhai Tailor, Rajdeepsinh P. Jadeja
Introduction: Osteoporosis and old co-morbidities make distal femur fractures difficult to cure. These fractures are most common in younger guys from high-energy injuries and older males from low-energy falls. Modern retrograde nailing and medial plates offer better stability. Screw location is key to fracture integration. High stress should be avoided when using proximal locking screws and the nail length should match the intramedullary channel. Aims and Objective: This study examines retrograde intramedullary nail fixation for distal femur fractures. Method: 50 patients with distal third femur fractures were studied in a retrospective observational cohort study at a trauma care facility during a three-year period from July 2020 to June 2023. After receiving a thorough evaluation, patients underwent fracture fixation (closed or open reduction with retrograde intramedullary nail) and were followed for 4-24 months to assess the success of the procedure and any issues that may have arisen. Result: Figure 1 shows that 58% of patients are labourers. Right-sided open femoral fractures (68%), largely from car accidents (76%), are shown in Table 1. In Table 2, AO classification A2 fractures (52%) are the most common. Table 3 shows shorter hospital stays (70% under seven days), varied follow-up (36% at 12-18 months), and shorter fracture union times (48% under 16 weeks). Table 4 shows knee mobility, surgical problems, and function and Figure 2 shows that closed fractures. Conclusion: In the treatment of “distal femur fractures”, retrograde intramedullary nails have been shown to be effective, leading to fewer problems, better results, and soft tissue preservation.

59. Refractive and Biometric Outcome of Premature Infants with Retinopathy of Prematurity: Comparison between Treated Vs Spontaneously Regressed
Praher Shrivastava, Anamika Dwivedi, Pankaj Kushwaha, Garima Mandloi, Sanskriti Ukey
Purpose: The purpose of this study was to determine refractive error and biometry of babies with retinopathy of prematurity at more than one year of age, and comparison between babies treated vs spontaneously regressed. Methods: Babies detected with any stage of ROP, threshold or prethreshold type 1 which required laser or pretheshold type 2 and mild ROP which spontaneously regressed, with a minimum follow up of one year were included in this study prospectively. Records were reviewed for gestational age, birth weight, and stage of disease, zone of disease and presence of aggressive ROP. Cycloplegic refraction was done and biometric parameters including the axial length (AL), anterior chamber depth (ACD) and Lens thickness (LT) were measured. Degree and type of refractive error and biometry were determined and a comparison between treated group and regressed group was done. Possible associations of myopia analysed. Results: Total 100 eyes of 50 babies were included. 64 eyes were treated with laser and 36 spontaneously regressed. Refractive error in treated group ranged from +4D to -18.5D whereas in regressed group it was +1.25D to -0.5D. 57.8% of treated and only 11.1 % of regressed group were myopic. Myope have mean SE of -3.27D (range -0.5 to -18.5D). Treated group had smaller axial length, shallower anterior chamber depth and thicker lens, suggesting myopia to be lenticular in origin. In this cohort lower birth weight and more posterior zone of disease was significantly associated with myopia. Conclusion: Substantial number of babies, treated for ROP develops myopia. Myopia was found to be mostly of lenticular origin. Early detection & timely rehabilitation of refractive error is imperative.

60. To Study the Correlation of Baseline Total Leukocyte Count and Absolute Neutrophil Count With Severity of COVID-19 Disease
Nikhil Gupta, Rahul Kanade, Pratiksha Ramnarayan Sahu, Simmi Dube
Background: The COVID-19 pandemic, caused by the emergence of the SARS-CoV-2 virus, has posed a significant global public health crisis, marked by varying disease severity. Identifying reliable prognostic markers is crucial for clinical management and resource allocation. Materials and Methods: In this retrospective observational study, we investigated the correlation between baseline total leukocyte count (TLC) and absolute neutrophil count (ANC) with the severity of COVID-19 disease in 102 adult patients admitted. Disease severity was categorized as mild, moderate, or severe based on clinical symptoms, oxygen saturation levels, and radiological findings. Statistical analysis included Pearson correlation coefficients and subgroup analysis within the severe disease category. Results: We found a significant positive correlation between baseline TLC and ANC levels with COVID-19 disease severity (p < 0.05). Subgroup analysis within the severe disease category demonstrated that patients with TLC levels exceeding 8.0 x 10^3/μL or ANC levels exceeding 6.0 x 10^3/μL were at significantly higher risk of requiring intensive care and mechanical ventilation. Conclusion: Our study suggests that baseline TLC and ANC levels can serve as readily available prognostic indicators for COVID-19 disease severity. Elevated levels of these hematological markers upon admission are associated with an increased risk of severe outcomes, providing clinicians with valuable tools for early risk assessment and resource optimization.

61. Prediction of Postoperative Pulmonary Complications on the Basis of Preoperative Risk Factors in Patients who had Undergone Coronary Artery Bypass Graft Surgery
Tauseef Neem Rashid Akhtar, Yatin Wagh, Pankaj Bhat
Background and Purpose: Pulmonary complications are among the most frequently reported complications after coronary artery bypass graft (CABG) surgery. However, the risks of postoperative pulmonary complications (PPCs) are not equal for all patients. The aim of this study was to develop a model, based on preoperative factors, for classifying patients with high and low risks for PPCs in order to implement tailored interventions. Subjects and Methods: Postoperative pulmonary complications were examined in 117 adult patients who had undergone elective CABG surgery at (Location). The presence of preoperative risk factors (N=12) that have been described in the literature was noted for each patient. A risk model was developed by use of logistic regression analysis. Results: Preoperative risk factors for developing PPCs were an age of ≥70 years, productive cough, diabetes mellitus, and a history of cigarette smoking. Protective factors against the development of PPCs were a predicted inspiratory vital capacity of ≥75% and a predicted maximal expiratory pressure of ≥75%. These risk and protective factors were included in the model (sensitivity=87% and specificity=56%), and a sum score for its clinical use was generated. Discussion and Conclusion: Six factors that can be determined easily before surgery, with the need for only simple pulmonary testing, can provide a model for identifying patients at risk of developing PPCs after CABG surgery.

62. Comparison of Various Techniques for the Diagnosis of Clinically Suspected Cases of Malaria with Special Reference to PCR
Kilikdar Mousumi, Dash Lona, Shastri Jayanthi
Introduction: Malaria is one of the most successful and pervasive parasitic infections ever known to mankind attributable to its treatability. Its early diagnosis using rapid diagnostic tests contributes towards effective management. Increasing mortality and morbidity resulting from malaria makes it crucial that a rapid and accurate diagnosis be made, in order to initiate prompt treatment in clinically suspected cases. Aims: To compare between various techniques for the diagnosis of clinically suspected cases of Malaria and also to evaluate the diagnostic utility of PCR. Material and Methods: A total of 200 clinically suspected cases of malaria presenting with fever and chills were included in the descriptive study. The samples were processed for detection of malaria parasite or its antigen. Peripheral blood smear examination (PSMP) was done using Leishman’s staining, Rapid Malaria Antigen Test (RMAT) by Accucare ( Lab care diagnostics Pvt Ltd) and conventional PCR for detection of Plasmodium species (P. falciparum, P. vivax) using Malaria diagnosis kit (ACTIVETM, Imperial Life Sciences Pvt Ltd, Gurgaon, Haryana, India) were performed on each sample. The diagnostic efficacy of each test against the appropriate gold standard has been studied using indices such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy along with 95% CI as the precision of their estimates. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 16.0, Inc. Chicago). Results: Out of 200 cases, PSMP detected and identified malarial parasites in 28(14%), RMAT in 35(17.5%) and PCR in 27(13.5%) of the cases. In 28 out of 200 samples, malaria positivity was seen by both PSMP and RMAT and speciation were in agreement (100%). Whereas PCR showed agreement in 22 cases in terms of speciation. Sensitivity of RMAT and PCR was 100% and 85.7% and specificity was 95.9% and 98.3% respectively. Additionally, the association between PSMP and RMAT, PSMP and PCR was statistically significant (P value=0.001). Conclusions: Rapid diagnostic tests and PCR technique can be useful adjuncts to microscopy to diagnose malaria cases accurately.

63. Efficacy of Palonosetron and Dexamethasone for Prevention of Post-Operative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholycystectomy
Hardik D. Kavar, Meet Kansagra, Sushmita M Shah, Devanshi Shah
Background and Aim: PONV (postoperative nausea and vomiting) is a very uncomfortable and unpleasant symptom. Dexamethasone and palonosetron are antiemetic medications with few side effects. The current study was conducted with the goal of determining whether the combination of palonosetron and dexamethasone would be more effective as an antiemetic for PONV prophylaxis than either drug alone, and the study was designed to accept or reject that hypothesis. Material and Methods: A double-blind, randomised interventional research was planned. The study involved 300 patients who met the inclusion criteria (age: 18-60 years, American Society of Anesthesiologists (ASA) physical status I and II, undergoing laparoscopic cholecystectomy under general anaesthetic). They were divided into three groups and assigned to one of three treatment regimens: (n = 100) in Group A Group B (n = 100) received Dexamethasone 8 mg plus Palonosetron 0.075 mg. Palonosetron 0.075 mg on its own OR Group C (n = 100) Dexamethasone 8 mg on its own. The primary outcome was the occurrence of PONV within 24 hours, while the secondary result was the number of rescue antiemetic medications required. To compare the means of the three groups, the one-way ANOVA test was performed. Results: The overall occurrences of PONV in the study 24 h postoperatively were 20% in group A, 40% in group B, and 82% in group C (P 0.001). The dexamethasone group required more rescue antiemetic than the other two groups. Conclusion: Palonosetron and palonosetron-dexamethasone combinations were more effective than dexamethasone alone in avoiding PONV in patients undergoing laparoscopic cholecystectomy.

64. Isolation and Antibiogram of Klebsiella Species from Various Clinical Samples of Patients Attending a Tertiary Care Teaching Hospital
B Vishalakshi, Mariraj J, Krishna S
Introduction: Klebsiella species is a gram-negative pathogen known to produce community acquired infections and hospital acquired infections. It is caused by Klebsiella pneumoniae followed by Klebsiella oxytoca. There is a development of antimicrobial resistance (AMR) and there is an emergence and spread of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae. Hence, the current study was conducted to identify it from different clinical samples and determine ESBL producers. Objectives: To isolate and identify the Klebsiella spp in all clinical samples in all age groups, to determine their susceptibility to antimicrobial agents and resistance for ESBL by standard screening and confirmatory methods. Materials and Methods: Prospective study was done for 1 year. With ethics committee approval and informed consent, clinical samples from 1-70 years from different IPDs and OPDs were included. Samples with incomplete information and contaminants were excluded. Results: The present study includes 455 non duplicate, consecutive clinically significant Klebsiella species. Maximum number of Klebsiella species was from pus followed by urine. Klebsiella pneumoniae subsp pneumoniae (55.4%)” was” the most common species isolated followed by Klebsiella oxytoca” (40.4%) and other Klebsiella spp (4.2%). Most of the Klebsiella species are isolated from the general surgical ward. Antimicrobial susceptibility testing has shown highest resistance against ampicillin (74%) and lowest to imipenems (3%). Among 455 isolates, ESBL producer by screening method were 218 isolates and further 105 isolates confirmed by confirmatory method. Conclusions: This study gave us the information on prevalence of Klebsiella and aids in development of an antibiotic policy for the hospital and as well as limit the spread of multidrug resistant bacteria.

65. Faster Onset (T5 Blockage) in Lateral Position during Elective Caesarean Section under Spinal Anaesthesia
Devendra Verma, Sarita Kumawat, Ravindra Kr. Gehlot, Basant Dindor, Hemraj Tungria, Mridula Sharma
Background: Spinal anaesthesia has emerged as technique of choice for routine scheduled caesarean section. The aim of our study was to evaluate the effectiveness of two maternal positions-lateral and sitting during administration of spinal anaesthesia for elective caesarean section. The hypothesis of this study is that there would be a difference in speed of onset of sensory blockade between sitting and lateral position causing hemodynamic changes in parturients. Methods: This prospective single-blind, randomized study was carried out in pregnant patients with singleterm pregnancy, taken up for elective caesarean section under spinal anaesthesia. They were divided into two groups: Group L: Parturients who were to receive spinal anaesthesia in lateral position, Group S: Parturients who were to receive spinal anaesthesia in sitting position. Time to reach sensory block at T5 level, maximum sensory blockage and Bromage score was recorded. Non-Invasive Blood Pressure, HeartRate and oxygen saturation was recorded at 2-minute intervals from giving Sub-Arachnoid Block (time zero) up to 10 min and then at 5 min intervals till the end of surgery. Results: Time to achieve T5 blockage in lateral group was 5.09±0.88 min and in sitting group was 6.38±0.96 min which was statistically significant (p= 0.00). Incidence of hypotension was more in lateral group 23 (22.5%) than sitting group 19 (18.6%), (p=0.479). The requirement of vasopressor was more in Group L (Lateral group) 8.00 ± 2.34 mg than Group S (Sitting group) 6.80 ± 2.9 mg (p=0.001). Conclusion: Spinal anaesthesia for elective caesarean section with 2 ml hyperbaric bupivacaine 0.5% can be given in either position, although lateral position is associated with faster onset of block with higher vasopressor requirement.

66. Morbidity and Mortality Profile of Extremely Preterm Infants- A Multicenter Network Study from India
Khushbu Maheta, Darshan Nayakpara, Jayesh Borsaniya, Bansi Kavar
Background: This study was conducted to determine the morbidity profile and short-term outcomes of extremely preterm infants (gestational age <28 weeks) admitted in level III NICUs of India over a period of 5 years. Material and Methods: This was a retrospective, observational study. 27 participating level III NICUs prospectively collected data of neonates meeting the pre-defined criteria, including gestational age and need of admission. Results were presented in form of mean with standard deviations and numbers with percentage. Trends of morbidities were noted over the years and among the different gestational age groups. Results: The gestational age ranged from 22 to 27 weeks, the mean gestational age being 25.8 (±1.44) weeks. The mean birth weight was 846 ± 264 grams. The major morbidities noted among infants of the study group were- RDS (84%), BPD, PDA (99%), NEC (7%), ROP (requiring treatment-2%), IVH (22%), PVL (2%) and sepsis (culture proven- 23%, probable 15%). The mortality rate was 42.39%, highest mortality seen among infants having NEC, followed by those having RDS and PDA. Conclusion: This study showed the morbidity profile of extremely preterm infants in India. This is the first study of this kind and could help form a basis for other studies determining the long-term outcomes in this population.

67. Evaluation of Different Calcium Channel Blockers on Blood Glucose Level in Albino Rabbits
Rajeev Prajapat, Shruti Chandra, Pooja Singh
Background: Calcium channel blockers (CCBs) are a class of drugs and natural substances that disrupt the movement of calcium (Ca++) through calcium channels. The most widespread clinical use of calcium channel blockers is to decrease blood pressure in patients with hypertension, with particular efficacy in treating elderly patients. The present study was done to evaluate the effect of different CCB on blood glucose level in normal albino rabbits. Methods: The present study was conducted on healthy albino rabbits of either sex weighing 1.5-2.0 Kg. The animals were made available in the animal house of Department of Pharmacology & Therapeutics of a tertiary care teaching hospital of Uttar Pradesh. Blood glucose level estimation was done by using glucose oxidase-peroxidase method in all the four groups viz; Normal saline, Verapamil, Diltiazem and Nifedipine group at predetermined intervals (0, 1, 2 and 6 hrs). Changes in blood glucose level in all groups were compared. Results: Verapamil caused hyperglycemia of significant level (p<0.001) at 1 and 2 hours. Increased in blood glucose level by Diltiazem and Nifedipine was also significant (p<0.05) at 1 and 2 hrs but the changes observed at 6 hours were insignificant in all the groups. (p>0.05). Conclusion: This study concluded that all three calcium channel blockers cause significant increase in blood glucose level in normal albino rabbits. Therefore it is advisable to prescribe anti-diabetic drugs and calcium channel blockers carefully with utmost caution and necessary dose adjustment in individuals suffering from diabetes.

68. Feto-Maternal Outcome in Pregnancy with Malaria
Jayeshkumar Dayabhai Maru, Rajal Vidyutkumar Thaker, Dhruvi Ashok Dadhania, Gautam Chandubhai Gavaniya, Swati Harshadbhai Bhut, Meera Hasmukhbhai Radadiya, Kartikey Prafullbhai Antala
Background: Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant women, her fetus and newborn child. This study was undertaken to know the prevalence of malaria in pregnancy, demographic details of patients infected with malaria in pregnancy and to study the feto-maternal outcome in pregnancy with malaria. Materials and Methods: This observational retrospective study was carried out from May 2017 to October 2019. Results: Proportion of malaria in pregnancy was 0.20%. The proportion of P.vivax  and P.falciparum was 0.19% and 0.01% respectively. The commonest pathogen found was Plasmodium vivax accounting for 91.9%. Majority of patients of pregnancy with malaria were in the age group of 20-24 years residing in the urban area. Majority of patients were illiterate and were multigravida. Majority 29(78.38%) patients came in third trimester. Missed abortion occurred in 1(2.70%) and Normal vaginal delivery was conducted in 26 (70.27%). Maternal anemia and thrombocytopenia accounted for 32(86.47%) and 29(78.38%) respectively. Live babies were 36(94.73%). Preterm babies were 14 (36.84%). NICU admission were 12 (31.57%). Majority of babies, 22 (57.89%) were of low birth weight (LBW) and had IUGR. Conclusion: Malaria adversely affects both pregnant female as well as fetus. It is therefore advised all patients with fever in pregnancy must have screening for malarial parasite and treated adequately to improve the maternal and perinatal outcome. Multidisciplinary approach with help of physician, neonatologist and anesthetist can help in reducing feto-maternal morbidity and mortality. More public awareness programme and community participation also play important role in prevention of malaria.

69. Correlation of Bohler’s Angle and Functional Outcome of Surgically Treated Displaced Intra-Articular Calcaneus Fractures
Suraydev Aman Singh, Manoj Kumar, Neeraj Mahajan, Rahul Singh, Sanjeev Gupta
Introduction: With controversy still existing over the functional significance of Bohler’s angle, the study aims to evaluate the correlation of post-operative Bohler’s angle in predicting the functional outcomes of intra-articular calcaneus fracture. Material & Methods: 37 displaced intra-articular fractures were selected. Fractures were classified as per Sander’s Classification. All the patients underwent operative intervention. The post-operative Bohler’s angle were determined on lateral radiographs. Patients were kept on routine follow-ups. American Orthopaedic Foot and Ankle Society (AOFAS) score was calculated at final follow up of 1 year. Results: We obtained Excellent results in 4, good in 19, fair in 10 and poor in 4 patients. The post-operative Bohler’s angle had significant correlation with final AOFAS hind foot score. Conclusion: Surgical restoration of Bohler’s angle to near normal range is of utmost significance to obtain better functional outcomes.

70. Thyroid Lesion Assessment in Rural Settings by Fine Needle Aspiration Cytology and its Comparison with Ultrasonographic ExaminationGupta Anil Kumar1, Chauhan Sachin1, Goel Shikha2*, Gupta Isha3, Rathore Renu4, Singh Deergha
Thyroid swellings are common all over word, ranging from 4-8% to 8.5% in India. Most of thyroid swellings are benign in nature but malignancy does occur in 5-15% cases. Therefore, early diagnosis and precise risk assessment are crucial in managing thyroid lesions especially in rural areas. Fine needle aspiration cytology (FNAC) is essential for cell diagnosis based on “The Bethesda system of reporting Thyroid Cytology” (TBSRTC) 1. Ultrasonography of thyroid lesion is an initial investigation for risk assessment of various thyroid lesions; and evaluated as per “Thyroid imaging recording and data system” (TIRADS1. In our study all thyroid cytology reports were evaluated in conjunction with USG findings. Our study show female preponderance (93.33%) with involvement of younger age group of 20-40 years (53.3%) . In our study all USG findings of TIRADS II were correctly diagnosed as colloid goitre, TIRADS III group had different cytological diagnosis as per TBSRTC; 2 were diagnosed as non-malignant and remaining 04 were upgraded to higher grade on cytology. Therefore USG findings in TIRADS III need to be evaluated more closely by cytology to identify the proper cytologic diagnosis. Studies are in favour of use of FNAC in thyroid lesions, especially in solitary thyroid nodules

71. Attenuating Haemodynamic Response to Laryngoscopy and Intubation
Sakshi Goyal, Vikas Kumar Gupta, Aditi Mishra, Shikha Mehrotra, Priyal Shrivastava
Background: Laryngoscopy and endotracheal intubation for airway management produces intense noxious stress response appearing as an alteration in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate which could be life threatening in selected group of patients. Dexmedetomidine is a selective alpha 2- adrenoceptor agonist having   sedative, hypnotic, anxiolytic, analgesic, sympatholytic properties. Nebulised dexmedetomidine has good bioavailability that is why nebulisation route was chosen. Aim and Objectives: Purpose of the study is to evaluate the effect of nebulised dexmedetomidine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation. Materials and Methods: An observational, prospective clinical study was carried out on 130 patients aged between 18-60 years of both sex of ASA grade I and II, undergoing elective surgeries under general anaesthesia. Patients were divided into two groups containing 65 patients in each group to facilitate intubation, Group D (n=65)- received Dexmedetomidine in dose of 1 mcg/kg diluted up to 5 ml with normal saline, Group N (n=65)- received normal saline via nebulisation route. Result: Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure were comparable in both groups at baseline with no statistically significant difference (p>0.05). There was no statistically significant difference found between the groups with respect to heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure after nebulisation and just before intubation (p>0.05). After intubation rise in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure were statistically significant in normal saline group when compared to dexmedetomidine group (p<0.05). At 1, 5 min post intubation there was a statistically significant difference (p>0.05) in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure between the two groups. While 10 mins post intubation difference in heart rate was statistically significant between the two groups but the difference in systolic blood pressure, diastolic blood pressure, mean arterial pressure were not statistically significant between the two groups (p>0.05). Conclusion: Nebulized dexmedetomidine demonstrated its effectiveness in attenuating the intense hemodynamic response induced by laryngoscopy and endotracheal intubation in patients undergoing elective surgeries under general anesthesia. This study highlights its potential as a valuable adjunct in airway management strategies to enhance patient safety and minimize perioperative cardiovascular stress responses.

72. Study of Surgical Difficulties and Post-Operative Morbidities in Patients with Repeat Caesarean Sections
Kancharla Venkata Srilakshmi Devi, Konide Sai Anudeep
Aim: This study analyze the intraoperative complications in pregnant that were undergoing repeat caesarean section (CS), and also compared the complications with maternal characteristics and previous CS. Method: This observational study carried out in 100 cases of repeat CS. Maternal age, previous CS, parity, and intra-operative complications were noted. Results:  30% of cases with previous 2 CS and 2% cases with previous 3 CS were recorded. Preterm CS was performed in 14% of women with previous 2 CS and 1% in previous 3 CS. There were 86% of intra-operative complications observed. Among 86 cases with complications, 47.7% cases had single intraoperative complications and 52.3% cases had multiple intraoperative complications in combination of 2, or 3 or 4. Out of 52.3% cases that had multiple intraoperative complications, Adhesions, and Thinned Lower Uterine Segment were the highest combinations. Placenta Previa with combination of Haemorrhage was observed in one case. The incidence of scar dehiscence was reported in 10% of cases with Adhesion, Thinned Lower Uterine Segment, and extension of uterine incision. A total of 46.4% of the study group had thinned lower uterine segment in previous 1 and 2 CSs. Three cases of bladder injury due to in combination with Thinned Lower Uterine Segment, and advanced Bladder were noted. Six cases had haemorrhages on table due to adhesions, Thinned Lower Uterine Segment and extension of uterine incision. Conclusion: Risk reduction is possible by managing with the strict guidelines at the first CS, and having regular antenatal checkups. The best way to reduce the multiple complications of repeat CS is to minimize primary and repeat CS whenever possible.

73. Evaluation of Association of Placental Growth Factor with Uterine Artery Diastolic Notch in Predicting the Onset of Preeclampsia in Early Weeks of Pregnancy
Kancharla Venkata Srilakshmi Devi, Konide Sai Anudeep
Aim:  Current study aimed to predict effectiveness of uterine artery and placental growth factor (PlGF) in predicting the preeclampsia (PE) and outcome. Materials and Methods:  100 antenatal women of 12 – 16 weeks of singleton pregnancy were studied. Uterine artery Doppler were studied in all cases and again rescanned at 24-26 weeks of gestation by Trans abdominal USG. Results: Uterine artery Doppler notching at <20 weeks is observed in 35% and uterine artery Doppler notching at 24 weeks is noted in 16% of women. Uterine artery Doppler notching at <20 weeks is observed in 34.3% of preeclamptic women. Uterine artery Doppler notching at 24 weeks is observed in 75% of preeclamptic women. In PE cases, the median PLGF level in PE was 15 pg/ml. The sensitivity of bilateral uterine artery notching is 52.3%, specificity is 84.6% positive predictive value is 54.5%, and negative predictive value is 70.5% in prediction of preeclampsia. PlGF in pre-eclamptic women found to have the optimal cut off using ROC curve was 1.2 with sensitivity being 90% and specificity being 23.4%, positive predictive value of 15.5% and negative predictive value of 93.8%. In preeclampsia women, 4 babies were associated with IUGR, IUFD in one preeclamptic woman. Study observed 85.6% sensitivity rate and 84.62% specificity with 98.2% of Negative predictive value regarding Notch + RI with >0.65 Optimal cut off to predict the PE. Conclusion: The combined measurement of maternal placental growth factor concentration along with mean pulsatility index (PI) of uterine arteries at <20 weeks of gestation has very predictive for pre-eclampsia. Uterine artery Doppler studies between <20 weeks help to categorize pregnant into low risk and high risk so that proper vigilance may be done in high risk women.

74. Correlation of Retinal Nerve Fibre Layer by Optical Coherence Tomography and Humphrey field Analysis in Primary open Angle Glaucoma
Prasanna Jit Das, Ruma Das Debsikdar, Athili Leshini, Priya Lakshmi Khangembam, Choudhury Tufail Ahmed Saki, Ankur Baruah
Objective: To quantitatively assess the sensitivity and specificity of retinal nerve fiber layer thickness by Optical Coherence Tomography and Humphrey Field Analysis in primary open angle glaucoma and evaluate and correlate their efficacy in diagnosing primary open angle glaucoma. Materials and methods: A total of 52 cases and 104 eyes diagnosed with POAG in the age group 40 years of age and above were included in the study. The diagnosis was made based on history, findings on slit lamp examination, gonioscopy, Goldmann’s applanation tonometry, direct and indirect ophthalmoscopy, RNFL Optical Coherence Tomography and automated perimetry (Humphrey’s visual field analyzer). The correlations between OCT RNFL and mean deviation with HFA were calculated. Receiver operating characteristic curve (ROC curve) and area under the curve (AUC) were evaluated. Results: When OCT RNFL was compared with standard automated perimetry which is HFA, the AUC was 0.793 for RNFL thickness in eyes with visual field defects, suggesting significant difference between the two (p<0.001). The current study also demonstrates that the OCT RNFL performs better as a diagnostic test to establish POAG than the conventional automated perimetry. Conclusion: The current study demonstrates that OCT RNFL thickness measurements are a reliable and sensitive diagnostic modality for early detection of primary open angle glaucoma. Thus, it implies that RNFL thinning determined by OCT stands superior to the HFA in the individuals with early glaucoma and glaucoma suspects who exhibit normal visual fields (HFA) by routine automated perimetry.

75. A Randomized Controlled Study Comparing the Efficacy of Early Total Enteral Feeding with Conventional Enteral Feeding in Stable Very-Low-Birth-Weight Infants
Benudhar Pande, Sanjukta Panda, Sameer Kiro, Prajit Saswat Hota, Atal Bihari Dandapat, Himansu Nayak, Kodavathu Siva Naik
Objective: To assess the impact of early total enteral feeding (ETEF) in comparison to conventional enteral feeding (CEF) on the postnatal age (in days) required for stable very-low-birth-weight (VLBW; 1,000–1,499 g) infants to achieve full enteral feeds. Methods: In this unblinded randomised controlled study, a total of 180 infants were assigned to either the ETEF group (n = 91) or the CEF group (n = 89). Feeding regimens were commenced as complete enteral feeds in the ETEF group and as minimal enteral nutrition (20 mL/kg) in the CEF group. The remaining daily fluid needs in the CEF group were administered via parenteral route. The primary outcome of the study focused on the postnatal age at which infants achieved full enteral feeds. The secondary outcomes encompassed occurrences of feed intolerance, prevalence of sepsis and necrotising enterocolitis (NEC), and length of hospitalisation. Results: The baseline variables, encompassing birth weight and gestational age, exhibited comparable characteristics within both cohorts. The neonates in the ETEF group achieved complete enteral nutrition at an earlier stage compared to those in the CEF group (6.5 ± 1.5 vs. 10.1 ± 4.1 days after birth; mean difference –3.6 [–4.5 to –2.7]; p < 0.001). The incidence of feed intolerance episodes and clinical sepsis was lower in the ETEF group, with a reduced length of hospitalisation (15.5 vs. 19.6 days) (p = 0.01). The occurrence of necrotizing enterocolitis (NEC) exhibited comparable rates within both study cohorts. Conclusion: The implementation of early total enteral feeding (ETEF) in stable very low birth weight (VLBW) infants leads to accelerated achievement of full feeds and reduces the length of hospitalization, without any heightened susceptibility to feed intolerance or necrotizing enterocolitis (NEC).

76. The Advantageous Impact of Intravenous Magnesium Sulphate in Full-Term Neonates Experiencing Perinatal Asphyxia
Himansu Nayak, Sanjukta Panda, Benudhar Pande, Manoranjan Naik, Prajit Saswat Hota, Prashanta Kumar Hembram, Swagateeka Sahoo
Background: The primary aim of this research endeavour was to ascertain the efficacy of intravenous magnesium sulphate therapy in facilitating prompt recuperation and achieving a positive neurological prognosis upon discharge for neonates who have experienced asphyxia at birth. Methods: Term neonates diagnosed with birth asphyxia were randomly allocated to receive either a magnesium sulphate infusion (Study group) or be part of the Comparison group. The neonates in both cohorts received treatment in accordance with the standard neonatal intensive care unit (NICU) protocol for birth asphyxia. The study group also underwent intravenous infusion of magnesium sulphate at a dosage of 250 mg/kg/dose (administered as 1 ml/kg/dose in 20 ml of 5% dextrose solution) over a duration of 1 hour, within 6 hours of birth. This was followed by the administration of 2 additional doses, repeated after 24 hours and subsequently at 48 hours. The vital signs were continuously monitored. Comprehensive clinical evaluations, encompassing thorough neurological examinations, were conducted on both cohorts until their release from the Neonatal Intensive Care Unit (NICU). Results: Each cohort consisted of 60 neonates. A greater proportion of neonates within the study cohort exhibited successful seizure management through the administration of a solitary anticonvulsant, in contrast to the control group. Within the cohort under investigation, it was observed that a notable proportion of neonates, specifically 92%, achieved successful management of seizures within a span of 48 hours. In contrast, the comparison group exhibited a lower rate of seizure control, with only 70% of neonates achieving the same outcome. This discrepancy was found to be statistically significant, as evidenced by a p-value of 0.048. There was a notable occurrence of early implementation of nutritional intake among the study cohort in contrast to the control cohort, with a statistically significant difference observed. In the study cohort, a total of 47 neonates (84%) exhibited recovery from abnormal neurological examination within a span of four days, whereas in the comparison group, only 26 neonates (53%) demonstrated similar recovery. This disparity in recovery rates between the two groups was found to be statistically significant (p=0.0001). Conclusions: The administration of intravenous magnesium sulphate to term neonates experiencing birth asphyxia within six hours of birth has been found to be beneficial in terms of early seizure management, prompt resolution of abnormal neurological manifestations, expedited initiation of enteral feeding, and reduced likelihood of neurological abnormalities upon discharge.

77. To Know the Perinatal and Maternal Outcome in Preterm Labour in Micronized Progesterone Treated Group
Ritika Agarwal
Background & Method: The aim of the study is to know the perinatal and maternal outcome in preterm labour in micronized progesterone treated group. Emergency cases admitted in department of Obstetrics and Gynaecology with high risk history of recurrent abortions, history of preterm labour, prophylactic circlage or a uterine malformation. Result: There was significant reduction in perinatal morbidity and mortality in study group. The percentage of perinatal mortality in cases was 1.21 and in control group 8.33%. The percentage of perinatal morbidity was almost similar in both groups 17.07 in study and 18.7 in controls group but there was significant difference in birth weight of labour born. In controls about 45.83% babies born weight more than 2.5 kg while 60.97% babies were above 2.5 kg in study group. The nursery stay was shorter in study group. Perinatal mortality was 12.53% and 1.21% in controls and cases respectively. Conclusion: Prevention of preterm labour has become one of the major objectives of perinatal and maternal medicine. Micronized progesterone use for prevention of preterm labour and for prolongation of pregnancy has been in phase III trial and the results have been very encouraging and it has opened a new chapter in field of medicine.

78. Precision of Fine Needle Aspiration Cytology in Evaluating Neoplastic Thyroid Lesions: A Comprehensive Diagnostic Analysis
Uzma Alvi, Mohammed Azharuddin, Shazima Sheereen, Abdul Hakeem Attar
Background and Objectives: Thyroid is unique in being largest endocrine organ amenable to physical examination and is affected by plethora of disorders ranging from developmental to neoplastic. After diabetes mellitus, commonest of the endocrine disorders are of thyroid gland. Solitary thyroid nodule leads to cosmetic issues, compression on adjacent organs or can have malignant potential. FNAC has been foremost diagnostic tool compared to others, requiring no admission/anesthesia. This study is done to determine age and sex distribution of thyroid lesions with clinical correlation, to evaluate diagnostic accuracy of FNAC in diagnosing neoplastic lesions of thyroid. Materials and Methods: This Prospective study (June 2022 to May 2023) comprised of 50 cases, referred to ESIC Medical college and hospital Gulbarga and FNAC of neoplastic thyroid lesions were done with histopathological correlation in 50 patients and statistical analysis was performed in all cases. Results: Thyroid lesions were common in age group of 31-40 years, with female predilection (83.95%), neck swelling was predominant clinically (100%) and fever and pain least common. Among the Neoplastic follicular neoplasm (14 cases; 28%), Hurthle cell adenoma (02 cases; 04%) papillary carcinoma (25 cases; 50%), medullary carcinoma (05 cases; 10%), (papillary carcinoma with Hashimoto’s thyroiditis (02 cases; 04%) and anaplastic carcinoma (02 cases; 04%) were seen. When comparing FNAC and histopathology results, FNAC has a sensitivity of 93.9%, specificity of 94.1%, positive predictive value (PPV) of 96.8%, negative predictive value (NPV) of 88.8%, and an accuracy of 94.0%. Conclusion: Thyroid cytology is an effective and economical initial diagnostic approach that demonstrates a high level of patient acceptance and is free from complications. Its reliability and simplicity make it a valuable tool in the diagnostic process. The ideal test should have a sensitivity and specificity of 100%. The closest method to ideal test is, thus, FNAC which has high sensitivity and specificity. The optimal approach for accurate results and avoiding mismanagement is to utilize both Fine Needle Aspiration Cytology (FNAC) and Ultrasound in combination. Thus, FNAC is followed as first line pre-operative procedure due to its simplicity, cost-effectiveness & good diagnostic accuracy.

79. Shock Wave Lithotripsy for Ureteric Stones: Success Predictors Based on CT-Scan Parameters
Manish Kumar Singh, Abhishek Bose
Background: For the treatment of nephrolithiasis, shock wave lithotripsy has established itself as a successful, secure, and genuinely least invasive approach. The procedure’s success can be impacted by a number of technical aspects as well as the patient’s choice. The purpose of this study was to pinpoint the NCCT parameters that would indicate if shock wave lithotripsy (SWL) would be effective in treating ureteral stones. Methods: The study included 102 patients who received SWL for ureteral stones identified by non-contrasted computed tomography between September 2019 and November 2022 at the Department of Urology, NMCH, Sasaram, Bihar. Remaining stones >4 mm were considered the failure. Age, gender, BMI, stone size, position, skin-to-stone distance (SSD), presence of Double J stent (JJ stent), and presence of secondary symptoms (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign) were also evaluated. Results: Stone size and stone density were strongly linked with the result of SWL in 102 patients with a success rate of 61.8%. While secondary symptoms such as tissue rim sign, perinephric fat stranding, and hydronephrosis, as well as SSD, JJ, and SSD, were minor. According to multivariate analysis, the two independent parameters influencing the outcome of SWL were stone size and stone density. Conclusions: The study showed that in individuals with upper ureteral stones, stone size and density are important and independent determinants of prognosis. SSD and impaction indicators must still be assessed, though.

80. A Prospective Randomized Clinical Study for Evaluation of Adding Desmopressin to Alpha Blockers in Treatment of Nocturia in Cases of Benign Prostatic Hyperplasia
Manish Kumar Singh, Abhishek Bose
Background: One of the most distressing symptoms of the lower urinary tract in males with benign prostatic hyperplasia (BPH) is nocturia. A good way to relieve bladder outlet obstruction is using alpha-blockers. The purpose of the current study was to offer BPH patients the best medical care currently available for nocturia. Methods: 44 male participants who complained of nocturia and lower urinary tract symptoms (LUTS) of BPH were included in this prospective, randomized study for a period of 12 weeks (from March 2022 to May 2022). They were split into two groups at random, each with 22 patients. Group A: The patient received once-daily oral tamsulosin with desmopressin. The patient in Group B received oral tamsulosin every day. Results: Patients in group A had an average blood sodium level of 142.35. Before therapy, there was no discernible difference between the groups, but after 12 weeks of treatment, group A mean sodium level was significantly lower than group B and declined from before to after treatment (mean of Na=137.68±2.033). As group A had a substantially lower nocturnal void and nocturnal volume than the other groups, and as both groups had greatly improved from before to after treatment, there was no discernible difference between the groups in either of these measurements. When comparing the total International Prostate Symptom Score (IPSS) before and after treatment, no significant differences were identified (6.36±2.59 in group A and 10.55±4.13 in group B), although group A had a considerably lower total IPSS after treatment. Conclusion: Desmopressin supplementation is an active treatment for BPH-afflicted males who experience nocturia and is preferred to α-blocker therapy alone.

81. Factors Affecting Glycemic Control among Patients with Type 2 Diabetes: A Cross-Sectional Study
Subhash Chandra Yadav, Kumar Mayank, Kaushal Kumar Mishra, Deepak Kumar
Background: Diabetes is a chronic condition that needs on-going medical attention as well as patient education on self-management in order to achieve optimal glycemic control and avoid long-term complications. In India, type II diabetes is on the verge of becoming an epidemic. Asia is home to more than 60% of the world’s diabetics, with China and India making up the majority of this region. In spite of the fact that the advantages of adequate glycemic control in preventing diabetes-related micro vascular complications are well recognized, it has been observed that more than 60% of patients still do not meet the advised glycemic target. Glycemic control is challenging to attain in standard clinical practice because it is influenced by several social, demographic, economic, illness, and treatment-related factors. Methods: The data for the current investigation was collected from diabetic patients who visited the SKMCH, Muzaffarpur, Bihar, medical OPD in a cross-sectional retrospective analysis. Data was collected between December 2022 to May 2023. Retrospective data collection was done on 206 diabetic patients. Results: In this study, 206 patients were included, and (63%) of them were between the ages of 41 to 60. 15.5% of drug use was for monotherapy, 47.1% was for combination therapy, and 23.8% was for insulin + OAD therapy. When compared to patients with a BMI of <25, patients with a BMI of >30 had a 4 times higher chance of having poor glycemic control (OR = 3.9, C.I. = 1.2–3.9, P = 0.02). Conclusion: In this study, it was found that age, the duration of diabetes, drug use patterns, and BMI all had a statistically significant correlation with glycemic control.

82. A Case Control Study on Estimation of Zinc Levels in Children with Acute Lower Respiratory Tract Infection
Sunil Kumar Agrawal
Background: With regard to conditions like acute lower respiratory tract infection (ALRTI), the significance of zinc in treating illnesses in children has been established, which has sparked a larger interest among researchers. Therefore, the purpose of this study was to assess serum zinc levels in ALRTI cases and to connect those levels with the clinical course of the disease. Methods: ALRTI was present in 61 patients, aged 2 months to 5 years, who participated in the hospital-based case-control study, along with 61 nutritionally and age-matched control subjects. At admission, the serum zinc level was estimated. Along with details of the clinical course such length of stay, oxygen needs, severity of disease, and outcome, a thorough history, sociodemographic information, and examination were recorded. Results: The difference between the mean serum zinc levels of patients and controls (patients 58.88±12.40 mg/dl, Controls 85.36±16.27 mg/dl) was determined to be statistically significant (p value = 0.0001). Zinc levels and length of stay had a negative connection (r = -0.052, p value = 0.691). When compared to cases of pneumonia (WHO IMNCI grading), cases of severe pneumonia had considerably lower mean serum zinc levels (p value = 0.0001). As compared to the patients who were released, those who required higher O2 concentrations and those who died had considerably lower mean serum zinc levels (p value = 0.0001) and respectively. Conclusion: Lower serum zinc levels are significantly associated with ALRTI and the lower the serum zinc levels; the more is the severity of disease and duration of stay in hospital for the patient, along with increased oxygen requirement and also increased incidence of mortality.

83. Prevalence of Cholelithiasis and To Evaluate the Advantages and Disadvantages of Laparoscopic Versus Open Cholecystectomy: A Comparative Study
Manish Kumar Singh, Rahul Singh, Ramjee Thakur
Background: One of the most common medical conditions requiring surgical intervention is gallstones. The frequency of cases has recently increased as a result of diet westernization. This study aims to understand the numerous presentational forms, their complications, and the various treatment techniques and their results. The aim of the study is to study the prevalence of cholelithiasis and to evaluate the advantages and disadvantages of laparoscopic versus open cholecystectomy surgical procedures. Methods: This is a prospective study conducted at Upgraded Department of Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from December 2016 to December 2017. 100 consecutive cases of cholelithiasis were admitted, investigated and operated during this period and results analyzed. Results: The majority of cases of cholelithiasis were in females in their fourth decade. Abdominal pain was the most frequent clinical manifestation. Each case was identified using abdominal ultrasonography. It was a diverse diet that was consumed. In 72 cases, laparoscopic cholecystectomy was performed, while in 28 cases, open cholecystectomy was performed. There was a 4% conversion rate. There weren’t many issues. Laparoscopic cholecystectomy took 90 minutes on average, compared to 96 minutes for open cholecystectomy. For open cholecystectomy, the average hospital stay was 9 days, compared to 4 days for laparoscopic cholecystectomy. Conclusion: Most patients with symptomatic cholelithiasis benefit from a safe and efficient procedure called laparoscopic cholecystectomy. Open cholecystectomy is preferred in situations where there are adhesions and inflammation.

