International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Analysis of Incidence of Pregnancy Rhinitis in a Known Population: An Observational Study
Shashank Ojha, Dipty Ojha
Background: Pregnancy induces significant physiological changes in women, including gestational rhinitis, a condition associated with various complications. Despite its relevance, gestational rhinitis is underexplored in the literature, prompting the present study to assess its incidence using standardized scales. Methods: A cohort of 100 pregnant women attending routine obstetrics follow-up in the department of Obstetrics and Gynaecology, United Institute of Medical Sciences Prayagraj and study duration was duration April to September 2023. The Visual Analogue Scale (VAS) and Nasal-Obstructive-Symptom-Evaluation (NOSE) scale were employed to evaluate nasal symptoms. Data were analyzed using SPSS software, and the cutoff values were set at 4 for VAS and 45 points for NOSE. Results: The overall incidence of pregnancy rhinitis was 25%, with trimester-specific rates of 10%, 18.4%, and 46.87% for the 1st, 2nd, and 3rd trimesters, respectively. The study identified 31 subjects with elevated NOSE or VAS scores, and among them, 25 exhibited both. Discussion: Pregnancy rhinitis, characterized by nasal congestion in the last 6 weeks of pregnancy without an allergic cause, affects approximately one-fifth of pregnancies. The study’s findings align with existing literature and emphasize the need for understanding and addressing gestational rhinitis. Conclusion: This study contributes valuable insights into the incidence of pregnancy rhinitis, revealing a substantial impact on pregnant women, particularly in the 3rd trimester. Standardized scales like VAS and NOSE prove effective in quantifying nasal symptoms. However, limitations, including a modest sample size and potential biases, should be considered in interpreting the results. Further research is warranted to explore diverse populations and potential influencing factors for a comprehensive understanding of gestational rhinitis.

2. A Study of Characteristics and Outcome of Cardiorenal Syndrome in Heart Failure
Sahoo Madhusmita, Sethy Sunita, Rout Kumar Suresh, Lenka Sandeep, Bisoyi Diptiranjani, Dash Kumar Bijay
Aim & Objectives: The objective of this study is to assess the prevalence, predictors, and outcomes of Cardiorenal syndrome (CRS) in patients hospitalised with heart failure (HF) in the medical wards of a tertiary care hospital. Material & Methods: The study employed a cross-sectional design. Patients who were 18 years of age or older and met the specified criteria for inclusion were recruited in a sequential manner over a span of 15 months. A comprehensive medical history and physical examination were conducted, together with appropriate baseline blood tests including blood chemistry, complete blood count, urinalysis, estimated glomerular filtration rate (eGFR), electrocardiography (ECG), echocardiogram, and renal ultrasound scan. The urinary protein creatinine ratio was measured in individuals who had proteinuria. At the time of initial presentation, serum levels of creatinine, urea, and electrolytes were determined. These measurements were then repeated once over the course of heart failure treatment. Heart failure and CRS were precisely characterised and categorised based on suitable criteria. Statistical analysis conducted with the SPSS software. Results: Of the 100 patients studied, 62 are male 38 are female, mean age 50.64 ± 13.4. Out of them 47 patients are under heart failure alone group, 53 patients developed cardiorenal dysfunction. Among CRS group, 86.8% are above 40years, (p 0.04) and have high frequency of diabetes whereas in non CRS group 76% are non-smoker. Majority of patients have type1 CRS and 72.5% CRS patients are classified under mild CRS. Serum Creatinine >1.91mg/dl and serum urea >120mg/dl are predictors of mortality. Patients diagnosed with CRS exhibited a significantly elevated mortality rates compared to those who did not present the illness. Conclusion: Patients with heart failure had a substantial incidence of CRS. The independent predictors of CRS were found as NYHA class 4 and age more than 40 years. Patients with CRS experience a considerably higher duration of hospital stay compared to those without CRS. Within a hospital setting, individuals with CRS experience a notably elevated death rate. Serum creatinine & serum urea are significant indicators of mortality.

3. Unravelling the Struggles and the Multifaceted Challenges among the Caregivers of Type 1 Diabetes Children in a Tertiary Care Hospital
Sr. Jincy KJ, Poornima RN, Bellinda George
Background: Type 1 diabetes mellitus imposes significant challenges for both diagnosed children and their caregivers worldwide, affecting their well-being and family dynamics. This study aims to explore the experiences of caregivers managing Type 1 diabetes in pediatric patients. Methods: The study was conducted at St. John’s Medical College Hospital in Bangalore over 12 months (August 2019 to August 2020). Our mixed-methods approach integrates qualitative and quantitative techniques. In-depth interviews with caregivers of children aged 1-18 diagnosed with Type 1 diabetes uncover unique challenges and coping strategies. Additionally, a modified questionnaire is administered to 80 caregivers, assessing knowledge, attitudes, and practices related to pediatric diabetes. Results: The diverse study cohort (n=80) spans ages 1 to 18, with 82% falling in the 6-15 age range. Gender distribution includes 37 males and 43 females, and residence comprises 41 from rural and 39 from urban areas. Caregivers exhibit varied educational backgrounds, adding richness to the demographic snapshot. Quantitative analysis of the questionnaire offers insights into caregivers’ knowledge, attitudes, and practices regarding Type 1 diabetes management. Qualitative analysis of in-depth interviews uncovers nuanced challenges and coping strategies, enriching our understanding of the caregiving experience. Conclusion: This comprehensive study contributes vital insights into pediatric diabetes care, emphasizing the need for tailored support and education for caregivers. The mixed-methods approach provides a holistic understanding of caregiver perspectives, laying the foundation for targeted interventions that enhance caregiver competence and well-being. Improving the support system for caregivers is crucial for the holistic management of Type 1 diabetes in pediatric patients.

4. Cytopathological Spectrum of Salivary Gland Lesions at Tertiary Care Hospital
Himani J. Oza, Neelaba K. Mori, Bhavdish Pandya, Poonam Kachrola
Background: Fine needle aspiration cytology (FNAC) is a cytodiagnostic method based on morphologic findings of group of cells aspirated using a fine needle. FNAC of salivary gland lesions has complexity and sometimes overlapping features that pose a diagnostic challenge for cytopathologists. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been introduced for uniformity in the reporting of salivary gland FNAC and improves in better patient management. Material and Method: I study 50 patients attending the surgery and ENT OPD with the chief complain about salivary gland swelling at the tertiary care hospital, Surendranagar from June 2022 to October 2023. I did FNA procedure and stain the smear and reported according to MSRSGC. Results: In this study total 50 cases over a period of around one and half year was studied. Most common age group is 41-50 year with male to female ratio is 1.2:1 is found. As per laterality right side was more involved than left side in lesion, predominantly in parotid gland followed by submandibular gland and minor salivary glands. Most of cases are of chronic inflammatory lesions in non-neoplastic and in neoplastic lesion benign lesions mainly (Pleomorphic Adenoma and Warthin Tumor) are more common. Conclusion: In the present study, the distribution of cases according to MSRSGC was comparable with the previous studies. Since its implementation, the MSRSGC has gained international acceptance as a tool to improve reporting standards and consistency in the complex diagnostic area and utilized for subsequent therapeutic case management.

5. Stria Gravidarum: Is It a Predictor of Intra-Abdominal Adhesions or Not?
Sharma N, Vegada D, Gandhi VS, Shah PK
Introduction: Caesarean section (CS) is a common obstetric procedure worldwide, and its rate has increased in recent times. Women with repeat cesarean sections are susceptible to postoperative complications such as injury to organs, vessels, fetus or postoperative obstruction requiring repeat surgeries. The reason for this could be intraperitoneal adhesions. Striae gravidarum (SG), characterized by linear skin changes, is a common pregnancy complication caused by dermal damage. The study aims to assess the role of SG in predicting intra-uterine adhesions in repeat caesarean sections. Materials and Methods: A total of 100 pregnant females with one or more caesarean sections participated voluntarily in a prospective, observational study conducted at the Department of Obstetrics and Gynecology, Geetanjali Medical College and Hospital, Udaipur. Preoperatively, women were graded for striae gravidarum using Davy’s scoring, and intra-abdominal adhesions were classified intraoperatively as per Modified Blauer’s classification. The collected data was analyzed using Microsoft Excel 2016. Results: The mean age of the participants was 26.6 years (SD±3.42). 86% had previous one CS, 12% had previous two CS, and 2% had previous three CS. All study participants (n=100) had striae gravidarum. Adhesions were present in 87% (n=87) of study subjects. The study found no significant correlation between SG and intra-abdominal adhesions. Factors such as age, parity, and mode of delivery showed no influence on the severity of SG. There was, however, a significant relationship between parity, past cesareans, inter-pregnancy gap, and intra-abdominal adhesions. Conclusion: Finally, SG is not a reliable predictor of intra-abdominal adhesions in recurrent caesarean procedures.

6. A Study of Vaccine Hesitancy among Parents in an Urban Slum in Mumbai
Mridula Solanki, Mrunali Autade, Maheswari P, Sonal Shetye, Sushant Chavan, Zil Gala
Introduction: In the urban slum of Malwani, Mumbai, India, this study aimed to investigate vaccine hesitancy among parents of children aged 1 to 5 years. The research aimed to assess prevalence, explore associated factors, and understand reasons contributing to vaccine hesitancy within this marginalized community. Methodology: A cross-sectional study involving 95 parents was conducted using an interview schedule encompassing sociodemographic profiling, the Parent Attitude about Childhood Vaccines Survey (PACV), and questions addressing determinants of vaccine hesitancy. Systematic random sampling was employed, and statistical analysis utilized chi-square tests for associations. Results: The majority of parents exhibited a non-hesitant attitude (86.3%) towards vaccination, while 7.4% demonstrated hesitancy. Concerns about side effects (28.4%) emerged as a prevalent reason for hesitancy, followed by ‘not applicable’ reasons (62.1%). The study revealed varying perceptions influencing vaccination attitudes, highlighting the need for tailored interventions. Conclusion: Vaccine hesitancy in Malwani’s urban slum reflects diverse perceptions and concerns among parents. Addressing safety apprehensions, dispelling misconceptions, and fostering trust through targeted communication strategies are essential to enhance vaccine acceptance within this community.

7. Assessing the Efficacy of Advanced MRI Techniques in Predicting Outcomes of Laparoscopic Abdominal Surgeries
Velamala Sarath Chand, Boddepalli Nagendra Naidu, M.Uma Maheswara Rao, Modalavalasa Venkata Satyanand
Background: Laparoscopic abdominal surgery is a minimally invasive technique requiring precise preoperative planning. Advanced Magnetic Resonance Imaging (MRI) techniques offer detailed insights, potentially improving surgical outcomes. This study evaluates the efficacy of advanced MRI in predicting the success of laparoscopic abdominal surgeries. Methods: A prospective study was conducted with 100 patients undergoing various laparoscopic abdominal procedures. Participants were selected based on predefined criteria and underwent preoperative high-resolution MRI, including functional imaging techniques like diffusion-weighted imaging (DWI). Predictive parameters included surgical outcomes, operative time, post-operative recovery, and complication rates. Statistical analyses were conducted to determine the accuracy, sensitivity, and specificity of MRI predictions. Results: Advanced MRI techniques accurately predicted surgical outcomes in 82% of cases. Higher accuracy (90%) was noted in surgeries with high complexity. MRI findings correlated significantly with intra-operative complications (p < 0.05), accurately predicting complications in 24 out of 30 cases. Post-operative recovery predictions were accurate in 75% of cases. The sensitivity and specificity of MRI predictions were 85% and 78%, respectively. Surgeons reported that MRI predictions were helpful for pre-operative planning in 88% of cases. Conclusion: Advanced MRI techniques demonstrate significant efficacy in predicting the outcomes of laparoscopic abdominal surgeries. These techniques are particularly valuable in complex cases and in anticipating intra-operative complications. The high predictive accuracy supports the integration of advanced MRI in pre-operative assessments to optimize surgical planning and patient management.

8. Bacteriological  Profile  and  Antimicrobial  Susceptibility  Pattern of  Isolates  Obtained from  Neonatal  Sepsis  Patients
Agrawal Ruchi, Sharma Seema, Shah Mitesh, Misra Vaibhav
Introduction: Sepsis is a dysregulated systemic inflammatory as well as immune response that lead to organ damage in response to microbial invasion. Infection is the leading cause of neonatal deaths in India. For appropriate management of neonatal sepsis evaluation of causative agents should be done from time to time. Present study was undertaken to determine the bacteriological profile and antibiotic sensitivity patterns of causative bacteria of neonatal sepsis. Aims and Objectives: To isolate and identify the bacteria causing neonatal sepsis with their antibiotic susceptibility pattern. Method: Prospective study conducted in department of Microbiology, Gajra Raja Medical College, Gwalior. Blood samples were collected from suspected case of septicemic neonates in blood culture bottles, subcultures were done. Growth was identified and antimicrobial susceptibility testing was performed for all isolates. Result: Gram negative bacteria are more frequently isolated than gram positive bacteria from blood culture of suspected neonatal sepsis with Klebsiella spp. being most common followed by coagulase negative staphylococci. Gram negative isolates were sensitive for meropenam, levofloxacin and piperacillin + tazobactam while Gram positive isolates were mostly sensitive towards linezolid and Vancomycin. Conclusion: Gram positive and Gram negative bacteria both can cause neonatal sepsis. Bacteria causing neonatal sepsis shows multidrug resistance.

9. Oral Simethicone, a Mouth Dissolving Film; Use as a Pre-Endoscopy Measure: A Single-Center Experience
Ayaskanta Singh, Swarup Kumar Patnaik, Jimmy Narayan, Kanishka Uthansingh, Debakanta Mishra, Manjit Kanungo, Saroj K. Sahu, Manas K. Behera,  Girish Kumar Pati
Introduction:  The stomach and duodenal bubbles and foam affect the proper mucosal visibility during endoscopy, which results in the missing diagnosis and increases the procedure time. The present study aimed to evaluate the role of oral simethicone as a pre-endoscopy measure. Methods: In the present study, 200 cases received the pre-medication and the remaining 200 without premedication as control subjects. The cases were randomized into two groups; the first group received the simethicone mouth-dissolving strip 10 minutes before the endoscopy procedure. The second group received no medication and was included as a control. The analysis of endoscopy images was handled by the investigator blindly. The mucosal visibility scores, duration of the endoscopy, and the patient’s satisfaction levels were recorded in the designed proforma. SPSS software version 22 was employed for statistical analysis for the current study. Results: The pre-medicated group had a significantly better mucosal visibility score than the control group in gastric lumen (0.16 ± 0.39 vs. 1 ± 0.97, p = 0.0001) and duodenal lumen (0.1 + 0.31 vs. 0.81 + 0.88, p = 0.0001). The patient satisfaction score was better than the control group with a significant difference (7.44± 1.45 vs. 5.4 ± 1.53, p = 0.0001); however, there was no significant difference in the mean procedure time (1.5 ± 0.41 minutes vs. 1.55 ± 0.63 minutes, p =0.4). Conclusion: Pre-medication with simethicone before the UGIE study improves mucosal visibility and patient satisfaction scores.

10. The Role of Cnidocytes in Transdermal Drug Delivery: A Systematic Review
Vijay A. Shivnani
Cnidaria is a water-dwelling phylum characterized by a cnidocyte stinging cell. In nature, cnidocytes are used to immobilize or “sting” prey, for defense, and for locomotion, but their mechanisms also hold implications for drug delivery. Oral drug delivery has limitations that warrant new drug delivery techniques. One prominent method, transdermal drug delivery, uses the skin as a drug administration platform. Drugs can be systemically absorbed through microcirculation after relatively less invasive, painless, and self-administered delivery through ointments, creams, patches, and microneedles. Research has shown microneedle technology (essentially arrays of miniature needles) could implement cnidarian cnidocytes to bypass current microneedle restraints. Although positive results support cnidocyte gel-based drug delivery, limited variety formulas, conditions, and drugs have been tested, warranting future research before widespread implementation.

11. Study on Prescribing Pattern of Drugs and Rationality of Prescription in Patients Attending Outpatient Departments of Tertiary Care Hospital at Rewa, Madhya Pradesh, India
Pathak V, Patidar A, Singh P, Singh B, Tiwari RN, Chaturvedi JN
Pharmacotherapy has been the mainstay of treatment since ages. Drug prescription pattern studies not only gives an insight to current trends of diseases that are commonly encountered in day today practice but also forms the basis of modifications in drug policies and rational use of medicines. The present study was aimed to describe the prescription pattern and rationality of various drugs and in patients attending the OPDs of various clinical specialties. Data regarding prescription was collected randomly in the prospective manner of 1000 outdoor patients visiting the tertiary care hospital affiliated to Medical College. Prescription of various groups, classes and individual drugs are described in percentage. The rationality of prescription was also analyzed by using WHO/INRUD core indicators of prescription. Vitamins were the most frequently prescribed class of drugs (18.1%) followed by NSAIDs (17.1%). Polypharmacy and frequent prescription of antimicrobials was a major concern found in this study. 98.1% of total prescribed drugs were by their generic name and were from NLEM, 2022. More judicious use of drugs, especially antimicrobials, will help in improving the rational use of medicines.

12. Evaluation of Bone Marrow Study in Pancytopenia Cases – A Prospective Study for 2 Years at Tertiary Health Centre
Ramya Durga T, Sunanda M, Sravani P, Chandralekha J, Vijaya Bharathi I
Introduction: Pancytopenia is an important clinico – haematological phenomenon. It is a triad of findings characterised by haemoglobin ˂ 9g/dl, total leucocyte count ˂ 4×109/l and platelet count ˂140×109/l. It is a symptom of a primary haematological disease or underlying medical condition. The etiology of pancytopenia varies from decrease in hematopoietic cell production, trapping of normal cells in the hypertrophied and over reactive reticuloendothelial system, ineffective hematopoiesis or replacement of normal bone marrow elements by abnormal or malignant cells. Most common presentation of pancytopenia is anaemia or thrombocytopenia. Most common indication for bone marrow examination is pancytopenia. Aim and Objectives: To know the preponderance of haematological parameters, the efficacy of bone marrow examination in evaluating various causes of pancytopenia and to do special stains in required cases. Materials and Methods: The present study is a hospital-based prospective study conducted at Department of Pathology, Government Medical College, Srikakulam, for a period of 2 years from October 2020 to September 2022. Results: A total of 41 patients were diagnosed as pancytopenia on peripheral smear examination during the study period. To know the exact cause of pancytopenia all the cases underwent bone marrow aspiration and few cases that were inconclusive, further went through bone marrow biopsy and the cause was concluded. Conclusion: The present study concluded that megaloblastic anaemia is the most common cause of pancytopenia at a young age with a male predilection. Healthy sanitation and hygiene practise, balanced diets, and education about all these could help to reduce pancytopenia’s preventable cause.

13. A Cross-Sectional Survey: Knowledge, Attitude & Belief about Antibiotic Use & Its Prevention among Nurses of Tertiary Cardiac Care
Maradia M, Gajjar S, Patel D, Christian A
Introduction: Nurses have an important role to care for hospitalized patients. They have a crucial role in preventing the emergence and spread antibiotic-resistant of microorganisms through infection control programmes and antibiotic stewardship. This requires correct knowledge and attitudes towards antibiotic use and their resistance. Objectives: This study was carried out to identify the level of knowledge and attitude on antibiotic use and antibiotic resistance among staff nurses of tertiary care hospitals on the occasion of Antimicrobial awareness week 2022. Methods: This cross-sectional survey was conducted in a tertiary cardiac care hospital in Ahmedabad, Gujarat, India on the occasion of Antimicrobial awareness week in November 2022. The survey was conducted for 103 nursing staff using a Self-structured questionnaire. Results: While assessing the Knowledge 19.43% had good and 63.10% of nursing staff had moderate knowledge, and 17.47% had Poor knowledge. Less than 30% knew that antibiotics were only used for bacterial infection, not active against viruses. In our study, the majority of staff nurses 78.64% had fair attitudes regarding antibiotics use and their prevention of resistance. Overall, our study found moderate knowledge & attitudes regarding antibiotics and their resistance among the nursing staff. Conclusion: Nurses have multiple roles in medication management. Nurses should be active in antibiotic stewardship that ensures proper management of antibiotics to minimize antibiotic resistance.

14. A Study of the Outcome of Pregnancy Complicated by Obstetric Cholestasis
Kumari Monika Agarwal, Anupama Arya, Vikas Pandey
Background: Obstetric cholestasis (OC) is a pregnancy-specific liver disorder characterized by pruritus and elevated bile acids, which may lead to adverse pregnancy outcomes. This study aims to investigate the impact of OC on pregnancy outcomes. Materials and Methods: We conducted a retrospective cohort study of pregnant women with OC, comparing them to a control group of healthy pregnancies. Data were collected from medical records, including demographics, gestational age at diagnosis, laboratory values, and pregnancy outcomes. Statistical analysis was performed using chi-square tests and logistic regression. Results: A total of 150 pregnant women with OC and 300 healthy pregnancies were included. The mean gestational age at OC diagnosis was 28 weeks. Women with OC had significantly higher levels of serum bile acids (mean 35.4 μmol/L) compared to the control group (mean 5.8 μmol/L, p < 0.001). Adverse pregnancy outcomes, including preterm birth (37% vs. 12%, p < 0.001) and low birth weight (22% vs. 8%, p < 0.001), were more common in the OC group. Additionally, neonatal respiratory distress syndrome (12% vs. 3%, p < 0.001) and neonatal intensive care unit (NICU) admission rates (18% vs. 6%, p < 0.001) were higher in the OC group. Maternal complications, such as cesarean section rates (44% vs. 28%, p < 0.001) and postpartum hemorrhage (8% vs. 2%, p < 0.001), were also increased in the OC group. Conclusion: Obstetric cholestasis is associated with adverse pregnancy outcomes, including preterm birth, low birth weight, neonatal respiratory distress syndrome, and increased NICU admission rates. Early diagnosis and management of OC are crucial to minimize these risks and improve maternal and neonatal outcomes.

15. Prevalence of Pregnancy Induced Hypertension and Its Awareness among Pregnant Women in Referral Hospital in North India
Namita Shrivasava, Ritu Rani
Introduction: Pregnancy-induced hypertension (PIH) is defined as new hypertension that appears at 20 weeks or more gestational age with or without proteinuria. Its prevalence varies from place to place. Complications related to PIH are the result of inadequate knowledge and lack of preventive practice. We aimed to study the prevalence of PIH and its awareness among female patients reporting to a referral hospital. Methods: Study was conducted on1000 consecutive pregnant patients in the age-group 20-35 years coming to ANC clinic in their first trimester. Women having systolic BP > 140 mmHg or diastolic BP > 90 mmHg in the first as well as second reading were included. Questionnaire about signs and symptoms of PIH was prepared and used for assessment. Statistical analysis was done using chi square test for categorial variables and independent t-test for continuous variable. P-value< 0.05 was considered significant. Results: Of total 971 patients who were followed-up till delivery, 14.11% developed PIH. It was more common among primigravida (17.76%), and was statistically significant. Awareness of symptoms was very poor with only 37.8% of the patients aware of any of the symptoms. Health care professionals and media plays most important role in creating awareness. Conclusion: PIH is affecting significant number of pregnant females, and is a matter of concern. Primigravida were least aware of the symptoms, despite the fact that they are more susceptible. Our study highlights the importance of strengthening knowledge among individuals by help of health care professional, media and community level prevention strategies.

16. An Aetiological and Clinicohistopathological Study on Cutaneous Vasculitis – A Cross Sectional Study
Mohanta Padmalochan, Singh Chandra Purna, Mohapatra Swikruti, Sethy Sunita, Ram Kumar Manoj, Mohanty Prasenjeet, Bisoyi Diptiranjani
Background: Cutaneous vasculitis is to the inflammation that occurs in these cutaneous blood vessels, which leads to blood flow changes, ischemia and damage. The condition can affect any blood artery, although it most commonly affects the post-capillary venules. Frequently, the illness is a component of a systemic disorder affecting the walls of blood vessels; therefore the appearance of skin symptoms is the first indication of the overall disease progression. The involvement of the dermatologist is crucial in the diagnosis and subsequent treatment of these illnesses. Objectives: To study the etiology and cutaneous as well as systemic manifestations in patients of cutaneous vasculitis. Methodology: This cross-sectional study was done at Department of Dermatology, SCB Medical College & Hospital from June 2020 to November 2021 among all age group of patients who were filling the inclusion criteria. Results: Our study included 65 patients attending dermatology OPD with clinical evidence of cutaneous vasculitis. Mean age of patients was 32.44 + 17.9 years. To assess the normality of data, Kolmogorov-Smirnov test was performed. The data set was observed to have normal distribution. Among the all study participants 55% of the study participants were male and almost 45% were female. Conclusion: The majority of patients who had cutaneous vasculitis exhibited polymorphic lesions, while most of them showed with palpable purpura. Leukocytoclastic vasculitis had been the most prevalent kind of vasculitis observed during histological testing. A skin biopsy revealing leukocytoclastic vasculitis failed to show evidence of systemic involvement. It cannot demonstrate that there was involvement of larger blood vessels. The cause of this medical issue could not be determined in most of the participants in the present study.

17. Comparative Study of Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Treating Neck of Femur Fractures in Geriatric Patients with Osteoporosis
Kishor Uikey, Hrishikesh Kumar Bakode, Pavan Singh Rahangdale, Mona Bhalavi
Background: Oesteoporotic femoral neck fractures in elderly patients have traditionally been Operated with total hip arthroplasty (THA) or hemiarthroplasty (HA) , Many studies suggested that THA may be the better option. Recently it was reported HA provide better outcomes. It is not clear as to whether BHA or THA is most appropriate. The purpose of this study was to conduct a  randomized Prospective study, comparing the BHA with THA Intraoperative blood loss, duration of surgery and Complications rate for treating FNF in  elderly patients. Objective: Comparative Study of Total Hip Arthroplasty Versus Bipolar Hemiarthroplasty in treating Neck of Femur fractures in Geriatric Patients with Osteoporosis. Methodology: Prospective study was conducted in January 2020, in the department of Orthopedics and Trauma Centre in J.A. Group of Hospitals, Gwalior (M.P.). 30 patients on the basis of inclusion criteria, Garden type 3 and 4 Intracapsular femoral neck fractures in the age group of 60 years and above, with independent ambulation before injury and requirement of high functional demand activity to be treated with either BHA or THR. Intraoperative Blood loss, duration of surgery, postoperatively Complications were compared and analyzed with functional assessment was done using Harris hip scores at Fourteen day, three month and six month, postoperatively. Results: Within the THA group, 86.7% of patients achieved a harris hip score ranging from fair to excellent, while only 13.3% of patients had poor scores at the final follow-up. Among the patients in the bipolar hemiarthroplasty group, 53.3% had a low harris hip score at the final follow-up. The study findings demonstrate the benefits of total hip arthroplasty in facilitating early recovery of hip function. At the 6-month interval following surgery, the Harris score of the total hip arthroplasty (THA) group was greater compared to the bipolar hemiarthroplasty group. Additionally, the THA group had a substantially larger proportion of excellent and good scores compared to the bipolar hemiarthroplasty group (P-value <0.001). This study shows the advantage of total hip arthroplasty in Post-operative complications while six month after surgery, the Harris score (P-value <0.001) of THA group was good score on other hand, duration of surgery and Intraoperative blood loss was  lower in Bipolar hemiarthroplasty than total arthoplasty hemiarthroplasty group. Conclusion: Two aspect i.e, Post-operative complications and Harris hip score at 6 months give better result in THA and Intraoperative blood loss with duration of surgery shows better result in bipolar hemiarthroplasty in treating femoral neck fractures in elderly osteoporotic patients.

18. Study of Abnormal Uterine Bleeding in Perimenopausal Females
Pushpa A. Yadava, Kush M. Mehta, Rupa C. Vyas, Shashwat K. Jani, Forum A. Desai, Dhruvi R. Patel, Dhwani R. Rawal, Naisargee G. Rawal
Background: Abnormal uterine bleeding (AUB) is a significant clinical entity. AUB and its subgroup, heavy menstrual bleeding (HMB), are common conditions affecting 14–25% of women of reproductive age. Abnormal uterine bleeding is a symptom. Abnormal uterine bleeding (AUB) is defined as any variation from the normal menstrual cycle and includes changes in regularity and frequency of menses, in the duration of flow, or in the amount of blood loss. AUB is reported to occur in 9 to 14% of women between menarche and menopause. Aims and Objectives: (1) To study the etiology of AUB and the various abnormal patterns of bleeding presented in peri-menopausal women. (2) To evaluate various diagnostic modalities for the diagnosis of abnormal uterine bleeding. (3) To assess medical and surgical management in cases of abnormal uterine bleeding. Methods: Our institute drains patients from urban, semi-urban as well as rural areas. This is a retrospective study of 76 women diagnosed as Abnormal Uterine Bleeding carried out in the Department of Obstetrics and Gynecology, at Tertiary Care Hospital in Ahmedabad, Western India between September 2022 to March 2023. After due permission from the authority, computerized records of all the women who were admitted for the management of Abnormal Uterine Bleeding were studied in detail. History, clinical features, vital data, and general, abdominal, and per vaginal findings of the women were noted. Past history of any pelvic pathology, pelvic surgery, or treatment taken for infertility was also taken into account. Analysis was done regarding their diagnosis and management. Results: The number of the patients which were maximum (45) were seen in the age group of 40-45 which is peri-menopausal age. Patients of parity 4 and above were maximum 47.8%.The majority of patients (76.4%) presented with heavy menstrual bleeding as their abnormal pattern of bleeding. Maximum patients in this study were diagnosed as having leiomyoma, adenomyosis and endometrial hyperplasia in which the most common symptom was heavy menstrual bleeding.45.2% of women in our study were anemic, out of which 3.9% had severe anemia. In all patients, ultrasonography was done primarily. It gave primary diagnosis for 67 patients. Other diagnostic modalities were done in patients who needed further evaluation. It appeared in this study that the maximum number of patients attended the hospital for treatment after suffering for 3–6 months (53.4%). 57.2% of the women had a proliferative endometrium which means AUB in peri-menopausal women is predominantly an ovulatory. In 11 cases, of the total, endometrial hyperplasia was seen indicating unopposed estrogen action seen in anovulatory AUB. Conclusion: Occurrence of AUB is more common after 40 years of age and in multiparous women. Heavy menstrual bleeding is the most common complaint among these patients. Diagnosis, symptomatic management and treatment of underlying cause associated with AUB in perimenopausal women are the way of approaches in time of availability of various medical and surgical treatment options.

19. Conducting a Retrospective Analysis of Falls and Their Impact on Musculoskeletal Health among the Elderly Population in Our Local Community
Marthand Kulkarni, Syed Natiq Hussain, Mohammed Nayeemuddin, Ambreen Fatima
India’s demographic landscape is experiencing a significant shift with the increase in its elderly population, particularly in urban areas. This demographic change brings about various healthcare challenges, including the prevalence of falls among the elderly in towns and villages. Materials and Methods: This retrospective analysis was conducted to investigate the impact of falls on musculoskeletal health among the elderly population residing in the district of Gulbarga, Karnataka in India. The study design involved the systematic collection and analysis of historical healthcare records from multiple healthcare facilities in the designated area. Results: A total of [60286] elderly individuals aged 65 and above were included in the retrospective analysis. The study population exhibited a diverse age range(65-99), with a mean age of [76.6] years. The majority of participants were female, comprising 63.98 percent  of the cohort.

20. Association between Sleep Duration and Blood Pressure in Adolescents
Vandana Bhoi, Y Srinivasu, Raju. H Patil, Anil Bhoi
Hypertension is a widespread public problem, and the relationship between sleep state and hypertension has been considered as a risk factor. However, the findings have been inconclusive. The objective of this study is to thoroughly examine the relationship between the amount of sleep a person gets and the occurrence of hypertension. Materials and Methods: We evaluated 182 adolescents. The sleep duration was assessed by calculating the discrepancy between the self-reported regular bedtimes and wake-up times. Adolescents were categorized into three groups: less than 6 hours, 6 to 8 hours, and more than 8 hours. The National High Blood Pressure Education Program Working Group on High Blood Pressure in Adolescents’ guidelines were followed for measuring blood pressure using the auscultatory method, and blood pressure was classed as high if it was either systolic or diastolic. Results: Systolic and diastolic blood pressure were measured in our research between participants who slept for less than six hours and those who slept for six to eight hours. P = 0.84 >0.05 and P = 0.53 >0.05 have been found, which is insignificant. The study found that mean ± SD  for systolic BP 125.62 ±12.89 at <6 h sleep duration and  122.34 ±11.5  at 6–8 h’ sleep duration with P > 0.05 which  is not significant. Like this mean ± SD for diastolic BP  81.41± 12.36 at <6 h sleep duration and 82.35± 7.54 at 6–8 h’  sleep duration with P > 0.05 which is not significant. Conclusion: However, the current investigation was unable to establish a statistically significant correlation between the duration of sleep and hypertension.

21. Study of Perceived Stress and Associated Factors with Vitamin D Levels in under Graduated Medical Students
Vandana Bhoi, Nagaraju, Y Srinivasu, Anil Bhoi
Background of the Study: The primary aim of medical education is to produce community members who can practice medicine safely and competently. Under stressful situations, academic proficiency might be diminished, impacting students’ grade point averages, and fostering detrimental behaviors. The Perceived Stress Scale-10 (PSS-10) is a valuable instrument for evaluating psychological stress. Being involved in the neurotransmitter systems in the brain. Vitamin D may have a role in the perception of stress. Objectives:  The aim of this study was to evaluate the perceived stress levels in medical undergraduates and determine its correlation with vitamin D levels.
Materials and Methods: Using the PSS-10, 81 students ranging in age from 18 to 24 years old had their stress levels evaluated. Stress levels are deemed moderate to severe when the overall score exceeds 14. Using the chemiluminescent immunoassay method, the serum vitamin D levels were determined. Results: There was a substantial difference in the levels of stress experienced by males and females, with females experiencing a considerably higher level of stress (P = 0.002) than males. Hypovitaminosis D affected around 87% of women and 91% of men, and there was no correlation between the sexes. Furthermore, despite the fact that there was a negative correlation between stress and vitamin D, the association was not statistically significant with a P value of 0.5. Conclusion: The findings of the study indicate that medical students have an elevated incidence of both stress and hypovitaminosis. Vitamin D, on the other hand, does not appear to be connected with the experience of stress.

22. A Prospective Clinical Study on Prognostic Factors in Perforative Peritonitis in a Tertiary Care Hospital
Nareddy Rajeev Reddy, G. S. R. Hareesh, G. Purushotham, Yarram Rajyalakshmi
Background: Peritonitis resulting from gastrointestinal tract perforations, which are frequent in this nation, necessitates immediate surgical surgery and has high rates of morbidity and death. The most serious consequence, a perforated duodenal ulcer, is thought to have a high death rate. In the past, this risk was attributed to factors such as delayed patient presentation, surgical postponement, and inadequate use of antibiotics. Methods: All patients of duodenal ulcer perforation who were admitted and treated in ACSR Medical College, Nellore between the period of August 2021 to November 2022 were studied after obtaining written informed consent. Approval of institutional ethical committee was obtained before the start of the study. Results: 110 patients of duodenal ulcer perforation who underwent surgery were studied. 32 (29.09%) patients belonged to above 60 years age group. The male: female ratio was 6.85:1. Among the sociodemographic factors, increasing age (>60 years), was found to be having a significant relationship with mortality following surgery. 37.27% of the study population had IHD, 40.90% used NSAIDs, 10.90% presented with shock and 50% presented to the health facility later than 24 hours. Ischaemic heart disease, use of NSAIDs, presence of shock during admission and late presentation were all associated with mortality. Conclusions: Increasing age, presence of IHD, use of NSAIDs, patients presenting in shock and those who presented late to the health facility, all had a poor prognosis.

23. A Clinicoepidemiological Study of Stroke Patients Admitted in MB Hospital, RNT Medical College, Udaipur
Manish Mittal, Rohit Jain, Richa Gupta, Suresh Chaudhary, Jitendra Hirani
Introduction: Stroke, a significant global health concern, poses a substantial burden on healthcare systems worldwide. In India, stroke remains a major contributor to mortality and disability-adjusted life years, especially in regions with limited healthcare resources. Objectives: This research aims to comprehensively analyze the clinicoepidemiological profile and outcomes of stroke patients in South Rajasthan, India. Materials and Methodology: A cross-sectional observational study was conducted at the stroke unit of M.B. Hospital, Udaipur, over a six-month period. A total of 323 confirmed stroke cases were included, and various sociodemographic and clinical parameters were assessed. Results: Findings revealed a high incidence of stroke in the 60-69 age group, predominantly affecting males. Hypertension emerged as the most prevalent risk factor, followed by diabetes and dyslipidemia. The majority of stroke patients presented with weakness or paresis alone, with a significant number discharged within seven days. Notably, a considerable proportion of patients had neurological deficits at discharge, emphasizing the need for continuous monitoring and rehabilitation. Conclusion: This study contributes valuable insights into stroke epidemiology in a region lacking population-based information, highlighting key demographic trends and clinical factors associated with stroke occurrence and management.

24. Clinical Profile of Newborn Babies with Retinopathy of Prematurity in a Tertiary Care Centre
Aishwarya R, Thanuja Anand S, Sankaralingam Umaiorubagam
Introduction: Retinopathy of Prematurity (ROP), a potentially blinding condition, is a proliferative retinopathy, occurring in premature and low birth weight neonate. The life-long impact of the disease on vision remains significant. Hence timely detection of ROP in at-risk infants using available screening tools and institution of appropriate therapy proves inevitable for favorable outcome. Based on this aim of our study is to evaluate the clinical profile of Newborn Babies with Retinopathy of Prematurity in a tertiary care center and also to describe the incidence and risk factors of preterm babies with Retinopathy of Prematurity and their outcome. Methodology: It was done as cross sectional study at Special Newborn Care Unit (SNCU), Department of Pediatrics, Tirunelveli medical college and hospital, Tirunelveli for a period of 18 months in neonates admitted in Special Newborn Care Unit (SNCU), Department of Pediatrics, Tirunelveli medical college and hospital, Tirunelveli. A total of 510 babies were screened for ROP during the study period. Wide Angle Retinal Imaging device (RetCam) was used for screening. ROP was graded into zones and stages according to the International Classification of ROP. Results: A total of 48 cases was screened ROP positive. Thus the incidence of ROP in this study is 9.41%. In this study, total number of babies screened positive for zone I was 3 (0.59%), zone II was 11 (2.16%) and zone III was 58 (11.37%). These 72 infants had regular follow up according to AAP guidelines. Out of 58 Zone III positive cases, 24 cases (41.3%) had stage 0 ROP while remaining 34 cases (58.6%) had significant stages of ROP. According to ICROP Classification, babies diagnosed of ROP were categorized into zones and stages. In this study, most of the babies were in Stage 1 (24) and Stage 2 (17). Only 7 babies were in Stage 3. Conclusion: Prevention of preterm delivery is the first step in the prevention of ROP. To avoid premature births without any risk factors, antenatal care should be enhanced. The key to success is oxygen management and inexpensive measures. After stabilization of the preterm infants, a chart should be given to the primary caretaker who should contain details regarding the present status of the infant and the advised follow-up date. Ophthalmologists and Paediatricians should maintain decorum so that no infant would be missed from the ROP screening.

25. A Case of Homicidal Paraquat Poisoning in a 4 Year Child
Treasa James, Akhilesh Pathak
Paraquat, a widely used synthetic herbicide in agriculture, poses a grave threat to human health. Ingesting toxic amounts of paraquat can lead to fatal consequences, causing severe damage to vital organs. World Health Organization categorizes paraquat as a ‘class II moderately toxic pesticide.’ Unfortunately, there is no specific antidote or effective treatment to save lives in cases of paraquat poisoning, resulting in a dismal prognosis worldwide. A 4-year male child was brought to the emergency department with alleged history of ingestion of paraquat poison at home. On detailed enquiry with his grandfather, it was found that the boy was given poison by his grandmother. Grandfather noticed the deteriorating condition of child at home and rushed the child to a nearby Primary Health Centre where gastric lavage and initial treatment was done and subsequently, he was referred to our Emergency Department for further management. Upon conducting laboratory investigations, the results revealed abnormal levels of urea and creatinine in the patient’s blood, along with the presence of haematuria, indicating the development of acute kidney injury. The child was treated in paediatric department for 7 days and finally discharged uneventfully. The case is rare of its kind with regard to the manner of homicidal poisoning by a close relative within home, which was also confirmed during the police investigation.

26. A Double- Blind Randomised Study of Parenteral Thiamine in Patients of Alcohol Dependence Syndrome
S. Kiran Kumar, P. Lokeswara Reddy, K. Srilakshmi, T. Suryanarayana Raju, Meghana S
Introduction: In emerging countries like India, alcohol use disorders (AUD) are on the rise. Apart from tobacco, alcohol (21.4 percent) was the most commonly used substance in the National Household Survey. [1] Between 17 and 26 percent of alcohol users met the ICD-10 criteria for dependency, resulting in an average prevalence of 4%. [1] In numerous ways, alcohol consumption has been connected to the development of cognitive impairment and dementia. . [2] Thiamine insufficiency, which can lead to Wernicke Encephalopathy and Wernicke-Korsakoff Syndrome, is one of the most well- known causes of alcohol-related brain injury. Thiamine deficiency (vitamin B1) is frequent in people who are addicted to alcohol. Early on, thiamine deficiency can cause cognitive issues. [3] Long-term alcohol usage causes adaptive changes in the brain, which induce alcohol withdrawal syndrome. It has been linked to changes in neurotransmitter, neuropeptide, and hormone systems. [4] Due to low food intake, reduced gastrointestinal absorption, and decreased hepatic storage, thiamine deficiency is more common in patients with alcoholism. Wernicke’s encephalopathy is caused by a combination of reduced dietary thiamine consumption, poor thiamine transport through the intestinal mucosa, and impaired conversion of thiamine to thiamine pyrophosphate. Because the metabolism of alcohol increases the demand for thiamine, ADS patients have a higher thiamine need, resulting in thiamine deficit. Aims and Objectives of the Study: To compare the clinical outcome in the 2 groups of patients receiving 100mg and 500mg of parenteral thiamine respectively. Methodology: A Double-blind Randomized Comparative study was conducted at Government Hospital for Mental Care, Visakhapatnam In-Patients diagnosed with Alcohol Dependence Syndrome from October 2020 – September 2021.Two Thiamine treatment regimens were designed containing either 100mg or 500mg per day for 5 days, labelled as Regime A and B respectively. Thiamine was administered parentally through intravenous route mixed in 100ml of Normal Saline in a slow IV drip. In-patients diagnosed with Alcohol Dependence Syndrome were randomly assigned a treatment plan using simple randomization. Neither the patient nor the examiner had knowledge as to which treatment regimen they have been assigned. Patients were assessed on Day-0 using the SADQ, CGI, CIWA-AR, scales. Patients were again being assessed with CGI, CIWA-AR, scales at the end of the treatment i.e on Day 5. Results: A total of 74 patients diagnosed with Alcohol Dependence Syndrome who met the inclusion criteria were taken into the study after obtaining a written informed consent to participate in the study.Group 1 included 38 participants who received a regimen of 500mg of thiamine for 5 days. Group 2 included 36 participants who received 100 mg of thiamine for 5 days. The sample population were assessed for improvement of illness using the Clinical Global Impressions-global improvement.15.8%(n=6) in group 1 and 13.9%(n=5) in group 2 were very much improved ; 50.0%(n=19) in group 1 and 41.7%(n=15) in group 2 were much improved ;31.6%9n=12) in group 1 and 44.4%(n=16) in group 2 were minimally improved ; 2.6%(n=1) in group 1 and nil in group 2 showed no change.Majority of the sample population were much improved. P-value (p=0.556) was not significant with chi-square test between the two groups according to the improvement of illness. Conclusion: The findings of this study have no found no significant difference in the supplementation of a higher of thiamine in ADS patients to reduce withdrawal; hence the current recommendations can be followed. There was no difference in the reduction of AWS and severity of illness with both doses of thiamine given. Probable risk factors for developing severe withdrawal identified were severe alcohol dependence and previous history of complicated withdrawal.

27. Take Home Message for Policy Makers: Study on Over-The-Counter Drugs among Puducherry Population
Velvizhy R, Sabari Selvan MR, Shanmugapriya Seshatri, Dhivya R
The inappropriate use of non-prescription drugs (NPD), particularly over-the-counter (OTC) medications, poses a significant global health challenge. This cross-sectional study conducted in Puducherry, India, aimed to assess the prevalence of OTC drug use and its adverse effects. The study involved 462 participants, mainly from the 20-40 age group, with a majority having graduate degrees. Private employees were found to use OTC drugs more frequently. Surprisingly, even with medical professionals participating, OTC medications were not replaced by prescribed alternatives. Many participants visited pharmacies without a prescription, relying on expired prescriptions or describing symptoms to pharmacists. Fever was a common symptom leading to OTC purchases, often for chronic conditions requiring proper medical attention. The study identified 26 oral drug groups, 3 topical drugs, and 15 injections purchased as OTC, with some life-saving drugs obtained without prescriptions. Adverse effects were reported by a small percentage of participants, mainly mild hypersensitivity reactions, gastritis, and diarrhea. The findings emphasize the need for stricter regulations and increased awareness about the potential risks associated with OTC drug misuse. While OTC medications offer convenience, affordability, and self-management, their misuse can lead to adverse outcomes, warranting a focus on regulatory measures within pharmacy practices.

28. Heart Rate Variability and Oxidative Stress Levels in Pre-Hypertensive Subjects
Nasar Ahamed, Manila Jain, Sudhir Modala, Priynaka Pandey
Background of the Study: Stroke and ischemic heart disease are more likely to occur in people with hypertension (HTN) or prehypertension (PreHTN), whether they have it alone or are also dealing with other metabolic disorders like diabetes and obesity. Objective: to learn about prehypertensive subjects’ oxidative stress levels and HRV. In order to better estimate the risk of acquiring cardiovascular mortality and morbidity, this study seeks to establish baseline data in people who do not yet have hypertension. Methods: Among the 148 male and female participants in this cross-sectional study, 74 were classified as having prehypertensive symptoms and 74 as having normotensive ones. Examine normotensive and prehypertensive individuals for a correlation between malondialdehyde and HRV. Results: There was a statistically significant difference in body mass index (BMI) between the groups (p = 0.000), but there was no difference in other baseline factors such as average age or height. In our study, we observed that prehypertensive subjects differed significantly from normotensive subjects in the following areas: Standard Deviation of Normal-to-Normal intervals (SDNN), Root Mean Square of Successive Differences (RMSSD), Normal-to-Normal intervals (NN50) that differ by more than 50 milliseconds, pNN50, VLF, Low-Frequency (LF) power, and High-Frequency (HF) power components. In our investigation, we found that prehypertensive individuals had a marked rise in oxidative stress. Conclusion: Alterations to cardiovagal regulation and elevated oxidative stress were indications of prehypertension. In comparison to the normotensive group, the prehypertensive group had a greater mean malondialdehyde level, according to our study. It is important to constantly monitor blood pressure in individuals with reduced heart rate variability.

29. Bifid Ureter: A Cadaveric Study
Sneha P John, Mayuri Ghorpade, Meenakshi Borkar, Shobha Verma, Mehera Bhoir, Manisha Nakhate
Bifid Ureter is a condition where upper end of the ureter is bifid. In the lower part of the course two ureters join together to open by a common orifice into the urinary bladder. It occurs due to premature division of ureteric bud. Aim: To study any anomalies of ureter in routine anatomical dissection. Methods: 50 cadavers of both sexes that had been fixed in formalin were used in the current study. During the dissection, the ureter’s anatomy was the main point of attention. From the renal pelvis to the uretrovesical junction, which opens into the urine bladder, the ureter was traced. One of them yielded a cadaver in which two ureters were independently draining a single kidney into the UB and were unrelated to any other congenital abnormality. The left kidney and ureter were both perfectly healthy. Conclusion: Patients with bifid ureters may be accompanied by other ureteral anomalies such as ectopic ureter and have an increased risk of developing urinary tract infection, hydronephrosis and stone formation. The knowledge of abnormality in renal collecting system is necessary for effective endo-urological applications and intrarenal surgeries. The present study adds on to the literature and will be helpful and interesting for the radiologists and urologists as it describes the ureteric anomaly.

30. Morphological Study of the Menisci of the Knee Joint in Human Cadavers in Maharashtrian Population
Varsha Bande, Shobha Verma, Mayuri Ghorpade, Sneha P John, Manisha Nakhate
Background: The menisci of the knee joint are crucial for joint congruence, load distribution, and prevention of osteoarthritis. Meniscal injuries are common and can have severe consequences. Understanding the morphological variations, width, and thickness of menisci is essential for diagnosis and treatment. Methods: This study examined 200 menisci of right and left lower limbs of 50 cadavers which include 100 medial and 100 lateral menisci. Morphological variations were categorized, and measurements were taken using a digital Vernier caliper. The menisci were dissected systematically, and data were recorded. Morphological and morphometric analyses were conducted for both medial and lateral menisci. Results: The medial meniscus predominantly exhibited a crescent shape (96%), while the lateral meniscus was mostly C-shaped (94%). Incomplete discoid meniscus were rare (1%) and exclusively found in the lateral menisci. The medial menisci were thicker on average compared to the lateral menisci. The width of the lateral menisci were generally greater than that of the medial menisci. Conclusion: This comprehensive study provides insights into the diverse anatomical characteristics of the human knee joint menisci. Predominant shapes, thickness, and width differences between the medial and lateral menisci were observed. These findings contribute valuable information for diagnosing meniscal issues and planning interventions.

31. Comparative Study of Saline Infusion Sonography with Hysterosalpingography in Evaluation of Tubal Patency
Saikat Dey, Monojit Chakraborty, Kedarnath Pal, Satarupa Roy
Background: Objective of the study is comparing Saline infusion sonography versus hysterosalpingography with diagnostic laparoscopy as gold standard in the evaluation of tubal patency in infertility cases. Methods: A comparative study was performed in a tertiary care hospital in Kolkata, India. The study was performed for a period of one and a half year from July 2020 to December 2021 in which fifty infertile women were investigated and comparatively evaluated as per objective with inclusion of primary and secondary infertile patients in reproductive age group. Informed consent was obtained from the patients. Patients with active pelvic infection, active vaginal bleeding, genital tract malignancy, suspected pregnancy and abnormal semen analysis of husband were excluded from the study. Results: Tubal patency test with diagnostic laparoscopy (as gold standard) confirmed all cases of Saline infusion sonography and Hysterosalpingography with additional patent tubes in 8% of Saline infusion sonography and 12% of Hysterosalpingography making the Sensitivity & Specificity of Saline infusion sonography was 85.71% and 83.33 % and of Hysterosalpingography was 78.57% and 75.00%. Conclusion: The present study showed slight better results with Saline infusion of sonography compared to Hysterosalpingography.

32. A Comparative Assessment of Safety and Efficacy of Terbinafine and Itraconazole in Patients of Tinea corporis
Tarun Agarwal, Vinay Singh, Mohd Faisal
Introduction: Tinea corporis, caused by dermatophytes, impacts the whole body. A frequent culprit is Trichophyton rubrum. Treatment with topicals is usually successful, although severe instances may need oral therapy. Climate leads to high prevalence in India. Clotrimazole and oral terbinafine are suggested for immunological variables that affect infection severity. Limited research in dermatophytosis has led to combination regimens, although their efficacy is unknown. Aim and Objectives: This study evaluates the relative merits of Terbinafine and Itraconazole as treatments for tinea corporis by comparing their respective safety profiles and effectiveness rates. Method: This one-year prospective study, conducted on 116 patients with Tineacorporis, aimed to assess infections and therapeutic effectiveness. Patients aged 18–60 with positive KOH tests were included, excluding those under 18, over 60, with specific medical conditions. Skin samples were collected via scraping, and microscopy identified various fungal elements. Randomized into Group 1 (terbinafine) and Group 2 (itraconazole), clinical and laboratory tests evaluated therapy effectiveness. The study provided detailed insights into Tinea corporis infections, treatment responses, and patient outcomes. Inclusion criteria covered age, diagnosis, and patient consent, while exclusions considered medical conditions, pregnancy, prior antifungal use, and other dermatological disorders. Result: The study presents comprehensive findings on the therapeutic effects of interventions in two groups (Group 1 and Group 2) over a research period. Figure 1 illustrates variations in itching intensity, revealing that Group 1 exhibited a more favorable response, particularly in reaching a state of no itching, compared to Group 2. Figure 2 depicts changes in redness, indicating that Group 1 demonstrated a better decrease in redness than Group 2. Figure 3 shows a substantial improvement in scaling for Group 1 compared to Group 2. Additionally, Figure 4 highlights the significant reduction in itching for Group 1 throughout the research period, suggesting a more effective treatment response. Overall, the graphical representations underscore the superior outcomes in Group 1 across various parameters, indicating the potential benefits of the intervention. Conclusion:The study has concluded that Terbinafine has shown a significant overall improvement compared to Itraconazole after one month of treatment.

