International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. A Comparative Study of Adult Male Circumcision with a Circular Stapler and Conventional Circumcision
Alekh Jain, Pramod Kumar Sharma, Rahul Agarwal, Gaurav Pandey
Abstract
Objective: To do comparative evaluation of the clinical outcomes of adult male circumcision with a circular stapler versus conventional adult male circumcision. The comparative evaluation was done based on the primary and secondary outcomes. Methods: We performed comparative randomized control to compare several aspects and outcomes of male circumcision with a circular stapler and conventional male circumcision in adults in the population of Central India. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. Results: The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (8000 ± 500.20 vs 1000.50 ± 125.00, respectively; P<0.01). Conclusion: Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique.

2. Prospective Study of Eclampsia in a Tertiary Care Hospital
A. Sakthi Priya, D. Joycerani, Agnes Synthiah, M Vijaya Lakshmi
Abstract
Background: Eclampsia is a known complication of preeclampsia during pregnancy and is associated with morbidity and mortality of both the mother and fetus if not properly diagnosed. The incidence of preeclampsia in hospital practice in India varies from 5% to 15%, and that of eclampsia is about 1.5%. In India, over the years, from 1976 to 2014, the risk of eclampsia ranges from 0.179 to 5%, with the average being 1.5%. This study aims to evaluate the incidence, maternal and perinatal morbidity and mortality, associated complications and treatment at our tertiary care hospital. Methods: The prospective study was conducted over a period of 3 years in Obstetrics and Gynaecology department of Government Sivagangai Medical College Hospital. The study included deliveries from July 2020 to June 2023.

Results: The total number of eclampsia cases was 23. The incidence of Eclampsia at our centre was 0.15%. The incidence of AP eclampsia 0.06% and incidence of PP eclampsia 0.08%. Maternal deaths due to eclampsia were 2. There were 2 early neonatal deaths due to prematurity and 1 early pregnancy loss. Among AP eclampsia most common mode of delivery was by caesarean section. Conclusions: The incidence of eclampsia in our study was 0.15% which is comparatively lesser than incidence recorded in other studies in our region. Effective mentoring, early referral and timely termination has reduced incidence of eclampsia in our institution. MgSO4 regimen plays a major role. Effective blood pressure monitoring, thromboprophylaxis and early ambulation in postpartum period are mandatory.

3. An Effective Approach to Reduce Postoperative Seroma Collection in Laparoscopic Inguinal Hernia Repair
A. Santhi, S. Umarani
Abstract
Background: Total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques are the two most commonly used laparoscopic procedures for inguinal hernia repair. These two techniques are preferred for favorable clinical outcomes, such as shorter hospital stay, lesser postoperative pain, and decreased incidence of surgical site infection. Still, seroma formation is the most common complication encountered after laparoscopic repair. Based on this aim of our study is to present a new technique to manage the distal sac and to avoid the clinical significant seroma formation after laparoscopic inguinoscrotal hernia repair. Material and Methods: This study was done as prospective observational study in patients undergoing Laparoscopic Inguinal Hernia Repair. Clinical History, Physical examination and other relevant details of the patient’s was collected and noted in the record. The TAPP or TEP repairs were performed using a standardized technique. Post-operatively patient followed with ultra-sonogram 3rd, 7th POD up to 4 weeks for any Seroma collection. Results: Among the study population, majority 68 (93.2%) of the study population had no complications after the surgery. About 4.1% (3) of the study population developed seroma and 2.7% (2) of the study population developed wound complications. The mean duration of surgery (in min) among the 67 study subjects who underwent TAPP is 59.32 and among the 6 study subjects who underwent TEP is 52.00. The Duration of hospital stay (in hrs) among the 67 study subjects who underwent TAPP is 50.09 and among the 6 study subjects who underwent TEP is 46.5. Conclusion: Considering the low prevalence of complications, shorter duration of surgery and less duration of hospital stay from our study results, we postulate that TEP can be preferred over TAPP assuming the other factors influencing the choice of surgery to be equal among two groups.

4. Study on the Various Surgical Techniques of Cholesteatoma at SMC Vijayawada
T V S S N Leela Prasad, L Dasaradha Rao, G B Sreenivas, Peter Mummidivarapu, K.Ravi, P Ratna Babu
Abstract
Introduction: This study was conducted to analyze the various techniques in surgical management of cholesteatoma. Study Design: 1 year study from January 2023 to December 2023 in Government General Hospital-Siddhartha medical college Vijayawada. Methods: Total of 50 patients with cholesteatoma was included based on symptomatology such as discharge from ear, hard of hearing, giddiness. Lower and upper age limit is 10 to 50 years, investigations include all hematological, radiological, and therapeutic procedures were done. All sensorineural cases excluded. Results: Male to Female ratio observed to be 3:1 most common age group was 11 years to 20 years MRM with Columella Ty-III.

5. A Clinical Study of Efficacy of Diathermy Incision Vs Scalpel Incision in Patients Undergoing Open Hernia Surgery
M.C. Venkateswarlu, S. Veerabhadrarao, G. Chandra Kala, N. Nitesh Kumar
Abstract
Introduction: An incision is a slit or cut used to get entree to deeper structures. Electro cautery is a medical term that refers to the process of burning a part of the body to get rid of or shut it. Although fears of severe scarring and poorer wound healing have restricted its usage for skin incision, electro-cautery is becoming more often employed for tissue dissection. Material and Methods: A total of 60 patients receiving mesh plasty for inguinal hernia are distributed into two groups in this prospective randomized research. A skin incision is made using electro-cautery in Group A, while a scalpel incision is made in Group B. The two groups are compared in terms of postoperative pain, wound complications, and the need for analgesics. Finally, using the Mann-Whitney U Test, the findings are examined and equated for the two groups. Results: Postoperatively pain will be calculated by using pictorial visual analogue scale at 6hours, 12hours and 24 hours. In case of pain score is >4 INJ.DICLOFENAC 50 mg IM would be given. In the post-operative period complication noted in hospital stay are calculated by means of Seroma- discharge of serous collection in suture site,   Hematoma- blood collection. Conclusion: The results of both groups, namely the diathermy and Scalpel groups, have been confirmed to be comparable based on the findings of this study of the following; 1. Postoperative pain, 2. The need for analgesics, 3. Wound problems after surgery.

6. Distal Arcade of Superficial Layer of Supinator Muscle: An Anatomical Study
Aditya Moota, Mohammed Awais Ahmed, Anitha T
Abstract
Background: The supinator muscle is located in the forearm and plays a role in the rotation of the forearm. Understanding the anatomy of the supinator muscle, including its layers and specific regions like the distal ar-cade, is important for healthcare professionals, especially in fields such as anatomy, physical therapy, and Or-thopaedics. Aim and Objectives: To make a detailed anatomic description of the distal arcade of the supinator muscle and its relation with the PIN. Materials and Method: This was an observational study done on 50 upper limbs belonging to 25 adult cadav-ers (17 males and 8 females) available in the Department of Anatomy, Chalmeda Anand Rao Institute of Medi-cal Sciences, and Karimnagar. The age of the cadavers ranged from 35 to 86 years. Study was conducted after getting permission from institutional ethical committee and after following inclusion and exclusion criteria giv-en below for the duration of 2 years. Results: In the present study 50 forearms and elbows were dissected. The nature of the distal arcade of superfi-cial layer of supinator muscle that was most commonly seen was the muscular type 21(42%), followed by the musculotendinous and tendinous types. Conclusion: Knowledge of the anatomic findings of the distal arcade of the superficial layer of the supinator and the localization of the PIN are important in the surgical management of PIN entrapment.

7. Scenario of Native Microorganisms Used to Cure Textile Dyes in a Microbiological Manner
Saboor Naik, V. Lakshmi, A.G. Murugesan
Abstract
Background: Contamination to this aquatic system brings serious threat overall socio-economic pattern of the study. So, proper analysis is needed to assess the pollution level also for the protection of environment and natural resources. Aim: o assess azo dye decolourising ability of the wild strains/native flora (Kovilpatti) of bacteria isolated from effluent of textile industry. Materials and Methods: Effluent Sample from textile industry effluent discharge sites, Remazol yellow, Bushnell Hass medium were used to conduct our research. Results: Textile mills uses acid based dyes which are able to damage ecosystem. Peoples are using various methods to remove that dyes but they are not efficient. To understand the efficiency of microbes on dye degradation this work was undertaken using wild strains isolated from dye contaminated effluent. Conclusion: These created pollution to water bodies and its surrounding ecosystem. Various physical, chemical and biological methods are available to curtail the problem but still there is no opt method to overcome this problem. In this study trial was done using wild / native dye degradative microorganisms for the decolourization of pure azo dye. If these microorganisms decolourize this synthetic azo dyes effectively then it will be taken to field for the bioremediation process. By considering ecological impact of azo dye the present study was undertaken with specified aim and objectives.

8. Comparative Study of Fetomaternal Outcome in Women with GDM on Insulin and Women with Normal OGCT Value
A. Vijayalakshmi, R. Aarthikarasi, Susithra Saravanan, T. Suganya
Abstract
Background: Gestational Diabetes Mellitus (GDM) is clinically defined as “impaired glucose tolerance with onset or first recognition during pregnancy.” This metabolic disorder is characterized by elevated blood glucose levels, posing challenges to maternal health. Globally, its prevalence ranges between 11-14%, impacting approximately 31.7 million individuals. In India, there is a concerning trajectory, with diabetes expected to surge to 79.1 million cases by 2030. Amis and Objectives: (1) The study aims to compare the maternal and perinatal outcomes in pregnant women with GDM on Insulin and women with normal OGCT values. (2) This study aims to investigate maternal outcomes concerning associated comorbidities, insulin necessity, methods of induction, and delivery mode in cases of gestational diabetes mellitus (GDM). (2) To study the fetal outcome in terms of Macrosomia, Shoulder Dystocia, Preterm labour, IUGR, Stillborn, and need for NICU care. Materials and Methodology: This comparative study was undertaken on 120 pregnant women to compare the maternal and fetal outcome in pregnant women with GDM on insulin and women with normal OGCT value in Government Dharmapuri Medical College Hospital, Dharmapuri in a period of 6 months from May 2023 to October 2023. Results: In our study, the maximum incidence of GDM occurred in the age group between 26 to 35 years. In this study, there is no statistical significance in primigravida and multigravida between both groups. In our study, 18.3 % of women with GDM had associated preeclampsia complicating pregnancy. Polyhydramnios is more common in GDM women and is a sign of poorly controlled blood sugar levels. In this study, the incidence of Polyhydramnios in women with GDM was about 43.3%. UTI is one of the most common complications associated with women with GDM. There was no statistical significance in this study between the two groups because of good glycaemic control. In our study, preterm labour was encountered in 13 women (21.7%). Among these, 7 women (11.7%) with preterm labour had associated UTI. More number of elective Inductions was done earlier in GDM women. Due to fear of complications of GDM, these women were not allowed to continue their pregnancies till the Expected date of delivery, whereas women without GDM were allowed till their EDD. The incidence of Macrosomia was 16.7%. Intrauterine death 2 (3.3%) was seen. Conclusion: To conclude, based on the observations made in this study, women with GDM on Insulin is associated with adverse complications in both the mother and fetus. Therefore, all antenatal women attending the OPD should be offered a simple Oral Glucose challenge test, and if found. Negative the test has to be repeated every trimester. Once diagnosed with GDM appropriate glycaemic control either via insulin or meal plans has to be achieved for good pregnancy outcomes and to prevent complications. .Early diagnosis, patient education, a multidisciplinary approach, and better glycaemic control are the keys to successful Fetomaternal outcomes.

9. A Cross-Sectional Study on Exploring the Morphological Characteristics and Clinical Significance of Nutrient Foramina in the Human Ulna
Arbind Kumar Choudhary, Anuja Sinha, Nawin Kumar
Abstract
Background: The human skeletal system is a remarkable marvel of biological engineering, bearing significance in anatomical research and clinical practice. Among its components, the ulna, a pivotal bone in the forearm, plays a crucial role in upper limb functionality and structural integrity. Of particular interest within ulnar anatomy are the nutrient foramina, small openings that serve as conduits for blood vessels, supplying vital nutrients to the bone. Understanding these foramina holds both academic and clinical importance. Methods: In a cross-sectional observational study, 65 human ulna specimens were examined. These specimens, sourced from well-documented anatomical collections or cadaveric sources, represented diverse age groups, sexes, and demographic backgrounds. The study involved a comprehensive assessment of nutrient foramina, including their location, number, size, and morphology. In addition, histological samples were prepared, and radiographic imaging was performed on select specimens. Statistical analysis explored potential correlations between foramen characteristics and demographic factors. Results: Morphological examination revealed significant variations in nutrient foramina across ulna specimens. These included diverse locations, numbers, sizes, and shapes of foramina, with the diaphysis being the most common site. Histological analysis affirmed the role of foramina in bone nutrition and remodelling. Radiographic imaging provided valuable three-dimensional visualization, confirming foramen characteristics. Statistical analysis, however, did not uncover significant correlations between foramen features and the age or sex of the specimens. Conclusion: This study advances the comprehension of nutrient foramina in the human ulna, enriching the understanding of forearm anatomy. Practical implications extend to orthopaedic surgery, where knowledge of foramen characteristics aids surgical planning and execution. Recommendations: Future research should explore nutrient foramina within the broader context of bone physiology and pathology. Expanding studies with larger sample sizes may yield further insights into the clinical significance of these structures, enhancing our ability to diagnose and treat bone-related conditions.

10. Knowledge, Attitude and Practices among Convalescent Plasma Donors Attending a Tertiary Care Centre in South-East Karnataka during COVID-19 Pandemic
R Sreelatha, Gayathri A M, Aishwarya V, Mohammed Shihab V K, Panchakshari Prasanna B K, Dheemantha P
Abstract
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019 and led onto a global spread in March 2020, after which COVID-19 was declared a pandemic. By July 28 2021, over 196 million cases were confirmed, spanning 188 countries or territories and accounting for over 4 million deaths Early in the outbreak, preventive and treatment options were limited, of which antibody therapy (i.e., convalescent plasma collected from individuals after recovery from COVID-19) has emerged as a leading treatment for COVID-19 [2] especially in treatment of severe cases . Several large clinical trials have now been initiated to evaluate the efficacy and safety of convalescent plasma treatment of SARS-CoV-2 patients. Data show that convalescent plasma treatment is safe and suggest that it can reduce disease if given early enough and with sufficient levels of antibodies. Objective of this study was to measure the level of efforts needed to promote convalescent plasma donation programs for COVID-19 convalescent population having no basic knowledge on the subject. Materials and Methods: A blood centre based cross sectional study was conducted in Department of Immunohematology and Blood Transfusion, Bangalore Medical College and Research Institute, Bangalore, Karnataka over a period of 9 months (July 2020 to April 2021). Bangalore is the Silicon Valley of India with a metropolitan population. The convalescent donors came to know about the plasma donation through various platforms namely social media (39%), NGOs (32%), newspaper/magazine advertisements (7%), television and radio (1%), heard from other people (4%), other plasma donors (7%) and incentive announced by government of Karnataka (10%). 27.45% plasma donors were aware about their blood group and 82.35% participants had previous history of blood donation. Only 15.68% (8 out of 51) participants were aware about the apheresis procedure and among them only 4 donors had previous experience of apheresis procedure. Attitude towards convalescent plasma donation: The questionnaire included following aspects with 5 point Likert scale assessment. 11.76% of CP donors knew that nulliparous females were eligible for plasma donation and 80.39% are unaware of female CP donation eligibility criteria. 13.72% donors preferred known persons over unknown in relation with replacement donation and 2 out of 51 participants preferred unknown over known. 9.8% participants responded they had no such preference. 19.61% participants think that it’s their duty as a citizen to help fellow countrymen who are in need and 5.8% had a neutral response. Conclusion: To increase awareness and marketing ‘Voluntary convalescent donation can enhance adequacy of convalescent plasma needs of the entire country. This study also underlines how different media, especially electronic media, can be used to propagate convalescent plasma donation.

11. Pediatric Intestinal Obstruction in Children Less Than 12 Years – Observational Study in a Tertiary Care Hospital and Review of Literature
L Dasaradha Rao, S Rohit, V L Sravanthi, Sasidhar Thorlikonda
Abstract
Aim: To study the clinical presentation, the demography, etiology, presenting features, management and outcome of intestinal obstruction in pediatric population of age less than 12 years over a period of 1.5 years in a tertiary care institute. Materials and Methods: It is a retrospective observational study of children presented with intestinal obstruction managed over a period of 1.5 years from June 2022 to December 2023 at Department of pediatric surgery Siddhartha medical college and hospital, Vijayawada. All children admitted into the department of pediatric surgery with a diagnosis of acute intestinal obstruction were studied. Neonatal cases (children age less than one month), Children with age more than 12 years and cases with paralytic ileus were excluded from current study. Cases were diagnosed by clinical features, x-ray erect abdomen. All children were subjected for serological examination for dys-electrolytemia. Contract enhanced computed tomogram (CECT) was demanded for cases in suspicion. Hospital records were verified and analysed using MS office professional 2013 and SPSS software version 29. Results: a total of 67 cases were managed for intestinal obstruction during the period of study. Male children (n=41) are effected most commonly. Pain abdomen was the most common presenting complaint followed by bilious vomiting and distension of the abdomen. Shock and dys-electrolytemia were among the complaints in 6 and 12 cases respectively. The commonest etiology identified was adhesions and congenital bands (n=23) in the present study followed by Intussusception. Trichobezor was the least common cause seen in only one child. All children were managed surgically. 2 cases succumbed to death due to continued dyselectrolytemia and shock in the present study. Conclusions: Intestinal obstruction is one of the common Pediatric Surgical emergency accounting for nearly 15% of the admissions at our center. The incidence is higher in males than in females. Abdominal pain, vomiting, abdominal distention and constipation are the predominant presenting symptoms. Adhesions and Congenital bands are the commonest type of intestinal obstruction 34.3%. Intussusception 28.3% and Malrotation 8.9% are the next common types in our study. Mortality is significantly higher in those who present late (>72hrs) than in those presenting between 24 to 72hrs. Mortality was noted in patients presenting late with signs of peritonitis, septicemic shock, gangrene of the bowel and perforation. Early diagnosis, correction of dyselectrolytemia and shock and timely surgical management can prevent gangrene of bowel and reduce mortality.

12. To Evaluate Different Doses of Lignocaine and Bupivacaine Combination for Ultrasonographic Guide Supraclavicular Brachial Block
Tahir Ali Khan, Richa Pandey, Urmila Keshari, Charulata Patidar
Abstract
Background: Regional anaesthesia is an effective technique to relieve pain in upper limb surgery. For upper extremity surgeries, Brachial plexus block, supraclavicular approach is the easiest and the most commonly used method. Local anaesthetics, lignocaine and bupivacaine for ultrasound guided in two different doses (20ml and 30ml) are used to provide analgesia. Aim and Objectives: To evaluate the efficacy and the onset and duration of sensory and motor block with lignocaine and bupivacaine for ultrasound guided supraclavicular brachial plexus block in two different doses (20ml and 30ml) and to assess hemodynamic stability and occurrence of side effects and complications. 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 supraclavicular block. The patients were randomly divided into two groups of 30 each .Group A patients received 0.5% bupivacaine (10ml) + 2% lignocaine (10ml).Group B Patients received 0.5% bupivacaine (15ml) + 2% lignocaine (15 ml) Descriptive statistics was done and were reported in terms of mean, standard deviation and percentages. Results: The mean heart rate in group A was 76.97±6.19 and in Group B it was 76.80±6.16. Mean Arterial Pressure (MAP) in Group A was 91.69±3.51 and in Group B it was 91.68±3.36.The mean onset of sensory and motor blockade was found statistically significant(p<0.05) which means that it takes higher time for onset of blockade with low volume 20ml in group A when compared with Group B. The mean Duration of Sensory Block in group A and group B was 271.67±51.60 minutes and 287.00±42.28 minutes respectively whereas the mean Duration of Motor Block was 245.00±53.74 min and was 270.67±42.18 minutes. The mean duration of motor block was significantly higher in group B as compared to group A. Conclusion: The application of USG guided supraclavicular brachial block can be considered sufficient to be able to provide similar duration of sensory block with 20ml combination of lignocaine and bupivacaine when compared with 30ml of same drug.

13. Validation of Automated ESR Method by Capillary Photometry with Conventional Westergren Method
Subinay Datta, Biswajit Sarkar, Srabani Ghosh, Palash Kumar Mandal, Payel Das, Shreya Halder, Mrinal Pal
Abstract
Background: Westergren method is routinely used for ESR measurement. However, it has various limiting factors. Alternative method has to be devised to overcome the limitations of the manual Westergren method. These new methods must be properly evaluated before introducing in clinical laboratories. Methods: A total of 708 randomly collected Ethylene Diamine Tetraacetic Acid (EDTA) samples from patients attending in hospital were assayed parallelly in the recently launched Hematology Analyzer Roller 20 LC and manual Westergren method. Results of these assays were subjected to statistical analysis using a coefficient of correlation and ROC. Results: The result showed that mean values of different range of blood ESR obtained by Capillary photometry was not significantly differ from gold standard manual Westergren method. To evaluate the correlation of capillary photometric method with reference method Pearson bivariant correlation analysis was performed. Over the whole range of blood ESR values in reference method, the capillary photometric method shows r value (r = 0.948, p < 0.0001) of blood ESR of same individual. It signifies that values of ESR in capillary photometry of the subjects are significantly correlated with value obtained from reference method. The ROC curves were analyzed and were plotted for the validation of the blood ESR estimation by capillary photometric method. The analysis of the ROC curve illustrated that 0.82 was the area under the curve (AUC) for the method (95% CI, 0.77–0.89, P < 0.05). Conclusion: Hence, it is concluded that in laboratories where the workload is high, automated method of ESR measurement can be conveniently used as a replacement of the standard Westergren method.

14. Clinico-Epidemiological Study of Non-Venereal Dermatoses Involving Male Genitalia
Rabi Narayan Nanda, Chandan Kumar Gantayat, S Jaganath Subudhi, Manoj Kumar Ram, Prasenjeet Mohanty, Diptiranjani Bisoyi
Abstract
Introduction: Non-venereal dermatoses of male external genitalia include a spectrum of disease of varied etiology. Any genital dermatoses whether venereal or non-venereal in both sexes is associated with immense stress and anxiety, because of the lack of proper knowledge in the field. Aim: To determine clinical and epidemiological pattern of non-venereal genital conditions in the male. Material & Methods: This was an observational study undertaken in patients with genital skin lesions attending the outpatient department of dermatology at a tertiary health-care center. A detailed history was taken; the genital and dermatological examination was performed. Patients with genital diseases were excluded from the study. Result: Majority of the patients were in the age group of 21-30 years. In this study genital alone comprised of 130 (65%) accounting for most patients followed by genital and skin involvement in 49 (24.5%), oro-genital and skin in 14 (7%) and oro-genital in 7 (3.5%). Pearly penile papules (PPP), scabies, lichen planus, pemphigus vulgaris cases were most common lesions in only genital lesion, genital- skin lesion, orogenital lesion and orogenital-skin lesions respectively. Conclusion: Nonvenereal genital dermatoses are more frequent than STIs, as shown by this study. Various causes of non-venereal dermatoses are highlighted in this study. The topic is complicated because it involves a wide range of illnesses with different aetiologies, both non-sexual and sexual.

15. Comparison of Two Doses of Intravenous Esmolol in Attenuation of Hemodynamic Response to Extubation in Laparoscopic Surgeries
Midur Kumar Sharma, Archana Rani, Saroz Ahamad
Abstract
Background and Objectives: The aim of this study was to compare hemodynamic parameters, including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, throughout the extubation time period after the administration of two different doses of intravenous (IV) esmolol. Material and Methods: This study was a prospective double-blind randomized controlled trial with patients classified as ASA grade I and II, aged between 18 and 65 years, who were scheduled to have an elective laparoscopic surgery under general anaesthesia with endotracheal intubation. A total of sixty participants were randomly assigned to three groups, with each group consisting of twenty individuals. The first two groups were administered intravenous esmolol injections at dosages of 0.5 mg/kg and 1 mg/kg, respectively. The third group got a placebo injection of 10 ml normal saline intravenously when the surgery was completed, prior to extubation. Results: The demographic data exhibited statistical similarity between the groups. Administering esmolol intravenously at both 0.5 mg/kg and 1 mg/kg effectively reduces the heart rate response. However, a bolus of 1 mg/kg is more efficient than a bolus of 0.5 mg/kg in reducing the blood pressure response during extubation. This higher dose provides more consistent control of hemodynamics both during and after extubation. Conclusion: Extubation and emergence from general anaesthesia result in substantial elevations in heart rate and blood pressure. It is crucial to focus on reducing this sympathetic response, particularly in patients who are more susceptible to its effects. Administering esmolol intravenously is a successful method for attenuating the heart rate and blood pressure responses during extubation after surgery, while maintaining stable hemodynamics.

16. Comparative Study between Oral Labetalol Vs Oral Labetalol with Oral Frusemide in Control of Blood Pressure among Postpartum Mothers with Severe Pre-Eclampsia
T. Suganya, A. Vijayalakshmi, Susithra Saravanan, R. Aarthikarasi
Abstract
Background: About 10% of all pregnancies are still affected by pregnancy-related hypertension, which continues to be a serious public health concern. It ranks as the second most frequent global cause of maternal death. Both normotensive women and those who have had prior hypertension typically have a blood pressure peak three to six days after giving birth. Even without hypertension during pregnancy, about 5.7% of cases of preeclampsia or eclampsia may manifest de novo in the postpartum period (up to six weeks). There is mobilization of fluid from the extravascular spaces and interstitial areas to the intravascular space during the postpartum period, leading to hypertensive crisis and complications. Numerous strategies have been put forth to quicken postpartum mother recovery, but it is still unknown how beneficial they will be and what the best postpartum antihypertensive regimen should be. It has been suggested to employ furosemide for this purpose. This is a crucial justification for the use of furosemide therapy because, due to its mechanism of action, this loop diuretic can act on patients with fluid overload by removing intravascular fluid that has been mobilised during the postpartum period. This lowers blood volume, blood pressure, and the requirement for antihypertensive therapy. Aims: The aim is to determine the effectiveness of a brief course of oral frusemide 40 mg OD in postpartum mothers with severe preeclampsia from postnatal day 1 to postnatal day 5. Objectives: (1) To assess if the brief course of oral frusemide. (2) Accelerates recovery. (3) Shortens duration of hospital stay by enhancing diuresis. (4) Reduces morbidity and mortality. (4) Reduces need for additional antihypertensive. Methodology: (1) The study was a single blinded randomized control study. (2) Patients are randomized by simple randomization. (3) The study was conducted among postpartum mothers with severe preeclampsia who are already on treatment with oral labetalol, admitted and delivered in department of OG in GDMCH. Results: (1) The data was collected from a total of 120 women who were equally divided into two groups, group A receiving labetalol and group B receiving labetalol and furosemide. (2) Almost half of them, 59 (49.17%) were between 28-37 weeks of gestation, 44 (36.67%) were found to be above 37 weeks of gestation and 17 (14.16%) were having less than 28 weeks of gestation. (3) Caesarean section was the most common mode of delivery observed in the study participants in 82 (68.3%). (4) About 13 (10.8%) study participants required additional anti-hypertensive drug (nifedipine) to lower their blood pressure among those receiving Tab. Labetalol alone. (5) There was a significant reduction in systolic blood pressure among those receiving Tab. Labetalol along with Tab. furosemide. (6) Complications were found to be significantly higher in group receiving Tab.Labetalol alone and all 5 cases of acute pulmonary edema were reported in the same. Conclusion: These study results show that there is significant reduction in systolic blood pressure when post-partum mothers with severe Pre-Eclampsia were treated with Tab.Labetalol along with Tab.Furosemide. Complications were found to be significantly higher among those taking Tab.Labetalol alone and all 5 cases of acute pulmonary edema were reported among them. Additional anti-hypertensive drugs were required for blood pressure control only. These results indicate that furosemide when used along with labetalol can be used as an effective anti-hypertensive drug in postpartum period.

17. Evaluation of Effectiveness of Early Clinical Exposure in Learning Anatomy to 1st MBBS Students
Varsha R. Bhivate, Manoj. R. Bhivate, Mithula Raj, Bhakti Sarang
Abstract
Context: The National Medical Council of India recently announced a number of reforms and upgrades to medical education, including the inclusion of “early clinical exposure” (ECE) in the newly proposed competency-based medical education. Aim & Objectives: To assess the knowledge, skill, the improvement in scores and perceptions of 1st MBBS students after early clinical exposure. To study feasibility of ECE as a T-L method for phase 1 curriculum. Materials & Methods: A prospective interventional study was done on the evaluation of the effectiveness of early clinical exposure in learning anatomy to 100 students of the 1st MBBS (21–22 batch) and Anatomy faculty in Terna Medical College, Mumbai, after ethical permission. Data was collected using a validated, anonymous, self-administrated questionnaire that also included clinical-based questions on thyroid glands and was assessed using a five-point Likert scale. Participants and faculties perceptions about ECE were studied. In the control group, the traditional method is used. Discussion: ECE improves learning in all three areas of a medical student’s learning – cognitive, psychomotor, and affective – indicating that it is an excellent strategy to supplement standard theoretical teaching. Results and Conclusion: ECE can be considered as an effective method of teaching, advantageous to the slow learners and an effective T-L method in teaching. 88.2%students feel that ECE should be an integral part of curriculum. 81.6% students feel there is significant improvement in knowledge in basic subject after ECE. But as per new guidelines by NMC 2023 number of hours for ECE reduced for phase 1 subject that should be revised.

18. Study of Cerebro-Spinal Fluid in HIV Infected Patients at a Tertiary Care Hospital in Maharashtra
Sarika Wagh, Bhushan Ubhale
Abstract
Background: The incidence of neurological complications directly related to human immunodeficiency virus (HIV) infection has not decreased proportionally, probably due to low penetration of anti-retroviral (ARV) drugs into the central nervous system (CNS), the neuronal toxicity of ARVs or the persistence of neuronal lesions caused by HIV infection before treatment. Hence, cerebrospinal fluid (CSF) analysis will be used clinically to treat opportunistic infections and co-infections. Method: 80 (eighty) adult HIV infected patients after 4-6 weeks of diagnosis aged between 19-50 years were studied. HIV infection was confirmed by retesting at our centre. Also, CD4 cell count was done. CSF was drained through a lumbar puncture under all aseptic precautions with standard protocols. MRI Brain was also done to rule out brain tumours and brain atrophy. Results: In the CD4 cell count study, 48 (60%) had 83 to 100 cells/mm³, and 32 (40%) had 101–140 cells/mm³. 25 (31.2%) HIV infected patients had Tuberculosis (TB), 41 (51.2%) had Candidiasis, 11 (13.7%) had Diarrhoea and 3 (3.75%) had Pneumonia as associated co-morbidities. The CSF analysis findings were: Proteins- 52 (65%) patients had 75-80 mg/dl, 28 (35%) had 81-90 mg/dl, Glucose- 50 (62.5%) had 38.44 mg/dl, 30 (37.5%) had 45-50 mg/dl, Cell count- 46 (57.5%) had 5-7/µL, 34 (42.5%) had 8-10/µL. India ink staining: 34 (42.5%) had 19-25 Cryptococci and 46 (57.5%) had 20–26 Cryptococci per high power field (hpf), Cryptococcal Antigen titre: 25 (31.2%) had 1:16, 55 (68.7%) had 1:32. The Cryptococcal culture (base line) was: 60 (75.1%) had 20–26 colony forming units (CFU)/ml, and 20 (25%) had 27–29 CFU/ml. Conclusion: CSF analysis has a well-defined and valuable role in the diagnosis of CNS infections in HIV/AIDS patients. It will help the clinician treat and avoid morbidity and early mortality because HIV infection is treatable, not curable.

19. ISO 15189 Internal Auditor Training- Feedback from Participant to Make It More Effective and Convenient
Dhvani Jethva, Shruthi Pappula, Sarita Patel
Abstract
Introduction: ISO 15189 will equip trainees with effective auditing techniques and will increase understanding of audit methodologies. Trying to improve the quality of training that will be given under NABL ISO 15189. Material and Method: The study was done for improving the training of internal audit. Participants who have already taken training were asked to fill questionnaire in the Google form regarding the cost effectiveness, mode of training, material of reference, No. of days of training, frequency at which training should be conducted and mock audit. For each question we had given certain option which will be chosen by earlier participants. For each question % of the answers are calculated individually to analyses whether the training is up to mark or has to be improved. Result: The results obtained are as follows, for the cost of training to be 58.1% answered it to be five thousand. For the no of days maximum people gave the answer as 3 days. For mode of training results obtained were 80.23% offline.60.46% of trainees wanted weekdays as the days to be included for training session.60.4% of participants wanted power point presentation as the method for training to be conducted. Once in year was selected by 40.6% of trainees for how frequently the training should be conducted. All the participants have answered for the mock audit to be conducted. Conclusion: Most of them seem satisfactory with the training. Many of them suggested we have small break sessions during training. Live training sessions was also suggested as it could be more interactive.

20. Study on Effect of Yoga and Meditation in Reduction of Stress in Diabetic and Hypertensive Patients
Imran Yusuf, Mohammad Najmuddin Khan, Juhi Aggarwal
Abstract
Stress is a response to a physical threat or psychological distress that generates a host of chemical and hormonal reactions in the body. As a part of the adaptive response to stress, various body systems such as the autonomic, cardiovascular, gastrointestinal, and immune systems may be affected. Yoga and meditation help therapeutically and promotes physical and mental health. Study group of patients & individuals were enrolled from both MGM hospital and International Sahaja Yoga Meditation and Research Centre. So it may be concluded that Sahaja yoga meditation if included as part of regular treatment regimen along with routine medication it can lead improvement in quality of life by reducing stress and thus prevent   complications of Diabetes mellitus & Hypertension.

21. The Comprehensive Evaluation and Management of Ocular Trauma in a Tertiary Eye Care Center of Central India
Kanoje Jyoti, Warkhede Padmini, Siddiqui Pervez Ahmed
Abstract
Objectives: This study was aimed to examine the presence of visual damage due to ocular trauma and assess visual outcomes, and document the clinical spectrum and outcome following ocular injuries among patients presenting to tertiary care centre in central India. Methods and Material: This was a hospital-based prospective interventional study conducted over a period of two years from August 2019 to August 2021. Patients with ocular injuries attending the casualty and the Ophthalmology department were included in the study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The patients were followed up at regular intervals, initially at one week and subsequently at three and six weeks upto 6 months. Results: During this study, 182 patients and 200 eyes with ocular injuries taken into consideration, amongst them there were 141 males (77.47%) and 41 females (22.53%) patients. The male to female ratio was 3.43:1. [Table- 1] During this study, age group with more incidence of ocular trauma was 21 – 30 years (31.32%). [Table -1] In our study, according to BETTS classification close globe injuries (69.5%) were more common than open globe injuries (30.5%). [Table-2] Contusion injuries (62%) were more common in closed globe injury while penetrating globe injuries (17%) were more common in open globe injuries. [Table-2] Ocular trauma score (OTS) 5 belonged to close globe injuries whereas ocular trauma score 1 belonged to open globe injuries, remaining ocular trauma score 2, 3, 4 belonged to both open and closed globe injuries and most of ocular injuries were between ocular trauma score 3 to 5. [Table-3] Ocular adnexa (75.5%) were predominately affected in ocular injuries with periorbital edema or ecchymosis (26%) being most common followed by lid laceration (23.5%) whereas sclera (10%) was least affected. [Table-4] Conjunctiva (47%) was the second most common structure to be involved in ocular trauma with subconjunctival haemorrhage (28%) being most common clinical presentation with conjunctival injuries. [Table-5] Cornea (42.5%) and iris (43.5%) were affected in almost equal proportions, presenting commonly as corneal foreign body (12.5%) and iris prolapse (17%) respectively. [Table-5] Traumatic cataract (7.5%) was the most common finding followed by Subluxated or dislocated (4.5%) in patients with Lens related injuries (13%). [Table-5] Among anterior chamber (36.5%) involvement, traumatic hyphema (17%) was found to be most common presentation [Table-5]. Vitreous (14%) was the most common structure affected followed by retina (12%) in posterior segment injuries (35%).[Table-6] Lid repair (23.5%) was most commonly performed surgery in closed globe and corneal-scleral laceration related surgeries (28.5%) most common surgical intervention in open globe injuries. [Table-7] Corneal opacities (25.5%) most common late complication followed by cataract (7.5%) and secondary glaucoma (5%) after ocular trauma. [Table-8] In closed globe injuries, 34.54% patients had less than 6/60 vision at the time of presentation which reduced to 12.23% after 6 months. [Table-9] In open globe injuries, only 44.26% of patient had visual acuity less than 6/60 after 6 months as compared to 96.72% at the time of presentation. [Table-10]. Conclusion: Ocular trauma remains a significant cause of monocular vision loss especially in developing country like India. Rural and young population are more prone to ocular trauma, entailing increased lifetime of disability years. Though open and closed injuries both causes long term complication and vision loss, open globe has poorer prognosis and ocular trauma score (OTS) is a simple and effective way to assess the visual of outcome. Medical as well as surgical intervention forms integral part of management in ocular trauma patients.

22. A Comparison between the Effect of Epley’s Manoeuvre and Brandt-Daroff Exercise on Patient’s Recovery Rate and Disability in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo
Mary Nirmala S, Kavitha M, Naadia R
Abstract
Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a prevalent vestibular disorder affecting 2.4% of the population, often leading to debilitating symptoms and impacting the quality of life. This study aims to compare the effectiveness of Epley’s maneuver and Brandt-Daroff exercises in the recovery pattern and disability of patients with posterior semicircular canal BPPV. Methods: A one-year prospective comparative study was conducted at the Department of Otorhinolaryngology in Government Kilpauk Hospital and Government Royapettah Hospital. A total of 69 patients (37 in Epley’s maneuver group, 32 in Brandt-Daroff exercise group) between 18 to 50 years old with typical symptoms of posterior canal BPPV were included. The study assessed the participants using Visual Analog Scale (VAS) and Dizziness Handicap Inventory (DHI) scores before and after the procedures. Results: Both groups demonstrated significant improvements in VAS and DHI scores post-treatment. Group A (Epley’s maneuver) showed a more substantial decrease in VAS and DHI scores compared to Group B (Brandt-Daroff exercise). The recovery rate, defined as VAS <2 and DHI<10, was higher in the Epley’s maneuver group. Discussion: The study aligns with previous research indicating the effectiveness of Epley’s maneuver in reducing symptoms and improving the quality of life in patients with BPPV. However, Brandt-Daroff exercises also showed significant improvements, suggesting its potential as a home-based alternative when access to medical care is challenging. Conclusion: Epley’s maneuver demonstrated superior outcomes in terms of recovery and reduction in disability compared to Brandt-Daroff exercises in the treatment of posterior semicircular canal BPPV. Brandt-Daroff exercises, while showing effectiveness, could serve as an alternative for patients facing barriers to immediate medical consultation, enabling self-management at home. Timely diagnosis and treatment of BPPV are crucial for alleviating symptoms, improving patients’ well-being, and reducing unnecessary healthcare burdens in the community.

23. To Measure the Thickness of Plantar Fascia by Ultrasonagram Before and After Botulinum Toxin-A versus Methyl Prednisolone Acetate Injection in Plantar Fasciitis
Geetha. T, Premalatha. K, Jeyakhar. J
Abstract
Background: Plantar fascia acts as dynamic shock absorber and it also give support to the longitudinal arch of the foot. Plantar fasciitis occurs due to repetitive trauma to plantar fascia leading to degenerative changes at its calcaneal origin leading to pain and dysfunction. This study is done to assess the thickness of plantar fascia by ultrasongram before and after intervention with Botulinum toxin-A injection versus Methyl prednisolone acetate injection. Methodology: Hundred Participants with plantar fasciitis was selected in PMR-OPD in Government Institute of Rehabilitation Medicine Hospital and divided into two groups by simplified Randomized control study. Group 1 received Botulinum toxin-A injection and Group 2 received Methyl Prednisolone acetate injection. Thickness of Plantar fascia using ultrasonagram and Visual analog scale (VAS) for pain was assessed before and after treatment at 6 months. Conclusion: This study shows that there was significant reduction in thickness of Plantar fascia after intervention in both the groups after 6 months and it correlates with decrease in pain measured by VAS score.

24. Development of Chronic Lung Disease: Restrictive Versus Obstructive Lung Disease in Post COVID-19 Patients
Narendra Bidarkar, Dinesh Ramesh Aahuja
Abstract
Background: This study investigates the development of chronic lung diseases post COVID-19, differentiating between restrictive and obstructive types. Materials and Methods: Conducted at Navi Mumbai Municipal Corporation Hospital, the study involved 50 post-COVID-19 patients, utilizing history, clinical examination, chest X-rays, and pulmonary function tests. Results: The study found a significant prevalence of restrictive lung disease (30%) and moderate obstructive airway disease (2%). Key findings include a reduced six-minute walk test in restrictive lung disease patients, and significant differences in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1) between those with and without restrictive lung disease. Conclusion: Post-COVID-19, a considerable proportion of patients experience respiratory function impairment, highlighting the need for thorough follow-up and potential pulmonary rehabilitation.

25. A Comparative Analysis of Laminectomy and Laminotomy for Lumbar Disc Prolapse Patients
Sandeep Pradhan, Amlan Dash, Bhabani Sankar Mohapatra, Udayan Das, Gopabandhu Patra, Barsha Baishali Parida
Abstract
Background: Lumbar disc prolapse is a common spinal condition that often requires surgical intervention for symptom relief. Two primary surgical approaches, laminectomy and laminotomy, are employed to address this condition. This study aims to comprehensively evaluate and compare the clinical outcomes, postoperative complications, and long-term benefits associated with these two surgical procedures, providing valuable insights into the optimal choice of surgical intervention. Methods: A retrospective comparative analysis design was utilized in this study. A total of 70 participants meeting strict inclusion criteria were included. Various variables were considered, including the surgical approach (laminectomy or laminotomy), clinical outcomes, complications, length of hospital stay, and long-term follow-up data. The surgical procedures were meticulously documented, encompassing patient positioning, anaesthesia, disc prolapse removal, and any additional interventions. Postoperative care was administered, and statistical analysis involved both descriptive and inferential statistics. Result: Analysis of the seventy patients revealed that both laminectomy and laminotomy yielded significant improvements in pain relief, functional recovery, and neurological outcomes. Importantly, there were no statistically significant differences between the two surgical approaches in terms of clinical outcomes and complication rates. The demographic analysis demonstrated well-matched patient populations. Postoperative complications were comparable, and hospital stay durations did not significantly differ between the groups. Conclusion: This study provides robust evidence that both laminectomy and laminotomy are effective surgical options for managing lumbar disc prolapse, offering comparable clinical outcomes and postoperative complication rates. The choice between these procedures should consider individual patient characteristics and surgeon expertise. Recommendations: Based on the findings, it is recommended that clinicians and surgeons carefully assess patient-specific factors and preferences when selecting the surgical approach for lumbar disc prolapse management. Additionally, further prospective studies with larger sample sizes should be conducted to validate and expand upon these results.

26. A Retrospective Cohort Study Comparing the Results of Open and Laparoscopic Appendectomy
Nehal Sisodiya, Tanu Priya, Chetan Aehral, Pateliya Bhavikkumar Ishvarbhai
Abstract
Introduction: Appendectomy is the most common emergency surgical procedure worldwide. In Western countries, the lifetime incidence of appendicitis is approximately 8%. Across all age groups, appendicitis is the most frequent reason for abdominal surgery. For over a century, open appendectomy has been the preferred method of treating patients with acute appendicitis. Aims and Objective: To compare the results of open and laparoscopic appendectomy. Material and Method: The study focuses on a retrospective analysis of appendectomies. This study examines the results of laparoscopic appendectomy and open appendectomy (OA and LA), taking into account a range of preoperative, intraoperative, and postoperative factors. With sample size of 250. Result: There were 250 appendectomy cases in the study, with 39% female and 61% male. There was no discernible difference in the distribution of leukocyte counts between open and laparoscopic appendectomies. There was no peritonitis in either group. Alvarado Scores differed greatly, with fewer cases involving laparoscopic procedures. Variations in appendix conditions were found during surgical procedures. Significant differences were observed in postoperative characteristics, with laparoscopic appendectomies being preferred in terms of hospital stay duration, oral analgesic use, and parenteral analgesic use. Conclusion: The overall positive results show that laparoscopy is a better option, providing an improved patient experience and possibly lowering healthcare costs, even though the longer operating time may initially raise concerns about its efficacy.

27. Caudal Block with Ropivacaine Vs Ropivacaine with Dexamethasone for Postoperative Analgesia in Paediatric Patients
Deepa. K.P, Sunish B. S
Abstract
Purpose: The purpose of the study is to investigate whether dexamethasone, when used as an adjunct to 0.2% ropivacaine administered caudally, enhances the analgesic potency in pediatric herniotomies. Methodology: In this observational analytical study conducted over a 6-month period at Government Medical College, Kottayam, involving the Anaesthesiology and Paediatric Surgery Departments, eighty-four patients aged 1 to 7 years undergoing elective herniotomies were enrolled. The study population met specific inclusion criteria and exclusion criteria to ensure homogeneity. Sample size determination was based on prior research, resulting in 42 participants per group. Various tools and procedures were employed, including premedication, standard monitoring during surgery, random group assignment, and blinded medication administration. Patients received either ropivacaine alone or ropivacaine with dexamethasone via caudal injections. Post-surgery, pain relief and sedation levels were assessed using standardized scales, and the duration of analgesia was recorded. Overall, the study design and procedures aimed to evaluate the efficacy of dexamethasone as an adjuvant to ropivacaine for postoperative pain management in pediatric herniotomy patients. Results: The two groups were comparable with respect to age, sex, weight, and duration of surgery. The mean duration of analgesia in Group B was significantly longer than in Group A, i.e., 391.43 ± 92.038 minutes and 238.57 ± 93.927 minutes, respectively (P < 0.001). There was also a significant difference in the number of doses of rescue analgesics required in the first 12 hours postoperatively, with Group A requiring 2.07 ± 0.677 doses and Group B requiring 1.29 ± 0.578 doses (P < 0.001). However, there was no significant difference in the sedation scores between the two groups for the first 6 hours postoperatively. Conclusion: In conclusion, we propose that the addition of 0.1 mg/kg of dexamethasone to ropivacaine for caudal blocks could significantly enhance analgesic efficacy in pediatric patients undergoing herniotomy.