84. Determination of the Gallbladder Wall Thickness in Patients with Cholecystitis and Cholelithiasis by Ultrasonography
Manish Kumar Singh, Rahul Singh, Ramjee Thakur
Background: Due to the involvement of experts with experience in the field of imaging diagnosis and the advancement of technologies for ultrasonography (US), the concept of the thickening of the gallbladder wall, which is a contentious topic for sonographers and is frequently found and taken into consideration, has been changing recently. The purpose of the study was to estimate the epidemiology by using ultrasonography to measure the gallbladder (GB) wall thickness in patients with cholecystitis and cholelithiasis. Methods: This case-control study took place in a hospital. The study included individuals with cholecystitis and cholelithiasis between the ages of 15 and 70, of either sex. In the fasting condition, the thickness of the GB wall was measured. The study used 50 samples in total, 36 cases (with diseased bladders) and 14 controls (with normal bladders). Results: More than one-third of cases (38.9%) were between 30 and 40 years. The mean age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. More than one-third of both cases (36.1%) and controls (35.7%) were males. The GB wall thickness was significantly (P = 0.005) higher among the cases (4.06 ± 2.28 mm) than that of controls (2.22 ± 0.67 mm). Full distention of the GB was in more than half of both cases (69.4%) and controls (57.1%). Partial distended was in 11.1% of cases and in 21.4% of controls. Contracted (8.3%) and over distended (2.8%) were only seen among cases. The GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (odds ratio = 0.08, 95% confidence interval = 0.01–0.43, P = 0.001). Conclusion: Patients with cholecystitis and cholelithiasis were shown to have thicker GB walls on ultrasonography compared to the control group.

85. The Influence of Alcohol on Physiological Responses to Trauma: Implications for Forensic Pathology: Retrospective Study
Suchita Kumari, Rohan Kumar, Raj Kishore Singh, Mrityunjay Kumar Azad, Malti Bhagat
Background: Consumption of Alcohol is common and generally acceptable in society, yet it has severe consequences for public health and forensics. The effects of Alcohol on the body’s response to trauma are examined here, focusing on the forensics field. Methods: A retrospective observational study used data from 250 trauma-related deaths. This study looked at demographics, past drinking habits, and physiological reactions. Significant correlations were found using statistical methods. Results: In 65% of the cases, Alcohol was found, with a mean Blood Alcohol Concentration (BAC) of 0.12 g/dL. Both traffic accidents (78% of all) and murders (63% of all) included Alcohol to a greater extent. The body’s physiological reactions to trauma were drastically altered by alcohol consumption. Alcohol consumption was associated with impaired cognition, a higher risk of hemorrhagic shock, an increased prevalence of systemic infection, aberrant coagulation profiles, and a slowed response to pain. These connections were solidified by statistical analysis. Conclusion: Forensic pathologists performing autopsies and public health campaigns aiming at minimizing alcohol-related traumatic episodes need to be aware of Alcohol’s effects to be effective. Interactions with other substances and the impact of preexisting medical disorders should be investigated in future studies.

86. To Evaluate and Investigate Potential Relationship between MRI Abnormalities of the Common Extensor Tendon (CET) and its Clinical Symptom in Patients with Chronic Lateral Epicondylitis: A Retrospective Study
Background: The condition known as tennis elbow, or Chronic Lateral Epicondylitis (CLE), is a painful ailment that affects the outside of the elbow. Magnetic Resonance Imaging (MRI) provides critical information for accurate diagnosis and treatment planning by revealing structural alterations inside the Common Extensor Tendon (CET). Method: Data from 250 patients at Government medical College and hospital Purnia with a confirmed diagnosis of CLE (Agale group) were analysed in this retrospective analysis. Clinical complaints were evaluated using standardised measures, and MRI abnormalities of the CET were diagnosed. Pearson’s correlation coefficients and multivariate regression were used for the statistical analysis. Results: MRI findings included tendon thickening (68%) and tendon rips (42% and tendon inflammation (56%) were common. MRI abnormalities positively correlated with pain (r = 0.62, p <0.001) and functional impairment (r = 0.48, p <0.001). Fewer MRI abnormalities were seen in patients experiencing symptoms for longer (r = -0.22, p = 0.017). Conclusion: Our results show that CET anomalies observed by MRI correlate firmly with patients’ reported symptoms of CLE. The results highlight the significance of MRI in CLE diagnosis and developing individualised treatment plans. This study significantly contributes to our understanding of the pathophysiology of CLE and highlights the need for further investigation into improving patient management.

87. Ultrasonographic Study of Brain of Neonatal Preterm Babies with Birth Asphyxia: A Retrospective Study
Jan, G N Singh
Background: Asphyxia at birth is still a significant cause for concern, as it is associated with high morbidity and mortality, especially in premature infants. Ultrasonographic features of brain damage in this susceptible population were the focus of this retrospective investigation at PMCH, Patna. Methods: We examined the records and ultrasounds of 250 premature infants diagnosed with birth asphyxia. The ventricular system, the parenchyma, and the periventricular regions were all evaluated using ultrasonography. Apgar scores and gestational age were among the clinical indicators recorded. The data was analysed using various statistical techniques, including correlation analysis. Results: The most prevalent finding was ventriculomegaly (35%), although other findings included periventricular leukomalacia (PVL), Intraventricular Haemorrhage (IVH), and cerebral edoema. Infants with lower Apgar scores at 1 minute were likelier to have IVH (p< 0.05). PVL was linked with gestational age (p <0.01). There was no statistically significant relationship between birth weight and individual ultrasonographic data. Conclusion: Our findings highlight the need for early ultrasonographic testing to detect brain injury in premature infants with birth asphyxia. Their association with IVH bolsters the predictive value of 1-minute Apgar scores. The intricacy of brain injury in this population, as demonstrated by the wide range of ultrasonographic results, further highlights the importance of individualised therapies and continuous monitoring.

88. Role of Arthroscopy in the Diagnosis and Treatment of Chondral Lesions: An Evaluation of the Diagnostic Accuracy and Therapeutic Benefits of Arthroscopy in Managing Cartilage Lesions in Various Joints: A Retrospective Cohort Study
Nitin Kumar, Soman Chatterjee
Background: Damage to the articular cartilage in the synovial joints, known as chondral lesions, is a significant problem in orthopaedics and sports medicine. This retrospective analysis considers arthroscopy’s diagnostic and therapeutic value for chondral lesions in various joints. Method: 250 patients who met the study’s requirements were enrolled. Patient records and imaging reports were thoroughly reviewed to evaluate demographic information, diagnosis accuracy, and therapy outcomes. The data was interpreted using statistical methods such as sensitivity, specificity, and paired t-tests. Results: When diagnosing chondral lesions, arthroscopy has shown to be highly accurate, with a sensitivity of 92.4% and a specificity of 88.7%. Arthroscopic procedures significantly reduced postoperative discomfort (p <0.001) and enhanced joint function (p <0.001). Most patients who underwent arthroscopic surgery reported being satisfied with their experience. Conclusion: Regarding chondral lesions, arthroscopy is invaluable, providing high diagnostic accuracy and significant therapeutic effects. Despite the study’s limitations, including its retrospective nature, researchers propose doing additional multi-centre studies to improve generalizability and advance state of the art in arthroscopic surgery. This research adds to the existing body of literature demonstrating the clinical efficacy of arthroscopy for treating chondral lesions in various joints.

89. The Impact of Hormonal Contraception on Bone Mineral Density in Young Women: A Retrospective Study
Priyanka, Deepali, Sweta Bharti, Kanchan Kumari
Background: Hormonal contraception has transformed family planning, but its possible impacts on the bone health of young women remain a source of concern. Given the significance of Bone Mineral Density (BMD) to bone health, it is essential to investigate the potential association between hormonal contraception and BMD. Methods: This retrospective investigation included 200 women between 18 and 30 who attended the Indira Gandhi Institute of Medical Science in Patna, Bihar, India. The study participants who claimed to utilise hormonal contraceptives were compared to those who did not. BMD was quantified using dual-energy X-ray absorptiometry scans. BMD changes were analysed statistically about birth control methods. Results: The results demonstrated that different contraceptive methods caused distinct variations in BMD. The BMD of the average oral contraceptive user decreased by 2.61 per cent, whereas the BMD of the average hormonal intrauterine device user increased by 2.48 per cent. The BMD of injectable contraceptive users decreased by 1.69 per cent, whereas the BMD of non-users (controls) increased by 0.80 per cent. Conclusion: This study illuminates the complex association between hormonal contraception and BMD in young women. These results emphasise the significance of delivering individualised contraception advice to address issues related to bone health. This study clarifies the complex interaction between hormonal contraception and BMD, allowing women to make better decisions for their overall health.

90. Optimizing Perioperative Management for Diabetic Patients Undergoing Non-Cardiac Surgery: A Retrospective Cohort Study
Sanjeev Kumar, Santosh Kumar
Background: Patients with diabetes who undergo surgery are at a greater risk for perioperative issues, although the significance of preserving stable blood sugar levels is still under investigation. In addition to perioperative HbA1c levels, perioperative glucose management and postoperative glycemic control may influence surgical outcomes. Understanding the relationship between glycemic management and surgical results is necessary for optimising care. Methods: For this investigation, the Electronic Health Records (EHR)of 500 patients with diabetes who experienced non-cardiac surgery between January 1, 2022, and December 31, 2022, were retrospectively reviewed. Evaluations were conducted on intraoperative glucose management, postoperative glycemic control, and perioperative HbA1c levels. The data were analysed using descriptive statistics and inferential tests, with p-values less than 0.05 considered statistically significant. Results: In the sample population, higher surgical site infection rates were observed (48% had HbA1c levels > 8%; p <0.05). Patients whose intraoperative blood glucose levels were within the normal range (100-150 mg/dL) had a decreased incidence of cardiovascular events. Postoperative hyperglycemia (> 180 mg/dL) has been associated with wound complications and extended hospital stays. Conclusions: During the perioperative period, diabetic surgical patients must have their blood sugar levels optimally managed. Perioperative assessment and optimisation, intraoperative care, and postoperative observation are crucial phases. The importance of optimising glycemic management for each diabetic patient to enhance surgical outcomes is highlighted by our findings.

91. Internal Iliac Artery Ligation: A Modality for Control of   Severe PPH in a Tertiary Care Centre
Shanti Snehlata, Sadhana Kumari, Raj Rani Choudhary
Background: Patients with diabetes who undergo surgery are at a greater risk for perioperative issues, although the significance of preserving stable blood sugar levels is still under investigation. In addition to perioperative HbA1c levels, perioperative glucose management and postoperative glycemic control may influence surgical outcomes. Understanding the relationship between glycemic management and surgical results is necessary for optimising care. Methods: For this investigation, the Electronic Health Records (EHR)of 500 patients with diabetes who experienced non-cardiac surgery between January 1, 2022, and December 31, 2022, were retrospectively reviewed. Evaluations were conducted on intraoperative glucose management, postoperative glycemic control, and perioperative HbA1c levels. The data were analysed using descriptive statistics and inferential tests, with p-values less than 0.05 considered statistically significant. Results: In the sample population, higher surgical site infection rates were observed (48% had HbA1c levels > 8%; p <0.05). Patients whose intraoperative blood glucose levels were within the normal range (100-150 mg/dL) had a decreased incidence of cardiovascular events. Postoperative hyperglycemia (> 180 mg/dL) has been associated with wound complications and extended hospital stays. Conclusions: During the perioperative period, diabetic surgical patients must have their blood sugar levels optimally managed. Perioperative assessment and optimisation, intraoperative care, and postoperative observation are crucial phases. The importance of optimising glycemic management for each diabetic patient to enhance surgical outcomes is highlighted by our findings.

92. Assessing the Role of Autonomic Nervous System Activity in Sudden Unexplained Deaths: A Physiological and Forensic Perspective
Suchita Kumari, Rohan Kumar, Raj Kishore Singh, Mrityunjay Kumar Azad, Malti Bhagat
Background: The medical and forensic communities still struggle to make sense of Sudden Unexpected Deaths (SUD). This analysis of Heart Rate Variability (HRV) and breathing patterns seeks to understand better the function of the Autonomic Nervous System (ANS) in SUDs. Methods: An extensive age range was used in the retrospective study of 250 SUD cases and a control group. Both the SDNN and RMSSD of HRV, as well as the Apnea-Hypopnea Index (AHI), were measured. The ability of ANS parameters to predict outcomes was investigated using a multivariate regression model. Results: Compared to controls, people with SUD had lower HRV (SDNN: 49.8 11.2 ms; RMSSD: 22.4 6.5 ms) and higher AHI (19.3 6.1 events/hour). A higher SUD risk was related to lower HRV (AOR = 2.34, p 0.001). These results point to ANS dysfunction as a critical component in (SUDs), including cardiac and respiratory factors. Conclusion: The importance of ANS evaluation in SUD research and comprehension has been shown by our study. Decreased HRV is an accurate predictor, which could help find people at risk for SUDs sooner so they can get help. The research expands our understanding of these mysterious deaths and suggests new clinical and forensic investigation directions.

93. Hysteroscopy in Sub-fertile Women: A Prospective Study
Dolly Ramnani
Objectives: 1) To study clinical profile of women who have undergone hysteroscopy. 2) To assess factors of infertility through hysteroscopy, complemented by laparoscopy. Methods: This was a prospective study conducted at the Department of Obstetrics and Gynaecology, Sir Sayajirao General Hospital, Vadodara over a period of 1 year. A total of 69 women were enrolled. Study was conducted over a period of one year from 16th April, 2009 to 15th April, 2010. Complete biodata and clinical history were elicited. Women were thoroughly examined and investigations were carried out. Hysteroscopy with 5mm, 30° hysteroscope was used and laparoscopy was performed in conjunction with it. Women were followed up after six weeks and at six months. Results: Maximum no. of women were between 26-30 years of age group (33 women) with mean age of 27.9 years and a range of 15-35 years. 49 had primary infertility (71%) and 20 had secondary infertility(29%). Diagnostic hysteroscopy was performed in 66 women; whereas, operative hysteroscopy was done in 3 women (4.34%). Hysteroscopy was normal in 60 women. 13 women conceived with ovulation induction drugs. Out of 22 women who revealed abnormal HSG, hystero-laparoscopy in same women revealed abnormality in only 13 women. Conclusion: Hysteroscopy and laparoscopy are diagnosing and treating both uterine and tubal infertility as well as some ovarian abnormalities. They permit to correct data from the HSG  and to improve the pregnancy rate.

94. Evaluation of Post-Operative Epidural Analgesia with 0.2% Ropivacaine HCL and 0.2% Bupivacaine HCL in Patients Undergoing Abdominal Hysterectomy Under Spinal Anaesthesia
Indrajit Das, Biswajit Sutradhar, Anupam Chakrabarti, Rahul Datta Roy
Background: Many people view epidural analgesia as the “gold standard” in analgesic method, and it is frequently used for post-operative analgesia following abdominal and lower limb procedures. While some researchers claimed that the newer local anaesthetic agent Ropivacaine provided superior block over conventional agent Bupivacaine, others did not find similar results. Hence our study is designed to compare whether there is any difference of analgesic efficacy between these two drugs in patients undergoing abdominal Hysterectomy under Spinal anaesthesia. Methodology: A Comparative observational study was conducted on total 60 (sixty) no of ASA PS I & II patients undergoing abdominal hysterectomy under spinal anaesthesia. Patients were divided in 2 groups with equal numbers in each group (n=30). Group R (Ropivacaine) received 10 ml of 0.2% Ropivacaine & Group B (Bupivacaine) received 10 ml of 0.2% Bupivacaine at VAS Score 5 in the postoperative period. Onset and duration analgesia, Haemodynamic parameters, and adverse effects- if any, were studied. Results: Bupivacaine group had a faster onset time with 11 min approx., while in Ropivacaine group it was around 15 min. The duration of analgesia was longer with Bupivacaine- approx 130 min than in Bupivacaine group- approx. 113 min. Overall side effects were more in Bupivacaine group as compared to Ropivacaine group. Pain relief was more with Bupivacaine in comparison to Ropivacaine. Conclusion: It is concluded that Bupivacaine produced better and longer-lasting analgesia than Ropivacaine. Moreover, bupivacaine had a faster onset time over Ropivacaine.

95. Application of double – far – near – near -far suturing for the closure of linea alba in midline laparotomy wounds for the patients of acute abdomen with perforation peritonitis admitted to Dr. Susheela Tiwari hospital, Haldwani: A Prospective Observational study
Shwetabh Pradhan, Prakhar Nagar, Sophiya
Objectives: The present study was undertaken to evaluate the outcomes using the technique of double-far-near-near-far sutures for the closure of linea alba in midline laparotomy wounds for the patients of perforation peritonitis. Methods: A total of 50 patients of generalized peritonitis were enrolled in this study. After the completion of surgery, linea alba was closed using interrupted loop nylon no.1 sutures by the technique of double, far-near-near-far suturing which comprised of taking a far bite starting at 1 cm from the edge of linea alba from outside to inside and then taking a near bite of 0.5 cm on the other side from inside to outside, a near bite on the previous side from outside to inside and finally a far bite on the other side from inside to outside. The suture was then converted to a horizontal mattress by taking a far bite 1 cm above or below the previous bite and repeating the suturing in the similar fashion. The two ends of the suture were tied to approximate the edges of linea alba. Results: Majorities of patients 21(42%) were in age group of 21-40 years. Patients were grouped as those presenting within 48 hours and those after 48 hours of onset of symptoms. Rate of surgical site infections(SSI) and duration of symptoms was greatly reduced but it was not statistically significant (p=0.178). The relation of SSI and site of perforation was also not statistically significant. The relation between low albumin and SSI was also statistically not significant (p=0.424). The association between active tuberculosis and SSI was not statistically significant (p=0.169). The rate of SSI and malignancy was also not statistically significant (p=0.395). The relation between serum creatinine values and SSI was not statistically significant (p=1). The relation of INR and SSI was not statistically significant (p=1). The relation of smoking and SSI was also not statistically significant (p=0.533). But, the rate of SSI was greatly reduced according to lower age, sex, duration of symptoms, site of perforation, lower albumin levels and lower creatinine levels. The surgical site infection (SSI) was seen in only 22% patients. There was no wound dehiscence encountered in any of the enrolled patients of the study. Conclusions: The present study concluded that the double – far – near – near-far method of suturing for the closure of linea alba in midline laparotomy wounds for acute perforation peritonitis is a good method of suturing with comparatively lesser rates of surgical site infections and no wound dehiscence.

96. Comparison of Gastrocnemius Myocutaneous Flaps with Gastrocnemius Muscle Flaps for Upper Third Leg and Knee Defects
Jainath, Puneeth, Suhas, Vishwanatha T
Introduction: Gastronemius muscle and myocutaneous flaps are most commonly used flaps for reconstruction of traumatic upper third leg defects. The myocutaneous flaps have advantage of reaching a higher defect compared to the mucle flaps. Myocutaneous flaps have the advantage of lesser adhesions and easier closer in the reexporation of defects for any definitive fixation of fractures. Objectives: The objective of the study is to evaluate the advantages of Gastronemius myocutaneous flaps over gastronemius muscle flaps in covering upper third traumatic leg defects. Methods: This was a comparative study of 30 cases of combined gastronemius muscle and myocutaneous flaps done for the traumatic upper third leg defects between January 2020 and December 2022. The advantages and disadvantages of gastronemius myocutaneous flaps over muscle flaps like in covering the larger defects and in reexploration of the traumatic defects for any definitive fracture stabilisation were analysed and outcomes evaluated. Results: 20 cases of upper third leg defects were covered with gastrocnemius muscle flaps and 10 cases with gastronemius myocutaneous flaps for upper third and knee defects. Both the flaps were effective in covering the defects with no any complications or flap failure. The gastronemius myocutaneous flaps had the advantage of reaching the defects over knee and middle third leg and covering large wound defects. The re exploration of the fracture site for any definitive fixation was better with gastrocnemius myocutaneous flap because of less adhesions and easier wound closure. Conclusion: The gastronemius muscle and myocutaneous flaps are very reliable flaps for covering traumatic upper third leg defects. The very ease of harvesting these flaps with reliable blood supply makes it a simple alternative flap cover option for upper third leg defects as compared to free tissue transfers. The gastronemius myocutaneous flaps have the advantage of covering larger wound defects and good skin resurfacingthat makes eventual revision easier.

97. Beyond Symptoms: Unraveling the Biochemical Variations in Mild and Severe COVID-19 Patients
Neelam Patil, Vibha Sakhare
Background: The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has presented an unprecedented global health challenge. While the spectrum of clinical manifestations ranges from asymptomatic to severe and life-threatening, understanding the factors that drive disease severity remains a critical and complex problem. The identification of reliable biochemical markers that can distinguish between mild and severe cases of COVID-19 is essential for early intervention, risk stratification, and informed clinical decision-making. This research seeks to address the following key research problem. Objective: To study biochemical parameters in mild and severe patients of COVID-19 infection. Material and Methods: This retrospective study was conducted using data collected from a tertiary care hospital in Mumbai, India, during the period of March to June 2021. The study population consisted of 100 adult patients (≥18 years of age) who tested positive for COVID-19 using Reverse Transcription Polymerase Chain Reaction (RT-PCR). Patients who did not require hospital admission were excluded from the study. Patients were grouped into 2 groups; mild (n=50) and severe (n= 50). Results: The biochemical parameters were compared in group-1 and group-2. Group-2 patients showed significantly higher levels of total bilirubin (< 0.0001), aspartate transaminase (p< 0.0001), alanine transaminase (p< 0.0001), alkaline phosphatase (p< 0.03) total proteins (p< 0.02), serum albumin (p< 0.005), serum urea (p< 0.007), serum creatinine (p< 0.0001), lactate dehydrogenase (p< 0.0001) and random blood sugar (p< 0.007). Conclusion: Our study’s findings provide valuable insights into the biochemical markers associated with COVID-19 severity. These markers can help clinicians identify severe cases early, tailor treatment strategies, and monitor organ functions during the course of the disease.

98. Clinical Study of Second Trimester Abortions in a Tertiary Care Hospital
Anju, Sukham Sandhu, Satinder Pal Kaur, Preetkanwal Sibia
Objective: To analyse the demographic profile of women seeking second trimester termination of pregnancy. Material and Methods: This prospective observational study included all cases of second trimester termination of pregnancy over a period of one and half years. A detailed history, physical and obstetrical examination was carried along with necessary investigations. Written informed consent and documentation was done. Results: Total 112 cases were studied. The prevalence of second trimester abortion in our study was 13.9%. 35.7% of the patients were in the age group of 28-32 years. 51.8% were Sikhs by religion followed by 45.5% Hindus. 67% cases were unbooked and 75.9% were from rural areas. 70.5% were multigravidas out of which 23.3% were grandmultiparas. Out of 70.5% of multigravidas 95.1% were not using any contraceptive. Conclusion: Counselling about contraception use should be done. Unmet needs of abortion services should be taken care at all levels of health care. Education about signs and symptoms of pregnancy will promote earlier identification of pregnancy and seeking early care. All health workers must be imparted knowledge about laws of abortion care.

99. Dermatoscopic Findings in Androgenetic Alopecia
Bansal Charu, Md. Raihan, Manali
Background: Androgenetic alopecia (AGA) is the term used to describe the typical, gradual patterned thinning of terminal hair on the scalp in a genetically predisposed individual. The diagnosis of this condition is mainly clinical. Previously, the only definitive way to diagnose and assess the extent of the condition was through a scalp biopsy. However, a new non-invasive method known as trichoscopy has emerged, offering an alternative approach. Trichoscopy involves using dermoscopy to capture images of the scalp and hair. This technique allows for the visualization of various structures such as openings of hair follicles, hair shafts, the perifollicular epidermis, and cutaneous microvasculature. Objectives: To study the trichoscopic features of androgenetic alopecia. Material and Methods: 80 patients with AGA (50 male and 30 female) were enrolled in this study. Data on age, gender, personal and family history, clinical type, onset and duration of disease were collected and evaluated. Trichoscopic examination was performed using video dermatoscope. Trichoscopy results were obtained in frontal, occipital and both temporal areas of the scalp. The data were statistically evaluated. Results: Hairshaft thickness heterogeneity (HSTH) was the most common trichoscopic feature seen in all the patients enrolled in the study. Brown peripilar sign was seen in 30 patients, white peripilar sign in 24 patients, pin point white dots in 20 patients, yellow dots in 2 patients, focal atrichia in 12 patients, scalp honeycomb pigmentation in 15 patients. Conclusion and recommendations: Trichoscopy is a simple, non-invasive tool that aids in diagnosis of AGA, allowing various sections of hair to be examined simultaneously. It provides easy documentation which also helps in evaluating a therapeutic response by comparing pre and post treatment images.

100. Comparative Study of Outcome of Type 1 Tympanoplasty in Dry and Wet Ears
K. Sudhakar, Rajesh Kumar Avuluri, S. Sukumar, Shaik Abdul Subhan Faruq
Background: Chronic Suppurative Otitis Media (CSOM) is still common in the rural populations causing loss of hearing and loss of man days. The prevalence of CSOM in India is affecting 05 crores population. Type-I Tympanoplasty procedures previously undertaken only in dry ears are being undertaken in wet ears also due to improvement in technical skills and instruments. The study compares the final outcome of Type- I Tympanoplasty procedures in wet ears versus dry ears. Aim of the study: To study the final outcome of Type-I Tympanoplasty procedure in wet ears of CSOM versus dry ears. To analyze the factors playing role in the final outcome like, wet ear, dry ear, size of perforation, Eustachian tube patency, mastoid pneumatization, type of organism and status of middle ear mucosa. Materials: 74 patients with CSOM were selected for a prospective study attending the Department of ENT, Government Medical College and Hospital, Anantapuramu, Andhra Pradesh between Sept 2021 and Aug 2023. A clinical study was conducted to analyze the final outcome of Type-I Tympanoplasty procedure in the wet ear versus dry ears of CSOM. All the patients were subjected to ENT examination, X-Ray mastoids, Audiometry. All the patients were subjected to Type-I Tympanoplasty using temporalis fascia graft. Cortical mastoidectomy was done in majority of the patients. Final outcome was measured in terms of healing of the graft and auditory gain in terms of PTA and closure of air bone gap. Statistical analysis was done to observe the final outcome. Results: Among the 74 patients, 24/38 (63.15%) were males and 14/38 (36.84%) were females in the group A and 25/36 (69.44%) males and 11/36 (30.55%) females in the group B. The gender ratio was: female to male in group A was 1:1.71 and in group B was 1:2.2. The overall female to male ratio was 1:2.96. The youngest patient was aged 13 years and the eldest patient was aged 57 years. pneumatization of the mastoids, Eustachian tube patency and status of the middle ear mucosa had a significant role in the incidence of the CSOM whether it is dry or wet type of ears (p value less than 0.05).There was no statistical significant difference between the two groups in regards to graft uptake, auditory gain. (p value less than 0.05). Conclusions: Type-1 tympanoplasty using temporalis fascia by underlay technique has good surgical success rate with excellent improvement of hearing either in dry or wet ear when cortical mastoidectomy is done in all CSOM ears. There was no statistical significant difference in the final outcome of the patients treated with Type-I Tympanoplasty.

101. An Analysis of School Survey on the Prevalence Strabismus and its Association with Amblyopia and Refractive Errors
Kanchana Lakshmi Devi, Ganti Snehitha, Yasam Raghavendra Reddy, Vankadara Nagasuresh, K. Bharani Kumar Reddy
Background: Among the different causes producing Amblyopia in children, untreated strabismus was found to be the commonest. Children with Amblyopia fail to develop binocular vision and learning skills thereof. Such children are a risk factor to develop psychosocial difficulties later in their life. Aim of the study: To conduct a clinical study to know the prevalence of strabismus in the school children; to know the types of strabismus. Materials: Design: The study was a cross sectional one undertaken to determine the prevalence of strabismus among primary school children in the villages around the Viswabharathi Medical College and Hospital during November 2021 to January 2023. Methods: Visual acuity, auto refraction, Hirschberg’s test and cover tests were used using a pen light torch to survey 286 children were performed for 584 out of 841 students (age range 5.5–7 years). Children with all types of strabismus or those who had a history of strabismus surgery were subjected to a full ophthalmic examination including slit lamp, extra ocular muscles examination, Worth 4 dots test, and fundus examination. Results: Students with strabismus with Amblyopia were 05, children with newly diagnosed refractive errors were 27 and with already diagnosed and treated refractive errors were 06 in the study. The prevalence of strabismus with Amblyopia was 1.74%. Among them children with astigmatism were 10/38 (26.31%), myopia in 09/38 (23.68%), and hypermetropia in 08/38 (21.05%) children. Conclusions: Prevalence of Strabismus was evident and regular school health surveys help us to identify early visual disturbances in children. Strabismus is definitely associated with Amblyopia and refractive errors in children. Early detection and prompt treatment with appropriate lenses would assist the children developing learning skills.

102. Study of Glycated Haemoglobin (HbA1c) and Lipid Profile as a Predictor of Dyslipidemia in Type 2 Diabetes Mellitus
Naresh Manne, P Rakesh, N Sreevani, B V Surendra
Background: Dyslipidemia is a very common finding in patients with type 2 Diabetes Mellitus (DM) which strongly increases risk for the development of cardiovascular diseases. the aim of the study was to investigate the association between glycated hemoglobin (HbA1c) and the lipid profile in patients with type 2 diabetes mellitus (T2DM) at a tertiary care hospital in Kurnool. Methods: The prospective observational case study was conducted on 120 Type 2 diabetic patients of age group more than 30 years, who visited the OPD/IPD of General Medicine affiliated diabetic center at Viswabharathi Medical College & General Hospital. Venous blood samples were collected from all subjects for fasting plasma glucose, Post prandial plasma glucose, HbA1c and serum lipid profile. The statistical analysis was done by SPSS. Results: Age of the patients ranged from 30 to 90 years and more than half were older than 60 years. Among patients with uncontrolled DM, uncontrolled FBS was in 84 (70%) and uncontrolled PPBS in 69 (57.5%) patients. Their mean fasting and postprandial blood sugars were 170.87±39.42 and 229.98±54.36 mg% respectively. Among poor glycemic control patients, mean serum value of TG, LDL were statistically significantly higher and mean HDL was statistically significantly lower. Among various lipid profile, LDL cholesterol had moderate positive correlation and HDL cholesterol had moderate negative correlation with HBA1c values. Among various lipid profile in males, LDL cholesterol had moderate positive correlation whereas HDL cholesterol had moderated negative correlation. Among females, LDL had high positive correlation and HDL had high negative correlation. Conclusion: This study confirms higher prevalence of dyslipidemia in diabetic patients than in non-diabetic patients. With the higher HbA1c, the severity of dyslipidemia increases in diabetic patients. So diabetic patients with elevated HbA1c and dyslipidemia can be considered as a very high risk group for cardiovascular diseases. Improving glycemic control can considerably reduce the risk of cardiovascular diseases up to a great extent.

103. To Determine the Need for Postoperative Antibiotics after Laparoscopic Appendicectomy in Nonperforated Appendicitis
Nihar U. Chandak, Bhagwan Raghunath Korde
Background: One of the most prevalent acute gastrointestinal inflammatory diseases in both children and adults, appendicitis frequently necessitates surgery and hospitalization. Every year, 14,000 patients in the Netherlands have their appendices removed due to possible appendicitis. There are two main forms of acute appendicitis: basic and complicated. Suppurative or phlegmonous appendicitis (transmural inflammation, ulceration, or thrombosis) with or without extramural pus is referred to as a simple appendicitis. Complex appendicitis involves perforated appendicitis, gangrenous appendicitis (transmural inflammation with necrosis), and/or appendicitis with abscess formation (pelvic/abdominal). Complex appendicitis accounts for 25–30% of all cases. Postoperative surgical site infections (SSIs) can be prevented with the proper prophylactic antibiotic usage. There is no definitive recommendation, though, for how long to use antibiotics. Numerous randomized control trials have advised a single preoperative prophylactic dosage. Aim: The aimed to determine the need for postoperative antibiotics after laparoscopic appendicectomy for nonperforated appendicitis. Material and Method: This randomized control trial (RCT) was carried out in the General Surgery Department. All patients receiving an emergency open appendectomy who had been admitted with acute appendicitis were deemed eligible for this study.  On a pre-made proforma, the demographic information, medical history, and specifics of the clinical examination of the patients were documented. Regular tests including complete blood counts, blood urea, serum creatinine, and other tests like abdominal ultrasounds were also carried out. The opaque envelope approach was used to randomize the groups. There were manufactured a total of 70 opaque envelopes with cards inside. A card saying Group A (the study group) was inside 35 of these envelopes, while a card mentioning Group B (the control group) was inside the remaining 35. Results: In comparison to group B, group A had a mean age that was 28.54 + 9.62 + 8.52 years older. Right iliac fossa pain was the primary complaint of all research participants. Grade III SSIs were treated conservatively in two patients in group B and three patients in group A. The difference in the incidence of SSIs between the two groups was statistically negligible. Regarding the mean age, gender distribution, pain, fever, nausea, vomiting, McBurney’s soreness, bowel sounds, total leukocyte count, ultrasonography, diagnosis, and histopathology report, there was no discernible difference between the two groups. Although group B’s average hospital stay was longer than group A’s, there was no statistically significant difference between the two groups. Conclusion: To lower the risk of postoperative SSIs, a single preoperative dose of the preventive antibiotics cefotaxime and metronidazole at the time of induction is sufficient, and further postoperative doses have no statistically meaningful advantages. In order to ascertain the precise requirement for postoperative prophylactic antibiotics to lower the SSIs, additional research on a bigger scale with many other abdominal procedures are necessary.

104. An Epidemiological Study of Patients Coming with Otorrhoea in a Tertiary Level Hospital in Jaipur, Rajasthan, India
Abhinav Rathi, Rachit Jain, Poonam Verma, Kanupriya Bhargava
Background: Otorrhoea, which is characterised by ear discharge, is a typical sign of a number of ear conditions, most notably otitis media. Effective care and prevention efforts require an understanding of the clinic-epidemiological makeup of otorrhoea patients. Previous research has concentrated on locating bacteria in ear discharge but has not examined demographic factors or particular causes/types of otorrhoea. Methods: In Jaipur, Rajasthan, India, a tertiary hospital undertook a cross-sectional study. A pretested questionnaire was used to gather information on age, sex, address, education, occupation, socioeconomic status, previous history, and personal history from patients who presented with otorrhoea. The updated Kuppuswamy socioeconomic scale was used to determine socioeconomic class. Utilising SPSS version 19 and Microsoft Excel, statistical analysis was carried out. Results: The study looked on the clinic-epidemiological profiles of patients with otorrhoea at a tertiary hospital in Jaipur, India. Chronic otitis media accounted for 70% of the 300 patients’ cases. Males made up 59% of instances, while those from lower socioeconomic classes (48%) were disproportionately impacted. Conclusion: Insightful information about the clinico-epidemiological profile of otorrhoea patients in a tertiary hospital in Jaipur is provided by this study. The prevalence of chronic otitis media highlights the requirement for strong preventive efforts. These results can direct healthcare practises for better otorrhoea management outcomes.

105. Comparative Assessment of Clinical and Psychiatric Profiles in Subjects Using Methamphetamine and Synthetic Cathinones
Amrita Chauhan, Purnima Raj, Madhav Shridhar Kadam, Renu Waghmare
Background: Synthetic Cathinones are widely used for the treatment of various psychiatric conditions including self-harm, violence, and psychosis as they exert psychoactive effects similar to methamphetamine. However, the differences in clinical presentation patterns of methamphetamine and synthetic cathinone remain unclear. Aim: The present study aimed to comparatively assess the clinical and psychiatric profiles of subjects using Methamphetamine and Synthetic Cathinones. Methods: The study assessed subjects with intoxication admitted to the Department of Psychiatry of the institute. In all the subjects, the interview was done to collect psychopathological, lifestyle, and sociodemographic data. Liquid chromatography–quadrupole time-of-flight mass spectrometry and immunoassay was done to assess substance from the urine sample. Logistic regression was used to assess physical complications and associations between the two groups.  Results: 12 subjects were identified with synthetic cathinone intoxication that were matched with 24 subjects with methamphetamine intoxication. In the two groups, a high risk of self-harm and violence was seen along with similar severity in the clinical psychotic symptoms. Habitual drinkers, smokers, unemployed, and unmarried subjects were dominant in both groups. High physical complications and lower history of family substance use were seen in synthetic cathinone intoxication compared to methamphetamine use. Conclusion: The present study concludes that the subjects with methamphetamine and synthetic cathinone intoxication have similar tendencies for self-harm, violence, and psychosis. However, a higher risk of physical complications is associated the synthetic cathinone intoxication which is commonly used in the psychiatry emergency department.

106. Assessing Severity of Symptoms of Children with Allergic Rhinitis Using Visual Analogue Scale in Northwest India
Sunil Kumar, Ghanshyam Swami, Rivneet Kaur, Vijendra Kumar Garg, Parth Swami
Background: Allergic rhinitis is a common chronic condition in the paediatric population. No reports regarding the assessment of the severity of symptoms of children with allergic rhinitis in the Indian population have been found in the available literature. The aim of this study was to assess severity of symptoms of allergic rhinitis in children using Visual Analogue Scale (VAS). Material and Methods: Seventy-five children with allergic rhinitis participated in the study (40 girls, and 35 boys, aged 7-13 years, mean age 10.71±4.83). Children were asked to evaluate their rhinitis symptoms by using Visual Analogue Scale (VAS). Results: The severity of symptoms of Perennial allergic rhinitis (PAR) was higher than the intermittent allergic rhinitis (IAR) as assessed by the Visual Analogue Scale (VAS). Mild Intermittent Allergic Rhinitis (IAR) was the predominant type of Allergic Rhinitis in our study. Conclusion: VAS scale helps in easy interpretation of severity of symptoms. The severity of symptoms of Perennial allergic rhinitis (PAR) was higher than the Intermittent allergic rhinitis (IAR).

107. Hearing Outcome in Cholesteatoma Patients after MRM and Type III Tympanoplasty
Ramde Odedara, Hiten Maniyar, Niral Modi, Swati Singh
Introduction: Chronic suppurative otitis media with cholesteatoma is a common condition in ENT clinics, and its surgical management remains a significant challenge in otology. The primary objective of cholesteatoma surgery is to eliminate the disease and establish a safe and stable ear. However, there is ongoing debate about whether canal wall down or canal wall up procedures are more effective in achieving these goals. Material and Methods: In this prospective study, we assessed the advantages of modified radical mastoidectomy (MRM) combined with type III tympanoplasty in terms of disease eradication and hearing improvement. The study included 100 patients with chronic otitis media (attico-antral variety) who underwent MRM with type III tympanoplasty at a tertiary care center. Temporalis fascia grafts were used for tympanoplasty. Results: The study included a diverse age range, with a mean age of 24.03±6.07 years. Most participants were aged 21-30 years (43.1%) and 11-20 years (35.5%). The gender distribution was predominantly male (72%) and female (21%). In terms of presenting complaints, all patients had ear discharge (100%), followed by hearing loss (91.39%), ear pain (43.01%), tinnitus (10.75%), and headaches (2.15%). Pre-operatively, the average air conduction improved significantly from 48.22 dB to 34.24 dB (p=0.001). The pre-operative air-bone gap (ABG) of 32.26 dB decreased to 21.1 dB post-operatively (p=0.0001), indicating significant hearing improvements. Conclusion: Our study shows that MRM with type III tympanoplasty effectively eradicated disease and significantly improved hearing in patients with chronic otitis media and cholesteatoma.

108. Unveiling Insights into Acute Megakaryoblastic Leukemia (FAB M7): A Comprehensive Analysis of a Case Series
Shazima Sheereen, Uzma Alvi, Mohammed Azharuddin, Abdul Hakeem Attar
Acute Megakaryoblastic Leukaemia (AMKL) is a specific type of Acute Myelogenous Leukaemia (AML) classified as M7 according to the FAB system. This subtype is distinguished by more than 20% immature blood cells, known as blasts, of which at least half belong to the megakaryocyte lineage. AMKL is a relatively uncommon form of AML that originates from undeveloped megakaryoblasts. We have interesting Acute Myeloid Leukemia (AML) cases, subtype M7. Despite being recognized as a separate entity for a considerable period of time, the lack of clear clinical features and morphological criteria presents a significant challenge in accurately diagnosing this particular variant. Presented are the clinical, morphological, cytochemical, and immunocytochemical characteristics of six cases of Acute Megakaryoblastic Leukemia (AMKL). Various morphological features, such as the existence of abnormal platelet count, large-sized platelets, and cytoplasmic blebbing in blasts, have been identified as crucial factors in the diagnosis of the condition in question, owing to their significant diagnostic value… To achieve a reliable morphological diagnosis, the utilization of cytochemistry and immunocytochemistry becomes necessary due to the lack of consistency seen in the observed features. Material and Methods: In the pathology department, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India, a retrospective study spanning a decade-long period from January 2010 to December 2020 was conducted. The study involved retrieving a total of six cases, and detailed clinical histories and other relevant information were extracted from the corresponding case files. Results: Among the 6 cases that were observed, the majority of them were males (M: F = 4:2). Out of the 6 cases, three of them belonged to the adult age group, while the other three were part of the paediatric age group, ranging from 1 year to 5 years old. Among the six cases analyzed, four cases (Case I, IV, V, VI) presented with symptoms of pancytopenia. Based on observations, the count of blasts in the peripheral blood typically falls within the range of 2% to 20%. Reticulin grade 2 was found in cases I and IV, grade 1 in cases II and V, and grade 3 in cases III and VI. PAS and NSE tests were positive, while fluoride resistance was negative in all six cases. Immunocytochemistry analysis revealed that all six cases were positive for myeloid markers (CD13, 33, 34, 45, 117) and CD 61 (Gp Illa), but negative for lymphoid markers (CD5, 7, 19, 20). Conclusion: Accurately diagnosing this variant is crucial due to its impact on prognosis. While immunophenotyping is the preferred method, it may not be accessible in all medical facilities. However, identifying specific features such as cytoplasmic blebbing, platelet budding, bone marrow fibrosis, clustering of blasts and cytochemical positivity for nonspecific esterase that is fluoride resistant can aid in the correct diagnosis of a significant number of Acute Megakaryoblastic Leukemia cases.