33. Evaluation and Comparison of Microalbuminuria Reduction by Spironolactone and Telmisartan in Normotensive Patients of Early Diabetic Nephropathy
Mohd Faisal, Vinay Singh, Tarun Agarwal
Introduction: Diabetic Nephropathy is a serious complication of diabetes which is related to persistent albuminuria and decreasing glomerular filtration rate. Its majority varies globally, impacting well-being and boosting morbidity. Microalbuminuria, an earlier marker, indicates kidney disease advancement, underlining the necessity for vigilant monitoring. Spironolactone indicates commitment in mitigating albuminuria, oxidative stress, and inflammation, offering a probable therapeutic avenue for diabetic nephropathy. Aim and Objectives: This study evaluates and compares the microalbuminuria reduction by Spironolactone and Telmisartan in normotensive patients of  early Diabetic nephropathy. Method: This was a six month prospective, open-label randomised controlled study. A total of 110 individuals  with diabetes and age between 25-75 years  with Urinary albumin creatinine ratio of 3-300 mg/g creatinine were selected at random, followed up with for 24 weeks, and then evaluated for safety and effectiveness by established ethical guidelines. Patients were divided into two groups using computer generated random table. Group 1 received Spironolactone 25 mg once a day and Group 2 received Telmisartan 40 mg once a day. Result: There was significant decrease in urinary albumin creatinine ratio in both groups during six month treatment(p=0.0001).There was insignificant decrease in SBP and  DBP in Group 1and significant decrease in Group 2. Conclusion: Spironolactone and Telmisartan effectively reduce microalbuminuria. Spironolactone can be considered in early diabetic nephropathy for microalbuminuria reduction without causing hyperkalemia.

34. Cytohistopathological Analysis of Cervical Lymphadenopathy: A Prospective Study
Shailendra Yadav, Mukesh Waghmare, Pravin Meshram, Nikhil Charmode
Introduction: When it comes to diagnosing cancer and other disorders, the two-thirds of lymph nodes that are located in the neck are among the most important. In India, FNAC is a crucial diagnostic tool for tubercular lymphadenitis since it is effective, inexpensive, and easy to use. Even in juvenile situations, FNAC shows great specificity and sensitivity because of its rapidity, safety, and reproducibility, which contribute to accurate diagnosis and treatment planning. Aim and Objective: To evaluate the Cytohistopathological characteristics of cervical lymph nodes. Methods: The use of fine needle aspiration cytology (FNAC) was crucial to a prospective study of cervical lymphadenopathy that ran from 2022–2023. The patient group was evaluated comprehensively across many clinical domains, including medical history and cervical lymph node examinations. Cytological diagnoses were obtained using FNAC using sterilized needles. Contributing useful insights to pathology, the research sought to improve the accuracy of cervical lymphadenopathy diagnostics. Result: This study found that the gender-specific distribution of non-neoplastic lesions revealed noteworthy patterns. Men exhibit a higher prevalence of acute and chronic lymphadenitis, whereas tuberculous lymphadenitis is more common in females. Reactive lymphadenitis slightly favours men. Overall, non-neoplastic lesions are notably more prevalent in men (51.14%) than in females (48.86%). The gender-based breakdown of total lesions (n=103) in the study underscores a higher incidence in men. Categorization reveals critical insights into primary and secondary lesion types, emphasizing the necessity for accurate diagnosis for optimal therapeutic strategies. Conclusion: Painful adult neck lumps are prevalent. Travel, animal interaction  and trauma are risk factors. Needless excisional biopsy can be avoided by using FNAC. FNAC and other tests reliably diagnose benign cervical lymphadenopathy, enabling conservative treatment in most patients.

35. Incidence of Hiatal Hernia in Patients with Gastroesophageal Reflux Disease (GERD)
Himani Sandhu, Akshay Sanjay Nagare, Santhosh Kumar Elavaree E, Rohit Singh, Sudhanshu Mishra, Ravi Sinha, Simarpreet Kaur, Shubham Singh
Introduction: Gastroesophageal reflux disease (GERD) arises from contact of the esophageal epithelium with acidic gastric contents that significantly affects the patient’s quality of life. Hiatal hernia is one of the factors causing reflux. Hiatus hernia refers to condition in which elements of the abdominal cavity, most commonly the stomach, herniate through the oesophageal hiatus into the mediastinum. Hiatal hernia is a frequent finding during upper gastrointestinal endoscopy. Type I hiatal hernia is the sliding hiatal hernia, which accounts for more than 95% of all hiatal hernias and remaining 5% is paraesophageal hiatal hernias. Aim and Objectives: The aim of the study was to detect the frequency of hiatal hernia (HH), in patients with Gastroesophageal reflux disease (GERD), to compare the acid reflux pattern in patients with and without HH, and to search the relationship between the erosive gastroesophageal reflux (GER) and HH. Materials and Methods: A total of 64 patients (30 Male, 34 Female) with GERD were examined.  The patients who presented with complaints of upper gastrointestinal symptoms and underwent upper gastrointestinal endoscopy in Hind Institute of Medical Sciences, Mau Ataria, Sitapur, UP. During the period of April 2022 to July 2023. The frequency of hiatal hernia (HH), in patients with GERD, the acid reflux pattern, the relation of body mass index and erosive esophagitis with HH were studied. Results: Out of 64 patients, 30 males (46.875%) and 34 females (53.125%) were part of the study, who presented with upper GI symptoms, 11 (17.19%) patients were diagnosed with hiatus hernia. Out of these 11 cases, 9 patients (81.81%) were found to be having sliding type of hiatus hernia and 2 patients (18.18%) having rolling type. The mean age of the patients was 44.0 6 ±9.6 years.  Hernia was small in 6 (54.54%) cases, medium in 3 (27.27%), and large in 2 (18.18%). There was no significant difference in body mass indices between patients with HH and GERD. HH was found to be significantly correlated with GERD (P≤ 0.05). Conclusion: Hiatal hernia is very closely associated with GERD by 17.19% incidences.  Early diagnosis and timely management or surgical intervention reduces morbidity associated with hiatus hernia and acid reflux. Hence, all patients presenting with persistent upper gastrointestinal symptoms should undergo upper GI endoscopy managed accordingly.

36. Association of Cochlear Implant Electrode Depth and Post Op Hearing and Speech Assessment in Deaf Children Aged Less than 6 Years
Divyakshi Pathania, Swati Mishra, Devanshi Modi, Sagar Jani
Background: Cochlear implants are the first true bionic sense organs. Cochlear implants, like the human hair cell, receive mechanical sound energy and convert it into series of electrical impulses. Cochlear implants have proven to be a successful intervention for individuals with severe sensorineural hearing loss who do not see improvement with conventional hearing aids. There are many factors that may impact upon poorly performing recipient some of which include the depth of electrode insertion, duration of severe to profound deafness and age of implantation. This study examined the performance of patients in relation to the depth of insertion at a regional level. Aim and Objectives: To study the correlation between angle of insertion of cochlear implant and hearing outcomes in terms of SIR and CAP Scores. Materials and Method: A comparative interventional study done on 35 patients under the age of 6 years, who underwent Cochlear implantation at KKR institute, Chennai over a period of one year. They were evaluated post operatively for the hearing performance on the basis of SIP and CAP score and the same was co related with the angle of insertion of the electrode and the type of cochleostomy done. Results: CAPS Improvement is statistically better in extended round window type than other types while SIRS Improvement was statistically better in round window type than extended round window type. Conclusion: Auditory performance improves significantly in most children who undergo cochlear implantation at age less than 6 years. Cochlear implantation outcome depends on   number of factors and depth of insertion might be one of them. The effect of angle of insertion on outcome is not independently statistically significant and depends upon many other factors.

37. Guy’s Stone Score in Percutaneous Nephrolithotomy. Is it Clinically Feasible?
Prasad C, Vishruth K Raj, Narendra S
Introduction: Since its introduction in 2011, Guy’s stone score (GSS) has piqued the curiosity of endourologists worldwide. Aim of our study is to apply the score, along with the modified Clavien system to assess its clinical feasibility in predicting stone free and complication rates following PCNL. Material and Methods: In our prospective study between September 2021 and August 2023, 164 patients with unilateral and 17 patients with bilateral stones underwent PCNL (Total 198 renal units). Patients grouped into 4 grades of GSS based on CT scan/IVU and intraoperative RGP findings. Standard PCNL performed in prone position. Data tabulated include calyx punctured, number of punctures, operating time, stone clearance, auxiliary procedures, complications as per Modified Clavien System and days of hospital stay. Stone clearance (absence of residual fragments or fragments <4mm) evaluated by post-op X ray KUB and USG at the time of discharge. Statistical analysis done using SPSS 21. Results obtained using Chi square and ANOVA tests and significance reported as p values. Results: Operative time (mean of 101.1 min) and hospital stay (mean of 8.1 days) were highest with GSS IV, as also number of punctures and auxiliary procedures needed. Overall complication rate was 45.9 % with more severe complications seen in higher GSS grades. Final stone clearance rate was 100%, 100%, 94.9% and 85.2% in GSS I, II, III, IV respectively. Conclusion: As envisioned, GSS is a practical, clinically applicable tool that predicts stone free and complication rates. It is extremely useful for pre-op counselling and deserves more widespread usage.

38. A Study of Serum Lipid Profile in Patients with Chronic Alcoholic Liver Diseases in Tertiary Care Level Hospital, Ahmedabad
Rahima Malek, Sohil Mansuri, Rizwan N Ansari, Shagufa M Pathan
Background: Excessive alcohol con­sumption causes a wide variety of medical and social problems and a considerable economic burden. Liver is the principal site for formation and clearance of lipoproteins. Liver diseases can affect serum lipid levels in a variety of ways.  The aim of this study is to determine the changes in levels serum lipid profile in chronic alcoholic liver diseases. Materials and Methods: A cross-sectional study was done and included 100 individuals (50 chronic alcoholic liver diseases cases and 50 normal controls). Serum Lipid profile estimated by colorimetric method on fully automated chemistry analyzer. Result: Data were fed under Microsoft Excel 2007 and statistically analyzed by Graph pad software; Version 6.0, which evaluated the differences of various parameters in both groups on the basis of p value. In Serum triglyceride and VLDL level, there was no significant change, serum cholesterol; HDL and LDL level was significantly decreased in chronic alcoholic liver diseases patients as compared to normal healthy controls. Conclusion: Estimation of serum Lipid Profile allows better assessment of hepatic synthetic function and evaluation of prognosis of patients with alcoholic liver disease. Hence these parameters should be regularly monitored in chronic alcoholic liver diseases patients.

39. Study of Cyto-Histopathology in Thyroid Lesions in South Karnataka Population
Honey Kumar, Laxmi V
Background: Thyroid lesions are quite common among endocrine disorders. Apart from FNAC, the Bethesda system for reporting thyroid cytopathology (TBSRTC) smear aspiration studies is ideal for proper diagnosis and to avoid unwanted surgery. Method: 25 patients with thyroid lesions were studied. Apart from FNAC, TBSRTC was studied in every pa-tient to evaluate the cyto-histopathological studies. Results: Nodular goitres were 2 (8%), 15 (60%) AUS/FLUS, 1 (4%), 3 (12%) FN/SEN, 3 (12%) SFM, and 1 (4%) Malignant In cytological histopathology correlations, 19 (76%) were benign and 6 (24%) malignant le-sions were observed. Conclusion: In the present pragmatic study, apart from FNAC TBSRTC is an excellent reporting system for thyroid lesions to diagnose malignant or benign lesions.

40. Study of Non-Alcoholic Fatty Liver Disease in Andhra Pradesh Population
Dadeboyina Suryakala, Yasar Arafath Shaik
Background: Non-alcoholic fatty liver disease is a benign steatosis disease that leads to steatohepatitis, cirrho-sis of the liver, and hepatic neoplasia. In the majority of cases of such disease, patients remain asymptomatic despite progressive liver disease. Hence, clinical manifestations and biochemical profiles are ruled out. Method: 95 NAFLD Patients were studied for USG, lipid profile, HbA1C, routine blood examination, blood pressure recorded by sphygmomanometer, and ECG recorded (if necessary) to rule out cardiac co-morbidities. Results: 19 (20%) were in grade I, 44 (46.3%) had in grade II, and 32 (33.6%) had in grade III, NAFLD. In the BMI study, 59 (62%) had 22.8 to 23.2, 36 (37.8%) were 23.3 to 242, 35 (36.2%) were pre-diabetic, 60 (63.1%) were diabetic, 25 (26.3%) were norma-tensive, 70 (73.6%) were hypertensive, 71 (74.7%) were hyperlipidemic, 26 (27.3%) had IHD, and 4 (4.20%) had MI. Conclusion: The prevalence of 3rd grade NAFLD among type II DM and dyslipidaemia is alarming. Hence, high-grade NAFLD must be treated efficiently to avoid morbidity and mortality because the liver is the largest metabolic centre of the body.

41. Study of Pulmonary Function Test in Factory Workers of Gujarat Population
Bhakti Praveenbhai Gadhavi, Charu Kharbanda
Background: Respiratory diseases are often diagnosed in laborers working in industries (factories) where they are exposed to toxic materials that are fatal to respiratory organs, mainly the lungs. Method: 100 (one hundred) factory workers suffering from respiratory diseases were studied. The pulmonary function test was assessed three times, and the best out of three was noted. Sixty healthy volunteers were also subjected to the pulmonary function test. The values of factory workers and healthy volunteers (controlled) were compared. Moreover, among factory workers, pulmonary function tests of smokers and non-smokers were also noted and compared. The spirometric parameters were recorded using an electronic, computerized portable spirometric vitalograph in the sitting posture. Results: Comparison of spirometric parameters FVC, FEV1, FVC%, and PEFR among smokers and non-smokers among workers. Moreover, these spirometric parameters in factory workers and healthy volunteers were compared, and the p value was highly significant in every parameter (p<0.001). Conclusion: The present pragmatic study has concluded that the decreased spirometric parameter values in factory workers have a bad prognosis and must seek medical aid to protect themselves from morbidity and mortality.

42. A Study of Serum Cystatin C and Serum Creatinine as Markers in Early Prediction of Acute Kidney Injury Patients Requiring Intensive Care in a Tertiary Care Centre
Raghavendra BL, Abhilash S Setty, Ahmedi Fathima, Varsha R Mokhasi
Introduction: AKI is a common complication in patients admitted to the ICU with a prevalence rate of 30% and mortality rate between 30% and 90% depending upon various causes. Serum Creatinine (S.Cr) inaccurately estimates GFR due to tubular secretion and reabsorption of creatinine and can be affected by age, sex, muscle mass, drugs and diet. Serum Cystatin C (S.Cys C) is a marker which is independent of the above factors and the present study is to estimate S.Cr and S.Cys C in patients who are admitted to Intensive Care Unit with predisposing factors of AKI. Objectives: 1. To study Serum Cystatin C and Serum Creatinine in subjects with AKI in ICU patients. 2. To study Serum Cystatin C and Serum Creatinine for the estimation of eGFR in ICU. Methods and Material: 86 patients with age above 18 years, who were admitted to ICU with predisposing factors of AKI between January 2021–December 2021 were taken by universal sampling and subjected to S.Cr and S.Cys C testing in order to establish their role as markers in early detection of AKI. Statistical Analysis: The data was entered into Microsoft excel spread sheet. The qualitative variables were coded. The collected data was summarized and presented as frequencies, proportion, mean and standard deviation, depending on the quantitative or qualitative variables. Analysis was performed using SPSS 22 version. Results: Among the 86 patients, 26 patients who developed AKI, 70% had high Cystatin C on day 1 with normal serum creatinine and the remaining patients had high levels of both Cystatin C and creatinine at the same time. Conclusions: Serum Cystatin C can be taken as an early marker in critically ill patients to predict the development of AKI as majority of those who developed AKI did show an early rise in levels of Cystatin C even prior to the raise in Serum Creatinine levels.

43. Seroprevalance of IgG Antibodies against SARS CoV-2 in A Tertiary Care Hospital in Chennai
Anjana Christy Alexander, Nanthini Devi Periadurai, Sujin Padmanabhan, Anitha Raj Velmurugan, Sarikasri Surendra Kumar, Kalyani Mohan Ram, Surapaneni Krishna Mohan
Background: The SARS-CoV-2 pandemic put the world into despair and caused a huge strain on global healthcare network because of its high morbidity and mortality rates. In order to stop the transmission of the virus a better understanding of its prevalence among the population is needed for implementing safety and treatment management protocols for betterment of the community. Understanding the prevalence in a community through RT-PCR testing likely underestimates true prevalence rate as the asymptomatic cases are mostly unlikely to be tested. In this case serological testing can play a vital role in estimating the prevalence rate of COVID- 19 among the population particularly in the asymptomatic cases. Objective: The aim of our study was to evaluate the seroprevalence of IgG antibody against SARS-CoV-2 among different subgroups of individuals. Method: The study participants were divided into four groups. The blood samples were collected from different subgroups of patients who visited the COVID -19 testing facility of a tertiary care hospital in Chennai. The samples were tested for COVID- 19 IgG antibody as per the kit insert provided by the manufacture and the results were documented. The antibody responses among different subgroup of patients were evaluated and appropriate statistical analysis performed. Result: Out of 160 study participants, 97 individuals turned out to be antibody positive and 63 individuals were antibody negative. Highest number of antibody positivity was observed in late COVID-19 positive group (92.5%) followed by the vaccinated group (87.5%). Highest number of antibody negativity was observed in COVID-19 RT-PCR negative group (72.5%) followed by early COVID-19 positive group (65.0%). Age and gender was not associated with the antibody production. Conclusion: COVID -19 IgG antibody productions do not depend on factors such as gender and age of the individual. The antibody production is influenced by the phase of infection (early or late phase) in COVID -19 positive individuals, higher amount of antibody positivity was seen in late phase of COVID-19 positive (more than 7 days after symptoms onset). COVID- 19 vaccination also produces significant IgG antibody production (72.5%).

44. Correlation of Fine Needle Aspiration Cytology with Histopathology in Palpable Breast Lumps
Lakshmi Narayanan M, Kannan K,  John Veslin T
The spectrum of breast diseases extends from benign conditions like fibroadenoma to highly malignant conditions like mastitis carcinomatosa. The vast spectrum of breast diseases poses a great challenge to the surgeon while evaluating the patient pre-operatively. Appropriate management of breast disease needs reliable preoperative tissue diagnosis to provide a clear picture of the illness to the patient as well as to plan the modalities of treatment. Advent of FNAC has provided a reliable pre-operative tissue diagnostic tool. FNAC is a direct first line approach to the evaluation of palpable masses. It does not require elaborate tissue processing and is therefore least expensive method of diagnosis (layfield et al.1993).The application of FNAC for the diagnosis of palpable breast masses was first introduced by Martin and Ellis in 1930 and since then has been established as an important tool in the evaluation of breast lesions.

45. Investigating the Prevalence of Multidrug-Resistant Tuberculosis in High-Risk Populations


Balija Alivelu Ankitha, Angotu Ankamma


Background: The prevalence and risk factors of multidrug-resistant tuberculosis (MDR-TB) in high-risk populations are critical to public health. This study investigates these aspects, offering insights into the spread and control of MDR-TB. It focuses on understanding how specific vulnerabilities contribute to the disease’s prevalence. The findings aim to guide effective interventions and strategies for managing MDR-TB in these key groups.

Methods: A total of 100 individuals from high-risk populations, including urban and rural areas with varied socioeconomic backgrounds, were recruited. The participants were screened for MDR-TB and assessed based on gender, age, geographic location, socioeconomic status, smoking status, previous TB treatment, HIV co-infection, and access to healthcare.

Results: Out of 100 participants, 15% (15 individuals) were diagnosed with MDR-TB. The prevalence was notably higher among smokers (20%) compared to non-smokers (10%). Subgroup analysis revealed that the highest prevalence (66.7%) was observed in the 36-50 age group. The study revealed a stark disparity between urban and rural areas, with urban dwellers comprising 80% of multidrug-resistant tuberculosis (MDR-TB) cases. A notable majority (60%) of these cases occurred in individuals with lower income levels. Resistance patterns were consistent across all cases, showing resistance to rifampicin, and 40% exhibited resistance to at least one additional second-line drug. Prior treatment for tuberculosis was a common thread, observed in 80% of the MDR-TB patients. Furthermore, 26.7% of the patients were also found to be co-infected with HIV. Notably, participants with regular access to healthcare had a higher treatment completion rate (80%) compared to those with limited access (50%).

Conclusion: This study underscores the high prevalence of MDR-TB in high-risk populations, particularly among certain age groups, urban residents, low-income individuals, and smokers. The findings highlight the need for targeted interventions and improved healthcare access to manage and prevent MDR-TB effectively.

46. Prognostic Significance of p53 Mutation in Oral Premalignant and Malignant Lesions- a Tertiary Care Center Study
Vaibhav Patel, Himani Patel, Meghavi Joshi
Introduction: Oral cancers accounts for up to 40% of all malignancies in developing countries including India. Early detection and treatment play pivotal roles in improving prognosis and overall survival rates. p53 immunomarker could be considered complementary to conventional prognostic evaluation. Aim: The aim of present study is to analyse the expression of p53 in relation to histopathological diagnosis along with the utility of labelling Index of p53 protein in of oral premalignant and malignant lesions. Also, to evaluates clinicopathological profiles of patients with oral lesions in terms of age, gender and site. Methods: The study was conducted over a period of 18 months at tertiary care center of north Gujarat. Total 39 cases of premalignant and malignant oral cavity lesions were examined for p53 immunomarker expression, staining pattern and staining intensity by immunohistochemistry study. Formalin fixed paraffin embedded tissue were used for both histopathology and immunohistochemical evaluation. Results: Among 39 cases, 9 (23.08%) were dysplastic lesions and 30((76.92%) were malignant lesions with male predominance. Tongue (48.71%) is most common site.92.31% cases expressed p53 in over 5% of cells. Among them, 88.88% of dysplastic lesions expressed p53 in>5% of cells and only one dysplastic lesion (12.5%) showed p53 expression >25%. The mean p53 LI in dysplastic lesions, in the present study was found to be 13.33% and in carcinoma it was 71.83%. 93.33% of SCC cases were positive for p53. 26 out of 30 cases (86.66%) of SCC showed p53 LI >25%., mean LI for p53 in SCC was found to be 71.83%. In the present study, 5/9 cases (55.55%) of dysplastic lesions showed p53 expression only in basal layer, while 2/9 cases (22.22%) cases showed both basal and suprabasal staining pattern and only one case (11.11%) showed p53 expression in all layers while one case was negative. In cases of carcinoma, 2/30 cases (6.66%) showed basal and suprabasal staining pattern while 26/30 cases (86.66%) showed p53 expression in all layers. p53 expression was mild in mild dysplasia compared to moderate and severe dysplasia and staining intensity ranges from moderate to intense for carcinoma. Conclusions: The significant correlation between progression of oral epithelium from dysplasia to neoplasia and increased expression of p53 suggest that it may be useful biomarker of malignant transformation in oral precancerous conditions and may serve as useful biomarker for cancer prevention programmes. P53 as prognostic markers may stand as useful supplements of histopathological assessment in the prognosis of potentially malignant oral lesions.

47. A Clinical Study of Dorsolumbar Spinal Fixation in Traumatic Paraplegia
Asman Ali, Chintu Patowary
Background: Dorsolumbar segment known for having relatively more mobile compared to other segments of spine. Injuries to this area can result in instability and various neurological issues. The goal of treatment approach is to address dorsolumbar spine injuries by decompressing nerves early and stabilizing the affected segment through rigid internal fixation with pedicular screws. This combination of strategies aims to promote healing and restore stability to the spine. Objective: The primary goal of the study is to prevent complications associated with traumatic paraplegia and stop further deterioration of neurological function by early mobilization to prevent complications and neural decompression to achieve neurological improvement. Materials & Methods: It is a prospective study which was conducted in the Department of Neurosurgery, CN Center, Gauhati Medical College and Hospital from September 2022 to August 2023.  In our study we included 50patients (M:F=9:1), age group from 11-70 years (mean 41 years), <2weeks post traumatic instability duration of lower thoracic or lumbar spine. All patients were surgically managed. Postoperatively patients were mobilized post op day 2 with rigid type thoracolumbar spinal brace. Postoperatively spinal support was used in all the cases for 1.5-2 months. Results: Preoperative and postoperative neurological statuses of the patients were recorded as per Frankel grading. 74% recovery was noted in patients with incomplete neurological injuries of the cases; minimal changes were noted with complete neurological injury patients. All pre and post-operative complications like bed sore, superficial skin infections and intra operative dural tear were managed successfully. Conclusion: The study showed satisfactory level of improvement of symptoms in selected group of patients, safe and effective with clinical and neurological improvement with acceptable level of cost with early Pedicular Screw and Rod Fixation for traumatic paraplegia for lower dorsal and lumbar spine injury.

48. Evaluation of Efficacy of Low Dose IV Ketamine for Prevention of Pain Associated with IV Propofol Injection
Shaik Vahida, Pavani Bussa, Shaik Ayesha, M. Bharathi.
Background: Propofol is the intravenous (IV) anaesthetic that is used the most frequently for induction and maintenance of anaesthesia as well as for sedation both inside and outside of the operating room. Propofol is very close to being the perfect IV anaesthetic agent; however, there is still a problem with pain during its injection. A low dose of ketamine may be useful because of its peripheral local anaesthetic impact, whereas a high dose of ketamine may be effective because of its central analgesic and sedative action. Objective: To study the efficacy of low dose IV ketamine for prevention of pain associated with IV propofol injection. Materials and Method:  Prospective, randomised and was conducted in Department of Anaesthesia GGH, Guntur. 60 ASA 1 and 2 patients ranging in age from 18 to 65 years old who were scheduled for surgery under complete intravenous anaesthesia were randomly assigned to one of two groups (A or B).. Patients in group A were given ketamine as the pre-treatment before they were given propofol. Those who were in group B were given saline prior to having propofol administered to them. Pain scores were measured by the investigator immediately following injection of propofol. A verbal pain score was assigned to each patient’s response to the questionnaire. Results: The comparison of pain score as per McCrirrick and Hunter evaluation scale between group A and group B at P5, P10 and P15 intervals were statistically highly significant (p value < 0.0001).The incidence of propofol injection discomfort was reduced from 95% in the group that received saline to 63% in the group that received ketamine pre-treatment. Conclusion: Pre-treatment with low-dose ketamine greatly reduces pain after propofol injection. The short-term preservation of hemodynamics after propofol injection was more effective than placebo. Low doses of ketamine do not cause any negative effects.

49. A Systematic Review on Maternal Complications in Cesarean Section
Rajesh Gondalia, Jagruti D Parmar
Background: This systematic review explores maternal complications following Cesarean sections, incorporating diverse study designs and global representation. Eight studies, ranging from cohort to case-control and cross-sectional designs were included in the analysis. Materials and Methods: A comprehensive evaluation of studies from India to the United States and Italy was undertaken. Sample sizes varied from 5779 to 286565. Postpartum infection, hemorrhage, hospitalization, obstetric trauma, and maternal death were assessed using relevant risk ratios and odds ratios. Results: Studies revealed mixed outcomes for postpartum infection, with elevated risks for puerperal infection and surgical complications following Cesarean sections. Hemorrhage findings were contentious, highlighting a lower risk in some studies but an increased likelihood of blood transfusion post-Cesarean. Hospitalization analyses indicated heightened ICU admission rates and rehospitalisation post-Cesarean. Obstetric trauma risk was lower with Cesarean sections. Maternal death findings varied, indicating an increased risk in Cesarean sections compared to controls, particularly in intrapartum scenarios. Conclusion: This synthesis highlights the multifaceted nature of maternal complications following Cesarean sections. Despite limitations, it prompts nuanced clinical considerations for personalized obstetric care, optimizing outcomes while acknowledging the intricate interplay of diverse factors.

50. Correlation between Level of Platelets Aggregation and Severity of Burns in Acute Thermal Burns Patient
Govind, R K Srivastava, Sunil Ranga, Ajay Pal
Introduction: In thermal burns patients the alteration of hemostatic mechanism is due to oxidative stress and sepsis. Aim:  To evaluate the level of platelets aggregation in acute thermal burns patient and correlation between level of platelet aggregation and severity of burns. Method: Study conducted on 30 cases of thermal burns and 30 healthy volunteers as control aged between 20-50 years at the Department of Burns, Plastic and Maxillofacial surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi from Jan. 2015-June 2016. Patients with thermal burns involving more than 20% of  total  body surface area,  Patients with age between 15-50 years and  who got Hospitalization within 24 hrs of burn injury were included in the study. Result: Patients ranged from 16 to 45 years with a mean age of 30.9 yr. Comparison of the platelet aggregation after the addition of ADP in both case and control groups were done and the mean platelet aggregation values were calculated. Mean aggregation percentage in the case group was found to be 64.6± 13.23% while that in the control group came out to be 71.3± 4.18% (p value >0.05) but significant difference was seen on 3rd and 5th day. Conclusion:  Thermal burn injury causes severe abnormality of ADP and collagen induced platelet aggregation in acute phase. This abnormalities of platelet aggregation correlate consistently with severity of burn in form of increased TBSA.

51. Is Second Resection Necessary for High Grade Bladder Carcinoma a Retrospective Analysis?
Abhilekh Tripathi, Sachin Sharma, Tilala Yash Manharlal, Jateen Anshuman, Kishore Kumar Behera, Sabyasachi Panda, Amiya Sankar Paul
Introduction: Urinary bladder cancer is quite common in eastern part of India as people here are more addicted to tobacco and smoking cigarettes and present with total gross painless intermittent hematuria as initial presenting symptoms. After initial workup of the patient is posted for transurethral resection of bladder tumor as part of treatment and staging. Method: In this retrospective analysis we studied 129 patients who were detected with UB mass were subjected to TURBT after initial work up and specimen sent for histopathological examination. Result: 45 patients were having high gtrade bladder tumor, of which 40 were subjected to second TURBT within 2 to 6 weeks. Only 15 patients had recurrent tumor. Most of the recurrence I.e. 13 was in multiple papillary and sessile, > 3 cm tumors and only 2 recurrences in solitary, > 3cm group. Conclusion: So the conclusion of our study is that 1. do secondary resection in patients with primary characteristic of tumor >3 cm, multiple papillary or sessile, with high grade should receive 2nd resection. 2. in some subset of patients with < 3 cm of bladder tumor, solitary with no deep muscle involved 2 nd resection can be safely avoided but this group of patients should be kept in close followup as per the institutional protocol.

52. A Clinical Study of Medical Management and Outcome of Un Ruptured Tubal Pregnancy by Using Single Dose of Methotrexate – A Prospective Observational Study in a Tertiary Care Center, Mandya
Shruthi R, Kavyashree G, Sandyashree P.K., Manohar. R.
Background: Methotrexate is the standard medical management for ectopic pregnancy. Pharmacologically, it is a folic acid antagonist which inhibits DNA synthesis. 90% of appropriately selected un-ruptured none live ectopic pregnancy respond to methotrexate treatment with no further management is required. In the UK, NICE guidance has identified the selection criteria to achieve the best and safest outcome in ectopic pregnancy treatment with methotrexate. Methotrexate also has a role in management of pregnancy of unknown location. Single administration of 50 mg/m2 body surface area is the most widely acceptable regimen for methotrexate in treatment of ectopic pregnancy. Post treatment b-HCG checks at day 0, 4 and 7 are also a widely accepted follow up regimen to ensure satisfactory decline in b-HCG levels. Methotrexate has a role also in managing none tubal ectopic pregnancies where surgical risks are high. Post treatment transient pain is common and represents a clinical challenge as it can also be failed treatment with ruptured ectopic pregnancy. Materials and Methods: All patients admitted to Mandya Institute of Medical Sciences at Department of Obstetrics and Gynaecology with diagnosis of unruptured tubal pregnancy managed medically between January 2022 and December 2022 were included in this study. The diagnosis of tubal pregnancy was made using both Transvaginal Sonography (for Adnexal mass size and Absence of cardiac activity) and Initial serum beta β-hCG levels. Results: The classical triad of tubal pregnancy was present in 11(44%) of patients. 15(60%) cases were found amongst the age group of 20 to 25 years, 14(56%) cases had their initial β-hCG levels <1500 m IU/ml, 4(16%), 3(12%), 4(16%) cases had β-hCG levels of 1500-2500 m IU/ml, 2500-3500 m IU/ml,>3500 m IU/ml respectively , 52% of cases had adnexal mass size measuring between 2-3cm, 44% of cases presented with adnexal mass size <2cm, whereas  4% of cases had initial adnexal mass size >3cm, 16(64%)patients had amenorrhea between 43-56 days, 6 (24%) and 3(12%) cases had amenorrhea of < 42days and >57 days respectively. In this study 21 (84%) were managed successfully by single dose methotrexate and 4(16%) cases were managed by exploratory laparotomy due to failed medical management. Conclusion:  Early diagnosis using hormonal studies, sonography, and management in an institutional set up can reduce the associated morbidity. Complete resolution was seen in all cases of single dose methotrexate regimen whose mean initial serum β-hCG was 2,275.12 m IU/ml, adnexal mass<2cm and amenorrhea <42days.

53. Perinatal Outcome of Preterm Labour – A Retrospective Study in a Tertiary Care Centre, Mims Mandya
Kavyashree G, Rashmi Mooleena M.K, Sandyashree P.K., Sanjay Kumar C.
Background: Preterm labour is one of the most common complications in pregnancy and leading cause of neonatal morbidity and mortality. Preterm birth is defined as birth between 20 to 37 completed weeks of gestation. Objectives: To study the perinatal outcome in preterm labour. Study Design: Retrospective Observational study. Methods: The study conducted from the records of January 2021 to December 2021(1 year) was analysed. Results: Total of 100 pregnant women with preterm labour were observed during this study. Following observations were made  45% belong to age group of 21 – 25 years, 76% were of gestational age between 32 – 37 weeks, 63% were multi-gravida, 49% had no associated risk factors,18% had pre-eclampsia,10% had GDM, 26% had previous history of PPROM,16% had previous history of preterm labour, 58% underwent PTVD, 40% underwent LSCS and 2% underwent VBAC, 99% were administerd with antibiotics, 21% were given steroids and tocolytics, Above 34 WOG 23% neonates were >2.5 kgs, 20% were between 1.5-2.5 kgs, Above 34 WOG 41% neonates & below 34WOG 30% did not require NICU facility. Conclusion: Preterm labour is an important cause of perinatal morbidity and mortality, administration of IV antibiotics, steroid prophylaxis and tocolytics have improved perinatal outcome, Iatrogenic induced preterm labour in association with maternal risk factors like pre- eclampsia, eclampsia, GDM, APH improves maternal and perinatal outcome.

54. A Comparative Study: Dexmedetomidine (5 micrograms) as an Adjuvant to Intrathecal Bupivacaine in Infra-Umbilical Surgical Procedures
Girij Bhople, Janhavi Shinde, Jueeli Tambulkar, Parikshit Salunkhe
Background: To compare the safety and efficacy of a spinal anesthetic agent hyperbaric bupivacaine 0.5% combined with 5 μg dexmedetomidine and 0.5% hyperbaric bupivacaine during infra-umbilical procedures. Several variables, including variations in hemodynamic parameters, the requirement for rescue analgesia, and the onset and duration of sensory and motor blockade were carefully assessed. Methods: The study comprised 110 ASA I & II patients (18-50 years) going through elective infra-umbilical surgery at a tertiary care hospital. Each subject was randomly assigned to one of two groups: Group I received bupivacaine alone, whereas Group II received bupivacaine plus dexmedetomidine. For spinal anesthesia, Group I was given 15 mg of 0.5% hyperbaric bupivacaine, and Group II was given the same dosage plus an additional 5 μg of dexmedetomidine. All the parameters such as the duration and commencement of the blockage, hemodynamic parameters, and the requirement for rescue analgesia. Results: Baseline characteristics were comparable. The onset of sensory/motor blockade did not differ significantly. However, Group II exhibited significantly prolonged sensory (238.09±47.77 minutes) and motor blockade (220.35±38.07 minutes) than Group I. Rescue analgesia time was delayed in Group II (279±54.58 minutes). No significant Variations were noted in heart rate systolic/diastolic blood pressure. No postoperative nausea or vomiting occurred. Conclusion: Spinal anesthesic 0.5% hyperbaric bupivacaine was found to be able to prolong sensory and motor blockage, delay the requirement for rescue analgesia, and sustain hemodynamic stability when combined with 5 μg dexmedetomidine, all without raising the risk of side effects. These findings imply that analgesia’s quality has increased. To validate these results, more multicenter trials with bigger sample sizes are needed.

55. Efficacy of Ketamine in Antidepressants – Resistant Cases of MDD
Ganga Ram Yadav, Saurabh Jaiswal, Srishti Jaiswal
Introduction: Major Depressive Disorder (MDD) is characterized by enduring desolation, self-reproach, and cognitive haziness. Global prevalence ranges from 2% to 21%. Treatment involves pharmacological options like SSRIs, SNRIs, and atypical antipsychotics, as well as non-pharmacological approaches like cognitive behavioral therapy. Treatment-Resistant Depression (TRD) lacks a universal definition, posing challenges. Ketamine, once an anesthetic, now shows promise, rapidly alleviating symptoms through unique pharmacodynamics. This review aims to evaluate ketamine’s efficacy and safety in treating MDD, especially in cases resistant to conventional therapies. Methods: This research, conducted at our  hospital from November 2022 to August 2023, investigates ketamine hydrochloride’s effectiveness in treating major depressive disorder (MDD) for individuals resistant to three antidepressant treatments. The study includes participants aged 21–80 diagnosed with MDD. Exclusion criteria encompass psychotic or bipolar patients, recent substance misuse, unstable medical conditions, and others. The trial, involving 72 patients, uses statistical analyses to assess changes in depression severity and response rates. The research aims to comprehensively explore ketamine’s antidepressant effects in treatment-resistant depression. Result: In a study on treatment-resistant major depression, a single ketamine infusion demonstrated superior efficacy compared to midazolam. Ketamine users (n=40) exhibited a significant decrease in Montgomery-Åsberg Depression Rating Scale (MADRS) score (13.81) compared to the midazolam group (21.69). More ketamine patients showed a ≥50% MADRS score decline (47.5% vs. 20%) and were rated “much improved” or “very much improved” on the Clinical Global Impression Scale (35% vs. 15%) within 24 hours post-infusion. Adverse events varied, with ketamine users experiencing more nausea/vomiting and constipation. Blood pressure dynamics differed between groups, indicating potential implications for patient monitoring. The inpatient and outpatient ketamine groups exhibited greater and more sustained reductions in depression severity over 7 days compared to midazolam. Response rates favored ketamine at all time points, emphasizing its consistent and superior efficacy. Over 25 days, both drugs’ efficacy declined, with ketamine showing a more rapid reduction. Alnefeesi et al.’s meta-analysis supports these findings, revealing substantial real-world efficacy of ketamine in treatment-resistant depression. Murrough et al.’s randomized controlled trial further underscores ketamine’s rapid and significant antidepressant effects, emphasizing its potential as a novel intervention for severe and chronic depression. Conclusion: This study concluded that people with severe depressive episodes that do not respond to therapy showed a rapid improvement in their depression symptoms after receiving a single infusion of ketamine.

56. Microbiological Profile and Antibiotic Resistance Patterns of Urinary Tract Infection in Geriatric Patients at a Tertiary Healthcare Center, Bhopal, India
Yash Nagar, Himanshu Sharma, Sudha Alawe, Manjula Gupta, Simmi Dube
Background: Urinary tract infection s (UTIs) common affect elderly individuals and  are among the most frequent indications for prescribing antibiotics in this population. Antimicrobial overuse is prevalent and can lead to negative consequences, such as developing multidrug resistant organisms. Aim and Objective: To investigate the microbiological profile and antibiotic resistance patterns of urinary tract infections in geriatric patients. Materials and Methods: This cross-sectional observational study included 200 elderly individuals receiving care at the Department of Medicine, Gandhi Medical College & Hamidia Hospital, Bhopal. Urine samples were collected and processed aseptically for analysis. The samples were inoculated on sterile culture media and processed using standard microbiological techniques. Antibiotic susceptibility testing was performed according to the Central Laboratory Standard Institute (CLSI) guidelines (2020). Results: The mean age of patients was 68.54±7.2 years. Urinary culture revealed the growth of various micro-organisms in 37.5% of cases, while significant bacteriuria was documented in 26.5% of cases. Increased risk for UTI in geriatric patients was attributed to various risk factors e.g. prostate hypertrophy in males, post-menopausal changes in females, various co-morbidities like diabetes mellitus and physical limitations. Prostatomegaly was observed in 50% of total male patients with culture positivity and 30.6% of total patients with positive culture had diabetes mellitus. Conclusion: Escherichia coli is the most common causative organism for UTI followed by Klebsiella. The commonly identified organisms demonstrate resistance to one or more antibiotics, with penicillins and cephalosporins being the most commonly resisted. However, the increasing prevalence of multidrug-resistant strainsis a growing concern when determining appropriate therapy for the management of UTI in elderly patients, in terms of effectiveness of existing antibiotics. Therefore, the antibiotics must be initiated cautiously with proper choice, dosage and duration of antibiotic when managing these cases.

57. Observing Effects in Perinatal and Maternal Outcomes of Term Oligohydramnios Patients
Abhilasha Jain, Arvind Meena, Yogesh Gupta, Chandrashekhar Waghmare
Introduction: Nature has made floating bed in the form of amniotic fluid cavity filled with liquor amnii for the requirement of fetus, for its existence and growth in sterile environment. Levels of amniotic fluids affects 2.4% of pregnancies. Early onset oligohydramnios has been associated with fetal congenital anomalies and poor fetal outcome. Hence this study was designed to observe effects of oligohydramnios in perinatal and post-natal phases and their outcomes Methodology: The present study was carried out in the department of obstetrics and gynecology at tertiary care institute of Madhya Pradesh over a period of one. In this hospital-based study a total of 227 patients of gestational age >37 weeks and ≤40 weeks were involved with 27 drop-outs. Hence finally 200 patients were selected for this study of which 100 had an AFI ≤5 and were included in the study group and 100 had an AFI>5. Results: Results of present studies shows Birth weight in Group1 out of 100 cases whom AFI >5cm; 24(24%) babies weighed <2.5 kg whereas majority i.e. 76(76%) weighed ≥2.5kg. In Group2 out of 100 cases in whom AFI was ≤5 more babies i.e. 51(51%) were <2.5kg  i.e. 49(49%) were ≥2.5kg. So L.B.W. of babies were more often associated with AFI≤5 i.e.51% as compared to AFI>5cm which is 24%. The p value statistically significant. Out of 200 women studied NICU admission were required in 38(19%) cases, in the Group 2 i.e. AFI ≤5 required i.e. 29(29%) as against 9(9%) of Group1 with AFI >5, therefore neonates of women complicated with Group2 are more likely to require NICU admission. Conclusion: Antepartum oligohydramnios was associated with increased perinatal morbidity, low birth weight, NICU admissions and increase rate of CS. Early intervention like induction of labour, close intrapartum monitoring etc., to be taken as prevention. It signifies need for prevention, early detection and timely intervention to prevent complications.

58. Role of Biochemical Markers in Acute Pancreatitis
Yekkanti Krishna Mohan, Vadlamudi Chandramohan, Jaladurgam Madhavi Latha, Avula Padma Vijaya Sree
Introduction: Acute Pancreatitis is a condition that is characterized by an acute inflammation of the pancreas. Patients who are experiencing significant acute upper abdominal pain should be suspected of having acute pancreatitis; nevertheless, in order to establish the diagnosis, it requires either biochemical or radiologic evidence. Aims and Objectives: The purpose of this study is to determine the role of biochemical marker in predicting acute pancreatitis. Methods: This is a Retrospective study conducted in Department of Biochemistry ,Government General Hospital, Kurnool from April 2023 to December 2023 .Data collected from the Medical records were age, Sex, Levels of Serum amylase and Lipase amylase lipase ratio. Results: Among the Total 90 patients males constituted 73.3% (n=66) and Females 26.7 % (n=24). The mean age and SD of the patients in this study group was 38.5±2.2.5years Mean and SD of Amylase, Lipase and Amylase Lipase Ratio was 870.3±754.23, 235.8±124.5 and 3.87±2.45. The sensitivity and specificity of amylase and Lipase at 3 fold above Normal limit were 83.33% and specificity 84.88 %. Positive predictive value 85.23% and Negative Predictive value 82.95%. Accuracy 84.09%. Conclusion: In patients with abdominal pain consistent with Acute Pancreatitis, the ACG practice guidelines consider lipase and/or amylase increase greater than 3 times ULN as diagnostic. Lipase is slightly more Acute Pancreatitis -specific than amylase. It rises earlier and stays higher than serum amylase in AP patients. Serum lipase outpaced serum amylase in diagnostic accuracy.

59. Open Intra-Articular Distal Femur Fractures Managed Surgically by Primary Plating: A Clinico-Radiological and Functional Outcome Evaluation
Siddhartha Naru, Ayon Das
Background: Open intra-articular distal femur fractures are one of the challenges for the Orthopaedic surgeons because of an increased risk of infection and soft tissue-related problems as well as difficulties experienced in union. The present study was aimed to assess the functional outcome of open distal femur articular fractures treated with primary plate osteosynthesis. Materials and Methods: Patients who underwent primary plate fixation for open post-traumatic distal femoral intra-articular fracture were included in the study. This was a prospective study conducted at a Tertiary care Private Hospital in Kolkata, between June 2018 to May 2019. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months, 9 months, 1 year and 1.5 year. Radiological and functional results were classified as per Neer’s scoring system. Result: Outcome at final follow-up was assessed using Neer’s scoring system. In a total of 31 patients, 23 (74.2%) showed Good to Excellent results whereas 5 (16.1%) patients had Fair outcome and 3 (9.7%) patients demonstrated Poor surgical result at the final follow-up. 18 patients (58.1%) did not develop any complications. The mean time for fracture union was 18.71 ± 3.33 weeks. Conclusion: Early and thorough debridement along with definite rigid fixation after anatomical reduction and maintenance of articular congruity using DF-LCP gives good results in properly selected cases of open distal femoral intra-articular fractures. It allows early weight bearing and range of motion of knee with good functional outcome while preventing the need of multiple surgeries.

60. Clinicopathological Study of Lichen Planus in a Tertiary Care Center of North India
Shailza, Amarjeet Singh Verma, Jyoti Singh Rajput
Background: Lichen planus (LP) is an idiopathic, chronic inflammatory disease of the skin, mucous membrane, and nails. Worldwide distribution is seen, with 0.38% of the lesion load present in India. The present study was conducted to study the demographic profiles (such as age and gender) and histopathology of LP and their clinical presentation. Materials and Methods: The present study was conducted in the Department of Pathology at NCR Institute of Medical Sciences. All cases presenting with LP and undergoing skin biopsy from December 2022 to May 2023 were included in the study. Detailed clinical history was taken, and histomorphological evaluation was performed for all the included cases. Results: A total of 50 cases of LP were analyzed. The mean age of presentation was 34.89 ± 16.02 years, with slight male predominance. The mean duration of the disease was 7.8 ± 5.4 months. Clinically, most cases presented with mild to moderate pruritis (64.51%), followed by intense pruritis (25.16%). Violaceous papules and plaques were the predominant findings in 80.64% of patients, followed by hyperpigmented papules and macules (13.54%). Histomorphologically, hyperkeratosis was observed in almost all cases (99.35%), followed by wedge-shaped hypergranulosis (65.80%). The most common variant found was classic LP (30.96%), followed by hypertrophic LP (29.6%) and LP pigmentosus (26.4%). Conclusion: Detailed history, clinical examination, and careful histological assessment help diagnose LP and differentiate its variants.

61. Penile Garotting: More than What Meets the Eye- A Rare Case Series Analysis of an Our Experience
Praveen Kumar Lakhera, Arvind Kumar, Prashant Patel
Background: Placement of garotting objects around penis for autoerotic, enhanced sexual performance, urinary incontinence or cult pactices purposes that represent a well-known challenge for urologists. Penile garotting is a urologic emergency with potentially severe clinical consequences. In many cases a rapid intervention and removal of the penile garotting objects is enough so that patients need no further interventions. Results: We have reported Retrospective evaluation of four different cases of penile garotting objects (Gold and Metallic ring, and Rubber band) presented at our department and we have used different methods for extraction of garotting objects of penis. Conclusions: We used Bashir and El-Barbary (table2) grading for injury of penis through penile garotting objects. Removal of these objects can be challenging and often requires resourcefulness and multidisciplinary approach.

62. A Prospective Observational Study of Postnatal Depression at a Tertiary Care Centre
Priyanka Katti, Goundi Waseem Akthar, Lakshmi. K. S
Background and Aim: Postnatal depression refers to depressive episodes, ranging from moderate to severe, that occur during pregnancy or after childbirth, but do not involve psychosis. This condition is a frequently occurring non-obstetric illness that results in considerable harm to women throughout the perinatal period. The current study aimed to ascertain the prevalence of postpartum depression during the puerperium period and provide appropriate referrals to counsellors or mental health practitioners for people at risk. Material and Methods: The study included a sample size of 150 participants and lasted for a length of 1 year. On the 7th and 42nd day after birth, the women were contacted via phone and administered the Edinburgh Postnatal Depression Scale, a validated questionnaire. The interpretation utilised was based on a threshold of EPDS ≥13 or affirming a positive response to question number 10, indicating the presence of depression and EPDS. Results: Among the 150 individuals who took part in the study, 24 individuals (16 percent) were diagnosed with post-partum depression. There was a significant variation in the occurrence of depression depending on the method of birth. Patients who were diagnosed with depression were more prone to experiencing perceived complications during delivery (p≤0.05), difficulties with breastfeeding (p≤0.05), and a hospital stay lasting more than four days (p≤0.05). There was no significant correlation between the availability of assistance and the location where the mother resided after being discharged. Conclusion: Among the 150 participants in the study, 24 individuals (16 percent) were found to have post-partum depression. The study participants who perceived their delivery as difficult were found to have a correlation with depression. It is crucial to have dedicated maternity and breastfeeding support nurses and lactation consultants to ensure the establishment of optimal feeding.

63. Trimester Level Serum Magnesium in Pregnant Women in Urban Area of Bhopal Region, India
Seema Tamrakar, Surya Tiwari, Aditya Thakur, Jaidev Singh
Background: Magnesium deficiency is frequent in women of childbearing age in both developing and developed countries. The demand of magnesium increases during pregnancy period, and the majority of pregnant women likely do not meet this increased need. Magnesium insufficiency during pregnancy may create a health risk for both the mother and the newborn. Aim: Aim of this study is to demonstrate the role of magnesium in 1st to 3rd trimester of pregnancy. Material and Methods: This present study conducted at Department of Biochemistry Mahaveer institute of medical sciences Bhopal, associated with the Department of Obs. & Gynae MIMS Bhopal, Total 150 cases attended ANC Clinic at the MIMS Hospital Bhopal. Pregnant women were taken from 20-35 years of age group. Estimation of serum magnesium concentration was done by automated calmagite kit method. Findings:  Mg levels were found slightly decreases in the 1st to 3rd trimesters, but the difference was not statistically significant. Conclusion: Results of the study demonstrated that magnesium could be an effective element for fetal wellbeing. Deficiency of magnesium may be possibly associated with pre-eclampsia and preterm delivery and possibly with low birth weight.

64. Role of Liquid Based Cytology in Cervical Cancer Screening and Its Clinical Correlation in a Tertiary Care Centre
Kurkuri SN, T Kiruthika
Background: In India, cervical cancer is the most common gynaecological cancer and accounts for about 1.8 per 100000 populations. Pap smear examination is a sensitive test for the detection of cervical malignancy. It is recommended between 21-65 years of age. The timely introduction of Liquid-based cytology (LBC) aimed to improve the efficiency of gynaecological cytology by improving sensitivity, specificity, standardizing procedures, improving sample quality, assisting with screening, and concurrent HPV DNA testing. Aim: To determine the prevalence of abnormal cervical smears on LBC and its clinical correlation. Materials and Methods: This was a retrospective observational study conducted over a period of 6 months between January 2023- July 2023 among the women visiting the outpatient department (OPD) of Obstetrics and Gynecology in KIMS hospital, Bengaluru – a tertiary care center. A total of 676 between the age group of 21-65 years meeting the inclusion and exclusion criteria were selected for the study. Results: All cervical smears were evaluated. Commonest age group undergoing test was 41-50 years. Of 676 women, 59.2% were multipara & 37.9% women had cancer cervix awareness.  Most common presenting complaint among patients was chronic white discharge per vagina (16.6%). Most common vaginal infection was Bacterial vaginosis. Maximum women across all age groups had a non-specific inflammatory smear (41.3%). The most common epithelial cell abnormality in the present study was Low grade squamous intraepithelial lesion. Conclusion: The value of exfoliative vaginal cytology is undisputed today. Pap smear test is the most affordable, simple, cost effective and practical method to evaluate cervical cancer and other lesions on cervix. Especially the LBC technique provides a clear background for epithelial cell abnormality identification. By universal screening of all women, the cervical cancer mortality and morbidity can be decreased to a large extent. There is need for strengthening the mass health education campaign and spread cancer screening programs to help prevent mortality and morbidity due to cervical cancer.

65. Acute Respiratory Distress Syndrome Associated with Dengue Fever in Children – A Case Series
Neha Agarwal, Amitesh Yadav, Rashmi Yadav
Pulmonary manifestations of dengue fever such as pleural effusion and respiratory distress due to fluid accumulation are known; however acute respiratory distress syndrome (ARDS ) as the inaugural presentation of dengue infection is uncommon[1-3]. ARDS albeit rare, is a potentially fatal complication of dengue infection. Treatment of ARDS associated with dengue is challenging ; it requires a different fluid strategy in contrary to the standard fluid protocols for severe dengue[4]. Literature regarding paediatric ARDS in dengue is scarce[4-6].We present a series of eight paediatric patients of severe dengue who presented with acute onset of dyspnoea and hypoxemia refractory to oxygen therapy , diagnosed to be due to ARDS . Early institution of non -invasive ventilatory support in conjunction with a conservative fluid strategy led to a favourable outcome in all our patients; except one with severe disease who succumbed to the illness.