28. Role of Mifepristone in the Management of Uterine Fibroid: A Hospital Based Prospective Study
Sweety Sinha, Rakhi Singh, Ankita, Anjali Kishore
Abstract
Background: Uterine fibroids are the most common benign tumors of uterus in the reproductive age group. Symptoms of fibroid may vary from women to women with most common symptom being heavy menstrual bleeding. Methods: This is a hospital based prospective interventional study carried out in department of obstetrics and gynaecology department, Patna medical college and hospital Patna from July 2022 to June 2023.The aim of the study was to assess the effectiveness of tab. mifepristone on reducing several symptoms related to fibroid uterus. Mifepristone 50 mg was advised on alternate day for 3 months and the result was assessed. Result: It was seen that mifepristone was very effective in reducing the mean PBAC score from baseline of 234.2 to 16.47 at the end of third month. Mean VAS score reduced from baseline of 5.61 to 2.26 at the end of third month. Mean fibroid volume reduced from 286.45 to 42.32 at the end of third month. Mean haemoglobin levels increased from 8.2gm/dl to 11.2 gm/dl. Conclusion: Mifepristone has proved to be very effective in management of uterine fibroid .It has shown a significant decrease in uterine fibroid size, increase in haemoglobin levels, decrease in heavy menstrual bleeding.

29. Assessment of Undergraduate Medical Students’ Perceptions of Novel Teaching Techniques Used in Pharmacology Involving Their Active Participation
Dnyaneshwar G. Kurle, Urwashi I. Parmar, Kritarth Naman Singh
Abstract
Introduction: The choice of teaching technique is one of the most important factors in the successful implementation of medical education. There is a need to try out novel teaching techniques that can involve the active participation of students to overcome the challenges of passive techniques like didactic lectures. Methods: The study involved a total of 180 second MBBS students who were divided into two groups of 90 students each to carry out one of the two activities, i.e. Students Corner or Symposium. The first group of students was told to submit one article each on the pharmacology topics in the form of short essays, crosswords, mnemonics, case studies, diagrams, flow charts, MCQs, etc. The second group was told to prepare and present a symposium in front of their peers. The pharmacology topics were allotted by the faculty. At the end of the academic year, feedback from all the participants was taken using a pre-validated questionnaire. Results: The perception of students was extremely positive for these new teaching techniques. Majority of them agreed that both activities helped them in a better understanding of the topic. Students’ Corner encouraged interest & creativity and helped in revising topics while the symposium helped in learning teamwork and public speaking. However, more than half of the students who contributed to the students’ corner thought that the activity was monotonous and about 2/5th of students thought that these activities were unnecessary. Conclusion: Novel teaching activities involving the active participation of students are effective and helpful in learning, they can be used as a supplement to the traditional methods.

30. Blunt Trauma Abdomen: A Clinical Study Concerning Management
Sopan Ramchandra Chougule, Shivaji Janardan Wadekar
Abstract
Background: One of the most frequent injuries, mostly from automobile accidents, is abdominal damage. The number of people suffering from blunt abdominal trauma has increased dramatically as a result of the quick rise in motor vehicles and their aftereffects. Two thirds to three quarters of blunt abdominal trauma are caused by motor vehicle crashes. A fall from a height, an attack with blunt weapons, sports injuries, workplace accidents, bomb blasts, and a fall while riding a bicycle can potentially cause blunt injuries to the abdomen. Blunt abdominal injuries typically go undetected. Therefore, frequently overlooked until actively sought after. Most abdominal injury cases end in death as a result of poor care. The accumulation of in-patient data from around the globe has led to a gradual rise in knowledge regarding the management of blunt abdominal injuries. This could be the result of a number of factors, including the amount of time that passes between a trauma and hospitalization, delayed diagnosis, insufficient and inappropriate surgical treatment, complications following surgery, and related trauma, particularly to the head, thorax, and limbs. Aim: The aim of the study was the blunt trauma abdomen with respect to management and outcome in the hospital. Material and Method: This observational study included eighty patients who had been screened using pre-established inclusion and exclusion criteria after they had presented to the Department of General Surgery with a history and presentation of blunt trauma abdomen. We acquired informed consent from each individual. Out of all the hospital admissions at this time, 80 instances had abdominal trauma in general surgery wards. The study comprised patients who were admitted and had a history of abdominal trauma, were receiving surgery, or were being treated non-operatively. A thorough medical history was taken, and the patient underwent pertinent diagnostic testing along with clinical findings. Results: Twelve patients and 68 male patients made up the total of 80 instances. As indicated below, 45 patients experienced penetrating injuries, while 35 patients experienced non-penetrating injuries. One instance of both penetrating and non-penetrating violence involved fatalities brought on by extreme shock as a result of several injuries. Our study has shown that non-penetrating injuries have a low death rate. This might be the case because the majority of them only had parietal wounds. According to the current study’s injury pattern, entry wounds were found in 40 (or 50.0%) of the cases in the umbilical region, right iliac, and right lumbar regions. Conclusion: The overuse of motor vehicles is leading to an increase in blunt injuries to the abdomen. The attending surgeon faces a therapeutic and diagnostic conundrum because of the vast range of clinical symptoms, which can include progression to shock or no physical findings at all. In light of this, the trauma surgeon should depend on his physical findings when applying modalities such abdominal paracentesis, USG abdomen, and X-ray abdomen.

31. In Midline Abdominal Surgery, a Comparison of the Electrocautery and Scalpel Incision Methods
Shivaji Janardan Wadekar, Sopan Ramchandra Chougule
Abstract
Background: The incision is a “slit or cut” that allows access to the supporting tissues. Traditionally, a stainless-steel scalpel is used to make cuts. It is expected that these incisions will hurt more and be more bloody. In a surgeon’s toolkit, electrosurgical devices are among the most valuable and often utilized items. In medicine, the process of burning a body part to remove or close it is referred to as cauterization. In order to produce a surgical incision, burn and seal blood arteries, and remove undesirable or hazardous tissue, electrocauterization, also known as electrocautery, is a common surgical technique. Additionally, its usage to lessen or cease bleeding is growing. The tissue is burned or destroyed using a tiny probe that has an electric current passing through it. Despite being accessible in every surgical theater, electrocautery is less commonly utilized for skin incisions because of concerns about tissue damage, inadequate wound healing, discomfort following surgery, and excessive scarring. The use of diathermy for skin incisions has decreased due to concerns about inadequate wound healing. The scalpel causes more blood loss but little injury to the surrounding tissue. Aim: The aim of the study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain, and wound infection. Material and Method: In the Department of General Surgery, a prospective observational comparative study was carried out. Patients who were willing to take part in the trial and had midline abdominal surgery scheduled were randomly assigned to one of two groups: group B (scalpel group) or group A (electrocautery group). The type of technique utilized to produce the incision was kept a secret from both the patient and the lead investigator who noted the results. One of the operating surgeons’ helpers documented the incision time and intraoperative blood loss; the lead investigator was informed of this information without disclosing the patient group. All patients who meet the inclusion criteria and are receiving mid-line abdominal surgery during the study period are included and randomly assigned to one of two groups: group B (scalpel group) or group A (electrocautery group). Results: The study comprised 80 patients in total; 40 were divided into groups A and B. In both groups, the distribution of ages and genders was comparable. Group A consisted of 25 men and 15 women, while Group B had 22 men and 18 women. The number of elective and emergency patients in the two groups did not differ significantly. Between the two groups, there was no statistically significant variation in the length of the incisions. The difference between the incision depth and the wound area was statistically significant. The two groups’ incision times and incision times per unit wound area differed statistically significantly. Significant variations were also observed in intraoperative blood loss between the two groups. Conclusion: Compared to using a knife, electrocautery during skin incisions during midline abdominal surgery resulted in reduced intraoperative blood loss and shorter incision times. Between the two groups, there was no difference in wound complications or postoperative pain. Given the aforementioned benefits of electrocautery, we can therefore say that it is a safe and reliable substitute for a knife when creating skin incisions during a midline laparotomy.

32. A Clinical Study of Comorbidities among Patients with Alopecia Areata
Champa Ramachandra, Rajashekar TS
Abstract
Introduction: Alopecia may be interpreted as a loss, miniaturization, involution, or increased fragility of the hair at all hair bearing sites, such as scalp, face, eyebrows, eyelashes, and body. AA is hypothesized to be an organ specific autoimmune disease mediated by T lymphocytes directed to the hair follicles. Although genetic predispositions and environmental factors may trigger the initiation of the disease, the exact cause is still unknown. Aim: To document the comorbid cutaneous and extra cutaneous conditions and the age of   their onset in patients with Alopecia Areata. Methodology: This study was done in the Dermatology Department of R. L. Jalappa Hospital from December 2013 to January 2015.  At 95% confidence interval and 2% absolute error, 60 subjects were studied. Results: Maximum patients in our study belonged to age group 31 to 40 years of age. Out of the 60 patients with AA, 23.3% (14patients) had atopic dermatitis and 3.3% (2patients) had vitiligo. Most atopic and autoimmune diseases were observed at ages of 11 to 30 years and    41 to 50 years. Conclusion:  Patients with AA are at an increased risk of multiple comorbidities, including psychiatric comorbidity, atopic dermatitis, thyroid diseases, allergic rhinitis, diabetes mellitus, hypertension and vitiligo compared with the general population.

33. Imperforate & Microperforate Hymen: A Case Series of Diagnosis and Management of Three Adolescents
Narula Aarti, Kaur Arshdeep, Kaur Satinder Pal, Gupta Anju, Gupta Saryu, Kaur Parneet, Kaur Ravinder, Singh Gurtej
Abstract
Introduction: Imperforate hymen (IH) is a rare obstructive congenital anomaly of the female genital tract. It arises as a result of complete failure of canalisation of inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina during foetal life. Patients are usually asymptomatic until onset of menarche after which menstrual blood begins to accumulate in the vagina leading to a spectrum of symptoms described later in the text. Microperforate hymen (MH) is a type of obstructive hymenal membrane, in which there is a tiny opening in hymen, which can lower the quality of life of the young women by interfering with vaginal intercourse and menstrual hygiene. Presentation in MH patients depends largely on hole size. Case Reports: We are reporting here cases of three adolescent girls who presented to Rajindra Hospital Patiala (RHP). Two of these were diagnosed with imperforate hymen and one with microperforate hymen. Discussion: A detailed gynecological history and examination play a key role in predicting these conditions. These conditions can be treated surgically by performing hymenotomy. Conclusion: Early diagnosis and management of imperforate and microperforate hymen helps in relieving the symptoms and preventing potential complications. Both of these two conditions can be managed surgically with very good outcome.

34. Prevalence, Clinical Presentation and Underlying Etiology of Bacterial Vaginosis: A Hospital-Based Cross-Sectional Study
Snigdharani Choudhury, Biswajit Pradhan, Lopamudra Das, Dharitri Mohapatra, Sashibhusan Dash
Abstract
Background: Bacterial vaginosis (BV) is the most common vaginal disorder, affecting a significant proportion of women. It’s wide spread prevalence and severe health implications make It a critical public health issue. Aim and Objectives: This study was done to identify the prevalence, microbiological characteristics, and underlying causes of BV. Materials and methods: This hospital-based case-control study was conducted on patients presenting with abnormal vaginal discharge, pregnant women, women experiencing preterm labor, women with a history of hysterectomy or medical termination of pregnancy (MTP), and women using intra uterine contraceptive devices (IUCDs). Results: Nearly half (48%) of bacterial vaginosis (BV) cases identified using the Nugent scoring system were found to harbor Gardnerella vaginalis (G.vaginalis) bacteria. A higher prevalence of G.vaginalis isolation was linked to an elevated vaginal pH, exceeding 4.5. Clue cell detection demonstrated a sensitivity of 69.23% and a specificity of 86.95%, while the amine test displayed a sensitivity of 73.07% and a specificity of 66.30%. Metronidazole, ampicillin, and chloramphenicol are effective antimicrobials against G.vaginalis infections. Conclusion: Bacterial vaginosis is a common health problem in women of reproductive age. Given the prevalence and adverse consequences of BV, implementing routine screening and effective management strategies is crucial to prevent future complications.

35. Evaluation of PEC- I and PEC-II Block with or Without Clonidine for Post-Operative Analgesia in Benign Breast Lesions
Preeti Lakra, Vikas Kumar Gupta, Jyotsna Kubre, Aditi Mishra, RP Kaushal
Abstract
Background: The PEC-I and PEC-II blocks entail the administration of a Local anaesthetic Solution into the space between the Pectoralis Major and Pectoralis Minor muscles, and the space between Pectoralis Minor and serratus anterior, with the purpose of blocking the medial and lateral Pectoral Nerves. Using only local anaesthetic results in a relatively brief duration of postoperative analgesia. Therefore, diverse adjuvants have been employed to enhance the quality and prolong the duration of analgesia. In our investigation, clonidine was utilized as an adjuvant. Aims and Objectives: The primary objective of our study is to assess the efficacy of PEC-I and PEC-II blocks with or without clonidine for postoperative analgesia in cases of benign breast lesions and secondary objectives encompass the assessment of postoperative pain scores and the time until the administration of the initial analgesic. Materials and Methods: The interventional type of study was carried out on 60 patients in the department of Anaesthesiology at Gandhi medical college Bhopal after the approval of institutional ethics committee of our hospital. Patients were assigned into 2 groups : Group C -30 Patients received 30ml of 0-25% Bupivacaine, 10 ml PEC- I and Bupivacaine 0-25% 20ml PECS-II with clonidine 0.2ml (30mcg) and Group P -30 patients received 30ml of 0.25% Bupivacaine, 10 ml PEC-I and Bupivacaine 0.25% 20ml PECS – II without Clonidine. Post operatively, pain was evaluated by NRS Scale for pain at 0,2,4,6,8,10,12 and 24 hours. Slow IV Tramadol 0.5mg/kg was used as the first Rescue analgesic whenever NRS Scale more than 3 or if the Patient demanded analgesia. Time of first rescue analgesia was noted down. Result: In this study, we found that pec block with bupivacaine & clonidine has better post-operative pain relief and longer duration of pain relief. It has late requirement of first rescue analgesia. Evaluating postoperative pain was our primary outcome. In this study, we observed that first rescue analgesia or duration of analgesia was more in patients who received PEC block with bupivacaine & clonidine being (445.33 ± 22.2) than patients who received PEC block with bupivacaine ( 366.67 ± 50.3) which was statistically highly significant (p< 0.001). The NRS scores among the patients who received PEC block with Bupivacaine & Clonidine were significantly lower than that of patients who received PEC Block with Bupivacaine during all the intervals of time.(p<0.001). PEC Block with bupivacaine and Clonidine (GROUP C) showed lower NRS scores at most of the time interval. Conclusion: This study has clarified that employing an ultrasound-guided PEC block, combined with Clonidine as an adjuvant alongside 0.25% bupivacaine, results in superior postoperative analgesia compared to using 0.25% bupivacaine alone. The inclusion of clonidine (30 mcg) in the PEC block with 0.25% bupivacaine demonstrates effective postoperative pain control, as evidenced by lower Numeric Rating Scale (NRS) scores, in contrast to utilizing 0.25% bupivacaine alone for pectoral nerve block in patients undergoing excision of benign breast lesions. Furthermore, the addition of Clonidine (30 mcg) significantly extends the duration of postoperative analgesia.

36. A Clinical Study on Radiolucent(Uric Acid) Stones in Tertiary Care Center
Maddala Sudarsana Rao, Rambabu Bala, Medavankala Prabhakara Rao, Mohammad Jahangir, P Shiva Prasad
Abstract
Background: Uric acid, first recognized in 1776, is a component of bladder stones that is controlled by metabolism, kidney excretion, and synthesis. Acidic urine and metabolic syndrome are connected to an increased incidence of uric acid stones. The distribution of age and sex, predisposing factors, causal factors, and clinical presentation of uric acid urolithiasis are the main objectives of this study. Methods and Material: A clinical study on radiolucent stones was conducted at King George Hospital, Visakhapatnam, from July 2021 to July 2023. Fifty cases with symptomatic uric acid calculi were selected based on clinical symptoms and radiological findings. Comprehensive assessments, including history, physical examination, blood and urinary tests, and radiological investigations, were conducted to gather thorough data on uric acid calculi. Result: In this study, 72% of participants were male, while 28% were female, with a mean presentation age of 34.5 years. The prevalence of uric acid stones was directly linked to a high-protein diet, and the most frequently reported symptom was pain in the loin. Conclusion: Uric acid calculi exhibit a higher prevalence in men (M: F ratio 5.5:1), typically occurring between 20-40 years (mean age 34.5 years). Low urine pH and volume contribute to their formation. The stones are more common in July to August. Management involves increased fluid intake, alkalinizing measures, preferably using potassium citrate, with or without bicarbonate. Conservative management proves effective for the majority of patients.

37. Assessment of Posterior Ligamentous Complex Injury by CT and MRI Scan in AO Type-A Fractures of the Thoracolumbar Spine on Radiographs
Mukesh Teli, Raskesh Malhotra, Manish Chadha, Anil K Jain, Vinita Rathi, Aditya Gulia
Abstract
Introduction: The posterior ligamentous complex (PLC) is thought to contribute significantly to the stability of the thoracolumbar spine. PLC functions as a posterior tension band and acts as the primary stabiliser of the vertebral column. Many studies focus on plain radiographic findings and various radiological parameters were identified that were determinants of probable PLC injury. However, confusion exists when plain radiography shows no signs of posterior column involvement. Methods: We recruited 49 Normal appearing plain radiographs cases for the study after fulfilling inclusion and exclusion criteria. Following this subsequent computed tomography (CT) scans and magnetic resonance imaging (MRI) were done and evaluated by Orthopedicians and radiologists for any signs of PLC injury. We also evaluated the correlation of PLC injury with parameters like loss of vertebral body height (LOVBH) and local kyphosis (LK) and their significance. Results: 13/49 patients initially diagnosed as AO-A on radiographs were revised to a diagnosis of AO-B on CT scan. 22/49 patients diagnosed as AO-A on radiographs were revised to a diagnosis of AO-B on MRI scans. This included 13 cases where a CT scan also showed posterior column injury and 9 cases where even a CT scan did not show evidence of posterior column injury. Using the Chi-square test we found that there was a statistically significant difference between CT scan and MRI in identifying PLC injury (p<0.001). we found a significant correlation between local kyphosis (LK) and PLC injury in patients having a kyphotic angle of >20° and it was statistically significant by the Chi-Square test (p<0.05), however for loss of vertebral body height (LOVBH), it was statistically non-significant. Conclusion: In a setting of normal-appearing plain radiographs, we noted to have missed 44.9% (22/49) of cases of PLC injury in AO type A fractures. Local kyphosis was significantly correlated with PLC injury but loss of vertebral body height was not.

38. Analyzing Fixed Drug Eruptions (FDES) Induced by Non-Steroidal Anti-Inflammatory Drugs (NSAIDS): A Case Series
Asha Latha Muppur, Rajalakshmi Rukmangathen, Anitha Nagari, Bharathi Uppu
Abstract
Background: Cutaneous adverse drug reactions (CADRs) account for 2-3% of all adverse drug reactions (ADRs), encompassing conditions ranging from mild rashes to severe manifestations like Stevens – Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). This study focuses on Fixed Drug Eruptions (FDEs), a subset of CADRs, particularly in the context of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Objectives: The primary aim of this study is to analyze the incidence and characteristics of FDEs in patients exposed to various NSAIDs. By examining these cases, the study aims to enhance understanding of the relationship between NSAID consumption and the development of FDEs. Methods: Employing a case series approach, this study tracked patients treated with NSAIDs who subsequently developed FDEs. The data was gathered from Adverse Drug Reaction (ADR) reports submitted to the ADR Monitoring Center (AMC) affiliated with our institute over a six-month period from June to November 2023. Results: In this period, six distinct cases of FDEs associated with NSAIDs were identified. These involved the following medications: Combiflam, injection Diclofenac, two cases with unidentified NSAIDs, a combination of Paracetamol and Aceclofenac, and finally, an injection of Paracetamol. Conclusion: This study highlights the potential risk of FDEs in patients consuming NSAIDs. The findings highlight the need for heightened awareness among healthcare professionals regarding the cutaneous risks associated with NSAIDs. This case series contributes to the broader understanding of drug-induced dermatological reactions, emphasizing the importance of diligent ADR reporting and monitoring.

39. Prevalence of Thyroid Disorders in Pregnancy
Soma Venkat Kota, Sangeeta Raman Jogi
Abstract
Background: Thyroid disorders are amongst the commonest endocrine disorders in women of child bearing age and are, therefore encountered commonly in pregnancy. Objective: To study Prevalence of Thyroid Disorders in Pregnancy. Methods: The present Prospective observational study was undertaken in obstetrics and gynaecology OPD IPGME & R, S.S.K.M. Hospital, Kolkata, during the periods from February 2015 to July 2016 in collaboration with department of Endocrinology.  Pregnant women in first, second and third trimester of any age group with no other medical complications with singleton pregnancy attending the (G&O) antenatal OPD will be selected as cases satisfying inclusion and exclusion criteria. Results: The prevalence of thyroid disorders in pregnancy in this study is 9.3%. The percentage of hypothyroidism, hyperthyroidism and out of all thyroid cases were 85.71% and 14.28% respectively. Percentage of TPO-Ab positive cases out of all hypothyroid pregnant women was 14.28%. Out of total 2 TPO –Ab positive cases, one case was having TSH level of 4-10Mu/L and one case had TSH level of more than 10Mu/L. Out of 9 subclinical hypothyroid cases, all women had normal level of free T4. There was one case of overt hypothyroid and had low free T4 level. Both the case of hyperthyroidism, detected in our study had low TSH level (0.1Mu/L),high free T4 level and HCG level for gestational age and negative values for TPO-Ab and TSHR-Ab at the end of first trimester. Conclusions: Thyroid disorder is one of the common diseases associated with pregnancy and have bad pregnancy outcome. Out of all thyroid disorders associated with pregnancy subclinical hypothyroidism is the most frequently disease.

40. Comparison between Bupivacaine V/S Bupivacaine Plus Nalbuphine in Supraclavicular Brachial Plexus Block: Double Blind Randomized Controlled Trial
Vatsal Shah, Anjali Tripathi, Divyang Sutaria, Komal Shah
Abstract
Background and Aim: Brachial plexus block is frequently performed for ambulatory upper limb surgery as an alternative to general anesthesia. It can significantly reduce pain, reduce post-operative nausea, and vomiting and allowing for faster discharge from hospital. Our current study was designed to test the hypothesis that nalbuphine when added as an adjuvant to bupivacaine in supraclavicular brachial plexus block enhanced the onset, duration of sensory and motor blocks, duration of analgesia, and quality of block for the patients undergoing ambulatory forearm and hand surgery. Material and Methods: Present prospective, randomized, double blind study was carried out in 60 patients in Department of Anaesthesiology, Sir T. Hospital, Bhavnagar. Patients were randomly allocated to one of the two groups of 30 patients each by distributing sealed envelopes. Group – A (Bupivacaine alone)- 30 patients received 29 ml of 0.375% Bupivacaine with 1ml of normal saline. 2. Group–B (Bupivacaine + Nalbuphine)- 30 patients received 29ml of 0.375% Bupivacaine with 1ml Nalbuphine (10 mg). Onset and duration of sensorimotor blockade, hemodynamic variables, duration of analgesia, and adverse effects were recorded. Results: Mean time to onset was significantly shorter in Group B compared to Group A and duration of sensory blockade was prolonged in group B which is statistically significant in favor of group B. Mean time of onset and duration of motor blockade was significantly changed in both groups showing shorter onset and prolonged duration in Group B. The duration of effective analgesia was significantly prolonged with addition of nalbuphine to bupivacaine. Conclusion: Addition of Nalbuphine 10mg to 0.375% Bupivacaine in supraclavicular brachial plexus block significantly shortens the onset of both sensory and motor blockades, prolongs the duration of sensory and motor blockade and the duration of analgesia but does not significantly reduce the frequency of rescue analgesic required in postoperative period.

41. Determination of Baseline Widal Titre among Apparently Healthy Individuals of South India
Anithra CA, Anitha K, Prabhusaran N, Chitra Rajalakshmi P
Abstract
Background: Enteric fever is now uncommon in industrialized countries as a result of advancements in food management, water or sewage treatment and introduction of antibiotics. Salmonella typhi, S. paratyphi A, and S. paratyphi B are the causes of enteric fever. Widal test is one of the oldest, most widely used and gold standard serological tests for diagnosis of enteric fever. Methods: The main objective of this study was to determine the baseline Widal titre among apparently healthy individuals of rural and urban locality around the teaching hospital of Tiruchirapalli, South India. Both genders aged between 18 to 63 years were included and people who tested positive for Widal during the last 6 months were excluded. Three ml of blood samples were collected, thereby screened by rapid slide agglutination test followed by tube agglutination test using Salmonella antigens available in the Widal test kit. The observation of agglutinins in different patterns was recorded. Results: Comparatively, the tube agglutination test showed high sensitive than slide test. Out of 300 samples, 173 and 158 showed positive reaction towards tube and slide test respectively indicated, performing the slide test alone may miss the positive cases. Monoantigenic agglutination was found in two sets including ≥1:20 in O antigen (152 samples) and H antigen (68 samples); Diantigenic responses were recorded with 9 and 3 samples in ≥1:20 of O and AH, and O and BH respectively. Conclusion: Interestingly, the baseline titre of Salmonella antigen was found among healthy individuals indicated their frequent or repeated exposure to the infectious agent.

42. To Evaluate Prevalence, Correlation and Treatment Effects of LUTS/BPH on Sexual Dysfunction
Tilala Yash Manharlal, Abhilekh Tripathi,Sachin Sharma, Pritam Pritesh Pattnayak, Pramod Kumar Mohanty, Sanjay Choudhuri, Sabyasachi Panda, Samir Swain
Abstract
Introduction: Objective of the study was to evaluate the prevalence of sexual dysfunction in LUTS/BPH patients, to assess the effect of LUTS/BPH effect on sexual function, to assess the treatment effect of LUTS/BPH on sexual function. Materials and Methods: Retrospective analysis conducted between October 2021 and September 2022 of the 150 patients with complaints suggestive of LUTS/ BPH. All were evaluated with history & Physical examination, Digital Rectal Examination & Focused neurological examination, Ultrasonography kidney, ureter, bladder and prostate, Uroflowmetry, Post void residue, the linguistic version of the “IPSS and IIEF – 15”. Results: Total 150 patients were considered for the study and evaluation. Sexually active male were 58.6%. 120 (80%) patients underwent surgical management; whereas 30 (20%) patients had received medical management. 69.17% of the patients had sever LUTS. The most common bothersome LUTS was weak stream of Urine 71%. In 7th decade of life 74.5% patients had sexual dysfunction. 54.28% patients with moderate LUTS had moderate to severe erectile dysfunction, whereas 51.81% patients with severe LUTS had moderate to severe erectile dysfunction, Correlation coefficient 0.76. With moderate LUTS 14.28% patients had sexual dysfunction, whereas with severe LUTS 56.62% patients had overall sexual dysfunction with Correlation coefficient 0.343. Quality of life was mostly satisfied or pleased of 33.33% with medical management, while post TURP 86.67% has improved quality of life. This comparison was statistically significant (P-Value 0.045). Conclusion: The prevalence of sexual dysfunction in patients with severe LUTS is 90.36% and severity of sexual dysfunction correlates with severity of LUTS.

43. Urogynecologic Fistulae: A Prospective Clinical Study in a Tertiary Center
Medavankala Prabhakara Rao, Maddala Sudarsana Rao, Rambabu Bala, Mohammad Jahangir, Vaibhav Joshi
Abstract
Background: Urogynecologic fistula (UGF) is a post-surgical complication commonly associated with gynecological treatments such as hysterectomy. Modern obstetric techniques have led to a decline in childbirth-related fistulae in affluent countries, but in poor countries with limited access to obstetric care, vesicovaginal fistulas (VVF) continue to remain, posing social and physiological difficulties. Efficient restoration necessitates exact surgical techniques customized to each patient’s unique attributes. To improve knowledge and treatment of UGFs, this study is conducted to thoroughly investigate patient demographics, incidence, and causes of different UGFs, as well as diagnostic standards and surgical procedures. Results will be compared with those of earlier studies. Materials and Methods: This prospective study, conducted from June 2021 to May 2023 at King George Hospital, examined urogynecologic fistulae that resulted from hysterectomy and obstructed childbirth. Urinary incontinence due to causes other than urogynecologic fistula is excluded. Comprehensive evaluations and a range of surgical repair techniques were used in the diagnosis. Continence three months after surgery was deemed a successful result. Results: The study involved 36 cases, predominantly vesicovaginal fistulae (VVF). Of these, 34 were primary fistulae, and two were recurrent VVF cases. Among VVF patients, 20 had simple and 9 had complex fistulae. No recurrences were observed in ureterovaginal and urethrovaginal fistulae. Treatment approaches included abdominal O’Conor repair (22 cases), vaginal repair (5 cases), combined abdominal and vaginal repair (2 cases), and McGuire Pubovaginal fascial sling in 2 patients. Conclusion: The lives of women are profoundly affected by urogynecologic fistulae, and the only effective treatment is meticulous surgery.  With possible benefits, both the abdominal and vaginal methods can yield great outcomes in certain situations. For good healing and problem monitoring following surgery, adequate urine drainage and routine follow-up are crucial.

44. Knowledge and Practice on Menstrual Hygiene among Girl Students in Saharsa District of Bihar
Sukriti Kumari, Srishti
Abstract
Objectives: The present study was to evaluate the knowledge and practice on menstrual hygiene and also evaluate the various barrier of menstrual hygiene among school going girl students. Methods: Data was collected using a predesigned and pretested structured questionnaire to study their level of awareness regarding menstruation. The data collection tool contained four domains: sociodemographic profile consisted of personal and menarche‑related characteristics, the knowledge domain included questions on the physiology of menstruation like origination of blood, frequency, and duration of the menstrual period, the flow of the cycle, awareness of menopause and knowledge on irregular cycles, etc. Practices aspect included questions like the type of absorbent; wash and dry used clothes; frequency of changing pads in schools and in their homes, cleaning of external genitalia, and various restrictions during menstruation. Results: A total of 500 school going girl students with age 13 to 19 years were enrolled. Mean age of menarche was 12.21±1.32 years. 68(13.6%), 46(9.2%) was excess and scanty blood flow during menses respectively. Irregular menses was seen in 108(21.6%) girls. Most of the girls 164(32.8%) were belonged in socioeconomic status II. 74(14.8%) girls had duration of flow 7 or beyond 7 days. 298(59.6%) girls were aware regarding menarche prior to menstruation. Dysmenorrhea was seen in 394(78.8%) girls. 384(76.8%) girls were not visited holy places or attending religious functions during menses. 169(33.8%) school going girls were not using sanitary pad due to 87(17.4%) expensive, 45(9%) difficult/embarrassing, 24(4.8%) feels uncomfortable and 13(2.6%) any others region. Conclusions: Majority of girls are still subjected to various restrictions or barrier during menses. Girls hesitate when discussing sensitive topics like menstrual hygiene, it is important to create a healthy environment where everyone can talk honestly about their personal experiences with this type of delicate subject. Education of girls pertaining to the basic knowledge of menstruation and hygienic practices should be more emphasized in the school curriculum. It is imperative to bring them out of age‑old traditional beliefs, taboos, misconceptions, and restrictions and equip them with lifelong skills regarding safe and hygienic practices. Teachers should be trained about menstrual health to empower them to transfer correct scientific information to girls through focused group discussions and other Information Education Communication (IEC) mediums in school, facilitate peer education and engage parents, especially mothers, during parent–teacher meetings to raise menstrual‑related awareness. Medical check-up camp should be organized time to time in Government as wells as private school for awareness and screening of menstruation related problem, knowledge and practice for menstruation hygiene.

45. Role of Plasma Fibrinogen in Diagnosis of Neonatal Sepsis and it’s Prognosis
Shashikala H Madiwalar, S B Hippargi, B R Yelikar, S V Patil
Abstract
Purpose: To study the relation between plasma level of fibrinogen and neonatal sepsis and its outcome. Methods: A prospective case control study was done including 48 neonatal sepsis cases in study group and 42 cases in control group. For all cases Plasma fibrinogen, prothrombin time (PT), activated plasma thrombin time (APTT), C-reactive protein (CRP) and blood culture were performed. Mean Plasma fibrinogen levels for both groups and cut off value of plasma fibrinogen for diagnosis was calculated using receiver operating characteristic curve. Results: Plasma fibrinogen levels were found to be higher in study group with than in control group (p< 0.050). Cutoff value of plasma fibrinogen for diagnosing neonatal sepsis was found to be 305.5mg/dl with a sensitivity and specificity of 80% and 72.8% respectively. Conclusion: In our study, we found that plasma fibrinogen act as an acute phase reactant and can be used as an immediate marker for detection of early onset neonatal sepsis.

46. Unmasking the Silent Threat: The Enigma of Head and Neck Squamous Cell Carcinoma
Rashmi K Patil, Pooja S C, Rujuta Datar, Rekha M Haravi
Abstract
Introduction: Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignancy throughout the world. It represents a significant global health burden due to its high morbidity and mortality rates. HNSCC exhibits varying degree of differentiation, invasion and lymph node involvement impacting its prognosis and treatment. Objectives: We aim to delve into microscopic characteristics of HNSCC, grading system and their prognostic significance providing foundation for accurate histological diagnosis and tailored treatment approaches. Materials and Methods: Study was conducted for 18 months and included 80 cases of histopathologically confirmed squamous cell carcinoma of head and neck. Clinical and histopathological features of each case were analysed. In radical resection cases, according to College of American Pathologists (CAP) guidelines TNM staging and histologic grading was done. Results: A total of 80 (51 biopsy and 29 radical resection) cases were included, among which 65(81.25%) were men, with a mean age of 54.8 years. Commonest risk factor was tobacco chewing seen among 64 cases (80%). 63 cases (78.75%) presented with an exophytic mass, followed by ulcer with leukoerythroplakia 4(5%). Most frequent site involved was buccal mucosa 34(42.5%) followed by tongue 12(15%). In radical resections 16 cases (55.1%) were showing lymph node metastasis, lymphovascular invasion and perineural invasion was seen in 6(20.6%) cases 8(27.58%) cases respectively. Most of them were of grade II accounting for 49 cases (61.25%), followed by grade I which totalled to 30 cases (37.5%) and a solitary(1.25%) case of grade III. A statistically significant correlation was obtained between age and grade of the tumour. Worst pattern of invasion, depth of invasion showed significant correlation with lymphovascular invasion, perineural invasion and lymph node metastasis. Conclusions: Our data reflect the histopathological characteristics of HNSCC. The intricate understanding of the pathological features of HNSCC is essential for optimizing diagnostic accuracy, prognostication and development of therapeutic strategies for improved patient outcome.

47. Comparing the Impact of Serum Triglyceride Levels on Maternal Fetal Outcomes between Normal and Hypertensive Pregnancies
Kalpana Kumari, Anil Kishor, Manoj Kumar Yadav, Ravish Ranjan
Abstract
Background: Preeclampsia is a pregnancy is a specific condition characterized byhypertension and proteinuria that remits after delivery. Hypertensive disorders are a long standing threat that endangers the lives of both mother and child. It can manifest in four forms during pregnancy i.e., gestational hypertension, chronic hypertension, preeclampsia and eclampsia. Material and Methods: This is a prospective comparative study, where data was collected from pregnant women, who were more than 28 weeks of gestation and met the inclusion criteria in Darbhanga medical college and Hospital, Darbhanga, Laheriasarai, Bihar. Comparison was done on blood pressure, triglyceride level, BMI, mode of delivery, maternal and foetal outcome among two groups i.e. hypertensive and normotensive. Conclusion: Levels of serum triglyceride are significantly increased in hypertensive patients. The mean serum triglyceride levels also significantly increased with increasein severity of hypertension. Hence it is important to identify the serum triglyceride levels among hypertensive patients.

48. Analyzing the Prevalence and Consequences of Anemia during Pregnancy within a Tertiary Health Care Setting in Bihar
Anil Kishor, Kalpana Kumari, Manoj Kumar Yadav, Ravish Ranjan
Abstract
Background: Anaemia is the leading cause of maternal morbidity and mortality in developing countries. It is now one of the most frequently observed nutritional diseases in the world. It is especially prevalent in women of reproductive age, particularly during pregnancy. Materials and Methods: This is hospital-based observational study all mothers admitted for delivery and diagnosed with anemia are recruited for the study, meeting the inclusion and exclusion criteria were considered as the study population. Study in the Department of DMCH, Darbhanga Bihar. Study duration Three year. Conclusions: The prevalence of anemia was 28.28%. It was low compared to NHFS and also other studies in the literature. Majority of the cases were mildly anaemic, so there were no significant complications seen.

49. Investing the Outcome for Both Mother and Fetus in Pregnancies That Go Beyond the Expected Due Date
Kalpana Kumari, Anil Kishor, Manoj Kumar Yadav, Ravish Ranjan
Abstract
Background: Postdated pregnancy has been defined as pregnancy that exceeds 280 days or 40 weeks of gestation. Expected date of delivery is most reliably determined early in pregnancy and may be based on Last menstrual period in women with normal regular menstrual cycle. If estimated gestational age by patient’s LMP is difficult to determine then EDD is obtained by Ultrasonography accurately in first trimester. Objectives: To study maternal outcome in Postdated pregnancy. Material and Methods: This is a prospective study that includes Postdated pregnancies admitted at Darbhanga medical college and Hospital Darbhanga, Laheriasarai, Bihar. which is tertiary care centre, the study period being 12 months. The data was collected using a piloted proforma meeting the objectives of study by means of personal interview with patients after taking informed consent. Conclusion: The clinician’s ability to identify a potentially compromised fetus has been improved by the introduction of reliable antepartum surveillance methods. Watchful waiting can safely be used in most postdate pregnancies with normal antepartum test results and without other risk factors.

50. Assessing the Obstetric Outcomes in Cases of Oligohydramnios Identified After the 34 Weeks of Gestation
Kalpana Kumari, Anil Kishor, Manoj Kumar Yadav, Ravish Ranjan
Abstract
Background: Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal & maternal outcome. Material and Methods: This is a prospective study conducted in the Department of Obstetrics and Gynaecology, in Darbhanga medical college and Hospital Laheriasarai Bihar. Duration of one year. Study covers 50 cases diagnosed clinically with oligohydramnios and confirmed by single or serial ultrasound scan after 34 weeks of gestation. Conclusion: An antepartum or intrapartum oligohydramnios is associated with significantly increased risk of caesarean section for fetal distress and low Apgar score, at 5 minutes. Isolated oligohydramnios is not associated with impaired fetal growth or adverse perinatal outcome.

51. Examining the Awareness and Perception of Anemia among High School Girls, Comparing Urban and Rural Settings
Anil Kishor, Kalpana Kumari, Manoj Kumar Yadav, Ravish Ranjan
Abstract
Background: The health consequences of anemia among adolescents are well documented. Anemia not only affects growth, development and learning process during adolescence but also affects the nutritional status resulting in deleterious effects in future pregnancy, especially when they are traditionally married at an early age and are exposed to a greater risk of reproductive morbidity and mortality such as increased incidence of low birth weight, fetal wastage, high perinatal mortality, infant mortality and maternal mortality, thus perpetuating a vicious cycle of health problems passing on to next generation. Methods: A school based Cross-sectional, comparative study. Total 650 adolescent high school girls of which 330 were from school of Darbhanga city & 320 from schools of field practice area of Darbhanga Medical College and Hospital Darbhanga Laheriasarai Bihar. Conclusion: The present study revealed that rural adolescent girls were more aware about anemia compared to urban girls, whereas both urban & rural girls had same perception about anemia. The prevalence of anemia was higher among rural girls compared to urban girls & among girls whose mother had completed primary level of education.

52. Study of Pattern of Neuropathy in Chronic Liver Diseases in a Tertiary Care  Center of Bhopal, Madhya Pradesh
Arvind Kumar, A K Nandmer, V K Nandmer, Simmi Dube
Abstract
Background: Chronic liver disease (CLD) is a leading cause of death worldwide, especially in developing nations. CLD is increasing in prevalence, as has been established recently. The most common causes of CLD include chronic viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, and hemochromatosis. Aims and Objectives: To study the pattern of neuropathy in patients with CLD. Materials and Methods: Present cross-sectional study was performed on 100 consenting patients with cirrhosis of any etiology having age >18 years at the Department of Medicine Gandhi Medical College, Hamidia hospital, Bhopal, between January 2021 to September 2022. Detailed clinical examination, liver function tests and serum vitamin B12 were done. Motor and sensory electrophysiological tests were performed in the upper and lower limbs on the right ulnar, median, common peroneal posterior tibial, and sural nerves using Neuroperfect plus-4Ch EMG/ NCV/ EP (Medicaid systems) machine. The results were analyzed and interpreted based on the normal nerve conduction values as detailed in standard references. Results: Chronic liver disease was more prevalent in the age groups of 31-50 years (65%) with male preponderance (75%), in a rural area (89%), those with primary education (65%) and were daily laborers (73%), 63% were consuming alcohol, consuming tobacco (37%) and were smokers (26%). The incidence of peripheral neuropathy (PN) in patients with CLD was 58%. The majority had mixed (23%) type of PN followed by a motor (22%) and sensory (13%) PN. Of those with alcoholic etiology, 59.7% had PN, half of the patients with cryptogenic etiology had PN, 56.5% of patients PN had hepatitis B as etiology, and 60% of the patients with hepatitis C etiology had PN (p=0.011).  All 37 patients with alcoholic etiology, had axonal neuropathy; similarly, all the 5 patients with cryptogenic and 3 hepatitis C etiology were axonal. Whereas out of 13 patients with hepatitis B etiology, 12 had axonal and 1 had axonal +demyelinating neuropathy (p<0.001). In the Motor nerve conduction test, distal latency was significantly higher in patients with mixed type of neuropathy; however, amplitude and nerve conduction velocity was reduced considerably in mixed type of neuropathy. The sensory nerve conduction test revealed that amplitude and nerve conduction velocity was significantly increased in the mixed type of neuropathy. Conclusion: Peripheral neuropathy is a common complication of CLD related to the etiology of CLD, like alcoholic cirrhosis, hepatitis B virus, and coexisting risk factors like alcoholism and smoking. The PN in CLD is predominantly sensorimotor, mixed axonal degeneration, and demyelinating type. Routine investigations for assessing PN may still not be indicated since the clinical implications are not studied extensively.

53. An Assessment of Serum Vitamin-D Level among Adult Non-Alcoholic Fatty Liver Disease Patients: A Study in a Tertiary Care Hospital in Eastern Odisha
Manas Talukdar, Sudeshna Ray, Subhashree Ray, Arindam Basu
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) has become a global epidemic. Approximately every third adult in the industrialized countries has a morbidly fatty liver. NAFLD is the most common cause of persistent abnormalities in liver enzymes. NAFLD is now increasingly being recognized as a cause of hepatocellular carcinoma, liver transplantation and finally death. Vitamin D, the sunshine vitamin, can be associated with the progression of NAFLD. Many studies have shown a correlation between Vitamin D and NAFLD. Materials and Methods: 50 cases and 50 controls were selected for the study over an approximate period of 2 years. The study was a cross-sectional study done in IMS & SUM Hospital. Results: The difference of mean Vitamin D level was found to be statistically significant between the cases and the controls. Alanine Transaminase level was also found to be statistically significant. Conclusion: Our study revealed that lower Vitamin D levels were found in patients suffering from NAFLD. However more studies are required to concretely establish this finding.

54. Thoracic Spinal Anesthesia – A Suitable Alternative to General Anesthesia in Elderly Patients with Co-Morbidities: A Case Series
Rajendra Verma, Vineeta Goda, Surendra K.Sethi, Mamta Damor, Saka Venni Vinod, Mahendra Kumar Verma
Abstract
Introduction: Elderly patients with comorbidities are more prone to perioperative complications under general anesthesia. In this case series, we report our experience with eight elderly patients who underwent abdominal surgery successfully performed under thoracic spinal anesthesia. Methods: TSA was performed in eight patients with serious comorbidities above 60 years of age for abdominal surgery between April 2023 and June 2023 in the emergency operation room at tertiary care hospital. Results: A total of eight patients with a mean average age of 61.75±19.23 years and ASA score >3 were included. TSA was performed in all patients without any complications. The majority of surgeries were explorative laparotomy 5/8. The peak sensory level achieved between the T3–T5 dermatome level and motor blockade was M3 (Bromage score). The mean duration of surgery was 60.63±24 min. Sedation is required in three patients. Intraoperative hypotension occurred in three patients and was corrected with IV fluids and intravenous Mephentermine. None of the patients required GA. The postoperative period was uneventful in all patients. Conclusion: In this study we demonstrated that TSA is a safe and effective alternative technique for anesthesia in high-risk abdominal surgery without postoperative complications. In our series, the outcomes were excellent; however, further research is warranted to better understand the role of TSA in high-risk patients.

55. Spontaneous Perforation of Choledochal Cysts in Children, Presentation and Management, a Multi-Institutional Study
Magray Mudasir A, Syed Mohsin Aijaz, Quyoom Nazia, Masoodi Talat, Rashid AK, Mufti Gowhar N
Abstract
Spontaneous perforation of the choledochal cyst is a disease entity in which the extrahepatic duct or the intrahepatic duct is perforated spontaneously without traumatic or iatrogenic injury. The aim of the study was to analyse this rarity depending on clinical findings, diagnostic difficulty and optimum management plan in a limited resource set-up. A total of 15 patients presented with perforated choledochal cyst over a period of 7 years. There were 9 females and 6 males. All the children were infants. Children presenting with febrile illness having a documented choledochal cyst on ultrasonography with abdominal signs were evaluated for a perforation. Febrile illness with abdominal signs is the usual presentation. Jaundice is also very common. All patients were sick and in sepsis that required reasonable preoperative resuscitation. Malnourishment as suggested by anaemia and borderline hypoalbuminemia and on table finding of peritoneal contamination, unclear anatomy and oedematous bowel was seen in these children. An initial drainage procedure was done till the patient stabilised. We consider that spontaneous perforation of a choledochal cyst is not rare in infancy. We advocate an initial drainage procedure followed by a definitive surgery later once the patient stabilises.