109. Prevalence of Postpartum Depression in Mothers Following Delivery in the Tertiary Center of Vidisha
Nehal Jain, Naresh Solanki, Vikas Yadav, Amrendra Kumar Singh, Rashmi Dhakad
Postpartum depression is a mood disorder with a high prevalence, especially in India. The aim of this study was to see the Prevalence of postpartum depression in mothers following delivery in the tertiary center of Vidisha. This is a cross-sectional study done in ABV Government Medical College and associated hospitals, we applied The Edinburgh Postnatal Depression Scale (EPDS) to evaluate mental health. We had seen that the prevalence of postpartum depression was found to be 12.7% in our study. Mean score for women in the immediate postnatal period was 3.86 (SD=5.334). Factors found to be statistically significant with development of depression were no/low level of literacy, lack of family support, marital disharmony and unplanned/unwanted pregnancy.

110. Role of MRI in Evaluation of Focal Epilepsy
Subrata Kumar Biswas, Sudipto Chaudhury, Sanjukta Mukherjee, Amit Kumar Das
Background: In this study, we aimed to characterise the CNS lesion and aid in planning as to whether medical or surgical modalities were necessary, aid in the diagnostic challenge in pharmacologically refractory seizure cases such as epilepsy syndromes and temporal lobe epilepsy, and to ascertain the varied role of neuroimaging in seizure disorder. Methods: This was a hospital-based cross sectional observational study, conducted among 88 patients with clinical presentation of focal seizure disorder, at the Department of Neuromedicine, including the epilepsy clinic of Bangur Institute of Neurosciences and the Department of Radiology, I.P.G.M.E. and R. and S.S.K.M. Hospital, from February 2012 to July 2013, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The presenting seizure pattern was classified into two groups: simple partial seizures and complex partial seizures (n=88). Co-relation of a history of febrile convulsions with mesial-temporal sclerosis (n=23). The various causes of refractory epilepsy were subdivided and classified. The patients were observed for premonitory symptoms or auras and noted down (n = 88). Comparison of coronal FLAIR with an axial or coronal T2 weighted sequence for finding hippocampal hyperintensity, also called hippocampal sclerosis (n = 23). Based on MRI features, the causes were determined. Mesial temporal sclerosis (26.1%), space-occupying lesions (19.3), and patients with normal MRI appearance (22.7%) were the three most frequent causes. Conclusion: MRI is an effective tool for detecting pathologies causing focal or partial epilepsy, except in some cases of non-lesional focal epilepsy. Coronal FLAIR images are superior to axial or coronal T2-weighted images for the detection of hippocampal sclerosis. There will be future scope for functional MRI, MRI and PET fusion or MRI and interictal SPECT fusion in cases of non-lesional MRI-negative focal epilepsy.

111. Medical and Surgical Co-Morbidities in Patients with Schizophrenia: A Single Centre Retrospective Analysis
Pratiksha Sahu, Samiksha Sahu, Sonal Nihalani, Prabuddh Godre
Background: Schizophrenia is a debilitating mental illness that often presents with a range of comorbid medical and surgical conditions. These comorbidities can significantly impact the overall health and quality of life of individuals with schizophrenia. Methods: We conducted a retrospective analysis of patient records at a single center, focusing on cases of schizophrenia with co-occurring medical and surgical conditions. Data regarding patient demographics, clinical presentations, diagnostic findings, and management strategies were systematically reviewed. Results: We present a case series of five individuals with schizophrenia, each illustrating unique medical and surgical challenges. These cases include fractures, nutritional anemia, post-dog bite inguinal lymphadenitis, post-operative psychosis, and normal pressure hydrocephalus. In each case, the presence of schizophrenia added complexity to the diagnosis and management of the comorbid condition. Conclusion: This retrospective analysis sheds light on the diverse medical and surgical comorbidities that individuals with schizophrenia may face. Understanding these challenges and implementing holistic care strategies can lead to improved overall well-being and a higher quality of life for this patient population.

112. Paravertebral Block In Percutaneous Nephrolithotomy
Chetankumar Tikar, Pradeep Jain, Sandesh Parab, Priyank Kothari
Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCNL). In this study we have compared two groups of PCNL surgery comprising 125 patients each, one with TPVB and one without TPVB. TPVB is effective modality in controlling early postoperative pain after PCNL surgery. However, there is no effect in late postoperative pain control after PCNL surgery with TPVB.

113. Comparative Study on Outcomes of Medical Management versus Combined Surgical and Medical Management of Chronic Rhinosinusitis with Polyps: A Retrospective Cohort Study
Prashant Kumar, Gopal Kumar Jha
Background: The clinical therapy of chronic rhinosinusitis with polyps (CRSwP) comes with difficulties. To inform treatment decisions based on evidence, this retrospective study compares medical management results to those of a combination of surgical and medical management for CRSwP. Methods: The data included 350 individuals with CRSwP, 190 with medical care and 160 receiving combination management. Clinical results, methods of treatment, and patient demographics were analyzed. Descriptive as well as inferential statistics were used. Results: Increased symptom improvement (81.9%), decreased recurrence (21.9%), and prolonged alleviation (24.1 months) were all observed in the group receiving combined management. In light of these results, it is clear that surgical intervention may be beneficial; however, specific treatment regimens are essential. More study is required to verify these findings and help direct treatment decisions. Conclusion: In situations of severe CRSwP, surgical intervention tends to yield better short- and long-term outcomes. Management approaches, however, should be based on patients’ choices, shared decision-making, and personalized treatment programs. Prospective studies and individualized treatment plans should be at the forefront of future investigations.

114. Nutritional Status of Pulmonary Tuberculosis Patients: A Hospital Based Cross-Sectional Study
Rakesh Kumar, Sudhanshu Shekhar Jha
Background: Millions of people are still affected by tuberculosis of the lungs every year. The impact of malnutrition on tuberculosis treatment and outcomes is well-documented. Patients with pulmonary tuberculosis had their dietary status evaluated, and links to demographic variables were investigated. Methods: 250 TB patients participated in a cross-sectional hospital research. Biochemical testing, nutritional analyses, and anthropometric measures were taken. Correlations and connections were investigated using statistical tests. Results:  The results showed that 72% of the population was malnourished, with indicators including a low mean BMI and central obesity. It was found that men generally had healthier weights than women do. The number of calories consumed was found to have a direct effect on body mass index. Conclusion: Improving treatment results for pulmonary TB patients requires attention to the patient’s nutritional health. If malnutrition is ignored, it can delay healing and cause additional difficulties. It is crucial for the person’s health and the success of public health initiatives to incorporate nutritional assessment and support into TB care.

115. Prospective Observational Study on the Management of Amoebic and Pyogenic Liver Abscess
Santosh Kumar, Sanjeev Kumar, Prem Prakash, Anunay Kumar
Background: Liver abscesses, whether caused by amoeba or pyogenic, can be pretty dangerous. The best possible outcomes for patients depend on rapid and correct diagnosis and treatment. Methods: We analysed 150 patients diagnosed with liver abscesses between January 1, 2022, and December 31, 2022, using a prospective observational study design. Patients’ demographics, clinical presentation, diagnostic procedures, treatment options, and outcomes were recorded. Associations were found, and statistical tests evaluated treatment efficacy. Results: 150 individuals with either pyogenic or amoebic abscesses were included in the study. Clinical manifestations varied between amoebic and pyogenic abscesses, with fever being more common in the former (83.7%). Abdominal pain was more common in the latter (91.2%), jaundice was less common in the former (12.0% vs 24.0%, p = 0.049), and other symptoms were more common in the latter (32.0%). Ultrasound (sensitivity 89.3%, specificity 91.7%), CT scan (sensitivity 92.0%, specificity 88.7%), blood cultures (sensitivity 78.7%, specificity 94.5%), and serological tests (sensitivity 95.3%, specificity 82.4%) were all highly accurate at distinguishing between the two aetiologies. High success rates were seen with antibiotic therapy for both groups (98.7% vs 96.0%, p = 0.143), whereas pyogenic abscesses fared better with percutaneous drainage (62.7% vs 75.3%, p = 0.032). Conclusion: As demonstrated by our research, the key to effectively managing liver abscesses is a combination of accurate diagnosis and all-encompassing treatment. Accurate diagnostics, effective treatments, and statistically meaningful findings improve clinical decision-making and patient outcomes.

116. A Prospective Evaluation on Functional and Radiological Outcome of Proximal Humerus Fracture in Adults Treated with Proximal Humeral Internal Locking Osteosynthesis System (PHILOS)
Kishore Babu Sattaru, Amarnadh Paidi, Sanjeev Kumar Kare
Background: To evaluate the clinical, radiological, and functional outcome of fractures involving the proximal part of the humerus treated operatively using proximal humeral internal locking osteosynthesis system (PHILOS). Methods: At the Government General Hospital (GGH) in Srikakulam, a series of 30 patients with closed proximal humerus fractures (Neer’s types), with a mean age of 51 years (range, 23-70 years), were surgically treated between October 2020 and November 2022. Using the Neer’s functional scoring system, the functional outcome was evaluated; radiological outcomes are analyzed by serial periodical x-rays and complications were noted. Results: All fractures have shown fracture union within an average period of twelve weeks. The average range of active Flexion, external rotation and abduction are 130.8°, 46.67° and 127° respectively. 17 (85%) of cases had normal muscle strength in the shoulder. Patients with 2-part fractures had better functional outcomes than 3-part and 4-part fractures. Skin necrosis, wound gaping and Deltoid atony was observed in one case each, post-operative joint stiffness in two cases; instability malunion and heterotrophic ossification was identified in one case each.  Mean Neer’s functional score is 87.1. Conclusion: proximal humeral fractures when managed surgically using PHILOS plate particularly in poor quality bones and comminuted fractures, gives a better stability and early mobilization, and hence greater range of movements and lesser stiffness.

117. A Study on Patient Outcomes, Rotator Cuff Integrity and Shoulder Function after Intra Medullary Nailing of Diaphyseal Fractures of Humerus
P. Anil Babu, CNS Mounika, B Harsha, D Venkateswara Rao, C. Shyam Kumar, Viswa Chaitanya Chandu, Shaik Mohammed Anjum
The surgical management of humeral diaphyseal fractures have different inherent draw backs owing to the complex anatomy, the unique biomechanical characteristics of the humerus which are often overlooked and characteristics of the arm and shoulder with their anatomical considerations also play a role.  Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. The antegrade nailing is a better option in younger patients, and in humerus with moderately wide or wide medullary canals. This study has been performed on 60 patients with humeral shaft fractures. The functional status of the shoulder is assessed post operatively at three months with Constant-Murley scores and the level of proximal tip of the intra medullary interlocking nail.

118. The Effect of Oral Pancreatic Enzyme Supplementation on the Course and Outcome of Pancreatic Exocrine Deficiency
Srinivas Thimmasarthi, Rajesh K Patel, Anand M, Haresh Memariya, Jay Kumar Gunvant Bhai Chotaliya
Background: The pancreatic juice plays a pivotal role in the digestion and absorption of nutrients. Pancreatic exocrine insufficiency (PEI) can be defined as reduction in pancreatic enzyme activity in the intestinal lumen to a level that is below the threshold required to maintain normal digestion. Patients with untreated PEI not only suffer from impaired quality of life due to steatorrhea, weight loss, abdominal discomfort and other PEI-related symptoms but also high likely to develop deficiencies in micronutrients and lipid-soluble vitamins. Objective: The present study is done to diagnose the exocrine deficiency of pancreas with various means and effect of oral pancreatic enzyme supplementation on the course and outcome in the patients with PEI. Methods: The study population consisted of all inpatients and outpatients of Department of General Surgery, Civil Hospital, Ahmedabad attached to B.J. Medical College. This study consisted of 50 consecutive cases who met the criteria for exocrine deficiency of pancreas. Diagnosis of PEI was made on basis of history, examination, laboratory and CECT findings. Each patient was supplemented with oral pancreatic enzyme supplements and was followed up for a period of 1 year with three visits – 3 months, 6 months and 12 months. At each visit, the patients were evaluated to assess changes in clinical features of PEI, changes in nutritional status and compliance with therapy. Results: In our study the patients were mostly males (74%) with age group ranging from 18-79 years. Most common etiology being higher intake of alcohol and majority of patients with symptoms like abdominal discomfort (94%), flatulence, increased stool frequency >2 per day (78%) with liquid consistency (diarrhea/ steatorrhea) (76%) and weight loss (86%). The average BMI of study sample at the time of diagnosis is 20.64 kg/sq m (SD 2.65) which improved to 21.402 kg/sq m at the end of study. Mean hemoglobin of study sample improved from 10.4 g/dl (SD 1.54) to 10.76 g/dl and average serum albumin had improved from 3.0 g/dl (SD 0.44) at primary survey to 3.3 g/dl at the end of study. CECT done in patients with severe acute pancreatitis with CTSI >8/10 had multiple etiologies causing significant destruction of pancreatic acini resulting in PEI. Laboratory and radiological findings also correlated with clinical features of exocrine deficiency of pancreas. Upon supply of oral pancreatic enzyme supplementation there is a significant improvement in overall clinical conditions of patients with PEI. Conclusion: The clinical, laboratory and radiological parameters will help in diagnosis, detecting the extent of disease process and helps in understanding the patients with PEI and their response to treatment with the therapy. In the present study, significant statistical correlation is found with the clinical outcome in terms of improvement in abdominal discomfort, weight gain, stool consistency, BMI and hematological parameters in patients using oral enzyme supplements. Oral pancreatic enzyme replacement therapy (PERT) has a significant role in improving the symptomatic conditions in patients with PEI.

119. Individual, Contextual and Programmatic Factors Influencing Utilization of Emergency Obstetric Care Services in Rural Varanasi
Gauri Sarswat, Abhinav Agarwal, Sangeeta Kansal, Alok Kumar
Background: Emergency Obstetrics care is an integrated strategy developed by the WHO, UNFPA and UNICEF that aims to equip health facilities with the capacity to provide evidence based, cost effective interventions to attend to the leading causes of maternal mortality. Methods: A community based cross sectional study design was conducted during April 2019 to July 2020. Total 201 women who delivered in last 6 month and had complications were included in the study. Facility assessment was done at two facilities of Chiraigaon block of Varanasi for the availability of EmOC services. Results: Overall utilisation of govt health facility for EmOC was 42%. Findings shows that utilisation of EMOC from  govt. health facility was more among lower age groups as compared to higher age group and statistically significant association was observed between education of respondents and utilization of EmOC services. Respondents who were aware of danger signs/complications during pregnancy were more utilized EmOC Services at Govt. health facility. Utilization was more among respondents with first childbirth order. There was statistically significant association was found between time taken to reach health facility and utilization of EmOC services. Respondents who belong to Lower class were more utilized EmOC services at Govt. health facility. The study has given adequate insights into the gaps and lacunae existing at health facilities. More than half of the respondents expressed negative images of health care provider at health facility. Conclusion: In this study, more than half respondents were not aware about danger signs/complications in pregnancy. Programmatic factors more influence utilization of EmOC services at Govt. health facility.

120. An Observation Study to Assess Effect of Hypoglycaemia on Platelet Indices and its Association with Occurrence of Cardio-Cerebrovascular Events in Diabetics
Goyal Manish, Sankhla Anil, Vyas Nirmal
Introduction: Hypoglycaemia is the most important side effect of diabetic treatment. Hypoglycaemia should be assessed in the context of possible long-term risk of cardio-cerebrovascular complications in co-relation with platelet indices. Method and Material: 50 diabetic patients presenting to hospital with plasma glucose <70 mg/dl requiring hospitalization for correction of hypoglycaemia were taken in study group. Sample of 50 diabetics with good glycaemic control were taken as control after matching with sex, age and other co-morbid condition for comparison. The blood sample of the patient were taken on arrival [0 hours] and 48 hours for various parameters and complete blood count including the platelet indices (MPV and PDW). All patients were followed up for the period of 3 months to note any cardio-cerebrovascular events. Results: Majority of patients were female (60%) and mean age was 64.4 ± 12.433 years. In study group both mean of MPV and mean of PDW at the time of admission and 48 hours of admission were significantly higher than control group. On follow up we found that 13(26%) study group patients had developed cardio cerebrovascular events. Discussion: We found that diabetics experiencing severe hypoglycaemia have higher value of platelet indices i.e. they have larger platelet volume and are probably more active metabolically. Therefore, larger platelets are more prone to develop cardio-cerebrovascular events in near future as compared to diabetics with good glycaemic control. So, the platelet indices are important, simple, cost-effective and useful in predicting the development of a cardio-cerebrovascular event sometimes in the near future.

121. FIB-4 and APRI in Risk Assessment of NAFLD in Central India
Shweta Jain, S. S. Biswas, Swati Jain, Vikas Jain
Introduction: Number of non-alcoholic fatty liver disease (NAFLD) cases is increasing day by day due to changes in food habits, exaggeration in metabolic syndrome, and lack of exercise. Test for diagnosis and staging of NAFLD Liver biopsy is the choice, but now a days numerous biochemical markers, scoring systems, and imaging studies are existing to diagnose and stage NAFLD which is allied to end-stage liver disease, hepatocellular cancer. Indices have been developed by researchers to assess liver fibrosis in NAFLD patients to avoid liver biopsy. In this study we aimed to compare fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), with USG for the assessment of hepatic fibrosis in patients with NAFLD. Material and Method: This cross-sectional study included patients with NAFLD conducted in People’s College of Medical Sciences and Research Centre, Bhopal (M.P.). Cases and comparison group were selected from patients presenting to outpatient Department of Medicine and Radiology by systematic random sampling. Anthropometric features of the participants including age, gender, weight, height was recorded. All participants underwent USG and had their AST, ALT, and platelet count measured in a random blood sample, taken within 1 month of the USG. Result: A total of 172 individuals were included, of which 86 cases are of NAFLD and 86 cases control with cases with mean age 44 yrs.47.3% had moderate risk and 14 % had low risk.  The mean AST and ALT levels were and 59.11±30.70 U/L and 69.022± 36.40 respectively in NAFLD cases. FIB4 and APRI are correlated with r= 0.832 with P=0.00 which is significant FIB 4. Conclusion: NAFLD can be assessed without invasion for fibrosis Our findings indicate that FIB-4 and APRI could play a role as a risk-stratification tool for a population health approach. NAFLD cases can progress to NASH and hepatocarcinoma so it should be diagnosed for fibrosis as early intervention.

122. Various Spectrum of Lesion in Palatine Tonsil Underwent for Tonsillectomy in Tertiary Care Center
Kaushal K Krajapati, Vaibhavi K Prajapati, Hemlata B Sunsara, Hardika B Patel
Background and Aim: The palatine tonsils are paired masses of lymphoid tissue that serve as an immune barrier against pathogenic substances entering the respiratory and digestive tracts. Tonsils, despite their defensive function, are susceptible to infection. This study was carried out to investigate the clinicopathological findings of diverse palatine tonsil lesions that had tonsillectomy in various age groups. Material and Methods:  For one and a half years, a cross-sectional study was undertaken in the Department of ENT at Tertiary Care Institute of India. The cases included were from various age groups, ranging from children to the elderly, and had recurring occurrences of Acute Tonsillitis. A total of 84 cases were operated on, with tonsillectomy performed in 80 cases (unilateral-12, bilateral-68), and tonsillar biopsy performed in 03 cases. The available data for all patients in terms of age, gender, and clinical symptoms was gathered. Results: The most common age group afflicted in all cases of chronic tonsillitis is 21-30 years, accounting for 36.25%, followed by 31-40 years, accounting for 28.75%. Tonsillectomy was performed in 80 instances and tonsillar biopsy was performed in 04 cases, with 36 males and 44 females ranging in age from 1 to 70 years. There were 05 cases of acute chronic tonsillitis, one case of acute ulcerative tonsillitis with micro abscesses, and two cases of reactive lymphoid hyperplasia. Two cases of granulomatous tonsillitis were observed. Conclusion: Chronic tonsillitis is a frequent issue that affects people of all ages and is identified in the palatine tonsil. Histopathology is important in detecting both benign and malignant tonsil lesions and determining the best course of treatment.

123. Post Total Neoadjuvant Therapy – Pathological Complete Response Among Individuals with Locally Advanced Rectal Adenocarcinoma in a Selected Tertiary Care Center, South India – A Follow-up Study
Karthikeyan S, Kannan J, Raja G, Pandidurai M, Arun Ramanan V, Divya Bharathi S, Satheesh Kumar D, Kiranmayee N
Introduction: Total Neoadjuvant therapy (TNT), an emerging treatment strategy, involves the administration of systemic chemotherapy before and after chemoradio therapy, with the goal of maximizing tumor response and enhancing long-term outcomes. This research article aims to investigate the incidence of pCR following TNT among patients with locally advanced rectal adenocarcinoma at a tertiary care center in South India. Methodology: This is a Prospective follow-up study conducted at a tertiary care center in the city of Chennai, South India between January 2019 and December 2022. After obtaining informed consent from eligible study participants, the investigator collected the sociodemographic and clinical profile information on demographics, tumor characteristics, treatment details, and follow-up outcomes of the study participants. Data collected was entered in Epidata version 3.1, while the data analysis was carried out using STATA version 12.0. Logistic regression analysis was used to identify potential predictors of pCR, including patient demographics, tumor characteristics, and treatment complications. Chi square test was used to assess the significance among categorical variables. P-value less than 0.05 was considered to be statistically significant. Results: Out of 55 participants in the current study, 30.9% were females. Pathological Complete Response (pCR) was seen in 21.8% of study population. The most common presenting symptom was Bleeding per rectum (63.6%) followed by tenesmus seen among 20% of the study participants. Nearly every second female study participant had mid rectum as the site of adenocarcinoma and more than 90% of female study participants had moderately differentiated adenocarcinoma. Around two out of five study participants with hypertension alone as comorbidity was seen among females, while more than half of the study participants (57.14%) with both diabetes and hypertension as comorbidity were reported among males and it was found to be statistically significant (p = 0.014). Conclusion: The present study provides important insights into the effectiveness of TNT in the treatment of locally advanced rectal adenocarcinoma. Our findings demonstrate that TNT is provides better pCR and support the incorporation of TNT as a standard treatment approach in locally advanced rectal adenocarcinoma.

124. Efficacy of Endoscopic Band Ligation in Esophageal Varices Due to Portal Hypertension
Upadhyaya Taniya, Gupta Pankaj, Shah Malhar, Kumawat Dalchand
Introduction: Portal hypertension remains the commonest cause of Upper gastrointestinal bleed in India and carries a high risk of rebleed and mortality. Endoscopic variceal band ligation (EVBL) is the cornerstone for the control of acute variceal bleeding. Aims: To assess the therapeutic efficacy of esophageal variceal band ligation in patients with esophageal varices due to portal hypertension. Materials and Methods: This study was conducted as a prospective observational study conducted at Geetanjali Medical College and Hospital, Udaipur, Rajasthan from January 2019 to June 2020 after institutional ethics committee approval. The study population comprised of patients >18 years of age who presented with portal hypertension and esophageal varices undergoing EVBL, Patients with diagnosis of portal hypertension on imaging or incidentally detected on routine/emergency endoscopy for haematemesis. Patients requiring intensive care and Patients with terminal illness were excluded. Results: In our study on 33 patients with esophageal varices due to portal hypertension, the most common etiology was cirrhosis of liver (93%). In 51% patients, cirrhosis was due to alcoholic liver disease, 24% had chronic Hepatitis B infection and 18% due to Non-alcoholic fatty liver disease (NAFLD). 3% had Non Cirrrhotic Portal Vein Fibrosis (NCPF) and 3% had Extrahepatic Portal Vein Obstruction (EHPVO). Out of 33 patients, 4 had complete esophageal variceal obliteration in 2 sessions and 29 had complete esophageal variceal obliteration in 3 sessions. Thus, 2 or 3 sessions were required for complete obliteration of all esophageal varices. Conclusion: complete obliteration of esophageal varices by repeated EVBL will save lives, which is inexpensive, easily available method with minimal complications and side effects. Our study concluded that 2 or 3 sessions of EVBL can obliterate all the varices of any grade or severity in 8 to 12 weeks, at 4 weekly interval endoscopies.

125. Post Operative Analgesic Efficacy of Intrathecal Fentanyl versus Tramadol as Adjuvant to Bupivacaine in Total Abdominal Hysterectomy
Bindu T V, Namratha L, Madhan Swamy D P
Background: Total abdominal hysterectomy is an infraumbilical surgery which is commonly done under subarachnoid block as it is easy to perform, economical and faster in onset. Duration of postoperative analgesia produced using local anesthetics alone is very limited, hence the use of adjuvants has become a necessity to improve the block characteristics and to enhance the duration of postoperative analgesia. Therefore, we decided to study the post operative analgesic efficacy of fentanyl and tramadol along with intrathecal bupivacaine. Materials and Methods: 84 patients of ASA 1 and 2 physical statuses posted for elective total abdominal hysterectomy were included in the study and were randomized into 2 groups using computer generated chits. Group F received 2.5ml of 0.5% bupivacaine heavy with 25mcg of fentanyl. Group T received 2.5ml of 0.5% bupivacaine heavy with 25mg of tramadol. These groups were compared for the following block characteristics like onset of sensory and motor blockade, duration of postoperative analgesia, hemodynamic variations and complications like sedation, nausea, vomiting, bradycardia, pruritis, urine retention etc. Results: Mean duration of postoperative analgesia in group F was 274.88± 64.41 min and in group T was 186.31± 16.27 min with a p value of <0.001 making it significant. Hemodynamic variations and complications in both the groups were similar and were not clinically significant. Conclusion: Postoperative analgesic efficacy of fentanyl group was superior when compared to tramadol group making it a better adjuvant in terms of postoperative analgesia. However, both tramadol and fentanyl groups showed similar hemodynamic profile and also complications which were not clinically significant making them the safe additives to intrathecal bupivacaine.

126. The Efficacy of Autologous Platelet Rich Plasma in Lateral Epicondylitis (Tennis Elbow)
Shiva Kumar H.B., Channappa T.S., Manju Jayaram, Yatish R.
Background: Lateral epicondylitis is the commonest chronic disabling painful condition affecting 1% to 3% of the population predominantly those between 35 and 55 years of age. Elbow pain with tenderness and restricted wrist extension are its common manifestations. Although a few conservative methods of treatment are available, recent studies have suggested platelet rich plasma (PRP) to be a safe and effective therapy in relieving pain and improving function for tennis elbow. Aim: To study the efficacy of autologous platelet rich plasma in tennis elbow. Methods: A prospective observational study was conducted in our hospital. 50 patients with chronic lateral epicondylitis aged above 18 years were included in the study. All the patients had a minimum of three months of symptoms, were selected based on the inclusion and exclusion criteria and underwent same method of treatment. All patients had a baseline assessment of numerical pain score and was repeated at 2 weeks, 4 weeks, 8 weeks, 3 months and 6 months post treatment. The platelet rich plasma (PRP) was prepared from venous whole blood. All patients had single dose injection of autologous platelet rich plasma in their extensor tendons at elbow through a peppering needling technique. Results: The Patients were more often successfully treated. When baseline numerical pain scores were compared with the scores at 8 weeks, 12 weeks and 24 weeks follow up, they showed improvement across time. There were no complications observed related to the use of PRP. Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of tennis elbow. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months.

127. Clinical Implications of Blood Transfusion Based on Blood Hematocrit in Patients after Percutaneous Coronary Intervention
Nitinkumar S Kadakol, Smitha M, Mallikarjun Biradar, Sunilkumar S Biradar, C N Manjunath
Background: Percutaneous coronary intervention (PCI) is the standard therapy for patients with symptomatic coronary artery disease and hemodynamically significant coronary stenosis. The combined use of antiplatelet and antithrombin agents during and after PCI has significantly reduced the rate of stent thrombosis and recurrent ischemic events. These therapies, however, unavoidably increase the risk of bleeding, red blood cell (RBC) transfusion, and mortality after PCI. Objective: The objective of the present study was to analyse how RBC transfusion affects the clinical outcomes of patients with hematocrit nadir within those parameters. Methods: A cross-sectional study was conducted in the tertiary teaching hospital. A total of 356 consecutive patients who had undergone PCI from January 2010 to December 2010 were enrolled in the study. From this cohort, 60 patients who had presented with a nadir hematocrit level of 24% to 30% after PCI were identified, of whom 24 had received a transfusion and 26 had not. PCI was performed according to the guidelines at the time of the procedure. Result: The mean age was nearly 63 years. Most of the patients had a history of systemic hypertension and around 50% had diabetes. Approximately 2/3 had a history of coronary artery revascularization– either coronary artery bypass grafting or PC. The baseline hematocrit was similar between the 2 groups; however, the nadir hematocrit was lower in the transfused patients than in those not transfused. Acute MI (33.3% vs. 11.5%) and cardiogenic shock (25% vs. 7.7%) as the initial clinical presentation were more frequent in the transfused patients than in the non-transfused patients. No difference was found between the 2 groups in the angiographic characteristics, except for the number of diseased vessels and the presence of left main disease, which were greater in the transfused patients. Conclusion: From our study findings we do not support the routine use of transfusion in patients who present with a nadir hematocrit of 24% to 30% after PCI because transfusion has got no mortality benefits in this range of hematocrit.

128. Hematocrit Values Before and after Percutaneous Coronary Intervention and its Clinical Relevance
Nitinkumar S Kadakol, Smitha M, Mallikarjun Biradar, Sunilkumar S Biradar, C N Manjunath
Background: Both preprocedural anemia in patients undergoing percutaneous coronary intervention (PCI) as well as the occurrence and magnitude of procedure-related bleeding or anemia after PCI have been associated with late mortality and adverse cardiovascular outcomes. Reports describing these associations have not used consistent definitions for the degree of blood loss and pre-PCI anemia.  Variations in the definitions of these parameters may potentially lead to confusion with regard to patient risk. Objectives: This study was undertaken to clarify the relationship between these 2 established risk factors (hematocrit at baseline and hematocrit decline after PCI) and adverse late outcomes. Methods: A cross-sectional study was conducted in the tertiary teaching hospital from January 2010 to December 2010 was enrolled in the study. 300 consecutive patients who underwent PCI and who completed 1-year follow-up were included in this analysis without any exclusion criteria. All patients gave written consent for the PCI procedure. Results: For description purposes, the entire population was divided with regard to hematocrit at baseline and the magnitude of hematocrit decline.  The study population was composed of mostly men (65%), with a mean age of 65 years and a high prevalence of comorbidities. More than 80% were hypertensive, around one-third had a history of diabetes, close to half had previous coronary revascularization, and almost 15% had a history of congestive heart failure.  The most frequent clinical presentation was either stable angina or unstable angina. The rate of drug-eluting stent use was >80%, with a high rate of angiographic success. Conclusion: Hematocrit at baseline and the drop after PCI should be recognized as important risk factors for adverse outcomes after PCI.

129. A Comparative Study on Biochemical Parameters before and after Haemodialysis in Renal Failure Patients at the Tertiary Health Care Centre, Madhya Pradesh
Jyoti Nagwanshi, Kapil Raghuwanshi, Sushma Choudhary, Vikas Rangare
Introduction: Renal failure is associated with alterations in biochemical equilibrium conditions as well as the manifestation of various clinical symptoms and indications. The utilisation of haemodialysis may be necessary for the management of both acute kidney injury (AKI) as well as chronic kidney disease (CKD). The primary goal of haemodialysis is to restore the intracellular and extracellular fluid environment that is characteristic of normal kidney function. Method: After approval from the institutional ethical committee, a prospective study was conducted in the Department of General Medicine, NSCB Medical College Hospital, Jabalpur in the period 1st September 2009 to 5th October 2010. Total 100 diagnosed cases of CKD/AKI were included in the study with the Haemodialysis sessions done. All patients were evaluated on the basis of history, examination, haematological and renal biochemical investigations done before and 4 hours after haemodialysis. The aim of our study is to investigate the renal biochemical changes like haemoglobin, blood urea, serum creatinine, sodium, potassium and calcium levels in patients with AKI/CKD before and after haemodialysis. Result: The mean decrement of urea and creatinine was 45.30 mg/dl, 2.82 mg/dl respectively, 4 hours after HD and it was statistically significant. The mean decrement of haemoglobin was 0.25 mg/dl and was statistically significant. The mean increment in calcium was 0.33 mg/dl and was statistically significant. 11 cases were hyponatremic, none of the patients were hypernatremia and after HD serum sodium level was within normal limit in all cases. Total 9 cases were hyperkalaemia, 7 cases were hypokalaemia and after HD serum potassium was within normal limit in all cases. Conclusion: Haemodialysis leads to the significant decrease in blood urea, serum creatinine, significant increase in serum calcium and sodium concentration and correction of serum potassium level. It is important to closely monitor the electrolyte profiles of patients undergoing dialysis, and to tailor the therapy to each individual’s specific needs.

130. Comparison of Pre-Operative and Post-Operative Lipid Profile in Laparoscopic Cholecystectomy Patients: A Prospective Study
Ajay Verma, Mohammad Afzal Ud Din, Syed Aaliya Nazki, Firoza Bano
Background: Cholelithiasis is a common surgical condition with an incidence of 1.4 per 100 persons per year worldwide. Based on evidence more than 50% of cholelithiasis have some sort of lipid disorder. Owing to one of the important causes of hospitalization surgical intervention is required for cholelithiasis for which Laparoscopic cholecystectomy has gained popularity. Removal of the Gall bladder is known to affect the production of bile acid and it causes re-distribution of bile in the enterohepatic circulation thus causing changes in the lipid profile. Aim: This study aims to study levels of various constituents of the lipid profile of patients with cholelithiasis pre- & post-operatively on the 7th day and one month after surgery. Materials and Methods: The prospective study was carried out on 33 patients of cholelithiasis admitted to the Surgery Department of Al-Falah School of Medical Sciences and Research Center, Faridabad, Haryana, India from July 2022 to June 2023 and who underwent Laparoscopic Cholecystectomy. Open Cholecystectomy and those in whom conversion from laparoscopic to open cholecystectomy were not included. The Lipid profile was evaluated pre-operatively and post-operatively on the 7th day and one month after the surgical procedure. Results: 33 patients were included in this study of which 26 were female and 7 were male. The participants were in the age group of 19 – 60 years with a mean age of 37.3 years. The mean of Pre-operative serum cholesterol was 168.5 ± 0.33 mg/dl which increased to a mean value of 224 ± 0.67 after one week and the level decreased to 168.5 ± 0.6 after one month. The mean Pre-operative serum triglyceride was 148.8 ± 0.02 mg/dl though it rose to 166 ± 2.5 mg/dl on the 7th day but declined significantly to 137 ± 12 mg/dl. Total Serum LDL pre-operatively had a mean of 89.2 ± 0.6 mg/dl though increased slightly after 7 days but decreased to 84 ± 0.9 mg/dl, a significant decrease from pre-operative value. The serum HDL pre-operative mean was 52 ± 0.03 mg/dl though declined after 7 days but almost reached pre-operative values one month post-operatively. Conclusions: Serum Triglycerides and Serum LDL cholesterol levels decreased postoperatively but serum cholesterol and serum HDL levels remained unchanged postoperatively.

131. Epidemiology of Nasal Bone Fractures: is it Most Common Maxillofacial Injury?
Prachi Srivastava, Rahul Dhakar, Kanishk Mehta
Introduction: Nasal bone fractures occur more frequently in a maxillofacial injury because of its location at the forefront of the face. Objective: To evaluate the prevalence of nasal bone fractures in our institute. Method: We retrospectively investigated 152 RTA patients and recorded their demographics and fracture sites and statistically analyzed for significant associations. Results: The age of the cases ranged from 5-70 years. The prevalence of nasal bone fractures in our study was 63.15%. The peak incidence was seen in 21 to 40 years. Males were significantly more affected than females. Conclusion: The results showed that nasal bone fracture was the commonest among all maxillofacial injuries, with maximum preponderance among young male adults.

132. Electrocardiographic Abnormalities in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Hareesh Pathak, Sourabh Pandey
Objective: The objective of this article was to determine the frequency of different electrocardiographic (ECG) abnormalities in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Material and Method: This is a retrospective study conducted at the respiratory medicine department at Mahaveer Institute of Medical Sciences and Research, Bhopal between January 2022 and January 2023. Patients aged 19-60 years with acute exacerbation of COPD (as per the GOLD guidelines 2023 definition) who did not receive any treatment for exacerbation were included in the study. Twelve-lead ECG was recorded for 10 minutes after the supine rest, with a 60 mm/s of paper speed, 10 mm/mV of gain, and filter default settings. Results: In total, 144 patients records (male: n = 126 [99.6%] and female: n = 18 [11.4%]) were included in the research. The mean age of the participants was 40.43 ± 11.61 years. In terms of severity, 44 (32.96) patients presented with mild, 43 (32.9%) with moderate, and 57 (34.4%) with severe exacerbation. Moreover, 38 (26.3%) participants had ECG abnormalities in which 16 (9.3%) patients presented with right atrial enlargement, and 9 (6.7%) with right ventricular hypertrophy. Conclusion: Patients with COPD who had severe acute exacerbation and a high smoking index have a high prevalence of ECG abnormalities. Hence, ECG may be a valuable tool for assessment of prognosis.

133. A Comparative Study to Evaluate the Efficacy of 0.5% Levobupivacaine with Magnesium Sulphate versus 0.5% Levobupivacaine Alone in Ultrasound Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries
Deeksha R Malkhedkar, Mamatha Chikkanarasimha Reddy, Shobha Dhayalan, Nikitha Somanayaka
Introduction and Aim: Magnesium sulphate as adjuvants to local anaesthetics in brachial plexus block augments the local anaesthetic effects and reduces the analgesic requirements postoperatively. The aim of this study was to evaluate the analgesic effects of Magnesium as an adjuvant to Levobupivacaine for supraclavicular block. Materials and Methods: In a prospective double blind study, where 60 patients of 18 to 60 years of ASA class I & II scheduled for elective upper limb surgeries were randomly divided into two groups of 30 each. Supraclavicular block was performed under ultrasound guidance. Group M received 18ml of 0.5% Levobupivacaine with 150mg Magnesium sulphate diluted to 2ml and Group N received 18ml of 0.5% Levobupivacaine and 2ml of Normal saline. Parameters observed were time of onset of sensory and motor blockade, duration of sensory and motor blockade, duration of analgesia, intraoperative hemodynamics and adverse effects. Results: The demographic profile was comparable between the two study groups. The onset of sensory block was faster in Group M, 3.167 ± 0.9129min compared to Group N, 4.733±1.1725 min. Onset of motor blockade was faster in Group M: 5 ± 0.9469min compared to Group N: 7.100±1.0619 min. Duration of sensory block and motor block was prolonged in Group M compared to Group N. Duration of analgesia was significantly prolonged: 12.300 ± 1.7201h in Group M compared to 9.033 ± 0.9820h to Group N. No significant difference was observed in heamodynamics, side-effects and complications. Conclusion: Addition of Magnesium sulphate to Levobupivacaine leads to early onset of sensory and motor blockade prolongs duration of sensory and motor blockade and provides good post-operative analgesia without any adverse effects.

134. Evaluation of Lipid Profile and Vitamin D Levels in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Analytical Study
Narendra Kumar, Shikha Saxena, Seema Seth, Sumeru Samanta
Background: Vitamin D deficiency is a widespread concern, affecting populations in countries with both abundant and limited sunlight exposure. This deficiency has been associated with an increased risk of developing type 2 diabetes mellitus (T2DM), insulin resistance, and impaired insulin synthesis. Therefore, this study aimed to investigate the relationship between 25-hydroxyvitamin D levels and lipid profile in patients with type 2 diabetes mellitus (T2DM) compared to healthy control subjects. Materials and Methods: A cross-sectional analytical study enrolled 300 participants aged 25 to 65 years. Among them, 150 had T2DM, while the remaining 150 were age- and gender-matched healthy individuals. Blood samples were collected from all participants to measure 25-hydroxyvitamin D, total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels. Statistical analysis was performed using IBM SPSS 26.0. Results: The T2DM group exhibited significantly higher levels of TC, TG, and LDL compared to the healthy control group. Conversely, T2DM patients had significantly lower levels of serum 25-hydroxyvitamin D compared to healthy controls. However, no statistically significant correlations were found between TC, TG, HDL, LDL, and 25-hydroxyvitamin D levels. Conclusion: This study confirms the heightened risk of dyslipidemia in T2DM patients with elevated TC, TG, and LDL levels. It also highlights the association between T2DM and lower levels of 25-hydroxyvitamin D. Managing dyslipidemia is crucial in T2DM, and further research is needed to explore interventions for optimizing vitamin D levels and improving lipid profiles.

135. Paraoxonase-1: Genetic Variations and Disease Association
Fozia Jamal, Shikha Saxena, P.C. Srivastava, Seema Seth
The association between Paraoxonase 1 (PON-1) polymorphisms and diseases has been a subject of extensive research. PON-1 is an enzyme involved in protecting against oxidative stress and inflammation. Numerous studies have investigated the potential links between PON-1 polymorphisms and various diseases, including cardiovascular diseases, diabetes, neurological disorders, liver diseases, and cancer. However, the findings from these studies have been inconsistent and often conflicting. While some studies have reported significant associations between specific PON-1 polymorphisms and increased or decreased disease risk, others have failed to observe consistent patterns. Factors such as study design, sample size, population characteristics, and genetic heterogeneity may contribute to these discrepancies. This review provides a concise overview of the current understanding of the association between PON-1 polymorphisms and diseases based on existing literature.