66. A Study on Dry Eye in Patients with Pterygium at a Tertiary Care Centre
C.G. Padmavathi, Y. Indira, Y. Malathi
Aim: Current study analyze the dry eye prevalence in patients with Pterygium. Method: Cross-sectional study conducted in 100 Patients with pterygium attending the Out-patient section at Department of Ophthalmology, Govt. medical college, Anantapuramu during study period of 2021 to 2022. Size of Pterygium, Schirmer test, Tear film Break-up Time, Tear Meniscus Height was assessed. Tests were done for each eye. Dry eye was considered to be present on the basis of the tests: Schirmer test without anesthesia: less than 10 mm. Results: On the basis of different criteria, at least 26 % of eyes were observed with Pterygium (either unilateral or bilateral) are affected with dry eye. Female were predominate (64%) than males. Majority patients were of 56 – 65 years age group. Majority workers Outdoor which accounts 69%. Diabetes mellitus was observed in 21% and hypertension in 26%. The mean size of right and left Pterygium was 1.89 and 1.24. Patients aged more than 70 years showed a significantly higher prevalence of dry eyes (p = 0.006). A significant relationship between occupation (outdoor and indoor) and Dry eye tests were not found in patients with Pterygium. Significant association is not found between the presence of Pterygium and the dry eye. There is no association between the size of Pterygium and dry eye. Conclusion: On studying different factors, age showed a positive association with dry eye tests among the patients with Pterygium. Diabetes and TBUT also showed a positive association among patients with Pterygium. Dry eye test among patients with pterygium showed no association with gender, occupation, smoking, menopause, and hypertension.

67. Spectrum of Scrotal Diseases and Its Management in a Rural Medical College
Nitin Kumar Jasvantlal Barot, Nautamkumar K. Pranami, Shaileshkumar S. Parmar, Jigneshkumar Dineshbhai Damor
Background: Scrotal issues represent prevalent surgical concerns among male patients. Unfortunately, due to delayed seeking of medical attention, these conditions are often identified at an advanced stage, leading to elevated levels of morbidity and mortality. This study aimed to ascertain the accurate incidence of scrotal pathologies in India, detailing their presentation, diagnosis, and subsequent management. Methods: A cross-sectional study at an Indian tertiary care hospital included 89 patients with acute scrotal diseases. Purposive sampling was applied, involving consenting individuals of all ages, encompassing skin-origin swellings. Exclusion criteria comprised unwilling participants, inguinal scrotal swellings, and systemic scrotal diseases. Patients meeting the criteria underwent scrotal examination, thorough clinical assessments, and relevant investigations. Experienced surgeons followed a standardized protocol for operations, with outcomes analysed based on patient recovery through conservative or operative management. Results: The findings revealed that 30% of the cases were attributed to Testicular torsion, followed by 24% diagnosed with Acute Epididymo-orchitis. A smaller percentage, 4%, was associated with acute scrotum resulting from trauma. Conservative management proved most successful in cases of epididymo-orchitis. Contrastingly, emergency exploration of the scrotum emerged as the optimal approach for pyocele, haematocele, torsion testis, testicular abscess, and Fournier’s gangrene. Conclusion: Our research highlights the efficacy of conservative management as the preferred strategy for cases of epididymo-orchitis. Conversely, for conditions such as pyocele, haematocele, torsion testis, testicular abscess, and Fournier’s gangrene, emergency scrotal exploration demonstrated superior outcomes. Tailoring the approach based on the specific pathology is crucial for optimizing patient outcomes in scrotal condition.

68. Evaluation of Methotrexate and Sodium Stibogluconate in the Patients of Type Two Lepra Reactions
Pritam Sakhare, Ranjit Wagh, Rohini Gaikwad, PL Waghmare, S.P. Rao
Introduction: Occurrence of Lepra reactions is one of the characteristics of Leprosy. Type 2 lepra Reactions have unpredictable course usually occurs 6 months after starting Multi Drug Therapy; presentation may be intermittent or continuous. Materials and Method: It was a Prospective, Interventional, Open Label, Systemic Randomized, Parallel Allocation Study carried out on 30 patients with Type 2 Lepra Reactions. The Anti-Inflammatory and Immunosuppressant are first-choice drugs to control symptoms. Prednisolone + Clofazamine are commonly used regimen, but have limitations. Methotrexate is known immunosuppressant Sodium Stibogluconate had been used for treatment of type 2 lepra reaction since 1940. Recent in vitro studies confirmed the immunosuppressant properties of Sodium Stibogluconate. The effect of Prednisolone + Clofazamine (P+C), Prednisolone + Methotrexate (P+M) and Prednisolone + Sodium Stibogluconate (P+SSG) on arithmetic mean score geometric mean scores were assessed for efficacy analysis. Results & Conclusions: (1) All three regimens, P + C, P + M, P + SSG reduce the clinical score to minimum after first week of treatment. Thus, these regimens are efficacious in reducing clinical symptoms of type 2 lepra reaction patients. (2) P + SSG provided slightly faster relief in decreasing clinical symptoms than P+C and P + M.

69. Comparative Study on Mortality in Neonates with Probable Sepsis and Neonates with Proven Sepsis in Tertiary Care Hospital, Western Up
Madhu Singh, Abhishek Singh, Navratan Gupta
Objective: This prospective observational cohort study was undertaken to compare the mortality in neonates with probable sepsis and neonates with proven sepsis in tertiary care hospital, LLRM medical college Meerut UP. Method: A total of 246, 123 in each group that is probable sepsis group and proven sepsis group who are admitted in NICU over a duration of 6 month and followed till next 6 month. Neonate who are admitted in the duration of 6 month are divided in two group, one is probable sepsis and another is proven. These 2 groups are followed for next 6 month and mortality and morbidity are compared between two groups. Result: Overall mortality rate of the neonates at the hospital was 14.2%, in our study. The mortality rate among probable sepsis neonates was 19.5% and proven sepsis was 8.9. Majority of the neonates were newborn (67.5%), males (69.1%) and term deliveries (94.3%).Proven sepsis neonates had thrombocytopenia (39.4%) than the ones who had probable sepsis. The duration of hospital stay was significantly longer among the proven sepsis than the probable sepsis neonates. None of the enrolled children reported any defect in the CVS, RS, CNS, Vision and hearing during the follow-up till 6 months. There was no significant association between the type of sepsis (probable/proven) and the incidence of diarrhoea, pneumonia, fever, re-hospitalization and feeding difficulties at 6 months of life. Klebsiella (40.7%) was the most common organism cultured. Conclusion: Mortality is significantly high in newborn with probable sepsis in comparison to proven sepsis.

70. Morphology of Distal Tendon of Semimembranosus; Its Undescribed Insertion with Functional and Clinical Significance
Namrata Valimbe Reddy, SS Joshi, SD Joshi
Background: Semimembranosus muscle is a well-recognised component of posteromedial corner of knee playing the role of stabilizer of the joint and restraining unwanted movements. Though the distal tendon of SM has been studied by many workers still there is a persistent confusion about the insertion of this tendon. Aim: The present study throws light on the available information that can enhance the understanding of biomechanical role, radiographic imaging and clinical studies related to the importance of the structures in the posteromedial corner of the knee. Setting and Design: The study was conducted in the department of Anatomy for a period of two and a half years. Material and Methods: In the present study upper ends of 80 tibia were examined and presence of prominent edges, tubercles, vascular foraminas and rough areas in the groove were recorded and photographed. The dimensions of semimembranosus tuberosity (SMTb) were measured. Variable shapes of SMTb, prominence of ridges, tubercles and vascular foraminas were noted. The dissection of distal tendon of SM was carried out in 22 limbs. Statistical Analysis Used: Chi- square test was applied to the various parameters included in the study and the ‘p- value’ was estimated to find the correlation. Result and Conclusion: The Posterior surface of medial condyle of Tibia had a groove which was deep in 62.4%. In approximately 95% tibias 4-7 vascular foramina were present in the groove. The tubercle though presents on both the margins, but its incidence was higher on the lower margin of the groove in 43%. The SMTb was found in all the tibias examined and in almost 1/4th it was very prominent. In 54.9% it was triangular in shape, in 30% it was semilunar and in rest it was quadrangular. Vascular foramina, Vertical ridges and tubercles were also observed. In cadaveric dissection the distal part of SMT in approx. 73% limbs had a triangular expansion and in the remaining it was distinctly bifid. In 13.63% there was a Triangular flap connecting the tendon entering in to the groove and the vertical component reaching the tuberosity.

71. Acute Urinary Retention in Children: A Retrospective Study Done in Tertiary Care Government General Hospital
G. Manohar, P Indira, Kunche Satya Kumari, Dinendraram Ketireddi , G Manogna, K Madhavi, S Jyotsna
Introduction: In childhood urinary retention is a rare entity with only sparse literature on the etiology. Materials and Methods: In a retrospective study, we reviewed the hospital records of all of the children younger than 12 years old who presented with AUR (Acute urinary retention). Data on the cases referred between 2021 and 2023 were collected from Guntur Medical College & few other Government medical colleges in Andhra Pradesh. Results: This study included 42 children 28 boys (66.7%) one year to 12 years (median age 4.5 years) and 14 girls (33.3%) one year to 12 years (median age 4.2 years). The most common cause in our study was mechanical obstruction in 21 children (50%). Infections were documented in 10 children (23.8%). Fecal impaction was seen in 6 patients. Neurological causes were seen in 1 case. No cause was found in 3 patients. Conclusion: The most common cause of acute urinary retention was lower urinary tract stones in our pediatric cases. Urinary retention in children has various etiologies. Timely diagnosis and prompt treatment are needed because it is often associated with severe underlying disorders.

72. A Comparative Analysis of Quality of life Outcomes in Patients Undergoing Mastoid Surgery: A Prospective Study
Aditya Goel, Ankita Singh, Indraprakash Prajapati, Anshul Sharma
Background: This study aimed to compare the quality of life outcomes following different mastoid surgery techniques, including Canal Wall Up (CWU) Mastoidectomy, Canal Wall Down (CWD) Mastoidectomy, and Mastoid Obliteration. The investigation addressed the impact of these surgical approaches on physical and mental health domains, symptom-specific outcomes, and cosmetic satisfaction. Materials and Methods: Sixty participants were evenly distributed across the three surgical groups. Demographic and clinical characteristics were recorded, and pre-operative and post-operative assessments were conducted using the 36-item Short Form Health Survey (SF-36), Chronic Ear Survey (CES), and a customized questionnaire for cosmetic satisfaction. Data were analyzed using appropriate statistical methods. Results: In the SF-36 analysis, CWU Mastoidectomy demonstrated superior post-operative physical health scores compared to CWD Mastoidectomy (p < 0.05). No significant differences were observed between CWU Mastoidectomy and Mastoid Obliteration. Similar trends were noted in the mental health domain. CES scores indicated substantial differences in the surgical groups’ hearing outcomes, ear drainage, and vertigo (p < 0.05). Cosmetic satisfaction scores favored Mastoid Obliteration. Conclusion: The study contributes valuable insights into the nuanced impact of different mastoid surgery techniques on quality of life outcomes. CWU Mastoidectomy showed advantages in physical health, while Mastoid Obliteration demonstrated superior cosmetic satisfaction. Consideration of symptom-specific outcomes is crucial in selecting the most appropriate surgical approach. The findings guide otologic surgeons in tailoring interventions for optimized patient-centered outcomes.

73. Comparative Analysis of Functional Outcomes and Donor Site Morbidity in ACL Reconstruction: Peroneus Longus Tendon versus Hamstring Tendon Autografts
Jitendra Nikumbh, Yogesh Gangurde, Harshal Patil, Sayaji Bhamre
Introduction: Anterior cruciate ligament (ACL) reconstruction commonly employs hamstring tendon autografts, but alternative sources like the peroneus longus tendon have gained attention. This study aimed to compare functional outcomes and donor site morbidity between peroneus longus and hamstring autografts for ACL reconstruction. Methodology: Forty patients underwent ACL reconstruction using peroneus longus tendon autografts, while another 40 received hamstring tendon autografts. Preoperative, postoperative, and follow-up assessments included International Knee Documentation Committee (IKDC) and Lysholm scores, graft diameter measurements, knee stability evaluations, and ankle range of motion assessments. Results: Functional scores (IKDC and Lysholm) showed substantial improvements postoperatively in both groups, with no significant differences between preoperative scores. Graft diameter differed significantly, with the peroneus longus tendon exhibiting a larger diameter. Knee stability, laxity, and ankle range of motion demonstrated no significant differences between the two groups. Conclusion: Despite variations in graft diameter, both peroneus longus and hamstring tendon autografts yielded comparable functional outcomes and knee stability post-ACL reconstruction. Ankle range of motion remained unaffected following peroneus longus tendon harvesting. These findings suggest the viability of peroneus longus tendon as an alternative autograft choice for ACL reconstruction.

74. Are Early Infants Adequately Protected against Pertussis: An Experience from a Tertiary Care Centre in India
Niranjan Sahoo, Ritu Agarwal, Gururaja R, Deeksha Katoch
Introduction: Infants younger than 6 months are the most vulnerable to severe pertussis.  Efforts at national level have been aimed to reduce the infant mortality associated with pertussis.  We aimed to determine the proportion of infants who have protective levels of serum anti-Pertussis IgG antibody levels at birth. Methodology: We conducted a cross-sectional observational study at the Department of Pediatrics at Base Hospital, New Delhi using cord blood of term babies, weighing 2.5 kgs or more to measure anti-pertussis antibody levels. Based on antibody titer, neonates were classified as fully protected (titer > 100 IU/ml), some protection (40 to 100 IU/ml) and no protection (< 40 IU/ml). We also collected data on maternal vaccination history and other variables. Results: The mean anti-pertussis antibody level was 39.93 ± 12.27 IU/ml, ranging from 0 to 280.7 IU/ml. Only 11% of the neonates were fully protected (> 100 IU/ml), 21.5% had some level of protection (40 to 100 IU/ml) and 67.5% were not protected at all (< 40 IU/ml). Among fully protected neonates, mothers of 86.4% had a history of Tdap immunization, and the rest 13.6% had a history of TT immunization. Mean anti-pertussis antibody levels were 117.42 ± 46.38 IU/ml, ranging from 77.38 to 280.7 IU/ml in neonates whose mothers received Tdap immunization, which were significantly higher than neonates of mothers who did not receive Tdap. Conclusion: We concluded that most of the infants had nil to minimal levels of IgG anti-pertussis antibody making them susceptible to severe pertussis infection before the first dose of vaccination. Tdap vaccination of mothers should be promoted and should be included in the national immunization schedule of India. Future studies assessing maternal sera and cord blood pairs are required to show that maternal antibody is actively transferred thereby significantly elevating newborn levels.

75. Comparative Analysis of Awareness Regarding Pharmacovigilance, Hemovigilance, and Materiovigilance among Medical Professionals in a Tertiary Care Hospital
Bharathi Uppu, Padmavathi Devagudi, Jayasree Dasari, Raju Dasari
Background: The importance of pharmacovigilance, hemovigilance, and materiovigilance in medical practice is undisputed, yet awareness of these areas among medical professionals varies. This study investigates the awareness levels of these three key vigilance systems among medical professionals in a tertiary care hospital. Methods: A cross-sectional survey was conducted among 100 medical professionals, including doctors, nurses, and allied health professionals. Data were collected using structured questionnaires and in-depth interviews, focusing on the awareness levels of pharmacovigilance, hemovigilance, and materiovigilance. Results: The study revealed that 70% of participants were aware of all three vigilance areas, with doctors showing the highest awareness (85%), followed by allied health professionals (65%) and nurses (60%). In pharmacovigilance, 60% of participants had a comprehensive understanding, while in hemovigilance and materiovigilance, the high awareness was 50% and 40%, respectively. Notably, experience and recent training significantly influenced awareness levels. Specialists and staff in related departments showed higher awareness compared to general practitioners. Conclusion: The overall awareness of pharmacovigilance, hemovigilance, and materiovigilance among medical professionals is encouraging but varies significantly across different professional roles and levels of experience. Continuous training and specialized education are crucial in enhancing awareness levels, particularly in less recognized areas like materiovigilance.

76. Management of Esophageal Perforation by Impacted Foreign Body: Experience in Our Centre
M. Karthikeyan, R. Prabhakaran, M. Gnanasekar, M. Sivakumar, Naganath Babu Obla
Aims: The treatment of perforating esophageal foreign body impaction is complex and unclear. We present the outcome of surgical treatment of esophageal perforations due to foreign body. Methods: During our study period, 4 cases of esophageal perforations due to foreign body ingestion were referred to our tertiary care center. We analyzed the FB types, lodging duration and location, complications, and the surgical approaches. Results: There were 4 patients. Mean age was 52 years. Three cases had dentures of variable sizes, and 1 had fish bone. All patients presented with perforations. Out of the four cases which has been described three of them got perforation in the upper oesophagus and one in thoracic oesophagus. One patient presented with emphysema. One patient underwent thoracotomy, two underwent neck incision and one sternocleidomastoid incision. All the patients were discharged uneventfully. Conclusions: Esophageal perforation following foreign body ingestion is rare and requires prompt treatment. Management of esophageal perforation will be difficult especially if it is due to foreign body. Management ranges from conservative to surgical treatment. . Surgical treatment tailored to the needs of individual patients is associated with a successful outcome and decreased morbidity. Here we are describing our experience in esophageal perforation due to foreign body and their management in our center.

77. Significance of Ultrasound Guided FNAC of Mass Lesions for Rapid Diagnosis
Naseema Sultana, Jagadeeswari S, Satish Kumar S, Chandralekha J, Vijaya Bharathi I
Introduction: Ultrasound guided FNAC is a safe, simple, cost-effective procedure for the lesions which are deep seated, small swellings and the lesions which yield less material on routine FNAC. Aim: To assess the utility of USG guided FNAC in rapid diagnosis of mass lesions. Materials and Methods: It was a prospective study done over a period of 17 months.75 USG guided FNAC were done in deep seated, small and unapproachable lesions. The smears were processed and evaluated for the cytological diagnosis. Results: Total of 75 samples were collected using ultrasound guided FNAC. The most common site was Lymph node (26.6%) followed by thyroid (22.6%) and breast (21.3%). Most of the cases were Inflammatory and Benign (32%) followed by malignant (25%) either primary or metastastatic, inconclusive (8%) and suspicious of malignancy (2.6%). Cytohistological correlation was made for few cases. Conclusion: FNAC combined with Ultrasound can improve the diagnostic yield and is very safe and minimally invasive procedure. It can be used as a pre-operative diagnostic procedure.

78. Factors Influencing First Year Medical Students in Choosing the MBBS Course and their Perceptions about the Medical Profession
Ruchi Dhar, Ashok Jayaram, Sushma B H
Background: The choice of a career in the medical field is a complex personal decision which is influenced by multiple factors. The study of these factors is important as it may provide an insight into the perceptions of doctors towards the Medical Profession. Various research studies regarding the motivations and perceptions of the students show that the most common motivations are altruism, the desire to help others. Understanding the factors that motivate students to choose medicine as their professional education can be of help to the providers of medical education in understanding the characteristics of the learners and their expectations when they enrol for the MBBS programme. Also, it is essential for the teachers to be aware of their learner’s perception about choosing a career in medicine; thereby their learning can be facilitated more effectively. Methods: A cross- sectional study was conducted among 115 first year MBBS students who were willing to participate in the study by asking them to fill a predesigned questionnaire. The questionnaire consisted of open-ended questions which were to be filled by the students in one or more sentences. The responses of the 115 students were recorded and subjected to qualitative analysis Results: In our study it was seen that multiple reasons were given for choosing the medical profession like service to the poor and underprivileged, parents wish, inspiration from parents etc. Respect in the society, job security and job satisfaction were considered as some of the privileges of the medical profession. Being honest, truthful and empathetic towards the patient were listed as a few responsibilities of the profession. Conclusion: In our study some of the most common reasons which influenced the students to join medicine was serving the poor and underprivileged, respect in the society, parents wish, inspired by other doctors etc. As far as the perceptions of the students about the medical profession are concerned, they regarded it as a profession with a lot of privileges and responsibilities at the same time.

79. A Comprehensive Examination of Microalbuminuria in Individuals Affected by Non-Hypertensive and Non-Diabetic Conditions: A Systematic Review
Deepa Periasamy, Sangeetha Raja, Bagavathiammal Periyasamy, Panneerselvam Periasamy
The work states that microalbuminuria (MA) is an amount of urinary albumin that is higher than the standard value, but also lesser than the amount identified by a predictable measuring scale. It also shows that in non-diabetic patients, the amount of sugar level in the urine of the person increases. The increases of the sugar level make increase of the drowsiness and the stress of the individual. The insulin level of humans decreases. These diseases in hypertension are elaborated as early identification of damage in the kidney and an interpreter for last stage in the kidney disease and cardiovascular disease. Thus makes the increase of the values of the keratin amount of the patient. This results as the major factor in making the uneven function of the body in making the filtration of the liquid. The malfunction of the kidney in the internal function of the body makes increase of other organ’s dysfunction.

80. Comparison of Clinical Profile of Acute Myocardial Infarction between Elderly and Young Patients Attending Tertiary Care Hospital
Krishka Baskaran, Bhuvaneswari T, Padmasini Baskaran, Ashok Sampath Kumar
Background: Cardiovascular disease (CVD) is a worldwide health issue that has reached pandemic proportions in both developed and developing countries. The aim of study was to determine the difference in presentation, risk factors, & complications of elderly and young patients with acute myocardial infarction (AMI). Materials and Methods: This is a retrospective study of 50 cases managed for Acute ST elevation Myocardial Infarction in the I.C.C.U. through the Department of Emergency Medicine, Panimalar Medical College &    Hospital, Chennai. Study period was from October 2022 to September 2023. Group I comprised 36 patients who were 45 years of age or below, while Group II included 14 patients who were older than 45 years of age. Subjects were analyzed for baseline clinical history, complications, and risk factors of AMI. A detailed clinical examination and relevant investigations were done. The various complications at the time of admission were recorded. 07 days in hospital follow up and 30 days follow up after discharge from hospital was done for various complications. Results:  sweating, dyspnoea and giddiness were observed predominantly in the elderly group with AMI than younger group, Smoking and family history of CAD was significantly more in Group I, while hypertension, dyslipidemia, diabetes and obesity significant in Group II. The incidence of major complications like congestive cardiac failure, arrhythmias, cerebrovascular episode was significantly higher in the elderly group (72%, 56%, 14%) as compared to (43%, 36%, 0%) respectively in younger group. Mortality was significantly high in elderly group (II) than young (gr I) with AMI, 10 (28%) Vs 2 (13%). Conclusion: We conclude that the manifestations & risk factors of AMI are different in elderly subjects compared to younger subjects. The elderly subjects have higher complication and mortality rate.

81. Histopathologial Study of Hansen’s Disease in Correlation with Clinical Features at a Tertiary Care Centre
Chowdari Balaji, Sravani Ponnada, Rajendra Prasad Jagannadham, Dasari Mercy Mrudula, Tammineni Ashalata
Background: Leprosy is a chronic disease caused by Mycobacterium leprae, infectious in some cases, affecting the peripheral nervous system, the skin and certain other tissues. Hansen’s disease is diagnosed and treated on clinical basis by WHO classification as Pauci bacillary and Multi bacillary. In problematic cases reliable diagnosis hinges around good histopathological diagnosis & demonstration of bacilli in the histological sections. Methods: This is a hospital based observational study for a period two years in the department of pathology, Andhra medical college from May 2018 to April 2020 with a sample size of 60 cases. Results: A total of 60 cases with a provisional clinical diagnosis of Leprosy were studied. The present study includes patients in the age range of 12-65 years with mean age of 35 years. The maximum incidence of Leprosy was observed in 21-30 years and 41- 50 years and the most commonly presenting skin lesion were plaques (60%) followed by nodules (26.7%). In our study BT Hansens was the most common clinical diagnosis, constituting 24 cases (40%), followed by LL Hansens in 12 cases (20%). In our study histologically, majority of the cases were BT type, constituting 22 cases (36.6%), followed by Indeterminate leprosy (21.7%). Fite Faraco stain for the lepra bacilli was positive in all the cases diagnosed histologically as Histoid hansen’s, LL & BL ( i.e 100% ). Conclusion: Clinical diagnosis may be the main stay for detection of leprosy, but histopathological examination combined with bacillary index is very much essential in diagnosing early lesions of leprosy, accurate typing of borderline lesions and differentiating leprosy from other dermatological lesions which mimics it.

82. Study on Cytomorphological Spectrum of Hashimoto’s Thyroiditis and to Evaluate the Correlation among Cytopathological Grading, Serum ATPO Levels and Biochemical Parameters in Tertiary Care Centre
Swathi Penki, Satyanarayanarao Polisetty, Sunil Kumar Komanapalli, Sirisha Gunta, Basumitra Das, Rajani Kuna,
Introduction: Hashimoto’s thyroiditis (HT) is an organ-specific autoimmune disease. Fine needle aspiration cytology is the safe and accurate method for diagnosis. Antithyroid peroxidase (ATPO) antibody titres correlate best with the degree of thyroidal lymphocytic infiltration. Objectives: This study was aimed to grading the thyroiditis and to correlate with clinical, biochemical and serum anti thyroid peroxidase levels. Materials and Methods: The present study is a prospective study and is conducted for a period of 1 year in our tertiary care centre. A total of 179 patients were referred for evaluation of thyroid lesions. We have included, newly diagnosed, those confirmed as having HT through FNAC (41 cases). ATPO, TSH were done for this study group. Results: Out of 70 HT cases ,41 cases met the inclusion criteria. In these 41 cases, 40 were females, age ranged from 11 years to 60 years, with majority of patients were in 4th decade. Majority of patients had cytomorphologically graded, grade 1 thyroiditis (21 cases), followed by grade 2(16 cases) and grade 3 (4 cases). ATPO was elevated in 38 cases. TSH was elevated in 6 cases. There was no obvious correlation between the cytological grades of thyroiditis and levels of anti-thyroid peroxidase antibody and TSH. Conclusion: Lymphocytic infiltration of the thyroid gland occurs much earlier than serological evidence in Hashimoto’s thyroiditis. Although elevated levels of ATPO levels strongly associated with Hashimoto’s thyroiditis there is no obvious correlation was observed between cytomorphological grades of thyroiditis and levels of ATPO and TSH. Hashimoto’s thyroiditis should be diagnosed by multidisciplinary approach.

83. Treatment of High Energy Tibial Plateau Fractures using Hybrid External Fixation
Karan C L, Vivekanand Nidoni, Akshaya
Background: High intensity intra-articular fractures of the proximal tibia combined with significant soft-tissue trauma can be challenging to manage. They require a combination of accurate reduction and minimal invasive techniques to achieve good results. The purpose of this study was to determine whether hybrid external fixation and minimal intervention of these fractures provide acceptable treatment outcome with less complications. Methods: In this study, we evaluated 25 patients with a median ISS of 14.3 admitted a level I trauma centre, with a bicondylar tibial plateau fracture. Eight patients sustained an open fracture. All patients were treated with a hybrid external fixator. Minimal open reduction and stabilisation with cannulated screws was performed in 14 of them. Results: Mean follow-up was 12 months (range 10 to 14 months). Radiographic evidence of union was observed at 3.6 months (range 3 to 6 months). Pin track infection was observed in 2 patients (8%). Conclusion: Hybrid external fixation, with or without open reduction and little internal fixation, was associated with favourable clinical and radiological outcomes and minimal complications when compared to previously reported series with conventional open reduction and internal fixation.

84. To Study the Significance of Hematological Parameters in Differentiating Malaria and Non-Malarial Acute Febrile Illness in a Tertiary Care Hospital in Visakhapatnam
Jagannadham Rajendraprasad, K. Sridhar Reddy, Tammineni Ashalata, Kartheek B.V.S., V. Lalitha
Background: Malaria is a common infectious disease and rarely can be life threatening if not treated properly. It is one of the major health problems in most populated areas of world [1] and an important cause of acute febrile illness in India. According to WHO’s latest world Malaria report, there were an estimated 249 million malaria cases in 2022 in 85 malaria endemic countries, increasing from 224 million in 2021. Method: The study was an observational study carried out in King George Hospital (KGH) Visakhapatnam. The study population were the acute febrile illness patients visiting the outpatient clinic and inpatient unit wards of General Medicine and Pediatric departments. A sample size of 100 patients was taken. Amongst them 40 cases were malaria positive and 60 was found to be suffering with Non-Malarial acute febrile illness. Results: Out of all 100 cases, 40 were malaria cases, 29 (72.5%) were found to be caused by P. falciparum,5 (12,5%) by P. vivax, 5 (12,5%) were mixed infections caused by both P.falciparum and P.vivax. 1 (2.5%) was caused by P. falciparum and P.ovale. Conclusion: A better idea about hematological picture in malaria is useful for early initiation of prompt treatment and avoids misuse of anti-malaria drugs and prevents drug resistance. Thrombocytopenia is strong predictor for malaria over non-malarial acute febrile illness.

85. Monteggia Fracture Dislocation: A Study on the Functional Outcome of Surgical Management in Adults
G. Praneeth Kumar Reddy, K. B. Vijaya Mohan Reddy, Y.V. Satyanarayana
Background: Monteggia fractures account for around 1% to 2% of all forearm fractures. In the treatment of Monteggia fractures, early identification, anatomical reduction, and stable internal fixation are the most critical factors. This study was conducted to study the clinical profile and functional outcome of Monteggia fracture dislocation. Methods:   In a prospective study from May 2020 to May 2023, eighteen adult patients with monteggia fracture were admitted and treated by closed reduction of radial head and compression plate fixation of ulna. Clinical details, details of management and outcome were noted. Results: In our study, majority of the patients were males. Majority of the patients were in the age group of 31-40 years with road traffic accidents being the commonest mode of injury. 67% of patients had type-1 fracture-dislocation. (78%) patients had union in less than 4 months. Using Anderson scoring system, we achieved 67% excellent results, 28% satisfactory result and 5% unsatisfactory in study case. The complication encountered were superficial infection in 2 patients. Conclusions: The procedure of early closed reduction of the radial head and open reduction and internal fixation of the ulna with a compression plate is a simple and efficient way of treating monteggia fracture dislocation in adults, with excellent functional outcomes.

86. Surgical Correction of Congenital Talipes Equino Varus Deformity with and without Internal Fixation (Using K-Wires): A Comparative Study
K. B. Vijaya Mohan Reddy, G. Praneeth Kumar Reddy, Y.V. Satyanarayana
Objective: One of the most prevalent congenital anomalies is talipes equino varus, or Congenital Talipes Equino Varus (CTEV). It is often treated using conservative and surgical approaches. The purpose of the study is to compare the functional outcome of two groups of club foot-one in whom the tarsal joint was fixed with k-wires after doing posteromedial soft tissue release and one in whom it was not fixed. Material and Methods: This is a 3-year prospective study conducted at the Government General Hospital, Kurnool from November 2018 to November 2021. There were a total of 28 feet treated. Out of these, 12 were corrected by, Turco’s post-medial soft tissue release and K-wire fixation and 16 were corrected by only Turco’s posteromedial soft tissue release. The period of follow-up ranged from 6 months to 2 years. Results: The study comprised a total of 20 patients ranging in age from 4 months to 3 years. Thirteen were male and seven were female. There were 8 patients with bilateral deformity and 12 with unilateral deformity. We had excellent results in 50 % of cases, good results in 41.67 % of cases, and poor results in 8.3 % of cases with internal fixation. We had excellent results in 50 % of cases and good results in 50% of cases without internal fixation. Conclusion: This study demonstrates that whether tarsal joints are internally fixed or not after soft tissue release, there is no appreciable difference in the functional outcome.

87. Study of Clinical and Dermoscopic Features of Hypopigmented Lesions: An Observational Study
Behera Swapnarani, Padhial Ketan Saswat, Pati Sandhyarani, Lenka Sandeep, Mohanty Jayashree, Ram Kumar Manoj, Bisoyi Diptiranjani
Background: Dermoscopy is a relatively new diagnostic modality which has gained importance in diagnosing various skin disorders. Recent studies have suggested its utility in diagnosing hypopigmentary disorders. Objectives: To study the clinical and dermoscopic features of hypopigmented lesions. Materials and Methods: Patients who presented to us during the study period with hypopigmented lesions were enrolled in the study according to inclusion and exclusion criteria. Detailed clinical examination of hypopigmented lesions was done. Dermoscopic examination with a handheld dermoscope having 10x magnification using both polarized and non-polarized modes was done. Dermoscopic features studied were pigment patterns, vascular patterns, scales, follicular findings and specific clues. Results: In this study patients with the following diseases were enrolled: Pityriasis Versicolor, Idiopathic Guttate Hypomelanosis, Vitilgo, Pityriasis Alba, Polymorphous Light Eruption, Nevus Depigmentosus, Hansen’s Disease, Pityriasis Lichenoides Chronica and Dyschromatosis Universalis Hereditaria. Reduced pigment network was seen in all the above conditions while absent pigment network was seen only in vitiligo. Scaling was seen mostly in Pityriasis Versicolor, Pityriasis Alba, Polymorphous Light Eruption and Pityriasis Lichenoides Chronica. Well defined margins were seen in Pityriasis Versicolor, Nevus Depigmentosus, Idiopathic Guttate Hypomelanosis while ill-defined margins were seen in Hansen’s disease, Pityriasis Lichenoides Chronica, Vitilgo, Pityriasis Alba and Polymorphous Light Eruption. Conclusion: Dermoscopy can be used as a useful adjunctive tool for the diagnosis for hypopigmented lesions especially where invasive procedures such as biopsy are not desired.

88. A Systematic Review on Factors Affecting Quality of Life in Pregnant Women
Rajesh Gondalia, Jagruti D Parmar
Background: This systematic review investigates diverse factors influencing the quality of life (QOL) in pregnant women. Focusing on sociodemographic, physical, and psychological aspects, it aims to offer a comprehensive understanding of the multidimensional nature of maternal well-being. Materials and Methods: A meticulous literature search was done in databases such as EMBASE, PubMed, and WOS, identified studies adhering to explicit inclusion criteria. Keyword selection and search terms were refined collaboratively, ensuring methodological rigor. Study screening involved a two-stage protocol, and data extraction followed a standardized form. Quality assessment employed specific tools tailored to study designs, maintaining robustness. Results: Synthesizing data from studies utilizing various tools, including WHO QOL BREF, SF-12, and SF-36, revealed the nuanced interplay of factors. Sociodemographic analyses revealed nuanced associations with back pain, pregnancy stage, infertility, and stress. Physical factors, encompassing epigastralgia and esophagogastric reflux, demonstrated significant impacts on overall QOL. Psychological dimensions, including domestic violence and sleep patterns, highlighted intricate connections to maternal well-being. Conclusion: A holistic approach to maternal care, acknowledging the interconnected influences, is imperative. Tailored interventions, informed by sociodemographic contexts and addressing physical and psychological dimensions, enhance overall maternal well-being.

89. Exposed Testicle Management in Fournier’s Gangrene: Thigh Pouch Implantation as a Potential Definitive Option
Sanjay Kumar Mahapatra, Tapan Kumar Nayak, Lalit Kumar Meher, Champak Meher, Arijit Prasad Swain, Ranjan Kumar Biswal
Introduction: Fournier’s Gangrene is a necrotizing infection of the perianal region and scrotum. It progresses very rapidly and is fatal due to its associated varieties of comorbidities. So massive debridement of the necrotic tissues required. Those who survived have massive skin loss at the scrotum. There are varieties of surgical options available for closure of the scrotum cosmetically. In elderly patients with comorbidities those who are not willing for orchiectomy and want to preserve the testis, the thigh pouch implantation would be a better option. Objective: To study the consequences after transplantation of testicles into the anteromedial aspect of the thigh pouch in patients with Fournier’s gangrene with massive scrotal skin loss. Materials and Methods: Nine patients of fournier’s gangrene were included in our study and were analyzed retrospectively. All have undergone initial extensive debridement of  necrotic tissue and stabilization of sepsis by broad spectrum antibiotics. Later on the exposed testicle is transposed into the anteromedial aspect of the thigh after creating a subcutaneous pouch there. The mean age, defect percentage, location, associated comorbidities, mean time for reconstruction, duration of hospital stay and complication rates were calculated. Results: Among the nine patients the most common comorbidity was Diabetes Melitus (66%), and others are chronic kidney diseases (33%), Hypertension (55%). The average time of hospital stay for reconstruction was 15 days and average time of hospital stay after reconstruction was 7 days. Two patients (22%) developed wound infection which was managed conservatively. Conclusion: Implantation of testicles into thigh pouches can serve both as an interim management to preserve the exposed testicles and facilitate wound care healing and may be approached as a long term surgical solution especially in older patients with multiple comorbidities.

90. Glutathione Peroxidase, Superoxide Dismutase, and Malondialdehyde Comparison in Urolithiasis Patients before and After Surgery
Dinkar Shesherao Maske
Background: Clarifying the pathogenesis of urolithiasis, which affects over 10% of the population in affluent nations, has been the focus of considerable efforts in recent years. As of right now, a number of studies have suggested that free radical oxidation, which is triggered when calcium oxalate crystals interact with renal tubular epithelial cells, plays a major part in the pathophysiology of oxalate urolithiasis, the most prevalent of the active forms of oxygen generated in the kidney. In the current study, the pre- and post-operative oxidant and antioxidant status of patients with complex urolithiasis was evaluated. When complex urolithiasis is surgically treated, oxidative stress is reduced and the capacity for antiradical and antiperoxidative protection is increased. Aim: Comparative analysis of glutathione peroxidase, superoxide dismutase, and malondialdehyde in patients with urolithiasis. Material and Methods: The study was carried out in the Department of Surgey, the present study was conducted on 50 patients of urolithiasis admitted in the indoor surgical urology ward for surgery. Results: Malondialdehyde plasma levels have been found to be significantly raised (p<0.0001) in pre-operative patients (12.71±1.65 nmoles/ml of plasma) as compared to the post-operative of volunteers (9.00±1.13 nmoles/ml of plasma). Table 1 also shows that there was a significant increase in the values of superoxide dismutase in pre-operative group (5.99±0.91 µmol/l RBC lysate) as compared to the post-operative group values (4.10±0.96 µmol/l RBC lysate). Conclusion: Enhanced SOD can lessen renal tubular epithelial cell injury and the production of calcium oxalate crystals. The found negative association between MDA and GPx and the positive correlation between MDA and SOD suggest that lipid peroxidation plays a role in the pathophysiology of urolithiasis.

91. To Ascertain Whether Postoperative Antibiotics are Necessary in Cases of Nonperforated Appendicitis Following a Laparoscopic Appendectomy
Dinkar Shesherao Maske
Background: One of the most prevalent acute gastrointestinal inflammatory diseases in both children and adults is appendicitis, which frequently necessitates surgery and hospitalization. Every year, about 14,000 individuals in the Netherlands get an appendectomy to treat suspected appendicitis. There are two different forms of acute appendicitis: basic and complicated. A suppurative or phlegmonous appendicitis, characterized by transmural inflammation, ulceration, or thrombosis, may or may not have extramural pus. Perforated appendicitis, gangrenous (transmural inflammation with necrosis) appendicitis, and/or appendicitis with abscess formation (pelvic/abdominal) are examples of complex appendicitis. Complex appendicitis accounts for about 25–30% of cases. Preventive antibiotic use in an appropriate manner lowers the risk of surgical site infections (SSIs) following surgery. On the other hand, there isn’t a definitive recommendation about 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: The Department of General Surgery carried out this randomized control study (RCT). This study included all patients admitted with acute appendicitis undergoing emergency open appendectomy.  On a pre-made proforma, information on the patients’ demographics, medical histories, and specifics of their clinical examinations were documented. In addition to standard tests like an abdominal ultrasound, other tests like blood urea, serum creatinine, and full blood counts were also carried out. The groups were randomly assigned using the opaque envelope approach. Seventy opaque envelopes with cards inside were produced. Of these envelopes, thirty-five had a card saying the study group, Group A, and the remaining thirty-five had a card mentioning the control group, Group B. Results: Group B’s mean age was 28.62±8.52 years; while group A’s mean age was 28.54±9.62 years. Every subject in the research had right iliac fossa pain at baseline. Conservative management was applied to the three patients in group A and the two patients in group B who had grade III SSIs. There was no statistically significant difference in the incidence of SSIs between the two groups. 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 mean hospital stay was longer than group A’s, there was no statistically significant difference. Conclusion: Additional postoperative doses have no statistically significant benefit, and a single preoperative dose of the prophylactic antibiotics cefotaxime and metronidazole at the time of induction is sufficient to reduce the risk of postoperative SSIs. Larger scale studies with a variety of other abdominal surgeries are needed to ascertain the actual need for postoperative prophylactic antibiotics to reduce the SSIs.

92. Comparative Study of Two Drugs Combination in Total Intravenous Anaesthesia – Propofol and Ketamine, Propofol and Fentanyl
Piyush Bhalchandra Wani, Shivraj N Chilwant
Background: Total intravenous anaesthesia (TIVA) is a genuine technique of ideal drug combination usually used in general anaesthesia. It has minimum cardiac depression, a lesser neuro-humeral response and decreased oxygen consumption. Hence, it is proven to be an ideal technique. Method: 100 (one hundred) patients were classified 50 in group-I, 50 in group-II, Group I was administered Propofol 1.0 mg/kg body weight, Ketamine 1.0 mg/kg body weight as bolus dosage and group-II was given Propofol 1.0 mg/kg body weight and Fentanyl 2mcg/kg body weight as a bolus. At different stages (pre-induction, induction, intra-operative, and post-operative anaesthesia), different stages were compared, and signif-icant results were noted. Moreover, post-operative side effects were also noted. Results: There was a significant p value in the induction stage, intra-operative stages of anaesthesia, and hemo-dynamic profile had a significant p value (p<0.001), but in the post-operative stages of anaesthesia, systolic and diastolic P were almost equal in both groups, hence the p value was insignificant (p > 0.001). It had negligible post-operative side effects. Conclusion: It is concluded that Propofol, Ketamine, and Fentanyl are ideal alternatives to gaseous anaesthetic agents in elective surgeries because TIVA has the fewest side effects because of minimal cardiac depression.

93. Comparative Study of Serum Calcium and PTH (Parathyroid Hormones) In Pre-Menopausal and Post- Menopausal Women of Madhya Pradesh
Maria Khatoon, Prakhar Maru, Vandini Singh
Background: Apart from menopause, there are many factors that cause osteoporosis, i.e., adverse effects of drug therapy, endocrine disorders, eating disorders, immobilization, marrow-related disorders, GIT, biliary tract or renal disorders, and cancer; hence, the exact cause of osteoporosis has to be ruled out. Method: 25 premenopausal and 25 postmenopausal women were studied. Apart from their anthropological parameters, their biochemical profile was studied. 5 ml of venous blood from each patient was collected. Serum calcium was measured by the colorimetric method (Erba kit). calcitonin and PTH were estimated by ELISA, and results were compared. Results: In anthropological parameters, the age group of premenstrual and postmenstrual women had a significant p value (p<0.001). In the comparative study of serum calcium and serum calcitonin, PTH had a significant p value (p<0.001). Conclusion: In the present pragmatic study, it is concluded that decreased calcium has to be increased by calcium supplements and a nutritious diet to prevent osteoporosis and postmenopausal syndrome.

94. Comparative Study between Plating and Titanium Elastic Nailing System for Mid-Clavicular Fractures in Andhra Pradesh
Rama Krishna Pabolu, B. Bhanu Pratap, Lavanya Gampa
Background: As the clavicle lies horizontally in the body, it is more likely to get fractured. As it does not have a medullary cavity (bone marrow), its healing is a great challenge for an orthopaedic surgeon. Method: Out of 100 patients with clavicle fractures, 50 were treated with TENS and 50 with plating. A routine blood examination (RBS), an ECG, and a radiological study were carried out, and general anesthesia was given. Results: Mean blood loss, timing for surgery, and size of wound were quite low in the nailing technique as compared to the plating technique, and the p value was highly significant (p<0.00). Surgical complications were also the least common with nailing techniques. The rate of union was 100% in both techniques. The mean dash square rate in the 1st, 2nd, and 6th months was highly significant in nail technique (p<0.001). Conclusion: In the present pragmatic study, it is concluded that Both techniques have 100% union of fracture and are equally effective in treating displaced mid-clavicular fractures. But due to fewer surgical complications, the TENS technique is preferred over the plating technique.

95. Radiological and Functional Outcome Titanium Elastic Nailing System for Femur Shaft Fracture among Children
Bhushan Salunkhe, Sarang Sawarbandhe, Pravin Agrawal
Introduction: Fractures of the femur shaft a`re common in all age groups and are frequently caused by high-energy events. For stable adults, intramedullary nailing is the recommended course of action, emphasizing prompt healing and functional recovery. 1.6% of juvenile bone injuries in children are femur fractures, and flexible intramedullary nailing has become a valuable surgical technique that provides stability, early mobilization, and less sequelae. Aim and Objectives: This study examines the functional and radiological results of the Titanium Elastic Nail System in kids who have fractured their femur shafts. Method: A one-year prospective institutional study was conducted with 28 patients aged 5-16 with femur shaft fractures using Titanium Elastic Nails (TENS) at a hospital. Initial assessment included airway, breathing, and circulation evaluation. Radiographs, limb immobilization with a Thomas splint, and comprehensive surveys were conducted. Inclusion criteria: ages 5-16, femur shaft fractures on X-rays, completion of investigations. Exclusion criteria: <5 or >16 years, prior fractures, pathological fractures, non-ambulatory/neuromuscular children, bilateral/compound femoral fractures. Result: The demographics, etiology, and fracture characteristics of pediatric femoral shaft fractures are examined in this study. Most reductions are closed because they are faster than open reductions. The majority of fractures heal in 8–9 weeks with little malunion. The surgical results show that Flynn’s method has a high success rate. Clinical decisions for the therapy of juvenile femur shaft fractures are informed by an understanding of these criteria, which emphasize effective interventions and postoperative care for the best possible results. Conclusion: Based on the research, Titanium Elastic Nails are very successful at promoting quick union, stability, and fewer problems in pediatric femur shaft fractures.

96. Study Treating Spinal Anaesthesia Induced Hypotension in Caesarean Section among Phenylephrine, Ephedrine Comparing the Need for Intravenous Vasopressor Therapy
Rakesh D R, Himadarshini L, A. Aparna, Panchakshari B G
Background & Methods: The aim of the study is to Study treating spinal anaesthesia induced hypotension in caesarean section among phenylephrine, ephedrine comparing the need for intravenous vasopressor therapy. An 18‐gauge IV cannula was placed in the non‐dominant hand and 500 ml of Ringer’s lactate solution was given as a preload. Spinal anaesthesia was given in sitting position at L2-3 or L3-4, with a 25G quincke spinal needle using median approach taking full aseptic precautions. The IM injection of the study medication was given into the left deltoid muscle immediately after the subarachnoid injection. Results: Maximum episodes of rescue ephedrine administration were observed in control group. In comparison with control group, episodes were significantly less in in ephedrine as well as phenylephrine group. Also among ephedrine and phenylephrine groups, the difference between phenylephrine and ephedrine group was not found to be significant. Conclusion: The patients were monitored for hypotension (decrease in MAP>25% of baseline MAP), bradycardia (heart rate<50 beats/minute). The episodes of rescue IV ephedrine were significantly higher in control group as compared to in ephedrine group (p=0.000) and in phenylephrine group (p=0.000). The difference between phenylephrine and ephedrine group was not found to be significant (p=0.461).

97. A Study on Use of Partial Ossicular Replacement Prosthesis and Total Ossicular Replacement Prosthesis in Ossiculoplasty at SMC Vijayawada
T.V.S.S.N. Leela Prasad, G.B. Sreenivas, Aditya Kanchumurthy, P. Ratna Babu, K Ravi, Peter Mummidivarapu
Objectives: A Prospective study to analyse the hearing followed by partial and total replacement prosthesis in chronic suppurative otitis media with open and closed mastoidectomy. Study Design: 1 year study from august 2022 to July 2023 in a Tertiary care Hospital – Siddhartha Medical College, Vijayawada. Methods: A Total of 40 patients with Chronic Suppurative Otitis Media with good cochlear reserve and good Eustachian tube function. Both male and female. Investigations include complete ENT examination, Oto-endoscopy, Pure tone Audiometry and CT Temporal bones. Following surgery pure tone audiometry is done in 3rd and 6th month. All cases with Sensorineural hearing loss are excluded. Results: Male to female ratio was observed to be 1:1.4, AB closure in this study is 80% of which 75% (30/40) cases underwent intact canal wall procedure while 25% (10) cases underwent canal wall down procedure. In patients with intact canal wall success Rate is 95.6% with PORP and 100% with TORP this has yielded A-B closure of 30 dB.

98. Dengue Awareness and Practices among Families Residing in Urban Slums in a City in Eastern India: A Community-Based Cross-Sectional Study
Ray SS, Pandit D
Background: Dengue fever is more prevalent in urban slums due to the mosquitogenic condition prevalent there. Neither there is any vaccine nor any specific treatment for dengue. So the mainstay of dengue control is adequate knowledge and good practices in its control. The study aimed at finding the level of knowledge and practices on dengue control by household in an urban slum area. Materials & Methods: This community based cross sectional study was done in the city of Puri in the Eastern coast of India. A total of 10 slums were selected and from each slum 45 houses were picked. A pre-designed questionnaire was used for data collection on knowledge and practices for dengue control & prevention. The data was analyzed using EPI Info 7.2 software. Results: We found that about one-third (35.5%) of the participants had adequate knowledge regarding dengue. All families were practicing some form of mosquito control measures. But only 29% of the household were found to have good practices for dengue prevention and control. Adequate knowledge and good practices were found to be significantly associated with higher education and high socio-economic status. Conclusion: The current study found that adequate knowledge and good practices were found in only 35.5% and 29% of the participants. There is a need to target health education and awareness program among the slum dwellers to improve activities for dengue prevention and control.

99. The Impact of COVID-19 Pandemic on Orthopaedic Trauma Practice and Patient Care at Tertiary Care Centre
Vivek Kumar Kori, Harshdeep Singh, Vinod Rawat, Deepak S. Maravi
Background and Objectives: This study has been undertaken to find out how the COVID-19 pandemic has affected patient care and orthopedic trauma practice at a tertiary care center. Method: In this retrospective comparative observational study, we have observed four periods from “1st march 2020- 28 Feb 2021 and 1st march 2021- 28 Feb 2022” as period III and IV i.e. COVID pandemic period compared with “1st march 2018-28 Feb 2019 and 1st march 2019- 29 Feb 2020” as period I and II i.e. non covid pandemic period. Demographic details and epidemiological parameters of trauma were collected and compared. Results: Due to the lockdown, there has been a reduction in the total number of patients coming to the trauma center, from 7.65 patients per day in Period I to 4.45 patients per day in Period IV. The cases of road traffic accidents decreased from 55.01% in Period I to 38.02% in Period IV, and a reduction in pediatric trauma cases from 18.02% in Period I to 12.01% in Period IV was noted. Conservative treatment increased from 45.20% in Period I to 57.97% in Period IV, while operative intervention decreased from 54.79% in Period I to 42.02% in Period IV. Forearm injury also showed an increase from 4.87% in Periods I to 8.37% in Periods 4. Injury around the elbow also increased, whereas shoulder injury decreased in Periods 3 and 4. Foot and ankle injuries increased, while leg injuries showed a decreasing trend in Periods 3 and 4. Injury around the knee did not show a significant difference, but thigh and hip injuries decreased in COVID Periods 3 and 4. Spine injuries also decreased from 7.98% and 8.76% in Periods 1 and 2, respectively, to 5.98% and 7.39% in Periods 3 and 4. Conclusion: Due to the lockdown, people were forced to stay at home, which led to an increase in the incidence of household injuries. There was a decrease in outdoor activities, resulting in increased trauma around the elbow and wrist among the pediatric age group. During the pandemic period, there was a shift in treatment pattern from operative to conservative methods. The main lessons learned for the next pandemic are that orthopedic departments need to remain flexible in infrastructural re-organization to increase critical care capacity, facilitate outpatient management by taking proper precautions, and provide proper patient exposure for undergraduates. Precise clinical drill training may also improve the clinical skills of upcoming doctors, enabling them to face any pandemic like COVID-19 with basic clinical skills.

100. The Impact of Inhalation Steroids on Chronic Laryngitis Patients with Voice Change: A Prospective Study
Anshul Sharma, Indraprakash Prajapati, Abhishek Rajagopal, Aditya Goel
Background: Chronic laryngitis, a condition characterized by persistent inflammation of the laryngeal mucosa, frequently presents with voice changes, significantly impacting patients’ quality of life. Aims and Objectives: To assess the efficacy of inhalation steroids in ameliorating voice outcomes and reducing laryngeal inflammation in individuals diagnosed with chronic laryngitis experiencing voice alterations. Materials and Methods: Seventy-five participants, aged between 18 and 65 years, were recruited based on clinical and laryngoscopic examination findings confirming chronic laryngitis at the Otolaryngology outpatient clinic at a tertiary center of Central India. Between December 2022 and June 2023, participants were randomly assigned to either Group A (Fluticasone propionate; 2 puffs twice a day + standard care) or Group B (standard care alone) through computer-generated randomization, with allocation concealment ensured by sealed envelopes. Outcome measures encompassed acoustic voice analysis (jitter, shimmer, noise-to-harmonics ratio), perceptual voice analysis (overall voice quality, pitch, loudness), and laryngeal inflammation scores assessed at baseline and post-treatment evaluations. Results: Both groups exhibited comparable baseline characteristics (age, gender, duration of symptoms). Acoustic Analysis: Group A showed significant improvement in jitter (p<0.001), shimmer (p=0.002), and noise-to-harmonics ratio (p=0.001) compared to Group B. Perceptual Analysis: Group A demonstrated significant improvement in overall voice quality, pitch, and loudness compared to Group B (all p<0.001). Laryngeal Inflammation: Group A exhibited a substantial reduction in laryngeal inflammation scores compared to Group B (p<0.001). Conclusion: Incorporating inhalation steroids, specifically Fluticasone propionate, into the comprehensive management of chronic laryngitis with voice change yielded promising results, offering a potential avenue for enhancing patient outcomes and improving overall quality of life.