56. Metacarpocortical Index to Predict Renal Osteodystrophy in Chronic Renal Failure Patients: A Hospital-Based Case Control Study
Kawaskar K, Gandhi Mohan R, Cherian Thomas, Mohan Kumar
Abstract
Objectives: To determine the role of metacarpocortical index (MCI) in predicting renal osteodystrophy among patients with chronic renal failure. Additionally, the association between laboratory parameters including blood urea, serum creatinine, serum calcium, serum phosphorous, serum alkaline phosphatase, serum uric acid and metacarpocortical index was determined. Methods: This was a hospital-based case control study conducted in the outpatient department and inpatient wards of the Department of Internal Medicine, tertiary healthcare facility in south India between patients between 18 and 60 years of age, of both gender with chronic renal failure, regardless of the cause. Results: The mean (SD) MCI among cases was 0.47 (0.09) and among controls was 0.71 (0.05) – the difference was found to be statistically significant (p<0.05). Among cases (n = 100), more than one third patients (39.0%) had blood urea levels less than 40 mg/dl; nearly half the patients (45.0%) had serum creatinine levels less than 1.4 mg/dl; a little more than half the patients (51.0%) had serum calcium between 7 mg/dl and 10.4 mg/dl; two third patients (67.0%) had serum phosphorus levels less than 4.5 mg/dl; two third patients (66.0%) had serum ALP levels between 60 IU/L and 100 IU/L; and more than two third patients (72.0%) had uric acid levels between 4 mg/dl to 7 mg/dl. The results of Pearson’s correlation analysis showed that serum urea levels had significant negative strong correlation (r=-0.69; p=0.001); serum creatinine levels had significant negative moderate correlation (r=-0.52; p=0.002); serum calcium levels had significant positive strong correlation (r=0.73; p=<0.001); serum phosphorus levels had significant negative moderate correlation (r=-0.51; p=<0.001); serum alkaline phosphatase levels had significant negative strong correlation (r=-0.70; p=<0.001); and serum uric acid levels had significant negative moderate correlation (r=-0.42; p=<0.001) with MCI values in patients with CRF. Conclusion: The study highlights the potential of MCI as an early indicator, aiding in the timely implementation of preventive measures to mitigate the risks associated with renal osteodystrophy.

57. Meconium Aspiration and Its Outcome during Perinatal Period: A Prospective Study
Rashmi Ranjan Barik, Samrita Seth, Rina Meher, Jyoti Ranjan Behera
Abstract
Introduction: When debris builds up in the fetal gut, it produces meconium, a thick, sterile, green, odorless substance. Meconium is made up of water, desquamated skin and intestinal cells, gastrointestinal mucus, lanugo hair, fatty material from the vernix caseosa, intestinal secretions, amniotic fluid, blood group-specific glycoprotein, bile, and drug metabolites. Typically, babies pass meconium only after delivery. On the other hand, meconium transit by the fetus in utero is linked to 8–15 percent of births. Following an episode of fetal hypoxia, it is generally accepted that meconium passes once the gut is stimulated and the anal sphincter relaxes. Small for date babies and post-mature babies have increased rates of meconium-stained amniotic fluid. Materials & Methods: The obstetricians closely observed the progression of labor, the consistency and length of meconium staining, and any indication of fetal distress such as bradycardia (less than 120 beats per minute), tachycardia (more than 160 beats per minute), or fetal heart irregularity in all moms who were diagnosed with MSAF. The attending team of obstetricians made the decision about a spontaneous, induced, assisted, or surgical birth depending on the different maternal circumstances and the presence or absence of fetal distress. Results: As can be seen from the data, 62.66% of the population lives in rural areas. Three quarters of the cases are from urban populations (32.28%), while 5.06 percent are from tribal populations. As a result, the majority of cases are associated with rural population. Ninety-nine percent of the 158 newborns with meconium staining were large for date (LFD), whereas 128 babies (81.02%) were appropriate for date (AFD). In our study, MSAF was encountered by 128 (8.10%) babies out of 1580 AFD babies, 15 babies (10.06%) out of 149 SFD babies, and 15 (32.06%) out of 46 LFD babies. Conclusion: The current study concludes that paediatricians and obstetricians routinely treat symptomatic MAS and MSAF. Postmaturity is the primary risk factor for multiple systemic artery fibrillations (MSAF). The chance of MSAF is greatly increased by additional obstetric risk factors, such as the existence of fetal distress. Oligohydramnious is highly associated with MSAF, and the thick meconiurn is more often associated with MAS symptoms. A selective approach may be utilized for infants with MSAF, conserving intratracheal suctioning for weak or depressed neonates. All the other infants need is attentive observation after the oro-nasopharyngeal suctioning is finished. Furthermore, births with MSAF, which are closely associated with birth asphyxia, are a common cause of neonatal deaths.

58. Unraveling the Complexity of Anemia in the Elderly: Insights from A Cross-Sectional Study At SLN Medical College And Hospital, Koraput, Odisha, India
Susanta Kumar Nahak, Luzoo Prachishree, Suryasnata Sahoo, Chandan Kumar Gantayat
Abstract
Background: Anemia, characterized by reduced hemoglobin (Hb) or hematocrit levels below the lower limit of the 95% reference interval adjusted for age, sex, and geographic location, presents a significant health concern among the elderly. Understanding its etiology, clinical manifestations, and regional variations is crucial for effective management. Methodology: A cross-sectional study was conducted at SLN Medical College and Hospital, Koraput, Odisha, India, involving 100 consecutive anemic patients aged 60 years and above. Data collection included comprehensive history-taking, clinical examination, and hematological investigations, alongside additional diagnostic procedures. Results: The study revealed a gender-balanced distribution among participants, with fatigue being the predominant symptom, followed by palpitations and anorexia. Clinical signs such as pallor and pedal edema were prevalent. Normocytic normochromic anemia was the most common type, with nutritional deficiencies and blood loss being the primary etiological factors identified. Discussion: Anemia in the elderly is multifactorial, with anemia of chronic disease and iron deficiency being notable contributors. The study highlights the importance of tailored diagnostic approaches and caution against indiscriminate hematinic use. Regional variations in etiological patterns underscore the need for context-specific management strategies. Conclusion: Our study underscores the complexity of anemia in the elderly, emphasizing the necessity for individualized care approaches tailored to address diverse etiological and clinical aspects. Through continued research and clinical vigilance, we aim to enhance outcomes and quality of life for elderly individuals affected by anemia.

59. A Study on Spectrum of Cytological Patterns in Cervical Pap Smear and Its Clinicodemographic Correlation at A Tertiary Care Centre
Sushrutha R, Athira K P, Mohit Kumar, Shashidhar M R
Abstract
Background and Objectives: Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide. This study has been undertaken to find out the prevalence of an abnormal Pap smear in a tertiary care centre. Aim of the Study: To evaluate women for non-neoplastic and neoplastic lesions using the Pap smear test and to investigate for the surveillance for clinical and demographic correlation. Methods: This was a retrospective and prospective study conducted in the Department of Pathology, HIMS, Hassan from 2012 to July 2022. A total of 3390 women were included in the study. Data were entered in Microsoft Excel and analyzed in SPSS software. Results: Out of 3390 women included in the study, majority women were in the age group of 35- 45 years (41.9%). Most cases (53%) were from rural area. Majority of the patients were asymptomatic (52.6%), followed by menstrual abnormalities (16.1%) and white discharge (13.7%). NILM-Inflammatory was the most common finding (61.5%), followed by NILM (17.7%). ASCUS, AGUS, ASC-H, LSIL and HSIL were detected in 3.9%, 0.6%, 0.7%, 3.2% and 2.1% respectively. SCC was reported in 1.1% of the study population. NILM, NILM-Inflammatory, ASCUS, AGUS, LSIL, ASC-H and HSIL were more common in the premenopausal age group. Atrophy and SCC were more common in the postmenopausal age group. Conclusion: Pap smear screening procedure is a simple, economical, useful and safe tool in detecting precancerous cervical epithelial lesions. Educational programs and medical camps should be conducted in the community to create awareness about the cervical cancer and its prevention by periodic pap smear examination.

60. Cardiovascular Consequences in Children with Chronic Kidney Disease: A Hospital Based Cross-Sectional Study
Yoheshwar P, Seshathri M, Cherian Thomas
Abstract
Objectives: To determine the proportion of children with chronic kidney disease requiring dialysis; and to determine the factors associated with children with CKD requiring or not requiring dialysis. Methods: This was a hospital based cross-sectional study with prospective enrolment of patients (children 1 to 18 years of age with chronic kidney disease (CKD, glomerular filtration rates less than 60 ml/min/1.73 m2)) conducted in the Department of Paediatrics, in a tertiary healthcare facility in central India between June 2020 and December 2021. Results: The majority of participants were males (81.3%), and three-quarters were aged ten or older. CKD stages varied, with 38.7% at stage 3, 40.0% at stage 4, and 21.3% at stage 5 and/or requiring dialysis. Several nutritional and hematologic abnormalities were observed, with 72.0% of children being underweight, 52.0% having anemia, and 42.7% presenting with proteinuria. Additionally, 46.7% exhibited abnormal calcium-phosphorus (Ca x PO4) product. The study reported a high prevalence of hypertension, with 22.7% having clinical hypertension and 90.7% having ambulatory hypertension. Metabolic disturbances were notable, including hyperkalaemia (17.3%) and acidosis (60.0%). Among children not requiring dialysis (76.0%), a lower mean (SD) Ca x PO4 product was observed (37.2, SD 2.3) compared to those requiring dialysis (41.5, SD 4.7; p<0.001). Hyperphosphatemia and hyperparathyroidism were more common in the dialysis group (66.7%) than in those not requiring dialysis (28.1% and 35.1%, respectively; p<0.05). Proteinuria was more prevalent in non-dialysis patients (89.5%) compared to dialysis patients (66.7%; p<0.05). Furthermore, LVH was significantly higher in the dialysis group (55.6%) compared to the non-dialysis group (21.1%; p<0.05). Children requiring dialysis exhibited higher LV mass, LVMI, and fractional shortening, indicating compromised cardiac function. Ejection fraction was also significantly lower in the dialysis group (51.7 vs. 60.9 in non-dialysis; p<0.05). Conclusion: These results underscore the intricate relationship between CKD, cardiovascular complications, and the impact of dialysis, emphasizing the need for tailored interventions to address the multifaceted challenges faced by children with CKD.

61. Compliance and Factors Affecting Weekly Iron and Folic Acid Supplementation Programme in Schools of Bhopal District
Prachi Kori, Preeti Kori, Sohan Mandloi, Akhil R Nair
Abstract
Background: The awareness regarding anemia and appropriate diet is also extremely poor in school going children. There is a misconception that only girls need iron. During this phase the requirement for growing boys also jumps significantly. To reduce the prevalence and severity of nutritional anemia among adolescent population (10-19 years) Weekly Iron and Folic Acid Supplementation programme (WIFS) launched by GOI. This study was planned to assess Compliance and factors affecting Weekly Iron and Folic acid Supplementation Programme in schools of Bhopal district. Materials and Methods:  After institutional ethical committee approval, a longitudinal school based study done in randomly selected government schools of Bhopal (M.P.), India. Results: Among 257, there were 128(49.8%) males and 129 (50.2%) females. At baseline prevalence of anemia was 32.8% among boys and 57.4% among girls. At follow up prevalence of anemia was 30.5% among boys and 55.8% among girls. Mean rise in hemoglobin at the end of three months is 0.229 ± 0.2407mg/dl. It was found to be statistically significant.At follow up it was found that total 215(83.7%) adolescents were compliant and 42(16.3%) were not compliant. Change in mean hemoglobin at follow up visit is more in compliant group with mean and standard deviation 0.263 ± 0.2382 compared to non-compliant. Compliance to iron folic acid supplementation was better observed among Hindu religion. It was found statistically significant (p < 0.05). Majority of the participants i.e. 99.2% boys and 96.1% girls did not have any side effects with consumption of iron folic acid supplementation, however there were some complaint of nausea in 2.1% girls only and dizziness 0.8% in both and 0.4% stomach ache in girls only. Analysis of the probable factors that can be associated with the change in mean hemoglobin shows that compliance towards iron folic acid supplementation and deworming was significantly associated with it. Rest of the factors (Gender, Religion, Type of family, Type of diet, Menstrual loss) was not significantly associated. Conclusion: Most of the school students consume IFA tablets under WIFS programme although irregularly and inadequately due to many reasons. However, a high degree of compliance can be achieved by emphasizing the positive benefits of weekly iron–folic acid supplementation though a comprehensive communication and motivation strategy.

62. Effect of Bilateral Infratrochlear and Infraorbital Nerve Block Combined With General Anesthesia for Nasal Surgeries: A Prospective Randomised Study
Pooja Makhija, Priyanka Sahu, Funnykesh, Mohd Vajahat Khan, Anuj Dubey, Garima Yadav
Abstract
Introduction: Pain and agitation are the commonest side effects after nasal surgeries which not only affect the recovery of the patient but also increase the hospital stay. With this background we decided to conduct the study in which we gave bilateral infra-trochlear and infra-orbital nerve blocks along with general anesthesia for nasal surgeries. Method: 60 patients, who were posted for routine nasal surgeries were equally divided into 2 groups with 30 patients each (Group NB and Group GA). In group NB (Nerve block+ General anesthesia) we gave bilateral nerve blocks (Infra-trochlear and infraorbital) by using 0.5% Bupivacaine 5ml after general anesthesia, in group GA (General anesthesia) we didn’t give any nerve block after general anesthesia. We observed intraoperative and postoperative analgesic requirement as well as hemodynamic stability of the patients. Result: Total analgesic requirement were significantly less in group NB as compared to group GA both in intraoperative as well as early postoperative period. There was decrease in the time spent by the patient in postoperative anaesthesia care unit in Group NB as compared to Group GA. Conclusion: Bilateral infra-trochlear and infraorbital nerve blocks, using 0.5% Bupivacaine during general anesthesia for nasal surgeries will not only decrease the intra-operative and post-operative analgesic requirement but also increase the intraoperative & postoperative hemodynamic stability.

63. A Retrospective Cross-Sectional Clinico-Pathological Study on Intestinal Obstruction Done at a Tertiary Care Level Hospital in India
Ravichandra Matcha, Chinnavenkateswarlu Midasala, Veerabhadrarao Sirigineedi, Ashok Prasadula
Abstract
Background: Patients with intestinal obstruction consist of a major proportion of emergency room visits and the complication is associated with a significant morbidity and mortality. It has a diverse aetiology which varies from country to country. In developed countries it is mainly due to adhesions and in developing countries it is due to obstructed hernias. This study aims at finding the common causes of intestinal obstruction in patients presenting to emergency room in our hospital and comparing it with common causes in western world. Patients and Methods: We retrospectively analyzed all the patients admitted with intestinal obstruction to our department from June 2022 to December 2023. Their demographic data, duration of symptoms before presenting to the hospital and interval between admission and surgery were noted along with the cause and level of obstruction. The type of procedure, post-operative complications, mortality or whether re-exploration was done was also noted. Results: A total of 246 patients presented with intestinal obstruction during this period out of which 186 patients underwent surgery. The commonest cause of obstruction was adhesions in 68 patients (36.5%) This was followed by obstructed hernias in 35 patients (18.8%) carcinoma in 32 patients (17.2%), tuberculosis in 28 patients (15%), strictures in 23 (12.3%) patients. Colorectal surgery was the most common previous procedure in the adhesions group –21 patients (31.1%). The overall operative mortality was 10 (5.5%). Conclusion: The aetiology of intestinal obstruction in our hospital is now mainly due to adhesions and is thus shifting towards the western pattern. But tuberculosis and obstructed inguinal hernias still constitute a sizable proportion of our patients.

64. Management of Tibial Pilon Fractures Using Delta External Fixator Method versus MIPO Technique: A Prospective Comparative Study
Anoop H S, Prashantha, Sanjeev MN, Prithviraj B Chavan, Vinay N
Abstract
Background: The treatment of Tibial Pilon fractures are one of the most dreaded of ankle joint fractures management, and they continue to pose a challenge to the orthopaedic surgeons. They are associated with extensive soft tissue damage, articular surface damage, and osseous comminution. The ideal treatment of these tibial pilon fractures is still a matter of debate. Aim: The aim of this study was to study the management and assess the functional outcome of patients with tibial Pilon fractures treated by Delta External Fixator method versus MIPO technique. Results: In our study, which included 30 patients with a follow up period of 1 year, outcome was excellent in the Delta External fixator group compared to MIPO group. Although the final AOFAS score and ROM were slightly less in Delta External fixator group. The time to weight bearing and time for radiological union were slightly shorter in Delta External fixator group than MIPO group of patients.

65. A Comparative Study on Use of Conventional Method versus Microdebrider Assisted Endoscopic Sinus Surgery in Sinonasal Polyposis
Amirunisa Begum Mohammed, S. Muneeruddin Ahmed, Dr. M. Mahendra Kumar, R. Bhanu Murthy
Abstract
Background: Sinonasal Polyposis is a common end stage local manifestation of chronic Allergic disease affecting the Nose and Paranasal sinuses resulting in nasal obstruction and Anosmia. It is due to an IgE mediated Allergic phenomenon resulting in the permanent pathological changes of the Sinonasal mucosa. Functional endoscopic sinus surgery is the most commonly performed surgery for Sinonasal Polyposis. Conventional method using cold steel instruments was in the vogue initially and now after the advent of microdebrider the indications and outcomes have changed for the better. This study attempts to assess the use of conventional method versus microdebrider usage in Sinonasal Polyposis. Aims Objectives of the study: To assess the uses of endoscopic Sinonasal surgery with conventional method and Microdebrider assisted methods and to assess the intra-operative and postoperative outcomes. Materials: Out of 50 patients divided as two groups based on the type of instruments used for FESS surgery. LM staging of the symptoms, CT scan of PNS and DNE findings were considered to assess the severity of Sinonasal Polyposis. Post-operative and Intra operative variables were observed and analysed. Observations: Group ‘A’ out of 26 patients 16 (61.53%) were males and 10(38.46%) females with a male to female ratio of 1.6:1. In Group B there were 15(68.5%) males and 09(37.5%) females with a male to female ratio of 1.66:1. Conclusions: Age of the patients ranged from 10 to 50 years with the mean age of 33.45±5.60 years.  2. Male to female ratio was 1.6:1. The operative time and surgical field visibility in the microdebrider method was much better with microdebrider than conventional method. Blood loss was also less with microdebrider assisted method. There was statistically considerable difference between microdebrider assisted endoscopic sinus surgery and the conventional method in total VAS scores at 3 months and 6 months postoperatively.

66. Early Peritoneal Drainage Alone Vs. Laparotomy in Neonatal Necrotizing Enterocolitis Management: A Comparative Analysis
L Dasaradha Rao, Sravanthi Vutukuru, Sasidhar Thorlikonda, Tarun Chowdary Mulpuri, Rohit Sajja
Abstract
Aim: Management of neonatal perforated necrotizing enterocolitis in a high-volume center. Methods: Retrospective analysis of all newborns managed with NEC between 2019-23. Records were reviewed and data pertaining to gestational age, sex, weight, severity of sepsis, nature of discharge from peritoneal drain, treatment offered, and survival were recorded, and data was analyzed. Results: Total 78 neonates were treated with perforated NEC. Out of which 42 were male, 36 were females. 20 were treated alone with primary peritoneal drain alone, 58 underwent salvage laparotomy after peritoneal drain. Group -1 (primary peritoneal drain alone) 30 patients – Air + serous fluid, Group 2 (salvage laparotomy followed by primary peritoneal drain), 12 air+ serous fluid, 27 bilious aspirates, and 19 feculent. Group -1 (12/20) survived group 2 (33/58) survived. Conclusion: Early peritoneal drainage helps in stabilization of neonates with perforated NEC, in neonates with air and serous fluid alone most of time peritoneal drain alone is enough. Laparotomy is required only is cases no improvement and with bilious and feculent aspirates. Early and aggressive intervention and timely management have better chance of survival.

67. A Comparative Study on the Outcome of the Clinical Outcome of Varicose Veins Treatment by Flush Ligation of Saphenofemoral Junction with and Without Stripping of Long Saphenous Vein
Manek Markose Roy, G. Vinayagam, Priyankadevi Egambaram
Abstract
Background: Varicose veins are dilated, tortuous, thin elongated vessels usually associated with valvular incompetence. With a shift to less invasive, endovenous treatment modalities in recent years, much attention and interest has been drawn to venous disease. Flush ligation at the saphenofemoral junction and stripping of the great saphenous vein is being increasingly replaced by endovenous methods such as radiofrequency or endovenous laser ablation for the treatment of varicose veins. Objective: This hospital-based prospective and comparative study aimed to study the clinical outcome of varicose veins treatment by flush ligation of saphenofemoral junction with and without stripping of long saphenous vein. Materials and Methods: A total number of 50 patients in whom the clinical and radiological diagnosis of unilateral/ bilateral varicose veins was established and were investigated for a period of 12 months (October 2022 to October 2023) were considered in this single-center study conducted at Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry. Inclusion criteria included all patients in whom the clinical and radiological diagnosis of unilateral/ bilateral varicose veins was established, aged 18 years to 60 years and having CEAP classification C2-6 EP AS/P PR. Patients admitted under general surgery with varicose veins were included in the study after taking their consent. Detailed history & thorough physical examination of the patients to be included under the study was done and recorded in a proforma for each patient separately. This study analysed both groups for postoperative complications like severe pain, hematoma formation, delayed ambulation, limb oedema, wound infection. Result: The most common age group in the study was 31-40 years. Out of 50 patients, 11 (22%) were male and 39 (78%) were female with a male to female ratio of 0.28:1. Unilateral Left limb was more commonly involved than the bilateral left limb in 19 (38%) patients among the study population. There was no recurrence of the disease in patients of group A and group B for both 1st month and 2nd month. Group A patients recorded recurrence of the disease in 4th, 5th and 6th month at 2 cases, 1 case and 2 cases respectively. Conclusion: This study concludes that there is not much significant differences in recurrence rate of both groups but there is delayed recurrence in those patients who under SFJ ligation WITH stripping of GSV.

68. Risk Factors for Infectious Complications of Ureteroscopy Following Obstructive Acute Pyelonephritis
Naushad Khatri, Abhishek Kumar Singh
Abstract
Background and Aim: Kidney stone disease is a frequently seen condition in urologic practice. Urinary tract infection (UTI) is often linked to KSD, both as a cause (such as struvite and carbonate apatite stones) and as a potential complication (like obstructive pyelonephritis and post-operative UTI). It is worth noting that a considerable amount of the financial strain caused by KSD is primarily focused on stones that are linked to infection. Our study sought to investigate the results of URS following OAPN in a significant patient population. Additionally, we aimed to evaluate potential risk factors such as RIRS and the time interval between OAPN and URS. The ultimate goal was to improve the management of patients who undergo stone removal after OAPN. Material and Methods: The study was conducted at a Department of General Surgery in a Tertiary Care Teaching Institute in India for duration of 1 year. An analysis was conducted on the data of patients who were referred to Study hospital and diagnosed with OAPN secondary to urinary calculi. The study focused on those who underwent emergency drainage over the past three years. Patient records were examined to gather important information on various factors that could contribute to postoperative complications. These factors included age, sex, body mass index (BMI), presence of diabetes mellitus, leucocyte counts and C-reactive protein at presentation of OAPN, type of preoperative drainage, days from drainage to surgery, operative time, and stone factors. Results: 12 cases underwent auxiliary shockwave lithotripsy. There were no deaths during the perioperative period. Several factors were found to be potential risk factors associated with postoperative UTI, including the presence of diabetes mellitus, duration from drainage to surgery of over one month, a high stone burden, simultaneous RIRS, and an operation time exceeding 75 minutes. These findings were statistically significant with a p value of less than 0.05. Conclusion: Individuals who had previous OAPN faced a higher likelihood of experiencing postoperative infectious complications. Several factors were found to be significant predictors of postoperative UTI, including diabetes mellitus, duration of more than one month from drainage to surgery, and undergoing simultaneous RIRS. Our findings indicated that there is a potential correlation between.

69. A Pilot Study – Efficacy of 0.15% Ropivacaine with Fentanyl for Management of Epidural Labor Analgesia in Primigravida Parturient
Sumedha Mehta, Seema S. Karhade
Abstract
Background: Ropivacaine is considered to have better safety profile and differential block compared to Bupivacaine.  Ropivacaine in Labor Epidural Analgesia can be useful in providing good pain relief with better maternal satisfaction due to less motor blockade. Materials & Method: This pilot study was conducted in 30 consenting nulliparous primigravida and Epidural labor analgesia was given by 0.15 % Ropivacaine with fentanyl. Our primary objective is to assess the analgesic efficacy using VAS score and degree of motor blockade of Epidural 0.15% Ropivacaine with fentanyl in nulliparous parturient undergoing labour epidural analgesia. Our secondary objective was the obstetric outcome in terms of rate of normal, instrumental vaginal or caesarean delivery, any side effects like nausea, vomiting, hypotension, maternal satisfaction score and the neonatal outcome. Observations and Results: Effective Ambulatory Labor Analgesia was observed in all 30 parturient with no failure rate. VAS score was highly statically significant (p < 0.001) between pre- bolus and post- infusion. None of the parturient required rescue analgesia or complained of VAS > 3 throughout the study. We found no significant motor blockade in our study. All Parturient were pain free, ambulatory with no motor blockade. Maternal Satisfaction score was excellent in 86.66% of parturient with no parturient complained of poor pain relief. Conclusion: In our pilot study we conclude that 0.15% Ropivacaine provide excellent walking epidural labor analgesia with no motor blockade resulting in good maternal satisfaction and neonate outcome.

70. A Study on Career Preferences, Perception and Attitude towards Working in Rural Area among Medical Undergraduates in Maharashtra
Kunde Pallavi B., Surve Rahul R., Dase Rajesh K., Shah Vedant G., Singh Reecha
Abstract
Background: India is facing the problem of unequal doctor: patient ratio among urban & rural area. Rural area suffers from inadequate health resources. Aim & Objectives: This study aims to study the career preferences, factors for acceptance or rejection to work in rural area & factors that can motivate medical undergraduates in Maharashtra to work in rural area. Materials& Methods: An online cross-sectional study was conducted among 330 undergraduate medical students in medical colleges across Maharashtra during July -September 2021. Final year part I & part II students & interns were the study participants. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25.0. Chi Square test was used to check statistical significance. Results: The total number of respondents was 330 comprising of 177(53.6%) from third year Part I, 104(31.5%) interns & remaining 49(14.8%) from third year Part II. Majority (69.4%) respondents were in the 20-22 years age group. There were 168 (50.9%) female & 162(49.1%) male respondents. About 79(23.9%) students will prefer to work in rural area. 61(18.5%) students will not prefer while 190(57.6%) students will prefer to work in rural area only under some conditions. Male students, students with rural origin & those with educated parents are more likely to work in rural area (P<0.05). The most common reason for preferring to work in rural area was that rural areas need more medical attention. Conclusion: Poor basic needs, no career growth, lack of guidance or poor infrastructure & heavy workload emerged as potential barriers for students to work in rural area.

71. Functional Outcome of Modular Bipolar Prosthesis in Intracapsular Neck of Femur Fractures
Arun Mathew George, Ananda Krishnan A, Rahul Roy
Abstract
Background: One of the most frequent fractures in the elderly is the femoral neck fracture. Bipolar prosthesis, which is said to have a lower incidence of problems than the tried-and-true unipolar prosthesis, is gradually replacing it. Modularity has the advantage of various sizes in the prosthesis which helps in maintaining limb length offset and soft tissue tension and helps in achieving identical anatomy and biomechanics as that of a hip joint. Therefore, this study will help us to evaluate the functional outcome of modular bipolar prosthesis in intracapsular femoral neck fractures. Methodology: After obtaining consent from 50 patients admitted in hospital who came with intracapsular fracture of femoral neck was included in this study. They underwent treatment by modular bipolar prosthesis after all necessary investigations and clinical examination. After ruling out any intraoperative complications and immediate postoperative complications, patients were followed up at 6 weeks, 3 months and at 6 months post-surgery. Post- operative wound was examined and checked for any complications, including limb shortening. Clinical evaluation was done using Modified Harris Hip score. Results: In this study of 50 cases there were 16 males and 34 females, with a maximum age of 80 years, minimum age of 50 years. There was a slight predominance of right sided fractures when compared to the left. At the final six months follow up assessment with Harris Hip Score 15 patients (30%) achieved ‘Excellent’ result, 22 patients (44%) achieved ‘Good’ result and 13 patients (26%) achieved ‘Fair’ result. At the end of study majority of the participants did not have any complications, only 5 (10%) and 3(6%) of them had wound infection and limb shortening as complications. Conclusion: We can conclude that modular bipolar hemiarthroplasty produces good functional outcomes with minimal complications for displaced intracapsular femoral neck fractures and has several advantages.

72. A Prospective Study of Bedsore Patients in a Tertiary Care Centre
Chelladurai S, Umarani S, Padma Kathirvel, Kannan G, Gottigundala Naveen Reddy
Abstract
Background: A pressure sore or bed sore is due to underlying prolonged pressure over that area. It is seen most commonly in bed ridden patients over the bony surfaces.it is classified into grades based on depth of involvement. Objective: primary objective is to study the natural course of bedsore patients from cause to treatment and effect on socioeconomic status. Methods: A prospective observational study was done for period of two years from 2022 to 2024, on 100 patients admitted for bedsore in a tertiary care Centre. Discussion: The mean age distribution was 44.7+/- 14.RTA and CVA are the major causes. Majority presented late with GRADE 4 after mean duration of 3.5 months. 60% of patients belonged to lower socio-economic class of which almost all of them became unemployed after the disease. Conclusion: Bedsore is one of major cause for mortality effecting both health and socioeconomic status of the patients. Hence, prevention of bed sore is utmost important with proper enlightenment.

73. Rapid Urine Cultures – Revolutionizing UTI Management for Faster and Better Patient Care
Sneha S. Bowalekar, Pratik H. Jariwala
Abstract
Purpose: Rapid reporting of urine cultures is important so as to avoid unnecessary antibiotic use in absence of infection. Also, use of broad spectrum antibiotics for treatment of urinary tract infections (UTI) in hospitalised patients without de-escalation should be curtailed. We aimed to provide negative result for urine cultures within 6-24 hours as well as antimicrobial susceptibility testing (AST) result within 24 hours for positive monomicrobial urine cultures with use of rapid automated system HB&L Light. Methods: The prospective observational study was carried out in Department of Microbiology between October 2022 and May 2023. Total number of urine specimens tested was 432. Growth results by both conventional culture (CC) and Uro-Quick (UQ) methods were compared. Antimicrobial susceptibility testing results by both CC and UQ isolates were compared wherein UQ isolates were directly used from either subculture agar or positive Monomicrobial pellet with single and double wash technique. Results: Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value of rapid automated urine culture system was found to be 97.7%, 100%, 100% and 100% respectively. 100% agreement was found in comparison of AST result amongst UQ isolates (processed from solid agar subculture) and corresponding CC isolates (n=20). Agreement for fluoroquinolones and nitrofurantoin ranged from 85% to 90% when UQ isolates (bacterial pellet from positive vial obtained after one wash technique) and corresponding CC isolates were compared for AST results (n=27). More than 90% agreement was observed for fosfomycin, beta lactam antibiotics except for 3rd generation cephalosporins, aminoglycosides and colistin. However, after double wash technique, agreement for AST results increased upto 97% to 100% (n=31). Conclusion: HB&L Light system can be used for rapid reporting of negative as well as positive urine cultures. Antimicrobial susceptibility testing results can be reported within 24 hours for positive monomicrobial urine cultures on rapid automated system.

74. Screening and Management of Anemia in Adolescent Girls in Lower Socioeconomic Strata
Banumathy S, Rathnakumar S
Abstract
Background: Adolescence is an opportune time for interventions to address anemia especially among girls in Indian population. Apart from the supplementation and additional requirements in antenatal mothers, improving the iron status before pregnancy is required. Preventing iron deficiency among adolescent girls is primordial thereby number of maternal morbidity and related mortality may be reduced. By keeping these issues, this study is aimed to screen the anemic status of the adolescent girls and addressing the importance of iron supplementation to improve hemoglobin levels. Methods: This study was conducted at Institute of Social Obstetrics and Government Kasturba Gandhi Hospital, Chennai. Around 500 adolescent girls were screened anemia and related socio economic status. Results: As a result, 68% were found to be anemic under various degrees. Upon iron folic acid supplementation and deworming, all the girls showed significant improvement in their hemoglobin levels. Severely classified anemic girls required long term supplementation to reach the normal level. In this study, the lower socioeconomic status, hookworm infestations were found to be attributable causes of anemia. Conclusion: Thus providing healthy supplementary foods to the adolescent girls in the home is advisable; if not possible prescribing supplements in order to improve the iron status. Taking steps by prophylaxis treatment, dietary modifications and helminthic control would increase the hemoglobin levels.

75. A Clinical Study on Management of Comminuted Trochanteric and Subtrochanteric Fracture at GGH Kadapa
Penugonda Ravi Shankar, R. Venkat, D. Nageswar Reddy, L. Anand
Abstract
Background: Fractures of proximal femur and hip are relatively common injuries in elderly individuals constituting 11.6% of total fractures. In this study, we compared the clinical outcome of fractures treated by proximal femoral nail with that of proximal femur locking compression plate. Materials and Methods: The present study consists of 24 elderly patients of peritrochanteric factures of femur satisfying the inclusion criteria who were treated with Proximal Femoral Nailing or Proximal Femur-Locking Compression Plate in Department of Orthopedics, Government General Hospital, Kadapa for a period of one year. Results: 24 cases were treated with Proximal Femoral Nailing or Proximal Femur-Locking Compression Plate in a randomized pattern who satisfied inclusion criteria. Intraoperative complication was found to be more with Proximal Femur-Locking Compression Plate in contrast to PFN. Postoperative rehabilitation was easier with Proximal Femoral Nailing though not statistically significant functional and anatomical outcomes were found to be better with PFN. Conclusion: Both Proximal Femoral Nailing and Proximal Femur-Locking Compression Plate have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages. Further studies with large number of patients and long-term follow up is needed to determine the optimal implant for the internal fixation of comminuted peritrochanteric femoral fractures.

76. Serum Lipid Profile in 2nd Trimester as a Predictor of Hypertensive Disorder in Pregnancy
Arulmozhi, Gayatri, Pravallika M
Abstract
Background: Hypertension disorders represent the most common medical complication of pregnancy. Studies state that abnormal placentation and endothelial dysfunction are the key factors in the development of pre-eclampsia. Lipid levels in the early pregnancy can be a good predictor of development of preeclampsia. Dyslipidemia in early pregnancy leads to more oxidative stress by the formation of lipid peroxidases and reactive oxygen species, thus predisposing to development of pre-eclampsia. The pathological state of hypertension at the maternal period predisposing the condition of pre-eclampsia occurs due to reduced capacity of perfusion in placenta enhance the dysfunction of vascular endothelial system which arises from lesser invasion of cytotrophoblasts into the arteries of uterus. The research aims to estimate the lipid concentration in the second trimester of pregnancy for prediction of hypertension. Materials and Methods: This study was done as a prospective cohort study at antenatal clinic, department of obstetrics and gynecology at Government Mohan Kumaramangalam medical college, Salem. Pregnant women with singleton pregnancy with LMP and USG confirmed pregnancy between 14 to 28 weeks of gestation were included in the study. A descriptive analysis was done among 100 pregnant women; they were subjected for routine investigations and clinical examination. Fasting blood samples collected from the selected pregnant women’s for lipid profile analysis. Results: The incidence of gestational hypertension in study was 34.3%. The total cholesterol ranging in the individuals tends to have the mean ranging 214.76 ± 72.25 mg/dl and these individuals have greater range of mean score of TG level 250.12 ± 66.81 followed by LDL mean score as 116.28 ± 45.55 mg/dl with the lowest range of VLDL mean scoring predicted as 36.34 ± 19.54 mg/dl. The total cholesterol, TG levels and VLDL have a significant effect on gestation hypertension in maternal period with the mean ranging as 25.32 and TG denoted as 277.69 whereas the values of HDL and LDL does not have any effect on GHTN. Conclusion: The lipid profile acts as the most promising biomarker in identifying the condition of hypertension in the pregnancy. Lipid profile analysis in early 2nd trimester is a simple noninvasive and economical for the prediction of hypertensive disorders in pregnancy.

77. Clinico-Histopathological Study of Leprosy Cases
Abhilasha Parmar, Hiren Vaghela, Aditi Patel, Kirit Jadav
Abstract
Introduction: Leprosy first described in ancient Indian texts from the sixth century BC, is a nonfatal, chronic infectious disease caused by Mycobacterium leprae, whose clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes and testes. Histological study of leprosy is very important in understanding the disease, its varied manifestation and complications. For accurate and adequate treatment, the diagnosis must be made early and it should be accurate. So clinicopathological correlation is very important in patient care and management. AIM: The aims of the studies was to study histopathological spectrum of various subtypes of leprosy along with to study the age and gender wise incidence of different subtypes of leprosy and to assess the concordance between clinical and histological diagnosis in cases of leprosy. Materials and Methods: A retrospective and prospective observational study of 121 skin biopsies diagnosed as leprosy over a period of three years at Medical College Baroda, Gujarat. RESULTS: In this study, most of cases occurred in age group (41-50) years (24.79%) and showed marked male predominance with M:F ratio=1.5:1. Lepromatous leprosy (30.57%) was the most common histopathological type of leprosy. The overall clinico-histopathological correlation was seen in 79 cases (65.28%) and a good concordance was seen in Type 1 reaction, LL followed by TL and HL. The least concordance was seen in BT. Conclusion: The specific histopathologic features in leprosy which are well defined and precise indicate the accurate response of the tissue, while taking into account the immunologic manifestations, whereas the clinical features indicate only the gross morphology of the lesions caused by the underlying pathological change. Since there is variable tissue response in the disease spectrum due to the variability of CMI, it is logical to expect disparity between the clinical and histopathological features while studying various types of leprosy.

78. Neonatal Intestinal Obstruction – A Retrospective Study in A Newly Established Tertiary Care Centre
Sravanthi Vutukuru, Sasidhart, Rohit Sajja, L. Dasaradha Rao, Tarun Chowdary M
Abstract
Neonatal intestinal obstruction is a common surgical emergency and occurs in approximately 1 in 2,000 live births. This retrospective study aimed to investigate the etiological spectrum of neonatal intestinal obstruction and analyze factors influencing the outcome of surgical management. The study included 26 newborns with a male-female ratio of 1.16:1 and a mean gestational age of 37.5 weeks. The most common cause of neonatal intestinal obstruction was found to be intestinal atresia (30.7%) and anorectal malformation (30.7%), followed by Hirschsprung disease (15.3%), Malrotation gut (7.6%). The mean age of presentation was 4 days, and the mortality rate was 19.2%. The study highlights the importance of antenatal detection, early intervention, meticulous resuscitation, and effective NICU care in improving the morbidity and mortality associated with neonatal intestinal obstruction over recent years.

79. Study to Evaluate the Efficacy of Reduction in Intraocular Pressure and Safety between Latanoprost and Tafluprost with Normal-Tension Glaucoma
Tamal Roy, Archana Kumari, Asif Hussain, Salman Shamim, Purnendu Kumar Singh
Abstract
Background: Normal-tension glaucoma (NTG) is a chronic eye condition characterized by optic nerve damage and visual field loss, often associated with intraocular pressure (IOP) within the normal range. The management of NTG primarily focuses on lowering IOP to slow down disease progression. Two commonly prescribed prostaglandin analogs, latanoprost and tafluprost, have been used to reduce IOP in glaucoma patients. This study aimed to compare the efficacy and safety of latanoprost and tafluprost in reducing IOP among patients with NTG over a 6-month period. Materials and Methods: A prospective study was conducted at J.L.N. Medical College in Bhagalpur, Bihar, with a sample size of 100 patients diagnosed with NTG. Patients were randomized into two groups: one receiving latanoprost and the other receiving tafluprost. Baseline IOP measurements were obtained for all participants. The IOP was assessed at regular intervals over the 6-month study duration. Adverse events and changes in visual acuity were also monitored. Statistical analysis was performed using appropriate tests to compare IOP reduction between the two groups. Results: After 6 months of treatment, the mean IOP reduction in the latanoprost group was found to be 3.5 ± 1.2 mm Hg, while in the tafluprost group, it was 3.8 ± 1.4 mm Hg. The difference in IOP reduction between the two groups was not statistically significant (p > 0.05). No serious adverse events were reported in either group, and both medications were well-tolerated. Visual acuity remained stable throughout the study in both groups. Conclusion: In this 6-month study comparing the efficacy and safety of latanoprost and tafluprost in reducing IOP among patients with normal-tension glaucoma, both medications demonstrated similar IOP-lowering effects and were well-tolerated. These findings suggest that both latanoprost and tafluprost can be considered as effective treatment options for NTG patients, allowing clinicians to tailor the choice of medication to individual patient preferences and cost considerations.

80. Level of Awareness Regarding Hepatitis B Virus and Its Vaccination among Medical Students and Importance of Early Clinical Exposure (ECE) as Per New Undergraduate Curriculum
Ripika Saxena, Sourav Garg, Rijul Ranjan, Anita Pandey
Abstract
Background: Hepatitis B virus (HBV) infection is potentially life-threating and can produce health hazard to all groups of healthcare workers including medical students. However, the level of awareness regarding HBV and its vaccination is lacking among the medical students. Methods: A cross – sectional study was conducted in a medical college attached to a tertiary care hospital. A total of 400 medical students belonging to 1st year, 2nd year, 3rd year and 4th year were evaluated using a self-structured questionnaire to assess the knowledge and awareness about HBV and the status of hepatitis B vaccination. Among the students who participated the 1st year to 3rd year students of MBBS batches had undergone medical training as per the new CBME based curriculum, however the final year students were trained as per the old MBBS curriculum. Result: There was significant improvement in the knowledge component of students after the introduction of CBME based curriculum from 2019 onwards.  Highest level of awareness was observed among the 3rd year students followed by 2nd year. However, the level of awareness was comparatively low among the students of 1st year and 4th year. Conclusion: The Level of Awareness regarding HBV, its vaccination and management of NSI was comparatively low among medical students. The hospital should make a mandatory policy for strict implementation of vaccination and safe injection practice for all the medical and allied subjects at the commencement of their courses.

81. The Endovenous Laser Ablation (EVLA) and Traditional Vein Stripping (TVS) for the Treatment of Varicose Veins in Forearm: A Comparative Analysis
Akshay Sanjay Nagare, Tabrez Roomy Shafat, Himani Sandhu, Alok Srivastava, Sawdahbibi Soyab Mohmed Motala, Biswajit Maity
Abstract
Background: Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. It is far more common to experience varicose veins, or spider veins, in your legs; many people do suffer from varicose veins in their arms. Luckily, there are treatment modalities available that have proven to be extremely effective and have minimal side effects. In this , randomized controlled trial, the endovenous laser ablation (EVLA) was compared with conventional surgery with stripping for the treatment of varicose veins of forearm. Aim and objectives: Compared the preoperative and postoperative outcomes of EVLA and Traditional surgery with vein stripping (TVS) in the patients with vein varicosis in forearm. Materials and Methods: The present study was a single-center, prospective comparative study conducted on patients admitted with varicose veins in the surgical wards of Hind Institute of Medical Sciences and Hospital, Ataria, Sitapur, UP. From March 2022 to August 2023. A total of 56 varicose veins patients admitted in ward were divided into the two groups of 28 patients in each group who underwent EVLA or TVS surgery as per patients consent. Patients were included in this study based on the inclusion and the exclusion criteria. Result: A total of 56 patients were divided into the EVLA group (n=28; 20 males, 8 females) and the TVS group (n=28; 22 males, 6 females). The mean age of the patients was 42.21± 10.24 years in the EVLA group and 41.9± 9.31 years in the TVA group (P =0.788). The left arm was affected in 71.42 % of the EVLA group and 64.28% of the TVS group (P =0.640). According to AVVSS (Aberdeen varicose vein symptom severity), in the EVLA group was 4.7±3.1 and 4.8± 2.7 in the TVS group, the differences were also found significant at 6, 12 and 24 hours (P=0.05). Pain severity in 6, 12 and 24 hours after the procedures were significantly different between the two groups . The pain severity score was found more in TVS group as compared to EVLA; at 24 hours it was 6.58 ±1.026, in TVS; whereas 4.17 ± 1.011 in EVLA. (p=0.05). Chronic pain (seventh day, 3, 6, and 12 months after the procedures) was present 14.28% in EVLA group and 25% in TVA group. It was found significant (P ≤0.05). According to NRS, the mean chronic pain severity in the EVLA group was 3.50 ± 0.657 and 5.99 ± 0.754 in the TVA group, and the difference was significant (P= 0.05). The length of the operation was 41.3±10.6 minutes in the EVLA group and 52.3±11.8 minutes in the TVA group that was also found significant (P=0.14). At 3 months, the recurrence rate of the EVLA and TVA groups was 3.5 and 6.7% respectively. The Post-VDS score was significantly lower in all EVLA patients as compared to TVS. The mean pre–post difference in the VDS scores in TVS was found higher and also found significantly different ( EVLA-0.89±0.14 vs. TVS-1.33± 0.91, P < 0.01).It was also observed that the return to normal activities (days) was better in EVLA group as compared to TVS, it was 2.1±02 (Days) in EVLA whereas, 3.2± 1.6 in TVA. (p=0.05). Conclusion: The TVS group was the increased incidence of hematoma formation and the movement of arms on the first postoperative day was very painful. The results of this study indicated the higher efficacy of EVLA for upper extremity varicosis treatment as compared to TVS. It has also been observed that the two methods were significantly different in length of procedure, complications, and pain. The cosmetic outcome of TVA method was not acceptable, as the one-year follow-up results indicated difference in there recurrence rate and pain with other complications. In this study the sample size was very small. Hence, these findings have to be further validated with large sample size of forearm before concrete recommendations.