136. Effects of Decentration on the Quality of Vision: Comparison between Aspheric Balance Curve Design and Posterior Aspheric Design Intraocular Lenses
Mrinal Singh, Abhishek Onkar, Deepak Marianus Lakra, Shiril Sandeep Sawaiyan
Background: The gradual Decentration of Intraocular Lenses (IOLs) can harm vision quality after cataract surgery. This study’s objective was to compare IOLs with an aspheric balance curve design and a posterior aspheric design regarding the effect decentration has on visual quality. Methods: 250 cataract surgery patients (mean age 68.5, range 55-80) participated in this prospective study. The subjects were randomly assigned intraocular lenses with either an aspheric balancing curve design (n = 125) or a posterior aspheric design (n = 125) design. Visual acuity, contrast sensitivity, and patient satisfaction were used to assess visual quality. Results: The data analysis revealed that decentration occurred with both IOL varieties. Comparing the two groups, the average decentration for the aspheric balancing curve design group was 0.22 mm (SD = 0.08), and for the posterior aspheric design group, it was 0.26 mm (SD = 0.09). There was no statistically significant difference between the two groups’ visual acuity (p = 0.127). In the group employing an aspheric balancing curve design, the average Log MAR was 0.09 (SD = 0.05), while it was 0.10 (SD = 0.06) in the group employing a posterior aspheric method. Neither contrast sensitivity (p = 0.218) nor patient satisfaction (p = 0.352) differed significantly between the two groups. Conclusion: Visual acuity, contrast sensitivity, and patient satisfaction are not substantially affected by the slight decentration in the aspheric balancing curve and posterior aspheric design IOLs. Both varieties of intraocular lenses are reliable options for cataract surgery, with comparable visual outcomes.

137. An Analysis of Treatment Outcome in Traumatic Intracranial Bleed with Midline Shift of More Than 5mm: A Tertiary Level Health Care Center Based Study
Ankit Agarwal, Shashank Sah
Background: Traumatic intracranial bleed is an acute event with a pathophysiology that is dynamic. It has the potential of inducing progressive neurological deterioration either because of its continued expansion over initial few hours or subsequently by the combined effect of hematoma and edema. The hematoma and edema induced mass effect leads to midline shift (MLS) that may cause secondary damage to the delicately balanced architecture of brain between the two hemispheres, thus aggravating the neurological deficits or may even threaten the life. Influenced by a multitude of factors, the treatment and its outcome varies across centers. This signifies the need to identify factors that might possibly be modified to deliver a favorable outcome or prognosticate the patient in concern. Among the factors having bearing on the decision of medical or surgical treatment, midline shift and Glasgow Coma scale score (GCS) are the most important ones and inversely related among themselves. We conducted a prospective study to assess their impact in need of surgery and outcome of treatment on a short-term basis. Objectives: In patients of head injury having acute intracranial bleed and producing mass effect and midline shift of more than 5mm – to determine (1). The percentage of patients requiring surgery. (2). To determine the incidence of mortality. (3). To evaluate the functional recovery at 6 months post trauma  Methods: 61 patients with traumatic intracranial bleed and MLS of 5mm or more were enrolled over a period of 3 years. Medical or surgical treatment as justified by clinico radiological parameters and standard guidelines were given. Analysis was carried out with the objectives of identifying -the need of surgery in study subjects, mortality and functional outcome at 6 months post injury. Results: 60% patient were less than 40 years of age.  50.8% patients were admitted with severe head injury (GCS<8). 73.8% patients (45/61) had a MLS between 5-10mm.  41 out of 61(66.7%) patients were treated by surgery. Overall, mortality was 37.7% (23/61). Of those who survived, 56.5% were functionally independent for activities of daily living at 6 months follow-up. Conclusions: Traumatic intracranial bleed associated mass effect and midline shift is associated with high mortality. Treatment benefit rapidly declines with increasing mass effect. Only half of the survivors achieve functional independence for activities of daily living at 6 months post trauma

138. Evaluating the Comparative Efficacy of Various Dosages of Midazolam in Preventing Etomidate-Induced Myoclonus: A Hospital based Study
Archana Rani, YogeshNarwat, Gunjan Arora
Background: Etomidate is a commonly used induction agent in clinical practice, primarily due to its numerous advantages. These include its ability to maintain a stable hemodynamic profile without affecting the sympathetic nervous system or baroreceptors, its minimal impact on respiration, and its ability to prevent histamine release in both healthy patients as well as individuals with reactive airway disease. However, it is possible that it may be linked to myoclonus, a condition that has been observed to occur in 50% to 80% of non-premedicated individuals. Ideally, an optimal pretreatment medication for the prevention of myoclonic movements should possess characteristics such as a short duration of action, little impact on respiratory and hemodynamic functions, and absence of any adverse effects on the recovery process following anaesthesia. The use of midazolam as a pretreatment to reduce myoclonus has been investigated using various dosages, with diverse outcomes. However, the most effective dosage has yet to be determined. Aims and Objectives: The objective of this study was to conduct a comparative analysis of the impact of three different dosages of midazolam (0.015 mg/kg, 0.03 mg/kg, and 0.05 mg/kg) in the prevention of etomidate-induced myoclonus. Materials and Methods: The sample for this study consisted of 164 patients who were members of the American Society of Anesthesiologists I/II. These patients were between the ages of 18 and 60 and provided consent to participate in the study. The participants were allocated into four groups using a randomization process. Subsequently, the participants in group M0 received pretreatment with normal saline, while those in group M1 received a dosage of midazolam at 0.015 mg/kg. Group M2 received a dosage of midazolam at 0.03 mg/kg, and group M3 received a dosage of midazolam at 0.05 mg/kg. The main objective of the study was to determine the frequency of myoclonus occurrence following the administration of etomidate. The secondary outcome criteria were the assessment of myoclonus severity and the evaluation of alterations in hemodynamic parameters. The quantitative data was compared using a one-way analysis of variance with Bonferroni’s correction. The chi-square test was utilized to analyze qualitative data. Additionally, in order to account for the numerous comparisons conducted across the four groups, Bonferroni’s correction was implemented. A significance level of P < 0.01 was deemed appropriate for determining statistical significance. Results: A considerable decrease in the occurrence of myoclonus was seen in group M1 when compared with group M0 (P < 0.001). Significant reduction in the intensity of myoclonus was detected in all three groups administered with midazolam, in contrast to the placebo group (P < 0.001). However, there was no significant difference observed among the patients who received varying dosages of midazolam. Conclusion: It is recommended to provide a pretreatment of midazolam at a dosage of 0.015 mg/kg as a preventive measure against myoclonus produced by etomidate.

139. Comparative Evaluation of Surgical Decompression and Steroid Injection for De Quervain’s Disease
Amit Shah, Deval Pancholi, Samarth Pravinchandra Shah
Background and Objectives: De Quervain’s disease is a known cause of lateral wrist pain, often affecting individuals engaged in manual labor, such as housewives and butchers. While there is on-going debate about its management, conservative approaches involve administering corticosteroid injections combined with lidocaine into the first dorsal compartment or performing surgical release through an oblique incision. This study aims to compare the efficacy of local corticosteroid injections and open surgical release for treating De Quervain’s disease in terms of symptom relief, patient satisfaction, and complications. Materials and Methods: 42 patients diagnosed with De Quervain’s disease were randomly assigned to two groups, the first group (n=21) received local corticosteroid injections, and the second group (n=21) underwent surgical decompression. The study assessed recurrence rates and patient satisfaction using a 10-point visual analog scale (VAS) after intervention. Results: The study included 35 females and 7 males, with a female-to-male ratio of 5:1. About 62% were very satisfied with the treatment in Group A (Local Steroid Injection), whereas about 81% were very satisfied with the treatment in Group B (Surgery). Incidence of complications was 67% in Group A and 10% in Group B. Conclusion: Surgical release yielded superior outcomes for cases of De Quervain’s tenosynovitis compared to local steroid injections.

140. Epidemiological Characteristics of COVID-19 Patients in India- an Observational Study
Purti C.Tripathi, Rahul Kumar Suryawanshi, Ritesh Upadhyay, Himanshu Singh
Background: Disease transmission of COVID-19, isolation and hospitalization of the patient can be reduced by early detection and diagnosis. Any delay in isolation and hospitalization can increase the difficulty in disease control and can lead to longer periods of infectiousness. In the present study, we have tried to understand the spread, common symptoms involved, recovery and death rates of the initial cases admitted in Chhindwara Institute of Medical Sciences (CIMS) hospital which would further help in framing better infection control practices for limiting the spread of the infection. Methods: This was an observational study carried out during October 2020 to December 2020 at CIMS Chhindwara to analyse epidemiological characteristics such as age and gender, admitted facility, district hospital or home isolation. Throat and nasal swabs were collected for diagnosis by Real-time reverse-transcriptase PCR. Results: Out of 850 patients, 538 were males and 312 were females with average age of 51.9 years. 586 patients were home isolated and 264 patients were admitted in hospital. 598 patients were asymptomatic, only 252 patients presented with COVID symptoms. Throat swab was the most common specimen collected. Significant association was seen between gender and cycle quartile with p value is less than 0.05. Conclusions: After review of all the epidemiological characteristics it was concluded that significant association was seen between gender and cycle quartile.

141. A Study to Find the Correlation between Sociodemographic Factors and Leprosy
Sandeep Kodali, Lohita M, K. S. B. Vaishnavi, Sompalli Suryanarayana, Geetakiran Arakkal, T Jaya Chandra
Introduction: Mycobacterium leprae, non-cultivable bacteria is the causative agent leprosy. Delay in the diagnosis and delayed presentation of leprosy is reported in the literature; these are important risk factors of the infection. With this back ground, a study was conducted to find the correlation between sociodemographic factors and leprosy. Methods: It was a retrospective analysis conducted in the Department of Dermatology, Mallareddy Institute of Medical Sciences, Quthbullapur. It was a retrospective analysis hence the informed consent was waived by the IEC. Individuals aged >18 years, who were clinically and or microbiologically confirmed to be leprosy were included in the research. The sociodemographic data of the participants was recorded as per the Modified Kuppuswamy scale. Body mass index (BMI) was estimated by entering the participant’s weight and height in the National Institute of Health (NIH). The data were analysed by SPSS version 21.0. The data was presented in mean, median and percentages. Results: Total 22 (100%) members were included; the male female ratio was 0.7. Maximum (41%) number of participants was in 28 – 37 years group and least (4.5%) in the 58 – 67 years group. Majority of the study members were in over weight (36%; 8). In this research, 63.6% (14) were residents of urban area. Infection was seen commonly in lower class and lower middle class, 27% (6) each, respectively. Conclusions: Leprosy awareness is the most important. This helps in early diagnosis as well as initiation of treatment so that the infection rate can be minimised. This automatically decreases infection rate.

142. Seroprevalence of Dengue Infection in and Around Rajamahendravaram Andhra Pradesh
Sireesha Chava, Mogalapu Ananda Satya Tej, Pamu Suseela Kumari, T Jaya Chandra
Introduction: Dengue is an acute, mosquito borne infection. Diagnosis can be made from single serum sample, detection of IgM antibody seems to be a valuable tool for the rapid diagnosis. With this a study was conducted to find the prevalence of dengue infection. Methods: It was a cross sectional study conducted in the Department of Microbiology, Government General Hospital, Rajahmundry. Both gender with clinically suspected included in the study. Non cooperative individuals and those without fever symptoms and unconscious patients were not included in the research. Blood was collected form larger median cubital or basilic or cephalic veins, processed for IgM ELISA as per the manufacturer guidelines. Chi-square test used to find the statistical correlation. P <0.05 was considered to be statistically significant. Results: Out of 2560 (100%) study members, IgM was detected in 315 (12.3%) and the male female ratio was 1.17. Gender wise statically there was no significant difference. Age wise, highest (8.4%; 215) positivity was in 16 – 30 years group. Highest (65%) number of study population were reported from tribal area and seasons wise, highest (70.5%; 247) number were found in monsoon period. Conclusion: More dengue seropositivity was identified more in monsoon season along with male prevalence. Early recognition, prompt management, vector surveillance and control strategies must be intensified.

143. Comparative Study of Pneumothorax Cases in COVID-19 and Non-COVID-19 Patients
Viral Shah, Mehul Gajjar, Rajdeep Dhandhukiya, Krutesh Sanjay Tripathi
Introduction: The pneumothorax is a potential life threatening emergency if not treated in timely manner. Aim of this study to compare characteristics and outcome between Non COVID and COVID patients having pneumothorax. Materials and Methods: All patients who had pneumothorax were included in study and divided in two groups: Non COVID and COVID positive patients. Clinical and demographic detail of each patient was obtained from the hospital information system and entered in case records forms. Results: Total 104 patients having pneumothorax were included. Out of them, 63 (60.57%) were male. Trauma was most common cause in Non COVID patients. The mortality rate in COVID patients with pneumothorax (89.36%) was significantly higher than Non COVID patients (29.82%, p < 0.001). Conclusion: Pneumothorax in COVID-19 patients is more common in older age groups, often accompanied by comorbidities, and has a higher mortality rate compared to non-COVID-19 patients with pneumothorax.

144. An Analysis of Tear Film Secretion and Stability in Patients Undergoing Phacoemulsification and the Effect and Need of Lubricating Eye Drops Used Postoperatively
Veena R. Karkhele, Deepanjali Patankar, Sayali Bhedasgaonkar, Seema Pallawkar, Snehal Nadkarni, Ashok Garje
Purpose: This study aims to evaluate tear film stability and tear secretion in patients undergoing Phacoemulsification. And study the effect and need of lubricating eye drops Used postoperatively. Methods and Material: A prospective randomized comparative cohort study of 140 eyes was carried out, having cataract and who have fulfilled inclusion and exclusion criteria and operated within period of 12months.
Study population randomly distributed in two groups,
Group-A- 70 eyes of study population received lubricating eye drops postoperatively.
Group-B- 70 eyes of study population who did not receive lubricating eye drops postoperatively.
Patients are evaluated for dry eye using Schirmer’s test, TFBUT, OSDI score preoperatively and postoperatively on day 7, day 35, and day 90. Results: Mean Schirmer’s test and TBUT value decreased significantly in group A as compared to group B on post op day 7 and day 35. Mean OSDI score value is increased significantly more in group A as compared to group B On post op day 7 an day 35 Mean Schirmer’s test and TBUT decreased on day 90 in group A and increased in group B. Mean OSDI score on day 90 decreased in Group A and increased in group B. Conclusion: We concluded that Phacoemulsification surgery causes dry eye postoperatively which is more in those who have not received lubricating eye drops postoperatively.

145. Microalbuminuria as a Marker of Morbidity and Mortality in Patients with Acute Myocardial Infarction
Vivek Gupta, Pawan Kumar Gangwal, Ranjita Bansal, Kusum Khoiwal
Introduction: Acute myocardial infarction is one of the commonest diseases in hospitalized patients in industrialized countries. Microalbuminuria is common in nondiabetic, nonhypertensive population and is considered to be an independent indicator of cardiovascular risk factors and cardiovascular mortality. Aim & Objective: To correlate the quantitative value of microalbumin in urine with the mortality and morbidity in acute myocardial infarction (MI) patients. Materials & Methods: Fifty six cases of acute myocardial infarction (MI) and fifty six healthy controls were included in this study. The study was conducted at National Institute of Medical Sciences and Research, Jaipur during June 2021 to May 2022. Biochemical and clinical risk factors assessed for MI. Microalbuminuria is defined as excretion of albumin in urine in the range of 20 to 200μg/min. (30-300mg/day). Results: Microalbuminuria level increased with age in both case as well as control group while the A/C ratio tends to decreased with the age in the case group and increased in control group. Mean value of microalbumin was 56.11± 20.69 in males and 61.45± 23.81 in females, while mean value of A/C ratio was 120.46± 91.42 in males and 142.65± 113.07 in females. Presence of Microalbuminuria in patients of acute MI predicts the complication significantly; out of 56 acute myocardial infarcted patients 18 patients develop complications in the form of arrhythmia, conduction defects, pulmonary odema, MI extension and death. Conclusions: Microalbuminuria is present in large number of non-diabetic, non-hypertensive Myocardial infarction patients. Level of Microalbuminuria increases with the age but there is no significant correlation with gender. Microalbuminuria level was high in patients of Myocardial infarction with complication. Therefore Microalbuminuria can be used as a marker of morbidity and mortality in the Myocardial infarction patients.

146. Evaluating the Relationship between HBA1C Levels, Lipid Profile, and TSH Levels in Subjects with Type 2 Diabetes
Lijo Daniel
Background: Previous literature established a link between diabetic status and thyroid dysfunction with data reporting a higher incidence of thyroid dysfunction in subjects with type 2 diabetes compared to type 1 diabetes. However, the literature data establishing this correlation are scarce. Aims: The present study assessed the levels of HbA1c (glycosylated hemoglobin) and TSH (thyroid stimulating hormone) in the subjects with type 2 diabetes and to assess the correlation between HbA1c levels and thyroid hormone levels and in HbA1c levels and lipid type in type 2 diabetics. Methods: The present retrospective study assessed 200 subjects from both male and female genders with type 2 diabetes mellitus. In all the subjects, laboratory data were retrieved for biochemical tests along with demographic data from the records of the institute. The data extracted were statistically analyzed to get the results. Results: The study results showed normal levels of T4 and TSH in study subjects with respective values of 14.1 pmol/L and 4.5 mIU/L respectively and an increased value of HbA1c with 8.4% in the study subjects. A non-significant relationship was seen in HbA1c and thyroxin with p=0.83 and a weak positive correlation in TSH and HbA1c with p=0.02. A weak positive correlation was also seen among HbA1c and low-density lipoprotein and total cholesterol with respective p-values of 0.002 and 0.001. Conclusion: The present study concludes that an increase in blood glucose levels can stimulate the anterior pituitary for increased TSH secretion. However, no direct correlation exists between the rate of thyroxin secretion and increased glycemic index. Also, a weak correlation exists between some lipid markers and blood glucose levels.

147. An Electroencephalographic Analysis of Real and Imaginary Motor Task by Gamma Power Coherence
Jitendra Kumawat, Jitendra Singh, Sandeep Saxena, Anuradha Yadav4, Kavita Yadav
Objective: The purpose of this study was to evaluate and compare the power spectrum coherence of the gamma band during the resting state, actual motor movement, and imagined motor movement. Methods: This laboratory-based comparative analytic observational investigation was conducted at S.M.S. Medical College and Attached Hospitals in Jaipur. A total of 56 healthy males between the ages of 18 and 40 were recruited from Jaipur city. The gamma band coherence was recorded by EEG for resting, real, and imaginary motor tasks and the coherence was compared. The gamma coherence power was analyzed. The significance was set at p-value<0.05. Results: Different brain regions, with the exception of the C3-C4 central region, exhibited good inter-spectral coherence-based connectivity when comparing the baseline coherence value with real and imagined movements. Conclusion: The coherence of gamma power shows no significant difference between resting, motor, and imagined movement, except in the central region, suggesting a high level of synchronization all over the brain areas.

148. A Clinical Study of Fundus Changes in Patients with Hypertensive Disorders of Pregnancy (PIH) in a Tertiary Care Centre
Bharat Kumar Jain, P. Satyavathi Devi, A. Venkata Ramana, E. Ramadevi
Background: This study was conducted to evaluate and determine the prevalence of retinal changes in hypertensive disorders of pregnancy (PIH), recognize the relationship between retinal changes and the degree of hypertension and proteinuria, quantify the prevalence of retinal alterations in 165 women with PIH-related hypertension diseases, and determine as to whether age, gestational age, parity, blood pressure, proteinuria, serum creatinine, serum uric acid, blood urea, and the severity of the disease are associated with the retinal alterations. Methods: This was a hospital-based observational study conducted among 165 pregnant females who had been admitted with HDP (PIH) to the Department of Obstetrics and Gynecology and those who had been sent to the Ophthalmology Department at Government General Hospital Srikakulam from March 2021 to August 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: When the severity of hypertension and fundus findings were studied and correlated, the data was statistically analysed using Fisher’s exact test and the p-value was found to be < 0.001. Fundus changes and the degree of proteinuria are studied and correlated. Data was statistically analysed using the Chi-Square test and the p-value was found to be < 0.001, showing a positive correlation between the two variables. When the results were statistically analysed using the one-way ANOVA test, a significant correlation between blood urea levels, levels of serum uric acid, levels of serum creatinine and the severity of PIH was discovered, with a p-value of 0.001. Conclusion: The health of the foetus depends on placental circulation. An ophthalmoscopic examination of the mother’s fundus may provide a clue to similar microcirculation changes in the placenta and indirectly to the wellbeing of the foetus. These changes serve as a guideline for termination of pregnancy as they may reflect similar ischaemic vascular changes in the placenta.

149. Implementing WHO Indicators to Evaluate Prescription Patterns in Paediatric Patients
Kislay Parag, Rajesh Ranjan Sinha, Ajay Krishna
Introduction: Antimicrobials are a class of medication that is more prone to cause the emergence of natural resistance. As a result, they need to be prescribed, given out, and used with more prudence. Antibiotics are separated into the three categories of Aware: Access, Watch, and Reserve to emphasise the need of their proper usage. current data on drug use, prescription behaviour, and Decision-makers would benefit from knowing the factors affecting antibiotic prescribing and their use % from Aware classification to create rules that will allow for more judicious usage of medications. Method: For six months, a prospective, observational study was conducted in the Department of Community Medicine, BMIMS, Pawapuri. The prescriptions were assessed using the WHO prescribing indicators, and the optimal WHO range was taken into account as a deciding factor for rational prescription. Result: They were predominantly female (53%). Antiemetics and antiulcer medications (26% and 13%), and antipuretics and analgesics (10%) were the most frequently prescribed medications. There were 6.54 medications on average each contact. Antibiotic prescriptions made up 16% of the total, while injectables made up 48% percent. Conclusion:  The results of this study show that the drug use patterns were not optimal in comparison to the recommended values of the WHO prescribing patterns. Although the use of antibiotics complied with WHO recommendations, there is a need to enhance prescription patterns by using medications from the Essential Drug List and generic names.

150. Efficiency of Intrauterine Insemination with Respect to the Donor Age and Sperm Quality
Vijaya Lakshmi Nambula, Suhas Deshpande, Preetha Solomon
Introduction: Artificial insemination was initially used to help male-factor sub fertile couples. In 1978, “in-vitro fertilisation (IVF)” revived interest, leading to safer insemination methods. Implementing sperm preparation processes has improved sperm quality. Modern civilizations have 8%–12% infertility, with male factors playing a major role. The age of the female recipient and proper donor selection may improve donor sperm use. Aim and objectives: The objective of this study is to evaluate the influence of donor age and sperm quality on the outcomes of “intrauterine insemination (IUI)”. Method: There were 120 female and 120 male sperm donors in this prospective clinical trial for “intrauterine insemination (IUI)” to treat infertility. From July 2022 to May 2023, researchers looked at patient information, ovarian reserve, sperm donor traits, and IUI techniques. Before IUI treatments, sperm samples were thoroughly tested and cryopreserved, and clinical pregnancies were observed. The purpose of this research was to determine what factors influence clinical pregnancy and live birth outcomes after IUI-D. Result: The study shows a positive link between pregnancy rates and populations over 0.75 million in numerous areas. The study found that the donor with less than 35 years and NMSI > 0.75 million had the highest pregnancy rate. The donors of more than 35 years old with lower NMSI had the lowest rate. These findings highlight age and NMSI as factors influencing pregnancy rates, though other factors can also affect fertility outcomes in assisted reproductive techniques. Conclusion: The study indicated that NMSI and mother age significantly affect pregnancy and live births. A 750,000 NMSI threshold increases outcomes without impairing predictions.

151. Study on Sociodemographic and Clinical Profile of Substance Dependence Patients in a Tertiary Health Care Center in Central India
Vijay Savita, Megha Maholi, Vijay Niranjan, Varchasvi Mudgal
Background: Substance abuse is a global phenomenon and prevalent all over the world in all the cultures. De-pendence of alcoholic beverages and tobacco are endemic in many societies, whilst the abuse of other illicit psy-choactive substances is growing concern in India. It has severe impact on physical, psychological, social and environmental aspect of life, leads to legal complication. Methods: It was an observational study, which enrolled 280 patients from DTC OPD through purposive sam-pling for one year duration. After fulfilling inclusion and exclusion criteria patient included in the study, with the help of pretested semi structured questionnaire. Results: Majority of the substance abusers were males (97.5%) and within the age group of 26 to 35 years (47.5%). Most commonly used drug was alcohol (52%), followed by opium (31%) and cannabis (11%). Mean age of initiation of substance 23.1years. Conclusions: Alcohol is most common consumed substance and high prevalence of illicit substance abuser like opioid and cannabis raising concern as these associated with more serious and fatal outcome. While many of the respondents began using drugs before or at the age of 15. Our results show that India needs management and prevention methods for substance abuse.

152. Xanthogranulomatous Cholecystitis: A Diagnostic Dilemma
Wasif Mohammad Ali, Imad Ali, Syed Amjad Ali Rizvi, Manzoor Ahmad, Mohd. Sadik Akhtar
Introduction: Xanthogranulomatous cholecystitis (XGC) is a benign gall bladder condition and an uncommon variant of chronic cholecystitis, which usually presents with non-specific symptoms. The dilemma of XGC is that it mimics gallbladder carcinoma (GBC) both preoperatively and intra-operatively. Hence it becomes very difficult to diagnose and manage these patients. Therefore, we have shared our experience of treating XGC and made an effort to develop a care pathway for XGC management. Materials and Methods: Retrospective review of clinical data of 1248 patients with the preoperative diagnosis of cholelithiasis, cholecystitis, or gallbladder carcinoma and had undergone surgery at our tertiary centre from May 2016 till December 2021. Twenty-six cases of XGC were identified and evaluated in terms of clinical features, laboratory examinations, radiological findings, the requirement of conversion from laparoscopic to open surgery, complications, length of hospital stay, endoscopic retrograde cholangiopancreatography (ERCP) and preoperative diagnoses. Results: In our study the incidence of XGC was 2.0%, mean age at presentation was 55.2 years, with female: male ratio of 1.8:1. In3 patients, GBC was suspected preoperatively (11.4%), 14 patients (53.8%) had obstructive jaundice at first presentation and required an endoscopic retrograde cholangiopancreatography (ERCP) before LC. Of these, 7 had common bile duct stones. One patient had impacted stone for which choledochoduodenostomy was done. Abdominal ultrasound scan showed marked thickening of the gallbladder wall in 18 cases (70%). LC was attempted in 23 patients but converted to open in 15 patients (65%conversion rate). In 1 patient right hemicolectomy was done along with open cholecystectomy because of dense adhesions. A total cholecystectomy was possible in 19 patients and partial cholecystectomy was the choice in 7 (26%). Conclusion: Severe XGC can result in diagnostic dilemmas and difficulties both pre-operatively and intra-operatively due to very close resemblance to gallbladder malignancy. In our study we have devised a pre-operative decision-making algorithm to differentiate between the XGC and GBC and manage accordingly.

153. A Comparative Study on the Outcome of Limberg Flap and Primary Excision with Lateral Closure Procedures in the Management of Pilonidal Sinus
D. Princess Beulah, K. Ramachandran
Pilonidal sinus disease is a much common condition affecting the sacrococcygeal region of young hirsuite males. Simple surgical procedures like primary excision of the sinus are sufficient for simple diseases and in those whose symptoms are relatively minor and are of short duration. This study aims to compare the outcomes of different procedures like primary excision and flap based techniques in the management of pilonidal disease. The prospective randomized study was conducted in Department of General Surgery, Government Stanley Medical College, Chennai. Totally 40 patients willing to undergo surgery will be randomly assigned to two study groups – Primary excision with lateral closure procedure and Limberg flap procedure. In the present study, the age group between 21 – 30 yrs represents majority of the study population (67.5%). Males represent majority of the study population which is 28 out of 40 compared with 12 females. Duration of surgery and duration of hospital stay was significantly higher among limberg flap when compared to excision group and it was significant with the p value shows less than 0.05. This is in discordance with previous studies. But, the results of duration of surgery and the duration of hospital stay favours primary excision procedure compared to limberg flap procedure with a high statistical significance [14].Thereby, this study concludes the advantages of primary excision procedure over limberg flap procedure in terms of shortening the duration of procedure for simple pilonidal sinus disease without compromising significantly on morbidity like wound infection and disease recurrence.

154. Imaging Characteristics in Patients with Normal Pressure Hydrocephalus at Tertiary Health Care Hospital
P V S Abhishek, Gajula Venu, S. Ravinder
Background: Normal pressure hydrocephalus (NPH) is a syndrome found in the elderly, which is characterized by the clinical triad of gait disturbance, dementia, and urinary incontinence without overt signs and symptoms of elevated intracranial pressure. According to estimates, NPH can cause up to 10% of dementia cases. It is important because ventriculoperitoneal shunting can be used to cure NPH. Aim and Objective: To describe the various imaging patterns helpful in the diagnosis of normal pressure hydrocephalus. Materials and Method: It was a prospective study. Inpatients and outpatients of age group more than 40 years of age, of both gender (males and females) diagnosed with normal pressure hydrocephalus as per consensus criteria were referred to Department of Radiodiagnosis from the Department of Neurology of Chalmeda Anand Rao Institute of Medical Sciences were enrolled in the study for the duration of 6 months. The patients underwent Magnetic resonance imaging / computed tomography study of brain. Computed tomography (CT) and Magnetic resonance imaging (MRI) show ventricular enlargement disproportionate to cerebral atrophy, with associated ballooning of frontal horns, periventricular hyperintensities, thinning and elevation of the corpus callosum, and widening of temporal horns without evidence of hippocampal atrophy in NPH. Results and Conclusion: Despite the fact that a diagnosis can be made solely on the basis of CT findings, MRI is more reliable for revealing concomitant illnesses (such as cerebrovascular disease) and for detecting NPH characteristic indications of prognostic value, in addition to avoiding exposure to ionizing radiation. The best imaging technique for capturing anatomical changes is MRI, which can also support the diagnosis with CSF flow investigations.

155. Study of Displaced Midshaft Clavicle Fractures Treated with Plate Osteosynthesis
Channappa T S, Manju Jayaram, Yatish R, Shivakumar H B, Karan C L
Background: Clavicle fractures are on the rise in recent years. Studies suggest high rate of malunion and non-union associated with these fractures. Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment. Methods: This is a prospective study conducted at a tertiary trauma care center. The inclusion criteria included age between 16 and 60 with acute isolated closed displaced mid-shaft clavicle fracture which were treated by open reduction and internal fixation with anatomical locking compression plate. Results: In this study, the mean age group of patients was 35.70 years of life with others ranging from 16 to 60 years. Out of 34 patients, 28 (82%) patients were male and 6 (18%) were female. Right side clavicle was affected in 11 patients and left was affected in 23 patients. The mean time of union in operative group was 12.4 weeks. The constant shoulder score was 86.5 in the study. Fracture union was noted in all cases by 12 weeks. Conclusion: In this prospective cohort study, plate fixation of middle third clavicle fractures showed excellent osteosynthesis. The patients experienced better functional outcome, immediate pain relief, early return to activities of daily living while avoiding complications.

156. A Cross-Sectional Study on Assessment of Colour Vision among Indian Medical School Attendees
Shital A. Patel, Dhatmishtha Dodiya, Sangeeta Chinchole, Babita Bansal, Deepak Agrawal
Background and Objectives: A reduced ability to distinguish between certain colours is called colour blindness. Colour-blind person is unable to perceive one or other primary colour depending upon loss of normal function or deficiency of cones. The main objective of the study to assess the colour vision in Indian medical school attendees. Material and Methods: In this, observational study total 1320 participants enrolled from both sexes. Colour vision was assessed by Ichihara charts available in standard format. Results: A total 1320 candidates 770 (58.33%) were males and 550 (41.66%) were females, out of these total 28 (3.63%) males and 4 (0.72%) females found to be defective in colour vision. Conclusion: This study demonstrates prevalence of defective colour vision more common and profound in males as compared to females.

157. Association of Cycle Threshold Values of rRT-PCR with Clinico-Demographic Profile of COVID-19 Patients in a Tertiary Care Hospital of Tripura, North East India
Gourab Chakraborty, Anup Saha, Pradip Kumar Das, Debosmita Paul, Niladri Sekhar Das, Jayanta Debnath, Sagnik Bhattacharjee, Antara Roy
Background and Objective: At the end of 2019, SARS CoV 2 virus causing COVID-19 disease had emerged in whole world leading to the pandemic. Real-time reverse-transcriptase polymerase chain-reaction (rRT-PCR) of nasopharyngeal /oropharyngeal swab has been the gold standard test for detection of SARS-CoV 2 infection. Ct value of RT PCR can be used as indirect marker of viral RNA copy. Aim of the study was to elucidate the association between Ct value and clinic- demographic profile of COVID-19 patients. Methods: A retrospective cohort study was conducted in the Department of Microbiology, Tripura Medical College & DR BRAM Teaching Hospital on 1471 COVID-19 patients who were diagnosed by rRT PCR during May 2021 to December 2022. Required data were collected from ICMR COVID-19 portal and Sample referral form(SRF) and subsequently analysed from May to June 2023. Age group and gender were taken as demographic variables. Ct values were categorized as group A(10-19),group B(20 -28) and group C(29-36) to establish their relationship with clinical symptoms and demographic characters. For statistical analysis Chi square test was utilized and p-value <0.05 was considered significant. Results: Out of 1471 rRT PCR confirmed COVID-19 patients highest cases were found among 21 to 40 years age group, 524(35.62%) and male patients,927(63.02%). Among symptomatic patients, 698 (47.45%) commonest complaint was fever, 453 (64.89%) followed by cough 341(48.85%) and breathlessness 174(24.92%). In relation to Ct value symptomatic patients, 149 (53.40%) were more in group A but there were more asymptomatic patients, 434(52.86%) and 209(56.33%) in group B and C respectively with significant association (P =0.0001).Ct value and clinical symptoms were also significantly associated (P=0.0000) in which fever and cough were more with Ct group B &C but breathlessness were mostly in Ct group A. Conclusion: Young age group with male preponderance were observed among COVID-19 patients of whom asymptomatics were more than symptomatics. Ct values were significantly related with symptomatology where fever and cough were largely associated with higher Ct value and Breathlessness was with lower Ct value. Therefore lower the Ct higher the viral load resulting in severe COVID-19 disease and vice versa.

158. Clinicopathologic Study of Tongue Lesions at a Tertiary Care Hospital
Sarita Kumari, Dharmendra Kumar, Deepak Kumar
The tongue is an easily accessible organ within the oral cavity, often regarded as an indicator of overall health in medical literature. It comprises specialized epithelium, muscles, nerve fibers, fat cells, minor salivary glands, and lymphoid tissue. Pathological lesions originating in the tongue can significantly impact a patient’s health and quality of life. Tongue lesions encompass a broad spectrum, including hamartomas, benign proliferations (e.g., irritation fibroma), true neoplasms like granular cell tumors, and malignancies such as oral squamous cell carcinoma (OSCC). A definitive diagnosis of a tongue lesion typically relies on a pathological biopsy report, taking into account the patient’s chief complaint, dental and medical history, oral examination, and clinical diagnosis. Clinical differential diagnoses are often organized based on the prevalence of pathologic lesions in specific locations, emphasizing the need for timely recognition. Epidemiological studies on the prevalence of tongue lesions have been conducted in various regions, such as Jordan, India, Turkey, and Iran. The presence of tongue lesions varies due to genetic and environmental factors across geographical regions. Iran, located in western Asia and characterized by its multiracial and multicultural nature, has seen limited epidemiological research on tongue lesions, some of which have suggested a high prevalence of oral cancer among tongue biopsies. Tongue lesions are of significant concern to both ENTpractitioners and patients, representing a substantial portion of oral mucosal conditions. This study aimed to ascertain the prevalence of diverse tongue lesions within the Indian population. A total of 4,926 patients seeking care at the Department of ENT JLNMCH Bhagalpur were examined for the presence of tongue lesions from October 2021 to September 2022. Patient ages ranged from 12 to 80 years, with an average age of 36.51 years. The prevalence of tongue lesions was found to be 12.07%. Among the identified lesions, coated tongue was the most prevalent, affecting 28.0% of subjects, followed by geographic tongue (16.4%), fissured tongue (14.9%), and depapillated tongue (11.5%). Males exhibited a higher frequency of these lesions compared to females. Among patients with tongue lesions, the most common systemic condition observed was anemia (189 cases), followed by hypertension (47 cases) and diabetes mellitus (38 cases).
The notably high prevalence underscores the importance of raising awareness about various tongue lesions within the general population. Additionally, it emphasizes the necessity for ENT clinicians to possess comprehensive knowledge of the etiology, clinical presentation, diagnosis, and treatment of these lesions. This understanding is vital for effective patient care and management.

159. Management of Scalds in Preschool Children: A Regional Study in Tertiary Care Institution
Neeti Jamwal, Priyanka Koushal, Ratnakar Sharma
Background: Scalds account for one-third to one-half of all burns in high and middle-income countries and globally account for approximately 5% of all burn-related deaths with pre-school children experiencing a disproportionately high mortality rate compared to other age groups. While there are enormous variations in the age of patients with burn injuries due to scalds, global studies demonstrate that the 0–5-year age group had the highest incidence. Pre-school children are disproportionately affected by these burns, and therefore the study was conducted with the objectives of1) To study epidemiology of scalds in pre-school children reporting to our Hospital; 2) To access the clinical profile of Scalds in preschool children and treatment offered; 3) To notify methods of prevention of scald burns in pre-school children. Materials and Methods: A prospective study was conducted in 50 pre-school children (0-5 years old) sustaining scalds admitted to Government Medical College and Hospital Jammu over a period of one year from 1st October 2020 to 31st September 2021. Results: Maximum number of patients were in the age group of >1 year to 2 years and>2 years to 3 years which accounted for 30% each of all the patients. The average age of the patients was 2.4 years. The number of male patients in our study accounted for 60% of all the cases whereas females contributed to 40% of the total cases.  Most of the patients were the residents of rural areas (70%) whereas 30% of the patients were from urban areas.  Majority of the patients (50%) belonged to upper-lower class families whereas 30% of them belonged to lower class families. Majority (62%) of the patients were brought to the hospital by their parents/guardians within 6 hours of sustaining injury and only 38% reported later. The median time interval was 3 hours. Hot water was the most common cause of scalds among children (54%) followed by hot milk (36%), hot tea (08%) and hot dal (02). Majority (40%) of the patients had %TBSA burn between 10 to 20% with mean percentage burn of 18% whereas only 14% of the patients had %TBSA burn of greater than 30%. The most common part of the body involved was abdomen (Lower Trunk) (62%) followed by Lower Limbs (50%) in association with other parts of the body and upper limb was the most common part of the body involved separately in 16% of the patients whereas face and feet were least commonly involved (02%). Majority of the patients (70%) had second degree superficial burns whereas 15 (30%) among them had second degree deep burns.  Most of the patients (90%) were managed conservatively with IV fluids, antibiotics, and antiseptic dressings, and 05 patients (10%) were surgically managed by Split-thickness skin graft. All the patients (n=50) were discharged with no mortality reported. Maximum number of patients (94%) did not develop any complication, 02 (4%) of them developed hypertrophic scarring and 01 (2%) developed minor graft rejection. Conclusion: Hot water scalds are the most common type of burn injuries among pre-school children. Management of scalds among pre-school children can be conservative in most of the cases whereas surgical modality in terms of STSG of the burn wounds is needed in some cases. The parental education plays an important role in the prevention of scalds. All the patients in our study were discharged after treatment and none had any significant complication during monthly follow up in out-patient consultancy. At the time of discharge, parents of the children were counselled about proper care of the children, nutrition and first aid.

160. Serum Levels of Iron Profile and Ceruloplasmin in Hypothyroid Patients and Normal Individuals: A Case Control Study
Leela P, Mamatha BV, Shreedhar AM, Chandrakanth KH
Background: Metabolism of thyroid hormones and iron is quite interdependent. Deficiency of iron can produce hypothyroidism and vice versa. Ceruloplasmin (Cp) is considered as a protective antioxidant due to its ability to react and scavenge free radicals. Objectives: To evaluate and to compare the serum levels of Iron, Total iron binding capacity (TIBC) and Ceruloplasmin in hypothyroid patients and normal individuals. Methodology: In this study we have taken a group of 50 clinically proven hypothyroid cases diagnosed by thyroid profile and an equal number of ages and sex matched healthy subjects. After taking written informed consent the fasting venous blood sample was drawn from both the controls and cases for the assay of Iron and TIBC by Ferrozine method and serum Ceruloplasmin by Nephelometry method. Results: A significant decrease in serum Iron and ceruloplasmin and increase in serum TIBC was seen in hypothyroid patients compared to normal subjects. (p value < 0.001). Conclusion: The present study establishes Iron, TIBC and Ceruloplasmin are useful biomarkers of oxidative stress in hypothyroidism.

161. Study of Cholecystitis in Adults of Andhra Pradesh Population
Motupally Aravind Kumar
Background: Gall bladder (GB) disease is considered one of the nation’s major medical problems. Acute or chronic cholecystitis usually presents an emergency in terms of both diagnostic urgency and therapeutic intervention. Delay in diagnosis further delays therapy, which leads to a life-threatening condition. Method: 90 adult patients aged between 35 to 65 clinically diagnosed with cholecystitis were carried out by a standard four-port technique for laparoscopic cholecystectomy. The operative time was calculated from the insertion of the first port to the skin closure of the last port. The open cholecystomy was done as and when deemed necessary. Results: In the clinical manifestations, 90 (100%) had tenderness in the right hypochondrium, 29 (32.2%) had fever, 7 (7.7%) had jaundice, 26.6%) had vomiting, 30 (33.3%) had leucocytosis, 16 (17.7%) patients needed emergency treatment, 74 (82.2%) had elective therapy, 77 (85.5%) had calculous cholecysitis, and 13 (14.4%) had idiopathic calculus. The organisms observed post-surgically were 30 (33.3%) E. coli, and 15 (16.6%) had staph. Auerus, 6 (6.66%) had salmonella, 14 (15.5%) had no organism, and 25 (27.7%) patients had cultured due to early healing. Conclusion: Early detection and early therapy of cholecystitis will prevent emergency operation morbidity and mortality in patients.