101. Study of Causes Responsible for Urethrocutaneous Fistula after Hypospadias Repair in Tertiary Care Centre
Kaushal Kumar, Dinesh Kumar Das, Smita Prasad, A. K. Malwiya, Ajit Singh
Background and Objective:  Urethro-cutaneous fistula after hypospadias repair remains a significant problem despite advances in surgical techniques.  The incidence of urethrocutaneous fistula development varies from 4 to 28 %.  In the case of severe proximal hypospadias, two – stage hypospadias, repair had previously been widely performed because of the high complication rate.  The Purpose of this study was to investigate the various factors associated with the development of urethrocutaneous fistula development hypospadias repair. Materials and Methods:  Between January 2017 and December 2020, 312 patients underwent hypospadias repair.  This study included 252 patients who were followed up for more than 6 months. Potential risk factors studied for the development of fistula after operation included age, location of hypospadias, type of hypospadias repair, suture materials, methods and duration of catheterization.  Data were analyzed retrospectively. Results:  Out of 252 patients, 54 patients (21.4 %, 54/252) developed urethrocutaneous fistula after hypospadias repair.  Fistula formation was statistically related with type of hypospadias and type of hypospadias repair.  In the multivariate analysis, only the location of hypospadias was a significant independent risk factor in urethrocutaneous fistula development after hypospadias repair (p value-0.001). Conclusions:  Our results suggest that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with the location of hypospadias (more proximal – type hypospadias).  Type of hypospadias repair, suture materials, suture techniques, and number of other combined urologic disorder were not related to the development of urethrocutaneous fistulas.

102. Post Dated Pregnancy and its Outcome
Puja Verma, Akriti Prasad, Dipti Roy
Background: When pregnancy goes beyond 40 weeks it is called post-dated pregnancy. The incidence of post term pregnancy varies from 3-12%. Post term or post-dated pregnancies are associated with various maternal and fetal complications. Aims and Objectives: This study was done to observe the maternal and fetal outcome in post-dated pregnancies. Materials and Methods: A total of 80 women attending labour room emergency with post-dated pregnancy (>40 weeks) were recruited for the study. Result and Conclusion: The mean age was 23.14±2.2 years. Maximum women were in the age group of 20-30 years (67.5%). More than 50% had meconium stained liquor whereas 42.5% had clear liquor. A birth weight more than 3 kg was observed in 21 babies which was 26.25 % and maximum of 53 babies (66.25%) had birth weight between 2.5 kg and 3 kg. Only 6 babies had birth weight less than 2.5 kg. Ten babies were admitted to NICU. Thus, post-dated pregnancies require strict vigilance during antepartum, intrapartum and post-partum period due to increased incidence of complications.

103. Role of Mentzer Index in Diagnostic Dilemma of Thalassemia Trait Viz A Viz Iron Deficiency Anaemia in A Teaching Hospital
Bhattacharya Shreya, Sinha Surbhi, Chahal Kaur Tejinderjit, Akhtar Md Ansar, Mukherjee Mala
Background: Iron deficiency anaemia being the most common cause of anaemia in the world. The individuals suffering from thalassemia trait usually have an asymptomatic course and they present with mild microcytic hypochromic anaemia on peripheral blood smear. Since the other cause of microcytic anaemia is iron deficiency which is much more common therefore it is important to differentiate it from thalassemia trait. Objective: To determine the role of Mentzer index and Electrophoresis in differentiating between iron deficiency anaemia (IDA) and anaemia secondary to β-thalassemia trait. Methods: This was a hospital-based retrospective observational study done on 2000 patients from December 2020 to June 2022 of all age groups. For the ease of statistical analysis patients who were found to be have iron deficiency anaemia by iron studies and thalassemia trait diagnosed by Hb electrophoresis were included in this study. History of prior blood transfusion within 3 months was excluded from this study. Mentzer index of all the patients were calculated and the results were analysed and further compared with HPLC. Results: Out of 2000 patients, 1100 patients (55%) had iron deficiency anaemia, 800 patients (40%) had β thalassaemia trait, and 100 patients (5%) had thalassaemic major. Mentzer index was found to be more reliable to detect true positive cases for β thalassemia trait with a sensitivity of 93.75%, specificity of 92.73%. Conclusion: Iron deficiency anaemia and thalassemia with many overlapping features can be differentiated by few parameters blood indices like Mentzer index. In resource-poor and developing countries like India where socioeconomic condition is uneven, it can be used as a screening tool.  Though In doubtful cases, the diagnosis can be confirmed by HPLC.

104. Bacterial Colonization of Leg Ulcers and Its Effect on Success Rate of Skin Grafting
Nilesh. P. Suthar, Amit. H. Desai, Ankitkumar Bagdai
Background and Aim: A number of studies have emphasized the relevance of qualitative rather than quantitative bacteriology, whereas others have done the opposite. However, the impact of bacteria in a wound is determined by three primary factors: bacterial load, pathogenicity of the bacteria, and host immune response. As a result, in this investigation, a quantitative bacteriological profile of granulating wound beds that were prepared for grafting was performed in order to determine the effect of bacterial bioburden on the success rate of Split Thickness Skin Grafting. Material and Methods: The current investigation was organized and carried out in the department of general surgery, in collaboration with the department of microbiology at the medical college and affiliated hospital. Before collecting the samples using standard proforma, a comprehensive history was documented. All patients were thoroughly evaluated, and their haemoglobin and random blood sugar levels were measured. The skin graft take up evaluation will be performed on the eighth post-grafting day to determine if the graft has taken up. On the tenth post-skin grafting day, the donor site dressing was removed and evaluated for symptoms of infection as well as whether or not the donor site was healing. Results: The study included 200 patients with chronic non-healing ulcers who met the inclusion criteria and were prepared for split thickness skin graft surgery. Of the 200 patients, 154 were male and 46 were female. Sixty-four patients out of 200 had pre-operative quantitative culture results showing bacterial counts > 10⁵CFU/g of tissue, indicating considerable bacterial development. Four patients out of the 64 had isolated mixed flora. Bacterial counts < 10⁴CFU/g of tissue were seen in fourteen cases. Conclusion: The outcomes of skin grafting in individuals with persistent lower limb ulcerations may be further improved by excluding these two categories, treating underlying venous and arterial issues, treating according to the swab findings, and closely monitoring these patients. These strategies merit more research. The bacterial bio-burden and pathogenicity in the wound determine the impact of bacteria on wound healing.

105. Autologous Platelet Rich Plasma Dressing Versus Normal Saline Dressing in Diabetic Foot Management
Lakshmi Narayanan M, Kannan K, John Veslin T
Purpose: This study aimed to compare platelet-rich plasma (PRP) versus conventional ordinary dressing in the management of diabetic foot wounds. Background: Diabetic foot wound treatment poses a considerable burden on the medical system, with long waiting times for healing in the public hospital system. PRP enables efficient treatment of many patients with hemostatic, anti-inflammatory, and analgesic substances. Patients and Methods: This prospective study was focused on 100 diabetic feet wounds. Patients were divided into two groups: and group A received PRP dressing (N=50, 50%). group B received conventional ordinary dressing (N=50, 50%) The mean follow-up period was 3 weeks. Results: Mean weeks for complete healing is significantly lower in platelet rich plasma group than normal saline group. Significant difference of initial and final area of infection site is 542.8 in platelet group, 277.4 in normal saline group. Percentage of area reduction (mean 39.25) is significantly higher in platelet group. Conclusion: There have been considerable advancements in the use of PRP in therapeutic processes in recent years in tissue regeneration therapy. PRP is a powerful tool for the treatment of chronic wounds and very promising for diabetic foot wounds; PRP enables healing, and reduces infection rates and exudates.

106. Exploring the Stress Landscape: An In-Depth Analysis of Perceived Stress, Contributing Factors and Its Effect on Sleep among Medical Students in Bangalore – A Cross-Sectional Study
Biswabinod Sanfui, Amal Titto V Augustine, Rahul S Pillai, Anil Redhu
Background: The escalating concern of mental health issues on university campuses, where students often report heightened psychological distress, necessitates focused exploration for effective interventions. While physical activity and reducing sedentary behavior have shown promise in enhancing overall mental health, understanding specific associations between various factors and perceived stress among university students remains crucial. Methods: This cross-sectional study, involving all the 454 participants, employed the Cohen Stress Scale and the Epworth Sleepiness Scale to assess stress levels and its impact on sleep, revealing that 13.65% reported low stress, 70.26% experienced moderate stress, and 16.08% faced high stress. Significantly, gender, smoking status, parent’s profession, location of stay, and transportation mode were associated with varying stress levels (p<0.05), and 49.77% reported satisfactory sleep, while 1.76% experienced insomnia, demonstrating a significant correlation between sleep quality and stress levels.(p<0.05). Conclusion: These findings emphasize the need for targeted interventions tailored to specific stressors identified among university students, shedding light on factors influencing stress and sleep quality.

107. Maternal and Perinatal Outcome among Pregnant Women Presenting with Decreased Fetal Movements in Third Trimester
Akhila Rachel Raju, Anjali Prem, Sathi M.S., Anitha Gopal
Background: Decreased fetal movement is one of the common complaints among the pregnant women presenting to emergency department. 55% of pregnancies with stillbirth gave history of decreased fetal movements prior to the diagnosis. It occurring on multiple occasions has increased risk of poor perinatal outcome. Hence early diagnosis of the cause for decreased fetal movements’ helps to initiate intervention when the fetus is still compensated; thus prevents progression to fetal death. Aims and Objectives of the Study: To estimate obstetric & perinatal outcomes of pregnant women presenting with decreased fetal movements in third trimester. To estimate obstetric & perinatal outcomes of pregnant women presenting with decreased fetal movements in third trimester. Materials: A prospective descriptive hospital based study in 197 pregnant women who presented with decreased fetal movements in the third trimester to the labour room of Govt. Medical College, Kottayam during February 2021 to October 2021 were included after ensuring the inclusion and exclusion criteria. Then they were followed up until delivery to study the maternal & perinatal outcome. Results: Among the 197 study subjects, 56.3% were Primigravida. 14.2% were presented with more than once with decreased fetal movements. The incidence was 12.2% with intrauterine fetal demise (IUD) at presentation. 77.15% were induced, 32% had caesarean section. Among the 173 live babies, 7.5% had APGAR < 7, 23.1% had fetal distress, 12.1% had perinatal asphyxia requiring resuscitation, 6.4% had meconium aspiration syndrome and 27.7% required admission in NICU. 27.9% were preterm and 16.2% had perinatal mortality. Conclusions: Women presenting with reduced fetal movement are associated with poor perinatal outcomes like preterm birth, low APGAR score, perinatal asphyxia requiring resuscitation, respiratory distress, meconium aspiration syndrome, NICU admission and perinatal mortality and also an increased rate of cesarean section. The patients with obstetric and medical complications in the present or previous pregnancies; presenting with decreased perception of fetal movements for more than one time was associated with poor perinatal outcome.

108. Comparative Analysis between Dexamethasone and Tramadol as an admixture to Bupivacaine in Supraclavicular Brachial Plexus Block
Milan Mehta, Ketan Modi, Balraj B. Joshi, Nikita Mevada, Mitul Hareshkumar Chaudhary
Background and Aim: There is a list of additives for supraclavicular block that can help enhance the onset, intensity, and duration of the block, which can also be beneficial for postoperative pain relief. Our study sought to compare the effectiveness of Tramadol and Dexamethasone when combined with Bupivacaine in Supraclavicular Brachial Plexus block. We examined various factors including the onset and duration of sensory and motor blockade, haemodynamic variables, and the time to first rescue analgesia within the first 24 hours after surgery. Material and Methods: A study was conducted on 105 patients who were scheduled for elective upper limb surgeries under brachial plexus block. These patients were randomly divided into three groups, with 35 patients in each group. The study involved three groups: one receiving Bupivacaine with Tramadol, another receiving Bupivacaine with Dexamethasone, and a third group receiving Bupivacaine alone. The study recorded the time when the sensory and motor block started and how long it lasted. Hemodynamic variables were measured from the beginning of the study until the first use of a rescue analgesic. Results: The study did not find any statistically significant differences in the age, gender, and body weight of patients in the three groups. The heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure of patients in all three groups were found to be similar at all the observation periods following the initial measurements. Conclusion: In this study, it was found that the combination of Dexamethasone at a specific drug dose was more effective than Tramadol. These findings provide valuable insights into the comparative effectiveness of these two combinations. Additionally, it is recommended to conduct further studies on different drug-dose combinations to confirm the results of the current study and identify the ideal and most efficient dosage of local anaesthetic and adjuvants.

109. The Functional Outcome of Medial Compartment Osteoarthritis Knee Following Proximal Fibular Osteotomy
Kishore Babu Sattaru, Ravikumar Korada, Rajeswara Rao Singuru
Background: Knee osteoarthritis (O.A.) is a chronic, progressive degenerative disease that affects the articular cartilage and due to anatomy and biomechanics medial compartment osteoarthritis knee is most common. Various treatment modalities like intraarticular injections, physiotherapy, visco- supplementation, arthroscopic debridement, high tibial osteotomy, and knee replacement with uni-compartmental arthroplasty have its own complications. Hence, there is a necessity for a modest technique easily reproducible, provides decent functional outcomes. In this scenario, this study is designed to know the functional outcomes, when an osteotomy of the fibula at proximal 3rd is performed in medial compartment osteoarthritis knee. Materials and Methods: This study is a Hospital-Based Prospective interventional study, study period between July 2019- June 2021(2 years), conducted in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. SAMPLE SIZE: 36. Patients fit for surgery and fall in the inclusion criteria for high fibular osteotomy taken for surgery The primary outcome observed will be the functional outcome of the patient. Preoperative and postoperative Oxford knee score (OKS), function sub-scores of the American Knee Society score (AKSS), and Visual Analogue Score (VAS) was noted along with Preoperative and postoperative weight-bearing ratio of medial/lateral compartment. Patients were followed up on for 14 days, 3 months, and 6 months after surgery, and the results were compared to pre-surgery scores at the end of the six-month follow-up period. Results: At 6 months, showed radiological improvement, all being statistically significant (P < 0.001).The average VAS score before surgery was 7.36+1.04, and six months later it was 1.72+0.77 .The average pre-op functional sub-score of the AKSS was 50.75+2.72, with a final score of 73.66+2 after six months. The average preoperative OXFORD score was 24.05+1.73, and the average postoperative OXFORD score was 33.94+2.2. the average medial/lateral joint space was 0.36+0.18, which increased in the postoperative phase, reaching 0.77+0.28 after six months. Conclusion: PFO has developed as a new procedure for people with knee osteoarthritis who want to alleviate pain and improve joint function. The study’s most remarkable findings were pain alleviation and an improvement in the medial to lateral joint space ratio.

110. A Study of Analysis of Factors Affecting Progression of Diabetic Retinopathy Post Cataract Surgery in Patients with Type II Diabetes Mellitus
C.G. Padmavathi, K.V. Manasa, K. Priyanka
Aim: To analyze the progression of diabetic retinopathy during the first year post-cataract extraction in operated and non- operated eyes. Method: This hospital based Prospective study conducted in 100 patients with diabetes mellitus who underwent cataract surgery (CS) at Department of Ophthalmology, Govt. medical college, Anantapuramu during study period of 2021 to 2022. Outcome variables include assessment of visual acuity, Slitlamp examination, direct and indirect Ophthalmoscopy. Results: Mean age of the study participants was 68.5± 12.5 yrs. Females were outnumbered i.e. 56%. The mean duration of DM was recorded as 13.5 ± 7.5 yrs. Mean fasting blood sugar in the study subjects was 170.1± 40.5 mg/dl. Pre-operative Visual acuity in fellow eye was >6/12, 6/12-6/18, 6/24-6/36 and ≤6/60 in 13%, 42%, 31% and 14% of the cases. Pre-operative visual acuity was 6/12-6/18, 6/24-6/36 and ≤6/60 in 29%, 38% and 33% of operated eye cases. Pre-operative cataract analysis shows 29% of the cases had immature cataract, and 71% of the cases had no cataract in the fellow eye. Pre op Diabetic retinopathy (DR) assessment in the operated eye shows 35% had no signs of DR, 44% cases had mild Non Proliferative Diabetic Retinopathy (NPDR) and 21% had moderate NPDR. Whereas in fellow eye, 49% had no NPDR, 38% had mild NPDR and 13% had moderate NPDR. Post- operative DR was progressed in 31% in fellow eye and 45% in Operated Eye whereas DR status was static among 69% in fellow eye and 55% in Operated Eye. Conclusion: Diabetic Retinopathy progression was high in the operated eye compared to the fellow eye. Progression of Diabetic Retinopathy was significantly associated with HbA1c. Progression of Diabetic Retinopathy was not associated with hypertension, dyslipidaemia, smoking and duration of DM.

111. To Observe the Effects of Oral Clonidine on Haemodynamic Changes Associated with Creation of Pneumoperitoneum in Laparoscopic Surgery
Rakesh D R, Himadarshini L, A. Aparna, Panchakshari B G
Background & Methods: The aim of the study is to observe the effects of oral clonidine on haemodynamic changes associated with creation of pneumoperitoneum in laparoscopic surgery. All patients received inj.  Ondensetron 4 mg IV and inj. Glycopyrrolate 0.2 mg IV before induction after securing a suitable peripheral vein. All patients were preloaded with ringer lactate solution 10 ml/kg BW. Results: In study group hypotension and bradycardia is more as compared to control group. In study group 18 patients had dryness of mouth and none in control group. In both groups 04 patients had episodes of shivering post operatively. Conclusion: The observations were discussed in terms of blood pressure, and side effects. The results of the study indicate that premedication with oral clonidine (2-2.5 mcg) in laparoscopic surgeries effectively counteracts the haemodynemic changes due to creation of pneumoperitoneum. Activation of postsynaptic α-2 receptor in nucleus tractus solitaries and locus cerulious of brain stem resulting in peripheral vasodialatation. The incidence of side effects was minimum in clonidine treated patients.

112. Leukoencephalopathy Secondary to Methotrexate Therapy in Patients of Acute Lymphoblastic Leukemia and its Relationship with Serum Homocysteine, Vitamin B12 and Folate Levels: A Prospective Study
Akshay Lahoti, Prabodha K Das, Sonali Mohapatra, Suprava Naik, Ashutosh Panigrahi, Biswajit Bhuyan
This study was done to analyze: 1) Risk of Leukoencephalopathy (LE) in Acute Lymphoblastic Leukemia (ALL) receiving Methotrexate (MTX). 2) Safety of re-administration of MTX. 3) Relationship of Homocysteine, B12, Folate with LE. Thirty four pediatric ALL patients were enrolled. Chemotherapy was initiated as per Modified ALL IC BFM 2002 Protocol. All patients underwent MRI Brain and serum Homocysteine, B12, Folate at four occasions. There was no difference in incidence of LE due to mode of MTX administration. There was no increase in incidence after four courses of HD-MTX. MRI at baseline was not a predictor of development of LE. Three of five LE Patients had abnormal B12/Folate/Homocysteine with corresponding abnormal MRI Brain. t(1:19) and t(9:22) were associated with Leukoencephalopathy but t(12:21) was not associated with LE. Patients of MTX induced LE can be re-challenged with further course of MTX. Baseline MRI is not a predictor for development of LE.

113. Clinical and Radiological Outcome of Bipolar Hemiarthroplasty for the Neck of Femur Fractures
Phalgun Kumar. K, Samiullah MD, Shaheed Abdul Arshad, Mahesh Sagar Athinarapu
Background: Femoral neck fractures predominantly affect elderly females and are rare in individuals under 60 years of age. This study was conducted to evaluate the functional outcomes of both cemented and uncemented bipolar hemiarthroplasty in patients aged 60 and above with intracapsular femoral neck fractures, aiming to identify factors influencing the outcomes. Methods: This retrospective investigation focused on patients who underwent bipolar hemiarthroplasty for femoral neck fractures at Government Hospital Wanaparthy, Telangana State. The list of patients who underwent bipolar hemiarthroplasty for femoral neck fractures was obtained from the medical records department. A standardized proforma, validated by the guide, was utilized for uniform analysis of all patients during a single visit.  Functional Outcome:  Utilized the Modified Harris Hip Score to assess functional outcomes for all patients. Results: A total of n=20 cases were studied during the duration of the study. In this study, the majority of cases had a transcervical type of fracture 80% followed by basicervical 15%, and the least common was subcapital fractures 5% of cases. The final Harris Hip Scores (HHS) revealed the majority of patients (65%) achieved “good” HHS scores (80-89), indicating significant improvement in hip function and quality of life. An additional 30% achieved “excellent” scores (90-100), further highlighting the positive impact of surgery on functional capacity. Conclusion: Bipolar hemiarthroplasty for femoral neck fractures offers relief from pain and a quicker return to unassisted activity, with an acceptable rate of complications. The ultimate functional outcomes are contingent upon the associated comorbidities and effective postoperative rehabilitation. There was no discernible correlation between functional outcomes and interprosthetic movements or radiological results.

114. Can Trauma with Isolated Femur Shaft Fracture Injury Cause Clinicalhypotension? A Systematic Review
Raja Shekhar. K, G Chandramouli, J Suryanarayana
Background: Closed isolated femur shaft fracture usually results from high energy trauma and traditionally assumed to have potential to cause hypotension that we rarely see in clinical practice. We wanted to find literature evidence of association between isolated closed femur shaft fracture and hypotension. Methods: Literature was searched on PubMed, Ovid databases and google scholar website. Hand-searching from references of the articles obtained. All the articles addressing this issue dating from 1955 to 2023 were included in this systematic review. Results: Overall, 13 articles were found that are directly or indirectly concerned about association of femur shaft fracture and hypotension. Out of which, 6 articles are directly related to isolated femur shaft fractures sustained in children or adults. 2 studies indirectly estimated high blood loss pattern with femur shaft fracture, but 5 studies that directly studied hypotension with isolated femur fractures in more than 500 patients, P values of these studies suggest isolated femur shaft fractures don’t cause hypotension. Conclusion: The available evidence from the studies that actually studied incidence of clinical hypotension in isolated femur shaft fractures show closed isolated femur shaft fractures rarely cause clinical hypotension.

115. Correlation of Age of the Patient, Histological Grade, Lymph Node Metastasis and Stage of the Disease with Hormonal Receptor Status in a Case of Carcinoma Breast
Ashwin Hebbar K, Madhan Swamy D P, Ajeet Bhimashankarrevatagaon, Gaurav Jain
Background: Breast cancer is a heterogeneous disease, with patient age, histological grade, lymph node metastasis, and disease stage being key factors influencing prognosis and treatment. This study aimed to correlate these factors with hormonal receptor status in breast cancer cases. Methods: A cohort of 40 breast cancer patients was analyzed. Chi-square tests were utilized to determine the correlation between age category, cancer type, histological grade, lymph node involvement, clinical stage, and hormonal receptor status (ER, PR, HER2NEU). Results: No significant association was found between age category and ER (χ² = 0.175, p = 0.676), PR (χ² = 0.175, p = 0.676), or HER2NEU status (χ² = 1.253, p = 0.263). A near-significant association was observed between cancer type and ER status (χ² = 4.675, p = 0.097). Histological grade showed a significant correlation with ER (χ² = 6.942, p = 0.008) and PR status (χ² = 6.942, p = 0.008). No significant correlation was found between lymph node status and ER/PR status. Clinical stage was significantly associated with ER status (χ² = 4.713, p = 0.030). Conclusion: The study suggests that while histological grade and clinical stage have significant associations with hormonal receptor status, age and lymph node involvement do not. These findings contribute to a better understanding of breast cancer pathophysiology and can inform more personalized treatment approaches.

116. A Prospective, Randomized, Double Blind Comparative Study on Caudal Epidural Postoperative Analgesia: Evaluation of Various Doses of Dexmedetomidine with Ropivacaine in Pediatric Infraumbilical Surgeries
Sanjoli Soni, Monika, Abhishek Ghai
Objective: This study was designed to investigate the effects of two different doses of dexmedetomidine in caudal blocks on postoperative analgesia and sedation score after pediatric infraumbilical surgeries. Methods: A total of 60 children who underwent elective infraumbilical surgeries were enrolled in this study. They were randomly divided into two groups: RD1 group receives- 0.25% ropivacaine 1 ml/kg + 1 µg/kg dexmedetomidine and RD2 Group receives- 0.25% ropivacaine 1 ml/kg + 2 µg/kg dexmedetomidine for caudal block. Primary outcome observed was duration of postoperative analgesia pain assessment using FLACC score. Postoperative sedation, haemodynamic stability and the incidence of side effects were the secondary outcomes. Results: Mean age, weight and duration of surgery were comparable among the three groups. There was a significant difference in the FLACC score between groups RD1 versus RD2 (P-value 0.05). The sedation scores were higher for group RD2 as compared to RD1. The time to first rescue analgesia in group RD1 was 12.03 hours, whereas it  for group RD2 it was 16.08 hours (P < 0.05). Conclusion: prolongation of the duration of analgesia, Decreased the need for rescue analgesics, were found better with 2 µg/kg dexmedetomidine for caudal block. Stable hemodynamics, No significant prolonged postoperative sedation were found better 1 µg/kg dexmedetomidine.

117. Different Types of Placental Location and its Effect on Maternal Outcomes in Primigravida
Lithingo Lotha, Dayananda Saikia, Asha Borah, Kavya S. Kumar
Background: The aim of the study is to determine the effects of different placental location in the upper segment of the uterus on maternal outcome in primigravida. Methods: A hospital based observational study of 570 primigravida with live born infants of more than 24 weeks admitted in the department of Obstetrics and Gynaecology at Assam medical college, Dibrugarh over a period of one year (July 2021-June 2022) with adequate information about the placental location from the second trimester ultrasound screening was done. Based on USG report, the patients were divided into 4 categories – fundal, anterior, posterior & lateral. The association between placental location & pregnancy outcomes was estimated as percentages. Results: In this hospital based observational study, both fundal and lateral placental locations, compared with anterior and posterior placental location, were associated with increased adverse  maternal outcomes. Very preterm delivery (24-31 weeks) were found to be higher in lateral (42.31%), followed by fundal (26.92%) placental locations. Moderate preterm delivery (32-36 weeks) was found to be more common in posterior placental location (34.2%), followed by fundal (26.3%) and lateral (26.3%) placental location. PROM was found to be more associated with lateral placental location (30.65%), followed by fundal (24.19%) and posterior (24.19%) and then anterior placental location(20.97%). Additionally, lateral placental location was associated with increased risk of preeclampsia. (32.35%).  Manual removal of placenta was more seen in lateral placental locations (43.75%), then fundal (37.5%), followed by posterior(12.5%) and anterior placental locations (6.25%). Lateral placentation was more associated with severe postpartum haemorrhage (52.94%), compared to other placental locations such as fundal (23.53%), anterior (11.76%) and posterior (11.76%).  Manual removal of placenta in combination with severe postpartum haemorrhage was found to be more associated with lateral placental location (50%), followed by fundal (25%) and posterior (25%) placental locations. Conclusion: From our study, it was concluded that fundal and lateral placental locations were associated with a number of adverse maternal outcomes, compared to anterior and posterior placental locations. Placental location by ultrasound examination done in second trimester can be used as non-invasive predictor in determining adverse maternal outcomes.

118. Clinical, Epidemiological and Hematological Profile of Snakebite in Adults
Satish B. Patil, Pallavi Nidode, Vrajesh Pethe
Background: This study was conducted to analyze the epidemiological profile, clinical features, complications, hematological profile, and outcome of snakebites. Methods: This was a hospital-based cross-sectional study conducted among 100 patients who presented themselves to the emergency medical ward with symptoms, signs, and definite evidence of snakebite to the Department of General Medicine and Emergency Medicine, Narayana Medical College, Nellore, Andhra Pradesh, from December 2019 to October 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The occurrence of viper snake envenomation with hemotoxic syndrome (44%) was the highest, followed by cobra and krait envenomation with neurotoxic syndrome (42%). The commonest symptoms are bleeding from the site of the bite (37), cellulitis (32), ecchymosis (24), respiratory paralysis (24), hematuria (22), epistaxis (18), paralysis of limbs (10), loss of consciousness (16), etc. 53% of snake bites case were found to have hemoglobinuria, 51% had hematuria, 59% had bacteriuria, 52% had anemia, 58% had myoglobinuria, 53% had leukocytosis, 6% had  thrombocytopenia, and 26% had coagulopathy. The haematological indices (RBC indices (MCV, MCH, and MCHC) and platelet indices (MPV, PCT, and PDW) were observed to be raised in snake bite patients when compared to their normal levels. 23% of snakebite cases showed prolonged PT, 21% showed prolonged aPTT, and 31% of patients showed prolonged 20-minute WBCT in a total of 100 cases. Conclusion: Regular public health programs related to prevention and pre-hospital management (first aid) should be highlighted. There is an urgent need to spread awareness among the community about the avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.

119. Study of Effect of Hematological Parameters in Malaria Infection-Our Experience in a Tertiary Care Centre
Sravani Ponnada, Saraswathi Sarat Srinivas Kukkala, Chowdari Balaji, Divyasree Neeli
Background: Malaria is a significant health problem in India, being one of the biggest burdens in terms of morbidity and mortality. The mortality rate is high in severe malaria (10-30%), and hematological changes play a crucial role in morbidity and mortality. Monocytes, neutrophils, and lymphocytes play a vital role in the induction of immune responses to malaria infection and their parameters have been proven as predictors of malaria infection and its clinical severity. Materials and Methodology: This study was done for a period of 2 years i.e., from October 2017 to September2019, in the Department of Pathology, Andhra medical college, Visakhapatnam, during which 107 smear positive cases and 100 controls were studied. In suspected malaria cases Peripheral smear, Thick & Thin Smear & Rapid diagnostic test was done. Rest of the sample was subjected to SYSMEX 5-PART-Hematologyanalyzer to determine the Monocyte to Lymphocyte Count Ratio (MLCR), Monocyte to Neutrophil Count Ratio (MNCR) and Neutrophil to Lymphocyte Count Ratio (NLCR). Results: Out of 107 smear positive cases, P. vivax is the most common species causing Malaria. 35 cases had severe Malaria with more cases attributed to P. falciparum followed by P. vivax infections. Severe anaemia is seen in 33 cases (30.84%) in which P. falciparum association is predominant. Moderate thrombocytopenia is the most common presentation. Severity of anaemia and thrombocytopenia correlated with parasitemia. Among leucocyte count ratios – there is significant correlation between Monocyte to Lymphocyte Count Ratio (MLCR) and parasitemia. Conclusion: The grade of anaemia and thrombocytopenia increases with the severity of malaria especially in P. falciparum infection. MLCR (Monocyte Lymphocyte Count Ratio) can be used as a screening tool/biomarker along with clinical and other haematological parameters to predict the severity of malaria.

120. A Prospective Study on Impact of Hepatic Ischemia-Reperfusion Injury on Cognitive Function Post-Surgery in the Elderly
Bhagabat Purusottam Dandpat, Debasisha Padhi, Haramohan Barik, Sakti Prasad Sahoo
Background: Hepatic ischemia-reperfusion (I/R) injury is a significant concern in liver surgeries, particularly partial hepatectomy. This condition, prevalent in the elderly, can lead to post-operative cognitive dysfunction (POCD), a complication categorized by memory and concentration impairments. Recent studies suggest a link between hepatic I/R injury, inflammatory responses, and POCD. Methods: In this prospective, observational cohort study, 110 elderly patients undergoing partial hepatectomy were enrolled. The study, conducted at a designated institute over a specified period, included patients with specific cardiac and hepatic function grades and educational levels. Individuals were divided into 2 groups: Category C and Category I/R. Cognitive function was assessed using tests recommended by Murkin et al., and serum levels of TNF-α, IL-6, S100β, ALT, and AST, were measured. Analyses of the data were done with SPSS 15. Results: Vital signs and overall condition did not significantly differ between the two groups. However, Category I/R showed significantly higher levels of TNF-α, IL-6, and S100β post-operation, along with a higher prevalence of POCD (54.5%) compared to Category C (20%). The study also found a substantial correlation between increased serum levels of inflammatory markers and the incidence of POCD. Conclusion: Hepatic ischemia-reperfusion injury is related with increased inflammatory responses and a higher incidence of POCD in elderly patients. These findings underscore the importance of minimizing hepatic I/R injury to preserve cognitive function postoperatively. Recommendations: Future research should focus on developing surgical and anesthetic strategies to reduce hepatic I/R injury. Additionally, exploring therapeutic interventions to mitigate the inflammatory response could be beneficial in preventing POCD.

121. Role of Intrapartum CTG in Reliable Prediction of Fetal Outcome: A Tertiary Care Hospital Based Study
Sweety Sinha, Ankita, Anjali Kishore
Background:  Fetal mortality, morbidity and neurological sequelae of fetal hypoxia can be reduced to a significant extent by effective monitoring in Intrapartumperiod. The study aims to evaluate the role of intrapartum cardiotocography (CTG) in accurately predicting the fetal outcome. Methods: This prospective observational study was conducted at the department of obstetrics and gynecology in the department of Obstetrics and Gynaecology, Patna Medical College and hospital, Patna, Bihar, India.) A total of 106 patients in labour participated in this study during the period of December 2022 to December 2023 who had delivered their child either by lower uterine caesarian section (LUCS) or normal vaginal delivery (NVD) during the study period. Result:   In this study, most patients were between 20 – 25 years of age(68.86%) . With respect to Parity, 44 out of 106 were primigravida (41%), 53 were multigravidas (50%). Out of the total patients enrolled, CTG was reactive in 74 cases (69.8%) and Non-reactive in 32 patients(30.18%). In this study, the non-reactive CTG accurately predicted poor Apgar in 65.51% cases. Of intrapartum CTG, findings were falsely positive in 11.7% cases and 34.5%  were false negative. Conclusions: CTG is one of the reliable methods of monitoring the fetus. Non-reactive CTG record with a high probability indicates the likelihood of the presence of perinatal asphyxia. However reactive CTG is not an accurate marker of fetalwell being. If fetal distress is suspected, optimal and adequate interventions or further investigations should be undertaken as necessitated.

122. Observation of Morbidities in Post Hysterectomy Patients Attending Gynaecology Department, PMCH, Patna
Rakhi Singh, Sweety Sinha, Tanu Priya, Anshuman Anand
Introduction: Hysterectomy i.e, removal of uterus and cervix; is the commonest gynaecological surgery done for various reason mostly in peri-menopausal or menopausal women. Like other surgery, hysterectomy is a major surgical procedure and is not without morbidities. Aims and Objectives: to study the various types of post hysterectomy morbidities, to assess the risk factors causing these morbidities, to formulate modalities to prevent various morbidities in women who underwent hysterectomy. Materials and Method: It is an observational study which was conducted in a tertiary care centre, PMCH. 100 post hysterectomy patients who had various symptoms were asked to be a part of our study. Results: Most common presenting symptoms were lower abdominal pain, low back ache, joint pain and discharge PV along with hormonal deficiency symptoms. Conclusion: Hysterectomy does not come without its own set of post op complications. But most of these morbidities can be tackled with proper pre-op patient preparations along with post-op management, proper counselling & follow up.

123. Prophylactic Antibiotic and Surgical Site Infection in Neonates: A Retrospective Study
Gopal Rauth, Dolly Solanki, Manish Nagendra, Uday Chandrapalsing Rajput
Background and Objectives: Surgical site infection (SSI) poses a significant burden of morbidity. While neonates exhibit heightened susceptibility to infections, there is a paucity of data on specific recommendations for perioperative antibiotic prophylaxis during the neonatal period. Our study aimed to assess the impact of prophylactic antibiotic regimen on SSI in neonates. Materials and Methods: Our retrospective analysis focused on infants undergoing abdominal surgery over a period of one year. SSI, conforming to Centres for Disease Control criteria, was defined as an infection within 30 days of an operative procedure involving the surgical incision’s skin, subcutaneous, or deep soft tissues. Perioperative antibiotic prophylaxis, involving the administration of specific antibiotics at surgery’s onset to forestall wound infection, was implemented. A formal regimen utilizing cefazolin for abdominal surgery was started, enabling pre-and post-introduction result comparison. Results: Throughout the study period, 89 abdominal surgeries were performed on newborns, primarily for indications such as intestinal obstruction, congenital abdominal wall defects, and necrotizing enterocolitis. The cohort exhibited a mean gestational age of 33 weeks and a mean birthweight of 1950 g. Antibiotic prophylaxis was administered in 37 episodes, with 78% optimally timed within 60 minutes before surgery. No prophylaxis occurred in 52 episodes. Neonates under pre-operative antibiotics for infection were less likely to receive perioperative antibiotic prophylaxis. Perioperative antibiotic prophylaxis utilization increased significantly after guideline introduction. Incidence rate of SSIs was 16.85 per 100 abdominal surgeries. High SSIs were observed within a week of surgery in infants who did not receive antibiotic prophylaxis. Conclusion: Despite the existing ambiguity in the literature concerning the risk of SSIs in neonatal surgery, we emphasize the importance of a meticulously tailored antibiotic prophylaxis regimen. The decision to persist in the utilization of cefazolin stems from a judicious evaluation of its efficacy, safety profile, and relevance to the neonatal surgical context.

125. Microbiological Profile in Neck Abscess: A Retrospective Study
Amrutha V Das, Anchal Kumar Jain, Aditya Goel, Indraprakash Prajapati, Rimsha Khan
Background: Neck abscesses present a clinical challenge due to their complex microbiological nature. Neck abscesses in the deep neck tissues are difficult to diagnose, localize, access, and manage. Microbiological Profile can provide important information in terms of identifying the causative micro-organism. Aims and Objectives: To investigate the microbiological profile of neck abscesses, examining prevalent bacterial isolates, age-specific patterns, comorbidities, polymicrobial infections, and clinical outcomes. Materials and Methods: The study employed a retrospective observational design, analyzing a cohort of 30 patients diagnosed with neck abscesses over 1 year duration in a tertiary care center of Central India. Informed consent was waived due to the retrospective nature, and patient data were anonymized for confidentiality. Demographic and clinical characteristics, including age, gender, comorbidities, and symptom duration, were extracted from electronic and paper-based medical records. Microbiological analysis involved obtaining bacterial isolates from pus aspirates or swabs with standard cultures and identification techniques. Statistical analysis included descriptive statistics and Chi-square tests. Results: One hundred and twenty bacterial isolates were identified, with Staphylococcus aureus being the most frequent pathogen (30%) and Methicillin-resistant Staphylococcus aureus (MRSA) at 15%. Distribution by age groups revealed the prevalence of Staphylococcus aureus in adults (35%) and the prevalence of Streptococcus pyogenes in pediatric cases (25%). Among diabetic patients, Staphylococcus aureus (40%) and Streptococcus pyogenes (25%) were common, while non-diabetic cases demonstrated Staphylococcus aureus predominance (25%). Polymicrobial infections were identified in 40% of cases, with various combinations. Interventions resulted in a mean hospital stay of 5.8 days, a clinical recovery rate of 90%, and complications in 10% of cases, including a 3.3% recurrence requiring additional surgical intervention. Conclusion: This study provides valuable insights into the microbiological landscape of neck abscesses, addressing key aspects such as bacterial prevalence, age-specific patterns, comorbid associations, and clinical outcomes. The findings contribute to the understanding and managing of these complex clinical entities, guiding future research and clinical practice.

126. Efficacy of Rebamipide Therapy in Aphthous Ulcers: A Prospective Study
Amrutha V Das, Anchal Kumar Jain, Aditya Goel, Indraprakash Prajapati, Rimsha Khan
Background: Recurrent aphthous stomatitis (RAS) poses a considerable challenge within the Otorhinolaryngology domain, impacting patients’ quality of life. Aim and Objectives: This prospective study aimed to assess the efficacy of Rebamipide therapy in managing RAS over 3 months. Methods: A cohort of 60 patients with recurrent aphthous ulcers was enrolled, receiving Rebamipide therapy orally in a Tertiary care center of Central India. Clinical evaluations, pain scores, and ulcer healing rates were recorded at baseline, 1 month, 2 months, and 3 months. Statistical analyses were conducted to assess changes over time. Results: Rebamipide therapy demonstrated a significant reduction in the frequency and severity of aphthous ulcers, with pain scores decreasing progressively over the 3-month period. Ulcer healing rates exhibited a consistent upward trend, reaching substantial levels by the study’s conclusion. Adverse events were minimal, with 5% of patients reported gastrointestinal discomfort. Conclusion: This study contributes evidence supporting Rebamipide as an effective and well-tolerated therapeutic option for RAS. Positive outcomes regarding reduced ulceration, improved pain scores, and enhanced ulcer healing rates underscore its potential clinical utility.

127. Computed Tomography (CT) Guided Interventions in Thoracic Lesions
Shruti Sharma, Richa
Background and Objectives: CT guided interventional procedures are the most preferred procedures in thoracic lesions. Thoracic interventions like CT guided fine needle aspiration cytology and core biopsy are minimally invasive procedures. To describe and assess the accuracy of CT guided fine needle aspiration cytology, automated core needle biopsy, diagnostic aspirations and drainage procedures for procurement of material (tissue) in the management of benign and malignant lesions of the thorax.  Methods: This is a hospital based observational study of CT guided interventional procedures in patients with thoracic lesions diagnosed by imaging methods like chest radiograph, CT or MRI scans. These patients were referred to the department of radiodiagnosis for CT guided thoracic interventions from the chest medicine department and other clinical departments of our Hospital ESIC Medical College and Hospital Bihta. The duration of the study is for a period of two years. Conclusion: CT evaluation and CT guided interventions are effective tools in the diagnosis and management of patients with thoracic lesions allowing prompt documentation of both benign and malignant lesions.

128. Study of Changes in Hepatic Enzymes after Laparoscopic Surgery
Mamta, Vikas Kumar, Alok Kumar
Background and Objectives: The purpose of this study was to investigate the effect of laparoscopic surgeries on liver function in humans and the possible mechanisms behind such effect. The modern era has witnessed a vast change in the field of medicine. With the advances in science and technology and better access to a variety of services. The purpose of this study was to investigate the effect of laparoscopic surgeries on liver function in humans and the possible mechanisms behind such effect. To evaluate the effects of laparoscopic surgery on liver enzymes Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP) and serum bilirubin. Material and Methods: The department of General Surgery at NMCH, Patna. Blood samples were collected from 60 patients undergoing various types of laparoscopic procedures preoperatively once and post operatively on day 1 and day 7. They were tested for liver function by comparing the level of serum bilirubin, serum alanine amino transferase (ALT), serum aspartate aminotransferase (AST) and serum alkaline phosphatase. The time of CO insufflation was also measured. Conclusion: Transient elevation of hepatic enzymes occurs after laparoscopic surgery. CO the major causative factor.

129. Role of High Resolution Computed Tomography in the Evaluation of Anatomical Variations of Sphenoid Sinus and its Clinical Importance
Richa, Shruti Sharma
Background and Objectives: Coronal high resolution computed tomographic study has become the most requested and precise imaging technique to demonstrate paranasal sinuses. The advantage of coronal sections in HRCT is that it shows progressively deeper structures as encountered by the surgeon during functional endoscopic sinus surgery. Out of the entire paranasal sinuses, sphenoid sinus is generally the most inaccessible sinus to the surgeons. The trans-sphenoid route is considered to be the standard approach for surgery of pituitary adenomas. Knowing the details of the anatomy of sphenoid sinus and the extent of pneumatization can guide the surgeon through difficult corners of the approach. This work determines the incidence of the different anatomical variations of sphenoid sinus as detected by HRCT scan and their impact on related neurovascular structures for the safe removal of inter sphenoid and pituitary lesions. Objectives:  To demonstrate the anatomical variations of sphenoid sinus and related structures on High Resolution Computed Tomography (HRCT). To establish the relations of the sphenoid sinus variations to adjacent crucial anatomical structures. Materials and Methods: The study data was collected from a total of 150 patients referred for High Resolution Computed Tomography (HRCT) of the paranasal sinuses to the Department of Radiodiagnosis of ESIC medical college and Hospital, Bihta over a period of 12 months. After obtaining a written informed consent and history, all the patients underwent HRCT axial section of paranasal sinuses (PNS).Once the axial sections were obtained through the paranasal sinuses, these images were reconstructed into coronal sections by multiplanar reconstruction (MPR) technique without exposing the patient. Conclusion: Sphenoid sinuses are the most inaccessible paranasal sinuses and are surrounded by significant anatomical structures such as the orbit and its contents, cavernous sinus, internal carotid artery (ICA) and the anterior cranial fossa. High resolution computed tomography of sphenoid sinus for the demonstration of the anatomical variations and its relation to the vital adjacent crucial anatomical structures helps in reducing the complications during trans-sphenoidal surgeries and functional endoscopic sinus surgery.

130. Non-Syndromic Oropharyngeal Hamartoma: A Case Report
Kanwar Vikrant Singh, Gurpreet Singh, Surabhi Gupta, Paromita Patra
This case report details the presentation, investigation, management, and histopathological examination of a rare occurrence – non-syndromic oropharyngeal hamartomas in a 2-year-old child. The child presented with a substantial orofacial mass on the dorsum of the tongue, causing significant functional impairments. Notably, the mass measured 8×4 cm and protruded outside the oral cavity. Additional findings included a nodular mass at the tongue tip, a lobulated mass on the right buccal mucosa (3×4 cm), cleft palate, microphthalmus of the right eye, and an accessory pinna on the right cheek. Diagnostic investigations, including ultrasound, revealed irregular soft tissue lesions with hypochoic areas and vascular channels, indicative of hemangioma. Blood parameters were within normal limits. Due to the size and symptomatic nature of the mass, surgical intervention was planned and executed under general anesthesia with nasal intubation. The procedure involved complete dissection and excision of the masses from the tongue and buccal mucosa. The surgical site was meticulously closed in layers using 4-O vicryl. Postoperatively, the child resumed oral feeds on the third day, and the recovery period was uneventful. Histopathological examination of the excised specimen depicted a hamartomatous lesion of the tongue characterized by stratified squamous epithelial lining, admixture of blood vessels, adipose tissue, fibrocollagenous tissue, cartilaginous tissue, nerve bundles, adenexal structures, and minor salivary glands. The report concludes by highlighting the rarity of lingual hamartomas, emphasizing the exceptional size and vascularity of the presented case. It stresses the necessity of considering hamartomas in the differential diagnosis of tongue lesions in pediatric patients. The definitive management approach discussed is complete surgical excision, with the importance of confirming the diagnosis through histopathological examination of the excised specimen. This case contributes valuable insights into the clinical presentation and management of non-syndromic oropharyngeal hamartomas in pediatric patients.

131. Association of Insulin Resistance to Electrocardiographic Changes in Non-Obese Asian Indian Subjects with Hypertension
Sanjeev Kumar, Mahadeo Mandal
This research looks at non-obese Asian Indians who have Hypertension and how resistance to insulin relates to changes in electrocardiographic (ECG) signals. To better understand this population’s cardiac risk factors, researchers must determine how insulin resistance affects electrocardiogram (ECG) characteristics. In this study, we look at the possibility of a link between resistance to insulin and modifications in cardiovascular risk factors in this particular population. The results of this research provide important information about the possible cardiovascular risks faced by this demographic subgroup by illuminating the complex link between resistance to insulin and electrocardiographic abnormalities. This study analyzes and examines the data thoroughly to determine if resistance to insulin is a factor in the unique electrocardiographic alterations seen in this population. This research seeks to shed light on the complex relationship between diabetes and cardiovascular mechanics by identifying probable connections. It intends to provide essential knowledge into potential hazards associated with cardiac issues in this specific demographic subgroup. The study’s results will hopefully illuminate the complex relationship between resistance to insulin and heart wellness in a particular subgroup of people in general, providing vital information on the dangers and consequences of cardiovascular disease in this community.

132. Umbilical Cord Blood TSH Level: Association with Congenital Hypothyroidism and Effect of Perinatal Factors
Mani Shankar, Pankaj Kumar Singh, Upendra Prasad Sahu
Objective: This retrospective cohort study sought to establish a correlation between TSH levels in umbilical cord blood and congenital hypothyroidism. This research aimed to determine how prenatal factors influence the thyroid health of premature infants. Methods: For the investigation, demographic, gestational, birth weight, and maternal information were collected from a cohort of 250 individuals. The determination of the population-wide prevalence of congenital hypothyroidism was conducted utilising TSH concentrations in umbilical cord blood. The relationship between perinatal variables and population TSH levels in congenital hypothyroidism was investigated utilising logistic regression. Results: Congenital hypothyroidism was more probable at TSH concentrations in umbilical cord blood exceeding 10.0 mIU/L (odds ratio 2.90, 95% confidence interval 1.20–7.05). Low birth weight and preterm birth were identified as autonomous risk factors for congenital hypothyroidism, constituting 6% of the observed cases. Thyroid function in newborns is significantly influenced by perinatal risk factors; therefore, TSH screening may have therapeutic implications, as suggested by these results. Conclusions: To detect congenital hypothyroidism at an early stage, umbilical cord blood should be screened for elevated levels of thyroid stimulating hormone, according to our findings. Perinatal factors necessitate individualised surveillance and interventions for infants born prematurely or with low birth weight. The findings of this study contribute to the comprehension of the significance of thyroid function in newborns and advocate for the inclusion of TSH screening in routine newborn examinations.

133. Role of Intravitreal Bevacizumab on Visual Acuity and Central Macular Thickness in Diabetic Macular Edema and Cataract
Ipshita Aparajita Nanda
Aim: To evaluate the role of intravitreal Avastin (Bevacizumab) on visual acuity and CMT in diabetic macular edema and cataract in a tertiary Eye Hospital in Eastern India. Methods: Diabetics with cataract and macular edema were divided into 2 groups. First group(n=17)underwent phacoemulsification and injection Avastin, the other group (n=14), phacoemulsification and SHAM injection. Both groups received focal photocoagulatin after 1 month. Results: At 3 months Avastin group showed significant improvement in BCVA and CMT while non Avastin group showed only significant improvement in BCVA(p<0.05). Patients in Avastin group showed better results in CMT and BCVA but the comparison with the non Avastin groups were statistically insignificant. For BCVA(p=0.883) and CMT(p=0.184). Conclusion: Intravitreal Avastin has no statistically significant role in diabetic macular edema with cataract when other standardized therapy like focal photocoagulation was combined.

134. Ultrasonography and Pregnancy Outcome in Threatened Abortion – A Prospective Observational Study
Swati Sharan, Vinita Sahay, 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 fetus, 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 fetal 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.

135. Comparative Study to Evaluate the Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation using Nebulised Lignocaine and Intravenous Lignocaine
Anuradha Gajraj, Ruhani Arora, Rishabh Aggarwal, Sanjeev Kumar, Vibha Mehta, Jyoti Sharma
Background and Aims: Laryngoscopy and endotracheal intubation are potent stimuli that can induce increased sympathetic activity leading to tachycardia, hypertension and dysrhythmias and increased levels of circulating catecholamines. Different drugs and methods have been proposed to relieve such stimulation induced responses. However, no apparent consensus has been reached as to which method is ideal in attenuation of these hemodynamic reflexes. Intravenous lignocaine is effective in controlling the haemodynamic response to laryngeal manipulations. 36Very few studies have been done to find the effect of nebulised lignocaine on hemodynamic response to airway manipulation. So we decided to compare the effect of nebulised lignocaine and intravenous lignocaine in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. Material and Method: 100 ASA class I or II patients scheduled for elective surgeries under GA requiring endotracheal intubation randomized into two groups. Group A (N=50) patients were nebulised with 2% lignocaine in dose of 2 mg per kg body weight. Group B (n=50):2% lignocaine in dose of 2 mg per kg body weight injected intravenously two minutes before induction. Intravenous induction was done with thiopentone 5mg/kg. Muscle relaxation was achieved with injection vecuronium bromide 0.1 mg/kg i.v. The patient was ventilated with oxygen and nitrous oxide (50:50) and 0.8% of isoflurane, followed 3 minutes later by laryngoscopy and endotracheal intubation by oral cuffed endotracheal tube, of duration less than 30 seconds. Laryngoscopy was done using Macintosh laryngoscopic blade. Endotracheal intubation was done using standard anaesthetic technique for insertion in sniffing position. After the performance of the study, anaesthesia was maintained using 0.8% of isoflurane in oxygen (50%) and nitrous oxide (50%). Hemodynamic parameters (HR, SBP, DBP, MAP) were recorded at various intervals. The comparison of normally distributed continuous variables between the groups was performed using Student’s t test. To determine the significant change at different time points from baseline within the groups were performed using Paired t test.p<0.05 was considered statistically significant. Results: Heart rate decreased after induction in both the groups. The increase in heart rate observed during laryngoscopy and intubation(T0) was more profound in Group Bas compared to Group A. Heart rate attained its baseline at 3 min(T3) in Group A and was significantly lower at 5 and 15 min as compared to Group B. The increase in SBP, DBP and MAP observed during laryngoscopy and intubation(T0) was more profound in Group B as compared to Group A. SBP, DBP and MAP attained its baseline at 3 min(T3) in Group A and was significantly lower at 5 and 15 min as compared to Group B. Conclusions:  Nebulisation with lignocaine is an easy, cost-efficient and better approach to attenuate the hemodynamic response rather than intravenous lignocaine.