82. Comparative Efficacy of Prophylactic Ilioinguinal Neurectomy and Ilioinguinal Nerve Preservation in Open Inguinal Hernia Repair – A Randomized Controlled Trial
Santhosh Kumar Elavaree E, Ankush Misra, Rohit Singh, Amit Mishra, Biswajit Maity
Abstract
Background: Inguinal hernia is one of the most common male diseases world-wide. Chronic groin pain is a significant clinical problem in patients undergoing open hernia repair which interferes with daily activities. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following Prophylactic Ilioinguinal Neurectomy, compared to Ilioinguinal Nerve Preservation when performing Lichtenstein’s tension free inguinal hernia repair. Methods: A total of Eighty male patients (≥18 years to ≥70 years) undergoing hernioplasty for inguinal hernia were divided into two groups. In group A (Prophylactic Ilioinguinal Neurectomy, PINE) , there were 40 patients who were subjected to prophylactic ilioinguinal neurectomy and in group B (Ilioinguinal Nerve Preservation, INPE ) there were 40 patients in whom preservation of ilioinguinal nerve was done during the hernia repair. Patients were followed up at 1 month, 3 and 6-months following surgery to assess the incidence of chronic groin pain and pain during daily activities. Result: At one month follow up there was no significant difference between the two groups regarding incidence of chronic groin pain or pain during daily activities. However, the incidence of chronic groin pain was significantly lower in Group A compared to Group B at 6 months follow up. During vigorous activities, more group B (INPE) patients had pain compared to group A (PINE) patients at 3-month [18 (45%) vs. Seven (17.5%); p=0.005; Chisquare test] and 6-month follow-up [16 (40%) vs. five (12.5%); p=0.006; Chi-square test]. Conclusion: Prophylactic ilioinguinal nerve neurectomy offered some advantages concerning pain in the first 6th month postoperative period. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.

83. Thyroid Dysfunction in Patient with Abnormal Uterine Bleeding in A Government Medical College/Government General Hospital, Srikakulam, Andhra Pradesh
G. Chandrakala, D. Goutami, T. Sasikala
Abstract
Introduction: Thyroid hormone is known to affect reproductive biology. Abnormal uterine bleeding is one of the common presentations in gynecology outpatient departments and thyroid dysfunction is known to affect its progression. This study aims to find the prevalence of thyroid dysfunction in diagnosed cases of abnormal uterine bleeding in patients in Government Medical College, Govt. General Hospital, Srikakulam, A.P. Methods: A Descriptive cross-sectional study was conducted in patients diagnosed with abnormal uterine bleeding in a Government General Hospital, Srikakulam, A.P from January 2023-December 20203. On basis of inclusion and exclusion criteria, 120 cases of abnormal uterine bleeding were included in the study. A blood sample was taken and a thyroid function test was done by chemiluminescence assay on an automated analyzer. Convenient sampling method was used for sample collection. Statistical analysis was done using Statistical Package for the Social Sciences version 17. Point estimate at 95% Confidence. Results: Out of the total cases of abnormal uterine bleeding, 27(22.5%) had thyroid dysfunction, among total cases, 93(77.5%) were euthyroid. The mean age of the patients was 35.5years.Among thyroid dysfunction, 8(6.7%) were hypothyroid, 15 (12.5%) were subclinical hypothyroid, and 4 (3.3%) were hyperthyroid. Conclusions: Thyroid dysfunction was common among patients with abnormal uterine bleeding; with subclinical hypothyroid is being the most common type.

84. Observational Study to Analyze Acceptance and Expulsion Rates of Post Placental Intra Uterine Contraceptive Device (PPIUCD) – CuT380A
Prajakta Deshmukh, Ashvini Deshmukh, Y. S. Nandanwar
Abstract
Background: The challenge of population explosion hinders socio-economic development, leading India’s Ministry of Health to focus on refined strategies, emphasizing non-invasive approaches in its 2020 plan. Post Placental Intra Uterine Contraceptive Devices (PPIUCD), specifically CuT380A, are promoted for safe, long-acting contraception. CuT380A, a Copper IUCD, offers a decade of effectiveness with minimal side effects. Objectives: The main objectives of the study are to assess the acceptance rates, expulsion rates before 6 weeks and before 6 months and associated complications of Post Placental Intrauterine Contraception Device PPIUCD (CuT380A) insertion. Methods: Contraceptive counselling was given to 1380 eligible couples during the antenatal period. A proforma was filled out for all participants. Women who accepted the Post Placental Intrauterine Contraception Device (PPIUCD) CuT380A in the antenatal period were inserted with the device immediately after delivery of the placenta. These women were followed up at 6 weeks and 6 months for expulsion and complications. Women who declined Post Placental Intrauterine Contraception Device (PPIUCD) CuT380A were asked for the reason and documented. The acceptance rate of Post Placental Intrauterine Contraception Device (PPIUCD) CuT380A and expulsion rate were recorded. Results: Of the 1380 women counselled, a total of 202 (15%) were inserted with Post Placental Intrauterine Contraception Device (PPIUCD) CuT380A. Women who had higher education and who underwent vaginal delivery had greater acceptance of the Post Placental Intrauterine Contraception Device (0.032 & 0.006 respectively). Preference to other methods of contraception, partner refusal, need to discuss with partner and family, fear of pain and heavy bleeding were the most common reasons for declining use of Post Placental Intrauterine Contraception Device. The common complication at 6 weeks interval was lower abdominal pain. The common complication at 6-month interval was menstrual disturbance. Expulsion rates at 6 weeks and 6 months were 0.9%. Conclusion: The Post Placental Intrauterine Contraception Device (PPIUCD) CuT380A was demonstrably safe, effective, has a high continuation rate. The expulsion rate was not very high and it can be reduced with practice and insertion techniques.

85. Association between Serum Concentration of 25-Hydroxyvitamin D and Community-Acquired Pneumonia
Chandan Gupta, Sunita Khandelwal, Ahmed Zuber, Amit Kumar Saini, Hardik Kabra
Abstract
Background: Pneumonia is an acute respiratory tract infection (RTI) which is classified according to age and specific causative organism. Pneumonia can be caused by bacteria, viruses or fungi. Vitamin A and zinc supplementation is used for the prevention of respiratory infections in developed countries. Recent research suggested the role of vitamin D in the prevention of pneumonia and increasing the individual’s immunity. Vitamin D also has antimicrobial properties and according to recent studies, its deficiency may be correlated to an increased frequency of respiratory infections. Vitamin D deficiency can positively affect a wide variety of microbial infections such as Gram-positive and Gram-negative bacteria, fungi, mycobacteria, and viruses.12 Given the importance of pneumonia and because vitamin D deficiency is one of the possible factors involved in susceptibility to pneumonia, further studies on the possible role of vitamin D deficiency in the prevalence or severity of the disease can be useful. Objectives: (1) To study the correlation of serum calcium and vitamin D3 level in community acquired pneumonia in children upto 18-year age admitted in JK lone hospital Kota. (2) To know the association of serum calcium and vitamin D3 in community acquired pneumonia in children upto 18-year age and to compare the association in number of episodes of disease. Methods: Children admitted in JK lone hospital Kota who full field the criteria of community acquired pneumonia. exclusion criteria were excluded. The following parameters, recorded on admission, were evaluated: date of presentation (month, year), age, sex, co-morbidity, duration of symptoms, clinical symptoms (body temperature, respiratory rate, heart rate, and arterial systolic and diastolic blood pressure), pneumonia-associated confusion, and relevant investigation sent on day of admission (CBC, RFT, LFT, serum calcium, vitamin d3) and report collected. Then reports were analyzed and the serum levels of 25-hydroxyvitamin D were determined by electrochemiluminescence binding assay in Roche Cobas 601 immunoassay analyzer and mean serum levels of 25-hydroxyvitamin D in each risk class were calculated. Then find Correlation between serum calcium and vitamin D3 level in pneumonia patients. Results: In our study sit was stated that majority of pediatric patients who had pneumonia belonged to 0–1-year age group i.e. 54%, followed by 21% in 1–3-year age group, 11% in 3–5-year age group, 9% in 5–10-year age group and 5% in >10-year age group. Percentage distribution showed that insufficiency (20-30 ng/ml) was maximum seen in 0–1-year age group, followed by 1–3-year age group. Vit D deficiency was maximum seen in >10-year age group, followed by 3-5 year and 0-1 year. Conclusions: The study shows a significant correlation between low Hb levels and low Ca levels and with increased episodes of pneumonia. Severity of pneumonia is inversely related to Vitamin D levels and Ca, Hemoglobin levels.

86. Comparison between Ferric Carboxymaltose and Iron Sucrose in Pregnant Women with Iron Deficiency Anaemia
Puja Verma, Akriti Prasad, Dipti Roy
Abstract
Iron deficiency anaemia is the commonest haematological disorder of pregnancy in India. In pregnant women intolerant to oral iron intravenous iron in various forms is available. This study compares intravenous ferric carboxymaltose and iron sucrose in 100 pregnant women. . After therapy the mean Hb at 2 weeks was 10.59 ± 0.73 and 11.61 ± 0.54 in IS and FCM group respectively. The mean Hb level at 4 weeks was 11.19 ± 0.8 g/dl and 12.01 ± 0.64 g/dl in IS and FCM group respectively. The mean MCV increased to 82.71 ±3.6 fl in 2 weeks and 84.61 ± 3.4 in 4 weeks in women treated with iron sucrose. The rise in mean MCV was also seen in women in FCM group which was 86.76±3.1 fl after 2 weeks and 87.84±3.4 fl after 4 weeks. FCM was found to be better as it increased Hb levels in lesser number of doses and less number of hospital visits as compared to IS.

87. Surgical Amputation for Diabetic Foot Ulcer and Various Risk Factors – Prospective Research
Sandhyarani Latchamsetty, Kuna Madhuri Devi, Yerramsetti Atchyuth Ramaiah, Sirigineedi Veerabhadrarao
Abstract
Introduction:  Diabetic foot ulcer (DFU) is an important complication of diabetes mellitus (DM). With this a study was conducted to find different risk factors of DFA. Methods: It was a prospective research conducted in government Medical College, Srikakulam. Study was conducted for a period of 6 months, from January to June 2022. Study protocol was approved by Institutional ethical committee. An informed written consent was taken from study participants. Adults >31 years, both gender those identified diabetic foot (DF) attended to general medicine and general surgery departments were included. Blood sample was collected by venue puncture, serum was used for glucose estimation. Then the individuals were referred to general medicine to confirm the diabetes status. After this, amputation was done as per the institutional guidelines. Data was presented in mean and percentage. Results: Total 124 members were included, gender wise, there were 59% (73) female and 41% (51) male; the male female ratio was 0.7. Age wise, majority (30.7%; 38) were in >71 years group, mean age was 58.3 years. When the duration of DM was considered, the incidence of DFU was found to be prevalent (26.6%; 33) in 6 – 10 years duration. Conclusion: DFU stand out as one of the prevalent, severe, and economically burdensome complications of DM. Significant risk factors identified include male gender, prolonged duration of DM, and an age exceeding 40 years. It’s important to note that this study has limitations, such as not taking into account Body Mass Index (BMI) and socioeconomic status.

88. Comparative Study of Diagnostic Efficacy of FNAC and Cell Block Study of Thyroid Lesions
Akshata B, Narayana Murthy G, Seema S Maharana
Abstract
Background: Thyroid swellings are far common among the neck swellings with a prevalence of 4 to 7% of adult population. Fine needle aspiration (FNAC) cytology is one of the important tools for preoperative thyroid swelling evaluation. Cell block sections give a better architecture and allow multiple sections and useful if the sample contains more blood and less cells in the conventional smears. Objective: To compare the diagnostic efficacy between FNAC and cell block study in thyroid lesions. Methods: A prospective observational study was undertaken in the Department of Pathology, PES Medical College and Research centre, Kuppam, during the period from June 2015 to June 2017 comprising of 100 patients presented with thyroid lesions. Smears were prepared from thyroid aspirates and stained with haematoxylin and eosin stain, May Grunwald Giemsa stain and Papanicolaou stain. Cell blocks were prepared from the remnants. Smears were scored based on cell obscuration by blood, cellularity, cell degeneration and cell architecture. The results were compared with histology. Data were recorded using Microsoft Excel. Descriptive statistics, frequency, and proportion were used to describe demographic variables. Results: The sensitivity, specificity, positive predictive value and negative predictive value, in diagnosing malignancy were 50%, 100%, 100% and 100%, for FNAC and 100%, 100%, 100% and 100% for cell block in comparison with cytology, respectively. Conclusion: The cell block method is better in comparison with conventional FNAC in diagnosing thyroid aspirate lesions.

89. Hematological Profile of COVID-19 Patients in a COVID Care Hospital
Sreeram B, Aysha Ali, Priya P Kartha
Abstract
Background: Various hematological abnormalities have been noted in SARS-CoV-2 infection, directly correlating with disease progression, clinical severity, and mortality rates. This study aimed to assess the hematological parameter abnormalities among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a tertiary care hospital located in southern India. Methods: This retrospective study was conducted by the Department of Pathology, Government Medical College and Hospital, Palakkad, Kerala. The hematology profile, based on CBC results collected in this study, included hemoglobin, hematocrit, red blood cell (RBC) count, red cell distribution width (RDW), white blood cell (WBC) count, absolute eosinophil count, absolute basophil count, absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, and thrombocyte count obtained from Sysmex XN-1000. Results: A total of n=350 patients’ data was included in the study. Out of which n=225(64.28%) were males and n=125(35.71%) were females. The mean age of the cohort was 38.51 ± 10.2 years.  The common age group was 21 – 40 years with 63% of all the cases reported in the study. The mean NLR was 5.05, which is higher than the normal range of 0.7-2.0. This suggests that the COVID-19 patients had an elevated NLR, which is a marker of inflammation and severity of illness.  Table 4 shows that COVID-19 patients have several hematological abnormalities, including elevated WBC count, anemia, thrombocytopenia, neutrophilia, lymphopenia, eosinophilia, and basophilia. Conclusion: several hematological parameters hold promise for predicting the severity of COVID-19 and for guiding timely and appropriate treatment interventions. Complete blood count (CBC), which is a readily available and cost-effective test in most medical centers, offers significant clinical value. NLR could be utilized as an alternative parameter for assessing inflammatory states in patients with confirmed COVID-19 cases.

90. Study of Correlation between Proinflammatory Cytokines and Stress marker enzymes in Alcoholic Liver Disease Patients
Aizaz Fatima, Jaidev Singh, Surya Tiwari, Mohammed Imran Khan
Abstract
Background: Alcohol-related liver disease is a major cause of morbidity and mortality worldwide. Chronic alcohol consumption leads to hepatocellular injury, fat accumulation and liver inflammation. Progression of ALD is well characterized and is actually a spectrum of liver diseases, which ranges initially from simple steatosis to inflammation and necrosis (steatohepatitis), to fibrosis and cirrhosis. Objectives: The study was designed to determine the effect of Pro-inflammatory cytokines & stress marker enzymes in alcoholic liver disease patients with reference to normal healthy individuals. Methods: 175 alcoholic liver disease patients were enrolled for the study & were compared to 150 normal healthy individuals of the same age from the Outdoor Patient Department of Maharaja Yeshwant Rao Hospital of Indore city. Those fulfilling inclusion & exclusion criteria were enrolled for the study & the blood samples were analysed for TNF­α, IL-6, plasma MDA and SOD. Results: Significant higher concentrations of TNF­α (p<0.001), IL-6 (p<0.001), and MDA (p<0.001) was demonstrated in patients with alcoholic liver disease when compared with normal healthy individuals. A significantly lower concentration of SOD (p<0.001) was demonstrated in patients with alcoholic liver disease when compared with normal healthy controls. Conclusion: Alcohol consumption causes excessive cytokine production in the liver, leading to inflammatory liver disease. Alcohol-induced liver injury is linked to oxidative stress as observed by decreased levels of SOD and increased levels of MDA.

91. Neonatal Sequential Organ Failure Assessment (Nsofa) in Early Prediction of Morbidities and Mortality in Neonates with Perinatal Asphyxia – A Prospective Cohort Study
Anilkumar Sajjan, Siddu Charki, Prakash V J, Mallangouda M Patil
Abstract
Background: The most common reason for resuscitation in the delivery room is birth asphyxia. Twenty-five percent of all early postnatal fatalities are related to hypoxic-ischemic encephalopathy (HIE) and subsequent organ failure. In newborns with sepsis, the neonatal Sequential Organ Failure Assessment (nSOFA) takes circulatory, respiratory, and platelet failure into account. Aim: To evaluate whether nSOFA is also a useful predictor for in-hospital mortality in neonates (≥ 36+0 weeks of gestation (GA)) following asphyxia with HIE and therapeutic hypothermia (TH). Results: nSOFA was documented at ≤ 6 hours of life. 65 neonates fulfilled inclusion criteria for TH. All but one infant received cardiopulmonary resuscitation and/or respiratory support at birth. nSOFA was lower in survivors (median 0 [IQR 0-2]; n = 56, median GA 39+3, female n = 28 (50%)) than in non-survivors (median 10 [4-12], p < 0.001; n = 9, median GA 38+6, n = 4 (44.4%)). This was also observed for the respiratory (p < 0.001), cardiovascular (p < 0.001), and hematologic sub scores (p = 0.003). The odds ratio for mortality was 1.6 [95% CI = 1.2 – 2.1] per one-point increase in nSOFA. The optimal cut-off value of nSOFA to predict mortality was 3.5 (sensitivity 100.0%, specificity 83.9%). Conclusion: Since early accurate prognosis following asphyxia with HIE and TH is essential to guide end-of-life decisions, nSOFA (≤ 6 hours of life) offers the potential to identify neonates at risk of mortality.

92. Study of Indications of Blood and Blood Components in Neonatal Intensive Care Unit and Pediatric Intensive Care Unit
Mukesh Kumar Jatav, Archana Shrivatava, Reeni Malik, R.K. Nigam
Abstract
Background: Transfusion of blood & its components is very important and often required in management of patients admitted in NICU (first 28 days of birth) and PICU(29 days to 12 years of age).Common indications of blood and blood components transfusion in paediatric age group patients are Anemia, Preterm, Low birth weight, shock, etc. Aims and Objective: (1) To study the indications of blood & its components in NICU and PICU unit. (2) To investigate current transfusion practices in critically ill children. (3) Analysis of the relevance of various components which should be used in NICU & PICU cases for proper utilization of blood & its components. (4) To identify most commonly used blood component. Method and Material: This is a retrospective study conducted by Department of Pathology over a period of 6 months from September 2021 to February 2022.Data of blood & its components supplied for NICU & PICU patients were collected from records of Blood Bank of Tertiary Care Center and studied. Result: (1) Total 335 cases of blood  transfusion and  its components were supplied to critically ill patients admitted in NICU and   PICU units, out of which 189 Packed Red Cells, 97 Fresh Frozen Plasma, 46 Platelet Concentrates and 03whole blood were supplied. (2) Number of transfusions used for pathological conditions were as following 83were used in Anemia,64 in shock,30 in preterm babies and 37 in low birth weight babies besides others. (3) Most common indication for blood transfusion was Anemia. (4) Most commonly used component was Packed Red Cells. Conclusion: Anemia was the most common  indication of blood transfusion. Whole blood  transfusion is still used which should be minimized. Blood wastage can be reduced with evidence based blood utilization strategies. Use of appropriate blood components should be encouraged.

93. Prognostic Impact of C-Reactive Protein (CRP) and Procalcitonin (PCT) Levels in Patients with Sepsis and Septic Shock
Khushali L Patel, Rina Viral Gandhi, Pankaj Garg, Nupur Pandya
Abstract
Introduction: There is limited data on the prognostic value of CRP and PCT in sepsis or septic shock. Therefore, this study aimed to explore the diagnostic and prognostic significance of CRP and PCT in patients with sepsis and septic shock. Materials and Methods: Total 150 patients with sepsis or septic shock were included. Blood samples were collected on the day of disease onset (day 1), day 3, and 7 for measurement of PCT and CRP.  Results: Out of 150 patients, 72.0% patients presented with a sepsis and 28.0% with a septic shock. Significant positive correlation was observed between SOFA score with serum PCT on day 7 only (r- 0.34, p – 0.03) and with CRP on day 7 only (r- 0.31, p – 0.04). Mortality rate at 30 days at 30 days was 32.0%. PCT was shown to have a good accuracy with regard to mortality on day 7 (AUC with 95% CI: 0.67; 0.46 to 0.82) compared to CRP on day 7 (AUC with 95% CI: 0.54; 0.35 to 0.62). Conclusion: Procalcitonin (PCT) is a a better indicator in determining severity of infection and the chances of survival for patients with sepsis. PCT is even better than CRP in predicting mortality within 30 days.

94. Unveiling Amyand’s Hernia: Clinical Perspectives and Surgical Approaches
GandetiKiran Kumar, Mudavath Keerthi, Ravipalli Sasidhar, Bogarapu Chaithanya Babu, Rapuru Sumanth, K. Sita Avanthi
Abstract
Amyand’s hernia, a rare variant of inguinal hernia characterized by the presence of the appendix within the hernial sac, poses diagnostic and management challenges. This case series presents five cases of Amyand’s hernia treated at medical institutions in India between 2020 and 2023. Clinical presentations varied, with cases ranging from incidental findings during hernia repair to acute appendicitis within the hernia sac. Surgical interventions included hernia repair, appendectomy, and management of associated complications. The discussion encompasses clinical characteristics, diagnostic challenges, surgical approaches, and classification systems guiding management decisions. Additionally, emphasis is placed on individualized treatment strategies based on the appendix’s inflammatory state, presence of abdominal sepsis, and patient comorbidities. This report aims to enhance awareness and understanding of Amyand’s hernia, facilitating improved diagnosis and management in clinical practice.

95. Perception of the Introduction of Objective Structured Practical Examination (OSPE) among Faculty of Preclinical and Paraclinical Departments in a Medical College
Ashima Bhaumik, Dipak Patil
Abstract
Background: Under the Competency based undergraduate curriculum the objective structured practical examination (OSPE) is a standardized assessment tool as it tests the students on what they can do rather than what they know. OSPE covers the lacunae that exist in traditional practical examination (TPE) which is more subjective and the element of examiner’s bias is present. The advantages of the OSPE are that it ensures a uniform marking scheme and consistent examination methods for both examiners and students. Objective: The primary objective of this study was to explore faculty perception, across pre and para clinical departments of a medical college, of using OSPE as an assessment tool. Methodology: A cross sectional study was conducted in a tertiary health care institute for a period of 2 months in 2020. Perceptions of all the medical teachers of pre and paraclinical departments with regard to introduction of OSPE was collected using a prevalidated Likert’s scale-based questionnaire which because of COVID 19 times was sent both by WhatsApp and e mail. Results: Among the faculty, all were aware about OSPE. However, with the exception of Community Medicine department where OSPE was being regularly used in combination with TPE, none of the other pre and paraclinical departments had started consistently using OSPE as a method of assessment. 80% faculty agreed (70% strongly agreed) that OSPE covered a wider range of knowledge than TPE. All were unanimous that it was a fairer assessment tool when compared to TPE. Examiner bias & patient variability can be removed to a large extent by OSPE was strongly agreed by 94.4%. However, 90% strongly felt OSPE needs a lot of coordination by staff and consumes a lot of time. 90% felt OSPE can be used as a formative assessment tool. 100% agreed that OSPE in combination with traditional practical examination (TPE) can produce good results. Data analysis: Descriptive statistics was used for the analysis of data and results were expressed as percentages. Conclusion: The faculty perceived use of OSPE as a useful and fair formative assessment tool and can be used in combination with TPE for best results.

96. Intraocular Pressure Patterns in the Eye with Retinal Venous Occlusions: A Comparative Study
Faseela CC, Praveen CP
Abstract
Background and Objectives: Retinal venous occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and is a major cause of visual loss worldwide. Age is the most important risk factor. Major local risk factor is glaucoma. Though glaucoma has been described as a risk factor for RVO, not many studies describe the occurrence of drop in intraocular pressure (IOP) following venous occlusive event and its mechanism. This study was an attempt to assess intraocular pressure (IOP) pattern of affected eye of patients with RVO compared with normal fellow eye. Material and Methods: The study had a comparative design and was done inside the setting of a hospital. Patients with unilateral retinal vein occlusion (RVO) were chosen from the Ophthalmology Outpatient Department (OPD) at the Ophthalmology department of the Government Medical College and Hospital in Kozhikode, Kerala, India using a convenient sampling method. This was accomplished subsequent to receiving authorization from the Scientific Review Committee and Institutional Ethics Committee, as well as obtaining written agreement from the patients. The ocular examination encompassed a thorough assessment of the anterior segment using a slit lamp, evaluation of visual function, measurement of intraocular pressure (IOP), and inspection of the fundus. SPSS was utilized for statistical analysis. Results: Mean age of retinal vein occlusion is 57.3 years. RVO is seen more commonly in males (60%).Slight preponderance of left eye affection (56.67%) is seen. In patients with central retinal vein occlusion, intraocular pressures of affected eyes, on comparing with normal fellow eyes, show no significant difference in each visit. In patients with branch retinal vein occlusion, intraocular pressures at subsequent visits show statistically significant difference between affected and unaffected eyes, with IOP being lower in affected eyes. Conclusion: RVO is a common vascular disease of retina, of which, Superotemporal branch retinal vein occlusion is the most common type. Present study did not find any statistical significant difference between intraocular pressures of central retinal vein occlusion (CRVO) in affected eye and normal fellow eye. In branch retinal vein occlusion (BRVO), there was significant difference between intraocular pressures of affected eye and normal fellow eye on follow-up.

97. Correlation of Serum Ferritin with HbA1c Levels in Type 2 Diabetes Mellitus
R.P. Vinodkumar, P. Ravisekar, R. Kalaiselvi
Abstract
Background: Diabetes is a metabolic disorder characterized by hyperglycemia which is associated with rise in the HbA1c levels. Excess iron damages β-cells of pancreas due to oxidative stress which can contribute to pathogenesis of diabetes mellitus. Serum ferritin, an acute phase reactant a marker of iron stores in the body and its level is considered to be an indicator of body iron stores. Objective: 1. To assess the serum ferritin, FBS, PPBS and HbA1c level in type 2 diabetes mellitus patients. 2. To find the correlation of serum ferritin with FBS, PPBS and HbA1c levels in this patients. Material and Methods: This study was performed in 100 Diabetic Patients attending Dialectology OPD in Government Mohan kumaramangalam medical college and hospital and 5ml of venous blood sample will be collected and analysed Blood sugar in fully automated chemistry analyser and HbA1c in D10 analyser and ferritin in chemiluminescent immunosorbant method. The statistical analysis was performed using SPSS version 16. Results: There was a positive correlation between serum ferritin and Fasting sugar, postprandial sugar, HbA1c. Serum ferritin is significantly related to Fasting Sugar (P value- 0.000013) moderate positive correlation; postprandial sugar (P value- 0.00001) a moderately strong positive correlation and glycated Hemoglobin (P value-0.00001) moderate positive correlation. Conclusion: The serum ferritin level increased in patients with type 2 diabetes mellitus and there is Positive correlation between HbA1c and serum ferritin has also been found. It indicates that in low resource setting serum ferritin can be used as a marker for glycemic control in diabetic patients it is cost effective compared to HBA1C screening.

98. A Prospective Study of Heart Rate Variability and Serum Uric Acid with Blood Pressure in Normotensives and Stage 1 Hypertensives
Abida Farheen, Gousuddin Arif
Abstract
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 private clinic, Kalaburagi, A total of 120 subjects in the age group of 30 – 40 years attending Noncommunicable diseases OPD. Among them 60 subjects were normotensives with systolic blood pressure < 130 mm Hg and diastolic blood pressure < 80 mm Hg. 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 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.

99. A Comparative Study on Small Intestinal Obstruction and Large Intestinal Obstruction in a Tertiary Care Hospital
Sanjay Choudhuri, Sridhar Panda, Sujit Kumar Mohanty
Abstract
Background: The research aimed to compare minor and major intestinal blockage. Bowel blockage is one of the most prevalent causes of acute abdomen and remains a major surgical emergency to this day. It is one of the most serious crises presented to the surgeon in all aspects. They account for between 12% and 16% of surgical admissions for acute abdominal symptoms. Acute intestinal blockage symptoms might vary from a somewhat normal look with just little abdominal pain and distention to a condition of hypovolemia or septic shock (or both) necessitating an emergency procedure. Methods: A total of 100 patients of acute intestinal blockage were admitted to all surgical wards at the Department of General Surgery SVRRGGH/SVMC between November 2020 and August 2022. The age, sex, and complete history pertinent to the etiology were recorded. Acute intestinal blockage is characterized by stomach discomfort, vomiting, constipation, and obstipation, as well as clinical symptoms such as fever and tachycardia. Results: In this investigation, small bowel blockage was more prevalent than large bowel obstruction; men had a higher incidence of intestinal obstruction than females; and post-operative adhesions were shown to be the major cause of obstruction.

100. An Investigation of the Antibiotic Sensitivity of Peritoneal Fluid Cultures in Cases of Perforative Peritonitis
Sanjay Choudhuri, Sridhar Panda, Sujit Kumar Mohanty
Abstract
Introduction: General surgeons often face peritonitis. Significant advances in the treatment of peritonitis have occurred in recent decades, owing mostly to the use of antibiotics and surgical procedures. The study’s aims were to determine the antibiotic sensitivity and resistance pattern of commonly used antibiotics against cultured microorganisms. Materials and Methods: This research used a cross-sectional design. The study was conducted out in the Department of General Surgery, SCB Medical College and Hospital, Cuttack, odisha. The trial ran from October 2022 until September 2023. This research used a sample of 40 people as participants.Result: Secondary peritonitis is a frequent consequence of hollow viscus perforations. Because patients may not  arrive to the hospital until much later, the death rate is high. The age groups of 31-40 years old and 20-30 years old accounted for the majority of perforation cases in our research. The average age when symptoms first occur is 35.26 years. According to our data, 52% of perforations occur in the second part of the duodenum, with the stomach accounting for 42%. Klebsiella accounted for 46% of the cases, E. coli for 34%, and just 2% were a mix of the two. Our research focuses on analyzing the sensitivity patterns of grown organisms. Ceftriaxone, ciprofloxacin, and amikacin were the most often detected organisms that showed sensitivity. Conclusion: The research discovered that the duodenum is the most prevalent location of perforation, followed by the stomach. Peptic ulcer disease was the most prevalent cause. The most prevalent bacteria responsible for secondary peritonitis in these individuals were Klebsiella and Escherichia coli, with mixed, proteus, and pseudomonas infections occurring seldom. The most effective antibiotics against Klebsiella and Escherichia coli were cephalosporins, quinolones, and macrolides, in that order of sensitivity.

101. Dyslipidemia and Cardiovascular Changes in Chronic Kidney Disease
Sridhar Panda, Sanjay Choudhuri, Sujit Kumar Mohanty
Abstract
Introduction: This research evaluated the lipid profile and cardiovascular consequences in individuals with chronic renal disease. Methods: This 2-year cross-sectional research included 60 patients with chronic renal disease admitted to the SCB Medical College, Cuttack. The trial included patients with bilaterally constricted kidneys, a GFR < 60 mL/min/1.73m², and people over 18 with a history of renal illness lasting more than 6 months. Results: The average total cholesterol for all patients was 189.8 ± 14.72 mg/dl. The mean total cholesterol in individuals with stage 5 CKD was considerably greater than in stage 4 and stage 3 patients. (p < 0.05, significant). The average triglyceride level across patients was 174.8 ± 16.29 mg/dL. There was no significant variation in mean triglycerides among CKD patients at various stages. (p > 0.05, not significant). The average HDL-cholesterol level across patients was 37.50 ± 7.56 mg/dL. There was no significant variation in mean HDL cholesterol levels across various stages of CKD patients. (p>0.05, not significant). The average LDL-cholesterol level across patients was 132.2 ± 15.74 mg/dL. There was no significant variation in mean LDL-cholesterol levels across various stages of CKD patients. (p>0.05, not significant). The mean VLDL cholesterol The average blood glucose level across patients was 37.50 ± 12.36 mg/dL. There was no significant variation in mean VLDL-cholesterol levels between various stages of CKD patients. (p > 0.05, not significant). Conclusion: CKD is a serious illness affecting guys aged 41 to 50 years. Dyslipidemia (increased cholesterol and triglyceride levels) and cardiovascular abnormalities are more common in CKD patients, particularly in stages 4 and 5. Further study is needed to address these critical risk factors and minimize mortality in this patient population.

102. Evaluation of Surgical Site Infection in Breast Cancer Surgery: An Observational Study
Sanjay Choudhuri, Sridhar Panda, Chandan Das, Sujit Kumar Mohanty
Abstract
Background: The purpose of this study was to evaluate postoperative site infections in breast cancer surgery patients. Materials and Methods: The current investigation was carried out in the Departments of General Surgery, Department of plastic and reconstructive surgery and Microbiology at SCB Medical College and Hospital, Cuttack. A total of 100 participants were registered. The participants were divided into four groups based on the type of breast surgery they had: mastectomy (without breast-saving techniques), breast-conserving surgery, breast reconstruction using the Lattismus Dorsi (LD) flap method, and subcutaneous amputation with simultaneous reconstruction using an artificial prosthesis. The surgical site infection was assessed. All of the findings were analyzed using SPSS software. Results: Overall, 11 percent of participants had SSI. The proportion of patients identified with surgical site infection (SSI) in each treatment group showed that those who had subcutaneous amputation with contemporaneous repair using an artificial prosthesis had a significantly higher incidence (27.2%). Conclusion: Surgical site infection (SSI) offers a substantial issue, justifying a focus on preventative measures.

103. Study of Gastrointestinal Tuberculosis and Role of Surgery in Its Management
Sujit Kumar Mohanty, Sanjay Choudhuri, Sridhar Panda
Abstract
Background: While abdominal TB is less frequent than its pulmonary cousin, this research will look at the clinical signs of Gastrointestinal Tuberculosis, the consequences of surgical therapies, and the anatomical distribution throughout the digestive system. Materials and Methods: Prospective observational research was carried out at SCB Medical college and Hospital, Cuttack from August 2020 to October 2022. The trial group consisted of fifty individuals with confirmed gastrointestinal TB. The diagnosis was made based on the clinical history, symptoms, and investigations such as ultrasonography, endoscopy, and histology. Patients received a variety of therapies depending on their condition, including surgery and anti-tuberculosis medication. Results: The prevalence of GI tuberculosis was virtually similar across sexes, with the majority occurring between the ages of 18 and 30. Presents major diagnostic and therapeutic obstacles. It is the sixth most common kind of extra-pulmonary TB, affecting the gastrointestinal system, peritoneum, lymph nodes, and solid organs. Objective: Common symptoms were stomach discomfort, lack of appetite, and fever. The ileocaecal region was the most afflicted area. Surgical intervention was required in situations with complications such as blockage or perforation. Postoperative problems included surgical site infections and pulmonary issues. Conclusion: The research found that GI tuberculosis is more common in younger persons, with a high incidence of concomitant pulmonary TB. Complications were often treated surgically, with resection and anastomosis being especially common. Anti-tuberculous therapy was a regular component of the treatment plan. The research emphasizes the need of increased awareness and early intervention in the treatment of gastrointestinal TB.

104. A Prospective Study to Compare Sevoflurane and Propofol for Laryngeal Mask Airway Insertion
K Lakshmana Rao, S Anal Kumar, B V V N Mahendra, Ch V V Siva Kumar
Abstract
Introduction: The laryngeal mask airway (LMA) is frequently employed to facilitate airway management. A study was conducted to compare the incidence of respiratory complications, including laryngospasm, hear rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) with the use of sevoflurane and propofol. Methods: It was a prospective study conducted in the government Medical College, Rajamahendrawaram between May to July 2023. Study protocol was approved by the institutional ethics committee. Informed written consent was taken from all the participants. Individuals > 18 years, both gender with those admitted for different surgeries, require general anaesthesia (GA) admitted in the general surgery department were included. All patients maintained a nil per oral status. The study members were divided in to 2 groups: group P and group S. Group P received propofol at a dosage of 2.5 mg/kg body weight, administered at a rate of 40 mg every 10 seconds. Loss of verbal contact was evaluated based on the patient’s response to their name being called. LMA insertion was attempted once satisfactory jaw relaxation was achieved. In addition to the complications various parameters such as number of attempts for successful LMA, meantime, HR, SBP, DBP were considered. T test was used for statistical analysis, P value < 0.05 was considered significant. Results: Total 100 members, 50 each group. Statistically there was no significant difference in mean number of attempts. Group P members demonstrated statistically significant earlier loss of verbal contact and loss of eyelash reflex. Except mean HR, Statistically there was significant difference in the mean SBP and DBP, respectively in groups. Conclusion:  The duration needed for achieving jaw relaxation and the overall conditions of LMA insertion were comparable in both groups. However, when considering the loss of eyelash reflex and loss of verbal contact, group P members demonstrated superiority over group S.

105. Role of Hysterolaparoscopy in Diagnosis and Management of Infertility
Manju Yadav, Garima Sharma, Gaurav Sharma, Anshu Sharma
Abstract
Aims and Objectives: The present study was planned with the aim to evaluate the role of hystero- laparoscopy for identifying the various pathological conditions, to develop a plan of treatment and to analyze the rate of complications. Material and Methods: 100 cases with complain of infertility attending the OPD of obstetrics and gynaecology Mahatma Gandhi hospital. All infertile patients with primary and secondary infertility of age group 18-40 years. Results: 75 cases (75%) were of primary infertility and 25 cases (25%) were of secondary infertility. In my study most common factor was tubal factor. In many cases, there were more than one factor. Therefore no of findings were more than number of cases taken. However inspite of thorough laparoscopic evaluation no cause was revealed in 20 cases (20%) and were included under unexplained infertility. Conclusion: We concluded that Laparoscopy and hysteroscopy combined together are valuable technique for complete assessment of female factors of infertility patient and should be used early in the diagnostic work up in cases of infertility.

106. Effect of Smoking on Ocular Surface and Tear Film: A Clinico Pathological Study
Pramod Kumar Meena, Swapna Devi,  Utsav Joshi, Jayanti Mala
Abstract
Aim: Smoking is an important risk factor for many chronic diseases; however its association with dry eyes is still unclear. The study was undertaken to evaluate the effect of smoking on ocular surface clinically and its correlation pathologically with the help of impression cytology. Methods: The study was conducted on 100 elderly patients from 18 to 50 years. The study group on the basis of number of cigarettes consumed was further subdivided in mild (<10 cigarettes per day) moderate (11-20 cigarettes per day) and heavy smokers (>20 cigarettes per day). OSDI score, TBUT (tear film break up time), Basal tear secretion (Schirmer test 2), and conjunctival impression cytology have been performed. Results: The study comprises of 100 patients, 50 smokers and 50 age matched non-smokers. The mean age of the smoker 38.40 ± 8.06 years and the mean age of nonsmokers in control group was 32.60 ± 6.54 years. Mean tear film break up time in non-smoker was 15.69 ± 4.34 sec as compared to 12.07 ± 2.29 seconds in smokers (p=0.0001). Mean score of Schirmer’s test was 13.58 ± 2.79 seconds in non-smokers as compared to 11.40 ± 2.64 seconds in smokers with significant statistical difference (p=0.001).  On Impression cytology, 20% of the subjects in smoker group showed grade 2 metaplasia and 8 % showed grade 3 metaplasia in comparison to 3% and 0 % in non-smoker group respectively (p=0.0001). Conclusion: Smoking is a significant risk factor in the development of dry eyes and ocular surface disorder characterized by squamous metaplasia and loss of goblet cells. Furthermore, the severity of dry eyes has positive correlation with the amount of smoking.

107. A Comparative Study of Functional Outcomes of Distal Humerus Fractures with Intra-Articular Extension Managed by Bicolumnar Fixation with or Without Olecranon Osteotomy
Darshan K S, Arjun Chakrapani, Rahul Ragate, Abhilash C S, Ramesh G
Abstract
Background: The standard of care for intra articular distal humerus fractures is ORIF with bicolumnar fixation. The most commonly used approach is that of Olecranon Osteotomy, though non osteotomy approaches have also been described and are in use. We sought to compare the functional outcomes of patients treated with osteotomy and non-osteotomy approaches. Methods: 24 consecutive patients with distal humerus fractures with intra articular extension were treated by Open Reduction and Internal Fixation with 2 parallel fixed angle anatomical locking plates. 16 patients were operated by Chevron Osteotomy and 8 patients by triceps sparing approach. Clinical follow-up with the Mayo Elbow Performance score and plain radiographic evaluation were performed for an average of 13 months postoperatively. Patients with vascular injuries, grade 3 compound open fractures and severely un reconstructable communited fractures were excluded. Results: Radiographic union was achieved at the  fracture site in 100% patients. 1 patient had non-union at the osteotomy site. The average time from surgery to radiographic union was 12.81 weeks (12.87 for without osteotomy, 12.75 for osteotomy). The net complication rate was 41% with higher rate of complications such as infection, neurologic sequelae and stiffness in the non-osteotomy group. Range of movement measurements obtained from the most recent clinical follow up was a mean flexion extension arc of 107 degrees. The mean MEPS score was 80.7 (73.625 for non-osteotomy and 84.062 for olecranon osteotomy). Conclusion:  Both olecranon osteotomy and non-osteotomy are effective approaches for the treatment of intra articular distal humerus fractures in terms of union (100% in both groups) but olecranon osteotomy provided better functional outcomes in our study.

108. Vitex negundo Linn (Nirgundi): Journey from Past to Future Therapeutic Prospects
Shweta Telang-Chaudhari, Jeetendra Singh, Hitesh Chaudhari, Vaibhav Aher, Shishir Pande
Abstract
There has been accumulating awareness in the application of herbal medication that they may serve as a safe, effective and alternate treatment approach in the management of various diseases associated with pain and inflammation. Vitex negundo is one of such medicinal plants that has been of interest to many researchers and has been of use in traditional medicine. Vitex negundo is found in India, Sri Lanka, Madagascar, Malaysia, India, China and East Africa. Different parts, preparations and bioactive components of Vitex negundo  possess potential protective and therapeutic effects against various disease and related conditions – We review the present state of scientific knowledge on the potential use of Vitex negundo  and some of its bioactive components in protecting against various pathologies. Previous studies in various preclinical models, although limited in number and vary in design; seem to support the use of Vitex negundo and some of its active components in abdominal pain, asthma, cold, diarrhoea, indigestion, eye disorders, rheumatism, dysmenorrhea, headache, etc.
However, there is need for further preclinical and clinical studies to validate the use of Vitex negundo  and its active constituents in prevention and treatment of various diseases.  Additionally, since only a few Vitex negundo  compounds have been evaluated, specific effects or mechanisms of action and possible side effects of other     Vitex negundo  compounds need to be extensively evaluated. Also, this review delves into present commercial preparations of Vitex negundo which are mostly topical application preparations. However, further research, including large sampled randomised clinical trials, is essential to establish its safety and efficacy in human populations and to unlock its full therapeutic potential.

109. A Study on Clinical Outcome of Percutaneous Ozone Nucleolysis for Lumbar Disc Herniation in a Tertiary Care Medical College
R. Dhansekaran, S. Senthil
Abstract
Purpose: All percutaneous minimally invasive disc treatments are typically indicated to contained disc herniations. Our study’s aim is to evaluate prospectively the efficacy of ozone nucleolysis in the treatment of either contained or uncontained lumbar disc herniations. Methods: Fifty patients, aged 35–70 years, with symptomatic herniated lumbar discs, without migration, sequestration, or severe degenerative disc changes, who failed conservative treatment, were included in our study. The patients underwent fluoroscopic-guided intradiscal oxygen-ozone mixture injection (5 ml) at a concentration of 27–30 μg/ml and periradicular injection of the same O2-O3 mixture, steroid, and local anesthetic. Clinical outcomes were evaluated, based on the Oswestry Disability Index and pain intensity scale results, obtained initially and at 2- and 6-month follow up. Results: Our initial results obtained at 2-month follow up were promising, indicating a significant decrease in pain disability and intensity in 78% (n=39) and 72% (n=36) of the patients respectively, and minimally increased to 82% (n=41) and 78% (39) at 6-month control. The mean preprocedural Oswestry disability index and pain intensity scores were 37 ± 12.1 and 2.45 ± 0.87, respectively, which were reduced to 17.56 ± 11.62 and 1.14 ± 0.86 at 6-month control. Conclusion: Ozone nucleolysis is a safe cost-effective minimally invasive technique for treatment of contained and uncontained lumbar disc herniations.

110. Factors Responsible for Poor Outcome in Pediatric Cochlear Implantation
Surya C, Sameer P, Abdul Salam RT
Abstract
Aim of the Study: To find the prevalence and factors responsible for poor outcomes in pediatric cochlear implantation. Materials: 85 children were grouped into four groups: Group 1: 1- 2 years, Group 2: 2-3 years, Group 3: 3-4 years and Group 4: 4-5 years. 12.9% belonged to group 1 , 35.3% belonged to group 2, 44.7% belonged to group 3 and 07.1% children belonged to group 4. The mean age was 3.08years with standard deviation 0.819. Results: A longitudinal retrospective descriptive study of 85 children, in which 42 were implanted with Med-el sonata Ti 100 implant with Medel Opus 2 BTE external processor and 43 children were implanted with Cochlear Nucleus CI24RE (ST) implant with Cochlear CP 802 BTE external processor. Conclusions: The mean age of cochlear implantation was 3.08 years with standard deviation 0.819 and no children underwent CI surgery prior to their first birthday. 87.1% of cochlear implantees have good auditory and speech outcomes, 11.8% have good auditory but poor speech outcome, and one with CAPD. 08.2% children had ADHD. Regular AVT and parental training has significant impact on cochlear implant outcome.

111. Fever with Thrombocytopenia in Children: Clinic-Etiological Profile in Tertiary Care Hospital
P Satish Chandra, Jyotsna Seepana, A Satyavani, K Madhavi, D. Chandra Mounika, U Sneha Jyothsna
Abstract
Introduction: febrile thrombocytopenia is the result of varied aetiology, and the clinical course is often unpredictable.  In the recent period, there has been an upsurge in the incidence of fever with thrombocytopenia in Andhra Pradesh. This may be due to the several emerging and re-emerging infections that cause frequent epidemics in the region. Objectives: To identify the etiology and clinical profile and assess the complications of febrile thrombocytopenia. Material and Methods: The study was carried out on 150 children 1 month-12 year, admitted to the Department of Pediatrics, government medical college Srikakulam, Andhra Pradesh, India with fever and thrombocytopenia. A thorough history was obtained and a general and systemic examination was done. Routine investigations were done in all cases and specific investigations as and when required. Results: Among 150 cases taken, 75% (112) of children had only a fever. 10% (15) of children had a fever with bleeding. 15% (23) of children had fever with shock. The most common cause was Dengue in 40% (60) of cases followed by malaria in 32% (48) of cases, scrub typhus in 7.3 %(11) of cases, enteric fever in 6.6% (10) of cases, and septicemia in 5.3% (8)of cases. Other minor causes include ALL (Acute Lymphoblastic Leukemia) in 2.6% (4) of cases, viral hepatitis in 2.6% (4) of cases, and undiagnosed in 3.3% (5) of cases. Out of these 150 fevers with thrombocytopenia cases, mild (1,00,000 -1,50,000) thrombocytopenia was seen in 25.3%(38) of cases, moderate (50,000-1,00,000) thrombocytopenia was seen in 54.7% (82)of cases and severe (<50,000) thrombocytopenia was seen in 20 % (30) of cases. This classification is based on the lowest level of platelet counts seen during their hospital stay. Conclusion: The commonest reason behind febrile thrombocytopenia during the study period was dengue fever followed by malaria and scrub typhus. Platelet counts are one of the indicators for the identification of bleeding manifestation and severity of disease.