162. Efficacy of Labetalol versus Fentanyl for Attenuation of Haemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation
Deepak Tank, Lovina Neil, Dhara Patel, Shobhana Gupta, Akash Dileepkumar Patel, Prajapati Maulik Dashrathbhai
Background and Aim: A special type of anti-hypertensive medication called labetatol primarily used for perioperative blood pressure management and hemodynamic stability. Due to its great strength and quick start of effect, IV fentanyl is used as a pre-medication to inhibit physiological response during laryngoscopy. present study was aimed to attenuate the haemodynamic response of laryngoscopy and intubationin adult patients posted for surgery under general anaesthesia with IV dose of Lobetalol 0.5 mg/kg and Fentanyl 2µg/kg over 5 minutes before induction and to compare effects of both the drugs. Material and Methods: The present study was done at GMERS Medical College and Civil Hospital. The approval from Institutional Ethical committee was obtained prior to the start of the study. This Study was conducted on 60 patients in age group 18 – 60 yrs. Patients are to be randomly allocated into two groups, Group F (for fentanyl) and group L (for Labetalol). Group-F (N=30): Intravenous Fentanyl 2μg/kg in 10 ml Normal Saline was given over 5 minutes, 5 minutes prior to induction. Group-L (N=30): Intravenous Labetalol 0.5 mg/kg in 10 ml Normal Saline to be given over 5 minutes, 5 minutes prior to induction. HR, SBP, DBP, MAP were recorded at Base line (Before Injecting study Drug), Pre induction (After 5 minute of injecting study drug), immediately after larygoscopy at 1 min ,3 min, 5 min, 10 min, 15 min, 30 min of post intubation then every 30 min till end of surgery. Results: Group L showed a significant fall in HR, SBP, DBP and MAP after injecting the drug, after induction, post intubation. When compare both the group, Labetalol 0.5mg/kg significantly attenuates the haemodynamic response to laryngoscopy and intubation. Fentanyl 0.5 µg/kg group attenuates the pressor response to laryngoscopy and intubation but not as effective as labetalol 0.5 mg/kg. Conclusion: Labetalol (0.5 mg/kg) is a better agent than fentanyl (2 μg/kg) in attenuating the sympathomimetic response to laryngoscopy and intubation. There was no increased risk of bradycardia or hypertension.

163. A Comparison of Postoperative Recovery Characteristics with Isoflurane and Sevoflurane in Patients Undergoing Laparoscopic Cholecystectomy
Sumit Kumar Singh, Nitin Kumar
Background and Objectives: Inhaled volatile anesthetic remain the most widely used drug for the maintenance of general anesthesia.  This is because of the ease of administration and predictable intraoperative and recovery characteristics.  Over the past years, there have been three gases and thirteen volatile anesthetic agents made available for clinical use, The purpose of this study was to evaluate comparatively post-operative recovery characteristics of patients undergoing laparoscopic cholecystectomy with isoflurane and sevoflurane as volatile anesthetic agent for maintenance of anesthesia. Materials and Methods: This prospective and randomized study was conducted in Department of Anaesthesiology and Critical Care, Darbhanga Medical College & Hospital, Laheriasarai, Bihar from October 2016 to April 2018. After obtaining Ethical committee clearance and informed consent from each patient, the study was, conducted on 60 ASA physical status I-II patients of either sex, aged 35-70 years and weighing 40-75 kg, scheduled for elective laparoscopic cholecystectomy under general anesthesia. Conclusion: Based on our study results we can say both the volatile anesthetic agents can be used for maintenance of anesthesia in elective laparoscopic cholecystectomy operations of ASA I and II patients. Both maintains good hemodynamic parameters and airway intraoperatively and post operatively.

164. Implementing WHO Indicators to Evaluate Prescription Patterns in Paediatric Patients
Kislay Parag, Rajesh Ranjan Sinha, Ajay Krishna
Introduction: Antimicrobials are a class of medication that is more prone to cause the emergence of natural resistance. As a result, they need to be prescribed, given out, and used with more prudence. Antibiotics are separated into the three categories of Aware: Access, Watch, and Reserve to emphasise the need of their proper usage. current data on drug use, prescription behaviour, and Decision-makers would benefit from knowing the factors affecting antibiotic prescribing and their use % from Aware classification to create rules that will allow for more judicious usage of medications. Method: For six months, a prospective, observational study was conducted in the Department of Community Medicine, BMIMS, Pawapuri. The prescriptions were assessed using the WHO prescribing indicators, and the optimal WHO range was taken into account as a deciding factor for rational prescription. Result: They were predominantly female (53%). Antiemetics and antiulcer medications (26% and 13%), and antipuretics and analgesics (10%) were the most frequently prescribed medications. There were 6.54 medications on average each contact. Antibiotic prescriptions made up 16% of the total, while injectables made up 48% percent. Conclusion:  The results of this study show that the drug use patterns were not optimal in comparison to the recommended values of the WHO prescribing patterns. Although the use of antibiotics complied with WHO recommendations, there is a need to enhance prescription patterns by using medications from the Essential Drug List and generic names.

165. Surgical Management of Unintentional Transvesical Caesarean Section: A study at a Tertiary Care Teaching Hospital (RIMS), Adilabad
K Ashok
Background: Iatrogenic bladder injury is a very rare occurrence in obstetric and gynecologic surgeries. There is limited data available pertaining to the optimal duration for transurethral catheterization post-injury, suture methodologies involving suture selection, and the potential complications involved. The objective is to evaluate the frequency, factors contributing to risk, treatment approaches, as well as the immediate and extended consequences of inadvertent transvesical cesarean section (UTV-CS). Methods: This case-control study was carried out in the Departments of General Surgery and Obstetrics and Gynecology, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad. The prevalence was determined based on the total number of CS procedures conducted at the center during the study’s timeframe from Jan 2019 to May 2023. The diagnoses of UTV-CS were verified through a manual examination of all charts and surgical procedure descriptions. Instances of bladder wall injury without UTV-CS were not considered. Results: A total of 26,236 deliveries took place between Jan 2019 to May 2023, with 11,785 cesarean sections (CSs) performed, accounting for 44.92% of the total deliveries. Instances of bladder injury without a ureterovesical-transection cesarean section (UTV-CS) were excluded from the analysis. Four CSs presented complications in the form of extensive bladder injuries, leading to unintentional fetal extraction through the bladder. The overall incidence of UTV-CS was found to be 0.0339%, which translates to 1 in every 2,947 CS procedures. Conclusion: The incidence of bladder injury during cesarean sections is low, it should always be considered as a potential complication. This study represents the first attempt to evaluate the incidence of UTV-CS, which might indicate a reluctance among obstetricians to report severe bladder injuries associated with cesarean sections. The risk factors identified for UTV-CS appear to be in line with factors generally associated with bladder injuries. However, due to the limited number of UTV-CS cases, a comprehensive evaluation of related risk factors in comparison to milder bladder injuries could not be carried out, and the conclusions are constrained by the scarcity of cases.

166. Supraclavicular Artery Flap for Resurfacing of Neck, Head, and Upper-Thoracic Defects
Rajesh Kumar, Vikas Kumar
Background: The region of head and neck is a delicately challenging part to resurface because it is a highly visible area of our body. Hence, in order to achieve best results distant flaps or free flaps are used in the defects of the tissue area. As of the study using supraclavicular artery flap for resurfacing the head, neck and upper torso constitute an adaptable choice. Materials and Methods: In this study, flaps have been used in neck injuries which were a result of after burn hardening of muscles. Although its application may be alike in other conditions also. A total of 18 supraclavicular flaps were reported on 14 patients for many defects in the head and neck area. Results: All the flaps sustained entirely and the post- operative morbidity was considerably low excepting the one flap. Conclusion: “The supraclavicular artery flap” supplies a natural colour and texture matching and also it supports the multi-dimensional movement of the neck.

167. CT Coronary Angiography in Patients of Coronary Artery Disease
Gajanan Dhansing Chavhan
Introduction: “Coronary artery disease (CAD)” is a leading cause of death globally. Invasive coronary angioplasty, while useful, is costly and carries risks. Non-invasive imaging methods like SPECT, PET, MRI, and CT have advanced for CAD diagnosis. Coronary CT is suggested by NICE for regular chest pain patients at 10-29% risk of CAD. Pre-medication with beta-blockers is provided to lower heart rate, and nitrate enhances artery visibility. Aims and Objectives: To assess the existence, importance, and severity of coronary artery disease by employing coronary CT angiography. Method: In a study consisting of 80 patients who had been referred for cardiac evaluation, numerous diagnostic procedures were carried out in order to evaluate “coronary artery disease (CAD)”. After taking out certain participants, the remaining group of forty patients was used for the study. The purpose of this study was to investigate whether or not there is a correlation between the findings of “computed tomography angiography (CTA)” and patient outcomes, taking into account CAD risk factors. Result: The univariate predictors of cardiac events and serious cardiac events are presented in Table 3. Significant predictors of both types of events included age, male gender, diabetes, high cholesterol, and high blood pressure. The correlation between body mass index and serious cardiac events was weak. There was no correlation between either family history of CAD or smoking and an increased risk of CAD. Both types of events were predictably linked to the Agatston score, which measures the presence of calcified plaque. Coronary artery disease (CAD) was found to be substantially related to increased event risks, and this was true even for nonobstructive CAD and for varying degrees of vascular stenosis. Conclusion: The study has concluded that CTA has proved its effectiveness as a diagnostic and prognostic tool in patients who have an undiagnosed heart disease.

168. A Clinical Study on Blunt Abdominal Trauma in Emergency Medicine Department with Special Reference to Role of Fast
Roshmi Rekha Gogoi, Dipak Kumar Sarma
Introduction: Trauma, or injury, is defined as cellular disruption caused by an environmental energy that is beyond the body’s resilience[1]. Trauma is the leading cause of death between the ages of 1 and 44 years. Blunt abdominal trauma (BAT) is injury to intra-abdominal or retroperitoneal viscera as a result of a non- penetrating force. It is commonly due to rapid deceleration or acceleration in combination with shearing and rotational forces [4,5]. Abdominal injuries occur in approximately 1% of all trauma patients. Aims & Objectives: To study the clinical presentation and management of blunt abdominal trauma patients attending the Emergency Medicine department and to assess the role of Fast. Materials and Methods: The Study was a Prospective observational study carried out during a period of one year from July 2018 to June 2019 in dept of Emergency Medicine Gauhati Medical College & Hospital. Results and Observations: The distribution of age ranged from 18 to 82 years and mean age was 33.7 ± 13.43 years. Majority of cases 95 (42%) were found in the age group 18 to 27 years. The next majority (28%) were in the age group 28-37 years, 63 cases. The least common ( 1%) were in the age group of 77 and above years. Out of 226 cases of BAT, larger number of cases were observed in males 185 (82%) than in females 41 (18%).FAST was done in all 226 patients with BAT. FAST was positive in 114 (50.4%) cases and negative in 112 ( 49.6%) cases. Conclusion: In patients with intra-abdominal injuries, majority were males and of young age group. Most of them presented on the same day with pain abdomen as the common presenting complain. Most of the cases were due to road traffic accidents and were commonly associated with orthopaedic injuries. FAST was found to be highly useful test and most FAST positive patients needed surgery.

169. Study of the Safety and Efficacy of 2% Sodium Cromoglycate Ophthalmic Solution and 0.1% Lodoxamide Ophthalmic Solution in Patients with Spring Catarrh in a Tertiary Care Hospital
T. Priyanka, K. Lydia, M. Pushpalatha, V. Nagasuresh
Introduction: Vernal keratoconjunctivitis comprises 0.5% of allergic eye diseases. The study is made to collate the effectiveness of drugs by following the patient to observe the reduction in signs and symptoms. Objectives: The objective of the study is to compare the effectiveness and safety of 2%sodium cromoglycate ophthalmic solution and 0.1% lodoxamide ophthalmic solution in patients with vernal keratoconjunctivitis (VKC). Materials and Methods: A randomized, comparative study conducted in patients attending the OPD of Viswabharathi medical college, Penchikalapadu, kurnool, Andhra Pradesh. The study included 50 patients who has attended our OPD diagnosed with VKC, of which odd number to Group A and even numbers to Group B with 25 each were given 2%sodium cromoglycate ophthalmic drops and 0.1% lodoxamide ophthalmic drops, respectively, two times a day for 8 weeks. The reduction in signs and symptoms in both groups was compared. Absolute eosinophil count was evaluated for all the patients before and after .The observations and results were tabulated accordingly, and data were analyzed using the SPSS version. The unpaired t‑test is used as the test of significance in between the two groups. P value is statistically significant when it is < 0.05. Results: Overall, 50 cases were included in the study, 72% of total patients were in the age group of 5–10 years, and 28% were in the age group of 11–15 years. There were 39 males and 11 females. After 8 weeks of follow‑up, the mean reduction in making the scores of symptoms and signs provided better and quicker relief of watering, ocular discomfort, and conjunctival hyperemia with 2%sodium cromoglycate eye drops. 0.1% lodoxamide eye drops provided faster improvement in papillary hypertrophy. Both drugs were equally effective in reducing itching. Laboratory findings of absolute eosinophil count had no statistical significance in between the two groups. Conclusions: In this study, based on the evaluation of therapeutic performance, 0.1% lodoxamide eye drops proved quicker relief to the symptoms and signs compared to 2%sodium chromoglycate eye drops but this was not statistically significant.

170. Quality of Life Assessment & Out-of-Pocket Expenditure in Multiple Myeloma: An Observational Study
Sudhir Pohregaonkar, Anjanvatikar Akshaykumar, Antara Sudhir Pohregaonkar, Gajanan Kadam, Rahul S Talekar, Pratik Shah
Background: Living with multiple myeloma, a form of blood cancer, can have a profound impact on a person’s quality of life (QoL) and often leads to significant out-of-pocket expenditures (OOPE). This observational study aimed to assess the QoL and estimate the financial burden incurred by individuals living with multiple myeloma in India. Materials and Methods: In this cross-sectional study, we recruited 150 individuals diagnosed with multiple myeloma from two major hospitals in India. To comprehensively evaluate their QoL, we employed well-established QoL questionnaires such as the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Additionally, structured interviews were conducted to collect data on socio-demographic characteristics and OOPE. The calculation of OOPE encompassed various aspects of the healthcare journey. We considered costs related to medical consultations, diagnostic tests, medications, hospitalizations, and transportation. To facilitate comparisons and analysis, all values were converted to Indian Rupees (INR). Results: Our findings shed light on the QoL and financial challenges faced by individuals with multiple myeloma in India. The study revealed that these patients reported a moderate-to-poor QoL, with a mean QoL score of 55 out of 100. This score underscores the significant impact of the disease on their overall well-being and highlights the need for interventions to improve their QoL. In terms of OOPE, patients with multiple myeloma in India incurred an average annual expenditure of approximately INR 150,000. The largest contributors to these expenditures were medication costs, which averaged around INR 75,000. Hospitalizations accounted for INR 40,000 of the OOPE, and diagnostic tests added another INR 20,000 to the financial burden. Conclusion: This study underscores the considerable burden that multiple myeloma places on the QoL of affected individuals in India. The disease’s impact extends beyond physical health, affecting various aspects of daily life and overall well-being. Furthermore, the substantial OOPE incurred by these patients highlights the pressing need for financial support mechanisms and improved access to affordable healthcare services in India. Policymakers and healthcare stakeholders should consider implementing interventions that can alleviate the economic and QoL challenges faced by individuals living with multiple myeloma, ensuring that they receive the comprehensive care and support they require.

171. Comparative Study of Unstable Proximal Femoral Fractures Treated with Proximal Femoral Nail (PFN) and Proximal Femoral Nail Anti-Rotation (PFNA)
P. Surendranath Reddy, P. Sai Vikranth, Srikanth Nara
Background: Hip joint fractures are quite common in old age due to degeneration of the calcarfemorale, which is a nail inserted by nature. It cannot be healed early; hence, it needs proper technique to maintain the normal functions of the hip joint. Method: Out of 30 patients aged between 50 to 70 years, 15 were inserted with proximal femoral nail (PFN) and 15 were inserted with proximal nail anti-rotation (PFNA). The helical blade of the whole PFN has two screws, one large, which stabilizes the fractured part of the femur, and another is anti-rotation, while the PFNA has a helical blade, which provides stability and anti-rotation mobility. Both surgeries were similar, but the instruments and techniques differed. Results: In the comparative study, the mean value of duration was 40.28 (±5.11) in PFN and 34.19 (±5.02) in PFNA, t test was 5.29 and p<0.002. Blood loss (ml): 75.76 (±14.30) in PFN; 59.38 (±11.95) in PFNA; t test was 3.40 and p<0.001 Fluoroscopy images 27.45 (±3.44) in PFN, 16.28 (±3.11) in PFNA; the t test was 9.35 and p<0.001. Postoperative complications were more common in PFN. Moreover, loss of reduction >1 cm was also common in PFN technique. The final outcomes, like mortality, persistent pain, and use of walking aids, were also higher in PFN technique patients. Conclusion: Among the both techniques PFNA is more performed because PFNA significant reduces duration of surgery time, loss of blood, Fluoroscopic imaging, and mortality rates. Hence, PFNA is a better option for hip joint fractures.

172. A Comparison of Thiopentone, Propofol and Combination of Ketamine-Propofol (Ketofol) as an Ideal Anesthetic Agent for Modified Electroconvulsive Therapy
Nikita Verma, Jyoti Nagwanshi, Ashwini Kumar Patel, Sonali Tripathi
Background: Electroconvulsive therapy (ECT) is a widely utilized psychiatric intervention that involves the deliberate induction of seizures in patients using electrical stimulation, with the aim of producing therapeutic outcomes. Electroconvulsive therapy (ECT) has the potential to induce significant disruptions in the cardiovascular system, as well as a notable elevation in cerebral blood flow & intracranial pressure. The cardiovascular alterations might be modified with the use of different anaesthetic medications. The most often utilized induction drugs for electroconvulsive therapy (ECT) are Thiopentone and Propofol. In recent times, there has been an exploration of the use of Ketofol, a combination of Propofol with Ketamine, in the context of electroconvulsive therapy (ECT). Aims and Objective: The purpose of this study was to conduct a comparative analysis of the impact of sodium Thiopentone, Propofol, and Ketofol as IV anaesthetic agents in modified electroconvulsive therapy (ECT). Specifically, the study aimed to assess the effects of these drugs on ECT-induced hemodynamic alterations, seizure duration, and recovery time. Material and Methods: The study conducted was a prospective, randomized controlled trial that included a total of 90 patients aged between 18 and 60 years, who had ASA grade I and II and were scheduled to undergo electroconvulsive therapy (ECT). The patients in group T were administered Thiopentone at a dosage of 2.5 mg/kg, while those in group P received Propofol at a dosage of 1 mg/kg. Patients in Group K were administered inj. Ketofol, which is a combination of Inj. Propofol at a dosage of 0.5 mg/kg and Inj. Ketamine at a dosage of 0.5 mg/kg.  The hemodynamic and recovery statuses of all groups were observed throughout the initial thirty-minute period. Additionally, data was collected on the length of seizures, the time it took for spontaneous eye opening to occur, the ability to respond to verbal commands, and agitation assessment scores. Results: A statistically significant disparity in heart rate at 10 minutes and systolic blood pressure at 5 minutes was seen in the Thiopentone group (p-values of 0.008 and 0.011, respectively) following the administration of shock, in comparison to the other two groups. There were no statistically significant changes seen in seizure length, latency to spontaneous eye opening, and responsiveness to vocal commands (p>0.05). The group T exhibited the greatest mean agitation score (2.14 ± 0.56), as compared to both group P (1.64 ± 0.48) & group K (1.78 ± 0.64) (P= 0.004). Conclusion: The hemodynamic stability of Propofol and Ketofol was shown to be superior to that of Thiopentone, whereas the seizure duration and recovery characteristics were equivalent among the three substances. Therefore, it can be concluded that both propofol and Ketofol exhibit effectiveness as induction drugs for electroconvulsive therapy (ECT), with propofol exhibiting a lower incidence of agitation compared to Ketofol.

173. Functional Outcome of Clavicle Shaft Fractures with Intramedullary Nailing: An Observational Study
Tanish Patil, Shouryashil Khambalkar, Kapil Ghorpade, Jaydeep Patil, Nagesh Naik
Objectives: The aim of the study was to analyse functional and radiological outcomes associated with clavicle fractures managed using intramedullary nailing. Methods: This was an observational study in which 80 patients with midshaft clavicular fractures were included on the basis of a predefined inclusion and exclusion criteria. The study was conducted in the department of orthopaedics of a tertiary care medical college situated in a semi-urban area. Demographic details and mechanism of injury was noted. All patients were treated by intramedullary nailing. Patients were followed up for 4 months. Clinical and radiological union was assessed at each follow up visit. Functional outcome was assessed by Quick DASH score. P value less than 0.05 was taken as statistically significant. Results: Out of 80 studied patients there were 58 (72.50%) males and 22 (27.50%) females with a male to female ratio of 1:0.37. The mean age of affected cases was found to be 34.86 +/- 8.25 years. Road traffic accidents (70.00%) followed by fall on outstretched hand (23.75%) were the most common mechanism of injury. At the time of final follow up (at 16 weeks after surgery) 79 (98.75%) patients were found to have clinical as well as radiological union and only 1 (1.25%) patient was found to have clinical union but radiological non-union. 64 (80%) patients had excellent functional outcome whereas 12 (15%) 4 (5 %) patients were found to have good and satisfactory outcome. Conclusion: Patients with clavicular fracture treated by intramedullary nailing have excellent functional outcome in terms of pain relief, daily activities and range of motion.

174. Magnitude of Association of Alopecia Areata with Autoimmune Disorders in Rural West Bengal: A Cross Sectional Analytical Study
Chinmay Halder, Swarnali Mandal, Mrinmoy Adhikary, Sumit Sen
Background: Alopecia areata is an organ specific autoimmune disease associated with other autoimmune diseases such as atopic dermatitis, thyroid diseases including Hashimoto’s thyroiditis, vitiligo, psoriasis, lichen planus, addison’s disease, pernicious anemia, lupus erythematosus, diabetes mellitus etc. Aims: To find out the demographic profile and search for prevalence of other autoimmune disorders in association with alopecia areata. Materials and Methods: This study was conducted on 120 patients with alopecia areata of any age and both sexes attending dermatology OPD. Same number of age and sex matched patients with cutaneous disorders other than alopecia areata were included in the control group. All the patients were interviewed regarding detailed demographic data, thoroughly examined to search for other cutaneous as well as systemic autoimmune diseases. All the patients were screened with thyroxin, triiodothyronine, thyroid-stimulating hormone, and microsomal antibody (Anti-TPO Ab) levels and few baseline investigations. Other laboratory investigations were done to diagnose other autoimmune diseases. Results: In this study, 25 (20.8%) alopecia areata patients had a history of atopy compared to 6 (5%) patients in the control group. 4 (3.33%) patients had vitiligo, which was the most frequently occurring associated cutaneous autoimmune disorder in this study. Out of 120 patients, 9 (7.5%) patients had thyroid disorders, which was the most frequently occurring associated systemic autoimmune disorder. Among alopecia areata patients 17 (14.17%) patients were found to have elevated Anti-TPO Antibody level whereas only 3 (2.65%) patients of the control group had such finding. Conclusion: Our study provides us the information about the high incidence of elevated autoimmune thyroid antibody (Anti-TPO) level and thyroid functional disorders associated with alopecia areata prompting us to perform thyroid function tests and thyroid autoantibody tests routinely for all patients with alopecia areata.

175. Clinico-Epidemiological Profile and Association of Autoimmune Disorders among Alopecia Areata Patients: A Hospital Based Study
Chinmay Halder, Fasihul Akbar, Dayamay Pal, Mrinmoy Adhikary
Background: Alopecia areata is an autoimmune disease associated with other autoimmune diseases such as atopic dermatitis, thyroid diseases including Hashimoto’s thyroiditis, vitiligo, psoriasis, lichen planus, addison’s disease, pernicious anemia, lupus erythematosus, diabetes mellitus etc. Aims: To describe the clinic-demographic profile of alopecia areata; to find out the incidence of different clinical patterns and search for prevalence of other autoimmune disorders in association with alopecia areata. Materials and Methods: This study was conducted on 120 patients with alopecia areata of any age and both sexes attending dermatology OPD. Same number of age and sex matched patients with cutaneous disorders other than alopecia areata were included in the control group. All the patients were interviewed regarding detail demographic data, clinical pattern of alopecia areata, thoroughly examined to search for other cutaneous as well as systemic autoimmune diseases. All the patients were screened with thyroxin, triiodothyronine, thyroid-stimulating hormone, and microsomal antibody (Anti-TPO Ab) levels and few baseline investigations. Other laboratory investigations were done to diagnose other autoimmune diseases. Results: In this study, mean age of 26.21 years with 87.5% of patients under 40 years of age. 87 (72.5%) patients were of patchy alopecia areata where most of the cases were of mild (S1) variety (84, 70%). 7 (5.83%) patients had vitiligo, which was the most frequently occurring associated cutaneous autoimmune disorder. Out of 120 alopecia areata patients, 11 (9.16%) patients had thyroid disorders, which was the most frequently occurring associated systemic autoimmune disorder where 14 (11.66%) were found to have elevated Anti-TPO Antibody level compared to only 3 (2.65%) patients of control group. Conclusion: In our study patchy alopecia areata was most frequent, majority were of mild variety; and vitiligo was the most frequently associated cutaneous autoimmune disorder. This study also indicated about the high incidence of elevated thyroid autoantibody (Anti-TPO) level and thyroid functional disorders associated with alopecia areata prompting us to perform thyroid function tests and thyroid autoantibody tests routinely for all patients with alopecia areata.

176. Comparison between USG Guided Interscalene Block Plus USG Guided Superficial Cervical Plexus Block (Single Prick) Versus USG Guided Interscalene Block Plus Landmark Guided Superficial Cervical Plexus Block (Two Prick) for Surgeries of the Clavicle: A Prospective Study
Tahira Akhter, Wasim Khursheed Mir, Fehmeedah Banoo
Background: Fractures of the clavicle are common, comprising 2.6% to 4% of adult fractures, mainly resulting from trauma and accounting for 35% of shoulder girdle injuries. Surgical fixation of clavicular fractures has traditionally involved General Anesthesia (GA) due to challenges in nerve blocking. However, GA has associated with risks. Regional Anesthesia (RA) has emerged as a favorable alternative for clavicular surgeries, but its use as the sole technique is limited due to the complexity of nerve blocking. This study evaluates the efficacy of combined USG-guided SCPB and ISB as the sole RA technique for clavicular surgeries, addressing a research gap. Methods: This prospective study at GMC Baramulla included adult patients undergoing clavicular fracture surgery. Ethical approval and informed consent were obtained. Sample size was calculated for 44 patients. Participants were randomized into two groups: Group A received USG-guided ISB and SCPB, while Group B received USG-guided ISB with landmark-guided SCPB. Anesthesia was administered by experienced anesthesiologists. Data on demographics, intraoperative details, anesthesia efficacy, success rate ( The main outcome or success was defined as absence of cold sensation for all 4 branches of the superficial cervical plexus at 15 mins), and postoperative complications were collected. Statistical analysis was performed using SPSS 20.0 with significance set at p < 0.05. Results: The baseline characteristics of 44 patients in Group A (n=21) and Group B (n=23) were comparable, including age, weight, height, BMI, surgical procedure, ASA class, and location of the fracture. Heart rate, systolic and diastolic blood pressure, and SPO2 remained consistent between the groups at various time points during the postoperative period. Group A had significantly shorter procedure time (15.73 ± 1.67 minutes) compared to Group B (18.62 ± 2.42 minutes). Single prick technique was more comfortable and acceptable by patients than two prick technique. However, there were no significant differences in the onset and duration of sensory and motor blocks, surgical procedure duration, conversion to general anesthesia, need for analgesic supplementation, success rate, or complications between the groups. Conclusion: The anesthesia efficacy, success rate, and complication rates were comparable between the two groups. Anesthesiologists can consider the advantages of reduced procedural time when choosing between the two techniques, while also taking into account individual patient factors and institutional resources.

177. Study of Renal Doppler Ultrasonography in Cases of Chronic Kidney Disease at IGIMS, Patna with the Influence of Demographic Data
Sumity Singh, Sanjay Kumar Suman, Manisha Kumari, Samiullah Hassan
Introduction: CKD (Chronic kidney disease) universally is considered as a major disease affecting public health and critically raises the burden on health care system. Timely diagnosis and management of CKD is very vital to holdup the advancement of disease. Doppler renal ultrasonography (US) possibly plays a significant role in defining CKD and its advancement to end stage renal disease (ESRD). Material and Methods: This study was a hospital based cross-sectional observational study performed on 50 CKD patients hospitalized or attending IGIMS, Patna. After 8-12 hours fasting, blood, Doppler US reports and demographic profile were collected. The collected data from all the participants was analysed using “SPSS Statistics Base 22 software” and p value <0.05 was considered statistically significant. Results: Our research observed significant difference in mean of pulsatility index (PI) and renal resistive index (RRI) from left interlobular arteries and both sides of main renal artery. PI from right interlobular arteries was also significantly different from control group although difference in mean RRI was statistically non-significant. The significant positive correlation of RRI with age and negative correlation with eGFR (glomerular filtration rate) was observed. Conclusion: Our study concludes that a suspected or diagnosed CKD patient must be examined by Doppler US to confirm or assess the renal prognosis. The better clinical application and understanding of Doppler US data can be made by simultaneously assessing the comprehensive variables which can influence the data.

178. Study of Clinical and Haematological Profile of Dengue Fever
Ajay Kumar M. Rathod, Gayatri H. Bamaniya, Divyang Makwana, Manish Parmar, Manthan Solanki, Vaibhavi Patel, Bharvi Ninama, Bhavik Prajapati
Background: Dengue fever is a mosquito borne illness that occurs in tropical and subtropical areas of the world. Mild dengue fever causes a high fever and flu like symptoms. The severe form of dengue fever can cause serious bleeding, a sudden drop in blood pressure (shock) and death. Methods: Data consists of primary data collected from the patients who are admitted in Shardaben Hospital, Ahmedabad in August 2020 to October 2022 and 100 patients were taken. Outcome: In present study, no mortality was recorded in dengue fever in August 2020 to October 2022, All patient had good recovery. Conclusion: Early diagnosis and adequate fluid management plays disease outcome. blood pressure, platelets, haematocrit an important role in should be monitored closely to evaluate the progress of disease.

179. Comparative Study between Intrathecal Hyperbaric Ropivacaine (0.75%) And Hyperbaric Bupivacaine (0.05%) with Fentanyl as an Adjuvant in Patients under Going Elective Caesarean Section: Randomized Double-Blind Clinical Trial
Chiragi Bumiya, Vrushali Aterkar, Neeta Bose, Anup Chandnani, Zalak R Patel, Ami R Patel, Dhruval P Patel, Vikas S Priyadarshi
Aim: To compare hyperbaric spinal Ropivacaine to hyperbaricspinal Bupivacaine with Fentanyl as an adjuvant for elective caesarean delivery in a prospective, randomized, double blinded study. Materials and Methodology: A total of 66 parturients for elective caesarean deliveries received either 15 mg of hyperbaric Ropivacaine (0.75%) (N = 33) or 10 mg of hyperbaric Bupivacaine (0.05%) (N= 33) with 10µg of Fentanyl. Thesensory and motor blockades were assessed and compared between the groups. Surgeons and patients’ satisfaction were also noted. Result: The two groups had similar demographics, and similar timefor onset sensory block to T6 and peak level but duration of sensory block was less in Group R compared to Group B (P<0.001). Total duration of motor blockade was also less in Ropivacaine group (P<0.001) leading to early ambulation and increase the patients and surgeons’ satisfaction score. Conclusion: In this prospective, double-blind study, 15 mg of hyperbaric Ropivacaine (0.75%) proved as effective as 10 mg of hyperbaric Bupivacaine (0.05%) for spinal anaesthesia during caesarean sections. Patients who received Ropivacaine reported higher satisfaction levels, especially regarding early ambulation, as rated by both surgeons and patients.

180. Exploring the Spectrum of Facial Dermatoses in Women: A Retrospective Clinico-Epidemiological Study
Babli Kumari, Shivani, Abhishek Kumar Jha, Vikash Shankar
Background: The psychological and physiological impact of facial dermatoses is particularly distressing for women. This research uses a retrospective clinico-epidemiological method to examine the full range of facial dermatoses in females. Methods: 800 women were analysed for demographics, prevalence rates, and clinical characteristics of different facial dermatoses through a thorough study of medical records, supplemented by interviews when necessary. Chi-square testing and logistic regression were used to study statistical data for patterns and correlations. Results: Acne vulgaris was the most common facial dermatosis (58.4%), but we found a wide variety. Melasma (15.7%), Rosacea (24.9%) are the most commonly found dermatosis. Acne was shown to be more common among teenagers and young adults than in older age groups. The most common kind of rosacea was the erythematotelangiectatic variety. Pregnancy and sun exposure were found to be significant contributors of melasma. Conclusion: Considering age-related prevalence trends, women with facial dermatoses require individualised therapy. Protection from the sun, in particular, is an essential preventative approach for dealing with these issues. Our retrospective clinico-epidemiological study helps to better patient treatment and improves public health initiatives in dermatology, while more research is needed to overcome study limitations and enhance our knowledge.

181. The Impact of Treating Allergic Rhinitis with a Combination of Medications on Bronchial Asthma and Vice Versa
Pramod Prabhakar
Introduction: Asthma and allergic rhinitis are regarded as two distinct manifestations of the same allergic disease. It is still unclear if treating rhinitis-related inflammation leads to improvements in asthma or vice versa. To examine how bronchial asthma and allergic rhinitis are affected by a combination of drugs was the main objective. Method: Patients who displayed both allergic rhinitis and bronchial asthma symptoms were chosen and split into two groups of 60 each. Patients in group 1 had nasal symptoms before pulmonary symptoms. Patients in group 2 were those whose lung symptoms appeared before their nasal symptoms. Following an 11-week treatment period, the effectiveness of intranasal fluticasone and fexofenadine in treating asthma symptoms was evaluated using the pulmonary function test (PFT) and asthma control test (ACT). After 11 weeks, the effectiveness of the combination of inhaled budesonide and salbutamol/formeterol on the symptoms of allergic rhinitis was evaluated in all group 2 patients using the Total Nasal Symptom Score (TNSS) and Visual Analogue Score (VAS). Observation: Patients ranged in age from 24.4±1.53 years on average, with 90 men and 30 women. After 11 weeks, group 1 patients’ mean FEV1/FVC climbed from 63.43 to 68.055 and their average ACT score went from 16.66 to 19.77 (both p values <0.04). The mean VAS score for all symptoms decreased post-treatment in group 2 and the mean TNSS value decreased from 8.817 to 2.8 (both p values 0.04). Conclusion: Thus, the therapeutic relationships between the two disorders that we discovered in this study pointed to the necessity for a coordinated strategy to the care of both diseases.

182. In Relation to Male Infertility, the Environment and Occupational Risk Factor
Komal Gupta
Introduction: Male infertility describes a man’s inability to conceive a child with a fertile woman. Forty to fifty percent of human infertility is caused by male causes. Male infertility is frequently brought on by a decline in sperm quantity and quality. The main objective of this study was to identify the environmental risk factors that may be affecting Lord Buddha Koshi Medical College and Hospital in Bihar’s declining male fertility. Method: 300 infertile males were chosen and assessed for this cross-sectional descriptive study using convenience sampling. Results: As a result of their direct exposure to pesticides and other chemicals, people who applied pesticides are more likely to experience infertility. When they drink alcohol and smoke, a higher percentage of males (39.18%) are infertile. Men who have been exposed to chemicals exhibit sperm destruction and low sperm counts. Conclusion: A variety of contributing factors may be to blame for the multifactorial illness process known as male infertility. Pesticide residues, xeno-estrogens, and dietary and lifestyle decisions could all have a negative impact on spermatogenesis. The negative societal effects should be lessened by taking action to raise awareness of the problem and by looking into male partners first.

183. Current Trends of Antifungal Susceptibility Pattern of Dermatophytosis by E-Test in a Tertiary Care Hospital, Puducherry
Soniya T, Shama Taj K R, Pradha V, Prathyusha Manipathruni
Introduction: The varied clinical presentation of dermatophytosis, which results in delay in diagnosis, poor compliance in follow up of cases consequently spread of infection in the community and antifungal resistance, had rekindled interest in rapid diagnostic method in identification of species and antifungal susceptibility testing. Antifungal susceptibility testing is receiving an increased attention with the advent of newer antifungal drugs. Aims and Objectives: To determine the antifungal susceptibility of the isolates using the E-test method. Materials and Methods: A total of 110 samples were collected from clinically suspected/ diagnosed cases of dermatophytosis patients visiting dermatology OPD. out of which, 82 were culture positive. All dermatophytes species were subjected to antifungal susceptibility testing by E-test method according to the manufacturer’s instructions using E-test strips for Fluconazole, Ketoconazole and Itraconazole. Results: The most active agent against all dermatophytes species was itraconazole with an MIC range of 0.094-12 μg/ml., MIC50 values of 0.094-0.5 μg/ml and MIC90 values of 2-8 μg/ml. Conclusion: The E-test rep­resented a simple and efficacious method for antifungal susceptibility testing of dermatophytes. The emergence of drug-resistant dermatophytes stresses the need of antifungal susceptibility testing.

184. A Hospital Based Study on Profile of Non-Diabetic Patients with Microalbuminuria in Acute Coronary Syndrome
Aaruni Rahul, Shailesh Kumar
Background: Microalbuminuria (MA) is a recognized marker of micro and macrovascular damage in patients with diabetes mellitus and is used as a stand-in for endothelial dysfunction in both diabetic and non-diabetic patients. It is defined as urinary albumin excretion of 30 to 299 mg/d in a 24-hour collection or 30 to 299 μg/mg creatinine in a spot collection. This investigation into the prevalence of microalbuminuria in non-diabetic Acute Coronary Syndrome (ACS) patients was undertaken. Methods: A cross-sectional study was conducted at a hospital with 100 non-diabetic ACS patients in a row. The relationship between Microalbuminuria in study participants and traditional risk factors for coronary artery disease (such as smoking, hypertension, dyslipidemia, and obesity) was investigated. All cases underwent investigations in accordance with the Proforma, which were then entered into the SPSS program for analysis. Results: In the study, there were 73% of non-diabetic ACS patients with microalbuminuria, which was statistically significant (p=0.04). The prevalence of microalbuminuria was statistically significantly greater throughout ACS presentations, peaking in NSTEMI (81.96%), STEMI (63.15%), and unstable angina (55%). With a history of smoking (81.25%, p=0.013) and hypertension (82.25%, p=0.013), it was discovered to be significant. Age, BMI, and dyslipidemia did not seen to be significantly associated. With an increase in risk variables, a statistically significant increased prevalence of microalbuminuria was observed. Conclusion: The prevalence of microalbuminuria is higher in ACS patients. A statistically larger number of cases with a history of smoking, hypertension, and the presence of more risk factors were related with MA.

185. Study of Decreased Serum Total T3 Level in Hepatitis B and C Related Cirrhosis by Severity of Liver Damage
Aaruni Rahul, Shailesh Kumar
Background: Thyroxin-binding globulin metabolism involves the liver significantly. Thyroxin-binding globulin, thyroxin-binding prealbumin, and albumin in plasma bind more than 99% of thyroid hormones. A healthy liver axis is necessary for thyroid function. In order to determine whether there is any correlation between thyroid hormones and the severity of liver damage, the thyroid hormone profile in patients with hepatic cirrhosis brought on by persistent HBV and HCV infections was examined. Methods: The thyroid function status of patients with the diagnosis of hepatic cirrhosis brought on by hepatitis B or C was checked. Scores for Child-Pugh and the MELD model for end-stage liver disease were computed. Patients were separated into two groups, one for each thyroid function test, with lower than normal and normal range thyroid hormones (for TSH, normal and upper than normal). It was considered whether thyroid function tests and the severity of liver disease correlated. Results: Along with an increase in Child-Pugh scores A, B, and C, the number of patients with T3 levels below the normal range (70-110 ng/dL) also increased dramatically. Child-Pugh scores and total serum T3 level were shown to be negatively correlated (r = -0.453, P< 0.001). Additionally, a negative connection (r = -0.305, P = 0.14) between the MELD score and T3 levels was found. Conclusion: In conclusion, the degree of liver damage affects blood T3 levels, which is an excellent indicator of hepatic function.

186. Study of MRI Breast with Special Reference to Diagnostic Accuracy and Assessment of Multifocality of Carcinoma Breast
Priyanka Singh, Ashok Kumar
Background: The existence and identification of multifocal and multicentric illness alters the ideal therapy strategy for breast cancer patients and considerably raises the chance of recurrence. With dense breast parenchyma, mammography has a low sensitivity to find numerous cancer foci in patients. We assessed magnetic resonance imaging (MRI) prospectively as a component of preoperative evaluation. Methods: Women with dense breast parenchyma (> 75% dense tissue) and clinical and radiological suspicion of breast cancer were included. Prior to surgery, mammography, ultrasonography, and MRI were performed on each patient. Multicentric and multifocal disease was found using surgical tissues. Neo adjuvant chemotherapy and radiation patients were not included. Results: 19 patients underwent evaluation. 14 patients had their histological diagnoses confirmed, and five and two patients, respectively, had multifocal and multicentric illness. For mammography plus ultrasound and MRI, the sensitivity and accuracy to identify multiple malignant foci were 42 and 64% and 100 and 92%, respectively (p< 0.05). Conclusions: For women with dense breast parenchyma, MRI is more practical and more accurate than mammography plus ultrasound at identifying both multicentric and multifocal breast cancer. In this group of patients, MRI can enhance the preoperative assessment of breast cancer.

187. Histopathological Analysis of Soft Tissue Tumours in Different Age Groups and Sex in a Tertiary Care Hospital
Kumari Rashmi, Mukesh Prasad Sah, Deepak Kumar
Background: Soft tissue tumors are a variety of lesions that develop from mesenchymal tissues in the body and have overlapping radiological and clinical characteristics. To make the right diagnosis, a histopathological investigation is required. Analysis of the trend and pattern of soft tissue lesions in various age groups and sexes is the primary goal of the current study. Methods: This prospective study was conducted on all specimens that had a clinical suspicion of being soft tissue lesions. The specimens that have been preserved in formalin are handled and inspected under a microscope. Results: Out of 200 cases investigated, 97% of the tumors are benign, while 3% are malignant. 3:1 male to female ratio means that men outweigh women. 31–40 year olds (30%) and 21–30 year olds (27%, respectively, saw the highest number of cases. Lipomatous tumors made up the majority of the benign group (87.6%), followed by blood vessel tumors (7.2%). Only males were observed with malignant tumors. Conclusion: Histopathology is the gold standard diagnostic technique, and a precise diagnosis can only be made after a meticulous and in-depth examination.