136. Effect of Cephalexin at High Dose in Patients with Cellulitis
Ram Milan Prajapati, Dinesh Kabre, Ashok Khatri
Introduction: Cellulitis, a frequent bacterial skin illness caused by Streptococcus or Staphylococcus, provides varying dangers among groups. Redness, heat, swelling, and soreness are some of the signs of it. Cellulitis left untreated may cause abscesses, septicemia, lymphangitis, and recurrence. Cephalexin is routine antibiotic therapy; however, growing resistance necessitates greater dosages for improved effectiveness, requiring further study on cellulitis safety and results. Aims and Objective: To evaluate the effects of a high-dose cephalexin regimen (1000 mg) compare to those of a conventional regimen (500 mg) in treating cellulitis. Method: In a double-blind, randomized  research ,conducted in the  hospital for one year period, the patients were given 7-day Cephalexin 1000 mg or 500 mg four times a day. Blinding and 1:1 computer-generated randomization reduced bias. Temperature, heart rate, discomfort, and erythema were assessed at days 3 and 7 after baseline vital signs. Blinding, adherence, adverse events, and satisfaction were surveyed. Using a 14-day follow-up, a multicenter study comparing high- and standard-dose Cephalexin established feasibility and sample size. Result: The effectiveness of various cephalexin doses in the treatment of cellulitis is examined in this research. For cellulitis care, Cephalexin 1000 mg may be better than 500 mg at avoiding oral antibiotic treatment failure and lowering the requirement for a class change in 100 randomized individuals. However, both groups showed excellent clinical improvements by Day 3. It is important to carefully evaluate the study-specific elements before interpreting them. Conclusion: The study has concluded that Cephalexin at a higher dose is significantly effective with minor adverse events that may be a little higher than the usual dose.

137. Fine Needle Aspiration Cytology (FNAC): A Valuable Tool for Diagnosing Soft Tissue Tumors and Tumor-Like Lesions: A Retrospective Study
Md. Zeeshan Haider, Anand Raj, Krishna Murari Prasad, Roushan Kumar
Background: Fine needle aspiration cytology (FNAC) is a common diagnostic method for soft tissue tumors; however, its accuracy and safety are currently being studied. This retrospective study assessed the efficacy of FNAC in soft tissue tumor diagnosis and its drawbacks. The main objective of this research was to assess how well FNAC works for soft tissue tumor diagnosis. Methods: This retrospective investigation comprised 80 FNAC cases from a “February 2023 to December 2023” that were histologically validated. Out of these cases, 26 were benign and 54 were malignant. Pre-FNAC histology was available for only seven of the 14 recurrence cases. These eight examples were excluded from the analysis. In the 46 remaining patients, FNAC was the major cancer diagnosis method. The specificity, sensitivity, and positive predictive value of FNAC for soft tissue tumor diagnosis were assessed. Results: The study found that FNAC had 91.5% specificity, 90.5% sensitivity, and 94.5% PPV for soft tissue cancer detection. Tumor classification was difficult; only 45.8% of patients were classified. Notably, three false-negative and two false-positive cases occurred. Both schwannoma and fibromatosis were misclassified as sarcomas. One fibrosarcoma, one malignant nerve sheath tumor, and one hemangiopericytoma were false negatives. Conclusion: With its excellent sensitivity and specificity, FNAC becomes a useful method for differentiating benign from malignant soft tissue tumors. However, the precision with which FNAC can classify tumors is still limited, as a significant number of patients necessitate additional histological evaluation in order to confirm the exact diagnosis. Recommendation: The findings suggest that FNAC should be used to diagnose soft tissue tumors initially. However, clinicians should avoid errors, especially in tumor categorization. If diagnostic doubt remains, histological confirmation should be considered for proper diagnosis and therapy. Pathologists and doctors can improve FNAC’s soft tissue tumor diagnosis utility through study and collaboration.

138. Health Control Status among Diabetic Patients and Compare with Normoglycemic Subjects
Indrajeet Yadav, Sanjay Wasnik, Akash Tomar, Priyanka Chouhan
Background & Methods: The aim of the study is to study Health control status among diabetics patient. It is important that the sample must possess almost all the qualities and characteristics of the population or the universe selected for the investigation. The sample of the present study comprised of 200 type 2 diabetic patients. Results: There was significant difference found between patients who are suffering with diabetic complications and patients who do not have diabetes complications on internal health locus of control (t=2.05) significant at .05 level of significance. Findings also revealed that patients without diabetes complications scored significantly higher in terms of mean score on internal health locus of control than those patients who are suffering with diabetic complications. Conclusion: Diabetic patients scored higher on resilience as compared to insulin takers, no difference was found on dimensions of health locus of control and dimensions of perceived social support between insulin dependent and tablet takers diabetic patients. Significant difference was found on physical functioning, role physical, general health and mental health dimensions of health status with tablet takers diabetics scoring higher than insulin dependent.

139. Assessing the Efficacy and Role of Diagnostic Laparoscopy in Subjects with Chronic Abdominal Pain
Amit Kumar, Brijesh Kumar Shukla, Vivek Maurya
Background: Most demanding and challenging conditions to manage across the globe in subjects of all ages are chronic idiopathic pain syndromes. Various diagnostic advancements have been made, pain in these subjects still presents a challenge for all available diagnostic and management methods. Objectives: The present study was conducted to assess the efficacy and role of diagnostic laparoscopy in the identification of the etiology of chronic abdominal pain which is not diagnosed. Methods: In 120 subjects with chronic abdominal pain with unknown etiology or who were refractory to the treatment for more than 3 months. Diagnostic laparoscopy was done for all the subjects. The collected data were subjected to statistical evaluation and the results were formulated. Results: The present study showed that chronic abdominal pain was more prevalent in females compared to males with the most commonly involved site being the periumbilical region. The pain was most commonly seen at the peri-umbilical region with 43.33% (n=13) subjects reporting pain in this region followed by diffuse abdominal pain in 30% (n=36) study subjects, and lower and upper abdomen pain in 13.33% (n=4) subjects each. The duration of pain was 3-12 months in 3.33% (n=4) subject, 12-18 months in 43.33% (n=52) subjects, 18-36 months in 16.66% (n=) study subjects, and was more than 36 months in 36.66% (n=44) study subjects. The findings on laparoscopic examinations have shown that normal peritoneal cavity was seen in 20% (n=16) study subjects, Partial torsion ovarian cyst in 3.33% (n=4) and Koch’s abdomen/tuberculosis in 16.66% (n=20), Chronic cholecystitis in 3.33% (n=4) study subjects, Endometriosis in 6.66% (n=8), postoperative adhesions in 16.66% (n=20) study subjects, and recurrent appendicitis was seen in 33.33% (n=40) study subjects.  Conclusion: The present study concludes that chronic abdominal pain is most commonly caused by recurrent appendicitis where diagnostic laparoscopy is efficacious and safe for diagnosing and managing these subjects.

140. Comparative Outcomes of VAC Therapy and Collagen Granules in the Healing of Diabetic Foot Ulcers
Narasimhaiah Lakshmi Prasad, Tasmina Nureen Huma, Md Asad
Background: Diabetic Foot Ulcers (DFUs) are a common and severe complication of diabetes, requiring effective management strategies. This study aimed to compare the outcomes of Vacuum-Assisted Closure (VAC) Therapy and Collagen Granules in the treatment of DFUs. Methods: In this prospective study, 100 patients with DFUs were randomized into two groups: VAC Therapy (n=50) and Collagen Granules (n=50). We evaluated the time to complete wound healing, infection rates, and patient comfort levels. Results: The time to complete healing was significantly shorter in the VAC Therapy group (8.2 weeks, SD ± 2.1) compared to the Collagen Granules group (9.7 weeks, SD ± 2.5) with a p-value of 0.03. The infection rates were 12% for VAC Therapy and 18% for Collagen Granules, not statistically significant (p = 0.30). Patient comfort was significantly higher in the Collagen Granules group (88%) compared to the VAC Therapy group (75%, p = 0.04). Conclusion: VAC Therapy demonstrated a faster healing time for DFUs, while Collagen Granules were favored for patient comfort. The choice of treatment should consider both clinical efficacy and patient preferences. Future studies focusing on long-term outcomes and cost-effectiveness are needed.

141. A Study of Postpartum Depression in a Developing Country: Prevalence and Related Factors
Kishankumar C Kanani, Ashutosh D Jogia, Ketan P Gadhavi, Rahulgiri M Aparnathi, Priyanka D Jogia
Background: Postpartum depression (PPD) is a prevalent and incapacitating condition among women after childbirth. Research is scarce on PPD and the factors that predict them in women from India. Aims and Objectives: To evaluate the prevalence of PPD and identify key socio-demographic, medical, and obstetric factors associated with the manifestation of PPD. Materials and Methods: Three hundred women who had recently given birth were studied in a prospective cross-sectional study of 6 months. The Edinburgh Postnatal Depression Scale (EPDS) was employed for depression categorization (cut-off ≥10). The designed diagnostic screening questionnaire was used to collect comprehensive data on socio-demographic variables, medical and family history, and obstetric factors. Multivariate logistic regression was employed to identify significant factors associated with PPD, adjusting for potential confounding variables. Results: The study included 300 women with a mean age of 27.5±3.42 years. Educational backgrounds varied, with 40% having secondary and 28% higher education. Most were married (85%), displaying diverse socioeconomic status 13% lower, 42% middle, 45% higher class]. Of the participants, 55% were primiparous, 60% had vaginal deliveries, and 20% experienced pregnancy/labor complications. EPDS scores revealed an 18.7% prevalence of PPD. Mild symptoms were observed in 8%, moderate in 6.7%, and severe in 4%. Binary logistic regression identified higher educational attainment, higher socioeconomic class, previous depression, pregnancy/labor complications, maternal age over 35, and cesarean section delivery as significantly linked to higher PPD risk. A total of 33 babies died (11% mortality). PPD rates showed no significant difference between normal vaginal delivery (85.7%) and cesarean section (94.4%) deliveries in mothers with deceased newborns (p=0.562). Conclusion: This study highlights a significant prevalence of PPD in a developing country. Identified risk factors emphasize the need for targeted interventions and support systems. The absence of a significant association between mode of delivery and PPD in cases of neonatal mortality suggests nuanced interactions warranting further investigation.

142. IgE Immunoglobulin Level and its Association with Morbidity in COVID-19 Positive Patients
Vibha Sushilendu, Prakash Chandra Mishra, C. Selvakumar, Neha Bharti
Background: COVID-19, caused by the novel coronavirus, has led to a global pandemic with varying severity among individuals. Blood group associations and IgE levels have been subjects of interest in understanding the disease’s impact. Methodology: We conducted a retrospective study, comparing 200 COVID-19 diagnosed patients with 100 controls. RT-PCR confirmed COVID-19 cases. Blood groups and IgE levels were determined using established methods. Statistical analysis was performed using chi-square tests. Results: Among COVID-19 patients, 63.01% were men, significantly higher than controls (p<0.001). Blood group A was most prevalent (46.17%), while AB was the least (9.04%). IgE levels were significantly elevated in COVID-19 patients across all blood groups (p<0.001), except for AB Rh (-) (p=0.117). Recommendations: Further research is needed to understand the blood type-COVID-19 connection. Utilize IgE levels for risk assessment, raise public awareness, enhance healthcare collaboration, and consider policy implications. Continued investigation into COVID-19 susceptibility factors is essential. Conclusion: This study highlights the potential association between IgE levels and COVID-19 and underscores the need for further research on blood group implications. Understanding these factors can contribute to a better understanding of COVID-19 susceptibility and severity.

143. Effect of Dexmedetomidine as an Adjuvant to Ropivacaine in Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Abdominal Hysterectomy
Sandhya Rani Shettihally Vishwanatha Reddy, Ravi Bhat, Gayatri CK, Imran Sholapur
Background and Objectives: Ultrasound guided TAP Block is novel approach for blocking the abdominal wall neural afferents (T6- L 1). It is used for postoperative analgesia in various abdominal surgeries. Here we compared analgesic effect of dexmedetomidine added to ropivacaine in TAP block vs dexmedetomidine given intravenously at the time of TAP block in patients undergoing abdominal hysterectomy. Secondary outcomes were to measure duration of analgesia, quality of analgesia, analgesic requirements in first 24h, sedation scores and any adverse outcomes. Methodology: A randomized double blinded study was performed with sixty patients of ASA I and II undergoing abdominal hysterectomy under subarachnoid block. At the end of surgery ultrasound guided TAP block was performed either with 0.375% ropivacaine 20 ml along with 0.5 mcg/kg dexmedetomidine as additive (Group DL, N = 30) and 100 ml NS as infusion or with 0.375% ropivacaine 20 ml along with 0.5 mcg/kg intravenous dexmedetomidine in 100ml NS (Group DS, N=30). Patients were assessed for quality of analgesia by VAS score, duration of analgesia, requirement of rescue analgesics, sedation, nausea or vomiting, haemodynamic parameters like pulse rate and blood pressure and any side effects for first 24h after block. Results: Demographic parameters were comparable in both the groups. VAS scores were lower in group DL than group DS at all time of assessment but it was statistically significant 1h and 2h after block. Duration of analgesia was significantly prolonged in group DL (6.32 ± 4.720h vs 2.98 ± 1.418h p < 0.05). total tramadol consumption was significantly lower in group DL 73.3± 29.3mg when compared to group DS 96.6± 34.5mg, (p < 0.05). Sedation scores were significantly lower in group DS at first h after the block, (p < 0.05). There were no statistically significant differences in haemodynamic parameters among both the group at most of time points of assessment, even if it was significant statistically at some time points, it is clinically significant. One patient developed hematoma at the site of block. No side effects related to drugs noted. Conclusion: TAP block is effective as part of multimodal analgesia not as sole analgesia for abdominal hysterectomy. Dexmedetomidine as an adjuvant to ropivacaine in TAP block prolongs duration of analgesia and reduces consumption of rescue analgesics when compared to systemic administration of dexmedetomidine.

144. Comparison of Efficacy of Paracetamol and Ibuprofen for Treatment of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants
Randhir Kumar Mishra, Amarjeet Patel, K. N. Mishra
Background: For the pharmaceutical closure of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm newborns, indomethacin and ibuprofen (IBU) have been approved. Although recent studies have shown that paracetamol (PCM) can also be utilized, more investigation is needed to determine its safety and effectiveness. The objective is to evaluate the safety and effectiveness of PCM and IBU in treating hsPDA in preterm newborns. Methods: With parental approval, an observational study was designed. Patients’ hsPDA was assessed based on 2D echo results and clinical observations. Following the establishment of inclusion and exclusion criteria, a 3-day course was provided to 100 patients who were then assigned to either PCM or IBU. If necessary, a second round of the same medication was administered following echocardiographic and clinical examination. The rate of ductal closure, medication safety, and adverse events served as the outcome measures. Results: 76.25% was the closure rate for the PCM group and 75% for the IBU group. In the first course, IBU had a much greater closure rate (45% vs. 16.25%). For PCM and IBU, the observed mean closure times were 4.54 days and 4 days, respectively. In the low-birth-weight group and in cases when platelet levels were below normal, PCM provided a greater closure rate. There was no discernible difference between the groups in terms of safety either. Conclusion: PCM is a superior option for individuals with low platelet counts and comorbidities, and it can be recommended as a first-line treatment for hsPDA cases in preterm newborns.

145. Cord Blood Albumin Level as a Predictor of Neonatal Physiological Jaundice in Healthy Term Neonate
Amarjeet Patel, Preeti Pushpam, K. N. Mishra
Background: In the first week of life, up to 60% of term and 80% of pre-term newborns experience neonatal jaundice, which is the most prevalent reason for readmission globally. The goal of the current study was to determine how well umbilical cord blood albumin levels predicted the development of neonatal jaundice in healthy term newborns. The present investigation is undertaken to determine value of cord blood albumin in predicting the eventual development of serious newborn jaundice. Methods: This prospective study, which involved 100 healthy term infants, was carried out in DMCH, Laheriasarai, Bihar. At birth, the cord blood albumin level was estimated. All infants with clinically diagnosed jaundice between the age 72 hours and 96 hours had their total serum bilirubin estimated. Based on cord albumin levels of less than 2.8 g/dL, 2.8–3.3 g/dL, and greater than 3.3 g/dL, respectively, the neonates were split into three groups, A, B, and C. The primary findings of the research were deduced based on serum bilirubin levels ≥17 mg/dL, phototherapy requirements for newborns, and exchange transfusion. Results: There were 21, 35, and 44 births in Groups A, B, and C, in that order. In Group A, 18 (85.7%) neonates had total bilirubin of >17 mg/dL, of which 16 (76.19%) required phototherapy and 2 (9.52%) needed exchange transfusion. In Group B, twelve (34.2%) of the twenty-three (65.7%) infants who experienced jaundice required phototherapy; no other neonate needed an exchange transfusion. Out of the 15 (34.09%) individuals in Group C, 1 (2.2%) required phototherapy for the development of jaundice, and none of them needed exchange transfusion (p<0.001). Conclusion: Whereas cord blood albumin >3.3 g/dL is likely safe for early discharge, cord blood albumin ≤2.8 g/dL is a substantial risk factor for neonatal hyperbilirubinemia, which necessitates early management. Therefore, it is recommended to routinely measure the cord blood albumin level in order to monitor neonates who are at risk.

146. Changes in Biochemical Profiles of Children with Severe Acute Malnutrition on Admission and After Nutritional Rehabilitation
Amarjeet Patel, Randhir Kumar Mishra, K. N. Mishra
Background: According to the National Family Health Survey-3, the prevalence of severe acute malnutrition in children under five is estimated to be 2.6% worldwide and 6.4% in India. The goal of the current study was to compare the biochemical profiles of children admitted with severe acute malnutrition (SAM) before and after nutritional rehabilitation. Methods: A hospital based observational study was undertaken at Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from June 2022 to May 2023 with 55 consecutive cases of SAM. Thirteen biochemical parameters were analyzed using the Vitros System 5600. Results: Serum potassium, sodium, and chloride mean values were 4.22±0.80 mEq/L, 101.12±16.36 mEq/L, and 134.59±19.37 mEq/L at admission; these values decreased to 136.66±19.95 mEq/L, 4.42±0.68 mEq/L, and 103.97±4.83 mEq/L following rehabilitation. In contrast, the values for magnesium, calcium, and phosphorus were 2.11±0.38 mg/dL, 8.70±1.00 mg/dL, and 4.33±1.23 mg/dL at admission, and 2.10±0.29 mg/dL, 9.45±0.65 mg/dL, and 4.76±0.84 mg/dL following rehabilitation, respectively. Serum total protein, albumin, globulin, and A: G had mean values of 6.53±1.44 g/dL, 3.30±0.88 g/dL, 3.23±0.87 g/dL, and 1.06±0.33 before admission; those values changed to 6.84±0.98 g/dL, 3.86±0.57 g/dL, 2.98±0.69 g/dL, and 1.34±0.28 correspondingly, during rehabilitation. The average levels of creatinine and urea were determined to be 26.25±19.30 mg/dL and 0.34±0.24 mg/dL at admission, respectively. Following rehabilitation, the levels were found to be 23.91±11.76 mg/dL and 0.31±0.15 mg/dL, respectively. Upon admission, the patient’s random blood sugar (RBS) was 85.20±17.88 mg/dL; during rehabilitation, it was 94.18±14.82 mg/dL. After rehabilitation, the mean value of calcium, phosphorous, albumin, A: G, and RBS were dramatically raised. Conclusion: Following nutritional rehabilitation, the biochemical abnormalities in a patient with severe acute malnutrition (SAM) improve and are linked to severe morbidity.

147. Study of Early Laparoscopic Cholecystectomy Outcomes in Acute Cholecystitis
Gopal Sharan Singh, Kunal
Background: Acute cholecystitis (AC) is a common acute abdominal condition seen in emergency rooms, primarily due to obstruction of the cystic duct. Gallstones-related cholecystitis affects 5–25% of adult Westerners, and many may get symptoms annually. The purpose of this research is to ascertain the surgical results of early laparoscopic cholecystectomy (LC) in individuals suffering from acute cholecystitis. Methods: From October 2022 to September 2023, a prospective study was carried out in the Department of Surgery, JLNMCH, Bhagalpur, Bihar. ELC was performed on 54 individuals in total for acute cholecystitis. Many factors were evaluated for these patients after surgery, including length of stay in the hospital, length of surgery, conversion to an open cholecystectomy, and cost-effectiveness. Results: The average age of individuals with AC was 55.1±12.5. 53.70% of the patients were older than 50 years old. There were only 35.19% men and 64.81% women. The average surgery lasted 70.3 +/- 12.8 minutes. When it came to problems, the most frequent one was conversion to OC, which occurred at a frequency rate of 1.8%. One patient (0.9%) experienced reactional hemorrhage. After surgery, patients spent an average of 2.12±1.1 days in the hospital. Two patients (1.8%) developed pneumonia, and one patient had a UTI. Injury to the bile ducts did not occur. The rate of in-hospital deaths was nil. Conclusion: A safe and efficient treatment for treating acute cholecystitis is early laparoscopic cholecystectomy.

148. Study on Clinical Profile and Outcome of Surgical Treatment of Perforated Peptic Ulcers
Gopal Sharan Singh, Kunal
Background: When open sores, or ulcers, develop in the stomach or first segment of the small intestine, it is known as peptic ulcer disease. A bacterial infection eats away at the digestive system’s protective lining, leading to the development of peptic ulcer disease in many cases. Ulcers are more likely to appear in those who use painkillers often. The purpose of the study was to assess the clinical profile and results of surgical management of perforated stomach ulcers. Methods: This was a combined retrospective and prospective study conducted from October 2022 to September 2023 on patients treated for peptic ulcer perforations at the Department of Surgery, JLNMCH, Bhagalpur, Bihar. All patients treated for peptic ulcers at JLNMCH, Bhagalpur, Bihar, during the study period were the study’s subjects. Result: 145 patients in all were included and examined. The study’s age distribution was as follows: 65 patients (44.83%) were under 65, 55 patients (37.93%) were between 65 and 80 years old, and 25 patients (17.24%) were under 80 years old. Figure 2 displays the study’s gender distribution. The majority of them had issues connected to their abdomens; of the patients, 91 (62.76%) were men and 54 (37.24%) were women. According to the clinical results, only 7 patients (4.83%) had a 30-day death rate, 14 patients (9.66%) experienced rebleeding, 9 patients (6.21%) experienced surgical complications, and half of the patients required blood transfusions. The average length of stay for patients in the hospital is six days, but they can stay anywhere from zero to forty-five days. Conclusion: Peptic ulcer perforation is still a common clinical issue in our setting, primarily affecting young men who are not known to have PUD. Despite the patients’ delayed arrival at our center, simple closure with an omental patch followed by Helicobacter pylori eradication was effective with great results in the majority of survivors.

149. Association of Cervical Length at 18 To 23 Weeks Gestation in Predicting Preterm Delivery in Twin Pregnancies: A Prospective Observation Study
Kumari Nisha, Renu Jha
Background: While only 1.4% of pregnancies end in complications, twin pregnancies account for 15% of infant deaths. Predicting preterm delivery could enable targeted interventions such cervical cerclage, tocolysis, and prenatal steroid induction, which could improve the outcome for the newborn. Predicting the likelihood of an early delivery can be done with the length of the cervix; a shorter cervix indicates a higher risk. The purpose of this research is to determine the relationship between cervical length and the incidence of preterm birth as well as to assess cervical length at the 18th and 23rd week of gestation in twin pregnancies in order to predict preterm delivery. Method: 69 prenatal patients in total underwent cervical length screening at 18 weeks and 23 weeks of gestation at DMCH, Laheriasarai, Bihar, as part of this prospective observational study. 17 women were lost to follow-up after failing to deliver at the trial site. Three patients were electively terminated due to obstetrical issues, hence they were not included in the study. Results: Preterm delivery was delivered by 22.4% of women at 18 weeks of gestation and 42.9% of women at 23 weeks of gestation with cervical lengths less than 25 mm, indicating a statistically significant link between short cervix and preterm delivery (P value< 0.001). Specificity and positive predictive value (PPV) were 100% at the 18- and 23-week gestation periods, respectively, whereas sensitivity was 18.92% and 54.05% at those times. Conclusion: The current study demonstrates a moderately unfavorable connection between preterm birth incidence and cervical length. This implies that the likelihood of a preterm birth reduces as cervical length increases. Preterm delivery is more likely in women with shorter cervixes.

150. Fetomaternal Outcome in Patients with Early Preterm Labour Following Administration of Magnesium Sulphate – A Hospital Based Observational Study
Kumari Nisha, Renu Jha
Background: The disability known as cerebral palsy (CP) is more common in individuals who are preterm and have low birth weights (LBW). Numerous research indicate that providing magnesium sulfate (MgSO4) to expectant moms can enhance the neurodevelopmental result of their offspring. to evaluate magnesium sulfate’s neuroprotective efficacy in cases of early preterm labor (28–32 weeks). The purpose of this study is to evaluate any negative effects magnesium sulfate may have on the mother or fetus. Methods: This hospital based prospective observational study was conducted at Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from January 2021 to December 2021. At the beginning, 72 expectant mothers who had planned preterm births at 28 to 32 weeks of gestation because of maternal or fetal indications were chosen. Of the 37 women who got MgSO4, two were unable to be contacted for more information. Thus, 35 women in the study group (Group A) who received MgSO4 and 35 women in the control group (Group B) who did not received MgSO4 participated in the study. Both groups received corticosteroids. Results: Compared to the MgSO4 group (3/35, 8.6%), the non-MgSO4 group had a substantially higher number of newborns that had IVH (5/35, 14.3%) (p Value = 0.452). In this study, compared to 2 (5.7%) in the MgSO4 group, 3 (8.6%) ELBW newborns in the non-MgSO4 group experienced IVH. One VLBW baby (2.9%) in the MgSO4 group and two (5.7%) in the non-MgSO4 group suffered IVH. 20% (7/35) of the newborns in the non-MgSO4 group who were between 28 and 30 weeks gestational age needed to be intubated, whereas only 4.4% (4/35) of the infants in the MgSO4 group needed to be. In the non-MgSO4 group, 5.7% (2/35) of the babies between 30 and 32 weeks needed intubation, whereas 14.3% (5/35) of the kids in the MgSO4 group needed it. (0.017 is the p-value). In the non-MgSO4 group, 5.7% (2/35) of babies born between 30 and 32 weeks gestation exhibited delayed milestones; in the MgSO4 group, no baby displayed any delayed milestones. Conclusion: Prenatal magnesium sulfate (MgSO4) seems to reduce the risk of intraventricular hemorrhage, the need for ongoing respiratory assistance, and invasive mechanical ventilation. The effects of antenatal magnesium SO4 are comparable for a variety of preterm gestational ages.

151. Role of Labor Admission Test by CTG as A Predictor of Perinatal Outcome: A Cross-Sectional Study
Kumari Nisha, Renu Jha
Background: Globally, perinatal hypoxia has a significant role in the morbidity and mortality of newborns. Fetal well-being assessment during childbirth has become a crucial component of labor management. The test of fetal well-being known as the labor admission test (LAT) can be used as a screening tool in the early stages of labor to identify fetuses that are compromised upon admission. This study aims to compare test results with newborn outcomes in order to examine the effectiveness of LAT in determining fetal well-being at the commencement of labor. Methods: This was a cross-sectional study conducted among women admitted in labor room of Obstetrics and Gynaecology department of DMCH from September 2019 to August 2020. After LAT, the patients were categorized as “Reactive,” “Equivocal,” and “Non-reactive” based on the FHR tracings that were obtained. These patients’ perinatal outcomes were also evaluated. Results: 106 (64.2%) of the 165 patients who took part in the study showed reactive FHR traces on LAT, 6 (3.6%) had ambiguous FHR traces, and 53 (32.1%) had non-reactive FHR traces. Of the patients who had a non-reactive trace, 45 (84.9%) were delivered via LSCS, 8 (15.1%) had meconium-stained fluid at 5 minutes, and 8 (15.1%) had an APGAR score of less than 7. In this group, about 27 (50.9%) neonates needed to be admitted to the NICU. Conclusion: LAT is a straightforward, non-invasive, low-cost screening method that can be used to identify fetuses that are unlikely to experience the stress of labor and go hypoxic, particularly in cases where financial limitations prevent every patient from having access to continuous electronic fetal monitoring.

152. The Prevalence of Pathogens Causing Bacteraemia Along with Antibiotic Sensitivity Pattern in Tertiary Care Hospital
Ravi Shankar Choubey, Akhilesh Kumar
Background: Bacteraemia is the medical term for the presence of bacteria in the blood or bloodstream. Septicaemia is defined as the growth of bacteria and the release of toxins into the bloodstream. Bacteraemia can be temporary, sporadic, or persistent. Intravascular and extravascular infections are the two types of blood stream infections. It has been demonstrated that determining the antimicrobial sensitivity pattern and performing early microbiological diagnostics increase treatment outcomes. The purpose of this research is to identify the causing agents and ascertain the pattern of antimicrobial sensitivity from blood samples taken from individuals suffering from bacteremia or sepsis. Methods: Prospective cross-sectional study carried out in a hospital setting at Turki Muzaffarpur, Bihar’s RDJMMCH. Between May 2023 and October 2023, 765 blood samples from patients with bacteremia were taken. The blood samples were drawn and handled according to protocol. The organisms were isolated and identified in accordance with accepted practices. In accordance with CLSI recommendations, antimicrobial sensitivity was established using Kirby Bauer’s Disc diffusion method. Results: Of the 765, 349 (45.62%) were female and 416 (54.37%) were male. Out of the 765 samples in total, 114 (14.9%) had good results. The results of this investigation indicated that 60 (52.66%) Gram positive organisms were more common than 51 (44.73%) and 3 (2.63%) Gram negative organisms or fungal isolates.Conclusion: Patients’ morbidity and death can be decreased with prompt detection and adequate treatment. These studies will also aid in the development of policies and guidelines regarding antibiotics to improve patient outcomes.

153. Identification of Several β -Lactamases and Their Simultaneous Presence in Gram-Negative Bacteria Isolated from Clinical Specimens at a Tertiary Care Centre
Ravi Shankar Choubey, Akhilesh Kumar
Background: Globally, the number of infections caused by Gram-negative bacteria is rising. In Gram negative bacteria (GNB), the extended spectrum β-lactamases (ESBLs), AmpC β-lactamases, and metallo β-lactamases (MBLs) have been identified as a source of antibiotic resistance. GNB that produces β-lactamase poses a serious diagnostic and treatment problem in the treatment of infection. Thus, the goal of the current study is to identify the antibiogram of isolates of Gram-negative bacteria, identify distinct β-lactamases and their co-existence, and assist clinicians in initiating the right antibiotic therapy for illness management. Methods: Following the recommendations set forth by the Clinical and Laboratory Standards Institute (CLSI), a total of 150 Gram negative clinical isolates were identified, and tests for antibiotic susceptibility were conducted on them. In accordance with CLSI recommendations, the combined disk diffusion method was utilized to detect ESBL. The phenyl boronic acid test was used to identify AmpC β-lactamase. The EDTA disc potentiation test was used to identify MBL. Result: Of the 150 Gram-negative bacteria that were examined, 26 (17.34%) produced just ESBL, and 50 (33.34%) produced only AmpC. In 16 isolates (10.67%), both ESBL and AmpC coexisted, while in 16 isolates (10.67%), AmpC and MBL co-occurred. Conclusion: For the purpose of managing infections effectively, further testing should be conducted in addition to normal antibiotic sensitivity testing to identify “hidden” resistance mechanisms.

154. Study Is To Identify the Isolates Causing Surgical Site Infections and Its Anti-Microbial Susceptibility Pattern
Ravi Shankar Choubey, Akhilesh Kumar
Background: Surgical site infections (SSIs) rank third among nosocomial infections and are linked to higher rates of morbidity, death, and medical expenses. Finding the isolates responsible for surgical site infections and their antimicrobial susceptibility pattern is the primary goal of this investigation. Methods: For the study, a total of 50 surgical site infection cases were collected. The suspected samples underwent conventional microbiological processing techniques. The antibiotic susceptibility pattern was determined using the modified Kirby-Bauer’s disc diffusion method. Using the Double Disk Synergy Test, the Enterobacteriaceae family isolates were first checked for the formation of ESBLs, in accordance with standards set forth by the Clinical and Laboratory Standards Institute (CLSI). As controls, reference strains of Klebsiella 700603, P. aeruginosa (ATCC-27853), S. aureus (ATCC 25923), and E. coli (ATCC 25922) were employed. Result: Nineteen (38%), of the fifty samples, were culture-positive, and 23 organisms in all were isolated. The most frequently isolated organism was Pseudomonas aeruginosa 9 (39.13%), which was followed by Staphylococcus aureus 3 (13.04%) and Klebsiella spp. 5 (21.73%). Ipenem, meropenem, and piperacillin-tazobactam were the most effective antibiotics against the majority of the Gram-negative isolates. The sensitivity of gram-positive organisms to vancomycin, linezolid, and levofloxacin has been observed. 44.44% of the isolates from the Enterobacteriaceae family produced ESBLs. Conclusion: In any hospital, the rate of infection is a reflection of the quality of care and treatment provided to patients. Thus, appropriate antibiotic policy and improved SSI stewardship are needed. It is advised to periodically examine the etiology and antibiotic susceptibility in both hospital and community settings.

155. Study of Asymptomatic Bacteriuria and Urinary Tract Infections in Pregnant Women
Akhilesh Kumar, Ravi Shankar Choubey
Background: One of the most frequent illnesses during pregnancy is urinary tract infections (UTI). These may result in major difficulties for the mother and the fetus if left untreated. The purpose of this study was to identify prevalent uropathogens that cause UTIs and to ascertain the prevalence of UTI in pregnant women. Methods: 180 pregnant women provided midstream urine sample. The samples were analyzed both by culturing and under a microscope. A urinary tract infection is diagnosed in patients who have a colony count of 105 CFU/ml of urine of a single uropathogenic bacterium in culture, regardless of whether they are symptomatic or not. Results: Thirty-three females (18.33%) with asymptomatic urine specimens had considerable development of uropathogenic organisms, supporting the diagnosis of UTI. After E. Coli (54.55%), Klebsiella species (24.24%), S. aureus (12.12%), Pseudomonas spp., Pseudomonas aeruginosa, and C. albicans (3.03% each) were the most frequently isolated pathogens. Conclusion: According to this study, 18.33% of pregnant women had a UTI. Since the majority of these instances show no symptoms at all, it is critical to screen for it early using the right laboratory testing. This will assist medical professionals in initiating the proper antibiotic treatment at an early stage, hence reducing the difficulties associated with urinary tract infections.

156. Study of Urine Culture Isolates Analysis from Microbiology Laboratory of a Tertiary Care Hospital
Akhilesh Kumar, Ravi Shankar Choubey
Background: A significant portion of each microbiology laboratory’s sample load consists of urine samples. Additionally, the most frequent hospital acquired illness is a urinary tract infection. To determine empirical treatment plans at the hospital level, it is crucial to investigate patterns of antibiotic resistance. Methods: The study of urine culture isolates was conducted on samples received to microbiology laboratory of Radha Devi Jageshwari Memorial Medical College & Hospital, Turki, Muzaffarpur, Bihar, from May 2023 to October 2023. For analysis, only isolates from urine samples of individuals who were not catheterized and had a colony count more than 105 CFU/mL were included. WHONET 5.6 software was used to analyze the antibiotic sensitivity pattern and species distribution. Results: After 801 urine samples were analyzed, 160 isolates were found (positive rate of 19.98%), with coliforms accounting for the majority (71.88%), followed by pseudomonas spp. (8.75%), candida spp. (8.75%), and so on. Urinary tract infections were more common in female patients (22.81%) than in male patients (17.45%). Of all the isolates, Enterobacteriaceae exhibited the highest level of resistance. The most sensitive antibiotics in the Enterobacteriaceae group were amikacin (85%) and imipenem (82%), while the most sensitive antibiotics in the pseudomonas spp. group were polymyxin-B (100%) and aztreonam (93%). Gram positive cocci were also subjected to testing and investigation of their antimicrobial susceptibility. Conclusion: Of all the isolates, Enterobacteriaceae are the most resistant and the primary cause of urinary tract infections worldwide. Antimicrobial agent use must be done with caution in order to lessen the burden of rising drug resistance in UTIs.

157. How to Bail out of Trouble While Fixing Inter Trochanteric Femur Fractures using Proximal Femur Nail
Pavan Kumar Peddibhotla, Harish Thota, Srinivasa Rao Biruduganti, Varun Kumar Paka, Rao Indra Peddibhotla
Background: Inter trochanteric fractures in elderly population with osteoporotic nature of bone are difficult to handle. Intra medullary fixation is ideal for these proximal femur fractures. PFN is a technically demanding surgery and outcome is affected by multiple factors which need to be closely monitored. A thorough knowledge of these guiding factors will improve the success rate and reduce complication. This study aims to identify those factors which have a say in the result of fracture management. Patient and Methods: We here report a prospective observation study on patients with inter trochanteric fracture (stable and unstable) treated by proximal femur nail (PFN) and analyze the various factors and their influence on the functional outcome following surgery. Results: As per Chang’s reduction quality criteria (CRQC), excellent reduction (CRQC score 4) was observed in 33 (42.30%) patients, acceptable reduction (CRQC score 2, 3) in 38 (48.71%) patients and poor reduction (CRQC score 0,1) in 7 (8.97%) patients. The Harris Hip score recorded was found to be excellent in 37 (47.43%) patients, good or fair in 35 (44.87%) patients and poor in 6 (7.69%) patients. Conclusion: PFN is a useful tool for management of these proximal femur fractures provided we acknowledge and consider factors known to affect the success of surgery.

158. Significance of Vitamin D in Systemic Lupus Erythemetosus- A Mini Review
Roy Joydeep, Choudhury Biswadeep, Dasgupta Nivedita, Duttagupta Sumita, Das Debajit, Deb Gupta Tanushree, Sharma Jyotika, Dey Ajit
Background: Vitamin D deficiency is more prevalent among SLE patients than the general population. Over the past decade, many studies across the globe have been carried out to investigate the role of vitamin D in SLE from various clinical angles. A possible explanation for this is the sun avoidance by SLE patients, which is an established trigger of lupus flares. Vitamin D also plays key roles as a natural immune modulator and has been implicated in the pathophysiology of autoimmune diseases, including systemic lupus erythematosus (SLE). Conclusion: This study suggest that many people have inadequate levels of 25(OH)D, particularly patients with SLE, who have additional risk factors for deficiency inherent to SLE.

159. Original Research Article: Emergency Obstetric Referrals to a Tertiary Care Hospital: Profile and Interfacility Transfer
Ankur Shakya, Avani Kadia, Sachin Prajapati, Devangi Panchal, Vaishali Rathwa , Ujjval Parikh
Background: Maternal morbidity and mortality remains a major challenge to health system globally. Referral services for identification and referral of high-risk pregnancies are an integral part of maternal and child health services. Timely and appropriate referral to higher and well-equipped centers with provision of EmOC is very crucial. Objectives: The objective of this study was to analyzed quality of interfacility transfer of emergency obstetric referral including transportation, and communication between referring institution, patient and the referral facility. This study also aimed to study feto-maternal outcome of these emergency obstetric referrals. Methodology: The observational study was conducted in Department of Obstetrics and Gynaecology in collaboration with Department of Paediatrics in Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Time period of the study was 14 months. Out of all referred women 224 were selected for the study after taking written consent. Results: During the study period, referral rate of obstetric cases were 16.4%. Majority of women were referred from public sector hospitals i.e. 98.2% and 2.7% were referred from two referring centers. Most of the women were referred from secondary health care centre i.e. 95.1% and only 1.3% women referred from primary health care centre, and 3.6% from tertiary health care centre. Most of the referred women were multigravida i.e. 59.4%. Majority of cases i.e. 56.3% were antepartum, followed by intrapartum and postpartum 37.9% and 4.5% respectively. Commonest obstetric causes for referral were hypertensive disorders of pregnancy i.e. 18.2%. Commonest medical cause for referral was anemia i.e. 78.4%. In all referred cases, majority of women used ambulance i.e. 78.6%, of which 98.9% were transported free of cost. Out of 224 referred women, 3 antenatal women expired, 4 had abortion, in remaining 217 women 38.71% women undergone LSCS. Out of 220 delivered newborns, 6.8% were stillbirth and 28.2% were preterm. A total of 27.7% newborns had birth weight <2.5 kg (LBW) and 19.1 % were SGA. Out of 205 live births, 18.1 % newborns were admitted to NICU, and neonatal mortality rate was 7.8%. Conclusion: To raise the standard of emergency obstetric care overall, referral procedures must be improved. Our results highlight the necessity of a regulated feedback and communication system between receiving and referring facilities. It is advised to simultaneously ensure EmOC at various health facility levels through the upgrading of health infrastructure.

160. Novel Scoring System in Predicting Severity of Blunt Trauma Abdomen at MKCG MCH Berhampur, Odisha
Sujit Kumar Mohanty, Suryasnata Sahoo, Beda Prakash Dash, Nirod Kumar Sahoo
Background: Now days when Blunt Trauma Abdomen (BTA) is an important cause of morbidity & mortality, it is required to prepare a scoring system for assessing the severity of Intra-Abdominal Injury (IAI). A scoring system that would produce results compared to compute tomography (CT) scans and which would be easily applicable and affordable. Methods: Cross-sectional observational study was performed from July 2022 to June 2023 for patients who presented to Trauma care centre, MKCG Medical College & Hospital, Berhampur, and Odisha with BTA. All patients were managed according to Trauma protocol. CECT abdomen and pelvis is the gold standard for diagnosis. Relevant data were recorded based on the mode of injury, clinical examination, FAST (Focused assessment with sonography for trauma), and CECT scan findings. Variables with a substantial relationship with CT scan were included in multivariate regression models, where a coefficient () was assigned to the variables. The scoring system was developed based on the obtained total   of each variable. Results: 122 patients with BTA were assessed. A 7-point scoring system for BTA was devised using those variables with significant p values. Patients were divided into 2 groups: > 0.43 were high risk and < 0.43 were low risk. In the high-risk group, immediate laparotomy should be done, and the low-risk group should be kept under observation. The receiver operating characteristic curve indicated a close relationship between results of laparotomy and Novel score (sensitivity=76.9% specificity =74.3%). Conclusion: A novel scoring system is a bedside tool for precisely predicting the severity of IAI in BTA and reducing unnecessary CECT and expenses.

161. Study of Appendicitis in Adult Population from Multiple Centres
Motupally Aravind Kumar
Background: Appendicular disease is considered one of the major medical problems in adult population. Acute or chronic Appendicitis usually presents an emergency in terms of both diagnostic urgency and therapeutic intervention. Delay in diagnosis further delays treatment, which leads to emergency complications like Appendicular Perforation, Appendicular Abscess etc. Method: 70 adult patients aged between 35 to 65 clinically diagnosed with Appendicitis were carried out by a standard three-port technique for laparoscopic appendicectomy or open appendicectomy. The operative time was calculated from skin incision to the skin closure and patient recovery from general anesthesia. The laparoscopic appendicectomy was done as and when deemed necessary. Results: In the clinical manifestations, 70 (100%) had tenderness in the right iliac fossa, 49 (70%) had fever, 7 (10%) had vomitings, 14 (20%) had leucocytosis. 19 (27%) patients needed emergency treatment, 36 (51%) had elective therapy. Out of 70 patients 44(63%) had Open Appendicectomy, 11(16%) Laparoscopic Appendicectomy, 5 (7%) had complications and 10(14%) patients were treated conservatively. Out of 70 patients diagnosed as Appendicitis 49(70%) was Male patients and 21(30%) were Female patients. The organisms observed post-surgically were 33(47%) E. coli, and 6(9%) had Klebsella, 4 (6%) had Streptococcus 12 (17%) had no organism as patients had cultured due to early healing. Conclusion: Early detection and early treatment of Appendicitis will prevent Emergency Operation morbidity and mortality in patients.

162. Clinical Study on Etiopathogenesis and Management of Headache in ENT
Dipjyoti Barman, Aliza Sukai, Kalpana Sharma
A study was conducted in the Department of Otorhinolaryngology Gauhati Medical College, Guwahati from 1st August 2021 to 31st July 2022. The aim of our study was, to study the clinical evaluation of headache, to find out the frequency of sinus disease causing headache, to find the common age and gender distribution of headache, to categorize different types of headache cases coming to an ENT specialist, to find out the triggering and relieving factors of headache. Patients suspected of Tension type headache were consulted with Psychiatrist and opinion obtained. Patients suspected of refractive errors were consulted with Ophthalmologist and opinion obtained. Routine blood investigations like Hb%, TC, DC, ESR, BT, CT, urine for albumin, sugar and microscopy. According to clinical diagnosis, radiological investigations i.e., X-ray Para nasal sinuses (waters view), CT Paranasal sinuses was advised. DNE was advised to patients with nasal symptoms. Acute infections were first treated with medication for 3 weeks. Patients with positive DNE findings and CT PNS findings were advised FESS. Out of 100 patients, 43 Patients had tension type headache (TTH), 16 patients had migraine, 31 patients had headache due to rhinogenic causes. Results of our study were compared with the published data available in the literature.

163. Correlation of Immunohistochemical Subtypes to Clinicopathological Parameters, Risk Stratification and Survival Analysis of Medulloblastoma in the First Decade of Life: A Hospital Based Study
Basanta Kumar Baishya, Tanmoy Bhuyan
Background: Medulloblastoma (MB) is a heterogeneous disease that displays distinct genetic profiles depending on molecular subgroups. This study is aimed to correlate molecular subgrouping of childhood Medulloblastoma using surrogate immunohistochemical markers and associate molecular subgroups, histopathological types, and available clinicopathological parameters with overall survival (OS) and progression-free survival (PFS). This study includes 30 children aged less than 10 years and  immunohistochemical staining using β-catenin and GRB2-Associated Binding Protein 1 (GAB1) antibodies, was used to classify the cases into wingless signaling activated (WNT), sonic hedgehog (SHH), and non-WNT/SHH molecular subgroups. Nuclear morphometric analysis was for assessment of degree of anaplasia and Kaplan-Meier survival curves were done. Results: The cases were classified into WNT (10%), SHH (30%), and non-WNT/SHH (60%) subgroups. Histopathological types varied significantly according to tumor location (p< 0.001), degree of anaplasia (p = 0.014), molecular subgroups (p < 0.001), and risk stratification (p = 0.008). Molecular subgroups varied significantly with respect to age distribution (p = 0.031), tumor location (p< 0.001), histopathological variants (p < 0.001), and risk stratification (p < 0.001). OS was 77.5% and 50% after 1 and 2 years, while PFS was 65% and 27.5% after 1 and 2 years, respectively. OS and PFS were associated with histopathological variants (p < 0.001 and 0.001), molecular subgroups (p = 0.012 and 0.005), and risk stratification (p < 0.001 and < 0.001), respectively. Conclusions: Medulloblastoma classification based on molecular subgroups, together with clinicopathological indicators, mainly histopathological types accurately risk stratifies children with Medulloblastoma and predicts their survival.

164. Epistaxis: Etiology among Hospitalised Patients in a Tertiary Care Hospital
Mili M.K., Yasmin S.I., Sarmah Monikuntal
Background: Epistaxis is one of the most common presentations in Otorhinolaryngology emergency. This study was carried out at Assam Medical College and Hospital, Assam to know the various causes of epistaxis that were presented and admitted to the Otorhinolaryngology department. Aims and Objective:  To find out the correlation between age and various causes. Method: This is a retrospective study conducted on the patients presenting with epistaxis and admitted to the Otorhinolaryngology department in Assam Medical College and Hospital from November 2022 to October 2023. Patients with a history of trauma, on anticoagulant medication and who were already diagnosed with bleeding or coagulation disorders were excluded from the study. Results:  In our study period a total of 120 patients were admitted during the study period and were studied. Male: female ratio was 3:1. The most common cause of epistaxis was hypertension with chronic alcoholism (31.66%), next most common cause was hypertension (30.83%). The most common cause among males was hypertension with chronic alcoholism, while among females was hypertension. The least common causes of epistaxis were: hypertension with acute kidney injury (0.83%), nasal myiasis (0.83%) and chronic fungal rhinosinusitis (0.83%). Maximum cases were observed in the age group 51-55 years and minimum in the age group 16-20 years. Maximum cases were observed in December and a minimum in August. Conclusion:  Epistaxis is a common presentation in otorhinolaryngology emergencies affecting any age group. However, the causes in different age groups were different.  More cases were observed among males compared to females. The maximum case was observed among middle-aged people.

165. Analysis of Endoscopic Transcanal Tympanoplasty: Benefits and Outcomes
Anshul Sharma, Jagram Verma, Yamini Gupta, Neha Raghuwanshi, Sonith Peter George, Rajkumar Mundra
Aim: To assess the outcome of Endoscopic Transcanal Tympanoplasty in terms of air bone gap, hearing gain & graft success. Methodology: 90 patients who underwent endoscopic transcanal tympanoplasty without elevating tympanomeatal flap from January 2020 – March 2021at M.G.M Medical College and M.Y. Hospital, Indore were included in the study based on inclusion and exclusion criteria. Patients were followed after 3 months and the outcome was analyzed. Result: The patients in the study are of age group of 20-70 years out of which 36 were males and 54 were females. Cause of the perforation was CSOM safe type in 84(93.34%) patients while only in  6(6.67%) patients have etiology was trauma.  Out of 90, 39(43.3%) patients were having SCP,30 patients (33.3%) were having MCP and 21patients (23.3%) were having LCP on the oto-endoscopic findings. 10 patients shows graft rejection while hearing loss improved  significantly with reduction in air bone gap. Conclusion: Transcanal endoscopic tympanoplasty without raising tympanomeatal flap is highly successful, safe, and less traumatic with low operation and hospitalization time as well.

166. Prospective Comparative Study of Conventional Continuous Method versus Modified Smead Jones Method of Fascial Closure in Midline Laparotomy Incision
Akkidas Suvarchala, S. Srinivasa Rao, Karuna Sudha Yarlagadda, Kalyani Adiraju, M. Samanth, Kallepalli Vineel Sai Deepak
Background: The occurrence of sudden disruption of the abdominal laparotomy wound is a major disaster in the life of a patient who has undergone an abdominal operation and a major psychological blow to the patient as well as the surgeon. Methods: 50 consecutively enrolled patients who underwent emergency midline laparotomies were enrolled in the study who were admitted in Department of Surgery, Government Medical College, Srikakulam. Intra-operatively randomized into two groups in 1:1 pattern. Results: The total number of patients who underwent laparotomy for generalized peritonitis in 2 years was 50. The post-operative wound infection rate in Group A was 32.4% and in Group B was 12.3% (p = 0.03). Conclusion: Present study concluded that the modified version of Smead-Jones techniques of laparotomy closure with prolene loop had very low incidence of early and may reduce the late complications. It was superior to other conventional methods of closure.

167. Antimicrobial Susceptibility Pattern and Detection of Extended Spectrum Beta Lactamase Production in Proteus Species Isolated From Various Clinical Specimens at Government Medical College, Kota (Rajasthan)
Singh Rashmi, Soni Ghanshyam, Morya Suchitra
Background: Proteus species is commonly associated with hospital as well as community acquired infections. The increasing resistance of Proteus spp to commonly used antibiotics with sensitivity only to reserve drugs such as Imipenem, Ceftazidime-Clavulanic acid, Piperacillin-Tazobactam is one of the most challenging tasks which is faced in clinical practice. The prevalence of ESBL producing Proteus varies from 19.4% to 69.4%. Aim and Objectives: The aim of this study was to detect extended spectrum beta lactamase production and assess the antimicrobial susceptibility pattern of ESBL producing bacteria in comparison with non-ESBL producers in Proteus species isolated from various clinical specimens at Govt. Medical College & A.G. of Hospitals, Kota.Material and Methods: A total of 100 non-duplicate Proteus species obtained from various clinical samples like urine, blood, pus, sputum, endotracheal aspirate and body fluids (pleural, ascitic, peritoneal and CSF) etc. were taken for the study from November 2020 to October 2021 and identification was done as per the standard biochemical identification methods. Antimicrobial susceptibility was performed by Kirby–Bauer disc diffusion method. ESBL production was detected by modified double‑disc synergy test, confirmatory disk diffusion test and E tests.  Result: Three Proteus species isolated were: Proteus mirabilis 63% (63/100), Proteus vulgaris 34% (34/100), and Proteus penneri 5% (5/100). Proteus species was most commonly isolated from pus (53%) followed by urine (28%), ear swab (7%), blood (5%), vaginal swab (4%) and sputum (3%) respectively. Maximum prevalence was seen in 31-45 years age group (25%) and minimum prevalence in >75 years age group (5%). Males were found to be more vulnerable than females in acquiring Proteus infections. Out of 100 Proteus isolates 69% were isolated from IPD cases and 31% were from OPD cases. Out of 100 Proteus isolates, 63 were positive for ESBL production by screening method, while 61 were positive by DDST method, 63 were positive by CDT method and 61 were positive for ESBL production by E test method. ESBL producers were most susceptible to imipenem (90.44%) followed by piperacillin-tazobactam combination (76.20%). P.penneri was the most resistant species. Conclusion: This study highlighted the increased prevalence of Proteus mirabilis when compared to Proteus vulgaris and Proteus penneri. Species Proteus penneri was more drug resistant when compared to Proteus mirabilis and Proteus vulgaris. Piperacillin tazobactam and Imipenem were effective in treating the resistant Proteus species to prevent unnecessary use of antimicrobial agents, increasing drug resistance and long duration of hospital stay.