112. Clinical Pattern of Non-Venereal and Venereal Genital Dermatosis in Males Attending Dermatology OPD in A Tertiary Care Hospital
Mohammed Zahir, Preetam Singh Katroliya, Chaturvedi Mohini, Argal Deepak, Vivek Kumar Dey, Animesh Saxena
Abstract
Context: The present study was conducted at a tertiary care centre to determine the prevalence and clinical patterns of various non-venereal and venereal genital dermatoses affecting males. Genital disorders include a spectrum of diseases with varied etiology. As, venereal, and non-venereal dermatoses tend to be confusing, they may be associated with mental distress and guilt feelings in affected patients. Aims: To determine the prevalence, clinical and epidemiological patterns of various non-venereal and venereal genital dermatoses affecting males. Settings and Design: Observational study was carried out at a tertiary hospital. Methods and Material: Data was collected from OCT 2019 to MAR 2020 (6 months). 240 patients with non-venereal & venereal dermatoses of external genitalia were studied. Investigations such as Gram stain, KOH mount, VDRL, ELISA for HIV were done to confirm clinical diagnosis. Statistical analysis: On completion of data collection, data was compiled using Microsoft excel version 2016 and analysis was done using IBM Corp., Armonk, N.Y., USA SPSS Statistics for Windows, version 20. Numerical data was expressed as mean and SD whereas categorical variables were expressed as frequency and proportions.  Independent sample t test was applied to assess the difference in mean between two groups whereas chi square test was applied to assess the difference between proportions. P value less than 0.05 was considered statistically significant. Results: The prevalence of non-venereal & venereal genital lesion during the period was found to be 6.1 per 1000 respectively among patients attending dermatology department. Conclusions: Based on this study, non-venereal diseases constitute the major burden of genital dermatoses in adult males. Our study will aid to understand prevalence, clinical and epidemiological patterns of various non-venereal and venereal genital dermatoses affecting males in future studies.

113. A Clinical Study on Early Complications of Thyroidectomy
M. Pavani, P. Vinay, J. Ramanaiah
Abstract
Background: Thyroid surgeries comprise one among the ordinarily performed procedures by a general surgeon. It is associated with specific morbidities which are related to the experience of surgeon. Nerves, vessels, parathyroid and surrounding structures are all at risk of injury during thyroid surgery. The common postoperative complications include post-operative haemorrhage, recurrent laryngeal nerve paralysis & voice change, thyroid insufficiency, parathyroid insufficiency, thyroid crisis (storm), wound infection, superior laryngeal nerve injury. Aim of the Study: is to know the occurrence of various post-operative complications following various thyroid surgeries at tertiary care hospital. Patients And Methods: A Prospective cohort study done in 60 cases undergoing thyroidectomy for various reasons admitted in the general hospital over a period of 2 years. Results: In this study complications seen in hemithyroidectomy are hypocalcaemia (1.6%), wound infection (1.7%). Complications seen in subtotal thyroidectomy were hypocalcaemia (3.3%), immediate haemorrhage (3.3%), seroma formation (1.7%), oedema of the flap (1.7%). No Complications seen in near total thyroidectomy. Complications in total thyroidectomy are hypocalcaemia (8.3%), immediate haemorrhage (1.6%), RLN palsy (1.7%), and SLN palsy (1.7%). Complication rate in benign diseases (21.75%) is more than malignant diseases (5.02%). Conclusion: Since the beginning of 20th century, there has been a significant decline in the incidence of complications and mortality in thyroid surgery, probably due to safer general anaesthesia, development of fine haemostatic instruments, better antisepsis. Other factors contributing to decreased incidence of complications in thyroid surgery include good knowledge of regional anatomy, proper evaluation, and adequate haemostasis, meticulous dissection with intraoperative identification of structure and to prevent damage to these structures.

114. Histopathological Analysis of Prostatic Lesions and Comparing the Role of p63 and High Molecular Weight Cytokeratin (HMWCK) in Distinguishing Prostatic Carcinoma from Benign Prostatic Lesions and its Precursors
Kalpana B. Rathod, Dhanshri Kashinath Shinde, Jeetesh Vinayak Gaunkar, Leena Nakate, Shweta Jadhav
Abstract
Background: Prostate cancer is one of the leading causes of morbidity and mortality in elderly men throughout the world. There is a tendency to under diagnose small focus of prostatic adenocarcinoma or over diagnose benign lesions mimicking cancer. The application of immunohistochemistry using basal cell specific markers like p63 and high molecular weight cytokeratin (HMWCK) can help in distinguishing prostate cancer from its benign mimickers thus confirming the diagnosis especially in equivocal cases. Aims: To study and compare the role of p63 and High Molecular Weight Cytokeratin (HMWCK) in distinguishing the prostatic carcinoma from its benign lesions and its precursors. Settings and Design: Tertiary Health Care Centre based cross sectional study. Material and Method: All cases of prostatic lesions received in the department of pathology in tertiary care center during the period of January 2019 to June 2020 were examined. Grossing and sectioning of the formalin fixed samples was done. Routine H & E staining and IHC immunostaining using P63 and HMWCK was done. Inadequate biopsies were excluded. Statistical Analysis: Using SPSS Software. Results and conclusion: Histopathological analysis of 115 prostatic lesions was done. The sensitivity of p63 was higher compared to HMWCK demonstrating that p63 is more sensitive in identifying the basal cells in non-malignant conditions. Both the immunohistochemical stains showed a very high specificity in the malignant lesions. The present study showed that immunohistochemistry using basal cell markers like HMWCK and p63 can be very significant to tackle diagnostic dilemmas in challenging cases and in premalignant conditions.

115. Study of Relationship between Iron Deficiency and Thyroid Function in Females of the Reproductive Age Group of Southern Odisha, India
Dhabaleswar Meher, Ansuman Mishra, Niranjan Nayak, Rina Mohanty
Abstract
Background: Iron deficiency is one of the overlooked causes of thyroid dysfunction. It is revealed that the prevalence of iron deficiency was very high in non-pregnant Indian women and was associated with a higher serum TSH and lower FT4 level. Aim: This study was planned to find out the relationship between these two conditions, so that iron supplementation can be adopted to avoid the morbidity and mortality associated with thyroid dysfunction. Method: The current study was a cross sectional observational study done between 2018 to 2020 in M.K.C.G. Medical College and Hospital, Berhampur, Odisha, India. In this study 50 non-pregnant females of the reproductive age group (15 to 45 years) were taken for study. Results: We found that 68% of females were iron deficient and 32% of females were having normal iron stores. TSH was raised in 35.29% in the iron deficient group as compared to 6.25% in the non-iron deficient group with a p value of 0.001. Serum TSH of 37 females out of 50 was normal (<4 mIU/L) and 13 females were having raised serum TSH (>4 mIU/L). The mean serum TSH was higher in the iron deficient group as compared to non-iron deficient group. 20% of the females had low FT4 (<0.7 ng/dl) and 80% had normal FT4. It was observed that FT4 was decreased in the ferritin deficient group as compared to group with normal ferritin. FT4 and serum ferritin were significantly associated with each other with p value of < 0.0001. The prevalence of mild and severe hypothyroxinemia was markedly higher in women with Iron deficient than those without (p<0.005). Conclusion: We concluded from our study that the prevalence of iron deficiency was very high in non-pregnant Indian women and was associated with a higher serum TSH and lower FT4 levels.

116. Blood Neutrophil to Lymphocyte Ratio as a Prognostic Marker in Cirrhosis of the Liver
Dhabaleswar Meher, Kamalakhya Samantray, Niranjan Nayak, Rina Mohanty
Abstract
Background: In this study, we wanted to correlate Neutrophil to Lymphocyte Ratio with development of complications in patients with cirrhosis of the liver in southern Odisha. We found out there is a statically significant association between Neutrophil to Lymphocyte Ratio and development of complications. Materials and Methods: This was a prospective observational study done between Sept. 2019 to Sep. 2021 in M.K.C.G. Medical College and Hospital, Berhampur, which is a tertiary care hospital in southern Odisha, India. Results: Out of 61% of alcoholic patients, 33% had elevated NLR, whereas 12% of total non-alcoholic patients had elevated NLR. This association was found to be statistically significant with p value of 0.022. 68% of patients who had elevated NLR developed complications either single or in combination. On the other hand, only 9% of patients having low NLR developed complications. Conclusion: Estimation of NLR is a cheap and easily available procedure which can be done in any hospital to monitor the development of complications in patients with cirrhosis of the liver.

117. A Clinicopathological Study of Patients with Cutaneous Granulomatous Lesions with Reference to Special Stain
Madhusmita Choudhury, Monoj Kumar Deka, Arindam Das, Soumistha Das, Salman Ahmed Choudhury
Abstract
Granulation reaction pattern is defined as “Granulomatous inflammation is a form of chronic inflammation characterized by collections of activated macrophages, often with T lymphocytes, and sometimes associated with central necrosis”. Granulomatous disease comprises some of the widespread diseases in the world such as leprosy and tuberculosis. Granulomatous inflammation in the skin could be due to infectious or non-infectious causes. Common infectious causes of granulomatous skin lesions include leprosy, TB, leishmaniasis and fungal infections. Uses of special stains such as ZN stain for TB, Fites stain for leprosy, Giemsa stain for leishmaniasis; Grocott methenamine silver stain and PAS stain for fungal infections may be helpful.

118. A Clinical Study on the Complications of Thyroidectomy in a Tertiary Care Hospital
Veda, S. Muneeruddin Ahmed, M. Mahendra Kumar, R. Bhanumurthy
Abstract
Background: Thyroidectomy is a procedure commonly performed by ENT surgeons. Thyroidectomy is indicated for different benign and malignant diseases of the Thyroid. Complications of Thyroidectomy are unique that it produces metabolic disturbances also. Aim of the study: To study the various complications of Thyroidectomy, its frequency, and management of postoperative complications after thyroid surgery; to correlate these complications with the extent of the surgery; and clinical overview of evolution of thyroid surgery. Objectives: To study the effect of management and follow up of the patients up to 1 year post-operative period in patients undergoing thyroidectomy. Materials: An analytical study was carried out at a tertiary care center over a period of 12 months. The mean age of the patients was 34.58±6.14 years. 70.82% of the patients were aged 26 to 46 years. 37.5% of the patients were males and 62.5% of the patients were females with a male to female ratio of 1:1.30. Results: The types of Thyroidectomy surgeries undertaken in this study were Hemithyroidectomy (48.34%), Total Thyroidectomy (29.45%), Isthumusectomy (16.18%), and Excision of the Adenoma (06.03%) in the affected Lobe. Postoperative hypocalcemia and recurrent laryngeal nerve injury occurred in 06.25%, 02.08% of the patients and Hypothyroidism in 02.08% of patients. Conclusion: Complications of Thyroidectomy surgeries are still common and the most dreaded one for the surgeon was RLN Injury. The complications can be minimized by keeping the operative field blood less, by dissecting the tissue carefully, and promptly identifying the RLN and preserving it. Use of cauterization used less frequently in the vicinity of RLN would help in preventing it’s injury.

119. Paediatric Vasculitis: A Comprehensive Case Study of Takayasu’s Arteritis with PRES Syndrome
Saini Sahil, Koreti Sunita, Verma Y.S., Gaur Ajay
Abstract
Background: Takayasu’s arteritis is a chronic idiopathic vasculitis of medium and large vessels with a chronic continuous or waxing-waning course. The aorta and its primary branches are most involved vessel. Systemic inflammation and distal ischemia give rise to the predominant clinical features. Clinical Description:  A 11-year-old male presented with abnormal body movements, abdominal pain, vomiting and headache. Examination revealed pulselessness of upper limb but blood pressure was persistently raised with difference in upper and lower limb BP over the course of illness, the child also suffered from PRES (posterior reversible encephalopathy syndrome). MRI brain reveals mild hyperintensity of bilateral posterior parietal lobes. Colour Doppler findings of upper limb revealed bilateral subclavian arteries narrowing and wall thickening. Computed tomography angiography suggested aortoarteritis. Correlation of clinical history, physical examination, investigation reports were helpful to reach the final diagnosis as Takayasu arteritis with PRES syndrome. Management: The patient was treated with antiepileptics, antihypertensives, steroids and other supportive measures were taken. The patient showed improvement but B.P was persistently high. Conclusion: Takayasu arteritis as a differential diagnosis of hypertensive encephalopathy should be kept.

120. Assessing Clinical Characteristics as Predictors of COVID-19 Associated Mortality
Raghuvanshi S Somnath, Nahar Nitin, Tiwari Anurag, Sahu Swapnil, Dubey Simmi
Abstract
Introduction: Clinical characteristics at presentation can help the healthcare professionals in determining severity and providing effective medical care, especially in absence of definite evidence-based pharmacotherapeutic options for patients with SARS-CoV-2. Materials and Methods: The current retrospective, observational study was performed in a tertiary care hospital to determine the demographic and clinical factors associated with COVID-19 mortality in 996 patients with laboratory-confirmed SARS-CoV-2 infection. A logistic regression analysis with the binary outcome (survivor/non-survivor) was used to estimate the association between COVID-19 related mortality and demographic and clinical characteristics at admission. Results: Of the 996 patients included, 60.34% were males. Among the patients included in our analyses, 240 (24.09%) died from COVID-19 related symptoms. The mean age of patients in the non-survivor group was significantly greater than survivor group (55.39±17.41 vs 45.56 ± 16.06, P<0.0001). Logistic regression analysis found that the odds of mortality were greater in patients with higher age [OR 1.72 (95% CI (1.65 – 1.9); P<0.0001]. Baseline clinical characteristics detected as risk factors for COVID-19 mortality include body temperature >990F [OR 1.507 (95% CI (1.159 – 1.959)], Pulse>100 [OR, 1.085 (95% CI 1.048 – 1.123)], severely high respiratory rate (OR, 1.82 [95% CI (1.551 – 2.136)], and poor oxygen (O2) saturation (OR, 1.252 [95% CI 1.045 – 1.499]). Conclusions: This study in patients with confirmed COVID-19 identified older age, body temperature >990F,  pulse >100, high respiratory rate and poor oxygen saturation as risk factors for COVID-19-associated mortality. Instantaneous, objective measures obtained at the time of admission, can be effective predictors of mortality.

121. Functional Outcome of Patients with Fractures of the Proximal Humerus Treated with Shoulder Hemiarthroplasty: A Short-Term Prospective Outcome Analysis
Arun Mathew George, Rahul Roy, Ananda Krishnan A
Abstract
Background: Our study is planned to evaluate the functional outcome of patients with proximal humerus fractures managed with shoulder hemiarthroplasty in view of range of movement, possible returns of basic functions around the shoulder girdle, radiological outcome, and resultant remaining disability in the course of healing and after completion of healing. Methodology: 21 patients with proximal humerus fractures were managed with shoulder hemiarthroplasty. All of them have completed a mean follow up of 6 months and was evaluated using the Constant Murley Scoring System. Results: The most common mode of injury was road traffic accidents which accounts for 66.67% of total cases followed by domestic slip and fall. There was a male (57.38%) to female (47.62%) ratio of 1.1:1. There was a side predilection of right to left of 61.91% to 38.09%. According to Neer’s classification, 28.57% had 3 part and 71.43% had 4-part fracture. As per Constant and Murley scoring, 47.61% of patients had good to excellent score and 38.1% had moderate score. The mean Constant score was found to be lower in patients with 4-part fractures as compared to those with 3-part fractures. Improvement of painless range of movement occurred in 80.95% patient. The most frequent complication in our patients was infection, which occurred in 3(14.2%) of the total cases. Conclusion: Comminuted proximal humerus fractures especially in the elderly, pose a significant challenge to osteosynthesis. Herein comes the economically feasible replacement option of hemiarthroplasty. This treatment modality allows early mobilization and reasonably good functional outcomes in such patients.

122. Changes in Foveal Avascular Zone Area in Patients with Retinal Vein Occlusion after Intravitreal Ranimuzumab
V. Sheeladeep, P. Viswabharathi, P. Viswamitra
Abstract
Background: Macular edema due to retinal vein occlusion (RVO) is a significant cause of visual loss. The conventional treatment for this condition is intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF). The study aimed to look into changes in foveal avascular area (FAZ) and visual gain in patients with macular edema caused by retinal vein occlusion (RVO) who was treated with intravitreal ranibizumab, an anti-VEGF agent. Materials and Methods: The clinical records of patient Eyes with a history of RVO that were treated with IVR and had at least two years of follow-up were retrospectively analyzed. 40 eyes of 40 patients participated in this retrospective study; 20 eyes had branch RVOs (BRVOs), and 20 had central RVOs (CRVOs). Data from patients’ medical records were examined, encompassing demographic information, duration of follow-up, and the evolution of best corrected visual acuity (BCVA) using ETDRS charts. The area of the foveal avascular zone (FAZ) was quantified using the initial angiogram that was accessible and the angiogram that was conducted during the last cross-sectional visit. Results: The BRVO group comprised 14 males and 6 females, while the CRVO group comprised 8 males and 12 females. The average age of the patients in the BRVO group was 57.86 years, while in the CRVO group it was 62.32 years. The initial FAZ area (mm2) was 47.1 ± 26.0 in the CRVO group and 0.44 ± 0.31 in the BRVO group. The initial BCVA(L) was 51.8 ± 24.1 in the CRVO group and 47.1 ± 26.0 in the BRVO group. The final FAZ area (mm2) was 0.47 ± 0.21 in the ischemic CRVO, 0.32 ± 0.12 in the non-ischemia CRVO,  0.48 ± 0.34 in the ischaemic BRVO and 0.41 ± 0.21 in the non-ischaemic BRVO. The final BCVA (L) was 39.8 ± 16.8 in the ischemic CRVO group, 69.8 ± 18.1 in the non-ischemia CRVO group, 37.9 ± 17.6 in the ischaemic BRVO group, and 61.2 ± 21.2 in the non-ischaemic BRVO group, all statistically significant. Conclusion: Ranibizumab was found satisfactory in the long-term treatment of macular edema secondary to RVO and was not associated with increased macular ischemia.

123. Evaluation of the Demographic Profiles of Pancytopenia in Paediatric Patients and Correlation of Hematological Parameters with Clinical Findings in Differentiating Causes of Pancytopenia
Shaoor Nazish, Sunil Kumar Mahato, Purnima Bharti, Md. Raihan
Abstract
Background: Pancytopenia is characterized by simultaneous decrease in all the 3 formed elements of the blood i.e red blood cells, white blood cells and platelets, resulting in anemia, leucopenia and thrombocytopenia. Respectively. Objectives: To correlate hematological parameters with clinical findings in differentiating causes of pancytopenia. Materials & Methods: This Prospective study was conducted in the Department of Pathology, Rajendra Institute of Medical Sciences, and Ranchi. The permission to conduct this study was obtained from the central research committee of R.I.M.S. Results: In PBS, the most common finding was normocytic hypoochromic anaemia in addition to pancytopenia (60% cases). This finding was seen in patients of aplastic anaemia (100% cases), hypersplenism (100% cases) & nutritional deficiency anemia (28.5% of cases). Patients with megaloblastic anemia had macrocytic hypochromic RBCs with hyper segmented neutrophils in the PBS. 71..5% patients with mixed nutritional deficiency patients had dimorphic RBCs in PBS, Patients with aplastic anemia had hypocellular bone marrow aspirate with depressed erythropoiesis, leukopoiesis & megakaryopoiesis. Patients with megaloblastic anemia had hypercellular bone marrow with megaloblastoid changes in erythropoiesis. Patients with hyper splenismand mixed nutritional deficiency patients had mild erythroid hyperplasia in the bone marrow. Acute leukaemia patients had hypercellular bone marrow with predominance of blast cells. Conclusion: A comprehensive clinical, hematological and bone marrow study of patients with pancytopenia usually helps in identification of the etiology. It is very important to diagnose the cause of pancytopenia early in the disease process, so that adequate intervention could be done on time for the patient.

124. A Study on Genial Tubercles in Human Dry Mandible
Rani Nallathamby, Boban Babu
Abstract
Background: The Mandible on its lingual surface presents small bony eminences termed as Genial tubercles. They are usually 4 in number, 2 above known as superior genial tubercles and 2 below, known as inferior genial tubercles. Genial tubercles are also known as mental spines or genial apophysis the superior genial tubercle (SGT) gives attachment to the muscle Genioglossus and the inferior genial tubercle (IGT) gives attachment to the muscle Geniohyoid. These two muscles play key roles in speech and deglutition and thence making the knowledge about these small sharp bony projections extremely significant. Aim: To conduct a study on genial tubercles and describe its various presentations and analyse them morphometricaly. Materials and Methods: Study was conducted in 100 human mandibles and the incidence of pattern of presentation was done by observational method and basic dimensional analysis of the tubercles was done with vernier calipers and comparison made with previous studies in different regional population. Results: Type 2 pattern showed predominance in the study. The mean genial tubercle height (GTH) measured was 1.6 mm, the mean width (GTW) was 1.3 mm. The average distance from the upper border of the SGT to the menton was 12.4 mm. The mean distance from the lower border of the IGT to the menton was 8.2 mm.

125. A Retrospective Study on the Correlation between BMI and Restrictive Lung Pattern in Middle Aged Males Using Computerized Spirometry
Vellimalai K
Abstract
Introduction: In the present scenario, BMI denotes the normal functioning of various systems in the body. Particularly lung function test gets altered with obesity. Now the exact relationship between BMI and restrictive lung pattern was not studied much. So the purpose of the present study is to estimate the effects of BMI on restrictive lung pattern. Objectives: Primary Objective: To analyse the correlation between BMI and restrictive lung pattern. Secondary Objective: To propagate the result among general public about the correlation between restrictive lung pattern and obesity (High BMI). Methodology: The pulmonary function test data was randomly selected. There is no clinical risk in this study, as the pulmonary function test data was obtained retrospectively from the procedure performed for the diagnosis of the patient’s treatment. Justification of Study: It is still not known whether high BMI alone represent appropriate predictor of altered lung function in the general public. So this study was done retrospectively with about 40 Spirometric values. The values were obtained from respiratory medicine OPD at PSGIMS & R. Coimbatore. The data collected were subjected to SPSS (Statistical Package for Social Sciences) for Statistical Analysis. P<0.05 was considered to be statistically significant. The data will not be revealed to any of the other patients, other doctors or other paramedical staff. It will be preserved for about 3 years confidentially in the departmental library. Result: Obesity is found to decrease the lung volumes and capacities by decreasing both lung and chest wall compliance. There is also an increase in resistance to out flow of air through the airways. There was no statistically significant correlation between BMI and FVC&FEV1.There was statistically significant correlation between FVC and FEV1(r=0.762,p value = <0.001) and FEV1&FEV1 /FVC.(r=0.648/p=< 0.001) There was weakly positive correlation between BMI and FEV1 / FVC. There was no statistically significant association between BMI and FVC, FEV1/FVC in linear regression. Conclusion: BMI could be an early predictor of restrictive lung disease. A reduction of BMI might reduce the rate of incidence of restrictive lung disease and the monitoring of BMI could possibly be a tool for preventing restrictive lung disease in general public. Ultimately a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for increasingly important patient population.

126. Vitex negundo Linn (Nirgundi): Journey from Past to Future Therapeutic Prospects
Shweta Telang-Chaudhari, Jeetendra Singh, Hitesh Chaudhari, Vaibhav Aher, Shishir Pande
Abstract
There has been accumulating awareness in the application of herbal medication that they may serve as a safe, effective and alternate treatment approach in the management of various diseases associated with pain and inflammation. Vitex negundo is one of such medicinal plants that has been of interest to many researchers and has been of use in traditional medicine. Vitex negundo is found in India, Sri Lanka, Madagascar, Malaysia, India, China and East Africa. Different parts, preparations and bioactive components of Vitex negundo  possess potential protective and therapeutic effects against various disease and related conditions – We review the present state of scientific knowledge on the potential use of Vitex negundo  and some of its bioactive components in protecting against various pathologies. Previous studies in various preclinical models, although limited in number and vary in design; seem to support the use of Vitex negundo and some of its active components in abdominal pain, asthma, cold, diarrhoea, indigestion, eye disorders, rheumatism, dysmenorrhea, headache, etc. However, there is need for further preclinical and clinical studies to validate the use of Vitex negundo  and its active constituents in prevention and treatment of various diseases.  Additionally, since only a few Vitex negundo  compounds have been evaluated, specific effects or mechanisms of action and possible side effects of other Vitex negundo  compounds need to be extensively evaluated. Also, this review delves into present commercial preparations of Vitex negundo which are mostly topical application preparations. However, further research, including large sampled randomised clinical trials, is essential to establish its safety and efficacy in human populations and to unlock its full therapeutic potential.

127. Clinico Cytopathological Correlation in Lymphadenitis of Suspected Cases of Tubercular Lymphadenitis in Children
Sanjay Kumar Yadav, Mandeep Singh, T. P. Singh
Abstract
Introduction: Lymphadenopathy is a common problem in children and may present as diagnostic problem to the children. Disease affecting cervical lymph nodes are of varying severity starting from simple curable infection to difficult incurable malignant disease. Objective: The purpose of this study was to observe the various clinical presentations of lymphadenopathy and correlate histopathological finding with the clinical diagnosis. Methods: This study was a prospective study done on 85 children with significant lymphadenopathy attended to Department of Paediatrics S. N. Medical College Agra during the period of 1996 to 1998. All the 85cases were divided into two age groups; 35 cases were in less than 5 years age group and 48 cases were in-between 5-12 years of age. There were 45 males and 40 females. Result: On cytology of the aspirated lymph nodes by FNAC there were 30 cases having granuloma with necrosis 36.6%, 24.4% cases of reactive hyperplasia, 19.5% cases of granulomatous chages, 15.9% cases of necrotic and 3.6% cases of purulent aspirates. Most of the reactive hyperplasia were children between 5-12 years of age. Mantoux test was possible in 52 cases out of82 cases. 63.4% in which 40 cases were of tubercular and 12cases were non tubercular. Parameters like positive mantoux test , Xray chest suggestive of pulmonary tuberculosis and presence of sinus or matted lymphnodes common in tubercular lymphadenitis (&lt;0.05%). Conclusion: FNAC of lymphnodes provides a diagnostic alternative to other investigations that it obviates the need for surgical biopsy. It does help in directing other persistent investigations, thus shortening the period of stay in the hospital. In the Present study FNAC with smear reexamination for AFB have been undertaken for the diagnosis of tubercular lymphadenitis in suspected cases of Lymphadenopathy.

128. Evaluation of the Outcome between Dressing and Vacuum-Assisted Closure for Chronic Non-Healing Ulcers
Anand Pandey, Ravi Parmar
Abstract
Introduction: Social and economic issues arise from chronic wounds after three months. Foot ulcers impact 25% of people with diabetes. There are problems with traditional saline dressings. Hydrocolloid alternatives lack scientific support. VAC promotes blood flow and tissue preservation by using FDA-approved foam and adjustable sub-atmospheric pressure. A successful technique for wound treatment is the VAC procedure, which uses scheduled vacuum cycles. Aim and Objectives: A comparison study of chronic non-healing ulcers should be performed to determine the effectiveness of dressings vs. vacuum-assisted closure in wound management. Method: The Shree Krishna Hospital research of 50 chronic non-healing diabetic foot ulcers from January 2022 to December 2023 includes a pre-formed questionnaire. The study included male and female patients of all ages and sexes. One group received standard dressings, while the other group received vacuum-assisted closure. Concerning the treatment, both groups were apprised. Cost, patient convenience, results, SINBAD score, and therapy duration are evaluated. Result: There is a significant gender imbalance in the study, with 68% men out of 50 participants. Conditions such as ulcer duration, family history, hypertension, hypothyroidism, and ischemic heart disease vary. Vacuum-assisted closure (VAC) reduced wound size more consistently and significantly (-4.84) than standard dressings (-3.6). Comorbidities were associated with a larger health metric improvement (-4.2) than non-comorbidities (-3.2). Conclusion: Chronic foot ulcers cause diabetes hospitalizations. A 2004 50-case experiment shows that Vacuum-Assisted Closure (VAC) therapy is successful, satisfying, and cheaper than standard dressings. Comorbidities impact dressing gently, not V.A.C. healing.

129. Study on the Association of Nerve Atrophy and Severity of Pain in Trigeminal Neuralgia
Sujata Kumari, Himanshu Kumar Choudhary
Abstract
Introduction: Trigeminal neuralgia (TN) is a painful condition that is often brought on by the construction of a blood artery. TN is a possible symptom of MS. Demyelination close to the compressed area can generate shock-like pains during epaptic transmission. Although healthy persons can experience neurovascular compression, it can be relieved surgically. The brains of those with TN show anatomical changes. Aims and Objectives: This study examines the relationship between trigeminal nerve atrophy and pain severity in trigeminal neuralgia patients. Methods: In this investigation, diagnostic criteria from ICHD-3 were used to evaluate 80 participants, 40 with primary “trigeminal neuralgia (TN)” and 40 matched controls. The study was conducted from September 2023 to August 2024. MRI data were gathered to look at “neurovascular compression (NVC)” and changes in brain anatomy, and the VAS and SF-MPQ were used to measure the level of pain experienced. This study seeks to better comprehend the pathophysiology of TN by exploring the relationships between NVC, brain plasticity, and clinical factors. Result: This study’s primary “trigeminal neuralgia (TN)” patients shared demographics with healthy controls, but their pain and emotional impact were much higher. An analysis found lower GMVs in some brain areas in TN patients. Numbers were higher in contralateral trigeminal nerve cases. Mediation study shows that trigeminal nerve morphology most affects pain severity. The study revealed direct effects of trigeminal nerve morphology on pain severity in primary TN patients. Conclusion: This study concluded that individuals with primary trigeminal neuralgia (TN) have significantly reduced grey matter volume (GMV) and ipsilateral trigeminal nerve (TGN) size.

130. Incidence of Diagnosed Drug Resistant Tuberculosis Cases in India As Reported by Central TB Division since 2007: Ecological Study
Pritam Sakhare, Anuradha Chivate, Sunita Ramanand, Shivashakti Pawar
Abstract
Background: India has maximal load of the tuberculosis in the world. Drug-resistant pulmonary tuberculosis is an important factor that determines the outcomes of the TB elimination efforts in India. Along with the advent of anti-TB drugs, drug-resistant tuberculosis (DR TB) has existed in India. This study would provide an insight about incidence of diagnosed DR TB cases based on Central TB Division reports and additionally help to avoid duplication of data reported through the various case reports, case series and reviews, as TB has been a notifiable disease in India since 2012. Objectives: To determine the incidence of diagnosed DR TB cases in India as reported by Central TB Division. Method: Various publications by Central TB Division Ministry of Health and Family Welfare, Govt of India, notably: Programmatic Management of Drug-Resistant TB 2021, India TB report 2022 and India Tb report 2023 have reported data on diagnosed DR TB cases in India since 2007. The annual number of DR TB cases as per Central TB Division and population of India as per World Bank population projections are used to calculate the Incidence of DR TB cases in India. Results: The incidence of diagnosed DR TB patients in India is increased from 0.5 per Lakh Population for the period 2007-2010 to 4.49 per Lakh Population in the year 2022. Conclusion: There is gradual increase in the incidence of diagnosed DR TB patients in India between the periods of 2007 to 2022.

131.  Analysis of the Outcome of Surgical Interventions in Gastrointestinal Diseases in Pregnancy: A Retrospective Study in a Tertiary Care Centre in South India
Karthikeyan, Sastha, S.S. Gayathri, Sumathi, Swathisree
Abstract
Introduction: The incidence of surgical disease is the same in pregnant and nonpregnant patients. A total of 1.5–2% of all pregnancies undergo nonobstetric surgical intervention. Aim: To analyse the outcome of surgical gastroenterological interventions in pregnant women affected with gastrointestinal disorders. Materials and Methods: Retrospective study done over a period of one year from January 2023 to December 2023 All pregnant women who underwent surgical intervention for gastrointestinal conditions were included. Results: Around 1029 patients admitted with gastrointestinal symptoms, among them 425 patients admitted with heart burns ( 41.3%), 504 ( 48.9%) patients admitted with nausea and vomiting, 22 (2.13%) patients with very severe abdominal pain and 73 (6.9%) patients with hematemesis. Among the 73 patients who presented with hematemesis, 52 underwent endoscopic variceal band ligation. Four patients had subacute appendicitis and were treated conservatively. Out of the 22 patients, 19 patients had acute appendicitis underwent appendicectomy, two patients had adhesive intestinal obstruction and they underwent laparotomy and adhesiolysis, one patient had Bleeding GIST an underwent laparoscopic Gastric sleeve resection. Among the 19 patients who had Acute appendicitis, they all presented with acute abdominal pain of <3 days duration and they underwent appendicectomy within 48 hours of admission. The mean age of 19 patients was 24 years +/- 2 years and the mean gestational age was 15 weeks+/-2 weeks. Two patients were operated in the first trimester (10.5%), 17 patients in the second trimester. Laparoscopic surgery was performed in four patients (21.1%). On admission to the hospital, all patients had vomiting, 11 patients had generalised abdominal pain (57.89%) and eight patients had fever along with right sided lower abdominal pain (42.1%). All patients underwent ultrasound and five patients (26.31%)underwent further imaging with Magnetic resonance imaging MRI. The mean time from admission to surgery was 28 hrs +/- 3 hrs. Postoperatively two (10.5%)of the patients had Preterm delivery. Two out of 22 (9.09%) patients had adhesive intestinal obstruction due to previous surgeries hence proceeded with emergency laparotomy, one of the patients had previous history of ruptured ectopic gestation for which she had undergone salpingectomy, another patient developed adhesive intestinal obstruction due to previous lower segment caesarean section. Both of them operated in the second trimester. Intraoperative period was uneventful. Conclusion: Surgical emergency in pregnancy if not treated this can significantly contribute to maternal and foetal morbidity and mortality. The article summarises the possible causes of surgical emergencies that can arise during pregnancy.

132. Awareness of Cervical Cancer and HPV Vaccine among the Reproductive Age Group Females Residing in Rural Field Practicing Area of Chengalpattu Medical College : A Cross Sectional Study
Getrude Banumathi P, Sujatha S, Lakshmi Gayathri V, Anitha Devi D
Abstract
Background: Cervical cancer is the fourth most prevalent cancer among women globally, marking around 604,000 new cases and 342,000 fatalities in 2020. India accounts for one fourth of the global burden of cervical cancer. HPV infection is the most common cause of cervical cancer. It can be prevented by vaccinating all young Girls against HPV. Cancer cervix Incidence can reduced by Effective screening and treatment. Objectives : (1) To Assess the awareness about cervical cancer and HPV vaccine among the reproductive age group females residing in rural field practicing area of Chengalpattu Medical College. (2) To find out the HPV vaccination status among the study participants. (3) To study the factors influencing Cervical cancer awareness and HPV vaccination status among the study population. Methodology: A Community based cross sectional study was conducted among the Reproductive women in the age group of 18-49 years residing in Manampathi block by using Multistage sampling method during April 2023 to June 2023 in which there are 164 Reproductive age group females were selected by simple random technique . After obtaining Institutional Ethical committee permission and informed consent from the participants the data was collected by using semi structured questionnaire . After that the data was entered in MS Excel and analysed using SPSS software version 25. Results: In this study the mean age of study participants was 38.2 ± 9 years. Among 164 participants, 35.4%, had Adequate awareness about cervical cancer. Women undergone cervical cancer screening was 20.1%. Knowledge regarding HPV vaccination was found to be 18.9%, those who are vaccinated against HPV infection was 1.8%. The strong association was found between adequate awareness with Education and working status of the study population.(p<0.000*). Conclusion : This study concludes that awareness about the cervical cancer and Knowledge regarding HPV vaccination was not satisfactory. The educated, employed women exhibited higher awareness levels regarding both cervical cancer and HPV vaccination. All the vaccinated individuals (1.8%) are belongs to Upper Socioeconomic status. So high focus on Cervical cancer awareness campaign and Screening, HPV vaccination in all health care level.

133. Study of Efficacy of Propofol and Thiopentone Sodium as Induction Agents for Modified Electroconvulsive Therapy
Tutika Spandana, R P Kaushal, Yashwant Dhawale, Rajkumar Ahirwal
Abstract
Background: Electro Convulsive Therapy (ECT) is still widely used as the least expensive, safest, and most successful therapeutic technique for several psychiatric disorders. Amnesia, airway control, preventing physical damage, achieving hemodynamic stability, and a smooth and quick awakening are the conditions for anaesthetics. Aims and Objectives: The purpose of this study was to evaluate propofol and sodium thiopentone as potential anaesthetic agents in modified ECT. Methods and Methodology: This study was conducted at Gandhi Medical College, Bhopal which included 60 patients of 18-40 years age, either gender, with ASA grade I or II posted for modified ECT after written and informed consent. Group P was given Propofol 1.5 mg/kg body weight and Group T was given 2 mg/kg body weight of thiopentone sodium. Results: In this study, modified ECT was given to 60 patients who received alternately either propofol or thiopentone and the results evaluated. The mean weight of the patients was 57.79 kg and the mean age 29.35 years, difference was highly significant. Gender and body weight were comparable in both groups. In present study majority of patients were of Schizophrenia, mania depressive psychosis, paranoid schizophrenia and bipolar mood disorder. A statistically significant change (p<0.05) in heart rate post ECT at 1 min to 5min. between the two groups. A statistically significant change (p<0.05) in the systolic blood pressure post ECT at 3 minutes, 4 minutes and 5 minutes between the two groups. Conclusion: When propofol is used for anaesthetic induction, shorter duration of motor seizure, significantly faster psychomotor recovery and faster Emergence from anaesthesia was noted with propofol as compared with thiopentone sodium for anaesthetic induction for modified ECT.

134. Comparative Evaluation of Propofol and Etomidate for LMA Insertion Ease and Hemodynamic Stability: A Randomised Controlled Trail
Nilesh Kadu, R.D Agaskar
Abstract
Background: Supraglottic airway devices, like the laryngeal mask airway (LMA), have become integral in airway management. While propofol is commonly used for LMA insertion, its dosage can lead to hemodynamic instability. This study investigates the effectiveness of propofol versus etomidate, each in combination with fentanyl and midazolam, aiming to optimize LMA insertion while preserving cardiovascular stability. Methods: In a randomized trial, 60 ASA I & II patients were allocated to Propofol (P) or Etomidate (E) groups. Both received standardized premedication, and induction involved intravenous Propofol or Etomidate. Key parameters, including jaw opening, LMA insertion ease, adverse effects, and hemodynamics, were assessed. Rigorous randomization and blinding protocols were implemented for unbiased evaluation. Results: Propofol exhibited superior jaw opening (83.3% vs. 43.3%) and ease of LMA insertion (96.66% vs. 70%) compared to etomidate. Adverse effects like myoclonus were significantly higher with etomidate. Both groups showed a decrease in blood pressure, but significant differences emerged after induction and LMA insertion. Propofol maintained hemodynamic stability, emphasizing its superiority in achieving optimal LMA insertion conditions. Conclusion: While fentanyl and midazolam with etomidate maintained hemodynamic stability, they did not enhance LMA insertion success. Propofol demonstrated better jaw opening, ease of insertion, and cardiovascular stability. The study underscores the challenge of balancing optimal LMA conditions and hemodynamic stability. Further research is needed to identify co-induction agents that enhance success without compromising cardiovascular parameters.

135. A Study on the Correlation between Blood Pressure and Body Mass Index (BMI) among High School Students in Rural Area of Karnataka
Massrat Firdos, Seema Chandrakant Takras, Syed Anam Inayatullah, Mujtaba Nausheen
Abstract
Background: This study addresses the increasing concern of hypertension in adolescents, particularly focusing on the correlation between Body Mass Index (BMI) and blood pressure in high school students in a rural area of Karnataka. Methods: Conducted as a cross-sectional observational study at Government High School in Markhal Taluqa, District Bidar, Karnataka, it involved stratified random sampling of students from 8th and 10th grades. Measurements included height, weight (for BMI calculation), and blood pressure, along with demographic information gathered through a questionnaire. Results: Gender-based analysis revealed significant differences in average height, weight, and diastolic blood pressure between males and females. The study identified moderate to strong correlations between BMI and both systolic and diastolic blood pressure, along with correlations involving age, height, and weight. Conclusion: The study demonstrates a clear correlation between BMI and blood pressure among adolescents, underscoring the importance of monitoring and managing BMI to prevent hypertension and related health issues in this demographic.

136. A Study of Three-Port versus Four-Port Laparoscopic Cholecystectomy
Alakh Narayan, Jawed Akhtar, Pranava Dutta Verma, Rajnish Chandran, Vivek Vaibhav
Abstract
Background and Objectives: Kelling introduced a visualizing scope for the first time in the peritoneum of a dog, it was a landmark in the history of surgery The objective of this study was to investigate the technical feasibility, safety and benefit of three-port laparoscopic cholecystectomy (LC) over the conventional standard four-port LC as routine setup. Materials and Methods: A total of 50 patients willing to participate in the study with valid consent were allocated into two groups by computer generated chit system. The first group, three-port LC group consisted of 25 cases and the second group, the standard four-port LC group consisted of 25 cases were analyzed for the following outcome measures namely conversion rates, operating time, intra-operative complications, post-operative pain score, analgesic requirement and hospital stay. Conclusion: three-port LC is technically safe and feasible with less post-operative pain score, less analgesic requirement, less hospital stay with comparable operating time and complications when compared to four- port LC. Three-port is also associated with less scars and cosmetic superiority.

137. Investigating Fetal Outcome of Jaundice in Pregnancy at a Tertiary Care Center: A Clinical Study
Priyanka Kumari, Rahul Ranjan, Krishna Sinha
Abstract
Background: Jaundice in pregnancy presents significant risks to both maternal and fetal health, with multifaceted etiologies ranging from benign to life-threatening conditions. Understanding the impact of maternal jaundice on fetal outcomes is crucial for effective management and intervention strategies. Methods: This retrospective observational study was conducted to investigate fetal outcomes associated with maternal jaundice in pregnancy. Data were collected from medical records of 74 pregnant individuals diagnosed with jaundice during pregnancy who received antenatal care and delivered at the tertiary care center. Variables including demographic information, gestational age at onset of jaundice, etiology of jaundice, maternal complications, fetal monitoring, mode of delivery, neonatal outcomes, and postpartum complications were analyzed. Results: The mean age of participants was 29 years (±4.5), with a range from 20 to 40 years. Gestational age at onset of jaundice ranged from 24 to 36 weeks, with a mean of 30 weeks (±3.2). Etiology of jaundice varied, with viral hepatitis (45%) and intrahepatic cholestasis of pregnancy (30%) being predominant. Maternal complications were observed in 50% of cases, with pre-eclampsia (30%) and HELLP syndrome (20%) being the most common. Abnormalities in fetal monitoring were noted in 40% of cases. Neonatal outcomes included low birth weight (55%), low APGAR scores (25%), and neonatal jaundice (35%). Significant associations were found between maternal age and mode of delivery (p = 0.034) and between etiology of jaundice and neonatal jaundice (p = 0.019). Multivariate logistic regression identified pre-eclampsia as an independent predictor of adverse fetal outcomes. Conclusion: Maternal jaundice during pregnancy poses significant risks to both maternal and fetal health, necessitating comprehensive management strategies. Early detection, close monitoring, and targeted interventions are essential for improving maternal and fetal outcomes. Recommendations: Further research is warranted to elucidate the underlying mechanisms of fetal complications associated with maternal jaundice and to develop optimized management protocols.

138. A Retrospective Study on Acute Abdominal Pain in Fertile Women: Right Iliac Fossa Localization
Rahul Ranjan, Priyanka Kumari, Rakesh Kumar
Abstract
Background: Acute abdominal pain in fertile women, particularly when localized to the right iliac fossa, presents a diagnostic challenge due to diverse potential etiologies spanning gynecological, gastrointestinal, and urinary origins. Prompt and accurate diagnosis is critical to ensure timely intervention and favorable patient outcomes. Methods: The retrospective study analyzed 132 cases of acute abdominal pain in fertile women, focusing on those with pain localized in the right iliac fossa. Participants aged 18 to 45 years were included, with data collected from medical records. Results: The mean age of participants was 32.5 years (±6.2), with the majority (65%) falling within the 25-35 years age group. Abdominal pain was the predominant presenting symptom (100%), with 78% reporting localization in the right iliac fossa. Acute appendicitis was the most frequent diagnosis (42%), followed by ovarian cyst torsion (18%) and pelvic inflammatory disease (12%). Surgical intervention was common for acute appendicitis (89%) and ectopic pregnancies (100%), while conservative management was predominant for PID & UTI. Most patients (86%) experienced symptom resolution without complications. Conclusion: Acute abdominal pain in fertile women, particularly when localized to the right iliac fossa, encompasses various diagnostic possibilities. Prompt diagnosis and appropriate management, involving a multidisciplinary approach, are crucial for optimal patient care and outcomes. Recommendations: Given the complexity of acute abdomen in fertile women, healthcare providers should maintain a high index of suspicion for diverse etiologies and prioritize timely diagnostic evaluation. Collaboration between emergency physicians, gynecologists, and surgeons is essential for comprehensive management. Further research into diagnostic algorithms and interventions tailored to this population is warranted.