188. To Study the Clinico-Hematological Profile of Hemolytic Anaemia at Jawaharlal Nehru Medical College, Bhagalpur, Bihar
Mukesh Prasad Sah, Kumari Rashmi, Deepak Kumar
Background: Red cell (membrane) breakdown exceeds red cell synthesis at a greater pace, resulting in hemolytic anemia. It can either be inherited or acquired. Defects in enzymes and membranes are the primary causes of membrane deterioration. A complete blood count test, a urine test, etc., can be used to diagnose HA. The purpose of this study is to examine the pathological and clinical characteristics of hemolytic anemia. Methods: From May 2022 to April 2023, 150 participants with HA were enrolled in this trial. Each patient’s clinico-hematopoietic profile was documented. Results: According to the present study, sickle cell anemia affected 18.7% of participants, beta thalassemia affected 167.7%, malaria affected 12%, sickle beta thalassemia affected 4.7%, and sickle cell trait affected 39.33%. In male patients, HA was more common (59%). Mean hemoglobin was highest in sickle cell trait (9.2gm/dl) and lowest in thalassemia major (5.2gm/dl). Beta thalassemia major patients had mean total blood bilirubin levels that were highest (1821.4ng/dl), and they also frequently experienced jaundice (57%), splenomegaly (47%) and hepatomegaly (34%). Conclusion: Younger males are more likely to have HA, with beta thalassemia trait and sickle cell anemia being the most common types. Malaria is the main cause of HA, excluding inherited factors.

189. A Comparative, Cross-Sectional Study of Psychotic Mania and Nonpsychotic Mania at a Tertiary Care Hospital
Sanjay Kumar, Indra Deo Singh
Background: Despite the fact that mania is a mood disorder and typically manifests as an elevated or irritable mood, increased goal-directed activity, pressure in speech, and flight of ideas, it can also show signs of psychosis, including Schneiderian first-rank symptoms. The goal of the current study was to compare and examine any discrepancies between groups with psychotic mania and those without it. Methods: For a total of 60 patients, we examined the sociodemographic and clinical characteristics of 30 patients with psychosis and 30 patients without psychotic mania. We conducted structured diagnostic interviews using the Mini International Neuropsychiatric Interview and evaluated the severity of mania using the Young’s Mania Rating Scale (YMRS). Results: Both the length of the hospital stay and Young’s Mania Rating Scale scores (Mann-Whitney U = 785.5; p <0.05) were significantly different between the two groups. In the course of correlation analysis, a negative association between the age of onset and the quantity of psychotic mania episodes was discovered (p = -0.477; p = 0.008). Additionally, a mediocre correlation between hospital stay length and YMRS scores (p = 0.331; p = 0.010) was found. Conclusion: Compared to nonpsychotic mania, psychotic mania tends to be more intense and necessitates a longer hospital stay. In order to change the course of the condition and lessen the socio-occupational damage, specialist early interventions are required in situations where there is a negative link between the age of onset and the number of episodes of psychotic mania.

190. A Hospital Based Cross-Sectional Study on Impairment of Executive Function in Alcohol Dependent Persons
Sanjay Kumar, Indra Deo Singh
Background: One of the most commonly abused substances in the world is alcohol, which is also becoming more and more common in our nation and continues to be linked to a wide range of social, economic, and health issues. This study’s objective was to evaluate the executive dysfunction of alcoholic dependent individuals to that of controls who were of a similar age. Methods: In this single interview cross-sectional hospital-based investigation, 50 alcohol-dependent cases and 50 healthy relatives of the patients were included. The frontal assessment battery (FAB) was used to measure the executive function in all patients and the control group. Results: When the results of the FAB were compared between the cases and the controls, it was discovered that the controls had a mean score of 16.96 and a standard deviation of 1.56, indicating better executive functioning, compared to the cases’ mean score of 10.02 and a standard deviation of 2.64, which indicated more executive dysfunction. Conclusion: Regular and prolonged alcohol use greatly reduces one’s ability to use their executive functions.

191. Comparative Study of MR Mammography and Sonomammography in Characterization of Breast Masses and its Histopathological Correlation
Vinayak Gautam, Shambhavi
Background: The most frequent type of cancer among women is breast cancer. Indian women are more likely to have breast cancer than cervical cancer. For early care and the decrease of mortality and morbidity, early diagnosis and characterization of breast masses are crucial. The study major goal was to define breast masses using high resolution ultrasound and magnetic resonance imaging, and then to contrast the results with those of histopathology. Methods: Women with breast masses participated in this cross-sectional study from February 2022 to January 2023 at the Department of Radio-diagnosis, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. The women got mammograms, breast ultrasounds, and needle biopsies for histological examination. The BI-RADS characterisation criteria were also considered for evaluating the breast lesions. Results: 106 breast masses in total were assessed and included in the analysis. 50 percent (53) of them were benign and 53 percent (53) were malignant. Separately, mammography and ultrasound had sensitivity levels of 68.5% and 72.5 percent, respectively. The combined sensitivity of mammography and ultrasonography was 85%. The BI-RADS 5 category had the highest sensitivity, at 59.9%, while the BI-RADS 3 and 5 categories had the highest specificity, at 100%. The BI-RADS 5 category had the highest accuracy, at 79.9%. Conclusion: The results of this study show that combining ultrasound and mammography could increase the sensitivity and diagnostic precision compared to using these imaging modalities separately. Additionally, to standardize breast imaging reporting, the BI-RADS reporting categorization, which has an ideal positive predictive value, should be encouraged.

192. Correlate Gray Scale and Color Doppler Ultrasonographic Findings of Thyroid Nodules with FNAC
Vinayak Gautam, Shambhavi
Background: Thyroid nodules are characterized by discrete lesions that are radiologically different from the surrounding thyroid tissue. They could be inadvertently seen on high resolution ultrasonography or clinically perceptible. Despite the fact that thyroid nodules are relatively common in the general population, most of them are benign. Although fine needle aspiration cytology is the gold standard for making the final diagnosis and allows for a true differentiation between benign and malignant nodules, high resolution ultrasonography plays a significant role in identifying the characteristics and quantity of lesions. Methods: From May 2022 to April 2023, the Department of Radiodiagnosis at Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar, conducted this hospital-based observational study. After getting written consent, fifty patients in all presented with thyroid enlargement or a palpable nodule with or without symptoms. Each patient had FNAC utilizing a 23G needle after high resolution ultrasonography using a 7–12MHz linear transducer. The outcomes were statistically evaluated with the right tools and procedures. Results: Most of the patients in our study were female and ranged in age from 30 to 60 years. Due to an inadequate sample size, FNAC failed to provide the final diagnosis in 4/50 cases. With USG, the identification of benign and malignant conditions was rather precise. While the majority of malignant nodules were hypoechoic on USG, the majority of adenomas were hyperechoic. Hypoechogenicity, microcalcification, invasion of the strap muscles, cervical adenopathy, and intralesional vascularity were indicative of malignancy. Thyroiditis and adenoma were the conditions that USG detected with the greatest accuracy, followed by colloid nodules, and malignant nodules with the least accuracy. Conclusion: It is possible to accurately distinguish between benign and malignant lesions using gray scale ultrasonography in conjunction with color Doppler imaging, as well as to identify thyroiditis or toxic goitre adenoma lesions. It aids in evaluating whether a nodule is solid or cystic. The USG clearly shows the amount of lesions. FNAC can be used to offer the tissue diagnosis in challenging circumstances.

193. Pyrazinamide Induced Hyperuricemia and Role of Allopurinol
Gyan Bharti, Deepti Saxena
Introduction: Tuberculosis is contagious and airborne disease. It is a disease of poverty affecting mostly young adults in their most productive years .95% of TB related deaths occur in developing world. Thus, the prevalence of TB was halved. India is the highest TB burden country accounting for 1/5 of the global incidence. where the global annual incidence for TB is to be 9.4 million cases, nearly 2,000,000 cases are reported from India. India ranks 17th among the 22 high burden country in terms of TB incidence rate, Pyrazinamide is a synthetic pyrazine analog of nicotinamide. It has a strong bactericidal activity against mycobacterium tuberculosis and has become an important component of short-term multiple drug therapy of tuberculosis. Hepatotoxicity is the commonest dose related adverse effect. Hyperuricemia is another important adverse effect reported with drug. Pyrazinamide inhibits renal excretion of urates frequently resulting in hyperuricemia. The effect is usually asymptomatic but acute gout has occurred in some patients. Methodology:  This observational study was conducted in Indraprastha Apollo hospital Sarita Vihar New Delhi in the department of Respiratory Medicine Critical Care and Sleep Medicine prospectively from May 2010 to December 2012. A total of 100 newly diagnosed cases of pulmonary Koch’s disease, patient who were on pyrazinamide containing regimen of category 1 ATT (intensive phase), Patients who gave consent for the study were included in the study. Results: In this study uric acid level was increased more in age group 26 to 35 years against the age group 41 to 60 years in our study. 36% patient developed hyperuricemia at the end of second week, 52% develop hyperuricemia at the end of the third week and 42% developed hyperuricemia at the end of 4th week of people.

194. A Study of Clinical Pattern and Severity of Atopic Dermatitis and its Correlation with Serum IgE Levels
Deepti Saxena, Gyan Bharti
Introduction: Atopic dermatitis is a non-contagious, intensely pruritic, inflammatory, chronic skin disorder having a course of exacerbation and remissions, occurring in infancy and childhood running in families with a history of atopy. It is frequently associated with an elevated immunoglobulin E level in serum. Serum IgE level in normal (non-ectopic) individual are only 0.05% of the IgE concentration.  Although IgG is typically the least abundant isotype, it is capable of triggering the most powerful immune reaction increase serum level of IG has subsequently been reported in patients with asthma, hay fever, atopic dermatitis. And also, in patient infested with intestinal parasites in several studies the concentration of other immunoglobulin classes has been investigated in atopic subjects. Thus, in this study we have studied the clinical pattern where topic dermatitis and IgE level inpatient diagnosed with atopic dermatitis, and we have also studied the correlation between the severity of AD and serum IgE levels. Material and Methodology: This cross-section type of descriptive study was conducted at Skin Institute and the School of Dermatology, Zamrudpur, Greater Kailash 1, New Delhi over a period from May 2010 till December 2011 instruct clinically diagnosed 100 cases of atopic dermatitis were included in the study. The diagnosis of AD was made on the basis of Hannifin and Rajka’s diagnostic criteria and presence of at least three major and three minor criteria were needed to diagnose the patient. Results: In this study 65% were males and 35% were female the male: female ratio was calculated to be 1.86: 1. Mean serum IgE levels among the study participants was found to be 1084.73± 776.27, medium value was 994.5. It was seen that in the study group out of 100 patients, 17 patients were in the age group of 1- 5 years, 31 patients in the age group of six to nine years, 50 patients in the age group of 10 to 15 years and only two patients are in the age group of above 15 years. On comparing the SASSAD score with serum IgE level of the study group it was found that severity score was higher in patient with raised IG E levels which mean that the patient with raised IE values have more severe disease.

195. A Comparative Study of Ultrasonography and Computed Tomography for Measuring Optic Nerve Sheath Diameter in Patients of Hemorrhagic Stroke
Soumik Sarkar, Partha Sarathi Sarkar, Silpa Priyadarsini Padmaraju
Objective: The primary aim of this study was to compare optic nerve sheath diameter (ONSD) measured using ultrasonography (USG) and computed tomography (CT) in patients with hemorrhagic stroke. The secondary aim of this study was to evaluate the diagnostic ability for detecting elevated intracranial pressure using ONSD measured by USG (USG-ONSD) and by CT (CT-ONSD). Patients and Methods: This prospective, observational study was undertaken from April 2022 to July 2022 in the Radiology Department of IQ City Medical College, Durgapur, West Bengal. ONSD was measured by USG and CT at 3 mm behind the posterior aspect of the globe. Result: A total of 69 patients have been studied. The median USG-ONSD and CT-ONSD were significantly higher in patients with haemorrhagic stroke. ROC plotting showed the significant agreement between CT & USG Measurements. Conclusion: The ONSD measured using USG and CT was increased in patients with elevated intracranial pressure in hemorrhagic stroke. Measurement of ONSD by USG and CT showed positive correlation.

196. Bedside Ultrasonographic Measurement of Optic Nerve Sheath Diameter In Acute Haemorrhagic Stroke Patients
Soumik Sarkar, Partha Sarathi Sarkar, Shreyam Bishayi
Objective: The aim of this study was to measure the optic nerve sheath diameter using Ultrasonography (US) in acute hemorrhagic stroke patients, as a surrogate for detecting raised intracranial pressure. Patients and Methods: This prospective observational study was undertaken from July 2020 to May 2021 in Radiology Department of IQ City Medical College, Durgapur, West Bengal. ONSD was measured 0.3cm from the posterior aspect of the globe by US. Result: A total of 48 patients have been studied. ONSD on Ultrasound shows a moderate positive correlation with midline shift and haemorrhagic volume in patients with acute haemorrhagic stroke. From the Pearson’s correlation  results,  we conclude that there exists a moderate positive correlation in between  US ONSD with midline shift  and US ONSD with haemorrhagic volume,  r=0.67 and r=0.62 were respectively. Consider the level of significance at 95% such that p <0.05. Conclusion: ONSD measured using Ultrasound shows moderate positive correlation with features of increased intracranial pressure in patients with acute haemorrhagic stroke.

197. Acute Presentation of Central Nervous System Tuberculosis:  A Retrospective Study and Review of Literature
Irfan Ahmad Shah, Shoaib Yousuf, Waseem Mirza, Ifra Urooj, Khushboo Ahmad
Tubercular meningitis has been classically described as sub-acute or chronic meningitis that evolves over a course of weeks to months. However in some cases the onset is acute or sometimes abrupt with features of encephalitis. In a review of adult patients of tubercular meningitis, 10 cases were found to have an acute presentation with features of encephalitis. Acute presentation was defined as symptom duration of 07 days or less. The international encephalitis consortium criteria were used for case definition of encephalitis. The patients varied in age between 14 to 35 years. Three patients had definite tubercular etiology while three were probable and four were possible tubercular encephalitis. Encephalopathy manifested in the form of worsening of sensorium in 06 patients, irritability in 02 and behavioral disturbance in 02 patients. The average duration of symptoms before presentation was 5.2 days. Signs of meningeal irritation were present in 09 patients. On CSF analysis, all patients showed pleocytosis with elevated CSF protein, while glucose was low in 08 patients. The average time delay before commencement of anti-tubercular treatment was 11.6 days. Nine patients improved while one died during hospital stay. Acute encephalitic presentation of central nervous system tuberculosis is an under recognized entity that requires a high index of suspicion. Early recognition of this entity can be life- saving and prevent serious complications.

198. The Impact of Surgical Techniques on Spinal Accessory Neuropathy: A Comparative Analysis of Neck Dissections at a Single Tertiary Care Center
Abhinav Rathi, Rachit Jain, Poonam Verma, Anju Singh
Background: In high-risk areas like India, head and neck cancers are a huge global health burden. Squamous cell carcinomas can develop in a variety of head and neck regions as a result of prolonged exposure to risk factors like alcohol, tobacco, and viral infections. Unique demographic and healthcare issues in India make it more difficult to manage this malignancy, including delayed diagnoses, poor access to care in rural areas, and side effects from treatment such shoulder weakness. By examining the effects of various neck dissection methods on spinal accessory neuropathy, we can learn more about its prevalence, risk factors, clinical signs, and functional results. Methods: At one tertiary care facility in India, 48 patients with head and neck cancer who undergone various neck dissections participated in a prospective study. Preoperatively and at 1 and 3 months after surgery, clinical evaluations comprising arm abduction tests (ABT) and electromyography (EMG) were carried out. The correlation between surgical methods, lymph node involvement, tumour invasion, and shoulder disability was evaluated statistically. Results: Across all surgical methods, postoperative EMG readings significantly decreased, indicating nerve dysfunction (p = 0.005). Necks with nodes were stiffer and showed more severe nerve dysfunction (p 0.001). These findings were supported by ABT scores, with stiffness patients reporting more significant postoperative decreases (p 0.005). Increased tumour invasion and positive lymph node counts were associated with worsening shoulder impairment (p 0.05). Conclusion: Shoulder dysfunction is significantly impacted by various neck dissection techniques, with node-positive necks and severe nodal involvement providing increased hazards. It is crucial to customise surgical methods to reduce nerve and muscle stress. For patients having neck dissections, additional research might result in improved surgical approaches and rehabilitation procedures.

199. Study of Menstrual Problems of Adolescent Girls Attending a Tertiary Care Hospital
Pratibha Jha, Seema
Background: Menarche is regarded as a turning point in a girl’s growth and development. Menstrual cycle onset age and pattern depend on a variety of variables. Many adolescent females experience dysmenorrhea, heavy bleeding, and irregular menstruation after menarche. The current study’s goal was to assess the sociodemographic characteristics of adolescent girls experiencing menstruation issues, as well as the nature of those problems and how they were handled. Methods: This retrospective study was carried out at the Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from September 2020 to August 2021. Results: 141 teenage girls with menstruation issues visited our hospital overall. 90 of them (63.8%) were late adolescents, 135 (95.7%) lived in cities, 70 (49.6%) belonged to the middle socioeconomic class, and 126 (89.3%) were single. Amenorrhoea, dysmenorrhoea, and irregular menstrual periods affected 86 (61%) people, 38 (27%) people, and 17 (12%) people, respectively. Patients were treated with appropriate counselling as well as medicinal and/or surgical care. Conclusion: In our study, the majority of the adolescent girls were anemic. Therefore, it is essential to educate people on the importance of nutrition, different menstrual disorders, normal physiology, and the prevention and management of anemia.

200. Study on Occurrence of Symptomatic Urinary Tract Infection and Asymptomatic Bacteriuria during Pregnancy and its Association with Maternal Outcome
Pratibha Jha, P. K. Mishra
Background: The likelihood that the illness may advance from asymptomatic bacteriuria (ABU) to a urinary tract infection (UTI) with symptoms, which may thereafter result in pyelonephritis and obstetric consequences, is increased by the pregnancy. The unfavourable outcome could lead to early delivery, poor birth weight, and increased fetal mortality. The goal of the current study is to evaluate the risk factors for UTI, the outcomes for mothers, the incidence of symptomatic and asymptomatic bacteriuria, and the bacteria that cause UTI during pregnancy. Methods: Between April 2022 and March 2023 at SDH/CHC, Biraul, Darbhanga, a total of 152 pregnant women with and without signs of a urinary tract infection were included as study participants. Midstream urine samples were obtained and processed after bacteriological tests as per usual procedure. Results: In the current study, 67 (44.1%) cases of bacteriuria were asymptomatic, while 85 (55.9%) cases had symptomatic UTIs. In 61 (49.6%) of the patients, E. coli was the most common bacterium identified, followed by Staphylococcus aureus in 24 (19.5%), Klebsiella pneumonia in 16 (13.0%), CONS in 12 (9.7%), and Enterococcus faecalis in 10 (8.1%) cases. The lower socioeconomic status was a factor in 65 (42.8%) cases, and the majority of the cases involved either high school (47.4%) or primary school (38.8%) as the only educational level. Of the 118 vaginal births, 101 (85.6%) were full-term normal births, however of the 17 (14.4%) preterm births, 12 (10.2%) had symptomatic UTIs and 05 (4.2%) had asymptomatic bacteriuria. Conclusion: Our study results demonstrated that increased symptomatic UTI and ABU were primarily attributed to low socioeconomic position and educational level. Regarding gestational age, there was no discernible variation in the prevalence of UTI and ABU. The study came to the conclusion that early and fast treatment of ABU during pregnancy greatly lowers the likelihood of a negative pregnancy outcome. As a result, it is advisable to check for ABU before becoming pregnant. Our study also revealed that the third trimester had a greater frequency of UTIs. Therefore, in the first trimester, all pregnant women should be screened for the presence of ABU, treated vigorously with the appropriate antibiotics, and promptly followed up.

201. Role of PFN Antirotation II in Osteoporotic Intertrochanteric Fractures, its Clinical and Functional Outcome: A Retrospective Study
Syed Azher Hussain, Mohammed Ibrahim, Akshayraj B Patil
Fractures around the hip are the most common osteoporotic fractures in geriatric patients. 35-40% of these fracture being unstable. Trochanteric fractures, especially unstable ones are associated with high rates of mortality and morbidity. Surgical fixation is accepted for managing inter-trochanter fractures to attain acceptable reduction and early mobilization after surgery in elderly patients. Materials and Methods: This was a retrospective study held in Department of Orthopedics Gulbarga Institute of Medical Sciences, Gulbarga. A total of 98 patients between from November 2019 to November 2022. Both Male and female patients were retrospectively included. Written informed consent was taken from all those included in the study. Results: Among 98 cases, 66 cases (67.34 %) were males and 32 cases (32.65%) were females. According to Boyd and Griffin classification, the most common Type of fracture is Type-4. Most common mode of injury was trivial fall. The mean duration of surgery was 39.45 min. The mean blood loss was 80.9ml. The mean value of fluoroscopic images used 28.2. The mean value of length of hospital stay was 6.1 days. The average Harris Hip Score obtained at final follow-up was 77.85. It’s a good compare to PFN gives good fixation, short operative time, less blood loss, less fluoroscopy image, less scar mark, less hospital stay. Conclusion: PFNA2 has a superior performance in the setting of osteoporosis, which is attributed to compaction of cancellous bone by the helical blade.

202. A Review of 50 Cases for the Management of the Sternal Dehiscence with the Pectoralis Major Flap
Rajesh Kumar, Vikas Kumar
Aim: The main motive of the study is to give details of the management of the sternal wound dehiscence with the help of the pectoralis major flap. Methods and Materials: A retrospective study of 50 patients who were subjected to a pectoralis major flap was carried out for the surgery of aortocoronary bypass and other diseases present since birth for two years at Patna Medical College and Hospital, Bihar, India. A double breasting technique using rectus extension was used for the unilateral or bilateral pectoralis major flap. The success of the surgery was accomplishing wound healing helps in the evaluation of the result. The patients were followed up from 4 months to 3 years. Result: 50 patients underwent pectoralis flap surgery. The patients were admitted to the hospital from 7-50 days after the flap surgery. The majority of the patients are released from the health care center by the complete closure of the wound. Due to sclerosing mediastinitis, 2 patients died right after the surgery. Shoulder joint movement was normal in all the patients. Conclusion: Treatment should include removing dead tissue from the wound and covering it with well-vascularized tissue. The double breast technique using rectus extension covers the entire defect without hampering the shoulder movement.

203. Comparison of EMG Responses of Serratus Anterior and Lower Trapezius in Push up Plus Variation Exercises on Stable and Unstable Surface in Subjects with Scapular Dyskinesia
Ganaie MI, Haque MK, Hussain S, Muzaffar J, Shagufta S, Muzaffar T
Introduction: This research evaluates the activation of muscles in scapular dyskinesis subjects and normal individuals during the execution of Push-Up Plus (PUP) exercises on both stable and unstable platforms. Methods: An EMG was used to examine the differences in muscular activation, with an emphasis on the serratus anterior and lower trapezius amidst the PUP exercises on the two distinct surfaces. Results: The research discovered increased muscle activation in scapular dyskinesis subjects on stable surfaces when contrasted with normal participants. In contrast, exercises on unstable surfaces showed no discernable difference between the two groups. Additionally, it was observed that there was a reduction in the activation of the lower trapezius and no significant alteration in the serratus anterior activation during PUP exercises on an unstable surface compared to a stable surface. Discussion: The study indicates that participating in unstable resistance training may lead to high muscle activation levels, causing less strain on the joint system and mimicking daily activities or sports demands. However, the degree of instability should be moderate to enable sufficient EMG levels to strengthen muscles. The study also speculates that scapular muscle activation may vary during similar exercises between subjects with shoulder dysfunction versus those with regular shoulder function. Conclusion: The research recommends further investigation into the impact of irregular surfaces on muscle activation, especially the rotator cuff muscles, and subsequent studies involving athletes suffering from shoulder impingement syndrome. This information would be invaluable for fitness coaches and rehabilitation experts to construct effective exercise programs targeting specific upper body musculoskeletal muscles.

204. Evaluation of Clinical Aspects of Varicocele and its Laparoscopic Management
Abhinav Kumar
Introduction:  Varicocele is the growth of twisted male reproductive veins, impacting 15% of men. It induces male infertility, and diagnosis pertains to physical exams or ultrasounds. Surgery alternatives differ, with laparoscopic transperitoneal Palomo varicocelectomy being famous. Testosterone disruption is related to varicoceles. Standards for ideal surgery comprise cost-effectiveness, minimal complications, and testicular process preservation. Aims and Objectives: The study examine Clinical Features and Laparoscopic Treatment of Varicocele through a Comprehensive Assessment. Method: The study focus of this examination was on a cohort of 31 individuals diagnosed with varicocele, a situation involving enlarged veins within the scrotum. The investigation followed a coming and observational analysis methodology, striving to reveal the multifaceted effect of varicocele on various parameters. By assuming this methodological strategy, the investigators pursued to verify a holistic understanding of how varicocele impacts various aspects, spanning from the initial physical signs to the diagnostic insights and the results of the surgical intervention. Result: The study’s results reveal the distribution of age groups among participants, along with symptom profiles and varicocele factors. Left-sided varicoceles were most familiar (77.19%), while Grade III (45.16%) was the predominant type. Ultrasound measures demonstrated pampiniform plexus vein diameter dilation and Valsalva manoeuvre flow reversal. After varicocelectomy, statistically significant improvements were pointed out in sperm density, motility, and pain scores. Laparoscopic ligation was the introductory approach (93.54%), with a mean operative time of 34.5 minutes for unilateral. Conclusion: Laparoscopic varicocelectomy shows a clearer perspective, quicker recovery, and a useful solution for enhanced quality of life.

205. A Clinical Study of Fundus Changes in Patients with Hypertensive Disorders of Pregnancy (PIH) in a Tertiary Care Centre
Bharat Kumar Jain, P. Satyavathi Devi, A. Venkata Ramana, E. Ramadevi
Background: This study was conducted to evaluate and determine the prevalence of retinal changes in hypertensive disorders of pregnancy (PIH), recognize the relationship between retinal changes and the degree of hypertension and proteinuria, quantify the prevalence of retinal alterations in 165 women with PIH-related hypertension diseases, and determine as to whether age, gestational age, parity, blood pressure, proteinuria, serum creatinine, serum uric acid, blood urea, and the severity of the disease are associated with the retinal alterations. Methods: This was a hospital-based observational study conducted among 165 pregnant females who had been admitted with HDP (PIH) to the Department of Obstetrics and Gynecology and those who had been sent to the Ophthalmology Department at Government General Hospital Srikakulam from March 2021 to August 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: When the severity of hypertension and fundus findings were studied and correlated, the data was statistically analysed using Fisher’s exact test and the p-value was found to be < 0.001. Fundus changes and the degree of proteinuria are studied and correlated. Data was statistically analysed using the Chi-Square test and the p-value was found to be < 0.001, showing a positive correlation between the two variables. When the results were statistically analysed using the one-way ANOVA test, a significant correlation between blood urea levels, levels of serum uric acid, levels of serum creatinine and the severity of PIH was discovered, with a p-value of 0.001. Conclusion: The health of the foetus depends on placental circulation. An ophthalmoscopic examination of the mother’s fundus may provide a clue to similar microcirculation changes in the placenta and indirectly to the wellbeing of the foetus. These changes serve as a guideline for termination of pregnancy as they may reflect similar ischaemic vascular changes in the placenta.

206. To Evaluate Efficacy and Safety of Latanoprost and Timolol in Patients of Primary Open Angle Glaucoma in a Tertiary Care Hospital of North India
Sanjay Kumar Verma, Neetu Gupta, Akanksha Suman
Background: Glaucoma is a progressive disorder of eye characterized by raised intraocular pressure (IOP) leading to optic nerve damage and blindness. There is rapid shift from traditional use of beta-blockers to PG analogues for the treatment of primary open angle glaucoma (POAG) as first line of drug therapy. In this study we compared the efficacy and safety of latanoprost (PGA) with Timolol (beta-blocker). Materials and Methods: A total of 70 newly diagnosed patients POAG who fulfilled the inclusion/exclusion criteria were enrolled and randomized into two groups. The first group (L-Group) was prescribed topical latanoprost 0.005% eye drop once daily, whereas the second group (T-Group) was prescribed topical timolol 0.5% eye drop twice a day. IOP was recorded at baseline, at the end of 1st week, 4th week and 12th week in both the groups and assessment of any adverse effects was done. Results: The IOP lowering efficacy of latanoprost was found to be superior to timolol. In the latanoprost group, the mean reduction in IOP from baseline to final visit was 10.13±0.13 mmHg, whereas only 5.84±0.03 mmHg in the timolol group which was statistically significant (p-value <0.001). Predominant adverse effect in L-group was conjunctival hyperemia and in T-group it was dry eye. Conclusion: Latanoprost was found to be having better efficacy and safety as compared to Timolol.

207. Clinical Picture of Oral Submucous Fibrosis and the Effect of Local Triamcinolone Therapy
Ashok Bhimrao Garje, Neeraj Ratnakar Shetty, Megha Panjiyar, Suresh Kumar Tarachand Jain, Veena Ramchandra Karkhele, Shanta N. Satpathy
Aim: Evaluation of habits, duration, causative factors and effect of intralesional Triamcinolone in oral sub mucosal fibrosis. Materials & Methods: Design- Prospective observational study, Setting- Tertiary health care hospital, Subjects- Cases of Oral submucous fibrosis with restricted mouth opening attending ENT OPD who were willing to be a part of the study. Methods: Diagnosis of OSMF was made on clinical features. Written and informed consent from all patients and in case of minors from their parents/guardians was taken. Detailed history was taken with special importance to the habituations and dietary habits. Detailed examination of oral cavity, oropharynx, nose and ear was done and disease staged. Treatment with Triamcinolone Acetate, injected submucosally in the dosage of 1 ml (40 mg) locally biweekly at sites of fibrosis was given. After 12 weeks, response to treatment was evaluated objectively by measuring the increase in inter–incisor teeth distance and subjectively on the basis of improvement in symptoms. Results: Mean age was 27.48 years. Males were 2.5 times more commonly affected than females. Most (56%) of the patients used Gutkha. Following treatment, 26 % showed an increase in mouth opening of greater than 11mm. highly significant improvement in the inter incisor mouth opening was seen following with submucosal injection of triamcinolone. There was statistically significant negative correlation between increase in mouth opening, duration of the habituation and frequency of addiction of the patients. Conclusion: There is both subjective and objective improvement in OSMF after treatment with intralesional steroid injection treatment.

208. A Study of Risk Factor for Delirium in Patients at Tertiary Care Hospital
Palani Swati, Ravi Thakkar, Milind Makwana, Naren Amin
Background: Delirium is a clinical syndrome that usually develops in elderly patient. It is characterized by disturbance in attention (reduced ability to direct, focus, and sustain attention) awareness (reduced orientation to the environment), and cognition (memory deficit, disorientation, language, visuospatial ability or perception). The disturbance develops over short period of time (usually hours to few days), represents a change from baseline attention and awareness and tends to fluctuate in severity during the course of a day. Aim and Objective: To describe the risk factors for delirium in patients at tertiary care hospital. Material and Methods: An observational study was conducted from January to June 2023, among the delirious patients admitted at tertiary care hospital of Surendranagar. The delirium status was assessed by clinical observation using DSM-V criteria. Total 50 patients were taken. Data were collected from medical records of patients. Data were entered and analysed using Microsoft excel version 2021. Results: The mean age of the patients was 57.11+/-19.63. Around 68% patients were aged above 50 years. Among delirious patient majority were male (74%). Nearly 1/3rd patients were from medicine ward. Among the delirious patients 32% having cardiac disease. Hyponatremia was found in 62% patients. Conclusion: It is concluded that majority patients were of older age (>50). Patients having cardiac disease, prior cognitive impairment, operated cases, hyponatremia, low chloride level could be a probable risk factors for development of delirium. It is recommended that prior knowledge of risk factors helps to manage patients efficiently and reduce the risk of delirium development.

209. Presence of SARS-Cov-2 in Nasopharyngeal and Conjunctival Swab of Residents of Hotspot Areas of Jaipur
Gupta Madhu, Goyal Girdhar, Atreya Tanu, Gupta Nidhi
Introduction: The COVID-19 pandemic, is an on-going  (COVID19), caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV2). This is still a big question, whether the coronavirus is present in conjunctival secretion or not? The relationship between COVID-19 and the ocular surface (conjunctiva, corneal epithelium and tear film) as a potential portal of entry and as a transmission mechanism is currently under discussion due to the high transmission rate of the disease. We did this study to identify presence of the virus at the conjunctiva and prevention of spread in the ophthalmology context. Methods: This Community based descriptive observational study was done in different hot spot areas by Department of Ophthalmology of Government RDBP Jaipuria Hospital (attached RUHS-CMS) Jaipur, Rajasthan in collaboration with CMHO Jaipur team. Total 158 subjects from the 4 hotspot areas of 18 years to 60 years age group (those who had history of contact with COVID positive patient) were included in our study and ophthalmological evaluation is done by torch light and tested for presence of SARS-Cov-2 by RT-PCR method in nasopharyngeal and conjunctival swab samples. Results: Out of total 158 subjects, in all 4 hotspot areas (A+B+C+D), 37 (23%) were symptomatic, rest 121 were asymptomatic. In hotspot area C (closed campus), out of total 37 subjects, 20 were symptomatic. At all the 4 hotspots (A+B+C+D) out of total 158 screened subjects 29 (18.35%) were positive for nasopharyngeal swab for COVID-19 but none of them had positive conjunctiva swab. At hotspot C (closed campus) out of total 37 screened subjects 16 (43.24%) were positive for nasopharyngeal swab for COVID-19 but none of them had positive conjunctival swab. Conclusions: This study shows that out of total 158 subjects, in all 4 hotspot areas (A+B+C+D), 37 (23%) were symptomatic, rest 121 were asymptomatic. In hotspot area C (closed campus), out of total 37 subjects, 20 were symptomatic. SARS‑CoV‑2 was negative in conjunctival secretion swabs of all the subjects living in hotspot areas. Hotspot C (closed campus) which was a closed area had a very high positivity of nasopharyngeal swab for COVID-19 disease (43.24%) but none of them had positive conjunctival swab testing by RT-PCR method. On the basis of our study, we can conclude that risk of transmission of SARS-CoV-2 is unlikely through conjunctical secretions if patient is asymptomatic.

210. Determination of Biochemical Parameters (AST, ALT, Total Protein, Albumin and ALP) in Corona (COVID-19) Patients
Laxmi Naval, Krishna Murari Lodha, Rinku Bansal, Ajay Kumar Bhargava, Deepti Gautam
Background: Present study was conducted to determine the biochemical parameters in Corona (COVID-19) patients and considering age and gender. Objectives: To determine and compare the levels of AST, ALT, TOTAL PROTEIN, ALBUMIN and ALP in the corona patients and healthy controls. Methods: Determination & comparison of serum (AST, ALT, TOTAL PROTEIN, ALBUMIN and ALP) was done between 50 Corona patients & 50 healthy controls. Biochemical parameter (AST, ALT, TOTAL PROTEIN, ALBUMIN and ALP) analysis was done using fully auto analyzer. Statistical comparison was done, results were expressed as Mean ± SD, p < 0.05 was considered to be statistically significant. Results: All groups were statistically matched in age distribution analysed. Serum (AST) concentrations in cases & controls were (61.14 ± 41.34 IU/L) & (34.26 ± 16.67 IU/L) respectively (p <0.0001). Serum (ALT) concentrations in cases & controls were (58.24 ± 45.60 IU/L) & (27.24 ± 14.63 IU/L) respectively (p <0.0001). Serum (TP) concentrations in cases & controls were (6.72 ± 0.94 g/dl) & (6.55 ± 1.16 g/dl) respectively (p =  0.424). Serum (Alb.) concentrations in cases & controls were (3.85 ± 0.89 µg/dL) & (3.87 ± 1.11 µg/dL) respectively (p = 0.890). Serum (ALP) concentrations in cases & controls were (97.76 ± 44.99 IU/L) & (99.48 ± 57.52 IU/L) respectively (p = 0.868). Interpretation and conclusion: Sreum (AST, ALT) showed significant increases in corona (covid-19) patients as compare to healthy controls, serum (TP, Albumin, ALP) were found insignificant.

211. Comparative Study of Intra-Articular Clonidine and Bupivacaine for Post-Operative Analgesia in Patients Undergoing Arthroscopic Knee Surgeries
Smriti Tiwari, Vaishali Mohod, Sunita Nayak, Saurabh Tiwari, Madhuri Dhabarde
Background: This study was conducted to evaluate the postoperative analgesic effect of intraarticular clonidine, compare the postoperative analgesic effect of intraarticular clonidine alone and in combination with bupivacaine, study the duration and quality of postoperative analgesia, study side effects if any, and determine as to whether the combination of intraarticular clonidine and bupivacaine is better than clonidine alone. Methods: This was a hospital-based prospective, randomised, double-blind and comparative study conducted among 60 patients of either sex scheduled to undergo elective arthroscopic knee surgery after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Patients were assigned to one of the three treatment groups, in double-blinded randomized manner of 20 each. Group I: received 30ml of 0.25% bupivacaine intraarticularly. Group II: received 30ml of 0.25% bupivacaine with 1 ug/kg of clonidine intraarticularl. Group III: received 1ug/kg of clonidine in 30ml of saline intraarticularly. Results: There was a significant difference in the postoperative pain score between the three groups. The mean value of the VAS score at rest at 4 hours, 8 hours and 12 hours was significantly lower in Group I as compared to Group II and Group III. P-value <0.05. The mean value of the VAS score at movement at 2 hours, 4 hours and 12 hours was significantly lower in Group II as compared to Group I and Group III. P-value <0.05. The mean value of the postoperative sedation score at 1 hour, 2 hours and 8 hours of intraarticular drug administration was significantly higher in Group II as compared to Group I and Group III (p-value <0.05). The mean value of the duration of analgesia in Group II was 533.5 min, which was significantly higher as compared to Group I’s 510.9 and Group III’s 512.5. (p-value <0.05). The post-operative requirement for analgesics during the first 24 hours of surgery was lower in Group II as compared to Group I and Group III. The mean dose of rescue analgesic required was 3.4 in Group II as compared to 3.95 and 4.4 in Group I and Group III respectively (p-value <0.05). The patient in Group II showed good analgesia and an earlier postoperative discharge from the hospital. The mean time of discharge from the hospital in Group II was 25.35 hours as compared to 27.9 hours and 27.6 hours in Group I and Group III respectively (p-value <0.05). Conclusion: There were no significant differences among the three treatment groups with respect to duration of surgery, or the time of discharge from OT recovery room. There was mild sedation in intraarticular clonidine group. Thus, the combination of intraarticular clonidine and bupivacaine provided longer duration of analgesia than either of the drug when used alone.

212. Prevalence of Headache and Eye Disorders among IT Professionals
Amrita Chakravarty, Shweta Sulabh, Preethi G., Rajani Netravati Kaki, Nagapriya N.G.,  Puneeth S., Varsha Natesh
Background: Computer usage have become part of our lives, being used by everyone ranging from children to IT professionals. Usage of digital screens have made our lives easier but has increased diseases associated with long hours of screen usage. Problems related to the eyes include frequent headaches, refractive errors, double or blurry vision, dry eyes, focusing difficulties, eye irritation, excessive tearing, eye pain and eye fatigue which have been recently grouped under, ‘Computer Vision Syndrome’ (CVS). Our study aims to find these diseases among people who have extended hours of screen usage. Methods: The present cross-sectional study was conducted on 150 IT professionals working in Bangalore, consent being taken. A structured questionnaire was prepared to assess the various aspects of headache among IT professionals such as duration, frequency and severity, as well as the incidence of ocular pain, refractory errors and spectacle usage among the same. The main criterion for selection of subjects is daily computer usage. The questionnaire was distributed among consenting subjects within the work premises of various companies of the Information Technology Industry in Bangalore. Duration of 5 minutes was given per subject to fill out the questionnaire. Their identities are kept undisclosed in order to maintain confidentiality. Results: Out of the 150 IT Professionals we conducted the study on, 93 of them suffer from headache i.e. with Prevalence Rate of 62.4% and 65 of them had Eye Pain i.e. with Prevalence Rate of 56.4%. There were a total of 114 Males and 36 Females. Conclusion: In conclusion, it was found that the prevalence of headache amongst IT professionals was quite high and increased with number of hours of computer usage in a day. The results were found to be similar in males as well as females. Ocular pain was found to be a less common complaint than headache.

213. To Study the Effectivity of Contrast Sensitivity as Marker of Preperimetric Glaucoma Compared to Ancillary Diagnostic Test Like OCT of Optic Nerve Head and RNFL Thickness
Seema Pallawkar, Memuna Bahadur, Arundhati Malviya, Deepanjali Patankar, Veena Karkhele, Sanjana Naik
Background: In this study, we wanted to correlate contrast sensitivity and RNFL thickness in preperimetric glaucoma cases and consider contrast sensitivity as an easily available early marker of preperimetric glaucoma. Methods: This was a hospital-based cross-sectional study conducted at a tertiary care hospital in Mumbai, over a period of two years after obtaining clearance from institutional ethics committee and written informed consent from the study participants. Results: In comparison of age wise distribution of contrast sensitivity in cases and controls, the mean contrast sensitivity was significantly reduced in case group compared to the age-matched control group. In comparison of age wise distribution of average RNFL thickness in cases and controls, the mean RNFL thickness (average) was significantly reduced in case group compared to the age-matched control group. In comparison of RNFL (avg) and CS in cases and controls, a drop in the RNFL thickness (average) in the case group from 75 microns to 65 microns (approximately 13% drop in RNFL thickness) reduced the contrast sensitivity from 1.65 log units to 1.50 log units. Conclusion: Contrast sensitivity alone cannot be used to diagnose a case of preperimetric glaucoma. OCT for RNFL thickness is a better tool for diagnosing cases of preperimetric glaucoma. In a diagnosed case of preperimetric glaucoma, contrast sensitivity can be used as a marker of progression of glaucoma. A drop in contrast sensitivity from previous values mandated a repeat OCT for RNFL thickness to check for glaucoma progression. Assessment of contrast sensitivity by Pelli-Robson’s chart for progression of preperimetric glaucoma is cost-effective.