168. A Study on Comparison of Minimal Separation Hydrocelectomy vs. Conventional Hydrocelectomy (Jaboulay’s Procedure)
A. Santhi, S. Umarani, S. Chelladurai
Background: To compare the new minimally access hydrocelectomy versus Jaboulay’s procedure regarding operative outcome and patient’s satisfaction. Minimal access hydrocelectomy surgery is a novel procedure and there is an adequate literature about the benefits of this surgical technique. In India, still in many hospitals we are practicing only conventional hydrocelectomy (Jaboulay’s procedure) and Lord’s plication techniques for the treatment of hydrocele. These techniques have its own complications. Based on this aim of our study is to compare the operative outcomes among the primary vaginal hydrocele patients those underwent minimal access hydrocelectomy and conventional hydrocelectomy and also to compare the operating time and hospital stay among the primary vaginal hydrocele patients those underwent minimal access hydrocelectomy and conventional hydrocelectomy. Materials and Methods: A total of 60 adult patients were divided into two groups A and B. Group A patients was subjected to conventional surgical hydrocelectomy (Jaboulay’s procedure) and group B patients were subjected to the new minimal access hydrocelectomy. A questionnaire was designed which contained the details of patient’s name, age, sex, symptoms or presenting complaints, duration of the swelling, site of the swelling, operating time in minutes, post-operative complications if any and duration of the hospital stay in hours. Results:  In our study group among conventional hydrocelectomy patients, 93% of the patients presented with post-operative complications. Only 7% had no post-operative complications. Only 10% of the study participants underwent minimal separation hydrocelectomy presented with edema and hardening and only 7% presented with wound infection. The difference in the operative time was statistically significant mean operating time in conventional hydrocelectomy (30.83 minutes) than minimal separation hydrocelectomy (17.93 minutes). Same was with hospital stay conventional hydrocelectomy (80.50 hours) more than minimal separation hydrocelectomy (48.57 hours). Conclusion: Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally access maneuvers provide the best operative outcomes regarding scrotal edema and hardening and patient’s satisfaction when compared to conventional eversion-excision hydrocelectomies.

169. Spectrum of Cases on FNAC of Lymph Nodes-A One Year Study in a Tertiary Health Care Centre
Pooja Nair V, Jagadeeswari S, Harika P, Chandralekha J, Vijaya Bharathi I
Background: Lymphadenopathy is one of the commonest presentations in inflammatory and neoplastic disorders. Fine Needle Aspiration Cytology (FNAC) is simple, quick, inexpensive and minimally invasive OPD technique used for establishing the etiology of lymphadenopathy. In this study we describe cytomorphological patterns of lymph nodes and its utility in establishing diagnosis. Objectives of present study were to assess the distribution of various cytomorphological patterns of lymphadenopathy and to assess the age specific distribution of various cytomorphological patterns of lymphadenopathy. Methods: This study was carried out in the Department of Pathology, Government Medical College, and Srikakulam on 214 cases of lymphadenopathy over a period of one year from January – December 2023. FNAC diagnosis was correlated with relevant clinical findings and investigations. Results: Total 214 cases were studied. Of these, 189 (88%) were inflammatory and 25 (12%) were neoplastic. Reactive non-specific lymphadenitis was the most common disease found in 102 (48%) patients followed by tuberculous lymphadenitis in 65 patients (30%) and granulomatous lymphadenitis in 22 patients (10%). Among neoplastic lesions, metastatic tumours were reported in 19 patients (9%) and Lymphoproliferative disorder/Lymphoma was reported in 6 patients (3%). Highest incidence of lymphadenopathy was found in patients of 10-59 years age group, among which most of the cases were non-specific lymphadenitis followed by tuberculous lymphadenitis. Amongst the neoplastic lesions, most of the cases were in the age group of 35-85 years. Site wise distribution showed that cervical region was the most common site for lymphadenopathy accounting for 159 cases (77%) followed by axillary and inguinal lymphadenopathy. Conclusions: FNAC is simple, safe, reliable procedure for diagnosis of lymphadenopathy.

170. A Cross Sectional Study to Determine the Therapeutic Response of Anti-Diabetic Agents Used in Type 2 Diabetic Patients at Tertiary Care Centre in Western Rajasthan
Aditi Arha, Amit Sagar, Rajkumar Rathore, Archana Vyas
Introduction: This study aimed to determine the optimum therapeutic response of Antidiabetic drugs by measuring the Glycated Hemoglobin (HbA1c) and Fasting Blood Sugar (FBS) levels in Type 2 Diabetes Mellitus (T2DM) patients above 40 years of age taking monotherapy and combination therapy. Methods and Materials: This is a prospective observational study. The study participants were recruited from among patients with a confirmed diagnosis of Type 2 Diabetes Mellitus, with a medical history of more than three months, and who had been consistently using the same anti-diabetic agents for the same duration. Prescribed anti-diabetic agents and therapeutic response in the form of FBS and HbA1c were recorded. Results: This study included 245 patients out of which, 143 Patients (58%) had uncontrolled diabetes mellitus which showed poor glycemic control after treatment. Glimepiride with Metformin was the most common antidiabetic drug prescribed but only 38% of patients had controlled FBS levels and 30% of patients had controlled HbA1c levels among the group. Biguanide was the most commonly prescribed group of antidiabetic agents. Prescribed Insulin preparations were Human Insulin and Glargine Insulin and newer oral antidiabetic agents like Glucagon-like peptide-1 (GLP-1) receptor agonists and Dipeptidyl Peptidase-4 (DPP-4) inhibitors are also prescribed. Discussion: In our study polytherapy was predominant over monotherapy, although the aim of the therapy should be to achieve optimum glycaemic control by monitoring FBS and HbA1c levels in patients.

171. To Compare Oral Gabapentin and Oral Pregabalin as Preemptive Analgesia under Spinal Anaesthesia for Abdomino-Pelvic Surgeries
Syed Himayathullah Hussaini, Sameera, Vinod V Hudgi, Anil Kumar S Kunnur, Sangeeta Awanti
Background: Various adjuvants both orally (clonidine) and intrathecally (opiods, neostigmine, alpha 2 agonist) have been used to prolong the postoperative analgesia of             intrathecal bupivacaine. Gabapentin and Pregabalin and a structural analogue of gamma- amino butyric acid given orally, has been found to prolong the analgesia of intrathecal bupivacaine. Objective: To compare the effects of 150mg of oral Pregabalin and 300mg of oral Gabapentin given  90mins before on duration of postoperative analgesia in patients posted for elective Abdomino-pelvic surgeries under subarachnoid block.  Methods: Hundred patients of either sex in ASA I and II aged between 18-65 years posted for elective Abdomino-pelvic surgeries under subarachnoid block were selected and divided into 2 equal groups of 50 each –Group P(Pregabalin) and Group G(Gabapentin) and the drug was given 90mins before induction of spinal anaesthesia. All patients were given 3ml of bupivacaine heavy intrathecally for the surgery.  Results: Mean of Total duration of postoperative analgesia in group P was 270.30 ± 25.07min and in group G was 260.04 ± 23.90min which was statistically significant. VAS score was low at 1st, 2nd,3rd and 4th hour in group P than group G but was statistically insignificant however the VAS score at 5th, 6th and 7th hour in group P was lower than group G and was statistically significant.  Conclusions: A preoperative oral dose of Pregabalin 150mg is more effective than 300mg of Gabapentin for reducing postoperative pain in patients undergoing Abdomino-pelvic surgeries. Pregabalin 150mg produce a prolonged postoperative analgesia compared to Gabapentin 300mg.

172. Cardiovascular Alterations in Newly Identified Hypothyroid Cases: A Cross-Sectional Study
Sandipkumar Rajeshbhai Patel, Shreya Dharmendra Patel, Heratkumar Dineshchandra Soni
Background and Objectives: Numerous clinical manifestations in both hypothyroidism and subclinical hypothyroidism stem from the thyroid hormones’ capacity to influence cardiovascular structural and hemodynamic characteristics. The aim of this study was to assess cardiovascular alterations in recently diagnosed hypothyroid patients. Materials and Methods: This cross-sectional study involved a total of 76 patients. TSH, T4, and T3 levels were measured using radio-immunoassay. Electrocardiograms (ECGs) were recorded for all patients in all 12 leads at a paper speed of 25mm per second with normal standardization. A PR interval greater than 0.2 seconds was considered prolonged, and QRS complexes less than 5mm in limb leads and less than 10mm in chest leads were deemed as low voltage complexes. Echocardiograms were performed on all participants. Each case underwent specific screening for cardiovascular manifestations, such as pericardial effusion and ventricular dysfunction. Results: The most prevalent findings on general physical examination were skin changes, followed by oedema and delayed ankle jerk. Approximately half of the subjects displayed no abnormalities. ST and T wave changes, sinus bradycardia, low voltage complexes and pericardial effusion were also observed in the subjects. Conclusion: Cardiovascular symptoms are less frequently linked with recently identified hypothyroidism. The incidence of pericardial effusion in hypothyroidism is significantly associated with the duration of the disease, emphasizing the importance of early hypothyroidism diagnosis.

173. Comparison of Intrathecal Dexmedetomidine with Buprenorphine as an Adjuvant to Hyperbaric Bupivacaine in Infraumbilical Surgeries
Babli Das, Abhijit Das
Background and aims: Emerging regional anesthesia trend uses less local anaesthetic, segmental blocks, supplemented with opioids, α2 agonists for prolonged analgesia and minimizes spinal anaesthesia drawbacks. Current study evaluated effects of dexmedetomidine (5μg) and buprenorphine (75μg), with intrathecal hyperbaric bupivacaine (0.5%) for sensorimotor block and analgesia. Methods: This prospective, randomized controlled, single-blinded study conducted in the Department of Anaesthesiology, Silchar Medical College, Assam after obtaining ethical committee clearance. Informed written consent obtained from 120 ASA I/II patients, aged18-60years, for infraumbilical surgery. Exclusions: coagulopathy, cardiac issues, pregnancy, obese (>30 BMI), spinal deformities. Randomly divided (3 groups, n=40 each) via sealed envelopes. Group BC received 3ml (15mg) of 0.5% Bupivacaine heavy + 0.5ml of normal saline (control). Group BD received 3ml (15mg)of 0.5% Bupivacaine heavy+ dexmedetomidine(5μg)in 0.5ml NS. Group BB received 3ml (15mg) of 0.5% Bupivacaine heavy+ 0.5ml of buprenorphine (75μg). Parameters assessed: onset and duration of sensorimotor block, analgesia duration, haemodynamics, sedation and side effects. Data analyzed with relevant statistics. Results: Onset of sensory and motor blockades showed no statistical difference. However, Group BD exhibited considerably longer sensory (438.88±31.27min) and motor (447.9±34.23min) blocks compared to Group BC (204.7±28.63min; 307.98±16.11min) and Group BB (279.88±16.58min; 305.2±11.1min) (p<0.0001). Group BD also displayed prolonged post-operative analgesic request time (459.13±37.11min), surpassing other groups (p<0.0001). Although Group BC had the highest sympathomimetic need (65%), Group BD demonstrated superior hemodynamic stability (p<0.022) despite transient bradycardia in fewer subjects. Conclusion: Dexmedetomidine (5μg) as an intrathecal adjuvant with 0.5% hyperbaric bupivacaine prolong the sensory and motor blockade duration. It increases the time to rescue analgesia, minimizes side effects, and provides sedation compared to other groups.

174. A Study on Effect of Storage Time on Different Sample Types in Measuring IL-6 in a Hospital Based Setup
Malavika Barman, Firdushi Begum, Elteza T. Jahir, Sumi Deka, Suman Chanda, Alakesh Choudhury, Mousumi Borgohain Borah
Introduction: Interleukin-6 (IL-6), a pro-inflammatory cytokine, concentration increases several folds during inflammatory conditions, making it a biomarker in diagnosis, therapy and prognosis in various diseases. However, several pre-analytical factors may affect the IL-6 assay. In this study, we aim to investigate the effect of storage time in different sample types (serum/plasma) on measurable IL-6 in Covid-19 cases. Materials & Method: Serum and Plasma (EDTA) samples were collected from 30 Covid-19 cases. The samples were divided into two groups. They were kept at 22–26°C (Lab room temperature). IL-6 was assayed by the Immunoturbidometric Immunoassay method on Vitros 5600 analyser of Orthoclincal Diagnostics. The first group was assayed within 1 hr of collection and the next group was assayed 2 hrs after assay of the first sample. The change in IL-6 levels in both groups for serum and plasma was analysed. Results & Conclusion: At the baseline, the paired plasma and serum IL-6 values had good correlation without any statistically significant difference (p>0.05). With the increase in storage time, a more pronounced (highly significant statistically p<0.0001) rise in un-separated serum IL-6 values were observed. But the plasma values remained stable (no statistically significant difference, p>0.05) over the same storage time. We can conclude that sample types and storage time may affect the IL-6 levels. Hence, plasma samples (EDTA) should be considered to ensure the accuracy and stability of IL-6 values.

175. Prevalence of Chronic Suppurative Otitis Media (CSOM) and Associated Hearing Impairment among School Age Children in Muzaffarpur District, Bihar, India
Amar Nath Prasad, Ravi Shekhar
Objectives: The present study was to evaluate the prevalence of chronic suppurative otitis media and associated hearing impairment among school age children in Muzaffarpur district, Bihar India. Methods: A total of 384 children with age group ≤ 5  to ≥ 13 years were selected. A proforma (case record form) was prepared to carry out the study. The initial school survey was carried out and the students were examined according to the pro forma (case record form), which was distributed to the children or to the respective class teachers. All the participants were examined with the help of the otoscope and other standard instruments used for routine ENT checkup. Results: Out of 384 children were selected. Among them, 216(56.25%) were males and 168(43.75%) were females. Among male and female participants, CSOM cases was found in18(8.33%) males and 12(7.14%) females respectively. Rate of Prevalence of CSOM was 30(7.81%). Majorities of CSOM cases 12(40%) were seen in age group of 9-11 years. And 7(23.33%) CSOM cases were found in 11-13 years. Most of the CSOM cases 135(35.15%) and 8(26.67%) were belonged in upper lower and lower socioeconomic status respectively.  Most of the CSOM 23(76.66%) was tubotympanic type. Most of the CSOM cases 13(43.33%) were suffered from moderate hearing impairment. Mild hearing impairment was seen in 10(33.33%) of CSOM cases. Conclusions: CSOM and its associations with hearing impairment was commonly seen in male children with lower socioeconomic status. These findings indicate that CSOM and its association with hearing impairment continue to be a common health problem in low-resource settings. Improving the health services and providing good access to health care among children in such communities is necessary to decrease the burden of illness.

176. Study on Prevalence of Hepatitis B in Pregnancy and Their Maternal and Fetal Outcome in Tertiary Care Center in MP
Mohini Rajoriya, Jyotsna Aradhana Biswas , Rini Bachotiya
Background: Hepatitis B virus infection in pregnancy has been associated with risk of adverse maternal and fetal outcomes in highly endemic settings. Prevalence of Hepatitis B virus infection in worldwide is 1.5 to 2.5% whereas in India it varies from 0.2 to 7.7%. Objective: To determine prevalence of Hepatitis B infection and their outcome  among all antenatal cases admitting in tertiary care centre of central India. Methodology: This is retrospective observational study conducted at MYH hospital, Indore. During November 2020 to October 2021. All Hepatitis B virus seropositive pregnant women admitting in MYH hospital during given time period were included in study and followed for maternal and fetal outcome. Result: The prevalence of pregnant women with hepatitis B  in pregnancy was found to be 1.02%(117/11394). highest prevalence (82) 84.6% seen in age group 20-30. Most of participant were in term of their pregnancy (84) 79.24% and preterm were (22) 20.76%.Most of the women were multigravida(66) 65.8% and primi gravida were (40) 34.18%. Outcome were normal labour (67) 63.2%, LSCS (33) 31.13%, Still birth (5) 4.7%, second trimester abortion (1) 1%. Baby born were low birth weight (<2.5kg) in 24.1% of deliveries. Immunoglobulin was given to all lives born babies (112). Conclusion: Hepatitis is a condition which turns to a dreadful state in later part of pregnancy for mother as well as fetus which may result in preterm birth or low birth weight in foetus. When associated or superimposed with conditions like gestational hypertension or coagulopathy or jaundice may result in dreadful maternal and foetal outcome. Vertical transmission of virus is preventable through use of immunoprophylaxis.

177. Role of Pleural Biopsy in Exudative Pleural Effusions
M Sandhya Swaroopa, VS Rajesh Khanna
Pleural effusion is the commonest clinical expression of pleural disease. Once light’s criteria differentiate the transudate from exudate, the latter poses a clinical challenge in making an etiological diagnosis, we conducted the study with an aim of finding the role of pleural biopsy in exudative pleural effusion it was a Prospective observational study Seventy consecutive patients of exudative pleural effusions were selected from the outpatient and inpatient department of our medical college hospital setting at district headquarters. Conclusions and Summary: We recommend closed pleural biopsy should still be the initial step in the diagnostic algorithm for undiagnosed exudative pleural effusions especially in a high tb-burdened and resource limited country like India and other Asiatic countries. CPB is safe and should be a routine complimentary diagnostic procedure in patients with exudative pleural effusions, in view of its negligible morbidity and mortality.

178. Impact of Establishment of Dedicated Pediatric Cancer Ward and Care in Treatment Outcome and Abandonment of Treatment in Pediatrics Cancer Patients
Subhash Singh Slathia, Sonam Chalotra, Sanjeev K. Digra
Background: Cancer is the 9th common cause for the deaths in children of five to fourteen years age in India. A dedicated pediatric cancer ward was established in pediatrics department, GMC Jammu in October 2014 to provide free of cost treatment to children with cancer belonging to poor families. Aim of study was to assess impact of establishment of dedicated pediatric cancer ward on treatment outcome and abandonment of treatment. Methods: Data of pediatric patients admitted with cancer was collected retrospectively from hospital records from January 2011 to December 2018. A comparative analysis was done to assess and compare treatment outcome before and after the establishment of dedicated cancer ward. Result: A total of 172 children were included. 33 (19.18%) were in shared care, 47 (27.32%) opted higher center and 92 (53.48%) opted our center for entire treatment. A marked progressive improvement in successful treatment from 26.92% to 67.02% and decline in abandonment of treatment 37% to 5% was observed while there was  no significant decline in mortality and treatment refusal. Conclusion: Establishment of dedicated pediatric cancer ward helped in improving treatment outcomes in terms of successful treatment and treatment abandonment.

179. Diagnostic Accuracy of Fine Needle Aspiration Cytology of Lymphadenopathies: Sensitive Tool
Poornima Raghunathan, Anisha Hari, Sridhar Honnappa
Introduction: Fine needle aspiration cytology (FNAC) is a simple, cost effective and sensitive diagnostic modality for initial assessment of lymphadenopathies with varying aetiology. The advantages of FNAC are, it is safe, rapid and inexpensive with minimal trauma done at an outpatient setup or at bedside. Aim: To assess the accuracy of FNAC of lymphadenopathies with emphasis on the discordant cases between cytological and histopathological diagnoses. Materials and Methods: A two-year retrospective study was done from January 2017 to December 2018; a total of 300 cases underwent FNAC of lymphadenopathies. 140 cases were included in the study with both cytology and histopathology correlation along with relevant clinical history and investigations were gathered. Results:  Out of 140 cases, the cytological diagnoses were found to be benign in 56 cases (40%) and malignant in 84 cases (60%). The cervical lymph node was the commonest site (59.5%). The most common metastatic malignancy was squamous cell carcinoma (59.5%) from the oral cavity tumours (54%). The most common benign lesion was chronic granulomatous lymphadenitis (47.6%). The sensitivity, specificity, positive predictive and negative predictive value of FNAC was 94.6%, 98.1%, 98.8% and 91.2%. Histopathological correlation showed diagnostic discordance in 10 cases (7.14%). Conclusion: FNAC is a safe, simple and inexpensive effective diagnostic   tool for evaluation of lymphadenopathies and can be used as a modality for first line of investigation. However, histopathological evaluation of the lymph node is required to confirm primary lymphoid malignant cases. It is the gold standard and cannot be replaced.

180. Role of Preoperative Spirometry Test in Predicting Postoperative Pulmonary Complications in High-Risk Patients after Abdominal Surgery
Deepak Goyal, Sangeeta Chauhan, Manish Shivani, Shubhendu Keshari, Nupur Chakravorty
Background: Postoperative pulmonary complications (PPC) are the most common type of postoperative complications among patients undergoing both cardiac and non-cardiac surgery including abdominal surgery. Whether preoperative spirometry in non-thoracic surgery can predict postoperative pulmonary complications (PPCs) is controversial. Aim: The aim of the present study was to investigate whether preoperative spirometry results can predict the occurrence of PPCs in patients who had undergone abdominal surgery. Material and Methods: This was a single centre, inpatient, hospital based prospective observation study involving 127 high risk patients undergoing major abdominal surgery. The incidence of the following postoperative pulmonary complications was measured: atelectasis, pneumonia, pulmonary embolism, bronchitis and acute respiratory failure. The association between PPC and the Pulmonary function test (PFT) were specifically studied by these parameters: FEV1 (%) (Forced expiratory volume in 1 second), FVC (%) (Forced vital capacity) and FEV1/FVC (%).  Results: A total of 18 patients (14.2%) developed PPC. The single most common PPC was pneumonia observed in 9 (7.1%) patients followed by acute respiratory failure in 5 (3.9%) patients. In the present study, all parameters of the PFT were significantly worse among the patients who developed PPC in comparison to those who did not develop PPC. Among the FVC, FEV1, and FEV1/FVC; the value of FEV1/FVC differed most significantly between the patients who developed PPC and who did not develop PPC. Conclusion:  Poor preoperative spirometry findings are associated with the development of PPCs among high-risk patients undergoing abdominal surgery.

181. New Onset Diabetes in Patients of Dilated Cardiomyopathy
Ashutosh Kumar, Bhawani Goru, Naseem Begum, Manikanta Monditoka
Background: Diabetes mellitus (DM) significantly increases the likelihood of developing new-onset heart failure (HF). The intricate pathogenesis of HF in individuals with DM is primarily linked to the detrimental cardiovascular impacts of elevated blood sugar levels and associated metabolic irregularities, often referred to as diabetic cardiomyopathy. The emergence of new-onset type 2 diabetes mellitus in the context of heart failure, termed cardiogenic diabetes mellitus is insufficiently examined and documented in the medical literature. Methods: The study was conducted on 100 patients with newly diagnosed cases of idiopathic dilated cardiomyopathy from the period 1st April 2017 to 31st March 2020 who were on monthly follow-ups since then. All patients included in the study were non-diabetic at the time of enrollment and for a minimum period of six months thereafter. The establishment of diagnosis of diabetes in the study population was according to the standards of medical care in diabetes- American Diabetes Association guidelines – 2014. Results: 45 patients were male with a mean LVIDD (left ventricular internal diameter in diastole) diameter of 6.2 mm ± 1.3 (95% CI, 5.4-7.2), LVEF (left ventricular ejection fraction) of 28% (95% CI,18-45%). Out of the 100 patients 33 patients developed type 2 diabetes over a period of one year. Conclusions: This study showing a high incidence of new onset diabetes in patients of heart failure with reduced ejection fraction (HFrEF). The cause may be drug induced by beta blockers or diuretics used for a prolonged period, a genetic predisposition having a common gene for the two diseases, a common pathophysiological pathway or may be due to emotional and environmental factors.

182. Propranolol in the Management of Infantile Ocular Haemangiomas and A Comprehensive Evaluation of Ultrasound and Colour Doppler Imaging: A Prospective Study
Ullas, Priyanka, Rajeshwari, Praveen Kumar
Background: Infantile periocular haemangiomas, the most common tumors in the orbit of children, often pose challenges in pediatric ophthalmology due to potential visual complications. This study explores the efficacy of propranolol in managing these vascular lesions, presenting a prospective study involving 5 patients. Objectives: The aim is to evaluate changes in lesion size, refractive errors, and visual compromise while considering the safety and clinical relevance of propranolol as a therapeutic modality. Methodology: Fifteen pediatric patients with infantile perioocular haemangiomas were enrolled in this prospective study and case series. Propranolol treatment was administered at a dose of 2 mg/kg/day. Comprehensive assessments included vision, refractive error, lesion characteristics, and monitoring for potential complications. Data were analyzed through t-tests to evaluate changes in lesion size and astigmatism. Results: Propranolol treatment demonstrated positive outcomes across all patients. Lesion size reduction ranged from 54% to 96%, accompanied by improvements in refractive errors. Visual compromise, primarily astigmatism, diminished in patients with pre-existing issues. No significant complications were noted during the treatment period. Conclusion: The results underscore the potential efficacy and safety of propranolol in managing infantile periocular haemangiomas. Reductions in lesion size, improvement in refractive errors, and resolution of visual compromise highlight the multifaceted impact of propranolol in this pediatric population. Ultrasound and CDI have emerged as valuable and accessible tools for diagnosing orbital lesions in the pediatric population Further research with larger cohorts and extended follow-up is essential for establishing propranolol as a standard approach in the management of these vascular lesions.

183. Status of Vitamin D Level in Children with Sickle Cell Disease: A Hospital Base Case Control Study
Rita Panyang Kataki, Aukifa KS Islam, Jyoti Bikash Sarma, Milan Kumar Taye
Background: Sickle cell disease (SCD) is one of the most prevalent genetic disease in several countries. Individuals living with sickle cell disease (SCD) reportedly have a high prevalence of vitamin D deficiency. Vitamin D is a group of fat soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, & phosphate & having multiple other biological effects. For better understanding the magnitude of vitamin D deficiency among  children populations with SCD, and whether the prevalence is higher among those with SCD compared with similar children without SCD,  present study was  carried out to know the status of vitamin D level in children having sickle cell disease and the impact of deficiency in the affected children. Methods: This was a hospital-based analytic study carried out over 12 months from June 2018 to –May 2019 in the department of pediatrics, of a tertiary care hospital, Assam. For Cases, all Diagnosed case of Sickle Cell Disease by HPLC who fulfill the inclusion criteria, after taking informed, written consent was selected and detailed history, clinical examination and relevant laboratory investigations was done. For Controls, Children without Sickle Cell & other haemolytic disease & who is age, sex & nutritional status matched as controls was taken and the Case control ratio is 1:2. The received data like age, gender, and socioeconomic status, age of diagnosis of disease, number of times blood transfusion received, presenting features, and anthropometric findings was recorded in predesigned proforma. Results: Out of 50 cases of sickle cell children, 42% (21) were sufficient vitamin D level (≥30 ng/mL), 24% (12) were insufficient vitamin D level (20-29 ng/mL) and 34% (17) were having deficient vitamin D level (<20ng/mL) While 90% (90) of the controls showed sufficient vitamin D level, 10% (10) showed insufficient vitamin D level. None of the cases or controls showed toxic level of vitamin D.  The difference of vitamin D level between the sickle cell disease patient and controls was statistically significant with p value of<0.001, with the mean value of vitamin D among cases being 31.02±16.54 ng/mL and among controls being 48.05±14.45 ng/mL. Conclusion: The study demonstrates a significant level of vitamin D deficiency in SCD children as compared to the control. So, it is recommended that vitamin D supplementation should be given to these patients in an adequate dose and for adequate duration. As most of these patients belong to the lower socioeconomic class so the vitamin D solutions should be supplied to these patients free of cost.

184. Comparative Analysis of Non-alcoholic Fatty Liver Disease Diagnosed By Ultrasonography with Lipid Profile and Body Mass Index in Young Adults
Nishant Patel, Silky Patel, Sachin Patel
Background and Aim: Obesity has a major consequence of cardiovascular disease which leads to increased mortality and morbidity abnormal liver steatosis by ultrasound grading might throw a warning sign of the future risk. The present study was taken to study the ultrasound grading of liver seatosis and BMI in young adult group. Material and Methods: Present cross-sectional; study was conducted at the Department of pathology as well as in Radiology at Tertiary Care Teaching Institute of India for the duration of 1 year. In 100 subjects, Height was estimated in centimeters and Weight was measured in kilogram on standard clinical weighing machine. BMI was calculated as Weight in kilogram divided by Height in meters squared. They are classified based on BMI and all the individuals liver ultrasound and lipid profile was performed. Results: Mean age of the adult group was 20.86 years±2.40 the majority of subjects were male 70 %. The number of subjects in both groups in lower and higher spectrum of BMI was much less. Mean Serum Triglycerides was significantly higher in BMI>25 group (210.50±30.15) when compared with BMI25 group (181.36 ±21.15) compared with BMI 25 group (34.98 ±5.48) when compared with BMI25 group when compared with BMI<25. Conclusion: There is an increased steatosis in high BMI subjects. Simple semi quantitative Ultra Sound Grading of liver steatosis will be help in earlier diagnosis of metabolic Syndrome and early interventions will reduce cardiovascular risk and improving prognosis of these patients.

185. A Comparative Study on the Efficacy of Internal Jugular Vein Cannulation Using Anatomical Landmark Technique and Ultrasonograph Technique
Shikha Singh, Madhuri Kumari, Santosh Kumar, Namita Mishra
Background: Internal jugular vein cannulation is a common procedure performed in various clinical settings. The choice of technique for cannulation can significantly impact the success rate and safety of the procedure. This study aimed to compare the efficacy of internal jugular vein cannulation using the traditional anatomical landmark technique and the modern ultrasonograph technique. Materials and Methods: A prospective, randomized controlled trial was conducted in a tertiary care hospital. A total of 150 adult patients requiring internal jugular vein cannulation were enrolled in the study. They were randomly divided into two groups: Group A underwent cannulation using the anatomical landmark technique, while Group B underwent cannulation using the ultrasonograph technique. The primary outcome measures included the success rate of cannulation, number of attempts, time to successful cannulation, and incidence of complications. Results: In Group A (anatomical landmark technique), the success rate of cannulation was 74%, with an average of 2.3 attempts required per patient. The average time to successful cannulation was 4.8 minutes, and complications occurred in 12% of cases. In contrast, in Group B (ultrasonograph technique), the success rate was significantly higher at 94%, with an average of 1.2 attempts per patient. The average time to successful cannulation was reduced to 2.6 minutes, and complications occurred in only 3% of cases. These differences were statistically significant (p < 0.05). Conclusion: The ultrasonograph technique for internal jugular vein cannulation demonstrated superior efficacy compared to the anatomical landmark technique. It resulted in a higher success rate, fewer attempts, shorter time to successful cannulation, and a lower incidence of complications. Incorporating ultrasound guidance into clinical practice for this procedure can improve patient outcomes and enhance the safety and efficiency of internal jugular vein cannulation.

186. A Study of Clinical Profile and Visual Outcomes of Patients with Traumatic Cataract
V. Sheeladeep, M. Sailaja, P. Viswamitra
Introduction: Traumatic cataracts cause severe vision loss and blindness in the general population and are related with a wide range of ocular traumas. The present study was conducted to study the clinical profile of traumatic cataract patients. Materials and Methods: A prospective observational study was carried out in the department of ophthalmology at Regional Eye Hospital, Visakhapatnam. A total of 50 patients were examined. Relevant clinical history, demographic data and visual acuity at time of presentation and post-operatively after 6 weeks were recorded. Results: It was observed that the age of the patients ranged from 4-60 years Most common affected age group was 11-20 years. 33 cases (66%) were reported in male population whereas 17 cases (34%) were female patients. 32 cases (64%) had traumatic cataract due to open globe injury and 18 cases (36%) had due to closed globe injury. wooden stick injury is the most common mode of injury accounting for 30% of the cases. Conclusion: Traumatic cataracts cause severe vision impairment, psychological suffering, and a significant financial burden. To prevent vision loss in traumatic cataract patients, a better understanding of these injuries is needed. Appropriate health education and early prevention are essential among the population.

187. Correlation of Crown-Rump Length between 6 Weeks to 13 Weeks + 6 Days and Birth Weight at Term
Smitha Krishnegowda, Ishwarya Bhandari
Introduction: Crown – Rump Length (CRL) is the measurement of the length of Human embryos and fetuses from the top of the head (Crown) to the bottom of the buttocks (Rump). This Formula is an approximation Gestational age (weeks of pregnancy) = Crown -Rump Length (cm) + 6.51 Low birth weight (LBW) infants are at increased risk of perinatal and infant death.2 LBW newborns have also been identified as a high risk group for a number of health Problems later in life. Methodology: This is a prospective observational study done on patients coming to the Department of OBG Kempegowda Institute of Medical Sciences, Bangalore. All antenatal mothers will be advised to undergo first trimester ultrasound between 6 and 13+6 weeks of gestation. Correlation between CRL and Birth weight at term will be analyzed for the participants that meet the criteria. Results: In our study among 150 patients 43% were primigravida and 57% were multigravida with the majority of them between 21-25 years of age. In this study 66.67% infants were low birth weight whereas 8.66% were more than expected birth weight. In our study correlation between CRL in first trimester and birth weight at term is not statistically significant. Hence we concluded that in our study there is no significant correlation between CRL and birth weight. Conclusion: Newborn who is found to have low birth weight at delivery doesn’t appear to have anomalous crown rump length growth patterns in the first trimester. The EFGR didn’t correlate with birth weight percentile.

188. Prevalence of Drug Resistance in Mycobacterium Tuberculosis in Western Rajasthan among Paediatric Patients
Yogesh Yadav, Pawan Kumar, Prabhat Kumar, Jyoti Choudhary
Background: Drug resistance tuberculosis is a significant clinical disease that can lead to poor results in tuberculosis patients. Drug resistance in Mycobacterium TB is most common in first-line anti-tubercular medicines, primarily rifampicin and isoniazid. Multidrug-resistant tuberculosis and broad drug resistance tuberculosis hinder our efforts to eradicate TB. Methods: Present study was a cross-sectional study. Samples from patients belonging to one year to 15 years age group, received from different districts of Western Rajasthan, were received and tested for drug resistance by CBNAAT and Line probe assay for drug resistance. Results: Out of 200 TB-positive cases, 61% were females and 39% were males. The mean age of study population was 13.05 (±3.15) years.  Conclusion: The high prevalence of drug resistance among TB patients in our study was noted. Furthermore, Jalore district was found to have 9.5% cases of XDR-TB, which is alarming.

189. Ocular Manifestations in Rosacea: A Clinical Study
Lalit Gupta, Charvie Gupta, Anurag Thakur, Yusaf Rizvi
Background: Rosacea is a multisystem disorder and to the general practitioner, involvement of the skin is what comes to the mind first of all. A broad array of ocular manifestations encompasses this condition and ocular examination is as essential as examination of other part of body when rosacea is talked about. Objectives: To study the ocular manifestations in patients with rosacea and to correlate the ocular and dermatological manifestations of rosacea. Methods: 114 newly diagnosed Rosacea patients were enrolled in study. Complete dermatological and ocular examination recorded and analysed. Observations:  Lid margin involvement, corneal affections with significant dry eye. Conclusions: All the patients attending to either of departments should have complete ophthalmologic and dermatologic evaluations, so that both ocular and dermatologic manifestations can be treated at the earliest, and complications can be avoided.  Symptoms frequently go undiagnosed because they are too nonspecific.

190. Assessment of the Prevalence of Depression among Type II Diabetic Patients at a Tertiary Centre in Eastern India
Md. Irshad Alam, Tushar, Kashif Shahnawaz
Background: Diabetes mellitus, commonly referred to as diabetes, is a chronic metabolic disorder characterised by elevated blood sugar levels. The present study was conducted to assess the prevalence of depression among diabetics. Materials and Methods: 98 type II diabetics of both genders were enrolled. The body mass index (BMI) was recorded. Postprandial blood glucose, fasting blood glucose, and HbA1c values were used to measure the degree of diabetes control. The Beck Depression Inventory (BDS-II) assessed depression. Results: Out of 98 patients, males were 50 and females were 48. Body mass index <25 kg/m2 was seen in 35 subjects, 25–30 kg/m2 in 24 subjects, and >30 kg/m2 in 29 subjects. Fasting blood sugar <110 mg/dl was seen in 21, 110–125 mg/dl in 30, and >125 mg/dl in 47 subjects. The difference was non-significant (P > 0.05). The duration of diabetes was <5 years in 20; 5–10 years in 24; and >10 years in 34. It was found that the risk of depression among type 2 diabetic patients increased significantly with the increase in the duration of disease (P = 0.002). The duration of treatment was <5 years in 13, 5–10 years in 36, and >10 years in 49 subjects. The difference was non-significant (P > 0.05). Conclusion: The prevalence of depression among diabetics was high. The risk factors for depression were age and central obesity.

191. Assessment of Serum Calcium Levels in Infants with Acute Bronchiolitis at a Tertiary Centre
Kunal Anand, Rajiv Kr Jha
Background: A frequent viral lower respiratory tract ailment that affects newborns and causes a major global health burden is bronchiolitis. The present study was conducted to assess serum calcium levels in infants with acute bronchiolitis. Materials and Methods: 120 infants with a diagnosis of acute bronchiolitis were put in group I and healthy controls in group II. 5 ml of venous blood samples were taken to measure total serum calcium, phosphorus, and ALP. Results: The present retrospective observational study included 120 infants, 60 cases, and 60 controls. Out of 120 patients, males were 62 and females were 58, but the gender difference was not statistically significant (p-value=0.64). The mean calcium level in group I was 8.1 mg/dL, and in group II it was 9.4 mg/dL. The mean phosphorus level was 5.4 mg/dL in group I and 5.9 mg/dL in group II. The mean alkaline phosphatase level in group I was 372.4 U/L, and in group II it was 346.8 U/L. The difference was non-significant (P> 0.05). In group I, rickets were present in 10 subjects, and in group II, in 4 subjects. The difference was significant (P< 0.05). Conclusion: The results imply that there may be a link between low serum calcium levels and acute bronchiolitis. The study also discovered that these patients have a higher prevalence of rickets, underscoring the significance of appropriate sun exposure and sufficient supplementation.

192. Comparison of Outcome of Perianal Surgery Wound When using Silver Colloidal Solution Spray V/S Povidone Iodine Sitz-Bath at a Tertiary Centre
Md. Quamar Zubair, Mohamed Ashraf Ali, A. K. Jha Suman, Md Mazharul Haque
Background: Perianal surgery refers to surgical procedures performed in the region around the anus. The present study was conducted to compare the outcome of perianal surgery wound when using silver colloidal solution spray v/s povidone iodine sitz-bath. Materials & Methods: 84 patients of perianal surgery with ASA I or II of both genders were divided into 2 groups of 42 each. In group I, silver colloidal solution spray was given and in group II, a twice-daily sitz bath along with povidone iodine was given. Parameters such as healing time, adverse events, post-operative pain, patient satisfaction and outcome were compared. Results: The age group 20-40 years comprises 20 and 24 and 40-60 years 22 and 18 patients in group I and II respectively. There were 25 males in group I and 23 in group II and 17 females in group I and 19 in group II. The satisfaction rating scale showed satisfaction in 24 in group I and 26 in group II and dis-satisfaction in 18 in group I and 16 in group II. The difference was significant (P< 0.05). The outcome was excellent in 20 in group I and 23 in group II, adequate in 18 in group I and 17 in group II, and poor in 4 in group I and 2 in group II. The difference was non- significant (P> 0.05). Conclusion: Povidone-iodine with sitz bath may be effective in preventing surgical site infection following perianal surgery in contrast to silver colloidal solution spray.

193. Comparison between Possum and P-Possum Scoring System for Predicting Prognosis in Patients with Perforation Peritonitis in a Tertiary Care Centre: A Prospective Study
Ayush Rathore, Kamna Dubey, Sandeep Ahirwar, Avinash Gautam
Aim: To compare the POSSUM and P-POSSUM scores and to determine the best suitable tool for risk prediction post-surgical intervention. Methods: The present study was conducted to compare the usefulness of POSSUM and PPOSSUM scores in the prediction mortality risk in patients undergoing surgery for perforation peritonitis. We had included 100 patients of perforation peritonitis in the present study. All patients presenting in the Department of Surgery of M.G.M. Medical College and M.Y. Hospital with complaint of perforation peritonitis formed the source of data for study. Result: Majority of the patients were in the age group 21-40 years and 41-60 years. The observed mortality in the present study was 22%, while the predicted mortality as predicted by POSSUM and P-POSSUM was 20% by each equation. Both POSSUM and P-POSSUM predicted the mortality slightly lower than the observed mortality. The sensitivity of POSSUM and P-POSSUM in the prediction of postoperative mortality was 100%, specificity was 90.91%, positive predictive value was 97.50%, negative predictive value was 100% and the diagnostic accuracy was 98%. The overall observed / predicted mortality ratio was found to be 1.1 by both POSSUM and P-POSSUM, showing that POSSUM and P- POSSUM both under predicted the postoperative mortality in patients undergoing surgery for perforation peritonitis in the present study. Conclusion: Hence, we recommend the use of POSSUM and P-POSSUM which is simple, easy to calculate be used in the prediction of postoperative mortality in patients undergoing surgery for perforation peritonitis.

194. Co-Relation between Canadian CT Head Rule & CT Scan Findings in Traumatic Head Injury at Tertiary Care Hospital
Pradyumn Gupta, Sandeep Kumar Ahirwar, Rohit Manyal, Avinash Gautam
Introduction: Traumatic Brain Injury (TBI) means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psycho-social impairment, or both. To overcome the side-effects & unnecessary cost of CT Scan, The Canadian CT Head Rule was introduced. The Canadian CT Head Rule guidelines help identify patients with GCS scores of 13-15 and consist of five high-risk factors. Material & Methods: 50 cases of mild traumatic head injury patients, GCS (13-15,) admitted in M.Y. Hospital Indore. In all cases we studied following methods were employed to carried out the present study. Complete detailed history, general examination, systemic examination, local examination, relation with Glasgow coma scale, CT scan head plain, Canadian CT head rule, investigations. Observation: Total 50 cases were studied out of them 37 were male and 13 were female. Total 35 patients (70%) were of 16-35 years of age, 13(26%) were 36-55 years of age. 02 patients were more than 65 years of age. Clinical features as vomiting, LOC, ENT bleed, convulsion found in 13,14, 05 and 01 patient respectively. Positive Ct Finding seen as ACUTE SDH 25 %, EDH 22%, Contusion 27%, brain edema17%, linear fracture 27%, depressed fracture 05%, SAA 08% and ICH 05%

195. Congenital Lung Abnormalities: Differential Diagnostic Findings, Surgical Management and Radio-Pathologic Correlation
Syed Mohsin Aijaz, Mudasir Ahmad Magray, Gowhar Nazir Mufti
Background and Objectives: A variety of developmental abnormalities of the tracheobronchial tree and pulmonary parenchyma are found in the newborn. There is limited data available on their presentation and clinical course from third world countries. Methods: This was a retrospective data review, conducted at a tertiary care hospital in northern India. The medical records of those patients diagnosed with CLM from June, 2014 to June, 2018 were evaluated. This study was undertaken after due approval by the Institutional Review Board of Sher-I-Kashmir Institute of Medical Sciences (approval no: 80/2018, date: 18.06.2018). The study population included children diagnosed as having CLM based on their clinical, radiological, and pathological features. Surgical details which included the timings of their surgical intervention, the type of surgery, the duration of the operation, intraoperative findings, and their intraoperative and postoperative complications were recorded. Patients, who fulfilled inclusion criteria, gave consent for surgery were admitted and were subjected to surgery. A total of 30 cases were taken. Results: Cystic lucencies were observed in all CPAM patients on chest radiograph; in 2 (n=3) patients of CLE; in all patients of BC; in 1 (n=2) patient of PS; in 1 (n=2) patient of BA whereas no cystic lucencies were observed in all PPB patients on chest radiographs. Mediastinal shift to opposite side was observed in 7 patients of CPAM; in 2 patients of CLE; in 1 patient of BC; and was not observed in any patient of PS, BA and PPB. USG chest indicated a significant finding in 73.3% of the patients. Cystic lesion was the most common finding present in 36.6% of the patients. most common procedure performed was left lower lobectomy in 23.3% of the patients followed by right upper lobectomy in 16.7% patients; right lower lobectomy in 16.7% patients; right middle lobectomy in 13.3% patients; left upper lobectomy in 10% patients. Conclusion: Congenital pulmonary airway malformation was the most common type of lung abnormality in this investigation. The most frequent method of presentation was recurrent respiratory tract infection, either with or without respiratory distress. Prenatal ultrasound awareness and emphasis can be increased through health education, which can prevent unwarranted delays in diagnosis and treatment. Surgery has strong long-term results and is curative.

196. A Study on Clinical Profile of Autosomal Dominant Polycystic Kidney Disease
Manjuri Sharma, Manas Gope, Prodip Kumar Doley
Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary form of kidney disease. Clinical data on this multisystem disorder are scarce from developing countries. We conducted a cross sectional observational study of the clinical profile of ADPKD patients over a period of one year in Gauhati medical college (single centre). Materials and Methods: A total of 40 patients 24 males and 16 females fulfilled the inclusion criteria of ADPKD, were gathered during the period of 1 year starting from May 2020 to May 2021. All the patients were subjected to a detailed history, clinical examination and laboratory investigations. X-ray chest (PA view), ECG and ultrasound of abdomen, Echocardiography were done. Diagnosis of ADPKD was established by renal ultrasonography using unified criteria by Pei et al. Results: Mean age was 46.5 ± 12.2 years. About 62.5% had early stage (Stages 1–3) of chronic kidney disease (CKD) and 37.5% had advanced CKD (Stages 4 and 5). Clinical features observed included pain abdomen (47.5%), nocturia (65%), hematuria (22.5%), nephrolithiasis (27.5%), urinary tract infection (UTI) (50%), and hypertension (72.5%). The prevalence of hypertension, nocturia Hematuria, UTI, Hepatic cyst was increased with increasing age which was statistically significant. Extra renal manifestations were polycystic liver disease in 15 patients (37.5%), cysts in pancreas in three (7.5%), and intracranial aneurysm in three (7.5%). A total of 8 patients (20%) developed end-stage kidney disease during the study period. There were statistically significant increased prevalence of mean age, Family h/o early esrd (Age<55 yrs), Smoking, Haematuria, UTI in ESRD group. Conclusions: In the present study, hypertension was most common presentation of this disease. So, control of hypertension is very important to prevent progression of this disease. Patients who are detected to have ADPKD should be regularly followed-up to pre- vent further progression by timely intervention. Also, family members of patients should be screened for disease and initiate treatment as early as possible.

197. Case Series – Caesarean Scar Pregnancy
Latha V Kharka, Annet Thatal, Twinkle Agrawal, Barun Kumar Sharma
The prevalence of Caesarean scar ectopic (CSP) pregnancies, a rare form of ectopic gestation where the trophoblast infiltrates a weakened myometrium at the site of a previous caesarean section scar, has seen an uptick commensurate with the increased frequency of caesarean deliveries. CSP, accounting for approximately 1 in 2000 pregnancies, poses significant risks due to the progressive implantation and invasion of the trophoblast. Timely and accurate diagnosis, primarily through ultrasonography, is critical in mitigating the heightened risk of maternal complications associated with delayed identification. Prompt detection not only facilitates immediate intervention but also significantly enhances patient outcomes by preserving future fertility prospects. In instances where ultrasonographic findings are ambiguous or insufficient, Magnetic Resonance Imaging (MRI) plays a pivotal role in the pre-therapeutic evaluation. This paper discusses a series of CSP cases managed with various therapeutic strategies, emphasizing the efficacy of early intervention in preventing complications and maintaining reproductive potential.

198. A Comparative Study on Correlation of Heart Rate Variability and Serum Uric Acid with Blood Pressure in First Stage Hypertensives
Shweta Patil, Nadera Yasmeen, Satish Kinagi
Blood pressure is the pressure exerted by the moving blood column on the walls of the arteries. It is one of the vital parameters of a human being. Being a vital parameter, it is essential for the survival of human life. The blood pressure in a human undergoes multiple changes over different stages of life. At birth it is around 70/50 mmHg. Then it gradually increases to about 90/60 mmHg at the end of first year of life. Materials & Methods: This study was conducted in the M R Medical College, Kalaburgi. Result: The mean value of LF in hypertensives (348.77±325.90) is statistically more than the mean value of normotensives (216.15±249.78) with ‘t’ value of 2.50 and a ‘p’ value of 0.014 (p<0.05). This signifies that the low frequency component is significantly high. Conclusion: Hypertension is a noncommunicable disease, and its incidence is increasing drastically all around the world. Consequently, the need for complete understanding of the pathophysiology of the disease and proper diagnostic and therapeutic measures to counteract the disease burden has also increased.

199. Prevalence of Pulmonary Tuberculosis and Fungal Infection in Presumptive Tuberculosis Patients (PTB) Attending a Tertiary Care Centre in Eastern Bihar: A Hospital Based Prospective Observational Study
Fasihuzzaman, Kahkashan Akhter, Priyanka Paul Biswas, Aninda Sen
Aims:  The aim of the present study was to find the prevalence of pulmonary tuberculosis and fungal infection in clinically suspected cases of tuberculosis attending Katihar Medical College and Hospital, Katihar, Bihar. Methods: All the sputum samples of presumptive pulmonary tuberculosis patients received in the department of Microbiology for the presence of M. tuberculosis and fungal coinfections. Early morning sputum samples were collected from the study participants and stored in sterile, leak-proof, wide-mouth containers. ZN staining of the sputum smears were done for detection of acid- fast bacilli and Gram staining for detection of fungal elements. Culture of unprocessed sputum was done on Sabouraud’s Dextrose Agar (SDA).  A routine examination of the culture plates was done to rule out any fungal growth on every alternate day for two weeks, after which the plates were discarded, if there was no fungal growth. Results: The male: female ratio of presumptive pulmonary tuberculosis cases was 2.2:1. Positive MTB was 75(19.2%), the number of fungal elements was 27 (7%) and number of both pathogens together were found in 19 (5%) patients. Out of the 75 positive MTB patients, 53(71%) and 22(29%) were diagnosed in male and female patients respectively. Among the 27 fungal isolates, 17(63%) in males and 10(37%) in females were isolated. Among the 27 (7%) out of 390 PTB patients, fungal elements were found. From among these 27, 18(67%) are moulds and 9(33%) were found to be yeasts. The moulds were identified as Aspergillus fumigatus in 14 cases and Aspergillus niger in 4 cases on the basis of colony morphology and LPCB staining.   9 yeasts were identified as Candida albicans by Grams staining and Vitek 2 compact system. Mean age was 41 years. Age group of 41-60 years has the highest rate of tubercular infection of 45.6%. Conclusions: Tuberculosis remains a global threat despite effort to eradicate the diseases and TB co-infection with fungus may complicate infection and treatment. The most predisposed age groups to both infections were ages 20-40 years, the most active segment of the economy. Screening for TB should be conducted concomitantly with mycosis for better treatment. Although the prevalence rates of all the co-infections were low and statistically not significant. Being chronic in nature and with confusing clinical and radiological findings, theses fungal infections are misdiagnosed as reactivation of tuberculosis. Hence, the increasing rate of morbidity and mortality can decrease if adequate measures are taken for the diagnosis at an early stage and appropriate treatment of the mycosis.

200. Use of Vasopressin in Vaginal Hysterectomy
Akriti Prasad, Puja Verma, Mamta Singh
Background: Morbidity of the patient can be decreased by reducing the intraoperative blood loss in major surgery like hysterectomy with use of vasoconstrictive drug, vasopressin. Materials and Methods: This prospective study was conducted in department of Nalanda medical college and hospital, Patna, Bihar. About 60 cases undergoing elective vaginal hysterectomy were selected and divided into two groups; 1st group A was taken as control while, in group B, vasopressin in diluted form was injected pre-operatively. Results: There was no significant difference in parameters like duration of surgery, change in vitals during surgery and postoperative complications in two groups. However, markable difference seen in amount of blood loss in two groups. Conclusion: Use of vasopressin pre-operatively can reduce morbidity in patients undergoing vaginal hysterectomy by controlling amount of blood loss intraoperatively.

201. Clinical Correlates and Microbiology of Invasive Fungal Disease in a Tertiary Care Hospital
Kumari Jyoti, Kumar Saurabh, Sunanda Kundu, Namrata Kumari
Background and objectives: There is a paucity of data in Indian literature regarding the risk factors, comprehensive clinical profile and treatment outcomes of Invasive fungal disease(IFD).Thus the aim of this study is to assess the frequency, type of IFD, clinical spectrum, risk factors, microbiological profile and outcome in patients with IFD. Methods: A cross sectional descriptive study, Study duration of One and Half Years. Patients with proven and probable IFD according to EORTC/MSG criteria were selected. Conclusion: Since elderly patients with risk factors like Type 2 diabetes, hemodialysis, prolonged ICU stay, and total parenteral nutrition were significantly associated with candidemia and mucormycosisthey need to be regularly screened for these infections. Those with underlying lung disease or prolonged steroid use need to be screened for pulmonary aspergillosis. IFD specifically those needing prolonged ICU care is associated with very high mortality.

202. Study and Review of the Variation in Coeliac Trunk and its Branching Pattern
Madhu Kumari, Pallavi, Sushil Kumar Singh, Birendra Kumar Sinha
Background and Objectives: Coeliac trunk is the ventral branch from abdominal aorta which supplies to the Stomach, spleen, liver, and gall bladder. The anatomical knowledge about variation Of Coeliac trunk and its branches is important for surgeons and radiologists. The aim of this study was to study the anatomy of coeliac trunk and its branches, and providing a wide range of information regarding branching pattern of coeliac trunk and its variations. Materials and Methods: The study is conducted in Dept of Anatomy PMCH, Patna, 35 well preserved cadavers were used for the study. Cadavers are dissected properly to visualize the celiac trunk and branches. Results: The mean length of celiac trunk was 4.8 mm and the mean diameter was 5.2mm. observation was done on the branching pattern of celiac trunk, collateral branches, bifurcation and trifurcation. Conclusion: Several author have been studied deeply all aspects of celiac trunk, its branches and variations and one should be updated from time to time.

203. Study of Significance of Partogram in Active Management of Labour in Primigravidae
Akriti Prasad, Puja Verma, Mamta Singh
Background and Objectives: The key to early diagnosis is the detection of disorders in labour progression specifically by following the evolution of characteristic patterns of cervical dilatation and fetal descent using the partogram. Although labour is a natural physiological process characterized by progressive increase in the frequency, intensity and duration of uterine contractions, resulting in effacement and dilation of the cervix with descent of the fetus through the birth canal. To recognize at an early stage abnormal labour in primigravidae, To assess perinatal morbidity, To assess maternal morbidity. Methods: This is Prospective study of Carried out total 400 patients conducted in the Department of Obstetrics and Gynaecology. Nalanda medical college and Hospital Patna. All the patients were primigravidae with term gestation, cephalic presentation without any complications who presented with both spontaneous and induced labour. WHO partogram was used for all patients. Conclusion: Use of partogram is a simple, safe, inexpensive and highly effective means of monitoring progress of labour. Hence it identifies the abnormality early and deliver them safely in time by active management of labour.