139. Role of Combined CT and MRCP in the Pre-Operative Assessment of Obstructive Biliopathy: An Observational Study, in a Tertiary Care Hospital
Tapash Rudra Paul, Bijit Lodh
Abstract
Obstructive jaundice is a prevalent hepatobiliary disease causing high morbidity and mortality. Despite advancements in diagnosis, management, and treatment, it remains a significant issue. Radiologists must assess the disease’s etiology, location, and extent before deciding on treatment. Ultrasound (US) is the primary technique for studying biliary obstructive diseases due to its accessibility, speed, and low cost. Traditional Computed Tomography (CT) is considered more accurate for determining obstruction causes. Magnetic Resonance Imaging with Magnetic Resonance Cholangiopancreatography (MRI with MRCP) is emerging as an exciting tool for noninvasive evaluation of patients with obstructive jaundice. This study investigates the use of MRI with MRCP for evaluating biliary duct systems, specifically in cases of cholangiocarcinoma or distal common duct obstruction. Methods: The study investigates the use of combined CT and MRCP in preoperative assessment of obstructive biliopathy, aiming to diagnose the condition using CT and MRCP and confirm their diagnostic accuracy with intraoperative findings. The observational study was conducted in collaboration with the Department of Surgery at AGMC and GBP Hospital, spanning one and a half years from January 2018 to June 2019. The sample size was 25 patients with obstructive jaundice, including those with clinical features, biochemical features, dilatation of the biliary system, clinically documented cause, and surgical or obstructive lesion. Patients under 12 years, those with prehepatic/hepatic jaundice, patients who refused to give consent, and those with contraindications for MRCP were excluded. The study was conducted with prior approval from the Ethical Committee of AGMC & GBPH Agartala, Tripura. Discussion: The study by Kushwah A et al (2015) found that obstructive biliary disease (OBD) is a common issue, with jaundice being the most common symptom. USG was the first choice for diagnosing obstructive biliary disease, with a sensitivity of 81.2%. The study also found that choledocholithiasis was the most common benign cause. MRCP was found to be more accurate and invasive than USG in diagnosing both benign and malignant diseases. MRCP has a high diagnostic accuracy of 98%, making it a new gold standard for diagnosing CBD and pancreatic ductal pathologies. It is recommended for preoperative diagnosis of gallstones, as it can rule out possible concomitant CBD stones. MRCP can also detect residual or iterative choledocholithiasis in patients post-cholecystectomy, potentially replacing endoscopic retrograde cholangiopancreatography (ERCP) and reducing unnecessary invasive procedures. The study highlights the importance of identifying obstructive and non-obstructive causes in diagnosing biliary disorders. Conclusion: Radiologists play a crucial role in selecting appropriate imaging for patient management, with ultrasound being useful for diagnosing biliary obstruction but not for obstructive jaundice. Non-invasive MRCP, with higher diagnostic accuracy, is essential for preoperative evaluation and treatment planning.

140. Role of Non-Invasive Ventilation in Type II Respiratory Failure Individuals
Sivaraj Karri, Vaddi Vidya Deepak, Rekha Nandhaki, Pillarisetty Madhu Harsha, Kambe Venkata Achutha V Durga Harika, Yadla Chaityasree
Abstract
Introduction: Noninvasive ventilation (NIV) involves administering positive pressure to the lungs without the use of an endotracheal tube. A study was taken to find the role of non-invasive positive pressure ventilation (NIPPV) in patients with type II respiratory failure and also to assess outcome. Methods: It was a prospective observational study conducted in the department of Respiratory Medicine, ASRAM Medical College, Eluru. Study was conducted from January 2017 to August 2018. Study protocol was approved by Institutional ethical committee. Individuals of both gender between 40 – 80 years, on moderate to severe dysponea for <2 weeks were included in this study. Respiratory rate (RR), heart rate (HR), arterial blood gas analysis (ABG) was recorded. Routine blood investigations and chest radiography were carried as per the institutional protocol. All patients were administered NIPPV using the Bilevel positive airway pressure (BiPAP) ventilator support system. Presence of sustained clinical improvement with reduction RR, HR and presence of normal arterial blood gas (ABG) analysis were required before weaning from NIPPV. P <0.05 were considered to be statistically significant. Results: Total 50 (100%) members were included, mean age was 56.82 ± 9.36 yrs. The male female ratio was 4. Before NIPPV, the mean + SD dyspnoea score was 9.08 ± 1.14 and it was 1.21±0.41 at the time of discharge; statistically there was significant difference. Similarly, there was significant improvement in the mean RR and HR. ABG parameters were also improved and statistically there was significant difference. Conclusion: The findings in the current study suggest that NIPPV is a promising therapeutic approach for managing selected patients experiencing exacerbations of COPD.

141. Study of Complex Supracondylar Humerus Fracture and its Functional Outcomes
Sudarshan A. Kamble
Abstract
Introduction: The fractures, specially upper limb, are frequent among children due to their nature of behaviour. Emergency intervention is usually required. There are two types of managements that are given. Open Reduction and Internal Fixation or Kirschner wire (K-wire), is used as intervention. There are debates regarding the efficacy of the managements. This study also analyzed the other parameters associated with cosmetic and duration of these interventions. Aims and Objectives: This study intends to find out the comparison between the clinical outcome of K-wire and ORIF in terms of efficacy, duration to fracture union and other related findings. Materials and Methods: This retrospective study was conducted by extracting information and records from the hospital who had supracondylar humerus fracture and were given either K-wire or ORIF management. The patients were classified into 2 groups, namely, those patients who were managed with multiple Kirschner wire (K-wire) and those who were managed with Open Reduction and Internal Fixation. After the operation, the patients were followed up after every after 3 weeks of their surgery. At the final follow up (which was about 10 to 14 weeks as per individual patient’s requirement), range of motion was tested and clinical outcomes were analyzed. Results: The study has found that the patients whose received K – wire management had significantly lower follow-up time (p<0.05) and duration of surgery (p<0.05). The study further pointed out that the cosmetic outcome was significantly satisfactory (p<0.05) among the K-wire group as compared to ORIF group. Conclusion: The study has concluded that the clinical outcome of both the managements are statistically similar. The acceptable and poor cosmetic outcome between the two groups are insignificant but there is significant difference (p<0.05) between the two groups in case of satisfactory outcome. The study also concluded that the follow up time and mean duration of surgery is significantly less if the patient is managed by K-wire as compared to the patients receiving ORIF management.

142. The Effect of Excessive Screen time on Sleep Quality among Pre School Children
Smriti Kumari, Urmi Poddar, Naveen Kumar, Vishal Prasad
Abstract
Background: The influence of excessive screen time on sleep quality among preschool children, aged 3 to 5 years, has emerged as a significant concern for researchers, parents, and health professionals alike. Previous studies have suggested a correlation between screen exposure and disrupted sleep patterns in young children, potentially impacting their overall development and well-being. Materials and Methods: A cross-sectional study was conducted involving 300 preschool-aged children from various early learning centers. Participants were divided into two groups based on their daily screen time exposure: low screen time (LST) of less than 1 hour per day and high screen time (HST) of more than 2 hours per day. Sleep quality was assessed using parent-reported questionnaires and the Children’s Sleep Habits Questionnaire (CSHQ). Data were analyzed using SPSS to compare sleep quality indicators between the two groups. Results: The results indicated a significant difference in sleep quality between the LST and HST groups. Children in the HST group had higher instances of sleep disturbances, including difficulty falling asleep, frequent night-time awakenings, and reduced overall sleep duration. Specifically, the HST group exhibited a 25% increase in sleep onset latency, a 30% increase in night awakenings, and a 20% reduction in total sleep time compared to the LST group. Moreover, a regression analysis revealed that screen time was a significant predictor of poor sleep quality, accounting for 35% of the variance in sleep disturbances among participants. Conclusion: This study underscores the negative impact of excessive screen time on sleep quality among preschool children. It highlights the need for guidelines and interventions to limit screen exposure in early childhood to promote healthier sleep patterns and, by extension, support developmental outcomes.

143. A Cross-Sectional Study of Socio-Demographic and Illness Factors Affecting the Pathway to Psychiatric Care
Sabbella Chandana, Medikonduri Vijaya Lakshmi, Swathi Ponnada, Anuhya Guyton G, Pabbathi Lokeswara Reddy
Abstract
Introduction: There is a significant treatment gap for Psychiatric disorders and some of the reasons being lack of knowledge about psychiatric illness as well as its treatment, stigma and misconception that mental illness was due to supernatural causes. The reasons for a significant delay in consulting a psychiatrist can be understood by studying the pathway to psychiatric care. This study was aimed to assess the relationship between socio-demographic and illness variables with the first care provider and to assess the perception of care givers in help seeking behavior. Methods: This cross-sectional, hospital-based study involving a total of 367 patients who had been newly registered in Government Hospital for Mental Care, Visakhapatnam was conducted using a convenient sampling method. Semi-structured proforma containing socio-demographic and illness variables, World health Organization (WHO) encounter form and care givers perception of mental illness proforma were used for data collection. Results: In this study, it was found that subjects who were female, belonging to a rural background and low socio-economic status, having less than 10 years of education, diagnosed with a major mental illness, residing at a distance of more than 150 kms from the hospital approached traditional healers first when compared to their counter parts. Those who had visited traditional healers in their initial consultation had more mean duration of untreated illness and high mean number of consultations. Conclusion: The pathway to care might vary based on regional and socio-cultural factors. The current study highlights the necessity for community education programmes about identification of psychiatric disorders as well as the sufficient training of non-psychiatric health care workers regarding the symptomatology of psychiatric disorders so that the patient could receive a psychiatric referral as early as possible.

144. Awareness among Medical Students on Noise Induced Hearing Loss after Prolonged Use of Personal Auditory Gadgets and the Audiological Evaluation of the Students with Hearing Loss
Rachith Reddy Pingili, B. Vijay Kumar
Abstract
Background: Noise induced hearing loss (NIHL), a preventable cause of hearing, is fast growing in the student communities. The type of device of external auditory delivery system used, duration, volume used, and other risk factors play their role in producing NIHL. An attempt is made to assess the awareness level of noise induced hearing loss among medical students and evidence based assessment of hearing in them. Aim of the Study: To understand the awareness among medical students about NHIL with the use of PADs and their effects on the hearing mechanism; to evaluate the audiological function of these students with the help of pure tone audiometry. Materials: 110 medical students out of463 were included and presented with a questionnaire on awareness of NIHL and their personal hearing problems. Demographic data is collected along with risk factors. Type of PAD used, its duration, and volume were recorded. The Objective and subjective assessment of audiological functions in them were done. All the data is analysed for comparison with other studies. Results: Out of, 110 students, 48 (43.63%) were aged between 18 and 21 years and 62 (60%) were aged between 22 to 25 years. 71 (64.54%) students were females and 39 (35.45%) were males, with a male to female ratio of 1:1.82. Smoking habit was present in 19 (17.27%) students and not present in 91 (82.72%) students. Family history of hearing loss (HL) was present in 11 (10%) students and no family history in 99 (90%) students. Urbanites were 67 (60.90%) and rural students were 43 (39.09%). Conclusions: Medical Students frequently using PADs for music at different volumes possessed sufficient information about impending HL and other ill effects of Health. Students were identified to have NIHL due to usage of PADs. Awareness about ill effects of PADs and road safety were possessed by majority of the students. Use of objective methods of hearing assessment should be undertaken to identify NIHL at the earliest in those who used PADs.

145. Serotyping of the Dengue Virus from a Clinical Sample by Using RT-PCR in A Tertiary Care Centre in Central India
Suneel Kumar Ahirwar, Sweta Doharey, Shashi Gandhi, Dharmendra Singh Rajput, Vijendra Singh Parmar
Abstract
Background and Objective: The dengue virus is a positive-sense RNA virus that is enveloped and classified as a member of the genus Flavivirus within the family Flaviviridae. There are four different but closely related serotypes of the virus that cause dengue. First, second, third, and fourth DENVs. The objective of this study was to determine the serotypes of dengue virus in clinically suspected cases. Material & Method: The present study was carried out from 2020 to 2021 in the department of microbiology at Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, and central India. Blood samples were received from suspected cases of dengue in the department of microbiology. All samples were tested for NS-1 antigen by the NS-1 ELISA kit. All positive samples by the NS 1 ELISA kit were subjected to detection of serotype by using real-time polymerase chain reaction. Result: A total of 450 samples were tested, out of which 45 were NS1 ELISA positive and 42 were PCR positive. Of the 42 dengue RT-PCR-positive samples, DENV-2 was found in 37 samples, DENV-4 in 3, and a mixed serotype in 2. Conclusion: The present study supports a better understanding of the different serotypes circulating in the study population and their association with the severity of the disease.

146. A Study to Assess the Knowledge, Attitude and Practice of Food Hygiene among Food Vendors
B. Prabakaran, S. Srinivasan
Abstract
Background: One of the frequent problems in the sale of street foods is their actual and potential hazard caused by bacterial contamination. Investigations of outbreaks of food-borne disease throughout the world show that, in nearly all instances, they are caused by the failure to observe satisfactory standards in the preparation, processing, cooking, storing or retailing of food. Only few recent studies are available on KAP on food hygiene among street food vendors .Hence this study was conducted with the purpose to shed light on knowledge, attitude and practice on food hygiene among street food vendors in Urban population in South Indian City. Methodology: This study was conducted as a cross sectional quantitative study design done among urban population in a south Indian city in Tamilnadu. Around 110 food vendors were interviewed and included in this study. The Questionnaire was developed keeping in mind the objectives of the study. It had 5 Parts including demographic characteristics, assessment of personal hygiene and assessment of Knowledge, Attitude and Practice on food hygiene. Results: Only 16.3% had adequate level of knowledge on cooking process.43.6% and 40% of the vendors had moderate and inadequate levels of knowledge on cooking process respectively. In our study 50% (55) of the study population had more positive attitude towards food hygieneAlso in our study, 75.4% (83) had good level of attitude in serving area hygiene among the study population. 76.3% (84) of the study population had good level of practice in food safety. Conclusion: Food vendors should be adequately educated on the role of food in disease transmission as well as on rules of personal hygiene and approved practices in handling street food. Along with administrative support, Promotion of awareness and increasing understanding of food safety issues among the general public would pave path for better food handling techniques. This also should be promoted with health education and training programs.

147. The Association of Smoking with Hearing Loss in Indian Adult Males: A Comparative Study
Adil Abbass, Abid Manzoor, Pranali Maan, Manju Rajain, Amit Kumar Verma, Mohd Abass Dar, Kashif Naem Siddiqqi
Abstract
Background: While extensive research has been conducted to investigate the health risks associated with smoking, there exists a noticeable gap in the scientific literature regarding the specific correlation between smoking and hearing loss. This study endeavors to address this gap by undertaking a meticulous review of existing literature and performing a comprehensive analysis, with a particular focus on elucidating the association between smoking habits and the prevalence of hearing loss within the adult male population in India. By employing rigorous scientific methods, including statistical analyses and data interpretation, our aim is to contribute valuable insights that can inform public health policies and interventions aimed at mitigating the potential auditory consequences of smoking in this demographic. The results suggest a significant correlation between smoking habits and hearing impairment, highlighting the need for further investigation and public health interventions. Aim: This study seeks to investigate the impact of smoking on hearing. Previous research has yielded mixed results, primarily in Western populations. The outcomes of this study may stimulate future inquiries, potentially shaping the development of early screening methods for hearing loss in smokers. Recognizing smoking as a significant risk factor can empower patients with information about its profound impact on hearing health.” Materials and Methods: The hearing tests were conducted in a soundproof room in the outpatient department of the ENT department at NIMS Hospital. The hearing examination included a general examination, ear examination, screening tuning fork test, and pure tone air-conduction and bone conduction tests using AD 226 Intra-acoustic audiometry. The audiometry test, conducted in a soundproof room at NIMS Hospital, utilized puretone audiometry (PTA) to assess hearing thresholds for different frequencies. Participants responded to tones, and the lowest volume level at which a response was recorded was considered the threshold. The study differentiated between right and left ears and independently assessed the extent of sensorineural hearing loss. This study included 110 subjects, including 55 smokers and 55 age-matched non-smokers. The data were analyzed using appropriate statistical tests. Results: Smoking was found to be significantly associated with hearing loss. Furthermore, the hearing loss was primarily sensorineural, with the mild type (26–40 dB) being the most common in smokers. Conclusion: The current study discovered a favourable relationship between smoking and its many characteristics with regard. In this study, smoking was associated with increased hearing loss in young and middle-aged males with 34.54% smokers and 10.90% non-smokers with hearing impairment among Indian adult males.

148. Determinants of Treatment Satisfaction among Patients with Diabetes: Importance of Patient-Reported Outcomes
Kalpana Purohit, Abdul Wadood Siddiqui, Sunita Singh, Amit Arya, Yangshen Lhamo, Mani Bharti
Abstract
Treatment satisfaction is a significant determinant for patients in terms of physical and mental satisfaction, wellbeing and quality of life. The efficacy and safety of diabetes treatment should also focus on patient-reported outcomes (PROs), This type of study is relevant for patients with chronic diseases such as diabetes. DTSQ is not only used for comparisons between different medications or treatment strategies, but also can be used to assess the quality of diabetes care in clinical settings. This is important as an improvement in treatment satisfac-tion may enhance patients’ self-analysis and adherence to therapy, leading to the achievement of long-term stable glycemic control and reduced the adverse effect due to diabetic complications. In this review, we summarize the current topics in DTSQ, introducing our own experience, and discuss the role of PROs in diabetes treatment.

149. Prescription Pattern of Antibiotic Use in Respiratory Tract Infections in a Tertiary Care Teaching Hospital
Syed Wasif, Sagar H, Harish. G. Bagewadi, S N Mani Devi Karampudi
Abstract
Background: Respiratory tract infections were one of the most common infectious diseases among human beings all over the world. Objective of the study: To assess the prescription pattern of antibiotic use in Respiratory Tract Infections in a tertiary were teaching hospital. Materials and Methods: It is a prospective, observational study in which 150 random patients attending Medicine OPD at GIMS, Kalaburagi with Respiratory Tract Infections were taken. Prescription, demographic and clinical assessment details were recorded in the Case Record Form (CRF). Results: In total of 150 patients taken in this study, Azithromycin (n=50), Levofloxacin (n=50), Amoxycillin (n=28) and Cefixime (n=22) drugs were prescribed for URTI. On day 3, Azithromycin group (n=18,36%), Levofloxacin group (n=29,58%), Amoxycillin group (n=17,60%) and Cefixime group (n=14,64%)  subjects still had one or more symptoms (cough, fever, sore throat, running nose or breathlessness). On day 5, Cefixime group (n=7,32%) had more than one symptoms, other groups had only few subjects with symptoms. Conclusion: In this study, Azithromycin and Levofloxacin were the common drugs prescribed for respiratory tract infections followed by Amoxycillin and Cefixime. Azithromycin was more efficacious compared to other drugs.

150. Comparison of Dexmedetomidine and Fentanyl as Adjuvant for Bupivacaine in Ultrasound Guided Erector Spinae Block for Laproscopic Cholecystectomy: Prospective Observational Study
Nirmala Mathew, Febin Sathar, Sreedevi CR, Divya D
Abstract
Objective: This prospective observational study aimed to compare the efficacy of dexmedetomidine and fentanyl as adjuvants to bupivacaine in ultrasound-guided erector spinae block for postoperative pain management following laparoscopic cholecystectomy. Methods: The study included two groups. Group 1 received dexmedetomidine, and Group 2 received fentanyl. Demographic data and baseline characteristics were analyzed, revealing a significant age difference between the groups. ASA physical status categories 1 and 2 were similarly distributed, indicating comparable baseline health statuses. While baseline cardiovascular parameters were comparable, significant differences in diastolic blood pressure and respiratory rate were noted. Clinical parameters, including heart rate, systolic and diastolic blood pressure, were assessed at various time points postoperatively. Numerical Rating Scale (NRS) scores for pain assessment were analyzed over the study period. The time interval from the injection of local anesthetic until the first demand for analgesic or the need for postoperative pain management (MNT) was compared between the groups. Total tramadol consumption and the incidence of postoperative nausea and vomiting were also assessed. Results: Group 1 exhibited varying heart rates compared to Group 2 at 2, 4, 6, 12, and 24 hours postoperatively. Significant differences in diastolic blood pressure at 2 hours suggested early divergence between the groups. NRS scores showed significant variations at 2, 4, 6, and 12 hours, indicating distinct effects of dexmedetomidine and fentanyl on pain perception. Group 1 demonstrated a significantly longer duration until the first demand for analgesic compared to Group 2. Total tramadol consumption was comparable between the groups, suggesting similar efficacy in controlling postoperative pain. The occurrence of postoperative nausea and vomiting did not significantly differ, but a trend in Group 1 suggests further exploration. Conclusion: Dexmedetomidine and fentanyl as adjuvants to bupivacaine in ultrasound-guided erector spinae block exhibit differential effects on hemodynamic parameters and pain management. Dexmedetomidine prolonged the duration until the first demand for analgesic, indicating potential benefits in postoperative pain control. Total tramadol consumption and the incidence of postoperative nausea and vomiting were comparable, warranting further investigation into potential clinical implications. These findings contribute to the understanding of optimal adjuvant selection for enhanced postoperative pain management in laparoscopic cholecystectomy patients.

151. The Effectiveness of Developmental Care Bundle for Late Preterm Neonates and Their Parents: A Systematic Review
Christy Suthasini N, Manjubala Dash, Jeyastrikurushev, Muthamizhselvi
Abstract
Background: Neonatal early supported transfer to home interventions aim to facilitate the transition of preterm infants from hospital to home care. This systematic review evaluates their effectiveness compared to routine NICU care. Methods: A comprehensive search was conducted, encompassing studies that compared early supported transfer to home interventions with standard NICU care. Key outcomes included duration of hospital stay, hospital re-admission, parental wellbeing, parental confidence, breastfeeding, and infant weight gain. Results: Ten studies with 12,821 participants were included. Early supported transfer to home interventions were associated with a reduction in hospital stay by an average of 11 days (P < 0.001). There was no significant increase in hospital re-admissions (RR 0.91, 95% CI 0.65–1.26, P = 0.57). No conclusive evidence was found regarding improvements in parental wellbeing or confidence. The interventions did not significantly affect weight gain or breastfeeding rates. Conclusion: Early supported transfer to home interventions may reduce hospital stays for preterm infants without increasing re-admission rates. However, their impact on parental outcomes needs further investigation. The moderate to serious risk of bias in the included studies suggests that these findings should be interpreted with caution.

152. Unravelling the Enigma of Impacted Fetal Heads: Exploring Causes, Caesarean Section Techniques, and Maternal-Fetal Outcomes in a Comprehensive Labor Study
Tinny Pratibha, Sona Soni, Aruna Kumar, Archana Dhakad
Abstract
Background and Objective: The deeply impacted foetal head refers to the situation in which the fetal head cannot be delivered by usual manoeuvres during caesarean delivery because the head impacted deep within maternal pelvis  and it is associated with increased maternal and foetal morbidity. Therefore, the primary objective of this case study is to identify the causes and associated risks of the deeply impacted head during cesarean delivery. Method: in this study, 200 pregnant females with a singleton foetus whose head was deeply impacted in the pelvis and underwent cesarean section at the Department of Obstetrics and Gynecology, Sultania Zanana Hospital & Gandhi Medical College, Bhopal were enrolled for a period of 1 year (1 January 2021 –  January 2022) for observational studies. Result: the most common risk factor associated with an impacted foetal head was primigravida followed by malposition of foetal head. Whereas the most common cause of the deeply impacted head which was observed was Deep transverse arrest of the head. Conclusion: the current study found various types of feto-maternal complications associated with deeply impacted heads during labor and how those complications can be arrested in advance by incorporating different techniques for foetal delivery.

153. Descriptive Study on COVID-19 Vaccination Knowledge and Acceptance among Women of Reproductive Age Group in Tamilnadu
K J Jeevitha, R. Rajakeerthana, Kavitha. G
Abstract
Introduction: The acceptability of the COVID-19 vaccine among women of reproductive age is not well understood. Therefore, this study aims to investigate and elucidate the level of knowledge regarding the COVID-19 vaccine and its acceptance among a cohort of women actively planning pregnancy. Method: This descriptive study was carried out among women residing in rural areas of Madurai, Tamil Nadu, India, comprising 227 participants of reproductive age group during the year 2021. Data collection was facilitated through semi-structured questionnaires administered via interviews. Statistical analysis was performed using SPSS version 21. Results: Among the 227 participants, approximately 50% fell within the 18-30 age range, and nearly 78% possessed at least a higher secondary education. Employment status indicated that 66% were employed, while the remainder were unemployed. Gravidity status did not exhibit significant differences in awareness. The overall awareness rate stood at 70%, with a corresponding acceptance rate of 61%. Conclusion: Despite awareness of the vaccines among women, hesitancy persists. Literacy significantly influences vaccine awareness and acceptance. It’s crucial to inform women of reproductive age that COVID vaccines are safe for use, with any side effects being mostly minor. While vaccine trials haven’t specifically targeted pregnant women, the benefits of vaccination far outweigh any potential risks to the fetus. Ensuring women are informed about this can help alleviate concerns and encourage vaccine uptake.

154. Comparison of Biochemical Profiles in Pregnant and Non-Pregnant Women of Bihar
Smitha Mallick
Abstract
Background: Pregnancy is associated with several physiological changes in the body, like hormones and meta-bolic changes that help the growth and survival of the fetus. However, biochemical profile derangement may lead to pregnancy complications. Hence, it is essential or mandatory to study the biochemical profiles during pregnancy. Method: 50 pregnant women and 50 non-pregnant women aged between 18-45 were selected. BMI, lipid pro-file, and blood pressure were studied and compared. Results: 13 (26%) women had the first trimester, 20 (40%) had the second trimester, and 17 (34%) had the third trimester. BMI mean value for pregnant women was 24.82 (±1.08) and for non-pregnant females was 22.19 (±1.03) t test 12.4 and p>0.00. The mean value of systolic BP in pregnant women is 110 (±2.2) and 105 (±1.2) in non-pregnant women (t test 14.1 and p<0.000). Diastolic BP 72 (±2.1) pregnant 70 (±1.3) in on-pregnant females t test 5.7 and p<0.000, Glucose levels, TC, TG, HDL, and LDL were elevated in pregnant females as compared to non-pregnant females. Conclusion: This pragmatic evaluation of the biochemical profile will be helpful to obstetricians and gynecol-ogists in predicting the status of pregnancies and fetal outcomes because nutritional status plays a vital role in pregnancy and the growth of the fetus.

155. Assessment of Home-Based Care for Young Child (HBYC) Program in Aspirational Districts of Madhya Pradesh, India: A Cross-Sectional Study
Herschel Dafal, Swati Saral, Anshuli Trivedi, Siddharth Agrawal
Abstract
Background and Objectives: In 2018, the Government of India launched the Home-Based Care for Young Child (HBYC) programme, which includes five scheduled home visits per quarter for children aged 3 to 15 months to enhance early childhood development. Evaluate the understanding and behaviors of Accredited Social Health Activist (ASHAs), other health workers, and mothers about HBYC. Cross-sectional assessment design with ASHAs, AWWs, ANMs, ASHA, and mothers of children aged 3 to 15 months as participants. Material and Methods: An evaluation was conducted on the knowledge and practices of 801 ASHAs, 200 other health functionaries, and 787 mothers regarding exclusive breastfeeding, complementary feeding, hand washing, iron folic acid (IFA) and oral rehydration solution (ORS) supplementation, and danger referral signs in eight aspirational districts of Madhya Pradesh. Results: 88% of ASHAs demonstrated accurate understanding of ORS, 85% of supplemental feeding, 85% of the adequacy of IFA, and 47% of danger indicators for child referral. 85% of moms were aware of exclusive breastfeeding, 40% knew about supplementary feeding, and just 18% knew the precise preparation of ORS. A statistically significant relationship was found between ASHAs doing home visits and the presence of ORS in households, as well as mothers’ understanding of the proper initiation of IFA (p < 0.001). Conclusion: The survey indicated that most health functionaries were knowledgeable of the duties, responsibilities, and critical activities associated with HBYC. There was a lack of information transmission by health workers, resulting in insufficient implementation of behaviors among mothers regarding HBYC. This requires implementing relevant measures ranging from enhancing the health system to creating capacity in order to speed up the adoption of the HBYC programme.

156. Image Guided FNAC in Lung Lesions; At Tertiary Care Centre
Mamta Jain, Sakshi Singh, Navita Gupta, Mayank Sharma, Abhishek Jain
Abstract
Image-guided fine needle aspiration cytology (FNAC) is regarded as a rapid, safe, and accurate diagnostic tool in examining lung lesions. This study aims to assess the role of image-guided FNAC in benign and malignant disorders of lung lesions, to analyse the results, and to compare the results with other studies. Over a period of two year (January 2022 to December 2023) one hundred and ten patients with lung lesions were studied for their age, sex, and cytological diagnoses. Out of 110 cases involved in our present study, 84 (76.36%) were male and 26 (23.63%) were female. Out of a total of 110 cases cytological diagnosis on image-guided FNAC showed 2 (1.8%) cases with benign pathology, 16(14.5%) cases were inflammatory in nature and 73 (66.36%) cases to have malignancy and 8(7.2%) cases were suspicious while results were inconclusive in 11(10%) cases. The most common carcinoma as diagnosed by cytology was squamous cell carcinoma accounting for 39 (53.42%) cases, followed by adenocarcinoma in 17 (23.28%) cases, small cell carcinoma in 7 cases, 3 cases as poorly differentiated carcinoma, large cell carcinoma in 3 cases, clear cell carcinoma in 1 case and metastasis in 3 cases, in which 2 were known case of adenocarcinoma and one is Ewing’s sarcoma.

157. Acute Kidney Injury Induced by Snake Bite and Its Outcome in a Tertiary Care Centre
Nandeesh Venkatappa, Inbanathan. J, Sushma TA, Mahesh Venkatesha
Abstract
Background: The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11–1.77 million bites in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India. The complications related to kidneys are observed in majority of patients with poisonous snake bite. Such renal failure, usually due to acute tubular necrosis, is frequently reversible. If bilateral cortical necrosis occurs, however the prognosis of renal recovery is grimmer. Hence this was conducted with the objective to determine risk factors associated with adverse outcome in patients with Acute Kidney Injury induced by snake bite. To determine association between treatment delay and outcome of Acute Kidney Injury. Methodology: Data was collected using predesigned questionnaire by interviewing the patients or by verifying the records. Participants demographic, clinical details and investigation profile were recorded in proforma. Complete Blood Count, Bleed in g time, Clotting time, Urine Albumin, Sugar, Deposits including RBCs, Blood urea, serum creatinine, electrolytes, Electrocardiogram, USG abdomen, Other investigations were taken based on the clinical status of the patient. Patients were classified into three stages of acute kidney injury proposed by Acute Kidney Injury Network [Modified RIFLE Criteria]. Serum Creatinine clearance was estimated by Cockcroft’s-Gault Equation. Data was entered into Microsoft excel data sheet and was analyzed using Epi Info version 7.2.6 software. p value of <0.05 was considered as statistically significant. Results: In the study out of 100 subjects included, 30 subjects were recruited during Dec 2022 to Dec 23. 70 patient details were obtained from records during 2013 to 2022. Among these subjects, majority of them were in the age group 21 to 30 years (28%), males were 56%, Russel viper bites were 44%. Bite to needle time was <6 hrs. in 64%, 60% were Haematotoxic snake bites, 52% had elevated serum creatinine, 30% had bleeding manifestations, 70% had cellulitis, 40% had hypotension, 50% required dialysis and 38% had mortality. Mortality was highest among subjects with Raised serum creatinine and reduced eGFR (54.17% respectively). Other factors such as age, gender, type of toxicity, Bleeding Manifestations, Hypotension and dialysis were not significantly associated with mortality among AKI subjects. Among subjects who took >6 hrs for treatment had highest elevated serum creatinine (72.2%), reduced eFGR (72.2%), bleeding manifestations (55.56%), cellulitis (88.89%), hypotension (61.1%) need for dialysis (72.2%) and mortality (61.1%). Conclusion: Raised serum creatinine levels and reduced estimated GFR levels were significantly associated with adverse outcome of death in Patients with Acute Kidney Injury in snake bite. Haematotoxicity, occurrence of cellulitis, bleeding manifestations, hypotension requirement of dialysis, elevated serum creatinine levels and reduced estimated GFR levels were significantly associated with bite to needle time of > 6 hours.

158. Stoppa’s Repair versus Lichtenstein Technique for Management of Bilateral Inguinal Hernia: A Comparative Assessment
Akshay V Kulkarni, Sachin Jain, Vijay Patel, Kailash Gindodia
Abstract
Overview: The surgical management of bilateral inguinal hernias has been a point of contention for a long time, particularly in terms of whether to repair them sequentially or simultaneously. The present study was done to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair. Methodology: The study included all patients of both genders with age of 18 years with bilateral inguinal hernias. Patients with following any condition-a complicated inguinal hernia; an obstructed or strangulated inguinal hernia; a recurrent inguinal hernia; previous abdominal surgery; a local skin infection-were excluded from the study. Patients were randomized into 2 groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patients underwent Stoppa’s repair. Observations: The operative time was significantly shorter in group 2 patients as compared to group 1. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. In Post-operative hospital stay, return to normal daily activities, and chronic groin pain, there were no statistically significant differences between the two groups. Conclusions: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable postoperative outcomes and had similar problems.

159. Clinico-Epidemiological and Laboratory Correlation of COVID-19 Patients at a Tertiary Care Centre in Hadoti Region of Rajasthan: A Cross Sectional Study
Ravi Kumar Verma, Pankaj Kumar Jain, Rajesh Yadav, Manoj Seval
Abstract
Objective: To study clinico epidemiological and laboratory parameters of Covid 19 in hadoti region of Rajasthan, India. Methodology: A prospective cross sectional was conducted on 120 patients, presenting to the Govt. medical college and associated group of hospitals of Kota, Rajasthan. The Covid 19 was confirmed by RT PCR. The data about demography and laboratory parameters were collected after admission of the patient to the isolation ward and analysed. Results: The mean age was 44.40 ±17.9 years. Male to female ratio being 2.75:1.There was 89 symptomatic and 31 asymptomatic patients. On presentation, the most common symptom was fever 71 (59.16%) followed by cough 61 (50.83%), breathlessness 48 (40%) and myalgia 40 (33.33%). On the basis of SPo2, 16% were Mild cases, 7.5% were Moderate and 5.83% were severe cases. The blood results showed that 26.66% of patients had increased leukocyte count, inflammatory markers were positive in 41.66%. And renal function test was deranged in 10% and varying degree of liver dysfunction with an increase in SGPT (29.16%), SGOT (37.5%) were seen. Conclusion: The clinico-epidemiological characteristics of Covid-19 patients behaved differently in different geographical location. The common symptoms in our study could emphasize on identifying potential patients in this geographic area. Knowledge about the disease presentation in each geographic area is important in planning the effective management strategies since the features are varied from place to place.

160. Sleep Disturbances in Children with Allergic Rhinitis
Hari Mohan Meena, Ashok Kumar Sharma, Pawan Dara, Sonika Meena, B S Sharma
Abstract
Objective: To assesses the pattern and proportion of sleep disorders among children having allergic rhinitis. Materials and Methods: Hospital based observational study in which 149 children aged 4 to 18 years attending S.P.M.C.H.I. (tertiary care hospital) Jaipur having clinician diagnosed allergic rhinitis were considered as study subjects. A validated PSQ questionnaire was supplied to parents/guardians of children to be filled with assistance of investigator for evaluation of presence/pattern of sleep disorder among these children. The data collected were subjected for statistical analysis. Results: The mean age of study subjects was 9.8±2.4 year. The family history of atopy was found in 63.08% children. Tonsillar hypertrophy was observed in 30.6% children. 52.34% children had adenoid hypertrophy. Snoring during sleep (62.41%) was the most common sleep disordered breathing pattern among children with AR followed by restlessness during sleep (46.3%), mouth breathing during sleep (56.37%), bruxism (26.84%), Sleep walking (18.12%), Sleep talking (24.16%), difficulty falling asleep (28.18%), nocturnal sweating ( 30.2%), early morning headache (27.5%), sleepiness during day (28.85 and frequent nocturnal awakening was found in 33.55% children. Conclusion: There are a significant proportion of children of allergic rhinitis have various type of sleep disorders.

161. Mitigation of Hemodynamic Response to Intubation with Esmolol, Diltiazem and Magnesium Sulphate: A Comparative Evaluation
Yashu Singh, Sachin Gajbhiye, Avinash Kashyap, Pradyumna Singh Kakodia, Sucheta Bagri, Mithun Mohan
Abstract
Introduction: Laryngoscopy and tracheal intubation are frequently associated with hypertension and tachycardia which sometimes results in grave complication like intracranial haemorrhage, various modalities can be implied to mitigate the stress response. Objective: Objective of our study is to assess the efficacy of intravenous esmolol 2mg/kg, intravenous diltiazem 0.2mg/kg and intravenous magnesium sulphate 60mg/kg. to attenuate the stress response of laryngoscopy and intubation. Study Design: Prospective, Randomised, Double blind. Place of Study: NSCB Medical College Jabalpur.  Methods: 80 patients of ASA class I and II who were scheduled to undergo general anaesthesia were given study drugs at the above mentioned doses before laryngoscopy and intubation. Subjects were then assessed for hemodynamic perturbations immediately following intubation and at 1, 3 and 5 minutes after intubation. Results: Patients in esmolol group showed minimum deviation of heart rate from mean which was 87.55±10.73, 76.9±7.76, 82.45±8.19, 82.65±8.31, 82.1±8.91 and 82.2±8.4 minutes respectively at baseline, immediately after study drug administration, immediately after intubation, at 1 minute, at 3 minute and at 5 minute after intubation. The least variance in mean arterial pressure was observed with esmolol (96.53±6.35, 84.72±4.56, 95.37±6.91, 93.77±6.12, 90.05±6.56 and 87.22±4.88 mmHg) and with magnesium sulphate (94.57±5.5, 89.12±5.32, 92.53±6.74, 92.45±6.38, 90.37±5.77 and 87.2±5.5 mmHg) respectively at baseline, immediately after drug administration, immediately  after intubation, at 1 minute, at 3 minute and at 5 minute after intubation. Conclusion: The study concluded that Esmolol at a dose of 2mg/kg bolus 2 minute before intubation is more effective to attenuate the cardiovascular pressure response to laryngoscopy and intubation than Diltiazem 0.2mg/kg and Magnesium Sulphate 60mg/kg.

162. Assessing Bilirubin Measures: Serum Vs Transcutaneous in Neonates
Mithila Das Mazumder, Joy D’souza
Abstract
Background: Neonatal Icterus in in newborns is a serious condition. It’s one of the most common reasons of infant immaturity. The total investigation of complete serum bilirubin (TSB) is a widely known procedure for identifying hyperbilirubinemia, but it is intrusive for neonates. TCB (TCB) was used to assess bilirubin levels since over 2 decades as just a non-invasive and painless method. Acute bilirubin encephalopathy, commonly referred as kernicterus, is indeed a bilirubin toxicity which is linked to significant morbidity and mortality. The focus of this research is and sees if there was a relationship among subcutaneous bilirubin levels and serum total bilirubin in normal babies with jaundice. The aim of this exercise would be to see how helpful a TCB metre would be the therapy of physical icterus. Methods: This observation is a cross-sectional study was done with healthy Babies delivered and admitted to the inpatient postnatal ward of the division of paediatrics in during the study (January 2015 May 2016), Vydehi Institute of Medical Sciences and Research Centre, Bangalore). 300 Samples collected during the study period will be considered for the study, satisfying inclusion and exclusion criteria. The gestational age of the baby will be assessed according to the Expanded Ballard Score within 24hrs of birth. Babies in the postnatal ward satisfying the inclusion and exclusion criteria will be identified. TCB meter on the forehead and sternum on the newborn will be done within 10 minutes of blood collection for serum bilirubin determination, which will be done at around 72 hours as pre-discharge screening. Results: There appears to be a strong link between TCB measurements and liver tests and Total serum bilirubin measurement. The serum bilirubin mean +/- SD is 12.19 +/-3.52. For both the forehead and breast bone the mean +/- SD for TCB were 10.33 +/- 3.34 and 12.40 +/-3.44, accordingly. As contrasted to a forehead, the standard error of a sternum as just a monitoring site in this research has the strongest relationship of 0.90 (p0.001) to serum bilirubin level. Conclusion: The study clearly demonstrates that perhaps the QTCB measurements and TSB measure using Transcutaneous Icterus metre MBJ20 get a significant correlation. As per the research, the sternum relates more to serum bilirubin levels than that of the forehead whenever the site is considered. TCB could be used for recording pre-discharge bilirubin levels (screening tool) and also can be used to make a rapid decision on phototherapy and duration of service.

163. Relationship between Arm Span and Stature in Adolescent Age Groups: A Cross Sectional Study
Sameer Sathe, Anil Mangeshkar, Ashok Najan, Harsh Kumar Chawre
Abstract
Background and Objectives: A person’s height may not always be able to be measured due to limb malformations, amputations, or cadavers in which just a portion of the deceased individual is still present. One of the most accurate ways for estimating tall is to measure arm span. Material and Method: This cross sectional study was conducted on 150 students of adolescent age groups from aged 10-19 years in one of the school of Datia during August 2023 to January 2024. Out of 150, 78 were boys and 72 were girls. Analysis was done by using computer based program (SPSS). Results: Statistical analysis of the data obtained shows strong correlation between height and arm span. This was found to be 0.91 in total subjects, 0.82 in males and 0.88 in females. Regression equations were derived and verified on subjects with known parameters using standard procedures. Conclusion: One of the best bodily measurements for accurately determining a person’s height is arm span.

164. Incidence and Risk Factor Profile of Retinopathy of Prematurity at a Tertiary Care Centre
Ch Stephen, Vannala Raju, Sreenivasa K Rao, Narayana Lunavath
Abstract
Retinopathy of prematurity is a vaso-proliferative disorder of the retina. Preterm infants are more prone for this disease especially low birth weight (LBW) neonates who are exposed to large amount of oxygen(O2). It is the leading cause of the preventable blindness in infants. This study was conducted to find the incidence of ROP in this region and to study the contribution of different risk factor profile to ROP. The study is a descriptive and observational study. A total of 400 preterm neonates satisfying the inclusion criteria were included in the study. The incidence of ROP was 10.25%. The duration of oxygen administration, need for oxygen supplementation, clinical sepsis, apnea, RDS, HIE, acute kidney injury, convulsions, positive CRP, administration of blood and its products and hypotension were significantly associated with development of ROP.

165. Comparison of Carbetocin and Oxytocin for Prevention of Postpartum Haemorrhage
Kalpana Kumari, S.M. Inamul Haque, Asha Singh, Mukesh Kumar
Abstract
Background: Postpartum haemorrhage (PPH) is a potentially serious and life-threatening complication that can occur after childbirth. The present study was conducted to compare carbetocin and oxytocin for the prevention of postpartum hemorrhage. Materials and Methods: 136 women with postpartum haemorrhage were divided into two groups of 68 each. Patients in group I were given a single intramuscular injection of heat-stable carbetocin, and patients in group II were given an intramuscular injection of oxytocin. The outcome measures were mean blood loss after vaginal delivery, proportion of women with blood loss > 500 ml, requirement of other uterotonic or surgical procedures, and incidence of adverse events. Results: Patients in whom labour was induced were 5 in group I and 3 in group II; patients in whom labour was augmented were 12 and 15; and patients with previous postpartum haemorrhage were 3 and 4 in group I and 3 in group II, respectively. The difference was non-significant (P > 0.05). Post-partum blood loss > 500 ml was seen in 7 and 12, additional uterotonic agents in 8 and 11, blood transfusion in 1 and 2, and additional surgical procedures in 2 and 3 in groups I and II, respectively. Adverse events recorded were chest pain in 5 and 4, flushing in 2 and 1, abdominal pain in 1 and 3, and nausea and vomiting in 3 and 2 patients in groups I and II, respectively. Conclusion: It was discovered that when it comes to reducing postpartum hemorrhage in women who have had a singleton vaginal delivery, carbetocin works marginally better than oxytocin.

166. Comparison of Propranolol and Topiramate for the Prevention of Chronic Migraine
Rajeev Kumar, S.M. Inamul Haque, Asha Singh, Mukesh Kumar
Abstract
Background: A migraine is a type of headache characterised by severe pain, often accompanied by other symptoms such as nausea, vomiting, sensitivity to light, and sensitivity to sound. The present study was conducted to compare propranolol and topiramate for the prevention of chronic migraine. Materials and Methods: 64 patients with migraine of both genders were divided into two groups of 32 each. In group I, topiramate was started at a dose of 25 mg daily and increased to 100 mg daily. In group II, patients received propranolol at a dose of 20 mg twice a day for three months. The degree of disability defined by the Migraine Disability Assessment Scale (MIDAS) was recorded. Results: The kind of aura was sensory in 9 and 11, vision in 10 and 7, motor in 8 and 5, and other in 5 and 9 in groups I and II, respectively. MIDAS grade I was seen in 3 and 4, II in 5 and 3, III in 9 and 7, and IV in 15 and 18 in groups I and II, respectively. The mean changes in the Migraine Disability Assessment Scale (MIDAS) score before and three months in group I were -16.2 and -14.3 in group II. The difference was significant (P< 0.05). Conclusion: For patients suffering from migraine with aura, there was no discernible variation in the effectiveness of topiramate and propranolol.

167. Comparison of Skin Staples and Conventional Sutures for Abdominal Skin Wound Closures
Digbijay Kumar Singh, Pradeep Jaiswal, Mukesh Kumar
Abstract
Background: Surgical wound closure is a crucial aspect of the surgical process aimed at promoting proper healing, and minimizing the risk of infection. The present study was conducted to compare skin staples and conventional sutures for abdominal skin wound closures. Materials & Methods: 90 patients undergoing elective surgery, with clean wounds of both genders were divided into 2 groups of 45 each. In group I, staplers were used and in group II, sutures were used. The site of incision, classification of wounds, closure time and patient acceptance were recorded. Results: Group I had 25 males and 20 females and group II had 23 males and 22 females. The site of incision was midline in 13 and 15, inguinal in 17 and 22, subcoastal in 9 and 6 and transverse in 6 and 2 patients. Classification of wounds was A in 36 and 35, B in 7 and 6 and C in 2 and 4. Patient acceptance was good in 40 and 35 and poor in 5 and 10 patients in group I and group II respectively. The difference was significant (P< 0.05). Conclusion: Stapling was more convenient, and cost effective, routine staple removal is less painful compared to suture removal.