214. Evaluation of the Format, Prescribing Pattern and Rationality of Prescriptions of the Patients Attending Outpatient Department of a Tertiary Care Hospital of Western Uttar Pradesh, India
Gaurav Kapil, Surabhi Gupta, Sharmendra Singh, Himanshu Agrawal
Objective: The World Health Organization (WHO) recommends that reasonable drug use be followed on a worldwide scale. However, there is a paucity of information from developing nations like India considering the prescriptions’ correctness and their appropriate use. In order to analyze the format, prescribing patterns, and rationale of prescriptions of patients attending Outpatient Department of a tertiary care hospital in western Uttar Pradesh (India), it was decided to conduct the current study. Methods: Photographs of the patient’s prescriptions, meeting eligibility requirements, and visiting   outpatient departments of various specialties facilities of Chatrapati Shivaji Subharti Hospital, Meerut were taken. These prescriptions were analysed using WHO Core Prescription Indicators. Results: Generic names were prescribed for 276 (46%) patients. 171 (28.5%) patients received antibiotic prescriptions. The most often given antibiotic was amoxicillin while most common Fixed Dose Combination (FDC) was amoxicillin-clavulanic acid, which was typically prescribed under a brand name (Augmentin). 72 (12.0%) patients received prescriptions for injections. Conclusion: The majority of the study’s metrics fell beyond the WHO’s recommended range for prescribing indicators. In order to enhance the nation’s prescription medication prescribing patterns and the standard of written prescriptions, an efficient intervention programme, such as training, was advised.

215. Emphysematous Pyelonephritis: A Single Centre Retrospective Study
Ketan Rajyaguru, Rupesh Shah, Vatsal Patel, Urvish Khatri, Krunal Pradhan
We present total 40 cases of Emphysematous Pyelonephritis (EPN) managed between 2018 & 2022. All the cases were analysed retrospectively. EPN was diagnosed by clinical presentation, X-ray, ultrasound and confirmed by CT scan. Total 40 cases (28 females and 12 males) of EPN were diagnosed. Out of 40 cases, 24 were acute pyelonephritis (APN), 12 were urosepsis and 4 were Multi-organ dysfunction syndrome (MODS). All patients were initially managed conservatively with antibiotics and IV fluids. Later patients were managed with either DJ stenting or percutaneous nephrostomy(PCN). Four patients directly underwent emergency nephrectomy. We conclude that we can manage patients of EPN more conservatively with drainage rather than  emergency nephrectomy.

216. Pre-Operative Airway Assessment in Patients Undergoing General Anaesthesia and Management of Difficult Intubation: A Randomised Nonblind Population Based Study
Shilpa Sharda, Swati Sharma, Sonu, Rama Kant, Krishan Gopal Jangir, Nikita Baser
Background: One of the most important causes of anaesthesia mortality and morbidity is the difficult airway. A screening test for prediction of difficult intubation must be rapid, easy to perform at the bedside and provide reliable result. The main goal of the study was to determine which airway assessment test and/or combination of tests was best at predicting difficult intubations. Aims and Objectives: To assess the airway pre-operatively in patients undergoing general anaesthesia. Methods: This observational, prospective study was performed on 80 consecutive adult patients with American Society of Anaesthesia (ASA) class I and II, of both sexes who required endotracheal intubation for elective surgeries under general anaesthesia. Informed written consent was obtained from all the patients. The following test were performed in all the patients during pre-anaesthetic checkup Mouth opening / Inter Incisor Gap, Neck Length, Neck circumferences, Mentohyoid distance, thyromental distance (TMD), sternomental distance (SMD), Modified Mallampati grading and Wilsons scoring system. Result: Vertical neck length, Interincisor gao <5cm, sternomental distance <12.5cm were significant criteria for predicting difficult intubation. For modified Mallampati grading, the test was 80% sensitive and 84% specific. The false positive rate was 16% and positive predictive value was 25%. For Wilson risk score, the sensitivity was 100% and specificity was 86.6% while false positive rate was 13.3% and positive predictive value was 33.3%. Conclusion: Our study concluded that the Wilson risk score is the most preferable for assessment of the airway and predicting difficult intubation.

217. Feasibility of Laparoscopic Appendicectomy in Complicated Appendicitis: A Prospective Single Center Experience
Vikesh Kumar, Sourabh Sharma, Hanuwant Singh, Panth Gheewala, Konark Thakkar, Ambar Prakash
Introduction: The most frequent abdominal emergency in the world and the most frequent reason for abdominal surgery across all age groups is acute appendicitis. Laparoscopic appendicectomy is preferred treatment method for simple acute appendicitis though some people are still hesitant to utilize it in place of an open appendectomy in cases of complicated appendicitis. Aim: This study aims to find the feasibility of laparoscopic approach for complicated appendicitis (perforated appendicitis & appendicular lump) in terms of successful completion, conversion to open, average operating time, post-operative complications and average hospital stay duration. Method: This prospective study included 50 patients who underwent laparoscopic treatment for simple and complicated appendicitis. Conversion to open, average operating time, post-operative complications and hospital stay duration were the outcome variables noted. Result: Out of these 50 patients, 14 patients were diagnosed with appendicular perforation, 6 patients with appendicular lump and 30 patients with acute appendicitis. Six patients were converted to open appendectomy in complicated appendicitis group while none in simple acute appendicitis. 4 out of 50 patients had post-operative complications. Patients who got converted to open procedure had a significantly longer hospital stay. Conclusion: The laparoscopic appendicectomy can be used to safely remove both a perforated appendix and an appendicular lump when expertise available.

218. A Comparative Study between Bronchoalveolar Lavage Cytology and Bronchial Biopsy in Diagnosis of Lung Malignancies
 Manisha Galani, Siddhartha Ghelani, Neelaba Mori, Dhrumi Dobariya
Background: Currently lung malignancy is the commonest malignancy in the world and also the commonest cause of the malignancy related deaths. Different diagnostic methods available to diagnose lung malignancy are imaging study, different types of cytological studies (BAL cytology, bronchial brush cytology, TBNA etc.) and histopathological examination (HPE) of bronchial biopsy. This study was aimed to compare the results of BAL cytology with HPE of bronchial biopsies and to correlate results, as HPE is considered as gold standard for tissue diagnosis. Materials and Methods: This study was carried out at C. U. Shah Medical College, Surendra Nagar in the Pathology Department from January 2018 to December 2022 (5 Years) including 122 patients attending the medicine OPD and was suspicious for lung malignancy. These all patients underwent bronchoscopy followed by collection of BAL fluid for cytology and biopsy for HPE. BAL cytology and HPE of biopsy were done in pathology department. Results of both were compared and correlated. Results: In this study total 122 patients were clinically suspected for lung malignancy. Among which tumour was found in 74 cases on BAL cytology but on HPE 80 patients came out as malignancy. Total number of false positive and false negative cases was 4 and 6 respectively. Sensitivity of BAL cytology was found to be 92.5% and specificity was 90.4%. Conclusions: BAL cytology results and bronchial biopsy (HPE) reports are correlated well for the diagnosis of lung malignancy. Though specific diagnosis or exact typing was done on biopsy only. Sensitivity value of BAL cytology is quite good in our study so it is concluded that BAL cytology can be used as a screening tool for diagnosing lung malignancy and ultimately guide the treating clinician to guide the further management of the patient of lung malignancy.

219. Assessment of Nutritional Status, Initial Haematological Parameters and Sociodemographic Factors in New Sputum Positive Pulmonary Tuberculosis Patients and Their Correlation with Treatment Outcome
Advait Mohan, Suresh Kumar, Anuj K Bhatnagar
Purpose: The purpose of the study was to find out the correlation between the initial nutritional status, initial haematological parameters, and sociodemographic factors and the treatment outcome at the end of 6 months of anti-tubercular therapy of the patients enrolled in the study. Materials & Methods: 100 new sputum positive Pulmonary TB patients were enrolled and the initial nutritional status of the patients was assessed with height, weight and BMI. Other anthropometric indices such as Waist Hip ratio, Mid Upper Arm Circumference, Waist Height ratio were also noted down to find out the nutritional status of the patients. The baseline haematological parameters such as Serum Haemoglobin, Total Leukocyte count, Platelet count, Total Serum Protein, Total Serum Bilirubin, ALT, AST, Blood Urea, Serum Creatinine, Random Blood Sugar were also determined. All the patients who were enrolled in the study were provided with Anti Tubercular Therapy for Drug Sensitive TB for a period of 6 months, as per the guidelines for Drug Sensitive TB under RNTCP. At the end of 6 months of treatment, the treatment outcome of the patients was found out. The patients who were cured were grouped into positive treatment outcome group. The patients who failed the regimen, who were lost to follow up and died during the course of treatment, were grouped into negative treatment outcome group. A few patients who got diagnosed with drug resistant TB during the study were grouped into treatment regimen changed group. None of the patients enrolled in the study developed any serious adverse effects during the study that required them to modify their ATT regimen. Result: In this study, out of 100 new sputum positive pulmonary TB patients, 60% patients were male with a mean age of 42.92± 3.46 years. Out of the total number of patients, 49% patients had a positive treatment outcome (cured), 5% patients succumbed to the infection, 9% patients were lost to follow up, 17% patients failed the treatment and 20% patients had to change their treatment regimen during the course of the therapy. Age and gender of the patients were found to have no significant association with the treatment outcome. 73.5% patients with their body weight above 60 kg had a positive treatment outcome. This corroborates the fact that by improving the nutritional status of the patient, the treatment outcome can improve. The mean BMI of the patients was 20.2±3.7 and 31% patients were underweight. Among the patients who were underweight, 64.5% patients had a negative treatment outcome. This substantiates the fact that underweight TB patients are more prone to have a negative treatment outcome than patients who have a normal BMI. 74.2% of the patients who had a low waist hip ratio ended up having a negative treatment outcome. This further confirms that nutritional status is a determining factor in the treatment outcome of Pulmonary TB patients. The MUAC of the patients were measured and 74.2% patients who were malnourished had a negative treatment outcome. Also, 49 patients who had a normal MUAC ended up having a positive treatment outcome. This establishes that improving the nutritional status of the patients can improve the treatment outcome. The waist height ratio of the patients was also measured and 74.2% of the patients who were underweight, ended up having a negative treatment outcome. Also, 55.1% of the patients who had a healthy weight had a positive treatment outcome. This also favours the fact that proper nutrition can improve the treatment outcome of the patients. 77.4% of the patients who belonged to the lower socioeconomic class, as determined by the modified Kuppuswamy scale had a negative treatment outcome. Also, 55% of the patients who had their treatment regimen changed also belonged to lower socioeconomic class. These points out that backwardness in social and economic conditions of the patients can result in negative treatment outcome. 87.1% of the patients who were anaemic had a negative treatment outcome. This suggests the strong correlation between anaemia and poor treatment outcomes in pulmonary TB patients. Correction of anaemia has to be a priority in pulmonary TB patients undergoing treatment. 87% of the patients with low protein levels had a negative treatment outcome. This points out the fact that hypoproteinemia has to be addressed alongside ATT for improving the treatment outcome in Pulmonary TB patients. Conclusion: Pulmonary TB is associated with significant nutritional abnormalities. The findings of the study point to the fact that apart from BMI as the sole parameter for assessing the nutritional status in TB patients, there is a need to consider other anthropometric indices such as waist hip ratio, mid upper arm circumference, waist height ratio that can significantly correlate with the treatment outcome.

220. Comparing Combined Pills to Progesterone-Only Pills for Abnormal Uterine Bleeding in Perimenopausal Women
Somendra Sahasikdar, Sumit Roy, Kazi Rokeya Rahaman, Balaram Ghosh
Abnormal uterine bleeding (AUB) is a prevalent and troubling indication encountered by perimenopausal females, frequently requiring medical interference. This investigation seeks to evaluate the efficiency and security of merged oral contraceptive pills (COCs) and progesterone-only pills (POPs) in the handling of AUB in perimenopausal females. A randomised regulated experiment was carried out; involving 300 participants aged 45 to 55 years with abnormal uterine bleeding. Participants were arbitrarily allocated to receive either combined oral contraceptives or progestin-only pills for a period of 6 months. The main result measures were decrease in haemorrhage severity and enhancement in quality of existence, evaluated using standardised scales. Additional outcomes encompassed adverse reactions, uterine lining examination, and client contentment. Data examination unveiled that both Contraceptive Oral Contraceptives (COCs) and Persistent Organic Pollutants (POPs) were efficacious in diminishing haemorrhage severity and enhancing standard of living (p < 0.05). Nevertheless, combined oral contraceptives (COCs) were linked with a greater occurrence of adverse reactions in contrast to progestin-only pills (POPs) (p < 0.05). Endometrial histopathology revealed no noteworthy disparities between the two cohorts. Patient contentment was greater in the POPs group (p < 0.05). In summary, both COCs and POPs are feasible choices for handling AUB in perimenopausal women, with POPs providing a favourable side effect profile and increased patient contentment.

221. Carbetocin is Better than Oxytocin in the Post Ceasarian Case
Somendra Sahasikdar, Sumit Roy, Kazi Rokeya Rahaman, Balaram Ghosh
Background and Objectives: Prevention of post-partum haemorrhage (PPH) is a major issue due to its impact on maternal morbidity and mortality. To compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss in caesarean- section at high risk of primary post-partum haemorrhage. Methods: This is a prospective, case-control study conducted from July 2022 and October 2022 within the department of Obstetrics and Gynaecology. Two hundred three women undergoing elective caesarean section were consecutively enrolled, with risk factors for primary post-partum haemorrhage such as: multiple pregnancy, two or more previous caesarean section, presence of uterine fibroids, previous myomectomy, presence of placenta previa, past history of PPH, fetal macrosomia and fetal malformations associated with polyhydramnios. A written informed consent was asked from eligible women on admission. Ethical clearance was obtained from Institutional ethics committee. Results: All relevant maternal subject characteristics in both study groups were comparable, except for the significantly increased use of anticoagulant drugs during pregnancy in carbetocin group (19.6% vs 3.9%, p<0.05). The main gestational age at caesarean was 38 weeks in the carbetocin group and 37 in the control group. There was significant difference in the amount of estimated blood loss and in the incidence of primary post-partum haemorrhage (>1000 ml) in both groups as seen after 24 hours caesarean section (p<0.05). Suggests the loss of maternal blood was less in Carbetocin as compared to oxytocin. Conclusion: In the third stage and the first 24 hours following delivery, which are both considered to be the “four stage of labor,” a single injection of carbetocin appears to be more efficient than a continuous infusion of oxytocin to maintain adequate uterine tone, with a low maternal blood loss and similar safety profile and minor antidiuretic effect.

222. Prospective Hospital Based Study on Functional Evaluation of Surgical Fixation of Distal Radius
Amit Patel, Sadik Shaikh
Background: Distal radius fractures are the most recurrent fractures happening in the upper extremity. Objective: To assess functional outcome and to assess the effectiveness of surgical fixation in the intra-articular distal end of radius fractures. Materials and Methods: In this prospective analysis, 40 patients who underwent surgical fixation were included. Following surgery, the patients were checked on at six weeks, three months, six months, and one year. The Gartland and Werley scoring methods were used to evaluate and rate the pain, range of motion, grip strength, and activity. Additionally assessed were radiographic measures. Results: forty cases were included and all of them were followed up to one year, most of them were in the age group of 31 to 40 years. Among them 11 were males and 5 were females. Both the dominant side in 31 cases and the non-dominant side in 9 patients were affected. In 31 patients, the mode of injury was a car collision, and in 9 patients, it was a fall. Functional outcome in 10 patients was excellent, 27 patients had good outcome and 3 patients had fair outcome according to Gartland and Werleys scoring system and it was statistical significant (p<0.05). Conclusion: Intraarticular distal radius fractures can be successfully treated with surgical fixation for ligamentotaxis.

223. Cancer Survivors’ Views on Digital Support for Smoking Cessation and Alcohol Moderation: A Survey and Qualitative Study
Dheerendra Kumar Sachan, Megha Prabhakar, Jyoti Singh, Manish Kumar Sachan
Background: Cancer survivors often face challenges related to smoking cessation and alcohol moderation, which are crucial for improving their long-term health outcomes. Digital support tools have shown promise in aiding behavioural change, but the perspectives of cancer survivors on such interventions remain underexplored. Materials and Methods: This study, conducted at Shrimant Rajmata Vijayaraje Scindia Medical College and Hospital in SHIVPURI, MP, spanned duration of 3 years and involved 100 cancer survivors. A mixed-methods approach was employed, comprising a survey and qualitative interviews. Participants were surveyed to assess their willingness to use digital support for smoking cessation and alcohol moderation. Qualitative interviews delved into their experiences, barriers, and preferences regarding such interventions. Results: Survey results indicated that 72% of participants were open to using digital support for smoking cessation and 68% for alcohol moderation. Qualitative findings highlighted key themes, including the desire for personalized interventions, concerns about privacy and security, and the importance of peer support networks. Notably, participants emphasized the need for easy-to-use, accessible, and culturally sensitive digital tools. Conclusion: Cancer survivors express a substantial interest in digital support for smoking cessation and alcohol moderation. To effectively engage this population, digital interventions should be tailored to individual needs, address privacy concerns, and incorporate peer support elements. This study underscores the potential of digital platforms to enhance the health and well-being of cancer survivors by addressing their tobacco and alcohol use.

224. Neurological Complications following Paediatric Congenital Cardiac Surgery: A Systematic Review
Kalpesh Onkar Patil, Vinod Kumar
Background: Neurological complications following paediatric congenital cardiac surgery constitute a significant concern that can have lasting effects on a child’s development and quality of life. This systematic review is being conducted with the objectives of providing a comprehensive overview of postoperative neurological complications in paediatric congenital cardiac surgery, and to identify risk factors associated with the development of these complications. Methods: The literature search encompassed an extensive database including PubMed, EMBASE, and Web of Science. Studies published after the year 2010 were included. The quality of included studies was assessed using appropriate tools tailored to the study design. The synthesis of data encompassed a narrative summary of study characteristics, outcomes, and findings. Results: Sample sizes in the selected studies ranged widely from 75 to over 3,800 participants. The mean age at surgery varied from 3 months to 5.5 years. Mortality rates differed significantly, ranging from 0.004% to 33.33%. Various neurological complications were reported, including seizures, stroke, altered consciousness, and neurological deficits, with incidence rates ranging from 1.75% to 37%. Conclusion: The study provides a comprehensive overview of the current state of knowledge regarding neurological complications following paediatric congenital cardiac surgery. Moreover, they emphasize the importance of standardized data collection and reporting practices to advance our understanding of this critical aspect of paediatric cardiac care.

225. Recent Trends and Advances in Pain Management for Male Circumcision in Pediatric Population: Systematic Review
Kalpesh Onkar Patil, Vinod Kumar, Megha Sonawane
Background: Circumcision is one of the oldest and most frequently performed surgical procedures done on males by pediatric surgeons. Pain management is one of the challenging tasks for both pediatric surgeons and anesthesiologists involved during the procedure of male circumcision. The aim of the present study is to systematically review the researchers conducted on pain management in pediatric male circumcision published during the past ten years. Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The literature search encompassed an extensive database including PubMed, MEDLINE, Science Direct and Embase. Studies published after the year 2012 were included in the analysis. The quality of included studies was assessed using appropriate tools tailored to the study design. The synthesis and analysis of data included a narrative summary of study characteristics, analgesic methods, pain scale used, surgical technique, and main study results. Results: Sample sizes in the selected studies ranged from 40 to over 1300 participants. Dorsal Penile Nerve Block (DPNB) was the most commonly performed regional anesthetic technique for male circumcision. Plastibell technique was the most commonly performed surgical procedures in the study. Neonatal Infant Pain Scale (NIPS) was the most commonly used pain scale in the present findings. Conclusion: In summary, the management of pain during and after male circumcision in the pediatric population has seen remarkable progress, reflecting a commitment to delivering safe, effective, and pain-free care to new-borns and infants.

226. The Efficacy of Percutaneous Revascularisation of Diseased Arteries in Symptomatic Patients with Buerger’s Disease
Amlin Thomas, Vinayagam Ganesan
Background: Buerger’s disease is associated with limb-threatening chronic arterial lesions. Objective: This hospital-based retrospective study aimed to investigate the efficacy of percutaneous revascularization of diseased arteries in symptomatic patients with Buerger’s disease. Materials and Methods: 42 patients diagnosed with Buerger’s disease between July 2022 to June 2023 were retrospectively investigated. Clinical data including biodata, complaints, clinical examination findings, investigation reports, operative records and post-operative follow up were taken up for analysis. The data was collected, coded and recorded on Microsoft Excel Spreadsheet program and descriptive statistical analysis was performed. Result: All the study participants were male (100%) and all were smokers (100%) with all of them experiencing lower limb symptoms (100%). Maximum presenting symptoms comprised of ‘ulcer’ (80.95%, while remaining presenting symptoms involved ‘wet gangrene of toes’ (19.05%). Conclusion: Percutaneous treatment of arterial occlusions in patients with Buerger’s disease seems feasible in the current era of improving devices and angioplasty materials. Procedures may be safely performed with good technical and clinical success rates, and without mortality or complications as experience increases.

227. Preoperative Predictors of Difficulty Laparoscopic Cholecystectomy: A Retrospective Single Center Study
Lochan Thanigachalam, Vinayagam Ganesan
Background: Laparoscopic cholecystectomy (LC) is a gold standard treatment of symptomatic gallstone disease. Meanwhile, it is also a challenging procedure demanding excellent expertise for the best outcomes. Many times, difficult laparoscopic cholecystectomy is a nerve-wracking situation for surgeons. It endangers patients by causing potential injury to vital structures. Objective: This hospital-based retrospective study aimed to find the diagnostic validity of preoperative parameters to predict the difficult laparoscopic cholecystectomy. Materials and Methods: A total number of 54 patients admitted in surgery ward for laparoscopic cholecystectomy and within whom the diagnosis of cholelithiasis established between January 2023 to June 2023 were included in this study. Inclusion criteria included patient presenting with or without acute cholecystitis or chronic cholecystitis with cholelithiasis planned for laparoscopic cholecystectomy, patient aged more than 18yrs of age and patients giving written informed consent to participate in the study. Exclusion criteria included patient with CBD Calculi, Dilated CBD, cholangitis, patient with symptoms with obstructive jaundice, patient with known Carcinoma of the gall bladder, patient not willing for laparoscopic cholecystectomy or having absolute contraindication for laparoscopic surgeries and patient’s refusal to participate in the study. Hospital records of these patients were retrieved from the MRD and data’s like biodata, history, clinical examination findings, preoperative investigations, operative records and post-operative follow up were collected, then we analyzed clinical and ultrasound findings of all patients. A preoperative score was calculated to each patient before surgery by the following predictors given below and categorized the difficulties. All the experimental procedures and protocols used in this study were approved by the Ethical Clearance Committee. The data was collected, coded and recorded on Microsoft Excel Spreadsheet program and descriptive statistical analysis was performed. Result: Among 54 patients, age below 50 years were 34 and above 50 years were 20, 40 were female and 14 were males and 30 were previously admitted. Conclusion: Gender (male), past history of acute cholecystitis, gall bladder wall thickness (≥4–5 mm), fibrotic gallbladder, and adhesion in the triangle of Calot were significant risk factors for difficult LC.

228. Pre-Operative Predictors for Acute Complicated Appendicitis: A Retrospective Observational Study
Raasiga Sivagurunathan, Vinayagam Ganesan
Background: Appendectomy can be challenging and occasionally converted to extensive resection for complicated appendicitis. However, optimal treatment strategies can be developed using preoperative risk assessment. Objective: This hospital-based retrospective study aimed to study the diagnostic efficacy of biochemical parameters like hyperbilirubinemia, hyponatremia, neutrophil: lymphocyte ratio, CRP, thrombocytosis to preoperatively differentiate between acute appendicitis and acute complicated appendicitis. Materials and Methods: A total number of 156 patients in whom the diagnosis of Acute appendicitis established was retrospectively investigated for a period of 6 months (December 2022 to May 2023). Amongst these 42 patients were diagnosed to have acute complicated appendicitis (based on USG report and Intra operative findings). The data was collected, coded and recorded on Microsoft Excel Spreadsheet program and descriptive statistical analysis was performed. Result: Out of 156 cases, male gender constituted maximum proportion than the female gender (59.61% vs 40.39%). Our study recorded the ratio of male: female as 1.5:1. Out of 156 cases, uncomplicated type of acute appendicitis (73.07%) constituted maximum cases than the complicated type of acute appendicitis (26.93%). The patients with female gender were mostly affected by complicated type of acute appendicitis (n=24;57.15%). Conclusion: Overall for Complicated Appendicitis, the more sensitive predictors are – CRP and Hyponatremia and the more specific predictors are Thrombocytosis and hyponatremia. In uncomplicated appendicitis, the most sensitive predictor was CRP and the most specific predictor was Thrombocytosis. Thus, the mean duration of surgery was prolonged in all complicated appendicitis. The surgical site infection was less common in laparoscopic surgeries for complicated appendicitis.

229. Evaluation of Efficacy of Sinbad Scoring System in Predicting the Risk of Amputation in Diabetic Foot Ulcer Patients: A Retrospective Study
Lakeen Puthupattan, Vinayagam Ganesan
Background: This study focuses on diabetic foot ulcers (DFUs), a grave complication of diabetes leading to amputations and mortality. It aims to evaluate the SINBAD scoring system’s effectiveness in predicting amputation risk among DFU patients, with potential implications for improved patient care. Objective: The primary objectives of this study are to assess the long-term prognosis and outcomes of diabetic foot ulcer (DFU) patients, with a specific focus on the risk of amputation and mortality over an extended period. Additionally, the study aims to evaluate the efficacy of the SINBAD scoring system as a predictive tool for amputation risk in DFU patients, providing valuable insights for clinical decision-making and patient management. Material and Method: This retrospective cohort study analyzed 58 DFU patients admitted to Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry from January to June 2023. It utilized the SINBAD scoring system to categorize patients based on critical parameters. Statistical analysis with IBM SPSS Statistics 24 assessed the system’s efficacy in predicting amputation risk, and ethical standards were maintained with institutional approval. Result: In this study of 58 diabetic foot ulcer (DFU) patients, 81% had low SINBAD scores (<3), signifying a lower amputation risk, while 19% had higher scores (≥3), indicating a greater risk. Those with scores of 3 or higher had a significantly higher amputation rate (10 patients) compared to lower-scoring patients (no amputations) (p = 0.001). The SINBAD system demonstrated a sensitivity of 100% and specificity of 95%, highlighting its effectiveness in predicting amputation risk. Additionally, BK amputations showed the most significant association with SINBAD scores (p = 0.003), followed by Barefoot amputations (p = 0.025), with AK amputations showing a less significant association (p = 0.120). Conclusion: The study underscores the utility of the SINBAD scoring system as an effective predictor of amputation risk in diabetic foot ulcer patients, with high sensitivity and specificity, offering valuable guidance for clinical decision-making and patient management.

230. Family History, Smoking and Diet as Risk Factors for Benign and Malignant Lesions of Prostate
Mitesh Shah, Puja Singh, Ruchi Agrawal, Rajesh Gaur, Amar Gangwani
Background: Around the world more than 1.1 million cases of prostate cancer were recorded in 2012, accounting for around 8 per cent of all new cancer cases and 15 percent in men. Various risk factors for prostatic diseases under investigation are migration, diet, obesity, height, endogenous androgen level, concomitant medical conditions. Positive family history is a significant risk factor for prostate cancer. Present study is an effort to assess family history, smoking and diet as risk factor for prostatic lesions. Material & Methods: Study was conducted after institutional ethical committee clearance in Department of Pathology, Gajra Raja Medical College and associated hospital, Gwalior (M.P.). Family history of prostatic disease, smoking and dietary history was taken from patients and their correlation is statistically assessed. Result: No statistically difference was found between control and study group for  vegetarian and mixed diet, while statistically significant difference was found for amount (odds ratio- 20.0, p-value-0.004, risk ratio-12.4 ) and duration (odds ratio-13.75, p-value-0.006, risk ratio-7.95) of smoking with malignant lesions while not for benign lesions. Family history was found only in 1 case of benign lesion. Conclusion: Present study shows only correlation of amount and duration of smoking and prostatic carcinoma while no correlation with diet and family history found. But further studies on large scale should be conducted to find correlation so as to assess risk factors.

231. Study of Fine Needle Aspiration Cytology and Immunohistochemistry in the Diagnosis of Cervical Lymphadenopathy
Laxmidhara Padhy, Sunil Kumar Das, Pushpanjali Khuntia, Aparajita Mishra
Background: Aspiration cytology and histopathological study with the help of FNAC have been used for the diagnosis purpose but sensitivity and specificity still remain away for final conclusion. Immunohistochemistry asses the tumour markers of infiltrating lymph nodes and helps to determine independent marker associated with better diagnostic accuracy. Aim: To study the diagnostic accuracy of FNAC and Immunohistochemistry for the cervical Lymphadenopathy. Methods: A Prospective study of 106 patients attended surgery OPD with prior information and consent was done in the period from 2016 to 2018 after approval of IEC. FNAC was done in 102 cases and then were referred for open biopsy. Sides and different levels were delineated with the help of land mark stiches placed just after the removal of the specimen. Specimens (28 cases out of 102) with inconclusive diagnosis or difficult diagnosis by histopathological study were sent for immunohistochemistry with cytokeratin test. Then the reports of FNAC, HPE and immunohistochemistry reports were compared and analysed for their diagnostic accuracy. Results: There is statistically significance when the tests were compared for age of patients, level of lymph node involved and pathological diagnosis like reactive hyperplasia, TB lymphadenitis and malignant conditions like SCC and adenocarcinoma. FNAC was more diagnostic for benign diseases than malignancies and more likelihood+ for primary lymph node malignancies than metastatic disease. The ratio of non- neoplastic to neoplastic was 6.21:1. Requirement of immunohistochemistry for the final conclusion for the pathological diagnosis was 25% but the diagnostic accuracy was 90.32% and more likelihood+ for diagnosis by immunohistochemistry for metastatic lymph node disease. Conclusion: Histopathological examination of neck dissection specimens is highly sensitive and specific for detection of metastatic deposits with high diagnostic odds ratio for lymphadenopathy. Micro metastases or sub pathological metastases are undetected by H&E staining but detected by immunohistochemistry or molecular analysis. The cytokeratin immunohistochemistry has come in a very handy and useful tool by unearthing the metastasis in those lesions which were decided to be non-malignant by histopathological examination. Immunohistochemistry is having with highest sensitivity, specificity and diagnostic odds ratio for micro metastases detection and molecular markers.

232. To Find Out the Incidence of Post-Operative Wound Infections among Obstetric and Gynaecological Surgeries
Jyoti Praseeth, Deepa Joshi, Prof Nilesh dalal, Sonali Dutt
Background & Methods: The aim of the study is to find out the incidence of post-operative wound infections among obstetric and gynaecological surgeries. Among the patients identified, they are continuously monitored for development of signs of wound sepsis and who had wound gaping and eventually had to undergo resuturing. To identify the risk factors which can lead to wound gaping and to identify the common causative organism. Results: Previous LSCS and PROM was the most common indications of LSCS; 74 (27.1%) and 64 (23.4%) respectively. Fetal distress 46(16.8%), NPOL 35 (12.8%) breech presentation 27 (9.9%), MSL 21 (8.8%) and Failed Induction 3 (1.1%) were other indications of LSCS. Abdominal Pain was the most common clinical feature followed by Fever; 201 (73.6%) and 179 (65.6%) respectively. No patient had septic shock and mortality. GDM and Gestation Hypertension was found in 137 (50.2%), 22 (8.1%) and 69 (34.5%) respectively. All the co-morbidities were found to be statistically significant with the wound gaping. Conclusion: Incidence of wound infection can be reduced if we can manage conditions like anemia, diabetes, hypertension, avoid protracted labour, use strong antibiotics when a membrane bursts, act quickly, and provide a well-equipped ward with a clean environment. Conditions like anemia, pre gestational diabetes and gestational diabetes should be identified as early as possible during the antenatal period itself. All women in the antenatal period should advised to take iron and folic acid supplements. All antenatal women must be screened for diabetes and hypertension. If screened positive appropriate measures must be taken to keep it under control.

233. Comparison of Efficacy of Biphasic BHI Media, Tryptic Soy Broth and Glucose Broth in Isolating Bacteria through Blood Culture of Suspected Septicemia Patients
Ruchi Agrawal, Mitesh Shah, Puja Singh, K.P. Ranjan
Introduction: Blood stream infection (BSI), bacteremia and thereby septicaemia remains one of the most important causes of morbidity and mortality throughout the world. The diagnosis of these infections can be confirmed by blood culture which is the gold standard for the diagnosis. No single blood culture medium or system is capable of detecting all the micro-organisms. Present study compares the efficacy of three culture media for isolation of bacteria through blood culture of suspected septicemia patients. Material & Methods: Study was conducted in Department of Microbiology, Gajra Raja Medical College, Gwalior (M.P.) over suspected septicemia patients for a period of one year. A total of 367 samples of blood culture used in the study. Blood was transferred to three blood culture bottles containing three different media as Biphasic BHI media, Tryptic Soy broth and Glucose broth then processed for isolation of bacteria. Result: Out of total 367 suspected septicemia patients, bacteria were isolated in 98 samples. Out of 98 culture positive cases, 62 isolates were gram negative bacilli and 36 isolates were gram positive cocci. Among gram-positive bacteria biphasic BHI bottle recovered significantly more Staphylococcus aureus bacteria (P < 0.037) than do the TSB bottle or Glucose broth bottle while for rest of bacteria no statistically significant difference was found among three medias. Conclusion: As present study show superiority of Biphasic BHI over TSB and glucose broth in isolating Staphylococcus aureus only. So all the three culture media seems to have almost similar efficacy in isolating organisms in septicemia patients.

234. Effect of Different Dispensing Tips on Material Wastage of Polyvinyl Siloxane Impression material: An In-vitro Study
T. Divya, Rajyalakshmi Ravuri, M. Praveen, Amtul Mubeen Mariya, Vimal Bharati, Golla Harshavardhan
Context: Newer dispensing tips that claim to minimize wastage of materials are now available in the market. Aims: To evaluate the material wastage of polyvinyl siloxane impression materials (light-body) mixed with 2 different dispensing tips- MIXPAC Yellow T-Mixer Dispensing tips and a Conventional Dispensing tips. Settings and Design: Study was conducted in the Department of Prosthodontics, Crown and Bridge and Implantology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana from 16th may 2022 to 23rd may 2022. MIXPAC INDIA supplied the MIXPAC Yellow T-Mixer tips and conventional helical dispensing tips. For weighing the Dispensing tips electronic precision balance (Electronic scale, Wensar Weighing Scales Limited.) is used. Methods and Material: A sample of 40 dispensing tips- 20 MIXPAC Yellow T-Mixer tips (Sulzer Mixpac Yellow T- Mixer tips) and 20 conventional helical Dispensing tips were used for the study. The tips were weighed before and after the light body material was dispensed through these tips using a light body dispensing gun. Statistical analysis used: Paired T-test was used to compare the weights before and after mixing in each of the Dispensing tips, whereas, unpaired t-test was used to compare the difference in weight between the two groups. A p value of <.05 was considered significant for all analyses. IBM SPSS version 25 was used for the statistical analysis of the data. Results: The difference in weights before and after mixing the polyvinyl siloxane impression material was significantly greater in the conventional helical dispensing tips group, indicating more material wastage when compared to yellow T mixer dispensing tips. Conclusions: The MIXPAC yellow T- Mixer dispensing tips had low material wastage when compared to conventional helical dispensing tips.

235. Study of NT-Pro BNP Levels in Patients of Isolated Right Ventricular Systolic Dysfunction with Normal LV Function after Angiotensin Receptor Neprilysin Inhibitor
Rohit Mathur, Viplov kesarwani, Vivek Lakhawat, Pawan Sarda, Anil Baroopal
Background: Angiotensin Receptor Neprilysin Inhibitors (ARNI) have shown promising results in reducing NT-pro BNP levels in left-sided heart disease. However, their effects on isolated right ventricular systolic dysfunction with normal left ventricular function remain less defined. Objective: This prospective study aimed to investigate the impact of ARNI therapy on NT-pro BNP levels in patients with isolated RV systolic dysfunction with normal left ventricular function. Methods: A total of 50 patients with isolated RV systolic dysfunction with normal left ventricular function were enrolled in this study and divided into two groups: ARNI group (n=25) and Non-ARNI group (n=25).NT-pro BNP levels was evaluated at baseline and  4 weeks. Pulmonary function tests was also conducted to assess respiratory parameters at these specified time points. Results: At baseline, there was no significant differences in  NT-pro BNP levels and pulmonary function parameters between the two groups. After 4 weeks of treatment, the ARNI group showed a significantly greater decline in NT-pro BNP levels in the ARNI group (p<0.001) compared to Non-ARNI group while the change in airway resistance by PFT was equal in both groups. Conclusion: ARNI therapy in patients with isolated right ventricular systolic dysfunction resulted in a significantly greater decrease in plasma NT-pro BNP levels without difference in airway resistance. These findings suggest the potential benefits of ARNI therapy in right-sided heart failure and warrant further investigation in larger randomized trials.

236. A Comparative Study on NS1 Antigen Detection in Acute Dengue Infection by Rapid Diagnostic Test and Elisa in a Tertiary Care Hospital
A. Shashikala, Prasada Rao Namburi
Introduction:  Dengue fever has emerged as a serious public health concern in India due to the high mortality and morbidity linked with it. It is the most frequent viral disease transmitted to people by mosquitos. As a result, early and rapid laboratory diagnosis of dengue fever is critical. The present study was done to compare Immunochromatography rapid diagnostic test (RDT) with Enzyme Linked Immunoassay (ELISA) for detecting Dengue virus NS1 antigen in patients of suspected of dengue illness. Materials and Methods: This cross-sectional study was done on 100 clinically suspected cases of Dengue at a tertiary care hospital in Kadapa, Andhra Pradesh, India. All the sera samples were collected and subjected to NS1 antigen detection test by rapid test and NS1 ELISA and compared. Results: Out of total 100 samples, 74 samples tested positive by NS1 rapid test & 86 samples were tested positive by NS1 ELISA. The sensitivity, specificity of dengue NS1 antigen rapid test was 84.8% and 93% when compared to ELISA. Conclusion: The NS1 ELISA test requires extra steps and time. RDTs take only roughly 15 to 30 minutes to complete in a single phase. Despite the fact that ELISA outperforms RDT, in nations with fewer infrastructures and in remote regions, RDTs are more useful for early diagnosis and management of dengue with less expertise in a short period of time.

237. Indication, Rate & Determinants of Caesarean Section Delivery in a 750 Beded Hospital in Unnao India
Ruchi Kumari, Jyotsana Gupta, Neha Verma
Introduction: In obstetrics caesarean section is a major lifesaving intervention worldwide for pregnant women and their newborns. It is amongst most frequently performed surgical procedures. Both primary as well as subsequent caesarean section rates are continuously rising which needs to be decreased. The main objectives of this study were to analyze the rate of Cesarean Section, proportion of various indications of C-Section & factors which are affecting their rate. Aims & Objectives: To determine: (1) Rate of Cesarean section. (2) Indications of Cesarean section and (3) Factors affecting rate of Cesarean section. Methods: A retrospective study was conducted for the duration of 1 year from 1st July 2021 to 30th June 2022 in Obstetrics and Gynecology department of Saraswati Medical College, Unnao (U.P), North India. Data of all live births was collected. In case delivery was conducted by cesarean section their indications as well as other demographic factors which can affect nature of delivery for example age and residential area of patient were recorded. Results: A no. of 489 women were delivered during this time period, out of that 184 women were delivered by cesarean section and normal delivery were 305.The overall caesarean section rate was 37.62% and normal delivery rate was 62.37%. In maximum no of cases i.e. 29.86% fetal distress was indication for cesarean section after that previous LSCS in 24.95%, malpresentation in 18.81%, contracted pelvis in 6.13%, hypertensive disorders of pregnancy in 4.29%, antepartum hemorrhage in 10.02% and obstructed labor in 5.93%. Conclusions: In this study, caesarean section rate was 37.62% which is comparable to other studies but higher as compared to WHO guidelines as it is a referral centre. Fetal distress & previous LSCS are most common indication in 29.86 & 24.95% of mothers respectively.

238. Comparison of Opioid Free Versus Opioid Based General Anesthesia on Post Operative Pain Intensity for Laparoscopic Surgeries: A Double Blinded RCT from A Tertiary Care Centre from Andhra Pradesh
N Syama Kumar, Y Nicolas Israel, Gantela Vijaya, G. Chandra Sekhar, Naveen, Anant A. Takalkar
Introduction: Efficacious multimodal analgesia and anaesthesia are basis of successful fast-track surgery. These multidrug regimens aim at decreasing postoperative pain, intraoperative and post operative opioid requirements, and subsequently, opioid related adverse effects and hastening recovery. Objective: Our study objective was to compare opioid free versus opioid based general anesthesia on post operative pain intensity for laparoscopic surgeries. Methodology: This is a prospective double blinded, RCT study design using simple random sampling and shuffled closed sealed envelope technique. Patients were randomly allocated into 2 groups; DK group: Receiving Dexmedetomidine 1µg/kg body weight & ketamine 25 mg intravenously before induction. F group: Receiving Fentanyl 1µg/kg/body weight intravenously before induction. Results: Mean VAS Score at these intervals was significantly low in Group DK compared to Group Fentanyl. There was a significant difference in usage of Inj Diclofenac 75mg distribution between two groups at 2nd hour post operatively (a greater number of patients were required rescue analgesic doses in group F). At other intervals there was no significant difference. There was significant difference in No of Doses of Diclofenac Distribution between two groups. Conclusion: Pain intensity was less in patients receiving Dexmedetomidine & ketamine as compared to that receiving Fentanyl. A greater number of patients were required rescue analgesic doses in group receiving Fentanyl.