204. Microbiological Study of MRSA Isolated From Wound Samples
Kumari Jyoti, Namrata Kumari, Sunanda Kundu
Background: Staphylococcus aureus present on skin and nasal passage, enter through the cuts or invasive procedures. It is responsible for a number of infections such as wound infections, deep infections that spreads from skin to cause bacteremia with or without endocarditis. It may also involve bone, joints, deep organs and tissues. Material and Methods: Total 150 isolates of MRSA collected from wound samples were characterize by different biochemical tests. Strains were tested with Mannitol salt agar out of 150 strains 145 strains were positive (96.6%), DNase test show’s 143 wre positive ( 95.3%) out of 150 strains, Phosphatase test show’s 146 (97.6%) strains were positive out of 150 strains, Gelatin hydrolysis show’s135 (90%) were positive out of 150 strains and Urease test show’s 142 (94.6%) were urease positive and 8 (5.4%) were negative. Conclusion: Staphylococcus species is a major concern for the medical community. In the past, patients were commonly treated with various Pencillin, Clindamycin Erythromycin and /or Gentamycin for Staphylococcal infections. However,  owing to many factors, including the extensive use of these antibiotics Staphylococci have developed resistance.

205. To Study the Maternal and Foetal Prognosis in Thyroid Disordered Pregnant Mothers by Evaluating TSH in Pregnant Women
R. Suchitra, Sreenivasa Shouri , B.V. Satish Kumar, J. Anusha
Background: After diabetes mellitus, thyroid disorders are the next most common etiology of endocrine dysfunction in females of fertile age group. Thyroid hormone(T3,T4,TSH) imbalances can have an impact on fertility, maternal health, and foetal growth and development. Aim: To study the maternal and foetal prognosis in thyroid disordered pregnant mothers by evaluating TSH levels in pregnant women screened during antenatal period who came during study period of one year in Government general hospital, Ananthapuramu. Materials and Methods: A Prospective randomised Study. Study Period: 12 months (August 2021-August 2022). Results: This is a prospective study of 101 pregnant women with thyroid problems who attended the prenatal clinic at the Government Medical College and Hospital in Ananthapuram for one year with prior informed permission.

206. A Rare Case Report of Pancreatic Pseudocyst Formation in Ectopic Pancreas
Manish Somkuwar, Parthrajsinh Rathod, Pranav Vasava, Mithun Barot
Background and goals: The ectopic pancreas is a extremally rare condition. Accidentally found  during laparotomy. However, However, diseases of the pancreas such as pancreatic pseudocysts can also occur in this ectopic tissue. Even with symptoms, preoperative  diagnosis is difficult.

207. Unusual Presentation of Gastrointestinal Stromal Tumors – A Case Series
Lakshmi Prasad, Nandan H N, Nishanth A L, Chandana Padmanabham Reddy, Shivakumar
Background: Gastrointestinal stromal tumours (GISTs) represent approximately 1-3% of all gastrointestinal tumours. Gastrointestinal stromal tumours (GISTs) are a type of soft tissue sarcoma that primarily occurs in the gastrointestinal (GI) tract, which includes the stomach and small intestine. These tumours originate from specialized cells called interstitial cells of Cajal, which regulate digestive tract movements. Most GISTs are associated with mutations in the KIT or PDGFRA genes. While some are benign, others can be malignant and potentially spread to other parts of the body. Symptoms of GISTs may include abdominal pain, gastrointestinal bleeding, and a palpable mass. Diagnosis often involves imaging studies, such as CT scans, and a biopsy to confirm the presence of GIST cells. Treatment approaches for GISTs include surgical removal of the tumour, targeted therapy using tyrosine kinase inhibitors like imatinib, and in some cases, chemotherapy. Regular monitoring and multidisciplinary collaboration are crucial for managing GISTs effectively. Case Series: Here we describe a series of cases of incidentally found GIST and their management. The first patient was a 45-year-old female with an incidentally found GIST in the ilium following an emergency laparotomy. The second patient was a 33-year-old female who presented with pain associated with difficulty in micturition and difficulty in passing stools. h/o generalised weakness, nausea, and fatigue present. h/o blood transfusion present. In the third case 71-year-old male presented pain abdomen dull aching abdominal pain for 2 days associated with difficulty in micturition and difficulty in passing stools. Discussion: Gastrointestinal stromal tumors (GISTs) demand tailored treatment strategies based on individual factors. Primary management involves surgical resection, aiming for complete tumour removal. However, GISTs often harbour mutations, guiding the use of targeted therapies such as imatinib, sunitinib, or regorafenib. These medications, inhibiting specific molecular pathways, play a pivotal role, especially in unresectable or metastatic cases. The choice of therapy is influenced by tumour size, location, and mutation profile. Regular monitoring and collaboration with oncologists are crucial for adapting treatment plans, ensuring optimal outcomes for patients with GISTs.

208. Laparoscopic Appendectomy in Children: Preliminary Study in Tertiary Care Centre of Rural India
Deepak Kumar, Lovely Kumari, Ravi Prakash, Kumar Bijyendra Sourabh
Background: Acute appendicitis is most common in children, adolescents and young adults upto 25 tears of age. The highest incidence is seen from age group 12-14 years. In acute appendicitis cases urgent appendectomy within 48 hours is recommended. This study is a preliminary level study in ESIC Medical College and Hospital placed in Bihta which is a peripheral area of Patna. This study focusses on the laparoscopic appendectomy. Materials and Methods: Retrospective study performed on 24 paediatric patients over one year from November 2022 till November 2023 under the Paediatric Surgery Department of ESIC Medical College and Hospital, Bihta, Patna, Bihar. All the patients who underwent laparoscopic appendectomy for appendiceal pathology were included. Demographic, clinical, radiological and laboratory data along with the results of surgical treatment was recorded. Results: The sample size was 24 paediatric patients, of which, 14 were boys and 10 were girls. The mean age was 8.5 years (6 years and 14years). The diagnosis before surgical exploration revealed 16 cases of acute appendicitis, 3 abscesses, and 5 appendicular lumps. 16 anterograde appendectomy and 8 retrograde appendectomy were done. Appendectomy was associated with a suction-washing in 3 appendicular abscess cases and 2 appendicular lump cases. Food vomiting, scapular pain and Douglas abscess were some operative complications seen. The mean operating time was 60 min (40 min–90 min). Conclusion: Paediatric laparoscopic appendectomy procedure is one of the most effective and better surgical procedures in the present times. Although, it is still a debatable one when complicated appendicitis patients are being treated.

209. Prevalence and Predictors of Low Backache among Office Workers: A Cross Sectional Observational Study
Baby Archana Rajulapati, P.T.V. Kiran Kumar, S. Siva Kumar, Bethala Suresh, Santhosh Karunakar Dodda
Background: Low backache is a common complaint among office workers, potentially linked to various occu-pational and lifestyle factors. This study investigates the prevalence and predictors of low backache in this popu-lation. Methods: A cross-sectional observational study was conducted with a sample of 100 office workers. Data on backache prevalence and potential predictors—such as sitting duration, ergonomic furniture availability, physical activity level, age, gender, workstation setup, stress levels and duration of employment—were collected through a structured questionnaire and analyzed. Results: The prevalence of low backache among participants was 48%. Prolonged sitting emerged as a signifi-cant predictor, with 82.86% of those sitting for more than 6 hours continuously reporting backache. Lack of ergonomic furniture was associated with a 60% prevalence of backache. Participants with a sedentary lifestyle reported a higher incidence (80%) compared to those with moderate (20%) and high (10%) activity levels. Age-wise, the highest prevalence was observed in the 51+ years group (73.33%). Gender-wise, females reported a higher incidence (60%) than males (40%). Participants using standard workstation setups had higher backache prevalence (60%) compared to those with standing desks (20%). High stress levels were associated with an 80% prevalence of backache. Employees with over 10 years of service reported 70% prevalence, which was higher than those with shorter employment durations. Conclusion: The study highlights the significant impact of occupational and lifestyle factors on the prevalence of low backache among office workers. Key predictors include prolonged sitting, lack of ergonomic furniture, low physical activity, older age, female gender, standard workstation setups, high stress levels, and longer dura-tion of employment.

210. What Lies Beneath and Beyond? A Case Series on Management of Intra Articular Distal Radius Fractures with Ellis Plate
Pavan Kumar Peddibhotla, Srinivasa Rao Biruduganti, Harish Thota, Varun Kumar Paka, Rao Indra Peddibhotla
Background: Volar plating is the workhorse technique employed for management of unstable intra articular fractures of distal radius. Surgical management is associated with high complication rates. There is no clear consensus regarding choice of treatment modality for managing these fractures. We here report a case series of unstable intra articular fractures of distal radius managed surgically with Ellis plate. Patients and Method: A prospective study was conducted on 50 patients with unstable distal radius intra articular fractures classified according to Frykman’s Classification, treated with volar Ellis plate applied through volar Henry’s approach. Patients were followed up for a minimum of one year period and the anatomical and functional outcomes were measured using the Lidstrom’s criteria. Results: Excellent results were observed in 44% of patients, good in 28%, fair in 24% and poor results in the remaining 4% of patients. Functional results observed were similar to the anatomical results. Conclusion: Volar Ellis plating technique can be relied upon as a reasonably good option for unstable distal radius fractures, provided proper care is ensured regarding placement of plate and screws under fluoroscopic guidance.

211. A Comparison of Urinary Cytology and Histopathological Study in Uri-nary Bladder Transitional Cell Carcinoma at Our Institute in a Prospective Study
Jateen Anshuman, Pritam Pritish Patnaik, Sabyasachi Panda, Sachin Sharma, Abhilekh Tripathi, Kishore Kumar Behera, Tilala Yash Manharlal
Background: Urine cytology is a standard diagnostic test to aid in diagnosis of bladder cancer. It detects the exfoliated cells from urinary tract and helps identify the presence of malignancy. The prognostic value of conventional cytology to monitor patients with superficial bladder carcinoma is well established. The study aims to correlate urine cytology with histopathology of the bladder transitional cell carcinoma and to study the role of urinary cytology in its diagnosis. Methods: 70 Patients admitted in Department of Urology, SCB Medical College and Hospital, Cuttack were prospectively studied. Freshly voided urine samples are collected for cytological examination. Cystoscopy was performed in all patients using rigid cystoscope and details of growth are noted. Material was obtained from TURBT biopsy, Radical Cystectomy specimen. Smears are stained with papanicolaou stain and haematoxylene and eosin stain. Biopsies taken are processed routinely and 3-5 u thick sections are cut. H & E Staining was done on tissue section. Lesions are histologically classified as Low grade, High grade & no malignancy. Results: Sensitivity of Urine Cytology study findings is High, meaning that malignancy +ve test result often occurs in those with malignancy. Specificity of Urine Cytology study findings is extremely low, meaning that malignancy –ve test very rarely occurs in those without malignancy. Overall value of Urine Cytology study in detecting malignancy as a combined screening and case-finding test is good. Conclusions: Voided urine cytology correlates with histological diagnosis in more than 60% of cases. Accuracy is more with high grade tumors. Urine cytology grading correlates in most cases with histopathological grading. The voided urine cytology is not only of diagnostic, but also of prognostic value. Voided urine cytological study can be a valuable adjunct to the clinician in the evaluation of suspected urothelial malignancy, as it is simple, non- invasive and with good accuracy in the diagnosis of TCC.

212. Study of Correlation of Non Alcoholic Fatty Liver Disease and Nephropathy in Type 2 Diabetes Mellitus
Harshavardhan C, Pramod Gowda B Patil, Mithun R, Hyarada Mallappa
Introduction: According to the World Gastroenterology Organization’s global guidelines, the overall prevalence of NAFLD is about 4% to 46% across the world. Considering the concept of bidirectional relationship between NAFLD and type 2diabetes mellitus, assessing the hepatic status for fatty infiltration could be an ideal marker of insulin resistance in type 2 diabetes mellitus and its complications. Objectives: To determine the correlation if any, between non-alcoholic fatty liver disease and microvascular complications in type 2 diabetes mellitus. Material and Methodology: A Cross Sectional study conducted in Department of General Medicine at the teaching hospital of Mandya Institute of Medical Sciences between June 2020 to May 2021. Study population was All Non-alcoholic Diabetic patients diagnosed to have a Fatty liver on USG. A minimum sample size of 78 was required for the study. Purposive sampling was used. Appropriate statistical tools were used in analyzing the data. The level of significance[α] was 5% i.e., p-value <0.05 is considered statistically significant. Results: In the study, all the participants were diagnosed with non-alcoholic fatty liver disease. Grade 1 NAFLD was observed in majority of the participants i.e., about 53.8% cases. Followed by Grade 2 around 34% and 10% cases had Grade 3 NAFLD. In assessing the association between diabetic complications in type 2 diabetic patients NAFLD, there exists statistically significant relation, all the three microvascular complications namely nephropathy. Conclusion: The study concludes that increased severity of NAFLD with increase in the age, blood sugar level, and triglyceride level. Direct correlation between NAFLD and microvascular complications due to type 2 diabetes mellitus which include diabetic nephropathy.

213. Study of Correlation of Non Alcoholic Fatty Liver Disease and Retinopathy in Type 2 Diabetes Mellitus
Harshavardhan C, Pramod Gowda B Patil, Parikshith J, Hyarada Mallappa
Introduction: According to the World Gastroenterology Organization’s global guidelines, the overall prevalence of NAFLD is about 4% to 46% across the world. Number of studies conducted in Indian population, concluded that the prevalence rate of NAFLD was about 9-32% and with a higher incidence of NAFLD among Type 2 Diabetes mellitus individuals found to be 12.5% to 87.5%. Considering the concept of bidirectional relationship between NAFLD and type 2 diabetes mellitus, assessing the hepatic status for fatty infiltration could be an ideal marker of insulin resistance in type 2 diabetes mellitus and its complications. Materials and Methods: All patients who are diagnosed with non-alcoholic fatty liver on USG abdomen in our hospital shall be explained about this study. Informed consent shall be obtained from those who agree to participate in the study. Information will be collected through a pre-tested and structured proforma for each patient. In the first part, data regarding identifier details like name, age, phone number, inpatient number, date of admission, etc., will be obtained. In the second part, information about the chief complaints, history of presenting illness, past history, will be obtained. Details regarding the general condition of the patient will be obtained. In the third part, General physical examination including anthropometry and relevant systemic examination is undertaken. In the fourth part, patient is subjected to fundoscopy, urine for micro albuminuria study for estimating the micro vascular complications, which is then correlated with the presence of fatty liver. Results: In the study, based on the findings from ultrasonography of whole abdomen, all the participants were diagnosed with non-alcoholic fatty liver disease. Further, on analysing the severity of the condition, Grade 1 was observed in majority of the participants i.e., about 53.8% cases. The next common finding was Grade 2 which comprised about more than one third of the study population. Remaining 10% cases suffered with the most severe form i.e., Grade 3 NAFLD. Fundoscopy was performed to assess the severity of diabetic retinopathy among the participants in the study. Accordingly, only 39.5% of the participants were found to be normal. Majority of the participants were diagnosed as non-progressive diabetic retinopathy. Whereas among those who were categorized as Grade 2 and Grade 3, majority were suffering from progressive diabetic retinopathy. Such that the analysis for any association between fundoscopy results and the severity of NAFLD, there exists statistically significant relation, thereby suggesting that more progressive the retinopathy, more was the severity of NAFLD in the study. Conclusion: On observing type 2 diabetes mellitus patients who were diagnosed with non-alcoholic fatty liver based on the findings from USG abdomen, the study found; The increased severity of NAFLD with increase in the age, blood sugar level, and triglyceride level. There is also direct correlation between NAFLD and microvascular complications due to type 2 diabetes mellitus which include diabetic retinopathy.

214. Study of Correlation of Non-Alcoholic Fatty Liver Disease and Neuropathy in Type 2 Diabetes Mellitus
Harshavardhan C, Pramod Gowda B Patil, Parikshith J, Hyarada Mallappa
Introduction: According to the World Gastroenterology Organization’s global guidelines, the overall prevalence of NAFLD is about 4% to 46% across the world. Considering the concept of bidirectional relationship between NAFLD and type 2diabetes mellitus, assessing the hepatic status for fatty infiltration could be an ideal marker of insulin resistance in type 2 diabetes mellitus and its complications. Objectives: To determine the correlation if any, between non-alcoholic fatty liver disease and microvascular complications in type 2 diabetes mellitus. Methodology: A Cross Sectional study conducted in Department of General Medicine at the teaching hospital of Mandya Institute of Medical Sciences between June 2020 to May 2021. Study population were All Non-alcoholic Diabetic patients diagnosed to have a Fatty liver on USG. A minimum sample size of 78 was required for the study. Purposive sampling was used. Appropriate statistical tools were used in analyzing the data. The level of significance[α] was 5% i.e., p-value <0.05 is considered statistically significant. Results: In the study, all the participants were diagnosed with non-alcoholic fatty liver disease. Grade 1 NAFLD was observed in majority of the participants i.e., about 53.8% cases. Followed by Grade 2 around 34% and 10% cases had Grade 3 NAFLD. In assessing the association between diabetic complications in type 2 diabetic patients NAFLD, there exists statistically significant relation, all the three microvascular complications namely neuropathy. Conclusion: The study concludes that increased severity of NAFLD with increase in the age, blood sugar level, and triglyceride level. Direct correlation between NAFLD and neuropathy  due to type 2 diabetes mellitus.

215. Ivabradine versus Metoprolol in Patients with Mitral Stenosis in Sinus Rhythm- A Randomized Comparison on Efficacy and Impact on Quality of Life
Roy Ayan, Biswal S. B., Hota P. S., Rath Bhabagrahi, Patel Nayan Kumar
Background: Beta-blockers are widely used in patients with mitral stenosis (MS) for heart rate (HR) control that alleviate exercise-related symptoms but with many limitations. Ivabradine, a novel selective bradycardic drug, may be promising outcomes in terms of safety and efficacy in rest and exercise.  Our study examined comparative efficacy of ivabradine and metoprolol on clinical, hemodynamic and exercise parameters with quality of life (QOL) in patients with MS in normal sinus rhythm. Material and Methods: Randomized single blind trial randomized 65 patients of different severity to BETA (n=33, metoprolol 50 mg BD) or IVA group (n=32, ivabradine 5 mg BD). After clinical evaluation, treadmill stress testing, Echocardiography, ECG at baseline, patients were re-evaluated after six months. EQ-5d-3L questionnaire evaluated QoL at 0,6 months. Results: Mean Resting HR in bpm significantly decreased over 6 months in both groups (88.59±12.77 to 71.75±6.04 in IVA; 88.30±12.37 to 72.61±9.9 in BETA) as well peak exercise HR (IVA 171.91±28.07 to 130.09±24.21 and BETA 167.55± 31.02 to 132.30±25.97) (p<.001) but was comparable intergroup (p>.05). on head to head, total exercise duration(TED) increased significantly in IVA(p=.002). In BETA minimum HR at Holter were significantly low (p<.001) with adverse bradycardic symptoms. No serious safety issues noted in IVA. QoL score (EQVAS) was significantly improved from baseline for both interventions (p<.001) as well as for IVA group (p<.001) whereas NYHA class improvement not significant. Conclusions: Metoprolol and ivabradine significantly improved clinical, hemodynamic, and exercise, QOL parameters from baseline. Ivabradine was superior in TED and Qol scores than metoprolol without significantly lowering minHR or BP. Ivabradine thus is an independent choice in rate control in MS with NSR.

216. Evaluation of Thyroid Hormone Level and Lipid Profile in Chronic Kidney Disease Patients
Anjani Kumar, Sanjeev Kumar, Rita Chaudhary, Madhu Sinha
Background: Low glomerular filtration rate and impaired kidney function are associated with chronic kidney disease (CKD). Indian research demonstrating the pathophysiological relationship between CKD and lipid profile has shown almost no lipid profile abnormalities in CKD to patho-physiologically noteworthy alterations in lipid profile in patients with CKD, such as elevated triglycerides and decreased high-density lipoprotein levels. This study aims to quantify thyroid hormone levels and investigate correlations between lipid profiles and thyroid hormone levels in patients with chronic renal disease. Methods:  In order to measure serum Total T3, T4, TSH, and serum lipid profile in undialyzed CKD patients and compare them with healthy controls, the current study was conducted on these patients. There were 130 participants in the study group. Of these, forty (Group 2) are in stage 3 of CKD, thirty (Group 3) are in stages 4 and 5 of CKD, and fifty (Group 1) were in age and sex-matched controls. Results: Comparing CKD patients to the control group, serum total T3, T4, and HDL showed decreases, while TSH and other lipid profile indicators showed increases. As a result, dyslipidemia and thyroid dysfunction are linked to CKD. Conclusion: This study demonstrates the strong correlation between the advancement of CKD and thyroid disease and dyslipidemia, as well as the prevalence of these conditions in CKD patients.

217. Study on Prevalence of Leucorrhoea in Women Attending in OPD of Gynecology and Obstetrics
Pratibha Jha, P. K. Mishra
Background: Vaginal discharge is a highly prevalent issue, especially in India, where it is linked to significant disability, medical attention seeking, and related expenses. The purpose of this study is to determine the sociodemographic factors related to the complaint of vaginal discharge among women of reproductive age, as well as to estimate the prevalence of vaginal discharge based on hospital data. Methods: Along with a control group of 50 women with complaints other than vaginal discharge, 100 women attending Gynecological OP with a complaint of vaginal discharge lasting one week or longer were recruited as study participants. Every case was chosen from the Outpatient (OP) Obstetrics and Gynecology SDH/CHC, Biraul, Darbhanga, between October 2022 and September 2023. Results: The range of ages was 19 to 47. Ages 21 to 30 accounted for 56% of the patient population. 60% of the study group is from an urban region, 40% is from a rural location, and 24% and 76% are from the control group. The study group’s maximum incidence of vaginal discharge was found in 61% of low-socioeconomic women and 39% of high-socioeconomic women. The control group’s maximum incidence was found in 76% of low-socioeconomic women and 24% of high-socioeconomic women. Conclusion: One of the most prevalent complaints among women who are fertile is leucorrhoea. Women are more prone to contract other dangerous sexually transmitted infections (STIs) because they are less likely to seek treatment for the morbidity associated with asymptomatic instances of bacterial vaginosis. In light of this, it is advised that women who visit family planning clinics or prenatal and Gynecology clinics be checked for BV cases and treated in order to lower their chance of contracting other STIs.

218. Study of Stress in Medical Undergraduate Student during COVID Pandemic in Darbhanga Medical College, Laheriasarai, Bihar
Rajiv Kumar Singh, Mritunjay Kumar, Sheela Kumari
Background: The Covid-19 pandemic is affecting the entire world right now. Those who belonged to the service class were farmers, company owners, or students were all obliged to stay imprisoned in their homes. The Covid-19 Pandemic has forced the closure of universities and colleges. Every student is anxious and waiting for this illness to be permanently treated so that the environment will be proper and classes may resume at their regular speed. The purpose of this study is to evaluate how undergraduate medical students perceive stress and how they individually manage it. Methods: From May 2020 to November 2020, a cross-sectional observational study was conducted. Participants were undergraduate MBBS students, and an online questionnaire (Cohen’s PSS 10 scale) via Google forms was used to measure their felt stress and coping mechanisms associated to the COVID-19 timeframe. Three categories were used to classify the overall PSS score: low, moderate, and high. Based on their responses, coping strategies were divided into distinct categories. Results: A total of 145 medical undergraduate student participated in the research. The overall perceived stress score for males (20.61) and females (23.21) was found to have a mean±SD of 21.703± 6.564. Participants who were female showed higher levels of stress than those who were male. They employed a variety of coping mechanisms to deal with the stress they felt as a result of the COVID-19 circumstances. The P-value for the PSS-coping and lifestyle pattern connection was determined to be 0.440 and 0.011, respectively. Conclusion: According to this study, 42.07% of male and 28.96% of female medical students reported feeling moderately stressed out overall, or 71.03% of them. They adopted a variety of coping mechanisms to deal with the stress, which caused a shift in their way of life. The majority of students reported having disturbed sleep cycles, which made them feel even more stressed. Therefore, it is imperative that action be taken right now to lower medical students’ stress levels.

219. Study of Correlation between Body Mass Index, Waist Hip Ratio, Blood Sugar and Blood Pressure in Young Adults in Mithilanchal Region
Rajiv Kumar Singh, Mritunjay Kumar, Sheela Kumari
Background: Global obesity is an epidemic that is becoming worse. An individual is considered obese if their body mass index (BMI) is 30 kg/m2 or more. It is one of the type 2 diabetes risk factors that can be changed. The purpose of this study was to ascertain the relationship between BMI, BP, and random blood sugar (RBS) in a group of young, healthy adults in Mithilanchal region. Methods: There are 100 young people in this study, 46 of whom are male and 54 of whom are female, ranging in age from 18 to 30 during study period from May 2021 to November 2021. After a 10-minute rest interval, each subject’s blood pressure was taken using a sphygmomanometer in their right arm. The individuals’ blood pressure, waist-hip ratio, BMI, and random blood sugar levels are measured. Result: The BMI averaged 26.26±3.34 kg/m2. WHR averaged 0.91±0.24. RBS was 96.20±18.21 mg/dl on average. In comparison to individuals with normal WHR, both diastolic and systolic blood pressures increased dramatically in those with elevated BMI status and excessively raised WHR. Additionally, compared to individuals with normal WHR, those with raised WHR had considerably higher RBS. Conclusion: In young adults, there is a favorable correlation between random blood pressure and blood sugar levels and elevated body mass index (BMI) and unusually elevated waist-hip ratio. As a result, young people everywhere run the danger of growing up to have chronic conditions like high blood pressure, type 2 diabetes, cancer, stroke, and other cardiovascular illnesses. Therefore, in order to stop the development of chronic diseases in the future, young people should have their BMI and waist-hip ratio regularly evaluated and maintained.

220. Effect of Yoga on Pulse Rate and Blood Pressure in Medical Student of Darbhanga Medical College, Laheriasarai, Bihar
Mritunjay Kumar, Rajiv Kumar Singh, Sheela Kumari
Background: Cardiovascular disease risk has grown due to changes in lifestyle, infrastructure expansion, junk food consumption, and stress levels. Engaging in sports, aerobic workouts, and other activities might trigger sympathetic activation. However, consistent yoga practice raises vagal tone and tends to lower sympathetic reactions. We therefore attempted to determine how yoga affect cardiovascular parameters of medical student in DMC, Laheriasarai, Bihar, including pulse rate, systolic blood pressure, and diastolic blood pressure. Methods: 50 healthy participants, of any gender, between the ages of 18 to 25 participated in this study from October 2021 to April 2022. Both before and after yoga, their blood pressure and pulse were measured. Results: After statistical analysis of the data, we found a p-value < 0.001, indicating a highly significant drop in the patients’ systolic and diastolic blood pressure, pulse rate, and blood pressure after practicing yoga. Conclusion: Regular yoga practice improves cardiovascular function, which may help lower the risk of cardiovascular illnesses.

221. Study on Clinical and Biochemical Changes in Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus
Rajiv Kumar Singh, Mritunjay Kumar, Sheela Kumari
Background: In affluent nations, non-alcoholic fatty liver disease (NAFLD) is the predominant cause of chronic liver disease. NAFLD has an even more aggressive course and can lead to early onset chronic liver disease in those with type 2 diabetic mellitus (T2DM). While hepatic ultrasonography is one of the numerous noninvasive techniques that can indicate the severity of NAFLD, biopsy is still the gold standard for diagnosing the condition. The purpose of this study was to use hepatic ultrasonography to assess the prevalence of NAFLD in patients with type 2 diabetes and to ascertain how it related to body mass index and other biochemical markers (glycated hemoglobin HbA1c, liver transaminases, and lipid profile). Methods: This observational study was carried out at Darbhanga Medical College and Hospital December 2020 to May 2021. All the involved patients were known to have T2DM. After being consented, their body mass index (BMI) was determined, and patients were classified into mild, moderate, and severe fatty liver based on ultrasonographic criteria. Then, the biochemical blood measurements were performed by a standard laboratory procedure to determine their lipid profile, liver transaminases, and glycated hemoglobin levels. Results: In this study a total of 109 patients (64 men and 45 women) with type 2 diabetes were included. The study group was divided into 2 subgroups: NAFLD – patients with USG evidence of fatty changes in the liver and Non-NAFLD – patients without any USG evidence of fatty changes in the liver. The prevalence of NAFLD was 65%, with men having a higher prevalence (56.3%) as compared to women (43.7%). Fatty liver showed a bimodal peak with a male predominance. More than half of the study population was obese and dyslipidemic, as identified by BMI and serum triglyceride levels. NAFLD subgroup had a higher prevalence of hypertension, smoking, obesity, central obesity, higher HbA1c and triglyceride levels and lower HDL level. Metabolic syndrome, as defined by IDF (2005) criteria, was present in 65% of the study group. CAD was more prevalent in the NAFLD subgroup (15%) compared to the non-NAFLD subgroup (13%). Using the Mann-Whitney test, it was found that BMI (p=0.022) correlated statistically to NAFLD, metabolic syndrome and CAD. Conclusion: The overall prevalence of NAFLD among type 2 diabetes mellitus patients is significantly high. Elevated GPT, triglyceride and HbA1c levels may correlate with the development of NAFLD in diabetic patients.

222. Study on the Effects of Common Salt on Blood Pressure in Normal and Hypertensive Subjects in North Bihar
Mritunjay Kumar, Rajiv Kumar Singh, Sheela Kumari
Background: The growing population is making hypertension a significant issue. In order to shed light on a single aspect of this enormous issue and provide a straightforward preventive measure, we shall now investigate the effects of regular salt on hypertension. Aim of this study to observe the effects of common salt on blood pressure in normal and hypertensive subjects. Methods: The study was done in the Physiology department, Darbhanga Medical College, Laheriasarai, Bihar, but involving persons attending various out patients department of the Hospital. Paper approval from the institutional ethical committee was obtained before starting the actual study. The timeline of the study was between June 2022 and December 2022. Test subjects were adults and recently diagnosed as hypertensive. Controls were healthy adults and normotensive, but were similar to controls in all other respects. BP (systolic & diastolic) was measured for all and pulse pressure and mean arterial blood pressure were calculated. Serum sodium, potassium and chloride levels were estimated and the urine also was examined for specific gravity, sodium and chloride. Salt intake of all subjected was enquired about and they were divided into four categories according to salt intake, viz. low salt in taker, optimum salt intaker, high and very high salt intaker. Their BP and other parameters were calculated and compared. Results were statistically analyzed using the SPSS software. Results: The mean systolic blood pressure (SBP)± standard deviation (SD) in mm of Hg in the normal or control population was 117.5±16.7 compared with that in the hypertensive or test population being 167.6±31.6. The mean diastolic blood pressure (DBP) ± SD in mm of Hg, obtained is 76.7±9.5 as compared to the test in control population which is 102.3±14.8. The mean pulse pressure (PP) ± SD in mmHg in the control population is 40.5 ±6.7 and that in the hypertensive population is 64.7±18.In our study, MABP was 90.2±11.5 in normal population, whereas it was 123.5±19.6 in the hypertensive population. The mean serum sodium of the control population was 138.7±19.7 mmol/L; on the other hand, the same in our hypertensive population was 144.2±20.1. In control population, the serum chloride levels were 101.4±13.0 mmol/L, whereas the same in hypertensive population was 112.4±15.4. The latter was distinctly higher, though was not statistically significant. The urinary specific gravity in normal, healthy person is 1.015± 0.051 (SD). In case of hypertensives, the same is 1.021±0.052.The average PPs in mm of Hg (SBP-DBP) were 40.7±5.4 in low salt takers, 42.2±10.7 in optimum salt takers, and 61.0±16.3 in high salt takers and 77.2±18.3 in very high salt takers. Again, the average MABP (DBP+1/3 PP) in mm of Hg in different types of salt takers, 92.6±10.5 in optimum salt takers, 119.3±8.4 in high salt takers and 135.8±7.4 in very salt takers. Conclusion: In conclusion it can be said that dietary salt has a reflection on blood pressure. Salt ingested quantity is directly proportional to blood pressure, whether it is SBP, DBP, PP or MABP. Further studies on a much bigger scale and in a more elaborate way are required to establish the validity of this issue. But, right now it is time enough to start salt restriction in general population, particularly hypertensive in a massive way.

223. A Lipid Profile Study Amongst the Cases of Type 2 Diabetes Mellitus: A Cross Sectional Study
Sanjeev Kumar, Anjani Kumar, Farhan Usmani, Madhu Sinha
Background: India is known as the diabetes capital and has the highest number of diabetic cases worldwide. One of the leading causes of Coronary Artery Disease (CAD) mortality worldwide is diabetic dyslipidemia in India. Disorders of lipoprotein metabolism, such as excess or insufficiency in lipoproteins, are known as dyslipidemia. This avoidable risk factor, which is more common in people with diabetes, has the potential to exacerbate cardiovascular diseases. The study’s objective is to ascertain how type 2 diabetes mellitus (T2DM) affects the lipid profiles of diabetic patients who present to tertiary care facilities. Methods: It was a cross sectional study conducted at Department of Biochemistry, Patna Medical College, Patna, Bihar from July 2022 to June 2023.. A total of 140 diabetic cases were chosen at random, and their dyslipidemia was assessed. Using commercially available reagent kits in a biochemistry analyzer, the fasting blood glucose concentration and Lipid Profile (Total Cholesterol (TC), High Density Lipoprotein (HDL), Very Low Density Lipoprotein (VLDL), and Triglycerides (TG)) were examined. Software that was appropriate was used to examine the collected data. Results: The mean age of the 140 diabetes cases that were investigated was 48.93 ± 12.1 years. The average fasting blood sugar (FBS) in the current study was 188.76 ± 54.63 mg/dl. In our study, there was a 13.6% and 41.4% prevalence rate for elevated total cholesterol (TC) and triglycerides (TG), respectively. In the diabetic participants, the prevalence rates for high LDL-C, very high LDL-C, and low HDL-C were 8.6%, 5.0%, and 72.9%, respectively. Conclusion: The serum total cholesterol, triglyceride (triacylglycerol), low density lipoprotein (LDL-C), and high density lipoprotein (HDL-C) values were low in the diabetic subjects, suggesting a higher risk of cardiovascular disease.

224. Study of Clinicopathological Correlation of Ovarian Tumours in P.M.C.H, Patna
Shiksha, Ankita, Krishna Murari Prasad
Background: Ovarian tumours are a common form of neoplasm in women. The complex anatomy of ovary and its peculiar physiology and the constant cyclical changes from puberty to menopause gives rise to a number of cell types each of which is capable of giving rise to tumours. Ovarian cancer is the 5th leading cause of death among women in the world and accounts for 3% of all cancers in female. Despite the new techniques in imaging and genetics, the diagnosis of ovarian tumours is primarily dependent upon histopathological examination. Methods: All surgically removed ovarian specimens from oophorectomy, laparotomy, or total abdominal hysterectomy with adnexa that were sent to the PMCH, Patna, and Department of Pathology for histopathological investigation were included in the current study. A thorough history was kept, together with microscopic and gross features. Results: Age distribution of ovarian tumors was found to be somewhat variable, with 51.72% of cases occurring in the 21–40 year age range. Of the 82 occurrences (74.54%) of parity with more than one, there were 28 (25.45%) with parity one or less than one. After noting the menstrual status of the study participants, it was discovered that 70.90% of them were in the premenopausal age group, which was more prevalent than the postmenopausal age group. The specimens collected were from two procedures: (1) ovarian cystectomy (26 cases, 23.6%), which was followed by (1) total abdominal hysterectomy with unilateral or bilateral adnexa combined (64 cases, 58.18%).Additionally, three specimens for oophorectomy and salpingo-oophorectomy, representing eight (7.2%) and four (12.9%) instances, respectively, were received. Of the 110 ovarian tumor patients, 14 had appendicitis connected with them, 8 had uterine vaginal prolapse linked with them, and 5 had calculus cholecystitis associated with them. Conclusion: Treatment, follow-up, and prognosis for ovarian tumors can all benefit from the current study findings. To deploy preventative measures in communities with higher risk, it also analyses risk factors.

225. A Study to Assess the Efficacy of Remdesivir in Managing COVID-19
Mansi Amrutlal Parkar, Krishnakant N Bhatt, Tvisha Piyushbhai Chaudhari, Dhara Hasmukhbhai Surati, Akhiljith AS, Vaidik Nileshbhai Paghadar, Meet Chintan Shah
Background: COVID-19, caused by the novel coronavirus SARS-CoV-2, emerged in December 2019 in Wuhan, China. It quickly spread globally, leading to a pandemic declaration by the WHO in March 2020. The virus primarily spreads through respiratory droplets, causing a range of symptoms from mild respiratory illness to severe pneumonia, posing significant public health challenges worldwide. The Present study was conducted to compare the efficacy of remdesivir in the management of COVID-19 disease. Methods: The present retrospective study was conducted among 200 confirmed severe cases of COVID-19 diagnosed and admitted at the government medical college, Surat during the study. The study participants were divided into two groups: Group A: Those who received Remdesivir along with other standard drugs (as mentioned in proforma) used for COVID-19. Group B: Those who received standard treatment only without Remdesivir. Inclusion criteria were Age >18 years, Severe cases of COVID-19, and patients who gave written informed consent to participate in the study. Results: The mean age of participants in groups A and B was 60.2 and 61 years, respectively (p>0.05). Around 44% of group A and 46% of group B had comorbidities like hypertension. Platelet counts at admission were 250910/μL for group A and 260900/μL for group B (p<0.05). Oxygen devices, including nasal cannula, were used more frequently in group A (64%) than in group B (40%) (p<0.05). Intubation rates were 34% for group A and 48% for group B (p>0.05). Hospital admission duration was shorter for group A (14.2 days) than group B (19.7 days) (p<0.05). Success rates for treatment and discharge were similar between groups A (93%) and B (84%) (p>0.05). Conclusion: The overall parameters improved in the remdesivir group as compared to those not receiving it. The number of patients requiring mechanical ventilation was significantly lesser as compared to the group not receiving remdesivir. Death was only 7% of the remdesivir group as compared to the non-receiving group where 15% deaths were reported. No significant adverse reactions were reported in the remdesivir group. Therefore, it appears that remdesivir appears to be effective in the management of severe covid 19 in this population.

226. Management Of Proximal Tibial Fractures with Different Modalities
Prashant Dumbre
Background: Fractures of proximal tibia have always been difficult to treat because of the subcutaneous location of its anteromedial surface. These days significant attention has been paid to the condition of soft tissue envelopes. Aims: To evaluate the end results of tibial plateau fractures treated and different modalities of the treatment and their complications in our hospital. Methodology: A prospective study was conducted on 30 patients with proximal tibial fractures at the Orthopaedic Department of MGM Medical College and Hospital, Navi Mumbai. Results: The mean age was 35.2 ± 10.73, and there were more men (70%) than women (30%). According to the radiological Schatzker classification, I fracture (33.3%) and III fractures (23.33%) were the most prevalent among the study population. The next most prevalent were types 2 and 4. Right proximal tibia fracture (66.7%) was the most common diagnosis among the study population, followed by left (33.3%). The study population’s most often used treatment methods were locked plates (33.33%), buttress plates (5%) with bone grafting, and (5% without). The study population’s most frequent early complications were pain (26.7%), limited knee mobility (41.3%), infection (10%), delayed union (51.6%), and malunion (3.3%). 56.7% of the study population had excellent outcomes, 26.7% had good outcomes, fair in 13.3%, and poor outcomes 3.3%. Conclusion: To consistently provide great and positive outcomes, the surgeon needs to have a solid understanding of the type of proximal tibia damage and be conversant with the range of current procedures available for treating these fractures.

227. To Study Malignant Phyllodes Tumor of the Breast with Rapid Growth
Sanjay Kumar Mahajan, Abhay Brahamane, Rinku Yadav, Deepak M, Kanishka Porwal
Background: Phyllodes tumor is an extremely rare tumor of the breast. It occurs in females in the third and fourth decades. The difficulty in distinguishing between phyllodes tumors and benign fibroadenoma may lead to misdiagnosis. Lymph node involvement is rarely described in phyllodes tumors; for this reason, sentinel node biopsy may be warranted. We present a cases women affected by huge tumor of the left breast with ulceration in the skin with a rapid tumor growth and with omolateral axillary metastasis. Method: Malignant phyllodes tumor is a rare lesion of the breast that can mimic breast benign mass on clinical diagnosis; on the other hand, it is characterized by a typical rapid growth. Clinicians and breast radiologists should pay particular attention to these features, in order to avoid a delayed diagnosis resulting in an aggressive surgical approach. In particular, breast radiologists could take into consideration ultrasound abnormalities in breast nodules and could accurately evaluate axillary lymph nodes in case of a breast lesion with rapid tumor growth. Here we present a case of a woman affected by a phyllodes tumor, an uncommon oncologic disease. Conclusion: Breast phyllodes tumor is a rare tumor. The early age of onset and the rapid growth make this report a special case. The diagnosis was confirmed by pathology and immunohistochemistry. Surgical extended resection is the treatment of choice; we performed total mastectomy with adequate surgical margins and omolateral axillary lymph node dissection. Adjuvant radiotherapy and chemotherapy may be administered in patients with high-grade tumors (as in our case), positive surgical margins, or postoperative recurrence, but their role is undefined.
In conclusion, we underline that phyllodes breast cancer may spread to distant organs and to axillary lymph nodes. Ultrasound abnormalities in breast nodules and breast lesions with atypical clinical and radiological presentations may be taken into particular consideration.

228. A Study of Refractive Impacting Academic Performance and Associated Risk Factors Among School Children in Karimnagar
N. Praveen Kumar, Vishnu CS
Background: Numerous children experiencing poor vision due to refractive errors often go undiagnosed, leading to academic challenges. Refractive errors represent a preventable cause of visual impairment, and since children may not express concerns about their vision, early detection, and treatment are imperative to avert potential future blindness. The primary aim of this study was to determine the prevalence of refractive errors in school children and explore associated factors. Methods: This cross-sectional study was a school-based study conducted by the Department of SPM, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. School students from 6th to 9th standard in selected schools of Karimnagar District Visual acuity was assessed within the school premises, either under the shade of a tree or in well-lit classrooms, utilizing the Snellen E chart. Vision screening was done with the help of an experienced optometrist under the supervision of an investigator. Results: A total of n=220 school children were examined. Within the cohort under study, 24.09% (N=53) of children were found to have refractive errors. In the present investigation, the prevalence of refractive error at the ages of 11, 12, 13, and 14 years was recorded as 15.09%, 18.87%, 28.30%, and 37.73%, respectively. (table 3). However, only 18.86% (N=10) of those identified with refractive errors had been previously diagnosed and were utilizing corrective spectacles, while the majority (81.13%) remained unaware of their vision issues. Additionally, it was observed that among those who were using corrective spectacles (N=10), a significant majority, constituting 80% (n=8), adhered to regular usage. Conclusion: Numerous ocular diseases originate in childhood, and the resulting morbidity may go unnoticed, negatively impacting a child’s academic performance and potentially leading to severe ocular disability later in life. This study emphasizes the elevated prevalence of undetected refractive errors in school children and underscores the significance of early detection and treatment through corrective spectacles to impede the further progression of refractive errors.

229. Intravenous Lignocaine versus Intravenous Dexmedetomidine in Attenuation of Haemodynamic Response to Laryngoscopy and Intubation in Adult Patients: A Comparative Study
Anupananda Chowdhury, Kalyan Sarma, Kashish Mittal, Urmi Chowdhury, Pranab Boro, Prabir Pranjal Das
Background: The stress response to Laryngoscopy and endotracheal intubation is a common physiological phenomenon. It can be transient and harmless in healthy normotensive patients, but it may be hazardous in patient with underlying cardiac disease. Materials and Methods: Sixty cases undergoing surgery under general anaesthesia aged between 18 to 50 years of both sexes with ASA grade I with Modified Mallampatti score 1 and 2 were selected randomly and divided two groups of 30 each. All patient were pre-medicated with Inj Ranitidine (i.v) Ketorolac 0.5 mg /kg and paracetamol infusion 15mg/kg before induction. Inj Glycopyrolate 0.004 mg/kg (i.v.), midazolam 0.02 mg/kg and Inj. fentanyl 1 µg/kg were given before induction. After Preoxygenation group L received 1.5 mg/kg Lignocaine intravenous and group D received Dexmedetomidine 0.5 µg/kg diluted in 100 ml of normal saline intravenous. Patients was induced with injection propofol 1% intravenously. until loss of response to verbal stimulus Pulse rate, systolic and diastolic blood pressure was recorded noninvasively before induction, post induction-1, 3, 5 and 10 minutes from the onset of laryngoscopy. Mean, SD and ‘t’ test was used for statistical analysis. Results: A better control of haemodynamic response was observed in patients receiving dexmedetomidine infusion(p < 0.001). Heart rate, systolic, diastolic and mean blood pressure fell gradually till 10 minutes after post intubation in both the group as compared to basal level. Conclusion: Dexmedetomidine showed better attenuation of haemodynamic response to laryngoscopy and intubation as compared to lignocaine.

230. Prevalence of Depression in Post-Menopausal Women in Central India
Reema R Gorte, Avinash Tekade, Namrata Loya
Background: Every woman face the menopause during her stage of growth. Menopause cause various health problems on body. Psychological problems are one of commonest problem in modern societies. Depression is common psychiatric disorder in women. Objectives:  The aim was to determine prevalence of depression in post-menopausal women. Materials and Methods: Fifty postmenopausal women of age 45 to 60 years and fifty premenopausal women of age 35 to 45 years were selected for the study. Depression assessed by Hamilton depression scale. (HAM-D Score). Results: In postmenopausal women, depression was significantly higher than premenopausal women (p=0.0218). Conclusion: The findings of our study suggest that the increase in prevalence of depression is due to hormonal background of menopausal status, age related health  problems.

231. A Clinical Comparative Study between General Anaesthesia and Spinal Anaesthesia for Laparoscopic Cholecystectomy in Elective Surgeries
Mridu Paban Nath, Debabrata Dutta, Girish Uzir, Dipjyoti Shyam
Background and Objectives: Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA), but there are studies which have found spinal anaesthesia (SA) as a safe alternative. The objective of this study was to compare the ease of performing Laparoscopic Cholecystectomy under General Anaesthesia and Spinal Anaesthesia. Material and Methods: The study was conducted in 60 patients who were candidate of elective surgeries for laparoscopic cholecystectomy (LC) with low tension pneumoperitonium with CO2 and divided into two random groups (30 in each group) of general anaesthesia (GA) and spinal anaesthesia (SA) In General Anaesthesia (n=30), Propofol, Fentanyl, Atracurium, Sevoflurane and Tracheal intubation were done. In Spinal Anaesthesia (n=30), Hyperbaric Bupivacaine 15 mg and fentanyl 20 µg to achieve a sensorial level of T3 were used. Intraoperative hemodynamic parameters, postoperative pain, complications, recovery, patient satisfaction, and cost were compared between the two groups. Results and Observation: Induction of anaesthesia were done between two randomly divided patients (n=30 for GA and n=30 for SA) and there were no conversion from spinal to general anaesthesia. Pain was significantly lower at 2, 4, and 6 hours after the procedure for spinal anaesthesia group as compared to those who received general anaesthesia. The cost of the spinal anaesthesia was significantly lower than that of the general anaesthesia. All patients were discharged after 24 hours. Conclusion: Laparoscopic cholecystectomy done under spinal anesthesia is safe and feasible and does not require any change in technique and, at the same time, has a number of advantages, as compared to general anesthesia, and should be the anesthesia of choice.

232. Analgesic Efficacy and safety of thoracic Epidural versus Paravertebral Blockade for Post-Thoracotomy Pain Relief
Munmi Sonowal, Barakha Gogoi, Arbind Kumar Ray, Mukesh Patir, Dipak Choudhary
Background: Effective management of post-thoracotomy pain is crucial for patient recovery. This study compared the analgesic efficacy and safety profiles of Thoracic Epidural Block (TEB) and Paravertebral Block (PVB) in this context. Methods: A total of 100 patients undergoing thoracotomy were randomly assigned to receive either TEB or PVB. Pain was assessed using the Visual Analogue Scale (VAS) at various postoperative intervals. Hemodynamic parameters (heart rate and mean arterial pressure) and lung function (FEV1, FVC, PEFR) were also measured. The incidence of side effects was recorded. Results: No significant difference was observed in VAS scores for pain at rest and during coughing between TEB and PVB groups (p>0.05). Hemodynamic analysis revealed significant variations in the TEB group at certain postoperative intervals, with a notable decrease in mean arterial pressure at 15, 30, and 60 minutes (p<0.05). Lung function parameters (FEV1, FVC, PEFR) postoperatively showed no significant difference between the groups. The incidence of nausea, vomiting, and urinary retention was higher in the TEB group. Conclusion: Both TEB and PVB are effective for post-thoracotomy pain management. However, TEB is associated with more pronounced hemodynamic variations and a higher incidence of certain side effects. These findings can guide clinicians in tailoring postoperative pain management strategies to individual patient needs.

233. Intra Articular Type C Distal Humeral Fractures Fixed with Orthogonal (90-90) Plating
Ashok Rakshith, Pradeep H, Ravi M Daddimani, Harish K, B G Sagar
Background: Distal humeral fractures account for 2% of all fractures and 30% of fractures around elbow joint. They occur in bimodal distribution, with one peak in young patients following high energy trauma and another in elderly due to low energy trauma. The current standard of care like any other intra articular fracture is stable anatomical reduction and early mobilization of elbow joint. We studied functional results of forty-seven patients fixed with orthogonal dual plating using Mayo’s Elbow Performance Index. Materials and Methods: Distal humerus intra articular fractures (AO TYPE C) were treated with open reduction and internal fixation with orthogonal plating in forty-seven patients. Functional outcome was evaluated using Mayo Elbow Performance Index along with radiological outcome. Results: The mean duration of follow up was 27.2 months. Forty-four fractures united primarily. One patient with compound grade 2 injury had deep infection treated in two stages, first debridement and implant removal and re-fixation after six weeks, had poor outcome. Two patients were lost to follow up, forty-five patients were available for final follow up. Another patient had skin impingement due to back out of K wires used for olecranon osteotomy fixation, K wires removal was done. Two had elbow stiffness, treated with arthrofibrolysis. The mean arc of elbow was 108 degrees. The mean MEPI was 84.55. The mean elbow flexion contracture was 11.6 degrees. Discussion: The management of intra articular distal humeral fractures has many variables with respect to the approach to reduce the fractures and use of implants which can hold the fragments in reduction. In due course of time, these factors play an important role in the functional outcomes of the patients. Faster rehabilitation, good elbow range of motion and satisfactory bony union all contribute to the final outcomes in these complicated fractures. Conclusion: Distal humerus fractures are challenging to manage. Good prognosis depends on many factors like fracture communition, need for olecranon osteotomy and good post-operative rehabilitation. In our study we have observed better outcome scores in C1 and C2 type of fracture as compared to C3 type.

234. Evaluation of Safety, Efficacy, and Expulsion of Post Placental Insertion of Intrauterine Contraceptive Devices (PPIUCD) In A Tertiary Care Center
Neelam Rajput, Pratima Kumari, Neelu Rajput, Divya Sinha
Introduction: According to USAID/ACCESS 2009 survey, couple protection rate in India is 50.7% and unmet need is 12.8%. According to WHO the optimum interval between pregnancies should be 36 to 60 months. Pregnancy before 24months of birth increases maternal and perinatal morbidity and mortality. PPIUCD has emerged as most cost effective and ideal postpartum contraceptive. The aim of this study is to evaluate acceptability, safety, efficacy and complications of PPIUCD at tertiary care center. Method: This was a prospective and longitudinal study conducted in the Department of Obstetrics and Gynaecology in Kamla Raja Hospital, Gwalior over a period of two years from November 2019 to July 2021. This study included 255 women who were admitted for delivery. PPIUCD was inserted within 10 minutes of placental expulsion in vaginal deliveries and during caesarean section. Follow up of these patients at 6 weeks and 6 months. Various parameters were analyzed. Results: Acceptance rate of PPIUCD was 1.66%, highest acceptance of PPIUCD was seen in para 2 (36.9%) followed by para 3 (25.0%) and (37.2%) patients were accepted due to its reversible nature. The mean age was 26.25 years. Most common complication was vaginal bleeding (15.2% at 1st follow up; 12.2% at 2nd follow up) followed by abdominal pain (10.9% at 1st follow up; 10% at 2nd follow up). Removal of PPIUCD due to mal position (21.2% at 6week; 20% at 6months) and vaginal bleeding (42.1% at 6week; 40% at 6months) of PPIUCD at follow up. Conclusion: During present study authors found that PPIUCD is highly effective, acceptable safe and with fewer side effects. PPIUCD is beneficial in Indian population where accessibility for contraception is lower during interval period and women do not come for contraception during postpartum period.