168. Anthropometric and Anthroposcopic Examination of Various Facial Shapes in Adult Population
Sameer Sathe, Ashok Najan, Anil Mangeshkar, Harsh Kumar Chawre
Abstract
Background and Objectives: Isolating characteristics that can be regarded as individualization factors is the main goal of facial identification research. Anthroposcopy typically deals with the morphological study of immeasurable traits. Hence, this study aims to assess different human faces using anthropometry and anthroposcopy. Methods: After receiving informed written consent, the study comprised a total of 100 adults, 50 of whom were male and 50 of whom were female and between the ages of 19 and 45. The study’s exclusion criteria included congenital aberrant profiles, evident baldness, post-operative head and facial injuries, and individuals that had received orthodontic treatment. Results: After calculating the prosopic index for all the subjects 48% were Hyperleptoprosopic, 23% were Leptoprosopic, 15% mesoprosopic, 10% Euriprosopic and only 4% were of Hypereuriprosopic facial types. The hyperleptoprosopic facial type had the highest average measures of the trigion to glabella, glabella to pronasalae, and nasion to subnasalae when comparing the average measurements of all vertical and horizontal dimensions across the facial types. Conclusion: The majority of Adults in our study have an oval face and a hyperleptoprosopic facial type, with the middle third of facial dimensions showing less gender variation. So, gathering information on the average measurements of all prosopic indices among adults and additionally contributing morphological traits that are typical of them may aid forensic anthropologists in reconstructing facial features through composite artist rendering sketches that are based on details provided by eyewitnesses.

169. Assessment of Spirometry in Patients with Subclinical Hypothyroidism
Vishwajit Kumar, Dinesh Prasad, Bijay Krishna Prasad
Abstract
Background: Elevated thyroid stimulating hormone (TSH) levels in the presence of normal serum free T4 concentrations are indicative of subclinical hypothyroidism (SCH). Therefore, the required test for the diagnosis of moderate thyroid insufficiency is the blood TSH measurement. The purpose of this study was to examine the results of pulmonary function tests in a group of female subclinical hypothyroid patients who had just received a diagnosis, and to compare the results of these tests to those of controls. Methods: The current study was conducted from July 2022 to December 2022 at the ANMMC, Gaya, Bihar, and Department of Physiology. Study subjects included thirty women in the 20–40 age range who had recently been diagnosed with subclinical hypothyroidism and did not have any history of cardiopulmonary diseases. They lived in and around Gaya city. As a control group, another group of thirty females—who were comparable to the research group but in good health—was drawn from the staff and friends. Spirometers were used to gather data on lung function for the current study. Data from spirometry, biochemistry, and clinical studies were analyzed using statistical software (Excel, Microsoft Corp.) before being moved to EPI6 Info, another statistical program, for further analysis. Results: Spirometry measurements of FVC, FEV1, FEV1/FVC, FEF25-75%, and PEF revealed a significant decline in patients when compared to controls. Conclusion: The subclinical hypothyroidism cases in the current study had spirometry alterations, with substantial decreases observed in parameters such as FVC, FEV1, FEV1/FVC, FEF25-75%, and PEF when compared to controls. This could be the result of the weariness, somnolence, and muscle dysfunction that SCH participants have been shown to experience.

170. Assessment of Cardiovascular Autonomic Function in Individuals with Rheumatoid Arthritis
Vishwajit Kumar, Munna Kumar Saw, Bijay Krishna Prasad
Abstract
Background: People all over the world suffer from inflammatory arthritis, such as rheumatoid arthritis (RA). Systemic inflammatory arthritis (RA) is a long-term autoimmune illness. It mostly affects the joints and is often associated with extra-articular symptoms such normochromic normocytic anemia, neuropathy, and rheumatoid nodules. This study aimed to assess cardiac autonomic function in rheumatoid arthritis patients and compare it to that of healthy individuals. Methods: From January to June of 2023, a cross-sectional study was conducted at the ANMMC, Gaya, Bihar, at the Department of Physiology. The investigation of autonomic functioning in RA was conducted on a group of 45±10-year-old males and females. There were fifty people in all; twenty-five were controls—healthy people not taking medication—and twenty-five had been diagnosed with RA using standards set by the American College of Rheumatology, along with matched pairs of controls based on sex. The history and examination details were entered into Performa. Patients were assessed for indications of potential dysfunctions of the autonomic nervous system (ANS). Result: This study involved 50 participants, divided into two groups: the Study group (Group – A) and the Control group (Group – B). Group A comprised twenty-five patients who received a rheumatoid arthritis diagnosis based on standards established by the American College of Rheumatology. Twenty-five healthy people made up Group B, who were not taking any medication to account for typical fluctuations. The valsalva maneuver and 30:15 ratio showed a lesser decline in the RA patients as compared to the control group, although the difference was not statistically significant (p>0.05). When comparing groups A to control, there was a substantial (P<0.01) decrease in the diastolic blood pressure change upon standing the blood pressure response. Conclusion: Cardiovascular autonomic function tests are useful in the early identification of autonomic dysfunction in this disease during normal clinical examinations. The overall assessment of all the tests conducted may yield more thorough information on autonomic function. In order to lower the cardiovascular autonomic morbidity in RA, evaluating autonomic function may be a routine clinical evaluation component.

171. Comparative Study on Pulmonary Function Tests in Smokers and Nonsmokers
Munna Kumar Saw, Vishwajit Kumar, Bijay Krishna Prasad
Abstract
Background: Compared to non-smokers, smokers have a higher risk of developing chronic obstructive pulmonary disease (COPD). The conditions known as chronic obstructive pulmonary diseases (COPD) include emphysema, bronchial asthma, and chronic bronchitis. A standard approach for evaluating and tracking illnesses is the pulmonary function test. The purpose of this is to estimate the pulmonary function tests, such as the Peak Expiratory Flow Rate (PEFR), Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and the ratio of FEV1 to FVC in smokers and non-smokers. Additionally to investigate how these individuals’ lung function is affected by their age and body mass index (BMI). Methods: This cross-sectional study was carried out from July 2022 to December 2022 at ANMCH in Gaya, Bihar. A total of 121 participants were chosen, 60 of whom were smokers and 61 of whom were not. Tests for spirometry were used to evaluate lung function. Result: It was discovered that smokers’ mean FVC, FEV1, and PEFR were lower than those of non-smokers. The mean spirometric values of smokers and non-smokers differed significantly. Conclusion: Spirometry is helpful in the early detection of abnormalities in persons who do not smoke or who smoke but are asymptomatic. PFTs should be carried out as soon as possible in smokers in order to identify reduced lung capacities and airflow restrictions.

172. Comparative Study between Intra-Umbilical Vein Injection of Oxytocin and Intramuscular Injection of Oxytocin in Third Stage of Labour
Pratibha Jha, P. K. Mishra
Abstract
Background: Maternal mortality refers to the death of a woman in either during or after her pregnancy including the time after an abortion or after giving birth. Maternal mortality rates and reasons vary throughout nations and cultures. Maternal fatalities differ for different states, regions, and categories of women in India due to the significant regional differences in healthcare availability and socioeconomic conditions. According to the most recent report from the national Sample Registration system (SRS), India’s maternal mortality ratio (MMR) for the period of 2018–20 is 97/100,000 live births, a decrease of 33 points from 130/ 100,000 live births in the 2014–16 period. The aim of this study was to assess the effectiveness of oxytocin injections into the umbilical vein and the muscles in reducing the amount of blood loss and the length of the third stage of labor. Methods: From November 2021 to October 2022, 134 cases at SDH/CHC, Biraul, Darbhanga, were the subject of a comparative analysis. The cases were then split into two groups of 67 participants each, one of which received an intramuscular injection of 10 units of oxytocin while the other group received 10 units of oxytocin diluted in 20 milliliters of saline. With the use of specific drapes known as “Brass-V drapes,” blood loss was measured in milliliters, and the length of the third stage of labor was recorded in minutes. The blood loss (measured in milliliters) and time (measured in minutes) of the two groups were compared. Results: Group 1 experienced a considerably shorter mean length of the third stage of labor (4.89±1.50 minutes vs. 5.79±2.20 minutes) than group 2. Group 1 experienced a considerably lower mean blood loss in the third stage of labor (94.64±43.38 ml vs. 120.42±43.41 ml) than Group 2. Conclusion: Compared to a traditional intramuscular injection, an intraumbilical vein injection of oxytocin is more effective at shortening the duration of the third stage of labor and reducing the amount of blood lost during it. Compared to intramuscular oxytocin injection, the intraumbilical method is painless, safer, simpler, and has a faster acting duration.

173. To Study the Role of Serum Lactate Dehydrogenase in Prediction of Adverse Outcomes of Pre-Eclampsia and Eclampsia
Priya Saxena, Kanchan Rani
Abstract
Background: In developing nations, pregnancy-induced hypertension is one of the most dreaded complications. This study aims to assess the relationship between blood LDH levels and the incidence, risk factors, and consequences of pre-eclampsia and eclampsia. The purpose of this research is to determine if serum lactate dehydrogenase plays a part in predicting the unfavorable consequences of pre-eclampsia and eclampsia. Methods: From October 2021 to September 2023, the present retrospective study was conducted at Department of Obstetrics and Gynecology, TMMC and RC, Moradabad, Uttar Pradesh. The patients were chosen from the labor room register admissions from the previous few years, regardless of age or parity, as well as from patients who were admitted as emergency cases. The patient details, including the whole obstetric history, examination, and laboratory results, were examined on a proforma created especially for this study. Results: 76% of the preeclampsia and 96% of the eclampsia patients in the study were unbooked cases, and the majority of them lived in rural areas, with the remainder patients coming from urban slums. Small proportions of patients with pre-eclampsia and eclampsia have hyperbilirubinemia. There was also evidence of abnormal liver enzyme levels in a small subset of pre-eclamptic and eclamptic patients. More than 600 IU/L of LDH was shown to be significantly higher in pre-eclamptic and eclamptic patients. Conclusion: Significant maternal and neonatal morbidity and mortality are linked to eclampsia. Due to a high percentage of unbooked patients and the majority not receiving therapeutic intervention prior to admission, there is a greater fatality rate. 76% of the preeclampsia and 96% of the eclampsia patients in the study were unbooked cases, and the majority of them lived in rural areas, with the remainder patients coming from urban slums. Small proportions of patients with pre-eclampsia and eclampsia have hyperbilirubinemia. There was also evidence of abnormal liver enzyme levels in a small subset of pre-eclamptic and eclamptic patients. More than 600 IU/L of LDH was shown to be significantly greater in pre-eclamptic and eclamptic patients.

174. Study On Prevalence and Associated Risk Factors of Pelvic Floor Dysfunction in Postpartum Women
Pratibha Jha, Sumedha Singh, P. K. Mishra
Abstract
Background: According to an epidemiological survey, pelvic floor dysfunction (PFD), the most prevalent dysfunction in women, has been estimated to impact between 23% and 49% of them. PFDs come with a host of drawbacks, including discomfort, humiliation, social isolation, and a lowered standard of living (QOL). In order to provide theoretical and empirical evidence for clinical diagnosis and treatment of postpartum pelvic floor dysfunction, this study intends to identify the elements that contribute to the development of such dysfunctions and quantify their severity. Methods: From December 2022 to November 2023, SDH/CHC, Biraul, Darbhanga, was the site of this cross-sectional study. Three hundred eighty-five recent mothers were asked questions about their symptoms, including faecal incontinence, flatus, and pelvic floor dysfunction. IBM SPSS Statistics 23 was used to examine the data. Results: There was a 20.7% prevalence of pelvic floor dysfunction, with 10.6% of cases being urine incontinence, 11.9% being flatus incontinence, 8.6% being faecal incontinence, and 1.6% being pelvic organ prolapse. The prevalence of pelvic floor dysfunction was shown to be significantly greater in women who were multiparous, had previously undergone genital surgery, had a lengthy labor, used fundal pressure, and had a history of instrumental delivery. Conclusion: The study found the characteristics linked to a high incidence of pelvic floor dysfunction and showed that one in five postpartum women had pelvic floor dysfunction. This group of women has an unmet need for routine incontinence screenings so that appropriate interventions can be arranged in a timely manner.

175. Comparative Study of the Immediate Effects of Several Yoga Asana on the Cardiac Autonomic Rhythm in Young, Healthy Volunteers
Dinesh Prasad, Vishwajit Kumar, Kamakhya Kumar
Abstract
Background: Among its many health benefits, yoga is a mind-body practice that has been connected to enhanced cardiac autonomic function. It is yet unknown how different yoga postures affect young, healthy individuals’ heart autonomic rhythm immediately. This study aims to measure the cardiovascular autonomic nervous system response to various yogic asanas and to investigate the complex mind-body mechanisms with particular reference to the immediate effect of Padahastasana (PD) and Ardha Chakrasana (AD) on cardiac autonomic nervous system. Methods: This cross-sectional study was carried out at the physiology department of JLNMCH, Bhagalpur, Bihar. Thirty experienced yoga practitioners (EYP) with an average age of 32.9±9.71 years had their heart rate variability (HRV) examined. Everybody who took part was in good health. The heart rate variability was assessed using the interventions of Padahastasana and Ardhachakrasana. Results: The parasympathetic component (SDNN, RMSSD, and SD2) is significantly elevated in the time domain parameters following Padahastasana and Ardha chakrasana, with the rise being greater after Ardha chakrasana. Though not statistically significant, sympathovagal balance was interestingly reduced after Padahastasana and increased after Ardha Chakrasana. This reaction could result from an increase in parasympathetic components following an instantaneous Ardha Chakrasana. Conclusion: According to our research, the HRV is a good tool for assessing the autonomic response of Ardha chakrasana and Padahastasana, with both positive predictive value and good specificity. Bending backwards is a better lifestyle intervention than bending forwards, and it should be used to lessen worry and tension.

176. Exploring the Etiology and Management of Primary Amenorrhea: A Comprehensive Study at Tertiary Care Hospital in Visakhapatnam
Varada Aparna, Nandigama Satya Vani, G. Srujana Goldie, V. Leela Madhuri
Abstract
Background: Primary amenorrhea, characterized by the absence of menarche by a certain age, presents a complex array of etiologies ranging from genetic abnormalities to hormonal imbalances. Understanding these underlying causes is critical for effective management. The study aimed to explore the etiology, clinical presentation, diagnostic outcomes, and management strategies for primary amenorrhea. Methods: An observational study was conducted at a tertiary care hospital in Visakhapatnam from June 2021 to November 2022, involving 25 female patients with primary amenorrhea. Data collection included detailed history-taking, clinical examinations, hormonal assessments, ultrasound imaging, and karyotyping. Statistical analysis was performed using Excel, focusing on demographic characteristics and diagnostic outcomes. Results: The study revealed a diverse range of presentations and underlying causes of primary amenorrhea. Swyer Syndrome and androgen insensitivity syndrome were among the identified etiologies, emphasizing the complexity of the condition. Individualized diagnostic and therapeutic approaches were crucial for effective management. Surgical interventions, hormonal therapy, and genetic counselling were implemented based on the specific diagnosis. Conclusion: A multidisciplinary approach integrating clinical evaluation, imaging studies, and genetic testing is essential for diagnosing and managing primary amenorrhea effectively. Early detection and intervention are paramount to prevent complications and improve patient outcomes. Continued research and collaboration among healthcare professionals are recommended to enhance understanding and refine treatment approaches. Recommendations: It is recommended to prioritize early detection and intervention for primary amenorrhea, employing a comprehensive diagnostic protocol that includes clinical evaluation, hormonal assays, imaging studies, and genetic testing. Furthermore, collaboration among healthcare professionals from diverse specialties is crucial for providing individualized care and improving patient outcomes.

177. Unusual Presentation of Hypertrichosis and Hyperpigmented Cutaneous Lesions in Neurofibromatosis
Aum Sanjay Bapat, Kamala Kant Bhoi, Priya Pathak, Manali Madhukar Shinde, Naresh Verma
Abstract
This case report presents an intriguing instance of Neurofibromatosis (NF) with an atypical combination of hypertrichosis and hyperpigmented cutaneous lesions, challenging conventional diagnostic paradigms. The patient, a 14-year-old male, exhibited multiple soft tissue lesions associated with café-au-lait spots and facial freckling. Histopathological analysis confirmed a benign peripheral nerve sheath tumor, favoring Neurofibroma. Notably, the coexistence of hypertrichosis and hyperpigmentation expands the phenotypic spectrum of NF. This case underscores the clinical heterogeneity of NF, emphasizing the importance of recognizing such unique presentations for accurate diagnosis. The diagnostic process, including imaging and immunohistochemical analysis, contributes to differential diagnosis and accurate management strategies. This report highlights the significance of reporting and understanding rare NF manifestations.

178. Comparative Efficacy of Tacrolimus and Mometasone Furoate in Topical Treatment for Atopic Dermatitis: A Randomized Controlled Trial
Abhishek Kumar, Uday Kumar Udayan
Abstract
Background: Atopic dermatitis (AD) significantly impacts patients’ quality of life due to symptoms like itchiness and skin inflammation. Tacrolimus and mometasone furoate are commonly used topical treatments for AD, each with unique benefits. While tacrolimus offers effective treatment without long-term steroid side effects, mometasone furoate provides potent anti-inflammatory effects. Comparative studies between these treatments aim to assess their efficacy and safety in managing AD. Methods: This randomized controlled trial enrolled 70 adults aged 18-65 with moderate to severe AD. Participants were randomly assigned to receive either tacrolimus 0.1% ointment or mometasone furoate 0.1% cream topically twice daily. Outcome measures included AD severity, pruritus improvement, adverse events, and quality of life. Statistical analysis determined treatment effects. Results: Both treatments significantly reduced AD severity and pruritus without significant differences between groups. Adverse events were mild and comparable. Quality of life improved similarly in both groups. Subgroup analyses showed no significant differences based on disease severity, age, or gender. Adherence to treatment was high, and both treatments were well-tolerated. Conclusion: Both tacrolimus and mometasone furoate are effective and well-tolerated treatments for AD. Clinicians can consider individual patient factors when choosing between them. Further research could explore larger-scale studies with longer follow-up to confirm these findings. Recommendations: Clinicians should consider tacrolimus and mometasone furoate as viable treatment options for AD, tailoring treatment choices to individual patient needs. Larger studies with longer follow-up could provide additional insights into treatment efficacy and safety.

179. Accuracy and Predictability of PANC 3 Scoring System in Acute Pancreatitis
Papu Bori, Ajit Kumar Pegu, Somnath Saha Roy, Jinku Ozah, Navil Farzad Islam, Sofiur Rahman
Abstract
Objective: To assess the severity of acute pancreatitis including mortality in relation to PANC 3 score and to evaluate the predictability of severity and mortality of PANC 3 score with BISAP scoring system. Methods: 90 cases of acute pancreatitis aged more than & equal to 12 years were enrolled in the study and patients with additional comorbidities such as cardiac failure, liver failure, renal failure, chronic obstructive pulmonary disease, diagnosed cases of chronic pancreatitis, and recurrent pancreatitis with a history of complications like pseudocysts and abscesses in the pancreas were excluded from the study. BISAP score and PANC 3 score were determined for the cases and compared. Results: To predict severe acute pancreatitis, receiver operating characteristic curve (ROC) produced AUC value of 0.918 for BISAP and 0.904 for PANC 3 score. To predict mortality, ROC curve produced AUC values of 0.885 for BISAP and 0.886 for PANC 3 score. Conclusion: PANC 3 score in predicting severe acute pancreatitis and mortality is comparable with that of BISAP score, as it is easy to calculate, simple to use, and does not require a person with experience, and simply needs data that are frequently acquired during or within 24 hours of presentation.

179. Accuracy and Predictability of PANC 3 Scoring System in Acute Pancreatitis
Papu Bori, Ajit Kumar Pegu, Somnath Saha Roy, Jinku Ozah, Navil Farzad Islam, Sofiur Rahman
Abstract
Objective: To assess the severity of acute pancreatitis including mortality in relation to PANC 3 score and to evaluate the predictability of severity and mortality of PANC 3 score with BISAP scoring system. Methods: 90 cases of acute pancreatitis aged more than & equal to 12 years were enrolled in the study and patients with additional comorbidities such as cardiac failure, liver failure, renal failure, chronic obstructive pulmonary disease, diagnosed cases of chronic pancreatitis, and recurrent pancreatitis with a history of complications like pseudocysts and abscesses in the pancreas were excluded from the study. BISAP score and PANC 3 score were determined for the cases and compared. Results: To predict severe acute pancreatitis, receiver operating characteristic curve (ROC) produced AUC value of 0.918 for BISAP and 0.904 for PANC 3 score. To predict mortality, ROC curve produced AUC values of 0.885 for BISAP and 0.886 for PANC 3 score. Conclusion: PANC 3 score in predicting severe acute pancreatitis and mortality is comparable with that of BISAP score, as it is easy to calculate, simple to use, and does not require a person with experience, and simply needs data that are frequently acquired during or within 24 hours of presentation.

180. Efficacy of VIA Test (Visual Inspection of Cervix with Acetic Acid) As an Alternative to Cytology and Colposcopy in Early Screening of Cervical Cancer: A Study in Tertiary Care Centre in Jaipur, Rajasthan
Mohan Meena, Rima Biswas, Seema Dhami, Himanshi Gangwal, Divya Saini, Hina Chaturvedi
Abstract
Introduction: Cervical cancer is major health problem in women worldwide. Cervical cancer is the only female genital tract cancer which can be diagnosed and treated in precancerous state by simple screening techniques. VIA/VILI are cheap and noninvasive methods and can be done in a low-level health facility. More importantly, VIA and VILI provide instant results, and those eligible for treatment of the precancerous lesions can be treated immediately. Various studies suggested that VIA and VILI test closely match the Pap smear in its performance in detecting cervical cancer precursor and with combination of colposcopy it has more effective in detecting cervical cancer in early precancerous stages .Studies have demonstrated that VIA or VILI are alternative screening methods. Material And Methods: This retrospective study was carried out at Department of Obstetrics & Gynecology SMS Medical College, Jaipur, from period of June 2023 to Dec 2023. 200 patients were studied. A relevant history regarding Obstetrical & Gynecological history, previous history of intake of oral contraceptive pills, IUCD insertion, of any treatment for white discharge, and other high-risk factors were taken. Patients were explained the procedure to be performed, written informed consent was taken, with the patient being reassured that the procedure was painless. Per speculum & a per vaginal examination was done. After taking pap smear, the same patients were subjected to visual inspection of the cervix with acetic acid. Using a cotton swab soaked in acetic acid, 5% acetic acid was applied for 1-2 minutes and then the cervix was carefully inspected for any acetowhite lesions, particularly in the transformation zone. VILI test was performed by application of Lugol’s Iodine and results were noted. Colposcopy was done in all patients in our study. All findings of VIA, VILI test ,pap smear and colposcopy findings were noted. Observation & Results: In our study we found that out of 200 patients who had Pap smear done 50 cases shows inflammatory smear, 33 patients had positive and normal pap smear results seen in 112 women. Out of positive pap smear CIN1, CIN 2 and CIN 3 were seen in 21[63.63%], [9.09%], 1[3.03%] patients respectively. One patient had carcinoma in situ in pap smear. VIA results were positive in 31[%] patients and 169 [84.5%] patients had negative VIA test result. VILI test was positive in 22[11%] patients and negative VILI seen in 178 [89%] patients. On Colposcopy 65 cases[32.4%] has low grade lesion.12 [6%] patients shows high grade lesion noninvasive and 8 [4%] patients shows high grade /invasive lesion. In our study, out of the total 200 patients who have undergone all three screening tests (Pap+VIA+VILI), 42 patients were showed positive results by a combination of these tests and undergone biopsy. Of these 42 positive cases, 22 (i.e., 52.38%) had CIN on histopathological examination This thus proved the adjunctive role of VIA and VILI to Pap smear in diagnosing premalignant and malignant lesions of the cervix, and so increasing the sensitivity of combination tests to 100% but specificity of theses combined tests are only 25.92%. Sensitivity of VILI test is 94.44, specificity of VILI test is 82.75%, PPV of VILI test 72.27%, NPV of VILI test is 96.0%. Number of false positive cases in VILI test 17.24 % and number of false negative cases in VILI test is 5.56 %. Sensitivity of combination tests (Pap +VIA+VILI) is 100.00%, specificity of combination tests is 25.92%, PPV of combination tests are 55.0%, NPV of combination tests are 100.00%. Number of false positive cases in combination test are 74.07% and number of false negative cases are 00%. Conclusion: Our study showed that VIA and VILI had sensitivity comparable to Pap smear and can thus be a suitable potential alternative/adjunctive screening test not only in a resource-poor setting but in well-equipped centres also. And, use of a combination of tests (Pap+VIA+VILI) had 100% sensitivity but at cost of low specificity and more false-positive results. VIA and VILI can be adopted as screening tools for the diagnosis of cervical lesions. Result and follow-up treatment can be provided in a single sitting hence fewer women are lost to follow-up.

181. A Clinical Study on Risk Factors Leading to Post-Operative Bladder Neck Contracture Following Transurethral Prostate Resection
Rambabu Bala, Medavankala Prabhakara Rao, MaddalaSudarsana Rao, Mohammad Jahangir, V Durga Prasad Mutyala
Abstract
Background: Benign prostatic hyperplasia (BPH) is prevalent in aging men, increasing with longer lifespan. Endoscopic procedures like bipolar TURP and Thulium laser (ThuP) surgery show effectiveness with reduced complications. Intraoperative bleeding and postoperative dysuria, linked to bladder neck contracture (BNC) at 2.2% to 9.8%, are common issues. Our study examines perioperative factors related to BNC after TURP or ThuP, assessing variations in BNC incidence across techniques. Materials and Methods: The study, spanning July 2021 to April 2023, focuses on hospitalized TURP patients with a sample size of forty. Inclusions require dysuria concerns confirmed by cystoscopy with voluntary consent, excluding individuals with high flow rates, detrusor underactivity, previous surgeries, or urological malignancies. Data collection involves medical history, physical examinations, and a post-TURP diagnostic cystoscopy, with SPSS version 27 for analysis and adherence to ethical considerations. Results: Key findings revealed that 92.5% of patients had benign prostatic hyperplasia (BPH), with a mean age of 62.95 ± 7.77 years. Mean PSA values were 6.04 ± 2.44 ng/ml, and mean IPSS scores were 18.04 ± 1.49. The surgery’s mean duration was 62.99 ± 2.23 minutes, with a mean resected gland weight of 42.38 ± 0.44 grams and resection speed of 0.87 ± 0.04 g/min. The study reported incidences of urethral mucosal injury (13.33%), capsule perforation (6.66%), TUR syndrome (3.33%), re-catheterization (3.33%), and continuous infection (6.66%). Univariate analysis identified PSA levels, resected prostate weight, and urine culture as risk factors for the development of post-TURP bladder neck contracture. Conclusion: High PSA, less Weight or smaller gland (<45) of prostate, pre- and post- operative positive Urine culture were established to be the risk factors for development of bladder neck contracture following TURP.

182. Morphology and Outcome of Fractures of the Ankle Treated by Internal Fixation
Haresh K. Hadiya, Prabhu N. Chaudhary, Jayur J. Solanki
Abstract
The ankle joint is formed of the distal tibia and fibula with their corresponding projections; the medial and lateral malleolus articulating with the dome of talus. The ankle joint is vital for maintaining posture and ambulation. Ankle injuries gain importance because body weight is transmitted through the joint and locomotion depends upon the stability of it. We have studied 68 patients with Ankle fractures at the Department of Orthopaedics, at state run 1500 bedded tertiary care hospital attached to post-graduate teaching institute located at central Gujarat, from August, 2019 to October, 2020. We planned to follow up the patient for a minimum of six months at every six weekly interval. At every follow-up, patient were assessed clinically for pain, swelling, mobility at fracture site, joint stiffness, signs of infection, wound status etc and radiologically for union status, alignment and implant status. The Olerud and Molander score and AOFAS score system rate outcome of patients with ankles fractures on a scale of 1-100 where higher score indicates good outcome.6 patients showed non-union at final follow up and the scoring system reflected the outcome.

183. A Study on Dyslipidemia in Patients with Hypothyroidism for More than 10 Years
Deepa VS, J Aaron Vetha Jose, R Sonya
Abstract
Introduction: Thyroid dysfunction has a great impact on lipids as well as a number of other cardiovascular risk factors. Hypothyroidism is relatively common and is associated with an unfavorable effect on lipids. Substitution therapy is beneficial for patients with overt hypothyroidism, improving lipid profile. Therefore, the mechanism of hypothyroidism-related dyslipidemia is associated with the decrease of TH and the increase of TSH levels. Our objective was to study lipid profile in patients of chronic hypothyroidism for more than 10 years. Methods: This observational study was conducted for a period of one year at a tertiary care teaching hospital in patients diagnosed with Hypothyroidism and on treatment for more than 10 years. 96 patients with hypothyroidism were selected after careful exclusion; lipid profile was evaluated in this patient in relation to TSH levels. Results: There exists correlation between rising TSH levels and total cholesterol in patients with chronic hypothyroidism. The relation is statistically significant with a p value of 0.001. Similarly triglycerides, HDL and LDL also had statistically significant relation. Conclusion: Thyroid dysfunction can have an important effect on lipid profile.  Biochemical screening for thyroid dysfunction is critical in all dyslipidemia patients, as well as in all patients with unexpected improvement or worsening of their lipid profile. Underlying thyroid disorders should be recognized and treated in this setting.

184. Association of Maternal Folic Acid and B12 Level with the Neoborn Birth Weight
Sardar Vikram Singh Bais, Amrita Sinha, Shabd Singh Yadav, Jayendra Arya
Abstract
Background: Vitamin B12 and folic acid deficiency in pregnant women is an important health issue. Vitamin B12 and folate are micronutrients essential for foetal growth and development. Maternal folate and B12 concentrations have been positively associated with birth weight. Aim: To find if any correlation exists between the level of serum B12 and folate in the mother and that of the neonate birth weight. Material & Methods: This prospective study included 100 pregnant women (gestational age: 37-42 weeks). Vitamin B12 and folic acid levels were measured. Lower limit for vitamin B12 was 200pg/mL and the lower limit for folic acid was 5 ng/ml. Data regarding age of mothers, pre pregnancy weight, neonatal birth weight and relationship between the birth weight and vitamin B12 or folic acid was recorded in all mothers. Results: The mean age of the mothers was 25.25 ± 3.62 years; mean pre pregnancy weight was 52.52 ± 6.28 kg.  Mean neonatal birth weight was 2.46 ± 0.55.  There was a positive correlation was observed between serum vitamin B12 and neonatal birth weight, found statistically significant (P<0.05) in 2nd trimester whereas not significant in 3rd trimester of pregnancy, also found significant correlation of folic acid level and neonatal birth weight. Conclusion: Maternal vitamin B12 and serum folate levels are significantly associated with birth weight of neonates, so during antenatal visit women should be screened for vitamin B12 and folate deficiency and vitamin supplementation should be continued throughout the pregnancy.

185. Relationship between Serum Iron of Pregnant Mother with the Birth Weight of Newborn
Sardar Vikram Singh Bais, Jayendra Arya, Shabd Singh Yadav, Akansha Singh
Abstract
Background: Term small for gestational age (SGA) babies are at risk for developing iron deficiency anemia. The association between maternal and infant iron stores is not clear. Objectives: Our study aimed to explore the association between maternal serum iron level and newborn birth weight (BW) in our tertiary care hospital. Methods: Prospective observational study conducted in the pediatrics department in GMH rewa from April 2020 to March 2021. Total 100 full term mothers were enrolled in this study. Basic demographics features of mothers, serum iron profile and neonatal birth weight was measured. Results: Out of total 100 pregnant women, most of them (85%) were 20-30 years age group, 68% belong to rural area. Pre Pregnant Weight was 46 – 50 kg in 36% followed by 51-55 kg in 24%.  Out of 100 neonates, 59 (59%) were male and 50% of neonates weight range 2.5-3.89 kg. Positive correlation was found between Neonatal birth weight and serum iron levels, which was statistically significant 2nd trimester (p<0.05) whereas not significant in 3rd trimester (p>0.05). Conclusion: Potential benefit of IFA supplementation and detection of their deficiencies can contribute to simple low‐cost interventions for reducing the incidence of LBW, SGA and IUGR.

186. Comparison between Nebulization with Ketamine (50mg) and Dexmedetomidine (50mcg) To Study Incidence of Postoperative Sore Throat
Ekta Shantubhai Patel, Dhruvikkumar Vhanesha, Priti D. Jadeja
Abstract
Background and Aim: Postoperative sore throat (POST) is a minor but distressing complication following general anesthesia. Present study was done with an aim to Study and compare efficacy of preoperative nebulization with ketamine and dexmedetomidine to reduce postoperative sore throat. Material and Methods: Sixty patients of either sex of American society of anaesthesiologists (ASA) grade I, II or III, 18-60 years of age were randomized into two groups of 30 each by chit method. Group K received ketamine 50mg (1mL) with saline (4mL) nebulisation. Group D received dexmedetomidine 50μg (0.5mL) with saline (4mL) nebulisation. The primary objective was to compare the incidence and severity of POST, as inferred from the patient interviews at 0, 2, 6, 12, 24‑h postoperatively. Results: All the parameter, heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure are reduced in Group D after nebulization with Dexmedetomidine while all have increased from base level in Group K after nebulization with ketamine. Group K had a significantly lower incidence and severity of POST compared to group K. Conclusion: From this randomized control prospective double blinded study, pre-operatively administered dexmedetomidine nebulisation is as effective as ketamine nebulisation in attenuating POST We also conclude that there is decrease incidence of post-operative other complications after nebulisation with both Dexmedetomedine and Ketamine.

187. A Tertiary Care Experience of Vesicovaginal and Uretero Vaginal Fistula Repair: Factors Predicting Success
T. Gnanasekaran, Induja, Rathinavelu, Vijayakumar, Siju Samuel
Abstract
Objective: To analyze the patterns of presentation and management of genitourinary fistulas due to obstetrics and gynecology complications at a tertiary referral center. Material and Methods: We conducted this retrospective study analyzing —patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2014 to December 2022. We recorded the patient’s characteristics and then analyzed the etiology, surgical management and success rates, and the primary end point of success being leak free patient. Results: The distribution of genitourinary fistulas in descending order was vesicovaginal – 64.17% and ureterovaginal -35.80%. The mean time to presentation was 177 days with a wide range of 20 days to 300 days. The most common etiology was abdominal hysterectomy (67.1%) followed by obstetric causes (14.9%). For vesicovaginal fistulas the route to be used for repair depended on surgeon’s preference and transabdominal route was successful in 95.4%. Conclusion: Genitourinary fistula is a socially debilitating problem. First attempt being the best is mandatory for successful repair. Modifying techniques according to site, size of fistulas is the key to success.

188. Association of Cholesteryl Ester Transfer Protein   Gene Taq1B Polymorphism and the Associated Lipoprotein Levels with Coronary Artery Disease
Umamaheswari. V, Renuka. P, Veena Juliette. A
Abstract
Background & Objectives: Cholesteryl ester transfer protein (CETP) is a hydrophobic glycoprotein with a crucial role in high-density lipoprotein cholesterol (HDL-C) metabolism. Its primary function is to transfer cholesteryl esters from HDL to apolipoprotein-B-containing particles in exchange for triglycerides. This process leads to a decrease in HDL-C concentration and an increase in non-HDL-C, contributing to the predisposition to atherosclerosis. The TaqIB polymorphism, located in intron 1 of the CETP gene, has been linked to plasma HDL-C concentrations. The study aimed to investigate the association between CETP gene TaqIB polymorphism, lipoprotein levels, and coronary atherosclerosis. Materials and Methods: Genotype analysis was done on 146 patients with angiographically proven coronary atherosclerosis and 145 control subjects by polymerase chain reaction followed by restriction digestion. Serum lipoprotein levels were analyzed by enzymatic endpoint methods using an autoanalyzer. Results: Patients had a significantly higher frequency of B1B1 genotype than control subjects (0.38 versus 0.21; p=0.000) with the age and sex-adjusted odds ratio of 2.4 (95% CI 1.6 to 3.2; p = 0.001), for developing coronary atherosclerosis.  Significantly lower HDL-C (38.5 +9.7 mg/dL versus 48.2+9.9, p=0.000) was observed in coronary atherosclerosis patients as compared to control subjects. Conclusion: The B1B1 genotype and the associated low HDL-C were significantly associated with coronary atherosclerosis.

189. Retrospective Analysis of Children Coming for First Eye Check up in a Tertiary Center
Mandal Merina, Kochgaway Lav, Shrivastava Vaibhav, Bhargava Sagar, Singh Maneesh, Mondal Abir Lal
Abstract
Purpose: To detect an ideal age of screening for amblyopia or its risk factors. Method: 500 patients below 16 years of age, who presented at a tertiary eye hospital for their first eye checkup, were included in the study. They were divided according to the age group of ≤ 4 and > 4 years, and ≤ 7 and > 7 years with the aim of detecting an ideal age of screening for amblyopia. Result: Mean age at presentation was 5.24 ± 3.58 years (standard deviation; SD). Though 75 patients were asymptomatic, ocular abnormalities were found in 30 (40%) of them. In the whole group of 500, abnormalities were found in 350 children (70%). Spectacles were prescribed in 218 (43.6%) patients with mean age of 6.07 ± 3.09 (SD) years. Total number of amblyopic children was 38 (7.6%) with mean age of 5.98 ± 3.41 years. In the ≤ 4 years age group, amblyopia was in 9 (23.68%)(mean age 2.13 years) and prescribable refractive error was in 46 (21.1%)(mean age 2.55 years). Mean age of 61 (12.2%) strabismic patients was 4.29 years and 16 (3.2%) pediatric cataract patients were 3.48 years. Conclusion: Significant patients had amblyopia or risk factors for it at a mean age of around 3 years. So the ideal age for first routine eye checkup for all children should be around 3 years.

190. Adverse Drug Reaction Profile of Liposomal Amphotericin B Used For Postcovid Mucormycosis in a Tertiary Care Hospital: A Prospective, Observational Study
Vishnu Priya R, Ramachandra Bhat C, Sudha K M, Abiramasundari, Sharon Snehaa Jeyakumar, Devipriya
Abstract
Liposomal Amphotericin B (LAMB) 3-5 mg/kg/day were the management of choice for Post covid Mucormycosis which caused various adverse drug reactions (ADR). Hence this study was undertaken to assess & classify ADRs in patients on LAMB used for Post covid Mucormycosis. This was a prospective, Observational study conducted in the Departments of ENT and Internal medicine, Madras Medical College between June 2021 to November 2021. All suspected ADRs were analyzed, classified & reported by pharmacologist to Regional Pharmacovigilance centre, Madras Medical College. Around 1118 patients of postcovid mucormycosis were present in the ward. Among them, 906(81%) were known diabetes mellitus patients who presented with Mucormycosis following Covid 19 infection. 447(40%) known Diabetes Mellitus(DM) patients with the history of Corticosteroid usage during covid 19 infection presented with Mucormycosis . Among them, 268 patients (24%) presented with one or more ADRs following the use of LAMB for mucormycosis. Following were the incidence of various ADRs- Infusion related reactions (28%), Anemia (64%), Hypokalemia (56%), Hyponatremia (63%), increased blood urea & serum creatinine levels (11%), Increased Alkaline Phosphate levels (28%) and Increased alanine transferase and aspartate transferase levels (11%). Causality was assessed using WHO-UMC causality assessment scale and 28% reports were assessed as certain and 72% reports were classified as possible. Preventability was assessed using Schumock and Thornton criteria and 28% ADRs were found to be definitely preventable and 72% ADRs were classified as not preventable. Severity was assessed by Modified Hartwig Siegel severity assessment scale and all the ADRs were found to be of moderate severity. This study would strengthen Pharmacovigilance monitoring and create awareness on importance of reporting by healthcare professionals.

191. Selenium and Vitamin E Status in Patients with Alcoholic Cirrhosis
U. N. Priyadharshini, D. Gayathri Priya, S. Prithiviraj
Abstract
Background: Alcohol is the common cause of liver damage worldwide. There is a significant role of oxidative stress and lipid peroxidation in the pathogenesis of ethanol-induced liver injury. Ethanol consumption results in depletion of endogenous antioxidant capabilities. Heavy drinkers are deficient in Selenium, which is required for the activity of Glutathione Peroxidase and antioxidant vitamins A, C and E. This study aims at assessing the antioxidant status of the patients with alcoholic cirrhosis. Objectives: The objective of this study is to estimate the serum levels of selenium and vitamin E in patients with alcoholic cirrhosis and compare the results with that of healthy individuals. Then find the correlation of selenium and vitamin E levels with serum bilirubin in alcoholic cirrhosis patients. Materials and Methods: This case control study included 50 healthy volunteers who served as control and 50 cases of alcoholic cirrhosis. The blood samples were analysed for selenium, vitamin E and Liver Function Tests viz. bilirubin, aspartate transaminase, alanine transaminase and albumin. Results: The mean and standard deviation estimated for cases vs controls were Selenium (0.68 ± 0.05 vs 1.03 ± 0.04) and vitamin E (19 ± 0.7 vs 29.7 ± 1.2). Pearson correlation coefficient between selenium and vitamin E levels in alcoholic cirrhosis patients was 0.785 and it was found to be statistically significant. Conclusion: Selenium and Vitamin E were significantly lower in cases when compared to controls. Supplementation of these antioxidants might be beneficial to the patients with alcoholic cirrhosis.

192. Antibiotics Treatment in Surgical Ward of a Tertiary Care Hospital in Reference to National Essential Medicine List of India 2022 An Observational Study
Marshall D. Kerketta, Kavita Topno, Kush Kumar
Abstract
Background: National list of Essential Medicine (NLEM) is a list of medicines, in order to increase the compliance through access to safe, effective, quality, and affordability of essential drugs. Essential medicine should be available in sufficient quantities to the patients for common diseases to control the drug resistance and economic burden to the government. Purpose: Our objective of the study is to observe the gap in balancing the essentiality, availability, and cost- effectiveness of antibiotics supplied and administered in the department of surgery in a tertiary care Government hospital. Methods: Antibiotics supplied in the surgical wards for three consecutive months were observed and analyzed whether or not they were in accordance with NLEM 2022 and AwaRe list. This study was done in Rajendra Institute of Medical Sciences, Ranchi, and Jharkhand, India. Results: Medicines which were supplied in the surgery ward were efficient to cover common surgical diseases. The Gap exists in total amount of antimicrobial drugs administered, and also in accordance with NLEM 2022 and awaRe grouping. Conclusion: It is essential to maintain supply chain of low cost and effective antibiotics in the wards in sufficient quantity and in regular periodicity, as par culture and sensitivity report of the patients. Supply of packets of complete course of drug for the disease to each patient, followed by audit of compliance by Pharmacologists on regular basis will help in reducing the drug resistance.

193. Physical Activity among College Students during COVID-19 Pandemic Lockdown in Mangaluru, Karnataka
Ashok Kumar MR, Anjan Kumar A N, Jayaramesh, Asha
Abstract
The COVID-19 pandemic prompted unprecedented measures worldwide, including in India, affecting the physical activity, nutrition, and sleep patterns of students. This study aimed to assess these impacts among students in Karnataka during the lockdown. A cross-sectional online survey gathered data on demographics, physical activity, and weight changes. Results revealed a high prevalence of unintentional weight gain (80.99%), with reasons including lack of exercise and unhealthy eating. Physical activity levels were low, particularly in vigorous activities, while sedentary behaviour was common. These findings underscore the importance of addressing lifestyle changes during pandemics to mitigate adverse health effects.

194. Diabetic Kidney Disease: Paradigm Shift in Comprehensive Management
Ashutosh Soni, Jagdish Vishnoi, Saurabh Gupta, Kamlesh Bhatt, Kalu Ram Sharma, Mohd Shakeel
Abstract
Being the country with highest Diabetic patients we also have higher prevalence of Diabetic Kidney Disease. It is the commonest microvascular complication yet not addressed intelligently. DKD mainly comprises reduced Glomerular filtration and Proteinuria. Dysglycaemic and raised blood pressure are two principal therapeutic targets in these patients. A comprehensive approach is the consensus in today’s era as dictated by recent landmark trials. ACE-i/ARB have been the cornerstone of management of DKD since long but now SGLT-2 inhibitors and Non-steroidal MRA are the benchmark for management and reversal of DKD and its complications. This review highlights the past and present era of DKD management and how the paradigm shift has taken place in approach worldwide.

195. Social Support Status of the Elderly Population in Selected Villages in a Central India District
Herschel Dafal, Kishor Uikey, Tushar Talhan, Anshuli Trivedi
Abstract
Background and Objectives: Social support is a crucial social factor affecting health as it helps individuals meet their physical and emotional requirements. The purpose of the study was to evaluate the level of social support that elderly people in rural central India received. Material and Methods: The observational cross-sectional study was carried out in four chosen villages in central India; involving 460 older adults who completed the MSPSS (Multi-dimensional Scale Perceived Social Support) questionnaire. Univariate analysis and multivariate analysis were carried out using R software. Results: Out of 460, 37 (8.04%) of the elderly were found to have low, 177 (38.47%) were moderate, and 246 (53.48%) were having high social support. The result showed age and education of the elderly were significantly associated with social support. Conclusion: Intergenerational activities, provision and strengthening of social platforms and the addition social support components with comprehensive geriatric assessment can improve the current status.

196. Role of Ocular Trauma Scores in Predicting Visual Outcome in Children with Open Globe Injuries
Sony K Jose, Lekshmi H, Natasha PK, Vijayamma N
Abstract
Background: One major factor contributing to vision impairment in children is ocular trauma. Numerous prognostic variables influence these children’s visual prognosis. For the purpose of visual prognostication in these children, the two most often used instruments are the Ocular Trauma Score (OTS) and the Paediatric Ocular Trauma Score (POTS). In OTS, initial visual acuity is considered a more significant predictor of visual outcome. But in most cases, children who have experienced recent trauma are not able to have their first visual acuity accurately recorded. The Paediatric Ocular Trauma Score (POTS), a new grading method, was created to get around this. Objectives: To evaluate the effectiveness of Ocular Trauma Score (OTS) and Paediatric Ocular Trauma Score (POTS) in predicting visual outcomes among paediatric open globe injuries. Material and Methods: This retrospective study analysed 58 instances of open globe injuries in children under the age of 15, who were treated at a tertiary eye care hospital in South India from 2014 to 2022. The study participants were categorised into 5 distinct groups according to OTS and POTS criteria. We were unable to allocate the OTS group to 9 children due to the absence of documented initial visual acuity. The achieved visual acuity at 6 months has been compared to the predicted visual acuity using statistical analysis for each group. Results: This research evaluated 58 cases of paediatric open globe injuries. Initial visual acuity (VA), globe rupture, endophthalmitis, and retinal detachment were statistically significant factors in our study for estimating final VA, with p-values of <0.001, 0.001, 0.005, and 0.021 respectively. The analysis of POTS parameters revealed that the initial VA, wound location, retinal detachment, endophthalmitis, and traumatic cataract were significant predictors of final visual acuity with p-values of <0.001, 0.021, 0.021, and <0.001 respectively. An OTS score of ≥86.5 accurately predicted a satisfactory visual outcome with a sensitivity of 51.7% and specificity of 100% in 49 individuals where OTS computation was feasible. A POTS score of ≥62.5 accurately predicted the favourable visual outcome with a sensitivity and specificity of 65.7% and 87% respectively, in a sample size of 58. Conclusion: Our research revealed that both OTS and POTS might serve as valuable indicators of the final visual acuity in paediatric open globe injuries. OTS has a more consistent correlation with final visual acuity in higher score groups compared to POTS. We believe that conducting extensive multicentric investigations is necessary to improve the prediction of visual acuity using these trauma scores.