239. A Comparative Study of Efficacy of Topical Nadifloxacin 1% with Clindamycin 1% in the Treatment of Acne Vulgaris with Benzoyl Peroxide 2.5% Being Used as Add-On Therapy in Both the Groups
Ramya K N, Harshavardhana K N, Harshitha C
Background: Acne vulgaris is a common dermatological inflammatory disorder of the pilosebaceous unit presenting usually at puberty. It is characterized by the formation of open and closed comedones (non-inflammatory lesions), papules, pustules, and nodulocystic lesions (inflammatory lesions) generally affecting the face, arms, and back. Objective: to compare the clinical efficacy and safety of eight weeks therapy of nadifloxacin 1% versus clindamycin 1% as add-on therapy to benzoyl peroxide (2.5%) in mild to moderate grade acne vulgaris. Methods: This Prospective, randomized, open label, comparative, efficacy study was carried out at Vydehi Institute of Medical Sciences and Research Institute, Bangalore. A total of 60 patients were included and were divided into two groups. One group was advised to apply clindamycin 1% gel and benzoy peroxide 2.5% gel twice daily (30 patients), while the other group was treated with nadifloxacin 1% gel and benzoyl peroxide 2.5% gel twice daily (30 patients) for 8 weeks. The efficacy parameters were changes in the total inflammatory lesion count and severity by Investigator Global Assessment (IGA) Scale from baseline to study end (eight weeks). All treatment emergent dermatological adverse events were evaluated for safety assessment. Results: Reduction of total inflammatory lesion count from baseline were highly significant in both the groups (P<0.0001), but between the group difference was not significant. Significant improvement in IGA scales was noted in both groups. Between-group comparison showed no significant differences. The safety and tolerability profile of both regimens were good and comparable. Conclusions: Topical nadifloxacin is a newer fluoroquinolone which is effective, tolerable, and safe for mild to moderate facial acne. Its clinical effectiveness is comparable to that of clindamycin when used as add-on therapy to benzoyl peroxide.

240. Prevalence of Internet Addiction and its Association with Depression, Anxiety, Stress and Self Esteem in Undergraduate Medical Students
Nikitha Reddy Beeram, Gunturu Anuhya Guyton, Ponnada Swathi, Kiran Kumar Singuru
Introduction: The increasing popularity of the use of the internet has led to the emergence of Internet addiction (IA) especially in younger age group. This addiction as well as its association with mood disorders and self-esteem can impede their studies, impact their long-term career goals and might have wide, detrimental consequences for society as a whole. Aim: To study the prevalence of Internet addiction and its association with Depression, Anxiety, stress and Self-esteem. Materials and Methods: A cross-sectional study was done among 407 Undergraduate medical students of Andhra Medical College, Visakhapatnam.3 reliable and validated questionnaires were Used. Internet Addiction Test, the Depression Anxiety Stress Scales (DASS 21), and the Rosenberg Self-Esteem Scale (RSES). The prevalence of IA and then its association with Depression, anxiety, stress and self-esteem was assessed. Results: Internet Addiction prevalence rate was 82.1%. There was significant difference between males and females (p=0.01) with a higher prevalence rate in males (88.7% vs 77.6%). There was significant association between Internet Addiction and Depression, Anxiety, stress. (p<0.001). However, there was no significant association between IA and self-esteem. Conclusion: With a progressively increasing use of the internet and a corresponding internet-related psychopathology the world over, it is imperative that an attempt should be made to identify students with potential IA, treat internet-related problems, address and treat the coexisting psychological problems like depression, anxiety, stress, and also prevent internet related problems to a possible extent. Awareness is important at higher level to address the issue and implement measures for its prevention and treatment. As an emerging problem affecting student education, rehabilitation programs may be useful in the future.

241. A Rare Case of Autoimmune Polyglandular Syndrome (Type 1 Diabetes Mellitus, Hypothyroidism, Hypogonadism), Systemic Lupus Erythematosus Associated with Dyslipidemia
Kumar Kamal, Mehta Neha, Goel RK, Raihan MD, Kumar Sushil
Introduction: Autoimmune polyglandular syndromes (APS) are rare disorders characterized by the presence of multiple autoimmune diseases. This abstract highlights a unique case of a 26-year-old female with coexisting Type 1 Diabetes Mellitus (T1DM), hypothyroidism, hypogonadism, systemic lupus erythematosus (SLE), and dyslipidemia, emphasizing the complexity of APS and the importance of early recognition. Case Presentation: A 26-year-old female presented with T1DM at age 15, hypothyroidism at age 18, hypogonadism at age 24, and SLE symptoms at age 25. Lab tests confirmed SLE and revealed dyslipidemia. No familial autoimmune history was evident. Conclusion: This case underscores the diverse clinical manifestations within APS. Co-occurrence of T1DM, hypothyroidism, hypogonadism, SLE, and dyslipidemia in one patient is rare. Prompt identification and management of such complex autoimmune conditions are vital for patient well-being and outcomes, requiring a multidisciplinary approach to care.

242. Effect of Intraoperative Intravenous Infusion of Magnesium Sulphate during Spinal Anaesthesia on Postoperative Analgesia: A Randomized Study
Misha B Agarwal, Leena P Patel, Rinkalben D Patel, Jayshree M Thakkar
Background: Intravenous infusion of magnesium sulphate given before noxious stimulation provides good postoperative analgesia. Aim: To study effect of intravenous infusion of magnesium sulphate during spinal anaesthesia, on duration of analgesia in postoperative period and need for rescue analgesia in postoperative period. Material and Methods: Study was conducted in June 2018 to august 2019 after approval from ethical committee of hospital. Fifty ASA grade I & II patients were randomly assigned into two groups (Group M and Group S of 25 patients each). Group M patients received inj. magnesium sulphate (MgSO4) as bolus dose of 50mg/kg over 15mins given before incision and maintenance dose of 15 mg/kg/hr IV infusion till end of surgery. Group S patient received saline infusion throughout the surgery. Intra-operative and post-operative hemodynamic parameters, post-operative VAS score and sedation score were recorded. Statistical analysis was carried out using statistical package for social science (SPPS Inc., Chicago, IL, version 11.5 for windows). Parametric data were analyzed using paired and un-paired t-tests. Qualitative or categorical variables were compared using Chi-square test or Fisher’s exact test. Results: No significant difference was found between the two groups in terms of age, weight, height, or gender. Postoperative VAS score was significantly lower in Group M than in Group S at 4hr, 12hrand  24hr (p=0.0001). The need for rescue analgesia in Group M as compared to Group S was significantly low (p<0.05). There was no significant difference in haemodynamic variables during the intraoperative or postoperative period in both the groups (p>0.05). 80% patients of Group M had grade 2 sedation score after 30 min of starting MgSO4 infusion as compared to 32% in Group S. 28% patients in Group M had PONV as compared to 40% in Group S. There was no adverse effect owing to MgSO4. Conclusion: Intravenous infusion of MgSO4 decreases post-operative pain, need for rescue analgesia and need for intraoperative sedation. In addition there is decrease incidence of PONV and shivering.

243. Role of Autologous Serum Ophthalmic Solution as Adjuvant Therapy in Management of Ocular Surface Disorders
Vanitha R., Anbuchezhian R
Introduction: Disruption of the function of ocular surface structures may result in ocular surface disorders (OSD). Treatment for ocular surface disorders includes artificial tears substitutes, temporary or permanent punctal occlusion, bandage contact lenses, and primary treatment of adnexal diseases. Ocular surface disorder is most commonly treated with artificial tear eye substitute. Recently autologous serum eye drops is routinely prescribed as an adjuvant therapy for the treatment ocular surface disorders, like dry eye disorders, neurotrophic keratitis, recurrent corneal erosion, persistent epithelial defects. Aim of our study is to compare the efficacy of autologous serum ophthalmic solution versus tear drops as adjuvant therapy in the reducing the symptoms of ocular surface diseases. Materials & Methods: This prospective study was conducted in a tertiary care teaching hospital for a period of 6 months. A detailed history of the patient was taken, General Examination and Slit lamp examination, and dilated fundus examination were done. Patients were treated as per the laid down guidelines. In addition patients with odd serial number in category were treated with autologous serum and patients with even serial number were treated with tear drops. Sign score and schrimers test was done and values were obtained. Results: There is no significant difference in improvement of lid edema. There was also no significant difference in improvement of conjunctival congestion during first, second and third visit but there was significant difference in improvement of conjunctival congestion during the fourth visit. There was significant difference during 4th and 5th visit in epithelial defect. There is also no significant difference in improvement of neovascularization. There is significant difference in improvement of Schirmer’s test. Conclusion: Autologous serum is found to be safe and significantly effective than the artificial tear substitute in the treatment of ocular surface disorders.

244. Comparative Study of Autologous Serum Ophthalmic Solution versus Tear Substitute as Adjuvant Therapy in Reducing the Symptoms of Ocular Surface Disorders
Vanitha R., Anbuchezhian R
Introduction: Disruption of the function of ocular surface structures may result in ocular surface disorders (OSD). Treatment for ocular surface disorders includes artificial tears substitutes, temporary or permanent punctal occlusion, bandage contact lenses, and primary treatment of adnexal diseases. Ocular surface disorder is most commonly treated with artificial tear eye substitute. Recently autologous serum eye drops is routinely prescribed as an adjuvant therapy for the treatment ocular surface disorders, like dry eye disorders, neurotrophic keratitis, recurrent corneal erosion, persistent epithelial defects. Aim of our study is to compare the efficacy of autologous serum ophthalmic solution versus tear drops as adjuvant therapy in the reducing the symptoms of ocular surface diseases. Materials & Methods: This prospective study was conducted in a tertiary care teaching hospital for a period of 6 months.  A detailed history of the patient was taken, General Examination and Slit lamp examination, and dilated fundus examination were done. Patients were treated as per the laid down guidelines. In addition patients with odd serial number in category were treated with autologous serum and patients with even serial number were treated with tear drops. Symptom score and above mentioned parameters were recorded during every follow-up. Treatment was continued till symptoms disappear. Results: In this study of 30 patients, Mean age of the patients is 40.5 yrs and mean age of the patients in group 1 is 39.8 yrs and group 2 is 41.87 yrs. There were 8 males and 7 females in Group 1 and 9 males and 6 females in Group 2 as a whole 17 male and 13 females. There is no significant difference in the improvement of symptom score of tearing, blurred vision, and stingy sensation. There was significant difference in improvement of the burning sensation, foreign body sensation and photophobia. Conclusion: Autologous serum is found to be safe and significantly effective than the artificial tear substitute in the treatment of ocular surface disorders.

245. Comparative Analysis of Tramadol, Ketamine and Dexmedetomidine in the Prevention of Intraoperative Shivering in Patients Undergoing Surgery Underneath Subarachnoid Blockade
Hiral Golakiya, Jaldeep Patel, Khyati A Makwana
Background and Aim: Shivering is a common postanesthesia adverse effect with a variety of causes. Core neuraxial blockade blunts the thermoregulatory mechanism by limiting vasoconstriction, resulting in the transfer of core heat from the trunk to the periphery. To manage intraoperative shivering, many pharmacological and non-pharmacological approaches are used. In this study, we employed Tramadol, Ketamine, and Dexmedetomidine to investigate the efficacy of avoiding intraoperative shivering in patients having spinal anaesthesia. Methods and Materials: The current study was conducted at the Tertiary Care Institute of India’s Department of Anaesthesia. The patients were divided into three groups, each with 50 participants: Group T (Tramadol 0.5 mg/kg), Group K (Ketamine 0.25 mg/kg), and Group D (Dexmedetomidine 0.5g/kg). Shivering was detected using Wrench’s grading system. Results: The Tramadol group exhibited the highest incidence of shivering with a shivering grade greater than two at 15 minutes and 30 minutes, with p values of 0.045 and 0.003, respectively. Conclusion: When compared to Tramadol and Ketamine, Dexmedetomidine at 0.5 g/kg successfully prevents intraoperative shivering in patients undergoing surgery under subarachnoid blockade.

246. Spectrum of MRI Findings in Clinically Diagnosed Parkinsonism
Patel Nidhiben, Patel Avni, Mundhra Krati, Shah Dharita, Hadiya Riddhi
Background: Differential diagnosis of Parkinsonism in clinical practice is challenging, particularly in early stages. MRI, despite its limitations, significantly improves accuracy in distinguishing between different types of neurodegenerative Parkinsonism. Aims and Objectives: (1) Differentiate between typical and atypical Parkinson’s disease in the early stages using MRI. (2) Investigate structural MRI abnormalities, specifically focusing on the MRPI (Magnetic Resonance Parkinsonism Index), in clinically diagnosed atypical Parkinsonism patients. (3) Rule out alternative diagnoses for Parkinsonism in presenting patients. Methods: A retrospective study conducted between 2022 and 2023 included 65 patients with Parkinsonism. Among them, 44 had typical Parkinsonism and 21 had atypical Parkinsonism. MRI signs were assessed and MRPI used for diagnostic value. The sensitivity of these MRI findings was calculated to assess their ability to detect and differentiate between typical and atypical parkinsonism. Results: Among 65 patients, those in parkinsonism group typically had normal brain MRI results after ruling out other causes, while the atypical parkinsonism group predominantly showed MRI findings, particularly suggestive of PSP and MSA, indicating that MRI has higher sensitivity in detecting atypical parkinsonism compared to typical cases. Conclusions: Brain MRI holds a pivotal role in parkinsonism diagnosis, aiding in the exclusion of other potential causes and facilitating early differentiation between typical and atypical forms. Alongside the MRPI, it can provide valuable support for diagnosing a specific form of atypical parkinsonism.

247. A Study of Variations in the Origin and Branching Pattern of Lingual Artery: Cadaveric Study
Atul Chandrashekhar Raut, Muthuchitra Pandian, Dhairyshilrao Y Shinde
Background: The lingual artery is a branch of external carotid artery (ECA), which is one of the major arteries that supplies blood to the head and neck. The presence of variations in the Lingual artery, its origin, course, relations and its branching pattern can become a matter of great concern to the Surgeons, Radiologists, ENT surgeons, Oncologists & Dentists. Aim and Objectives: to gain knowledge about the course, relations and variations in branching pattern of Lingual artery from its origin in the carotid triangle of the neck to its termination in the tongue. Materials and Method: This study was under observational study, by using conventional dissection method, in which 50, embalmed human adult cadavers specimens allotted for routine dissection to the first year MBBS students at our  Institute were included in the study, for the duration of one year after following inclusion and exclusion criteria and approved by institutional ethical committee. Observation and Results: The branching pattern of origin of lingual artery varied from separate branches to common trunks with superior thyroid artery, facial artery and combined both. The lingual artery originated as separate branch from ECA in 40 specimens (right 22 and left 20) In 3 specimens (right 1and left 2), they were arising as common thyrolingual trunk, and in 7 specimens (right 5 and left 2), they originated as linguofacial trunk, in common with facial artery. Conclusion: variations in the development and branching pattern of the lingual artery are not rare and should be evaluated before any diagnostic or therapeutic interventional procedures are planned in head and neck, oral and dental surgeries.

248. Comparative Analysis of Dura Puncture Technique and Conventional Epidural Technique in Labor Analgesia
Vasudha Gupta, Devalina Goswami
Introduction: Many medical guidelines emphasize that if there are no medical contraindications; pain relief during labor can be provided solely based on the mother’s request. This reflects a patient-centered approach to obstetric care, where the mother’s comfort and well-being are prioritized. The primary objectives of providing pain relief during labor are to ensure the safety and well-being of both the mother and the baby and to create a positive and manageable birthing experience. Managing pain effectively can reduce maternal stress and anxiety, improve maternal satisfaction, and promote better obstetric outcomes. Aim and Objective: To compare the efficacy of labour analgesia with Dural puncture epidural versus standard epidural technique. Material and Methods: This is a prospective, randomized; study was conducted in Department of Anaesthesia, AIIMS New Delhi, during Feb 2019 to Jan 2020. Randomization is done to give equal chance to participants of any group. In this study patients were randomly allocated using computer generated random number 50 number of patients were randomly divided in to 25 each group. The primary and secondary researchers measure the outcome and record the data. 50 parturients will be randomly selected and divided in to 2 groups. Randomization done by computer program and sealed envelope. Result: The mean to achieve adequate analgesia in group B (Dural puncture epidural technique was lesser than group A (traditional epidural technique). (11.60 ± 2.36 vs 10.04 ± 1.90 min) P value < 0.05 and is statistically significant. The systolic BP at 0 min was 125.8 mm hg in grp A, and 123.2 in grp B, AT 10 MIN THE SYS BP was 116.3 mm hg in grp A and 112.7 in Grp B, and at 20 min the systolic BP was 112.0 and 110.7 mm hg in grp A and B respectively. Conclusions: When comparing the Traditional Epidural technique with the Dural Puncture Epidural technique for labor analgesia, it was found that the Dural Puncture Epidural technique provides faster attainment of adequate analgesia compared to the Traditional Epidural technique. Additionally, the Dural Puncture Epidural technique has shown to enhance the spread of analgesia in the sacral region, leading to quicker onset and better bilateral pain relief in laboring women.

249. Deficient Ovarian Reserve in Genital Tuberculosis
Prashanta Krishna Gupta, Seema
Objective: To assess ovarian reserve (OR) in infertile women with GTB and compare with women with proven fertility by Hormonal and Ultrasound markers of ovarian reserve. Methods: A cross-sectional study was conducted at an outpatient DMCH, DARBHANGA, India with 50 women with Gestational Tuberculosis (GTB) and 50 healthy controls.  Ovarian reserve tests were done by estimating serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), on day 3 of a natural menstrual cycle and anti-Mullerian hormone (AMH) in any day of cycle. On D3 Antral Follicles Count (AFC) were also estimated on Ultrasound. Result: The median FSH was 8.91 (5.60-11.07) mIU/ml, LH 6 (4.65-8.55) mIU/ml and the mean E2 61.30±15.23 pg/ml which were significantly higher than controls (FSH-5.50, LH-3.80, and E2-41.53).   The median AMH levels 1.23 ng/ml was significantly lower in GTB than controls (AMH-2.50). And, the median AFC 6.0(4.0-8.0) was significantly lower in GTB than control 11.0 (8.25-12.0). Conclusion: The median FSH, LH and the mean E2 on day-3 of cycle and AMH on any day of cycle along with AFC are good predictors of Ovarian reserve and found to be low in GTB.

250. Hematological Parameters in Dengue Fever: A Study in Tertiary Care Hospital
Rajiv Ranjan Singh, Renu Kumari, Ajit Kumar Chaudhary
Background: Humans contract the dengue virus through the bite of an infected mosquito. The severity of this condition is predicted using a variety of clinical and laboratory criteria. The study aim was to ascertain the hematological parameters in dengue fever patients. Methods: Serology was performed on 100 cases that had a confirmed diagnosis of dengue. Complete blood count, coagulation profile, and liver function tests were performed, along with a thorough history, physical exam, and investigation. They were observed during their hospital stay and afterward. Results: The prevalence of dengue infection was higher in the adult age group, with a slight male predominance. With other constitutional symptoms, dengue fever was the most frequent presentation. The most frequent clinically evoked symptom was petechial ecchymosis. In the majority of patients, hematological abnormalities including elevated hemotocrit, platelet count, and unusual lymphocytes were observed. The mainstay of management was supportive therapy. 2% of the cases had overall mortality. Conclusion: Early detection of Dengue infection will be aided by elevated hematocrit, thrombocytopenia, leucopenia, and atypical cells in the peripheral smear. For a good outcome of the condition, early detection and prevention of complications are more crucial than treatment.

251. Epidemiological Study of Hanging Deaths in Muzaffarpur Area, Bihar
Kunal Animesh, Santosh Kumar, Bipin Kumar
Background: Asphyxia caused by hanging occurs when the body is suspended by a ligature that wraps around the neck, with the weight of the body acting as the restricting force. The most prevalent reason for hanging is suicide, followed by accidental, with “lynching” being the lone exception. Regarding the demographics, the type of ligature, the types of injuries inflicted to the body, and other factors, this study sheds some insight on the new trends in hanging. Methods: This is a autopsy based prospective study carried out on cases of death due to hanging in mortuary of Department of Forensic Medicine & Toxicology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from October 2019 to September 2020. Results: In our study, 172 cases of hanging deaths (134 men and 38 females) were presented for medical-legal post-mortem examination. In 36.63% of cases, people who hang themselves are between the ages of 21 and 30. Hindus made up 93.02 percent of the entire study population. 42.44% of cases were unmarried, while 57.56% were married. Urban areas had an 83.14 percent higher rate of hanging deaths than rural areas (16.86 percent). In 45.35 percent of cases, the student had finished high school. Nuclear households accounted for 61.04% of incidents. More than half of all cases involved students (30.81%) and self-employed individuals (30.81%). In this study, the majority of victims (72.09% instances) belonged to the middle class socioeconomic group, with 19.77% of cases being brought in on Wednesday and 16.86% on Sunday. In our analysis, the majority of victims were discovered at night (36.63% of cases), then in the early morning (25.0%). 95.93% of the cases were discovered hanging in enclosed spaces.

Conclusion: The results of this study will emphasize the current situation of hanging deaths and assist law enforcement in solving many crimes.

252. To Study the Effect of Meditation, Diet, and Exercise in Type‑2 Diabetic Patients in Mithilanchal Region
Renu Kumari, Rajiv Ranjan Singh, Sheela Kumari
Background: A behavioral therapy that is practiced both in India and all across the world is Raja Yoga meditation (RM). It seems to be a straightforward, feasible meditation method that one might apply on a regular basis. Methods: All diabetes patients in the age range of 30 to 60, including both sexes, who have been receiving therapy for 5 to 10 years, participated in the current study in the Mithilanchal Region, mostly in the area around Darbhanga, Madhubani, Sitamarhi, etc. Results: Blood sugar levels pre- and post-intervention showed a significant mean difference in Group A of 34.82±50.53. a number of Tukey test comparisons of the three groups’ fasting blood sugar levels. The difference between Group A and Group C was determined to be substantial, indicating that Group A’s impact is superior to that of Group C. Using a one-way anova test, post-meal comparisons between and within groups are made. This result is important because the F value was 8.24 and the P value was 0.001. It is a noteworthy finding that in Group C, the mean difference in haemoglobin A1c (HbA1C) levels was 0.86±1.48 with a P value of 0.048. Conclusion: When used as a supplemental intervention, RM had a better impact on glycemic control than other groups. Additionally, all three interventions meditation, diet, and exercise have a positive impact on HbA1C levels.

253. Cutaneous Adverse Drug Reactions with Fixed-Dose Combinations: Special Reference to Self-medication and Preventability
Kumar Gaurav, Navin Kishore, Asha Singh
Introduction: A cutaneous adverse drug reaction (CADR) is any unfavourable cutaneous clinical manifestation that happens after taking a certain medicine. ADRs are more likely to occur when fixed dose drug combinations (FDCs) are used than when a drug is taken alone. Method: In Department of Pharmacology, Nalanda Medical College, Patna, a prospective, spontaneous ADR reporting research was carried out over a period of one year. ADRs that were reported after suspected FDC usage were assessed for severity (modified Hartwig scale), causality (WHO-UMC likelihood scale), and avoid ability. Result: 60 ADRs were recorded as a result of FDCs, of which 11 (36.33%) were reported for females and 19 (63.34%) for males. The range of cutaneous ADRs included mild to potentially fatal reactions. 4 (6.6%) of the 2 (3.3%) life-threatening ADRs recorded were attributable to irrational and rational FDCs. The majority of ADRs were brought on by antihistaminic with leukotriene receptor blocker FDCs. 19 (31.6%) and 15 (25%) of the 34(56.6%) antihistaminic with leukotriene receptor blocker FDCs suspected of causing ADRs were rational and irrational, respectively. Conclusion: Cutaneous ADRs are more likely to be brought on by irrational FDCs. Physicians can combat the evil of illogical prescribing by being aware of and routinely reporting such ADRs.

254. Evaluation of the Clinical Characteristics and Management of Lower Limb Varicose Veins
Anupam Ranjan, Sweta Rani, Shri Krishna Ranjan
Objectives: Varicose veins in the lower limbs are the most common peripheral vascular disease, and therapy for these conditions’ dates to the dawn of time. The goal of this research is to examine the various clinical manifestations of varicose veins, their therapy, and their consequences. Materials and Methods: Patients who were admitted and received treatment at A. N. Magadh College and Hospital, Gaya, Bihar for a while provided the research’s data. After being informed about the nature of the condition, the many possible treatment modalities, and the results of those treatments, patients who had signs and symptoms of varicose veins and were found to have varicosities of the superficial veins upon clinical examination were included in the study. Results: Our study revealed that the condition is much more common in active adulthood, namely for the age of thirties, and that males are more impacted than females. It has been discovered that careers requiring extended standing and the use of intense muscular exertion might cause or contribute to varicose veins. Varicose vein development may be significantly influenced by hereditary factors. 25% of patients reported a family history of close relatives suffering varicose veins. More individuals (60%) than those who sought treatment for cosmetic reasons visited the hospital due to illness problems.  Patients had a range of symptoms and physical characteristics, with dilated and convoluted veins being more typical. The most frequent venous system impacted is the long saphenous system. Conclusion: If cases are carefully chosen and handled, complications are only a few. The morbidity rate is extremely low thanks to the current methods, which also allow the patient to have a nearly normal life after surgery. Although the most recent approaches to managing varicose veins are producing positive outcomes, they still require long-term monitoring and preventive care for further diseased outcomes.

255. Evaluation of Outcomes of Pregnancy Based on Placenta Previa Position
Sweta Rani, Girija Kumari, Anupam Ranjan
Background: Placenta previa is defined when placenta partially or completely covers internal OS. Placenta previa affects the onset of labour and mode of delivery in increases the rate of morbidity of mothers and newborns. Aim: This study aimed to evaluate the effects of placenta previa on gestation and parturition. Methods: Two hundred women with single fetus gestation and a low-lying placenta were taken for the study. In these women, the effects of complete and incomplete placenta previa were evaluated, along with the effects of placenta placed on the anterior and posterior wall of the uterus was also evaluated. Factors for evaluation were factors related to mothers’ and newborns’ health. Result: Women who had completely low-lying placenta had higher events of preterm labour compared to the women who had incompletely low-lying placenta. The women who had completely low-lying placenta on the anterior wall of the uterus had even higher chances of preterm labour compared to the women who had completely low-lying placenta placed on posterior surface of uterus. In the case of an incompletely low-lying placenta, there was no significant difference between the onset of labour according to the position of the placenta. Conclusion: The probability of adverse events during parturition increases in the case of a low-lying placenta. Knowing the effects of placenta previa on the mother’s and newborn’s health helps obstetricians take necessary measures before parturition.

256. Predicting Labour Duration Based on Biomechanical Measurements of the Cervix
Sweta Rani, Girija Kumari, Anupam Ranjan
Background: Predicting the timing and process of childbirth in pregnant women has long posed a challenge for healthcare professionals. Unfortunately, there has been limited advancement in preventing adverse outcomes associated with either premature or overdue deliveries. According to the perspective of the author, who specializes in maternal-fetal medicine, there is potential promise in approaching labor from a biomechanical perspective and treating it as an engineering problem. This novel approach may hold the key to unraveling the complexities of the labor process. Method and Objective: The labor induction is a routine approach in obstetrics. Having a way to predict the duration of labor would greatly assist in planning and enhance patient satisfaction. The main objective of this research was to assess the effectiveness of a novel biomechanical measurement method for the cervix, which utilizes the “aspiration technique”, in predicting the length of labor following induction. Results: No technical issues were encountered during the aspiration or sonographic assessment. Amongst various examinations, the assessment of the “Bishop score” was consistently recorded as the majority uncomfortable for patients. It’s important to note that both the duration until reaching the dynamic phase of labor and the period until parturition demonstrated significant correlations with the “Bishop score”, while there were no notable correlations with cervical length, CCI (cervical compliance index), or termination pressure. Conclusion: The application of the innovative biomechanical cervix measurement technique using the aspiration method has proven to be both technically feasible and positively received. Within our small study cohort, we did not identify any apparent link between termination pressure and time period of pain of labor.

257. Dysnatremia in Patients with Chronic Liver Disease
Arun Singh Jadoun, Abhishek Kamendu, Ashutosh Kumar Tripathi, Abhilasha Singh
Background: Chronic liver disease (CLD) is a prolonged impairment of liver function, leading to cirrhosis and fibrosis. The prevalence of CLD is increasing, especially in low-income countries such as India, where hyponatremia is a common electrolyte imbalance. Hyponatremia in cirrhosis is associated with disease severity and complications, impacting patient survival. However, the relationship between serum sodium levels and specific complications remains unclear. Materials and Methods: We conducted a study at Narayan Medical College and Hospital, Sasaram, India, involving 50 CLD patients aged over 18 years. Patients with comorbidities affecting serum sodium levels were excluded. Demographic data, clinical findings, and laboratory results, including serum sodium levels, were collected. Complications were assessed using the Model for End-stage Liver Disease (MELD) and Child Pugh Score (CPS). Ascites severity was graded. Statistical analysis was performed to assess associations. Results: Among the participants, 33% had serum sodium levels ≤130 mEq/L (Group A), 33% had levels between 131-135 mEq/L (Group B), and 34% had levels ≥136 mEq/L (Group C). No significant age or gender differences were observed between the groups. Patients in Group A exhibited higher rates of jaundice and altered sensorium. Hepatic encephalopathy, hepatorenal syndrome, and coagulopathy were significantly more common in Group A. Mean MELD and CPS scores were higher in Group A patients. Mortality was significantly higher in Group A (28.1%) compared to Group B (11.1%) and Group C (0%). Conclusion: Decompensated CLD is linked to abnormal serum sodium concentrations, with hyponatremia being the most common electrolyte imbalance. Lower serum sodium levels are associated with higher MELD and CPS scores, as well as an increased risk of hepatic encephalopathy, hepatorenal syndrome, and coagulopathy. Mortality is significantly higher in patients with hyponatremia. Serum sodium levels serve as a valuable prognostic indicator in CLD management.

258. Serum Amylase Levels as a Prognostic Marker for Clinical Severity and Outcome in Organophosphorus Poisoning: A Comprehensive Study
Mickey Patel, Ravi Shanker, Rajan Mangla, Ranjan Kumar
Background and Aim: This comprehensive study investigates the potential of serum amylase levels as a prognostic marker for assessing the clinical severity and outcomes of organophosphorus poisoning cases. Organophosphorus compounds are widely used as pesticides and are responsible for a significant number of poisonings in developing countries. Materials and Methods: The study, conducted on 240 patients, explores the correlation between serum amylase levels and various clinical features such as pupil size, mental status, secretion levels, heart rate, and respiratory failure. Result and conclusion: The results indicate that elevated serum amylase levels are associated with the severity of poisoning and poor clinical outcomes. This research emphasizes the importance of early detection and treatment of organophosphorus poisoning and highlights serum amylase levels as a valuable tool for prognostication.

259. Effect of Metabolic Syndrome on Pulmonary Function Tests
Rajan Mangla, Ravi Shanker, Mickey Patel, Ranjan Kumar
Background & Aims: The link between impaired lung function and cardiovascular events and type 2 diabetes mellitus has been established but the link between impaired lung function and metabolic syndrome in Asian population has not been thoroughly investigated. Our study sought to investigate the relationship between poor lung function and metabolic syndrome in of male and female. Materials and Methods: This research was carried out in the Department of Medicine at Narayan Medical College and Hospital in Jamuhar, Sasaram. After receiving Institutional Ethical Committee permission and getting informed consent 80 patients of 18 & above age falling in the category of metabolic syndrome attending medicine OPD were included based on inclusion and exclusion criteria, pulmonary function test were performed and recorded. Data was analyzed using t test and Annova and p=<0.05 was considered significant. Results: SBP, DBP, waist circumference, serum glucose, and serum triglycerides were significantly higher in males and HDL-C was significantly lower in females. Pulmonary function tests like FEV1, FVC were significantly higher in males than females. Conclusion: In our study means of FVC and FEV1 were significantly reduced among subjects, which indicate that subjects who are having 3 or more components of metabolic syndrome serve as a reason in the reduction of lung functions. Conclusion: obesity contributes to the development of lung function decline, as well as the relationship between metabolic syndrome and lung function.

260. A Study to Analysis of Various Cytopathological Patterns on Pap Smears-Cervical Cytology in Government Medical College and Attached hospital Dungarpur Rajasthan
Praveen Kumar Bairwa, Kaustubh Singh, Siddhi Roat, Mohammad Khusnood
Background: The most effective method of detecting cervical cancer has been called the Pap smear (cervical cytology-Papanicolaou). Method for detecting premalignant and malignant lesions using a Pap smear. The study’s primary goal is to analyze the wide range of cytopathological abnormalities found in all women’s cervical Pap tests at the pathology lab of a government medical college with an adjacent hospital in Dungarpur. Methods: This is a Cross sectional study which is conducted in Department of Pathology in Medical College Dungarpur for a period of 1 years during 15 August 2022 to 14 August 2023. We evaluated total 1870 reported pap smears during the study period and analysed for the prevalence of various cytopathological abnormalities. Results: 86 instances of epithelial abnormalities were discovered in 1870 individuals. In 1732 patients (90.05%), a non-neoplastic cytological diagnosis was made. Low grade squamous intraepithelial lesion (LSIL) (42 cases, 2.24%) and High grade squamous intraepithelial lesion (HSIL) (22 cases, 1.17%) were the two most frequent epithelial abnormalities. Conclusion: In India, one of the most frequent cancers among women is cervical cancer. We strongly advise performing a cervical cytology screening using conventional or liquid-based Pap cytology since they are quick, painless, economical, and efficient for finding precancerous lesions.

261. An Overview of Correction of Contour Deformity of Frontal Bone Using Autologous Tissues
Arunesh Gupta, Pooja Mistry, Aravind Hosamani
Background: Frontal bone fractures are relatively rare, comprising just around 5% of all maxillofacial injuries. These fractures cause bone deformity which hampers facial aesthetics significantly. These are caused by high velocity, high energy impacts. Wide variety of materials is being used for reconstructing the contour deformities such as porous polyethylene implants, titanium mesh, various autologous materials. Not many studies are available in the literature regarding use of autologous material in frontal bone contouring. This study emphasises the importance of the same. Aims and Objectives: To study various autologous options used for contour deformity correction. Materials and Methods:  The study was conducted in the Department of Plastic Surgery at TNMC BYL Nair Ch. Hospital. The clinical series comprises 14 consecutive patients selected by inclusion and exclusion criteria. All patients underwent reconstruction using autologous tissue. Evaluation of the same has been done in this study. Results: All the patients were males with an average age of 30.5 years. 28.5 % of the deformities were caused due to accidental fall, and rest 71.5% were due to road traffic accidents. In 4 patients immediate correction was done and in 10 patients delayed correction was done. Average time duration was 7 months. In six (42.85%) patients a coronal incision was used to explore the defect whereas in eight (57.14%) patients old scars were used to approach the defect. In 50% cases cartilage was used, 28.57% cases bone was used and fat 14.28% and fascia 7.14%. Out of the 14 cases, 1 patient developed cartilage resorption and 1 patient had fat necrosis. Both these complications were managed with minor procedures on OPD basis. Rest of the patients had acceptable contour with good patient satisfaction. Conclusion: With various treatment options available autologous tissue gave results which were simple, durable, cost effective and have low risk.

262. To Analyse the Clinical and Radiological Outcomes of Subtrochanteric Fractures of Femur Managed with Long Proximal Femoral Nailing
Sharma Saurabh, Gupta Mansi, Sahu Manoj, Gupta Anshul, Meena Rajesh, Shriwastava Ashish
Background & Method: The aim of the study is to analyse the clinical and radiological outcomes of subtrochanteric fracture of femur managed with long proximal femoral nailing. A semi-structured questionnaire was designed to collect the socio-demographic details and the clinical history from all the patients with subtrochanteric fractures. For all patients the operative procedure was done under spinal/epidural anaesthesia. After placing the patient on the fracture table, using discussion about reduction techniques before the fracture is reduced and the affected limb is slightly adducted in such a way it helps in facilitating the proximal femoral nail insertion through greater trochanter. Result: Mean values of outcomes of study subjects- Mean duration of surgery was 1.52±0.38 hr. whereas Radiological union time (weeks), Blood Loss (ml), Neck shaft angle (°) and Full weight bearing time (weeks) were 21.66±1.91 weeks, 205.70±100.05 ml, 124.24±7.79 degrees and 13.340±3.75 weeks respectively. Conclusion: Majority of the patient in our study were between 41-50 years with a mean age of 42.12±13.19 years. The complication encountered like broken implant or varus collapse was less. We could achieve excellent range of motion.

263. Results of Autogenous Bone Marrow Injection in Delayed Union Cases of Open Fractures of Tibial Shaft Treated by Various Surgical Procedures
Sahu Manoj, Gupta Mansi, Sharma Saurabh, Gupta Anshul, Shriwastava Ashish
Introduction: Tibia is the most commonly fractured long bone from its shaft.1Tibial fractures are most common fracture among long bones with complications of delayed union, non-union and infection. The purpose of this study to access the role of bone marrow infiltration in delayed union, non-union cases as this method is quick, easy and effective. Material and Methods: 36 patients’ cases of displaced compound fracture of tibial shaft selected for bone marrow infiltration treated by conservative method, external fixator and intramedullary nailing. Results: 25 patients out of 36 patients showed rapid healing by bone marrow infiltration method. Discussion: Autologous bone marrow infiltration is a percutaneous method with 70% success rate in delayed union and non-union case. It is safe and easy method.

264. Epidemiology of Open Tibial Shaft Fractures in Vindhya Region of Madhya Pradesh
Sahu Manoj, Gupta Mansi, Gupta Rajesh, Gupta Anshul, Ronak Jain
Introduction: Open fractures are more common in tibial shaft and delayed union, non-union and infection are relatively common complications of tibial shaft fractures, Tibia is the most commonly fractured long bone from its shaft. Open Fractures are particularly common in tibia because of its subcutaneous location. Even small degrees of rotational mal-alignment of the fracture tibia become noticeable because of hinge joints on its either side. In this study we evaluated the pattern of tibial shaft fracture in vindhya region of Madhya Pradesh. Material & Method: The study consisted of 36 selected cases of open fractures of tibial shaft and pattern of tibial shaft fracture is based on mode of trauma, type of injury, level of fracture and radiological type of fracture. Results: Results being based on mode of trauma, type of injury, level of fracture and radiological type of fracture. Road traffic accidents (RTA) are most common mode of trauma with 61.11%. 33.33% of Grade III B open type of injury constitutes highest among Grade III An open, Grade II open, Grade I open fractures. Lower one third and spiral type of fracture is most common with 44.44% and 41.66% incidence respectively. Discussion: The study was done in vindhya region of Madhya pradesh to study pattern of open tibial shaft fracture. Lower one third of tibial shaft fracture is common in this region. Male with age group 30-39 being commonly involved in fracture. So an idea of open tibial shaft fracture and its pattern in particular area is presented in this study.

265. Dysnatremia in Patients with Chronic Liver Disease
Arun Singh Jadoun, Abhishek Kamendu, Ashutosh Kumar Tripathi, Abhilasha Singh
Background: Chronic liver disease (CLD) is a prolonged impairment of liver function, leading to cirrhosis and fibrosis. The prevalence of CLD is increasing, especially in low-income countries such as India, where hyponatremia is a common electrolyte imbalance. Hyponatremia in cirrhosis is associated with disease severity and complications, impacting patient survival. However, the relationship between serum sodium levels and specific complications remains unclear. Materials and Methods: We conducted a study at Narayan Medical College and Hospital, Sasaram, India, involving 50 CLD patients aged over 18 years. Patients with comorbidities affecting serum sodium levels were excluded. Demographic data, clinical findings, and laboratory results, including serum sodium levels, were collected. Complications were assessed using the Model for End-stage Liver Disease (MELD) and Child Pugh Score (CPS). Ascites severity was graded. Statistical analysis was performed to assess associations. Results: Among the participants, 33% had serum sodium levels ≤130 mEq/L (Group A), 33% had levels between 131-135 mEq/L (Group B), and 34% had levels ≥136 mEq/L (Group C). No significant age or gender differences were observed between the groups. Patients in Group A exhibited higher rates of jaundice and altered sensorium. Hepatic encephalopathy, hepatorenal syndrome, and coagulopathy were significantly more common in Group A. Mean MELD and CPS scores were higher in Group A patients. Mortality was significantly higher in Group A (28.1%) compared to Group B (11.1%) and Group C (0%). Conclusion: Decompensated CLD is linked to abnormal serum sodium concentrations, with hyponatremia being the most common electrolyte imbalance. Lower serum sodium levels are associated with higher MELD and CPS scores, as well as an increased risk of hepatic encephalopathy, hepatorenal syndrome, and coagulopathy. Mortality is significantly higher in patients with hyponatremia. Serum sodium levels serve as a valuable prognostic indicator in CLD management.

266. Serum Amylase Levels as a Prognostic Marker for Clinical Severity and Outcome in Organophosphorus Poisoning: A Comprehensive Study
Mickey Patel, Ravi Shanker, Rajan Mangla, Ranjan Kumar
Background and Aim: This comprehensive study investigates the potential of serum amylase levels as a prognostic marker for assessing the clinical severity and outcomes of organophosphorus poisoning cases. Organophosphorus compounds are widely used as pesticides and are responsible for a significant number of poisonings in developing countries. Materials and Methods: The study, conducted on 240 patients, explores the correlation between serum amylase levels and various clinical features such as pupil size, mental status, secretion levels, heart rate, and respiratory failure. Result and conclusion: The results indicate that elevated serum amylase levels are associated with the severity of poisoning and poor clinical outcomes. This research emphasizes the importance of early detection and treatment of organophosphorus poisoning and highlights serum amylase levels as a valuable tool for prognostication.

267. Effect of Metabolic Syndrome on Pulmonary Function Tests
Rajan Mangla, Ravi Shanker, Mickey Patel, Ranjan Kumar
Background & Aims: The link between impaired lung function and cardiovascular events and type 2 diabetes mellitus has been established but the link between impaired lung function and metabolic syndrome in Asian population has not been thoroughly investigated. Our study sought to investigate the relations