235. Evaluation of Dexmedetomidine Nebulization as Adjuvant to Lignocaine During Awake Flexible Fiberoptic Bronchoscopy
Deepesh Gupta, Urmila Keshari, Veenashree Managavi, Richa Pandey
Background: Awake Fiberoptic Intubation (AFOI) is considered as the gold standard for patients with difficult airway. Lidocaine may be accompanied with respiratory depression, seizure, and cardiac arrhythmias. On the other hand, Dexmedetomidine has favorable properties such as analgesia, sympatholysis, sedation and cardiovascular stability. Aim and Objectives: To assess the efficacy of dexmedetomidine intranasally with lidocaine in AFOI in comparison to using lidocaine alone in terms of haemodynamic stability, sedation, ease of intubation and any complication with the procedure. Materials and Methods: This observational hospital based study was conducted on 60 patients of either sex aged between 18-60 years with ASA status I or II scheduled for elective surgeries under general anaesthesia. The patients were randomly divided into two groups of 30 each. Group D (4ml of lignocaine 4%+dexmedetomidine 1 mcg/kg) Group L (4 ml of 4% lignocaine). Descriptive statistics was done and were reported in terms of mean, standard deviation and percentages. Results: The mean heart rate during AFOI was 71.16±7.02 in Group D and 95.62±10.04 in Group L. The Mean Arterial Pressure (MAP) during AFOI was 74.4±6.2 in group D and 101.78±5.56 in group L. There was statistically significant (p-value <0.001) decrease in mean heart rate and MAP in group D as compared to group L. There was a significant difference (p-value <0.001) in time to intubation, intubation conditions, post intubation score between the two groups. There was no significant decrease in Saturation of Peripheral Oxygen (SpO2) or respiratory depression in both groups. Conclusion: Intranasal dexmedetomidine with lidocaine provides better haemodynamic stability and improves the quality of intubation during AFOI.

236. A Rare Case Report of Pancreatic Pseudocyst Formation in Ectopic Pancreas
Manish Somkuwar, Vishal Bhabhor, Parthrajsinh Rathod, Pranav Vasava, Mithun Barot
Background and Goals: The ectopic pancreas is an extremally rare condition. Accidentally found during laparotomy. However, However, diseases of the pancreas such as pancreatic pseudocysts can also occur in this ectopic tissue. Even with symptoms, preoperative  diagnosis is difficult.

237. Calcium Creatinine Ratio: A Predictor of Preeclampsia
Akriti Prasad, Puja Verma, Mamta Singh
Background: There is hypercalciuria during a normal pregnancy, while PIH is associated with hypocalciuria and low urinary calcium-creatinine ratio. Since PIH represents a state of profound pathophysiological changes and, one of the important alteration is a change in urinary calcium creatinine ratio and microalbuminuria in patients of PIH, this test has emerged significantly as the early predictor for the development of PIH. Material and Methods: The present study was carried on in Department of Obstetrics and Gynaecology, Nalanda medical college and hospital over a period of one year from November 2019 to September 2020.This study was done on 100 normotensive patients with gestational age of 20- 24 weeks attending routine antenatal clinic. The patients were divided in two groups: Study group – comprised of 50 normotensive patients who had either one or more risk factor for development of preeclampsia and Control group- comprised of 50 normotensive pregnant patients, who had no risk factors for development of preeclampsia. Urinary calcium is calculated from spot morning urine sample by Orthocresolpthalin method. Normal urinary excretion of calcium in healthy adult is 100 – 300 mg/day. Urinary creatinine is calculated by Jaffe’s method. Normal urinary creatinine excretion in healthy adult is 1.5 – 3 gram/day. All collected data was reviewed and analyzed for relationship of urinary calcium creatinine ratio with development of preeclampsia in both study and control group. Result: Maximum number of patients in the study group and in the control group belonged to 18 – 25 years of age group. 70% were primigravidae. Less urinary calcium levels seen in cases of preeclampsia. Parity does not have any significant effect over calcium excretion in both groups of patients. In the study group (n = 50), 10 (20%) had CCR ≤ 0.04 while in the control group (n = 50), 5 (10%) had CCR ≤ 0.04. Out of total 100 patients, 15 had CCR ≤ 0.04 and out of these, 10 (66.67%) had developed preeclampsia later on. On the contrary, out of 85 patients with CCR> 0.04, only 5 (5.8%) had preeclampsia and remaining 80 patients did not have preeclampsia. Conclusion: Measurement of urinary calcium creatinine ratio is a non-invasive, inexpensive and easy to carry out method. It can be used as early predictor to identify pregnant women having high risk of developing preeclampsia and thereby help in initiating prompt education of the patients and timely prophylactic interventions, thus minimizing the severity of preeclampsia.

238. Study of Bacteriological Profile and Antibiogram of Infections in Intensive Care Units of a Tertiary Care Hospital
Kumari Jyoti, Sunanda Kundu, Namrata Kumari, Kumar Saurabh
Background and Objective: The intensive care unit (ICU) often called as the epicentre of infections, due to its vulnerable population. It has been reported that the incidence of nosocomial infections in the intensive care unit (ICU) is about 2 to 5 times higher than in the general inpatient hospital population. The present study aims to know the causative organisms and antibiotic susceptibility of infections in intensive care units. Methods: It is a prospective study with 300 patients with suspected infections included were included. Samples were processed as per standard guidelines and the colonies were identified according to standard biochemical tests. Antibiotic susceptibility testing was done on Muller Hinton agar using Kirby Bauers’s disc diffusion test. ESBL production was tested by disc diffusion method as in CLSI phenotypic method (2017). Conclusion: There is increase in number of infections in ICUs due to multidrug resistance organism, which is the big public health threat and challenge for both prevention and treatment of infections. Thus, the incidence rates, the causative agents and their susceptibility play a vital role in the management of infections in ICU.

239. Hemodynamic Changes with Dexmedetomidine and Fentanyl as Adjuvant To 0.5% Bupivacaine in Erector Spinae Plane Block For Perioperative Analgesia in Percutaneous Nephrolithotomy Patients
Sampreeta S Reddy, Swati Bisht, Manjunath Irappa Wali
Background: Erector spinae plane block is a paraspinal block in which drug reaches paravertebral, interfacial planes and provide pain relief. The drugs injected also causes hemodynamic fluctuations. Adjuvants used in block enhance these fluctuations which are noted in current study. Objective:  To know the Hemodynamic changes (Hypotension, bradycardia) in peri-operative period in patients receiving erector spinae plane block with 0.5% bupivacaine and adjuvants dexmedetomidine and fentanyl for percutaneous nephrolithotomy. Methods: This prospective randomized double blinded study was carried out in the Department of Anesthesiology of tertiary care center from January 2019 to June 2020. Results: The overall change in Pulse Rate (BPM) over time was compared in the three groups using the Generalized Estimating Equations method, significant difference in the trend of Pulse Rate (BPM) over time between the three groups (p = <0.001) is noted. The overall change in Systolic BP (mmHg) over time was compared in the three groups using the Generalized Estimating Equations method, significant difference in the trend of Systolic BP (mmHg) over time between the three groups (p = <0.001) is noted. The overall change in Diastolic BP (mmHg) over time was compared in the three groups using the Generalized Estimating Equations method, significant difference in the trend of Diastolic BP (mmHg) over time between the three groups (p = <0.001) is noted. Conclusions: Statistical significance (p <0.05) was seen among 3 study groups in terms of hemodynamic variation (p < 0.006).

240. Study of Prevalence of Type 2 Diabetes Mellitus among Asha Workers in Rural Blocks: A Community Based Study
Deepak Telange, Dnyaneshwar N. Digole, Akshay Salgar, Pratima Khatake
Background: The rise in type 2 diabetes mellitus patients is associated with population growth, economic development, ageing populations, increasing urbanization, dietary changes, obesity, reduced physical activity and changes in other lifestyle patterns. Proper health education by health care personnel and new research findings and useful strategies can reduce the worsening of diabetes mellitus. The study was conducted to know the prevalence of type 2 diabetes mellitus among ASHA workers in rural blocks. Methods: The present community based cross sectional study carried during 1st January 2021 to 31st December 2021 in the field practise area of tertiary care centre in rural area. A total of 350 ASHA workers were taken as sample size from three rural blocks as study population. The WHO guidelines were used for diagnosis of diabetes cases, fasting blood glucose more than 126 mg/dl considered as diabetic. Data was collected and compiled using Microsoft Excel, analysed using SPSS 23.0 version. Results: The majority of ASHA were in age group 41-60 years (57.43%) and married (92.57%) The prevalence of diabetes among ASHA workers found to be 8.29%. The prevalence of risk of diabetes among ASHA workers shows high risk among 8.86% followed by moderate risk (11.71%) and low risk (79.43%) Conclusion: The present study concluded that the prevalence of diabetes mellitus is increasing among working females.

241. Prevalence and Predictors of Hyper-Homocysteinemia among Ischemic Stroke Patients – A Hospital Based Prospective Observational Study
Cherian Thomas, Miriam Cherian, Anna Varkey
Objectives: The objectives were to estimate the prevalence of hyper-homocysteinemia in patients with ischemic stroke presenting to a tertiary care hospital in south India; to assess the correlation between levels of hyper-homocysteinemia and carotid intima media thickness in these patients. Methods: This was a hospital based prospective observational study conducted in the outpatient department and inpatient wards of the Department of General Medicine between January 2021 and December 2021. Results: The results showed that the levels of homocysteine was raised in 69.0% of the patients – >15μmol/L; however, the levels of <15μmol/L, that is normal in 31.0% of the patients with ischaemic stroke. Male gender (72.5% vs 32.3%), smoking (60.9% vs 9.7%), alcohol intake (62.3% vs 9.7%), presence of hemiplegia or hemiparesis (63.8% vs 32.3%), and infarct site being carotid artery (88.4% vs 61.3%) was significantly associated with raised levels of homocysteine is patients with ischemic stroke (p<0.05), in comparison with female gender, nonsmokers, patients without alcohol intake, without hemiparesis or hemiplegia and involvement of vertebral artery, respectively. Majority (80.6%) of the patients with homocysteine levels <15μmol/L had carotid intimal thickness <0.75; however, among 66.7% patients with homocysteine levels >15μmol/L, the carotid intimal thickness was >0.90mm – this difference was found to be statistically significant. The results of correlation analysis showed the Pearson’s correlation coefficient to be 0.628 – significant positive moderate correlation (p<0.05) between carotid intimal thickness and homocysteine levels. Conclusion: Monitoring both homocysteine levels and carotid intimal thickness could offer a more comprehensive assessment of vascular risk, allowing for timely and tailored preventive measures.

242. Study between Fentanyl – Propofol versus Ketamine – Propofol Combination for Sedation and Recovery in ERCP Procedure
Tutika Spandana, Yashwant Dhawale, Rajkumar Ahirwal, Y Sandhya Rani, R P Kaushal
Background: The gold standard diagnostic and therapeutic approach for pancreaticobiliary diseases is the ERCP, which is frequently carried out in daycare. It is necessary to have a sufficient depth of anaesthesia under sedation or Total Intravenous Anaesthesia (TIVA) for immobility, analgesia, and patient comfort. The ideal sedative–analgesic mixture ought to preserve a patient’s hemodynamic status and ought to cause no breathing depression, a quick onset and reversal to initial values, and a small occurrence of postoperative nausea and vomiting. Several pharmacological agents including dexmedetomidine, fentanyl, ketamine, and propofol, are now widely accessible, taking into consideration short induction, rapid recovery, and lessening complications associated with using a single drug. Aims and Objectives: To investigate the groups receiving Fentanyl-Propofol (FentP) versus Ketamine-Propofol (KetP) in ERCP in terms of sedation, rescue sedation requirement, and recovery scores during ERCP. To observe the procedure’s hemodynamic changes, postoperative pain score and complications of ERCP. To observe the occurrence of any side effects and complications related to Fentanyl-Propofol (FentP) versus Ketamine-Propofol (KetP). Materials and Methods: A study was carried out at Gandhi Medical College, Bhopal which included 30 adult patients between the age of 18-65 years of ASA Grade I, II and III who underwent ERCP after informed consent. Both groups received 1mg Midazolam and Inj Glycopyrrolate 0.2mg in the pre-anaesthesia area. Group A received Ketamine-Propofol (KetP) and Group B received Fentanyl-Propofol (FentP), each contain 15 patients. All patients are given a loading dose of Propofol 0.75 mg/kg and 75𝜇g/kg/minute infusion was started. The group FentP received Fentanyl 2𝜇g/kg and the group KetP received Ketamine 0.5mg/kg. Ramsay sedation scores, the necessity for rescue sedation, hemodynamics changes, complications during surgery and Modified Aldrete score are noted. Results: Ramsay sedation scores at 0, 2, and 4 minute in group B (FentP) are significantly lower, suggesting patients in group A (KetP) experience early sedation (P value 0.00). However, the FentP group has significantly greater sedation scores at 8, 10, and 15 minutes (P value 0.05).There was no statistical difference between the two groups in terms of recovery time (P value > 0.05). There was a significantly reduced requirement of rescue sedation in group KetP (P value < 0.01). FentP caused slightly delayed recovery time and respiratory depression compared to KetP. MAP in group FentP was lower than baseline, this suggests KetP provides better hemodynamic stability than FentP. Conclusion: KetP (Ketamine – Propofol) group offers greater sedation, need lesser rescue sedation dose of Propofol, faster recovery with better hemodynamics and fewer complications when compared to FentP (Fentanyl – Propofol) group. Ketamine and Propofol are advised in patients having higher risk of respiratory depression. Pain after ERCP is less in FentP group compared to KetP group.

243. An Observational Study of Magnesium Sulphate Added as an Adjuvant to Intrathecal Levo-Bupivacaine Heavy in Patients with Mild Pregnancy Induced Hypertension Undergoing Caesarean Section
Y Sandhya Rani, Yashwant Dhawale, Neelesh Nema, Spandana Tutika, R P Kaushal
Background: Adequate analgesia following caesarean section decreases morbidity, improves early ambulation, patient outcome and facilitates care of the newborn baby. Intrathecal Magnesium sulphate, an NMDA antagonist has been shown to prolong analgesia without significant side effects in healthy parturients. Aims and Objectives: To study the effect of adding intrathecal Magnesium sulphate to 0.5% Levo-Bupuvacaine (heavy) in patients with mild pregnancy induced hypertension where blood pressure increases( i.e >140/90mmHg) after 20 weeks of gestation in women with previously normal blood pressure undergoing caesarean section. Materials and Methods: After obtaining consent, 60 patients of ASA I & II between the age group of 21 -35 years undergoing elective and semi-emergency caesarean section under spinal anaesthesia are randomly divided into two groups.  Group C: Control group, N=30 patients 0.5% 2cc (10mg) Levobupivacaine heavy. Group M: Magnesium sulphate group, N=30 patients 0.5% 2cc (10mg) Levo-Bupivacaine heavy +0.1cc 50% (50mg) magnesium sulphate. Onset, duration and recovery of sensory and motor block, duration of spinal anesthesia and post-operative analgesia were recorded. Results: The addition of intrathecal magnesium sulfate prolonged the duration of spinal anesthesia by 42 minutes compared to the control group. Postoperative analgesic consumption over 24 hours was significantly lower in the magnesium group. Motor recovery time was prolonged in the magnesium group, but no significant hemodynamic effects were observed. Conclusion: Intrathecal magnesium sulfate as an adjuvant to spinal anesthesia in cesarean section for PIH patients prolongs spinal anesthesia duration and reduces postoperative analgesic consumption. While motor recovery time was prolonged, no significant hemodynamic effects were noted, indicating its safety and efficacy as an adjunct in obstetric anesthesia.

244. Oxidant-Antioxidant Balance in Uremic Patients with CKD and on Renal Replacement Therapy
Srilakshmi Katari, Sowjanya Yerram, Kalavathi Chanamallu, Bhanu Kumar Chitteti, Sobha Devi Kolla, Nissi Namratha Thathapudi
Background: Oxidative stress is the main underlying mechanism in CKD patients, leading to cardiovascular disease and renal failure. The antioxidant response to the oxidative stress, is however altered with the renal replacement therapies (RRT) like Hemodialysis (HD) and Peritoneal Dialysis (PD) and also obviously by the intensity of damage to the kidneys (Stage of CKD-based on eGFR). Aim and Objectives: The current study aims to evaluate the homeostatic response of the body to the oxidative damage by the ROS. Methods: Estimation of pro-oxidant status by assay of thiobarbituric acid reactive substances, hydroperoxides and protein carbonyls. The defensive antioxidant substances like, SOD, Catalase, GSH peroxidise, GSH reductase were studied. Results: TBARS and LPO were found high in patients undergoing Hemodialysis and protein carbonyls were high in Peritoneal dialysis patients. The antioxidants were declined in severe stage of CKD and also in HD patients. Conclusion: Our study showed that impaired renal function and duration of dialysis treatment are associated with increased Oxidative stress condition. Further investigation is still required in order to estimate the imbalance between antioxidant and oxidant factors.

245. Correlation of Cytological Grading with Histopathological Grading in Malignant Neoplasms of Breast
Dasari Mercy Mrudula, Suryakala Chappa, Dasari Mary Manjula, Chowdari Balaji, Ponnada Sravani
Background: Carcinoma breast is the most common non-skin malignancy in females with annual incidence of 10,00,000 cases  and contributing to 25.8% of total new cases diagnosed in 2020. Fine needle aspiration cytology (FNAC) is a simple, less invasive and cost effective procedure. Methods: Grading of breast carcinoma by Robinson criteria was done on FNAC smears, followed by histological grading by modified Scarff‑Bloom‑Richardson (SBR) grading system for histopathology specimens of breast carcinoma and comparison was made. Results: Out of 65 cases of carcinoma breast, all were female patients; most common age of presentation was 4th and 5th decades. Correlation of cytological and histological grading for grade 1 lesions was 80%, grade 2 lesions were 97.8% and for grade 3 was 66.7%. Conclusion: Cytological grading of the breast carcinomas is a feasible procedure and can be carried out by any laboratory and pathologist with ease.  Cytological grading correlated well with histological grading can be incorporated with cytology reporting benefitting the patient in the era of neo-adjuvant chemotherapy.

246. Study of Urinary Tract Infections in Infants with Acute Fever in North Karnataka Population
Pradeep R. Reddy, Vijay Kolhar, Pratibha Manjunath Patagar
Background: Urinary tract infection (UTI) is one of the most common pediatric infections. Infants with acute fever are identified by both pyuria and uropathogenic organisms. If untreated, it leads to hypertension, end-stage renal disease, and prolonged morbidity. Method: 70 infants admitted for fever were studied. Symptoms were increased frequency of micturation, crying while voiding, and pyuria. General and systemic examinations were done to rule out them. Phimosis, vulvular synechiae, and suprapubic mass, renal mass, dysmorphic features, and associated congenital anomalies were observed. A provisional diagnosis was done mainly based on signs and symptoms. Routine urine analysis, mi-croscopic analysis of urine, and urine culture were carried out. Positive patients were further examined by USG and MCU, and a differential diagnosis was also done to confirm the UTI. Results: 70 (100%) fever, 26 (37.1%) vomiting, 40 (57.1%) irritability, 49 (70%) failure to thrive, 10 (14.2%) jaundice, 15 (21.4%) convulsion, 21 (30%) gastro-enteritis, 18 (25.7%) fever without focus, 10 (14.2%) URTI, 13 (18.5%) UTI, 6 (8.57%) septicaemia, and 4 (5.71%) bronchitis. The highest antibiotic sensitivity of the or-ganism growing urine culture sample was 63 (90%) amikacin, followed by 51 (72%) laxacin, 41 (58.5%) nor-floxacin, 20 (41.4%) gentamicin, and the least was 7 (10.5%) ceftriaxone. Conclusion: The prevalence of UTI varies with age, sex, circumcision, and the hygienic status of infants. Urine culture should be an essential part of the evaluation of infants with fever.

247. Prevalence of Commonest Plasmodium Malaria in Children below 10 of Age in North Karnataka
Vijay Kolhar, Pradeep. R. Reddy, Pratibha Manjunath Patagar
Background: Malaria is one of the oldest recorded diseases in the world. It has infected humans for the last 50,000 years. The paediatric population is especially vulnerable to this preventable illness if it is diagnosed and treated at the earliest possible time. Method: 70 paediatric patients under 10 years old were studied. The peripheral smear test was studied by Rapid Kit test positive. The P. falciform/P. vivax was detected. Results: 31 females and 39 male children were studied. The highest numbers of children were >5 years old: 14 females, 18 males. 52.8% P. falciform +ve 24.2% p. vivax were +ve, and 22.8 children had mixed (PF/PV +ve) positives. The effect of Hb% was 24 (34.2%). had Hb% <5mg, 26 (37.1%) Hb% 5-7 gm/dl, 12 (17.1%) had Hb% 7-10 gm/dl, and 8 (11.4%) had Hb% > 10 mg/dl. The mortality was 8 (11.4%) children. Conclusion: The present study will help the paediatrician treat malaria patients efficiently and avoid mortality.

248. Evaluation of Topical Versus Intravenous Lignocaine for Insertion of I-Gel with Propofol: A Comparative, Analytical Study
Snehal Kulkarni, Yadhunandan S., Manjunath H. G., Srinivas V. Y., Sudarshan M. B.
Introduction: Insertion of I-Gel for ventilating patients under general anaesthesia requires suppression of airway reflexes and hemodynamic stability. The objective of this comparative analytical study was to compare the ease of insertion of I-Gel following induction of anaesthesia with intravenous propofol preceded by ‘topical’ lignocaine spray and ‘intravenous’ lignocaine. Methods: 60 patients of 18-60years of age of both sexes, ASA Grade I and II who underwent elective surgeries were given Inj. Propofol 2mg/kg IV followed by Inj. Lignocaine 1.5 mg/kg IV over 30 seconds in 30 patients (Group IV) and Lignocaine aerosol 10% 40 mg topically in 30 patients (Group TL). Conditions of I-Gel insertion, gagging, laryngospasm, coughing at time of insertion, ECG, NIBP, SPO2 and EtCO2 were recorded according to scheduled times. Results: In terms of number of attempts, patient response, airway manipulations, ease of insertion and insertion time, patients’ airway secured with I-Gel in group TL vs group IV in (96.67% vs 73.33%, 93.33% vs 66.67%, 93.33% vs 66.67%, 93.33% vs 66.67%, 12.13sec vs 13.60sec respectively) which was found to be statistically significant (p<0.05). Conclusions: Topical Lignocaine 10% aerosol prior to propofol induction provided excellent conditions for I-Gel insertion with minimal patient response and minimal requirement of airway manipulations.

249. Identification of Genetic Risk Factors in Chronic Pancreatitis in South Indian Population –A Pilot Study
S. Balamurali, Karthikeyan S, Padmanabhan S, Sastha A, Villalan R, Heman Kumar, Ramajayam Govindan, P. Maheshkumar
Background: Chronic pancreatitis is an irreversible process and potentially life-threatening disease, in most cases a causative factor will be alcohol (70%). In about 10-30% of the patients the etiology is undetermined, these categories are labelled as idiopathic chronic pancreatitis. Unexplained recurrent acute pancreatitis however may be associated with known genetic mutations in the cationic trypsinogen gene (PRSS1), the SPINK1 gene, or the CFTR gene. Furthermore, a better understanding of the interactions of the etiological factors with susceptibility SNPs will aid in diagnosing and treating the disease at an early stage. Based on this aim is to study the prevalence of SPINK1 and PRSS1 mutation in patients with chronic pancreatitis in south Indian population. Methodology: This study was done as an observational cross sectional study among patients with chronic pancreatitis, recurrent abdominal pain, idiopathic chronic pancreatitis, persons with family history of pancreatitis. We did the study in 42 patients between September 2019-August 2021 at Government Rajaji hospital, Madurai. SPINK1 and PRSS1 mutation analysis was done in all patients. Results: We did this study in 42 patients of chronic pancreatitis. In our study population abdominal pain was the main complaint in all patients. Loss of appetite (n=28) and loss of weight (n=24) is the next common feature among our study participants. In our study population, no patients had family history of pancreatitis. In our study 23 out of 42 patients had recurrence of episodes. 4 among 42 patients in our study had levels in CA 19.9 positive. No significant relation was there with the SNP. In our study heterozygous PRSS1 – positive for mutation was present in all patients in our study (100%). SPINK1 mutation was positive in 18 patients (43%) in our study. Conclusion: Mutation of PRSS1 and SPINK1 may predispose patients to acute pancreatitis, especially in those abusing alcohol, and may promote a more severe course of the disease. Having an idea which polymorphisms confer susceptibility to acute pancreatitis, and which polymorphisms modify the immunological response to acute and recurrent acute pancreatitis that lead to chronic pancreatitis will also be important in determining the timing of genetic testing and subsequent intervention. Genetic testing in future will help in avoiding progress to Chronic or recurrence in pancreatitis patient by taking rational preventative measures.

250. Perception of Educational Environment among Undergraduate Medical Students in a Medical College in Assam
Dastidar Abhijit, Begum Tazkira, Borah Manas Pratim
Background: The academic environment of any medical college determines a student’s likelihood of success. In addition to identifying the challenges and offering feedback, the aim of this research was to compare how Phase I, Phase II, and Phase III students at Assam Medical College, Dibrugarh, perceived their learning environment. Objectives: (1) To assess, through the DREEM questionnaire, how medical students feel about their learning environment. (2) Determine whether student opinions differ based on gender. (3) Identify strengths and shortcomings in each of the 5 domains. Methods: The DREEM (Dundee Ready Education Environment Measure) questionnaire has been utilized in a cross-sectional descriptive study that involved 408 students from various phases who were given it at various times. The students have been informed of the aim of the research and the need for confidentiality, and their cooperation was asked for. The completed surveys were gathered and subjected to statistical analysis. The mean and SD of data were shown, and a one-way analysis of variance had been utilised to find out how the scores varied among the questionnaire’s five domains. Analysis was also done on the variations among the three phases and gender. Result: The overall DREEM score was 119±43.53/200 (interpretation: predominantly positive). The results attained across the various domains have been 27.90±9.72 in SPL (interpretation: a more positive perception); 26.98±10.42 in SPT (interpretation: moving in the right direction); 19.89±8.56 in SAP (interpretation: feeling more in the positive side); 28.53±9.94 in SPA (interpretation: a more positive atmosphere); and 16.23±4.90 in SSSP (interpretation: not too bad). Students who were female had a higher DREEM score than students who were male, although not significant statistically. Nonetheless, the study pointed out certain inadequacies in the environment of learning. Conclusion: Perceptions of students for their environment of learning are influenced by a broad range of hidden and diverse factors. Monitoring student feedback should be an on-going process to pinpoint problem areas and quickly implement any necessary corrective actions.

251. Comparison of Pupil Size and Accommodative Facility Before and After Screen Use
Lakshmi Cherungottil, Raju K V, Irshad E, Mona Mohammed Abdusalam
Purpose: In the era of ever rising digital screen use the symptoms and assessment of digital eye strain still does not have uniformity and there is no significant study to quantify or evaluate accommodative system derangements. Our study is to test the effect of digital screen use on accommodative facility and pupil size and to test the null hypothesis. Methods: It is a hospital based prospective interventional study conducted from April to August 2022 in Medical and Paramedical students of a tertiary care centre in North Kerala. Results: The average pupil size was 5.7±0.88 mm before and 5.7±0.85 mm after screen use. The accommodative facility was 7±2 cycles before and 9±2 cycles after screen use. Paired t test refuted the null hypothesis of screen use on accommodative facility and the null hypothesis of pupil size was proven (p <0.0001). Conclusion: Accommodative facility increases after short duration of screen use but more studies are required to assess the correlation of duration of screen use and the effect on accommodative facility to prove that it is an integral parameter to be evaluated in digital eye strain.

252. Lipid Profile and Lipid Ratios Is Predictor of Cardiovascular Risk in Prediabetics and Diabetics
Sanjay Wasnik, Vijay Chouhan, Narayan Parmar, Amita Mehta
Introduction: Dyslipidaemia is very common in diabetes and play an important role in development of atherosclerosis, leading to cardiovascular diseases. It is very beneficial to identify lipid abnormalities in diabetics and prediabetics so that early intervention can reduce the cardiovascular complications. Present study was planned to compare lipid profile and lipid risk ratios of prediabetics with normoglycaemic control and diabetics in central India population. Material and Method: A total of 320 subjects (103 Prediabetics, 116 Diabetics and 101 Control) were enrolled in this study after taking their written and informed consent. Lipid profile and Lipid ratios of all groups were measured calculated and statistically analysed. Result: TC, TG, LDLc and atherogenic indices were significantly increased in prediabetics as compared with normoglycemic controls. HDLc significantly decreased in Prediabetics. We also observe that above lipid profile and lipid risk ratios were significantly high in the diabetics in comparison to the control and prediabetic group. Conclusion: The Prediabetic subjects due to their dyslipidaemia are at high risk for developing cardiovascular disease. Therefore, screening of prediabetic individuals for dyslipidaemia is recommended to arrest the development of cardiovascular complications.

253. Exploring Medication Use in Geriatric Out-Patients: Observations from a Tertiary Care Set-Up in Eastern India
Amit Kumar, Shikha Kumari, Amar Kumar Gupta, Samsuj Joha, Shatavisa Mukherjee, Nikhil Era
Background: The global aging population, including India, is increasing rapidly due to healthcare advancements, leading to a significant rise in the elderly demographic. Geriatric individuals often require prolonged medical interventions and medication regimens, making it crucial to understand medication use patterns. The aim of this study is to examine the drug utilization patterns & the potentially inappropriate prescription using Beers Criteria among elderly individuals in a tertiary care setup in Eastern India. Methods: A cross-sectional observational study was conducted on patients aged 60 years and above for 6 months at a tertiary care teaching hospital in Eastern India. Eligible patients were interviewed, and their case records were thoroughly reviewed. The collected data were entered into a pre-designed case record form. Results: Analysis of the cohort of 130 patients revealed that 63.84% were men and 36.15% were women. Most patients (36.92%) fell between 60 and 70 years, while the fewest were above 90 years (2.3%). Polypharmacy was observed in 90.76% of the sample, with cardiovascular issues being the most prevalent (22.3%). The average number of pills per prescription was 5.5, and 85.9% of pharmaceuticals were prescribed using generic names. Antibiotic prescription stood at 61.4%, injections at 64.8%, and 96.3% of prescribed drugs were from the National List of Essential Medicines of India. Among disease prevalence in elderly most were from cardiovascular disease. According to an updated AGS-Beer criteria, 35 (27%) of adults over age 60 took at least one prescription medication, while more than 11% of the same group take more than equal to three prescriptions a month. Conclusion: Our analysis revealed occurrences of irrational prescribing practices necessitating that prescribers should get thorough instruction on the proper and rational use of drugs, including the Beers Criteria that is specifically tailored for the elderly population.

254. Role of Doppler Parameters in Pregnancy for Predicting Adverse Outcome
Kapila Suguna Deepti, Ivvala Sai Prathyusha, Kompalli J Satyasiva Raghuteja, M Naren Satya Srinivas
Introduction: Identifying fetuses at a higher risk of perinatal compromise is crucial for improving outcomes in pregnancies affected by late-onset fetal growth restriction (FGR). Unlike early-onset FGR, where blood flow in the umbilical artery is a standard for identification and management, late-onset FGR often exhibits normal umbilical artery flow. Consequently, more accurate predictors are needed for adverse outcomes in late-onset FGR pregnancies. Aim: To assess the role of Doppler parameters in pregnancy, focusing on their significance in assessing maternal and fetal well-being. Material and Methods: This prospective study, conducted at a tertiary care center from January 01st, 2023 to December 31st, 2023, focused on fifty cases of high-risk pregnancies in the third trimester. This study was conducted at GITAM Institute of Medical Sciences and Research, Vishakhapatnam. Patients meeting inclusion criteria included antenatal women of 3rd trimester referred to department of Radiodiagnosis for Doppler study. Exclusions comprised patients in labor upon admission, those refusing delivery at the center, and cases involving twins. Result: In the current study, several vascular indices have been examined to assess their characteristics within the sample. The “UA-S/D” variable exhibits a mean value of 2.4270 with standard deviation of 0.56224.  The standard error of the mean, reported as 0.07951, additionally, other vascular indices have been investigated. Specifically, “UA RI” has a mean of 0.544, “UA PI” has a mean of 0.558, “MCA PI” has a mean of 0.724, and “MCA RI” has a mean of 0.742. The standard deviations for these variables indicate the extent of variability around their respective means. For example, “UA RI” has a small standard deviation of 0.081. Conclusion: Multi-vessel color Doppler ultrasound studies play a crucial role in monitoring patients having adverse pregnancy outcome. Notably, it outperformed the individual assessments of umbilical artery pulsatility index (UA PI).

255. Effect of Screen Time on Visual Evoked Potentials in Young Adults
Jalsi Joseph, Danti Joseph, Sabarinath Ravichandar, Krishna Prasanth
Introduction: Visual evoked potentials (VEPs) are electrical potential differences recorded from scalp to visual stimuli. VEPs provide a sensitive method for documenting the abnormalities in the visual pathways. Screen time usually refers activities done in front of the screen. There are studies which have said that too much screen time increases the risk of Obesity, Anxiety, Depression, Retinal Illumination, Lack of judgment skills, Sleep disturbances and more chances of Cardio vascular diseases. This study was aimed to assess the effect of Screen Time on VEP. Material and Methods: It was a cross-sectional analytical study. The participants (N=100) were divided in two groups: Group ‘A’ (control group) with 50 normal individuals and Group ‘B’ (study group) had 50 individuals using screen time more than 6 hours per day. Pattern reversal visual evoked potential was recorded. VEP Parameters – N75, P100 & N145 latencies and amplitude of P100 (N75-P100 and P100-N145) were recorded in both groups. The level of significance was tested between two groups using student’s t-test. Results: The latencies of N75 and P100 wave were significantly increased (p value = 0.001). The amplitude of P100 wave did not show much differences (p value = 0.001). Whereas, N145 wave latency was increased but not significant. Conclusion: We conclude that using screen time for longer time in a day can also affect the visual processing mechanism as evidenced by VEP changes.

256. Qualitative Comparison of Frozen Section with Routine Histopathological Section – Our Institutional Experience
Anisha Hari, Poornima Raghunathan, Sridhar Honnappa
Introduction: Intraoperative frozen section is a vital tool for making a quick diagnosis for the surgeon. It is also an integral part of quality assurance in surgical pathology laboratories when compared with the paraffin section reports. Aims and Objectives: 1) To analyze the discrepancies and deferrals in frozen section reporting when compared with the formalin fixed paraffin embedded sections. 2) Average turn over time. Materials and Methods: A retrospective study was undertaken of all frozen sections reported in our institute, MS Ramaiah Hospital, from 1st June 2016 to 31st July 2018. The records of frozen section reports were reviewed and correlated with its paraffin section reports for concordance. Results: A total of 257 frozen section reports were evaluated. 247 cases (96.10%) correlated and 10 cases (3.89%) were discordant.  The overall sensitivity, specificity, positive predictive value and negative predictive value of the frozen section as compared to paraffin sections were 100%, 50%. 96.1% and 100% respectively.   The average turnover time was 20 minutes. Conclusion: Frozen section is an accurate and a valuable tool for intra operative surgical management.  Errors in some subspecialties were higher than in others.  The overall goal is to reduce errors, the number of deferrals and improve frozen section diagnosis turnaround times, which will have a great impact on patient care and surgical decision making.

257. Association between Screen time and Psychosocial Hidness: A Closer Look
Neeraj Singh
Aim: The aim and objective were to obtain an association between screen time and the psychosocial morbidities of adolescent students. It is indicated in studies that there is a strong correlation between the amount of time spent on screens and mental health development issues such as attention deficit disorder, anxiety, and depression. Method: The data collection took place in secondary classes students public or private schools in Deolali, who have enrolled in classes 7th to 12th (12-17 years only) and can communicate in English. A group of 1300 adolescents was assessed, with a M: F ratio of 1.23. The total number of male-to-female participants was 718 and 582, respectively. Results: The PSC-Y scores were plotted against the gender of the participants, p-value 0.39. 154 female adolescents had positive scores as against 175 male participants. In the blood group, ‘B’ blood group 35.4% whereas ‘O’ 30.3% (p-value 0.77) statistically insignificant. The study found that most of these adolescents had psychosocial morbidity. The average weight was 48.5 kg with an SD of 12.4 kg. The increasing weight of participants had a highly significant relationship with positive PSC-Y scores (p-value 0.0000046). The family structure of the participating cohort was 16.7% living in joint families, 44 respondents had joint family structures, and 285 had nuclear families. The comparison on the Χ2 test was insignificant (p-value 0.58). 73.7% of participants reported with sleeping time of 6-8 hours. The distribution of sleep time was similar among both genders (p-value 0.0019). Conclusion: The study found a significant association between increased screen time and adolescent psychosocial morbidity and potential approach could involve devising public health initiatives that specifically focus on reducing the amount of leisure time individuals spend in front of screens, particularly among this demographic.

258. A Study on Time Related Changes in Bacterial Pattern in Burn Wound Infections and Their Antibiogram in a Tertiary Care Hospital
A. Renuka Devi, J. Vijayalakshmi, S. Shanthi Kumari, A. Praveen Kumar
Background: Burns remain a significant health problem in terms of morbidity, long term disability & mortality throughout the world, especially in economically developing countries. Objectives: To identify the bacterial agents responsible for burn wound infections from admission day 0 to day 21 and to study the antibiogram of bacterial isolates for effective infection control. And also to detect various resistant organisms like MRSA, ESBL, AmpC β-lactamase and MBL producers phenotypically. Results: 112 burn patients were included in the present study. A total of 448 swabs were collected. Most frequent isolate was Pseudomonas aeruginosa 30.15%, followed by Staphylococcus aureus 23.71%, Klebsiella pneumoniae 12.3%, Coagulase negative Staphylococci 10.82%, Escherichia coli 9.27%, Acinetobacter baumanii 6.95%. MRSA was isolated in 30.43% cases. ESBL, AmpC, MBL production was seen in 16%, 8% and 10% cases respectively. Studying the time related changes of bacteria in burns wound showed that on day 0, most of the samples were sterile and an initial predominance of Gram positive cocci in the first week. From day 14, Gram negative bacilli began to predominate. Antimicrobial sensitivity testing showed Colistin to be very effective drugs for Gram negative bacilli while Linezolid very effective for Gram positive isolates. Conclusion: The antimicrobial treatment must be changed as microbial flora of the burn wound is an ever-changing entity. Constant analysis of the wound cultures will help the treating physicians to keep abreast with the pathogens and their antimicrobial susceptibility. Early detection of the ESBL, AmpC, and MBL producing isolates in a diagnostic laboratory could help to avoid treatment failure. Aggressive infection control measures should be applied to limit the emergence and spread of these pathogens.

259. Evaluation of Immunochemical Expression of Human Telomerase Reverse Transcriptase in Oral Leukoplakia and Oral Squamous Cell Carcinoma: A Case Control Study
Mahesh Nirujogi, Ayyagari Kameswara Rao, G. D. Anand Swaroop, Parameswar Peela, Sravya Kodati, Kuna Rajani
Background: Telomerase in association with oncogenes or with inactivation of tumor suppressor genes induces tumorigenic activity by inhibiting cellular senescence, promoting survival. Aims and Objectives: The study was carried out to evaluate the Immunochemical expression of human telomerase reverse transcriptase (hTERT) in normal mucosa, Oral Leukoplakia (OLP) and Oral Squamous cell carcinoma (OSCC) patients by using Immunohistochemistry (IHC). Settings and Design: The study was conducted in 40 individuals, including 10 healthy individuals, 15 individuals with clinical, histopathologically confirmed OLP and OSCC patients each. Materials and Methods: Incisional biopsy was performed from the lesion proper and haematoxylin and eosin (H&E) staining was performed for confirmatory diagnosis, IHC was performed by using mouse monoclonal hTERT antibody. Statistical Analysis: All the data was analyzed using SPSS software version 22.0. Nuclear labelling score (LS) was compared across the groups using T-test. The mean percentages of cells stained for normal, OLP, OSCC were compared using ANOVA. Results: The Labelling Index (LI) for normal mucosa, normal to OLP and OSCC were 1.00±0.82, 2.20±1.01 and 2.93±0.59 respectively. The mean nuclear LI increased from normal (1.00±0.82), through normal to OLP (2.20±1.01) to OSCC (2.93±0.59). The mean nuclear Labelling Score (LS) increased from normal (1.00±0.82), through OLP (5.20±3.93) to OSCC (7.80±2.88). The mean LS was significantly higher in OSCC when compared to OLP. Conclusion: The strong expression of hTERT in OLP and OSCC suggests that telomerase activity is involved in the development of dysplastic epithelium leading to multistage oral carcinogenesis.

260. Retracted 

261. A Clinical Study of Enterocutaneous Fistula
Vivek Saini, Girish Bhardwaj, Vineet Sharma
Introduction: A fistula is defined as an abnormal or surgically made passage between a hollow or tubular organ and body surface, or between two hollow or tubular organs. Aim: To review and study patients who presented with enterocutaneous fistula. Method: Study was conducted on 70 patients aged between 21-70 years, admitted in various surgical wards of Mahatma Gandhi and Mathura Das Mathur Hospital attached to Dr. Sampurnanand Medical College, Jodhpur over a period of five years from 1st July 2012 to 30th June 2017. The cases included in the prospective study were personally attended and all relevant data recorded. All cases of enterocutaneous fistula admitted in surgical wards were included in the study. Result: Bowel resection and anastomosis is the most common procedure associated with occurrence of enterocutaneous fistula followed by intestinal perforation repair. Most fistulae occurred within first post-operative week. High output fistula, hypoalbuminemia, anemia, electrolye imbalance and fistula with bilious discharge carries high mortality. Conclusion: Exteriorization of bowel loop has an edge over resection and anastomosis.

262. Effect of Free Radicals on Ageing Process in Human Health
Singh Sunita D, Choudhury Manashwini, Singh Devanshi, Singh Daulat, Gogoi Javin Bishnu
Ageing is the natural phenomena defined as progressive, gradual and irreversible loss of tissue and organ function over time. Among the various theories proposed to explain aging, the role of free radicals has gathered significant attention. Free radicals play a crucial role in the aging process in human. exposure to various aging-related diseases, including neurodegenerative diseases, cardiovascular diseases, metabolic diseases, musculoskeletal diseases, immune system diseases and malignancy by promoting oxidative stress and cellular damage. These reactive molecules can damage DNA, shorten telomeres, disrupt gene expression, induce epigenetic modifications, and activate aging-related signaling pathways. Can also be made by the body after exposure to toxins in the environment such as use of tobacco and ultraviolet (UV) rays. These toxic effects can contribute to the gradual decline in physiological functions and tissue homeostasis observed during aging. Tumor suppressor genes direct the proteins that repair damaged DNA or cause cells that are damaged so badly. They can’t be fixed to be removed through “programmed cell death” (apoptosis). Usually, it’s a series of mutations in tumor suppressor genes and other genes that lead a cancer cell to form. Minimizing free radical-induced damage and supporting antioxidant defense mechanisms through a healthy lifestyle can help mitigate these effects and promote healthy aging. Antioxidants prevent free radical induced tissue damage by preventing the formation of radicals, scavenging them, or by promoting their decomposition. Synthetic antioxidants are recently reported to be dangerous to human health. Thus the search for effective, nontoxic natural compounds with antioxidative activity has been intensified in recent years. By understanding the mechanisms of free radical-mediated aging, it may be possible to develop interventions and therapeutics to slow or prevent age-related diseases and promote healthy aging.

263. To Develop a Classification System for Prognosis of Cases of Floating Knee
Saumya Agarwal, Harpreet Singh, Anamendra Sharma, Kalika Gupta
Background: To prognosticate a condition a classification system plays a pivotal role. Various classification system has been proposed in the literature does not incorporate soft tissue injuries and neither any associated patella fracture and extensor mechanism disruption. There is a pressing need to classify this complex injury pattern taking into consideration associated soft tissue injuries as well.  The study aimed to propose a classification system that comprehensively categorizes fracture types, integrating associated soft tissue and ligament injuries verified with MRI assistance. Methods: The study was conducted at a tertiary care centre from November 2020 to August 2023. The research involved 100 patients with floating knee injuries who underwent MRI assessments for soft tissue injuries. A questionnaire was sent to various esteemed Orthopaedic surgeons all over Indian subcontinent to validate the proposed classification.  Results: 20 leading orthopaedic surgeons agreed that associated ligament/meniscus injuries affect the clinical outcome of patients with floating knee. 70% of the surgeons advocated that existing Fraser classification is not sufficient and 60% suggested that our proposed classification fulfills the need of a revised classification system which incorporates associated ligament and meniscus injuries. Out of 100 patients of floating knee injuries who underwent MRI, seventy-two patients had meniscus/ ligament injury. 12 (9.6%) patients had patellar fractures with extensor mechanism rupture. Conclusion: Our aim is to initiate timely and accurate treatment by comprehensively addressing all associated injuries, including previously overlooked ligament damage around the knee. In addressing the complexity of Floating knee injuries, our focus has been on enhancing diagnosis and treatment through a newly introduced classification system.

264. The Management of Renal Matrix Calculi in a Tertiary Care Teaching Hospital
Anbalagan M, Induja J, Prabhakaran P, Gnanasekaran T
Background: Matrix stones are an uncommon form of urinary calculi, presenting a diagnostic and therapeutic dilemma to the practicing urologist. Endourological procedures like PCNL and URSL are safe and efficacious for the management of matrix calculi in recent times. Based on this aim of present study is to define incidence of renal matrix calculi in pts undergoing PCNL. Also to describe clinical, laboratory and radiological features and efficacy of PCNL in treating matrix stones. Methodology: We retrospectively reviewed the records of 800 PCNLs performed from June 2011 to May 2016, and identified 16 patients in urology department of tertiary care teaching hospital and collected all related data. Results: Flank pain was commonest mode of presentation followed by recurrent urinary tract infection. Pyuria was present in 12 patients and urine culture showed significant growth in 10. A plain X- ray showed a small radio-opaque calculus in 8 patients. Computed tomography diagnosed calculi in missed patients too. PCNL was abandoned initially in four patients due to pyonephrosis. The mean hospital stay was 4.52 days and decrease in hemoglobin was 0.92 g/dL. Conclusions: Matrix calculi occurred in 1.24% of patients undergoing PCNL. PCNL rendered patients stone-free with minimum morbidity. In future, prospective multicentric studies are necessary to provide insights into the aetiopathogenesis of this rare entity. Histochemical investigation can also provide an insight into the possible sequence of events in normal stone formation.

265. HER 2 NEU and KI67 Expression as Immunolocalization in Colorectal Carcinoma
T Shruthi, S. P. Smitha Vadana
Introduction: Colorectal adenocarcinoma is the fourth most common malignant disease and it is the leading cause of morbidity and mortality. Both HER-2 neu and Ki-67 in immunohistochemical studies can be used for predicting the prognosis and treatment in colorectal carcinomas. Aim and Objectives: To study the expression pattern of HER2 neu and Ki67 expression of different grades in colorectal carcinomas. Materials and Method: The present study was conducted in 65 cases of histopathologically proven colorectal carcinoma cases and evaluated the clinicopathological patterns of colorectal carcinoma and the relationship of with the clinicopathological variables. Results: HER 2 neu was positive in 87.7% of the cases. It was seen in 32.6% cases of well differentiated, 48.8% of moderately differentiated, 2.3% of poorly differentiated adenocarcinomas. Mucinous carcinomas showed 11.6% positivity for HER 2 neu. HER 2 neu positivity was more in grade II tumors compared to that in other grades. Conclusion: Colorectal carcinomas which express HER2 neu showed more positive cases but there was not significant association with clinicopathologic parameters. Immunohistochemical technique for detection of KI-67 proliferative index is simple and applicable to surgical specimens. However, it is not enough to monitor KI-67 proliferation index alone for prognosis in colorectal cancer as it was not significantly related to variable clinicopathologic parameters.

266. Antenatal Mothers’ Perspectives on Antenatal Visits: A Comprehensive Exploration of Knowledge, Attitudes, Practices, and Awareness: A Cross Sectional Study
Nilesh G Patel, Jinish Surana, Suryakshi Verma, Vedanti Wagh, Yashvi Goyali
Introduction: Pregnancy demands meticulous care, with antenatal care playing a pivotal role in maternal and neonatal health. Disparities persist globally in antenatal care utilization, particularly in underdeveloped regions. This study explores antenatal mothers’ perspectives in Gujarat, India, within the Southeast Asia Region, aiming to comprehend knowledge, attitudes, practices, and awareness regarding antenatal visits. Materials & Methods: This cross-sectional study was conducted at a tertiary care hospital in Vadodara, Gujarat which included antenatal mothers. Eligible participants aged 18 years and above, provided informed consent, focusing on low-risk pregnancies. A structured, pretested questionnaire covered sociodemographic details and antenatal care inquiries. Ethical considerations ensured participant privacy. Data collection involved convenient purposive sampling. Results: Demographically diverse participants revealed variations in education, occupation, marriage age, and parity. Knowledge assessment identified 43% with poor knowledge, 51% with average knowledge, and 6% with good knowledge. Positive attitudes were prevalent (85%), and good practices were reported by 58.5%. Age distribution analysis showed variations in knowledge, attitudes, and practices across age groups. Discussion: Most participants demonstrated average knowledge, positive attitudes, and good practices. Discrepancies in study results were attributed to socio-economic variations, access to healthcare, educational levels, and cultural influences. Targeted interventions are crucial, especially for those with poor knowledge, emphasizing nuanced approaches to bridge existing gaps. Conclusion: This study provides nuanced insights into antenatal care perspectives, informing policy and healthcare interventions. Addressing knowledge gaps and sustaining positive attitudes are crucial for enhancing antenatal care utilization. Tailored interventions are essential to promote maternal and neonatal health, reducing disparities in antenatal care uptake.

267. Significance of Masood Scoring System in Classification of Proliferative Breast Diseases on FNAC
Kishore Kumar. CH, Lakshmi C V, Sreedevi. P, Mani Kumari K N M, Papa Ratnam K
Introduction: The categorization of breast lesions is valuable in identifying women at an increased risk for the subsequent development of breast cancer. On fine needle aspiration cytology these lesions are usually categorized into proliferative breast disease without atypia and proliferative breast disease with atypia as it is not possible to exactly delineate various histological entities. FNAC of breast is a highly sensitive and specific modality to distinguish benign and malignant lesions. However, it is important to distinguish PBD with atypia from cases of PBD without atypia due to differences in prognosis and management. Risk of development of carcinoma is 1.5 – 2 times, 4 -5 times and 8 -10 times for PBD without atypia, PBD with atypia and in situ carcinoma respectively. One approach to resolve the diagnostic difficulties posed by PBD on FNAC has been to apply an objective scoring system. The scoring system proposed by Masood et al., is the most widely tested of the various scoring systems, although not all authors have found it to be useful. This study was undertaken to test the usefulness of the scoring system proposed by Masood et al versus cytomorphological diagnoses in cases with proliferative breast disease. Aims and Objectives: To analyze the cytomorphological features of proliferative breast diseases in conjunction with cytologic scoring system proposed by Masood et al., and correlating with histopathology. Application of scoring in a step wise manner on atypical aspirates as this can help in selection of cases suitable for biopsy. Materials and Methods: It is a prospective study undertaken during the period – October 2020 to September 2022. All smears were stained with Papanicolaou stain, H&E & MGG. Only cases having papanicolaou stained FNAC smears as well as histologic confirmation on biopsy or lumpectomy were included in the study. Results: All patients included in study were females within the age range of 15 to 65 years. We analyzed the various categories of breast lesions cytomorphologically and evaluated them according to Masood scoring and the Modified Masood scoring system put forth by Mridha et al. Conclusion: Overall Concordance Is Better When Cytomorphology Alone Is Correlated With Histopathology.

268. Management of Unstable Intertrochanteric Femoral Fractures in the Elderly: A Retrospective Study
Chandra Kishor Das, Ketan Kumar
Background: Unstable intertrochanteric femoral fractures in elderly populations are often the result of low-energy trauma and present a significant healthcare challenge. Managing these fractures requires careful consideration of surgical approaches, postoperative care, and rehabilitation to optimize outcomes while minimizing complications. Methods: This retrospective study involved 104 elderly patients aged 65 years and older who sustained intertrochanteric fractures. Patients were treated with either cementless Bipolar Hemiarthroplasty (BHA) or Proximal Femoral Nailing (PFN). Data were collected from medical records, including patient demographics, comorbidities, surgical details, and postoperative complications. Statistical analysis was performed using SPSS 11.5, comparing variables such as surgery duration, blood transfusion rates, Harris Hip Scores (HHS), and postoperative complications between the two cohorts. Results: The study found that PFN offered potential advantages over BHA, including reduced blood transfusion requirements, shorter surgery durations, and slightly higher HHS. However, both procedures were associated with the risk of postoperative epidermal infections. There were statistically significant differences in surgery duration and blood transfusion rates between the two cohorts. Conclusion: Managing unstable intertrochanteric femoral fractures in the elderly is a complex endeavor. While PFN appears to offer certain benefits, both surgical methods present challenges, emphasizing the need for ongoing research and the development of best practices. The study contributes valuable insights into treatment options for this vulnerable patient population. Recommendations: Further research is essential to refine and individualize treatment approaches for elderly patients with intertrochanteric fractures. Future studies should explore the impact of patient-specific factors, such as bone quality and functional status, on treatment outcomes. Additionally, efforts should focus on optimizing postoperative care, including infection prevention strategies and early rehabilitation protocols.

269. Longitudinal Analysis of Clavicle Fractures Managed with Pre-contoured Locking Compression Plates: A Prospective Investigation
Chandra Kishor Das, Ketan Kumar
Background: Clavicle fractures are a common orthopedic injury, often resulting from sports-related incidents, falls, or motor vehicle accidents. While conservative management has been a traditional approach, surgical intervention with pre-contoured locking compression plates has gained prominence, especially for specific fracture patterns. This study explores the efficacy of surgical treatment for clavicle fractures, assesses associated complications, and evaluates functional outcomes to contribute to improved patient care. Methods: A prospective observational study was conducted involving 55 patients who underwent surgical intervention for clavicle fractures. Inclusion and exclusion criteria were established