197. A Comparative Evaluation of Dexmedetomidine and Fentanyl as Adjuncts to Bupivacaine in Intrathecal Anaesthesia
Manju, Archana Tripathi, Swati Ojha, Vidushi Nama
Abstract
Introduction: To enhance spinal anaesthetic efficacy, adjuvants from different pharmacological classes of drugs are used to augment and prolong analgesia. Dexmedetomidine, a α2-adrenoceptor agonist acts by binding to presynaptic C-fibers and postsynaptic dorsal horn neurons. Fentanyl is a lipophilic μ-receptor-agonist opioid it exerts its effect by combining with opioid receptors in the dorsal horn of the spinal cord and may have a supraspinal spread and action. Aim: A Comparative Evaluation of Dexmedetomidine and Fentanyl as Adjuncts to Bupivacaine in Intrathecal Anaesthesia. Methodology: A prospective, comparative randomized, double-blinded study was performed on 60 patients. These 60 patients were divided into 2 groups Group dexmedetomidine (n = 30) and Group fentanyl (n = 30) and were compared for onset of analgesia, motor blockade, total duration of anaesthesia, sedation score, hemodynamic variables and postoperative side effects. Result: The mean time of onset of sensory block in group D was 3.9±0.70 min, and in group F it was 5.1±0.79 min. The difference was statistically significant. The mean time of onset of motor block in group D was 4.8±0.83 min, and in group F it was 5.75±0.69 min. The difference was statistically insignificant. The duration of analgesia in group D was 486.6±23.13 min and 296.33±25.16 min in group F. The difference was statistically significant. The duration of motor block in group D was 419.7±10.24 min and 160.36±6.37 min in group F. The difference was statistically significant. Conclusion: Dexmedetomidine is a better adjuvant than fentanyl in spinal anaesthesia as far as patient comfort, stable cardio-respiratory parameters, and intra-operative and post-operative analgesia are concerned.

198. Comprehensive Assessment of Short and Long-Term Clinical Outcomes of Elderly COVID-19 Patients Post Discharge from a Tertiary Care Designated COVID-19 Hospital in South India
Raghavendra B.M., Suresh K., Mohan Kumar M.
Abstract
Objective: The aim of our study is to describe the symptomatology, health consequences and sequelae up to one year after symptom onset amongst the Elderly hospital survivors with COVID-19. Methods: A 3rd, 6th and 12-month follow-up of elderly (more than 60 years of age) COVID-19 survivors was done between 25-9-2020 and 24-9-2021. A telephonic follow-up was conducted with the patients or caregivers at the third month, and the patients’ replies were recorded. At 6-month & 12-month follow-up visit, survivors were interviewed with questionnaires on symptoms and health related quality of life (HRQoL) and received a physical examination, a 6-min walking test and other relevant investigations. Symptoms, HRQoL, the modified British Medical Council (mMRC) score, and the distance walked in six minutes (6MWD) were the primary outcomes. Findings: 115 elderly COVID-19 survivors completed both the visits. Median follow-up time was 187 days after symptom onset for 6-month visit and 353 days after symptom onset for 12-month visit. The proportion of patients with at least one sequelae symptom decreased from 143(73%) at 6 months to 99(51%) at 12 months (p<0.01), the decrease was observed in all the symptoms studied in the patients. The most often reported symptom was dyspnea upon exertion (during routine daily activities), which decreased from 133 (68%), at 6 months, to 82 (42%), at 12 months (0.001). The proportion of patients with fatigue or muscle weakness fell from 105(54%) at 6 months to 70(36%) at 12 months (<0.01). More patients had anxiety or depression 10(6%) at 6 months Vs 9(5%) at 12 months (p-0.02), among whom mild anxiety or depression was predominant. There were no significant changes observed in the median 6MWD between 6 and 12 months. The proportion of patients with dyspnoea characterised by mMRC score of 1 or more slightly increased from 39(20%) at 6 months to 45(23%) at 12-month visit. Conclusion: Most elderly hospital survivors with COVID-19 had a good physical and functional recovery over time but some of the symptoms persisted at 12 months follow-up.

199. A Retrospective Comparative Study of Arthroscopic Versus Open Surgical Treatment for Recurrent Anterior Instability of the Shoulder
Sanjeev Kumar, Vikash Ranjan, Utkarsh
Abstract
Introduction: Recurrent anterior shoulder instability is a common orthopedic concern, particularly among active individuals. This was treated by Open Bankart procedure but with time and developing technology arthroscopic and less invasive procedures have been developed.  In this retrospective study, we delve into the comparative analysis of open Bankart procedure versus arthroscopic procedure for instability in the shoulder, shedding light on the evolving landscape of treatment options for this challenging condition. Materials and Methods: The investigation was conducted at a tertiary care center. It aimed to compare the outcomes of two distinct surgical approaches: open surgery (Group A) and arthroscopic surgery (Group B) in addressing the condition. A total of 100 patients were taken in the study and divided equally in each group. Both the groups were compared on the basis of pre and post op characteristics and intraoperative responses. Results: The results revealed that open surgery (Group A) was associated with a significantly shorter surgical duration but required longer hospital stays and led to increased post-operative hemorrhage compared to arthroscopic surgery (Group B), the hospital stay was just 4 days for the Arthroscopic procedure whereas it was 8 days for the Open procedure. Time taken for the Arthroscopic procedure was 96 minutes approximately but for the Open Procedure took 68 minutes. Conclusion: In conclusion, this study highlights the comparative outcomes of open and arthroscopic surgery for recurrent anterior shoulder instability. Open surgery appears to offer better stability (higher Rowe scores) but with longer hospital stays and increased post-operative hemorrhage. Arthroscopic surgery allows for quicker recovery and shorter hospital stays but requires further evaluation regarding stability. The choice between these approaches should be individualized, considering patient needs and surgical expertise.

200. Advances in Diagnostic Technologies for Early Detection of Dengue Virus
Amit Kumar, Pratulya Nandan
Abstract
Polymerase Chain Reaction (PCR) methods, IgM/IgG antibody tests, and NS1-based antigen screening are among the current standard approaches used for Dengue Virus (DENV) testing. However, new diagnostic tools are appearing, showing promise for reducing costs and speeding up testing processes; this is excellent news for rural and low-resource areas throughout the world. Modern tools for diagnosis have come a long way, covering both traditional and point-of-care options. Firstly, different methods have been developed and created to find other signs and variants of the Dengue virus. These include visual, electrical, microfluidic; enzyme-linked immunosorbent assays (ELISA) and biological sensors that can be used on smartphones. Recent progress in genetic and point-of-care tests, along with new technologies like personal sensors, mobile phones, and low-power electronic devices, has opened up new ways to treat diseases, to keep an eye on patients, and keep an eye on dengue in real time. In addition, there are a number of promising new quick and point-of-care medical technologies that improve innovative tools for diagnosis in this field. The development and improvement of diagnostic tools are constantly being reviewed and improved. In conclusion, newly developed methods and technologies are continually improving early detection capacities and managing the disease in the field of DENV identification, which is experiencing fast evolution. This discovery is of utmost importance in the fight against the spread of DENV and for the successful treatment of those who have contracted the virus.

201. Haemodynamic Effects of Esmolol versus Dexmedetomidine in Response to Extubation in Case of Elective Surgery under General Anaesthesia, A Randomized Double Blinded Interventional Study
Leelawati Siyag, Rajendra Prasad, Ankita Jain, Manish Khandelwal, Nidhi Khandelwal
Abstract
Introduction: Extubation is associated with awakening, pain, anxiety and airway irritation which may lead to haemodynamic responses similar to intubation, resulting in hypertension, tachycardia and arrhythmias. The present study was undertaken to evaluate the attenuating effects of dexmedetomidine and esmolol which belong to different pharmacological groups on haemodynamic changes with tracheal extubation in patients undergoing elective general surgery. Material & Methods: 60 patients were randomized into 2 groups of 30 patients each to conduct a randomized double blind interventional study to compare the effects of i.v dexmedetomidine 0.5mcg/kg vs esmolol 1.5 mg/kg in attenuation of post extubation haemodynamics (SBP, DBP, HR and MAP) in patients undergoing elective general surgery under general anaesthesia and to note the side effects if any. Observation & Results: After administration of study drug fall in HR was seen in both groups. But in group A fall in HR start at T1 and did not show rise compare to basal value during extubation and post extubation period(T3-T7). In group B fall in HR start at T3 and there was no increase in HR during extubation and post extubation period (T3-T7). Rise in MAP was seen in both the groups at T0 and T1 and the difference between group A and group B was statistically significant. Fall in MAP was seen in both the groups from T2-T7 that is after study drug administration. MAP was higher in group B as compare to group A. Conclusion: We concluded that dexmedetomidine and esmolol both controls arterial pressure and heart rate, but dexmedetomidine is the preferred drug because of better quality of extubation due to sedation caused by dexmedetomidine.

202. Clinico-Hematological and Etiological Spectrum of Pancytopenia / Bicytopenia in Children Aged 1 To 15 Year in Southern Odisha (An Institute Based Study)
Shilpa Padhi, Pramita Sahu, Nuguri Bala Manideep, Minakshi Swain, Sushruta Mohanty
Abstract
Background: This study has been conducted to evaluate the underlying causes and the clinico-hematological profile of pancytopenia and bicytopenia in the pediatric age group. Methods: This was a hospital-based prospective cross-sectional observational study conducted among 75 patients in the pediatric age group of 1-15 years in the Department of Pathology, MKCG Medical College and Hospital, Brahmapur, over a period of 2 years from August 2019 to September 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Both bicytopenia and pancytopenia presented with fever (76%), followed by bleeding manifestations (18%). Clinical findings like pallor (97%) and hepatosplenomegaly (73%) were observed in the majority of the cases in both bicytopenia and pancytopenia. On CBC, anemia and thrombocytopenia in combination were the most common presentations of bicytopenia, followed by anemia plus leucocytopenia. Anemia and thrombocytopenia were seen in 97% and 94% of cases, respectively, while leucopenia was seen in only 8% of cases. On peripheral smear examination, normocytic normochromic RBCs were seen in 73% of cases, followed by microcytic hypochromic RBCs in 20% of cases. Bone marrow aspiration and biopsy revealed acute leukaemia to be the leading cause of bicytopenia and pancytopenia, with 40% of cases, followed by aplastic anemia, comprising 23.7% of cases. Conclusion: Infectious causes like malaria and nutritional deficiencies (iron deficiency or vitamin B12 deficiency), though treatable, can lead to serious complications such as subacute combined degeneration of the spinal cord and growth and developmental delays if not diagnosed in a timely fashion and treated accordingly. The clinical findings and peripheral blood smear supplemented by bone marrow aspiration and biopsy can provide crucial information in the workup of patients with cytopenias and aid in early identification of the primary etiologies which will have profound impact on the morbidity and mortality in pediatric patients.

203. Limberg Flap Procedure for Sacrococcygeal Pilonidal Sinus
Deepak Sharma, Bajrang Sharma
Abstract
Background: Sacrococcygeal pilonidal sinus is a common and morbid disease associated with high recurrence rate after surgery. Many conventional surgical procedures have been described for its management with their merits and demerits. The present study aims to evaluate the efficacy and complications of Limberg flap reconstruction surgery. Methods: This hospital based prospective study was conducted on 30 consecutive patients with pilonidal sinus disease attending Surgery Department. Results: All patients were followed up initially at 2-week interval, then at 1 month and again at six months. Four patients (13.33%) developed complications two (6.67%) had seroma formation, 1 (3.33%) had flap necrosis and the other 1 (3.33%) had superficial surgical site infection. Conclusion: Limberg flap for reconstruction of the defect after excision of recurrent sacrococcygeal pilonidal sinus is an effective and reliable technique, easily performed, subjectively high patient satisfaction, associated with complete cure and low incidence of post-operative complications.

204. Epidemiology of Acute Abdominal Pain: A Cross-Sectional Study
Bajrang Sharma, Deepak Sharma
Abstract
Background: Pain Abdomen is a symptom caused by a wide variety of disorders ranging from organic to functional. The organic causes of pain abdomen may be inflammation ulceration, perforation, haemorrhage, malignancies, obstructions or distension of intra-abdominal organs including the retroperitoneal structures. Methods: An institution based, cross-sectional study was conducted on 200 patients were admitted with surgical causes of pain abdomen. Data were collected on the day of discharge, with the help of pre-tested, semi structured Schedule. Results: In this study the presenting symptoms were vomiting, abdominal distention, constipation, fever and diarrhea were present. In this study, the most common cause of acute abdomen was acute appendicitis, it was present in 37 (37.00%) of study subjects. 2nd most common cause was gall bladder related pathology and was present in 38(19.0%) of study subjects. Conclusions: Most common cause of surgical acute abdomen was acute appendicitis. Adequate health infrastructures at the primary and secondary health care level may be an important step forward to address common causes of acute abdomen.

205. Diagnostic Accuracy of Ultrasound for Rotator Cuff Tears of Shoulder Joint Compared to Magnetic Resonance Imaging
Mahendrasinh I Chauhan, Prathit N Patel, Bhagyesh V Prajapati, Parth A Trivedi
Abstract
Introduction: Rotator cuff pathologies are a common cause of shoulder pain and disability. Ultrasound and MRI are preferred for diagnosing rotator cuff tears, with MRI offering high sensitivity and specificity but being costly and time-consuming. Ultrasound is a cost-effective alternative, but its accuracy in distinguishing complete and partial tears can vary. This study aimed to compare the accuracy of US and MRI in diagnosing rotator cuff pathologies. Materials and Methods: This prospective study enrolled 40 patients who were referred for ultrasound and MRI due to shoulder pain. Radiologists performing the ultrasound and reporting the MRI results were unaware of each other’s findings. The study aimed to determine the sensitivity, specificity, and accuracy of ultrasound in diagnosing different musculo-tendinous shoulder pathologies, using MRI as the gold standard. Results: Patients with rotator cuff tears had a mean age of 48.5 ± 10.2 years. Both ultrasound and MRI showed strong agreement (k = 0.80) in diagnosing rotator cuff tears. The supraspinatus tendon (65.4%) was most commonly affected. Ultrasound had high accuracy in diagnosing supraspinatus tears (98.0%), followed by infraspinatus (94.0%) and subscapularis (90.0%). Accuracy was better for larger full-thickness tears (100%) compared to partial thickness tears (85.0) and tendinosis (87.5%). Conclusion: Ultrasound and MRI have good agreement in diagnosing rotator cuff pathologies. Ultrasound is the preferred choice due to its availability, affordability, and tolerability, with MRI reserved for uncertain ultrasound results.

206. Post COVID Health Profile of Patients Attending OPD of Medical College Teaching Hospital of Datia M.P. India
Arya Kalpana, Kumar Sanjeev, Gupta Shubhanshu, Adhikari P., Sukla P., Mitra Bikranjeet, Raghuvanshi Ashish
Abstract
Background: The post corona virus disease 2019 syndrome is defined as the persistence of symptoms after viral clearance and emergence of new symptoms after a few months following recovery from covid 19. In Some study quoted incidence is ranges from 10% to 35%, however rates as high as 85% have been reported among patients with a history of hospitalization. Objective: This study was aimed to assess the prevalence of post Covid Symptoms & to assess demographic profile of patients. Methods: This was Cross Sectional Study conducted from 10th July to 10thOctober 2023 (three month) among the patients attending OPD of Medical College associated Hospital of district Datia. A Semi structured Questionnaire based proforma was used to collect information of 110 covid positive patients. Patients without confirmed covid -19 test result & without consent were excluded from the study. For data analysis used M S exel 2019 was used. Result: The Mean age of patients was found 44.5 year and proportion of male was 56.36% which was slightly higher then female i.e. 43.64%. Most post covid symptoms were found among females in comparison of males. In females most of patients have fatigue (100%), myalgia (85.71%), low mood/depression /Anxiety /sleep disturb (61.90%) and in males most common post covid symptoms were found breathlessness (40.62%) and headache and giddiness (25%). Prevalence of post covid symptoms was found 37% in hospitalized patients during covid pandemic and it was only 11 % among mild symptomatic & not admitted covid patients. Conclusion: Even after recovering from COVID-19, people may develop symptoms hence as a result of Covid -19 long term consequences should not be neglected as they may lead to increase morbidity and can added burden of the health system so that a special screen of all general patients who were found covid positive during pandemic must be ensured in all health facility.

207. To Evaluate the Role of Intralesional Injection of Platelet-Rich Plasma versus Corticosteroid Injection in Lateral Epicondylitis
Nilesh Kothari, Rajesh Chouhan, Priyank Deepak
Abstract
Background and Aim: The disease is also known as ‘tennis elbow’ or lateral epicondylitis (LE). The disease affects between 1% and 3% of adults each year. It often occurs in patients between the ages of 35 and 50 years with high demands on gripping or repetitive wrist movements. A variety of treatment options are available to treat lateral epicondylitis, including analgesics and immobilization. Ninety percent of cases resolve spontaneously within 6-12 months. Other modalities include wrist bracing, elbow bracing, local corticosteroid injection, PRP injection shockwave therapy, and modifying poor technique in sports or work. Material and Method: The study included 40 patients of lateral epicondylitis (fulfilling the inclusion criteria) who presented to the OPD/Casualty of Centre for bone and joints, Kokilaben Dhirubhai Ambani Hospital, Indore, between January 2023 and January 2024. The study was a prospective and interventional type. We tried to objectively determined the efficacy of two conservative treatment modalities, PRP injection and corticosteroid injection therapy in terms of DASH score and VAS score, in 40 patients with tennis elbow with 20 patients in each group Results: With a mean age of 41.6 years (range: 21 to 56 years), 40 patients (group 1 PRP- 20 patients, group 2 CS -20 patients) had LE. There were 8 male patients and 32 female patients. The mean DASH Score dropped from the pre-procedure to the 6-month mark, demonstrating a noteworthy drop in the DASH Score and demonstrating the efficacy of 71.2 to 32.5 at the 6-month mark in the PRP group and 69 to 41.1 in the CS group and the Mean VAS Score dropped from the pre-procedure to the 6-month mark, demonstrating a noteworthy drop in the VAS Score and demonstrating the efficacy of 8.1±0.7  to 1.5±0.4  at the 6-month mark in the PRP group and 8±0.7 to 3.0±1.1 in the CS group. Conclusion: PRP was associated with superior outcomes for reducing pain intensity and elbow joint function in the long term.

208. Comparison of Dexmedetomidine and Propofol Sedation for Awake Oral Fiberoptic Intubation
Hemant Yadav, Garima Tyagi, Ravichandra R. Dodawad, Surabhi Gupta
Abstract
Background: Awakefiberoptic intubation is a critical procedure for managing difficult airways, with the choice of sedative being pivotal for patient comfort and procedural success. This study compares the efficacy and safety of Dexmedetomidine and Propofol for sedation in this context, focusing on hemodynamic stability, patient tolerance, and intubation conditions. Methods: A total of 60 adult patients undergoing elective surgery requiring awake oral fiberoptic intubation were randomized to receive either Dexmedetomidine or Propofol. Hemodynamic parameters, oxygen saturation, respiratory rate, Bispectral Index scores, Ramsay Sedation Scores, and conditions for intubation were meticulously recorded and analyzed. Results: Dexmedetomidine showed superior hemodynamic stability with significantly lower heart rate (P<0.001 from T1a to T4) and blood pressure (P<0.001 from T1 to T4) compared to Propofol. Patient comfort was enhanced under Dexmedetomidine, evidenced by improved tolerance (60% showing no reaction vs. 23.3% with Propofol, P=0.016), fewer incidences of coughing (83.3% vs. 56.7%, P=0.024), and better vocal cord conditions for intubation (80% open vocal cords vs. 50%, P=0.043). Both sedatives effectively maintained adequate oxygenation and appropriate sedation levels without significant differences in respiratory rates or Bispectral Index scores. Conclusion: Dexmedetomidine offers a preferable profile for sedation in awake oral fiberoptic intubation, providing better hemodynamic stability, patient tolerance, and conditions for intubation without compromising respiratory function or oxygenation. These findings support the selection of Dexmedetomidine as a sedative in this specific clinical scenario.

209. Outcomes and Predictors of Early versus Late Decompressive Craniectomy Following Traumatic Brain Injury
Neil John Mannukaden, Rose Bist, Kumar Lakshman, Abhishek. V, Anil Kumar P, Suresh Kumar K L, Rajmohan B P
Abstract
Background: The timing of decompressive craniectomy (DC) in managing traumatic brain injury (TBI) remains a contentious issue, with debates surrounding the outcomes and predictors of early versus late intervention. Methods: This observational, prospective cohort study included patients undergoing DC for TBI at a tertiary care center. Patients were divided into early (within 24 hours post-injury) and late (after 24 hours post-injury) DC groups. Data on demographics, mode of injury, pre- and post-operative Glasgow Coma Scale (GCS) scores, presence of mass effect, midline shift, time to surgery, and Glasgow Outcome Scale Extended (GOSE) scores at discharge were collected and analyzed. Results: A total of 174 patients were studied, with 87 in each group. No significant difference was observed in age distribution (p=0.41) or gender (p=1.0). Mode of injury significantly influenced the timing of DC, with falls more common in late DC (51.72% vs. 17.24%, p<.0001). The late DC group had higher pre-operative GCS scores (9.32 ± 3.91 vs. 5.83 ± 2.45, p<.0001). Mass effect was present in all early DC patients but in only 19.54% of late DC patients (p<.0001). The mean time to surgery was significantly shorter in the early DC group (9.2 ± 2.88 hours vs. 64.17 ± 29.62 hours, p<.0001). The late DC group showed a higher percentage of favorable GOSE scores at discharge (47.13% vs. 10.34%, p<.0001). Conclusion: The study suggests that while early DC is crucial for patients with significant mass effect and midline shift, late DC can result in comparable or better outcomes for patients with higher initial GCS scores or different modes of injury. The decision on the timing of DC should be individualized based on clinical presentation and injury characteristics.

210. Correlation between Barrett’s Esophagus and Hiatal Hernia in Chronic GERD patients in rural population of Northern India
Shubham Singh, Mohammad Ismile Ansari, Rohit Singh,  Ravi Sinha, Rakshit Agnihotri, Biswajit Maity
Abstract
Hiatal Hernia (HH) and Barrett’s esophagus (BE) are the two important complications of Chronic Gastroesophageal Reflux Disease (cGERD). The prevalence and the risk factors for HH and BE in the patients with cGERD of rural Northern India were investigated. The relationship between Size of HH and BE with clinical and endoscopic findings were also evaluated. Materials and Methods: A total of 156, chronic gastroesophageal reflux disease (cGERD) patients (male-96, female-60) previously confirmed by clinical and endoscopic findings,  were enrolled in the Department of general surgery, Hind Institute of Medical Sciences, Mau, ataria, Sitapur, UP, India, for upper gastrointestinal endoscopy.  Upper endoscopy reports were examined retrospectively from patients with symptoms of cGERD for prevalence of HH and BE and associated factors. On endoscopic suspicion of columnar lined epithelium (CLE), the patients were randomly divided in two groups for  either 4-quadrant conventional biopsies at 2 cm interval or Methylene Blue (MB) directed biopsies, were also obtained. The two groups were compared for the detection of Specialized Intestinal Metaplasia (SIM), which was diagnosed if the intestinal goblet cells were present. Size of BE and HH were also measured for correlation. Results: Out of 156 patients with cGERD, were randomly  divided in two groups ( Group A= Conventional Endoscopy and Group B= Chromoendoscopy, 78 patients in each group).  A total of   88 (56.41%) patients were suspected of CLE on endoscopy (A+B). After taking biopsy samples from the 88 patients, only 84 (53.84%) had specialized intestinal metaplasia on histopathological examination. 41 (46.59%) patients in the conventional group and 43 (48.86%) patients in the chromoendoscopy group (p=0.64) were diagnosed as having BE. It was also observed that 132 (84.61%) cGERD patients were having as  Hiatal Hernia. Hiatal hernia size, lower esophageal sphincter pressure, esophageal acid exposure, and number of reflux episodes ≥6 min significantly correlated with BE. Stepwise regression identified hiatal hernia size (p =0.001) and lower esophageal sphincter pressure (p =0.001) as significant predictors of BE.  Age and  BMI ≥25 were also related to BE and HH. Conclusions: Prevalence of HH and BE in the  rural northern India were 46.32% and 12.5% respectively in cGERD patients and the presence of hiatal hernia was strong risk factor for Barrett’s esophagus in old age with ≥25 BMI.

211. Study to Evaluate ECG Markers for Detection of Left Ventricular Systolic Dysfunction
Amit Kumar, Dhananjay Singh Shekhawat, Chandra Bhan Meena
Abstract
Background: Early diagnosis of severe LV dysfunction with echocardiography improves outcome. But in developing country like India echocardiography and other advance imaging are not available in peripheral centre. We selected a combination of electrocardiogram (ECG) markers for screening of individuals with severely reduced LVEF. Methods: A single centre crossectional observational study was conducted including 160 cases with LVEF <35% and 160 control with LVEF >35% . Subjects  were evaluated for prevalence of conventional ECG markers and association of nine additional ECG markers with LV dysfunction. Results: Conventional ECG abnormalities LBBB observed in 20% case and 5% control  with significance (p=0.001), atrial fibrillation observed in 11.8% case and 9.3% control (p=0.47) with no significance. At least one major ECG abnormality was observed in 46(28.75%) of cases with LVEF ≤35% and 22(13.75%) control  with LVEF >35% (p < 0.002). Abnormal > 4 ECG parameter was observed in 15(9.37%) cases with LVEF ≤35% and 4(2.5%)  control  with LVEF >35% (p < 0.016). The presence of any one of these abnormalities for predicting LVEF ≤35% produced a sensitivity of 83%, specificity of 55%. Except delayed QRS transition and delayed intrinsicoid deflection rest other parameter were significantly associated with LVEF ≤35 (p < 0.05). Conclusions: An expanded panel of nine obtained ECG markers correlated strongly with severely reduced LVEF. This electrical surrogate score could facilitate screening of severely reduced LVEF, and warrants further evaluation.

212. Correlation of Atherogenic Index of Plasma with Coronary Artery Disease in Myocardial Infarction Patients: An Observational Study from North-India
Gautam Jesrani, Dhananjay Singh Shekhawat, Gagan Mittal
Abstract
Background: Atherogenic Index of Plasma (AIP) is a newer marker of dyslipidemia that includes both atherogenic and anti-atherogenic lipid factors, i.e. triglycerides and high-density lipoprotein, and is recently studied for various cardio-vascular disease risk evaluations. However, its correlation with coronary artery disease (CAD) is scarcely described in the current literature. Aim: To study the correlation of AIP with CAD in myocardial infarction (MI) patients. Material and Methods: This was a single-centered observational study for a period of six months. Patients of age ≥18 years with a diagnosis of acute MI were included in this study, and lipid analysis was performed to identify the AIP. Then the patients underwent conventional CAG, and the GENSINI severity score was calculated on the basis of angiographic results. Both of these parameters were then correlated with Pearson’s ‘r’ correlation analysis and, a p-value <0.05 was considered statistically significant. Results: A total of 114 patients fulfilled the eligibility criteria and were included in this study. The mean age of the study group was 60.7 years, and male participants were more in numbers than female individuals (88 vs. 26). The average AIP and GENSINI scores were 0.15 and 35.8 respectively, and correlation analysis between the two parameters demonstrated a positive r-value (0.4405) with a statistically significant p-value. Conclusion: The study concluded that AIP has a positive correlation with CAD severity in the MI population.

213. Case Series of IRIS and Choroidal Coloboma with Other Ocular and Systemic Associations
Busireddy Pravallika Reddy, Kammam Anjaneyulu, B. Usha Latha, G. Ravi Babu, K.V.N. Sreedevi
Abstract
Objective: To explore the various ocular and systemic associations in patients with iris and choroidal coloboma for better understanding of clinical implications and management strategies. Methods: This is a prospective study done over 1 year in patients with coloboma. Detailed history followed by complete ophthalmic examination including anterior and posterior segment, a comprehensive review of medical records and evaluation was performed to identify associated anomalies. Results: A total of 8 patients with coloboma were included in this case series with a median age of 26 years. Out of 8 patients, 2 were males and 6 were females. 75% of cases presented with bilateral coloboma while the rest 25% of cases exhibited unilateral involvement. 88% of patients had visual acuity from <6/60 to PL+. Various ocular associations identified in these patients include microphthalmia in 38%, cataracts including congenital and posterior subcapsular cataracts in 50% cases, nystagmus in 25% and posterior staphyloma in 38% cases. Only 1 patient had systemic association such as charge syndrome. Conclusion: Iris and choroidal coloboma are rare congenital ocular anomalies that arise due to incomplete closure of the optic fissure during embryonic development. This case series reveals a diverse spectrum of ocular and systemic associations in patients with iris and choroidal coloboma. Early detection and intervention for associated conditions can significantly impact the long-term visual and overall outcomes of the affected individuals.

214. Morbidity Profile and Associated Risk Factors amongst Workers in Organized and Unorganized Sectors of Kamrup Metro and Kamrup Rural Districts of Assam
Kumaril Goswami, Jhankar Hazarika, Shashanka Shekhar Chakraborty
Abstract
Background: An occupation is a regular activity performed for wage or salary, profit or family gain, to fulfil their requirements and to lead a financially secured life. Occupational health is concerned with the health of the workers in relation to work and working environment where they work to earn their livelihood. Occupation has been mainly classified into two major sectors namely organized sector and un-organized sector. The organized sector is one that is incorporated with appropriate authority or government, on the contrary the un-organized sector deals with small scattered units which are not under any appropriate authority or government. Unorganized sector mostly includes agricultural labours, contract labours, construction workers, home-based workers engaged in different small scale industries like beedi rolling, agarbatti making, tailoring, embroidering work, etc. Methods: This was a community based cross-sectional study carried out in Kamrup metro and Kamrup rural, Assam, India, among the workers engaged in different organized and un-organized industries during the period April 2022 to July 2022 (4 months). The study included those participants who gave consent for the study and those who were working for the past 1 year. Those who did not give consent for the study and those who were not willing to participate were excluded from the study. The sample size was calculated out to be around 256 taking prevalence of any morbidity among construction worker (p) as 80%, allowable error of 5% with 95% confidence interval by using formula. The subjects were interviewed using a predesigned, pretested, semi structured performa. Before starting the interview, the construction workers were explained the purpose of the study. Then an informed consent was taken from him/her. One to one interview method was used to interview the workers after taking consent and the data was collected with the help of a pre validated schedule. Results: The study shows that 38.6% of workers belong to skilled occupation, 20.3% workers belong to semiskilled and 41% workers belong to unskilled occupation. 15.6% workers work for less than 8 hours a day, 39.84% workers work for 8-10 hrs a day and 44.5% workers work for more than 10 hours a day. It was found in the study that 74.6% workers had respiratory problems, 74.2% workers had skin problems, 72.6% workers had digestive tract disorders and 59.3% workers had musculoskeletal problems. It was found in the study that association between duration of hours of work spent per day at work place and injuries/accidents at work place is not statistically significant. Conclusion: In our community based cross-sectional study carried out in Kamrup metro and Kamrup rural, Assam, India, we find common health problems among construction workers working in both organized and un organized sectors. Respiratory problems, skin problems, digestive tract disorders and musculoskeletal problems were significantly higher among construction workers.

215. Occupational Radiation Exposure and Cataractogenesis–A Hospital-Based Case Control Study in Eastern India
Shrutakirty Parida, Snehalata Dash, Sangram Keshari Biswal
Abstract
Introduction: Ocular ionizing radiation exposure produces characteristic dose related, progressive lens changes leading to cataract genesis. Exponential growth in the use of ionizing radiation for diagnosis, treatment and procedure guidance has enhanced our growing concern regarding occupational radiation exposure. Crystalline lens being one of the most radiosensitive tissues is highly vulnerable to this occupational radiation induced adverse effects. Objectives: This study aims to determine the incidence and type of cataract found in occupationally exposed medical personnel to ionizing radiation and to find out role of protective eye shields in exposed group by comparing it with unexposed age, sex matched controls (medical personnel). Methods: This was a hospital-based case-control study. All selected participants completed a questionnaire regarding detail occupational history. Complete ophthalmological evaluation was done. Lens opacity grading was done with slit- lamp biomoicroscopy (Haag streit) and as per the Lens Opacities Classification System III. Dilated fundus examination was done in all patients. Patients with very hazy media and no or minimal fundus view B-scan was done. Results: Incidence of cataract was 24.8% in case group whereas it was 10% in the control group (p-value <0.0001). There was a male preponderance (Male: Female=1.48:1), with an earlier onset of cataract in case (40 – 50 years) versus control (50 – 60 years) group. The most common type of cataract in radiation exposed group was posterior subcapsular cataract (19%) as compared to nuclear cataract (6.3%) in the unexposed group. Effectiveness of protective eye wears on incidence of cataract was well evidenced with a relative risk (R.R) of 0.387. Conclusion: Radiation induced cataractogenesis occurs at lower doses than expected. Frequent failure of use of protective eye wears explains the crucial need for radiation monitoring and risk assessment for medical staff. Long-term follow-up studies are needed to analyse the risk of cataract formation over extended time periods following exposure to low-dose ionizing radiation.

216. Evaluation of Serum Interleukin-6 Levels in Diabetic Foot Ulcers
Santosh Kumari Sharma, Sunil Kumar Bairwa, Devendra Ajmera, Atul Kumar Sharma
Abstract
Introduction: Interleukin-6 (IL-6) is a cytokine, which has an important role in inflammation. Diabetic Foot Ulcers are one of the complications of Diabetes Mellitus (DM). DM is a chronic inflammatory disease and up to one-third of diabetic patients may suffer from Diabetic foot ulcers (DFU) during their life span. So this study aimed to evaluate the serum levels of IL-6 in diabetic patients with infective or non-infective foot lesions (IDFU/NIDFU). Methodology: In this study total 100 patients were enrolled and divided into three groups containing 40, 30 and 30 in each group. All patients went through full history taking and clinical examination of diabetic foot ulcer. Serum IL-6 was estimated by ROCHE Cobas e411 machine. Results: Serum IL-6 level in control group were found 38.65±22.37 pg/ml. In NIDFU patients Serum IL-6 level were found 135.1±139.26 pg/ml. In IDFU patients Serum IL-6 level was 580.97±398.15pg/ml (p < .0001). Conclusion: IL-6 appears to be a relatable marker in Diabetic Foot Ulcers progression.

217. A Cross Sectional Study to Observe Cost of Benzodiazepines in Adult Patients with Psychiatric Disorders
Balu S, Sharma N, Raj R, Shailza Balu
Abstract
Background: Benzodiazepines are sedative-hypnotic medications that have been used for decades in the treatment of anxiety, epilepsy, insomnia, and other conditions. Prolonged use of benzodiazepines leads to adverse effects like addiction problems, with withdrawal symptoms, diminishing effect and difficulty in discontinuing treatment. Aims and Objectives: This observational cross-sectional study was designed to study the cost of benzodiazepines in adult population in psychiatry outpatient department of a tertiary general hospital. Materials and Methods: In 1 year duration study, 400 patients on benzodiazepines enrolled in this study and they filled up a questionnaire designed for the study. The data was evaluated using descriptive statistics. Results: The most economical drug was found to be Clonazepam 0.5mg dose, which is a longer acting benzodiazepine. Its cost per pack of 10 tablets was Rs 5.5 with per day cost was Rs 0.55. The costliest benzodiazepine prescribed was Chlordiazepoxide 10mg twice a day with cost per pack of 10 tablets was Rs 21 with per day cost was Rs 4.2. Conclusion: There is a requirement for data, which can help implement better strategy for regulation of the cost analysis at all levels to reduce burden on the patient. More studies in larger samples and multiple centres throughout the nation are needed to justify our findings.

218. Study of the Histopathological Spectrum of CNS Lesions and Their Radiological Correlation in a Tertiary Hospital in South India
Sunil Kumar Katari, Harinath Devineni, S. Suneetha, Sreedhar, Praveena G, Khadeeja T, P.V. Kiran Kumar, P.V. Ramana Babu, T. Dhanamjaya Rao
Abstract
Introduction: Lesions of the central nervous system (CNS) can take a serious clinical course, even when they are inflammatory or benign neoplasms. Radiology is the only means of non-invasive assessment prior to a surgical diagnosis. In recent times, advanced radiological techniques have been available for diagnosis and precise localization for a stereotactic biopsy. The radiological impression of any CNS lesion, however, requires confirmation by histological examination of a biopsy. Hence, histopathology remains the gold standard for diagnosis. Aims and Objectives: To study the histopathological spectrum of the CNS lesions in our health care unit, as well as to compare the histopathological diagnosis with the radiological diagnosis and observe the correlation between them. Materials and Methods: This retrospective, comparative study included 364 cases of CNS lesions from January 2020 to July 2023. Their clinical history and radiological findings were noted. The histopathological diagnosis was correlated with the radiological diagnosis using Cohen’s kappa, with the former being the gold standard. Results: Out of 364 cases considered for study, 210 males were affected compared to 154 females. The non-neoplastic lesions were 177, out of which males were 97 and females were 80. The most commonly found nonneoplastic lesions were inflammatory lesions. The Neoplastic Benign Lesions were 116, out of which males were 54 and females were 62. The most commonly found benign lesions were noninvasive meningothelial meningiomas. The neoplastic malignant lesions were 71, out of which males were 34 and females were 37. The most common malignant lesion was glioblastoma. The overall correlation between the radiological and histopathological diagnoses was 96%. Using Cohen’s kappa, a value of 0.87 was obtained when the collective data was compared, implying a “near perfect” agreement between the two modalities of diagnosis. Conclusion: Our study showed that lesions of the central nervous system have a varying age- and sex-wise spectrum. There was a near-perfect agreement between the radiological and histopathological diagnoses, suggesting the latest radiological advancements in technology are nearing accuracy in spite of being noninvasive. This makes them a highly recommendable modality for provisionally diagnosing CNS lesions. However, histopathology is the yardstick against which all the emerging techniques must be measured.

219. Effectiveness of Selected Interventional Strategies on Knowledge, Practice, and Quality of Life Among Chronic Kidney Disease Patients (CKD) Undergoing Hemodialysis in Selected Hospital at  Berhampur, Odisha: A Pilot Study
Ranjita Beura, Manjubala Dash, J. Jasmine, R Danasu
Abstract
Background: Chronic Kidney Disease (CKD) significantly impacts patients’ quality of life, particularly those undergoing hemodialysis. This study evaluated the effectiveness of selected interventional strategies on knowledge, practice, and quality of life among CKD patients. Methods: A total of 20 CKD patients undergoing hemodialysis were divided into experimental and control groups. The study assessed changes in knowledge, practice, and quality of life post-intervention. Results: The experimental group showed a substantial increase in knowledge about CKD and hemodialysis post-intervention, with scores improving from 10 ± 2 to 20 ± 3 (p<0.01). Quality of life scores in physical health and emotional wellbeing also significantly improved from 50 ± 10 to 70 ± 12 and 40 ± 15 to 65 ± 10, respectively (p<0.01). The study also found a positive correlation between improved quality of life and higher education levels (r=0.4, p<0.05). Conclusion: The interventional strategies significantly improved the knowledge and quality of life among CKD patients undergoing hemodialysis. These findings highlight the critical role of patient education in CKD management.

220. Evaluation of Risk Factors Associated with Central Serous Chorioretinopathy and Role of Systemic Propranolol as a Treatment Modality
Praveen CP, Padmaja Krishnan, Jyothi PT
Abstract
Background and Objectives: Central serous retinopathy (CSR) is an idiopathic condition characterized by accumulation of transparent fluid with acute serous detachment of neural retina at the macula. CSR mainly affects adults in the age group of 20 to 50 years with a male predominance. It usually present as acute onset of unilateral defective vision or metamorphopsia producing significant visual morbidity in young productive adults. Many forms of therapy had been employed for its treatment ranging from antihistamines, diuretics, NSAIDS, vasodilators, antitubercular drugs, osmotic dehydration and currently argon laser photocoagulation. But the results in all of these series had been equivocal and the clinical evaluation is difficult due to the tendency of the condition to recover spontaneously. Recently, few researches had shown a favorable role of beta blockers in the resolution of CSR. This study was an attempt to study the various factors predisposed to CSR and effect of systemic Propranolol in the resolution of CSR. Material and Methods: The study was done inside the setting of a hospital. Patients with clinical features of CSR were chosen from the Outpatient Department (OPD) at the Ophthalmology department of the Government Medical College and Hospital, Calicut, Kerala, India using a convenient sampling method. This was accomplished subsequent to receiving authorization from the Scientific Review Committee and Institutional Ethics Committee, as well as obtaining written consent from the patients. A detailed history was taken in each case to find the association of different risk factors. In group P, 40 mg Propranolol tablet was started on daily basis at the time of first visit itself and the treatment continued till the resolution of CSR occurred or to a maximum of 2 months whichever is earlier. Similarly, in group C, control group tablet B complex were given. In group M, miscellaneous group, patients were allowed to continue the same treatment appropriately. All the patients were followed up at the end of 2 weeks, 1 month, 2 months, 3 months, 4 months and 6 months. Results: The main victims of the disease were young people between 25 to 45 years. Among them also, the peak incidence was between 36 to 40 years of age. The male to female ratio was 2.9:1. The occurrence of CSR has a noticeable association with insufficient sleep pattern of the patient as a precipitating factor than other factors. It is evident that in Propranolol group only, the percentage of eyes showing resolution in the first two months remains unchanged in both occasions (41.7%). In the other two groups, when the whole course of disease is considered, the percentage of eyes showing resolution in the first two months are markedly decreased than the first visit. Conclusion: Present study reflects a tendency of earlier occurrence of CSR in Indian people than Western people and does not affect the adolescents in the age group between 15-20 years. The occurrence of CSR has a noticeable association with insufficient sleep pattern of the patient as a precipitating factor than other factors. Propranolol 40mg daily for few weeks, considered to have a favorable role in the resolution time of CSR. Propranolol makes no difference in the final visual outcome of the disease as compared to placebo or other kinds of systemic therapy.

221. Clinical Profile of Children with Febrile Seizures in A Tertiary Care Institute in Central India: A Descriptive Study
Rashmi Parihar, Akanksha Jain, Nency Sahu, Swati Mulye, Jaya Upadhyay
Abstract
Background: Febrile seizures is a common problem in children below 6 years. This study was conducted to evaluate the clinical profile of children presenting with febrile seizures and to identify risk factors for recurrence of febrile seizures in these children. Materials and Methods: A Retrospective and prospective case record based study were conducted in a tertiary care center in a department of pediatrics after taking approval from institutional ethical committee. Convenience sampling method was used .Data and descriptive analyses were done using statistical package for the social sciences version 25. Point estimate at 95% confidence interval was calculated along with frequency and percentage for binary data. Results: Out of total 11250 children admitted in pediatric ICU/wards 470 have febrile seizures. We enrolled 364 children in study, out of them, 200 (55%) male and 164 (45%) female with 309(84.9%) simple and 55 (15.1%) complex febrile seizure.  Peak age was found in 6 month to 18 month age group 210 (57.7%), Recurrent febrile seizure noted in 117(32.1%) children and fever in more than  half the cases 225 (61.9%) was caused by viral fever followed by  Upper Respiratory Tract Infection 77(21.4%). Clobazam prophylaxsis were taken intermittently in 358(98.4%) cases. Anemia was found in 72% of cases. Conclusions:  Simple febrile seizure was more common and the peak age of presentation 18 month  of life and more commonly in male .One third of febrile seizures were recurrent and half the children had Viral fever as the most common etiology of fever followed by febrile upper respiratory tract.

222. Short Term Neurodevelopmental and Growth Outcomes of Very Low Birth Weight Infants with Neonatal Sepsis in Central India: A Prospective Cohort Study
Malini KP, Rashmi Parihar, Avyact Agarwal, Jaya Upadhyay
Abstract
Introduction: Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birth weight), but the long-term functional outcomes are unclear. The long-term outcomes of very low birth infants are influenced by prematurity, as well as the occurrence of various short-term morbidities such as Respiratory Distress Syndrome (RDS), sepsis, Necrotising Enterocolitis (NEC), Patent Ductus Arteriosus (PDA), Intraventricular Hemorrhage (IVH), Paraventricular Leukomalacia (PVL), Retinopathy of Prematurity (ROP), and Chronic Lung Disease (CLD). The objective of this   study was to assess Growth Neurodevelopment and outcomes in preterm infants with Neonatal sepsis. Methods: A prospective cohort study was conducted in the Neonatal Intensive Care Unit (NICU) at NSCB Medical College, Jabalpur, and Madhya Pradesh, India. The duration of the study was one year and six months, from March 2018 to September 2019. A total of 40 very low birth   infants were enrolled and followed-up for six months. The infants were divided into two groups: Group1 (<32weeks) and Group2 (>32weeks).Physical parameters such as weight, length, and head circumference were recorded on admission and at one, three and six months of corrected gestational age. Developmental assessment was performed using the Denver Developmental Screening Test-II (DDST-II) method. Laboratory sepsis profile was sent and association of risk factors with Growth and Neuro developmental outcomes was assessed. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and the Chi-square test, Fisher’s-exact test and Student’s t-test were used. A p-value less than 0.05 were considered significant. Result: Among the 40 subjects 12 (30%) were <32 weeks, and 28(70%) were >32 weeks. Overall, parameters were higher in infants >32 weeks. Culture proven sepsis was positive in 25 cases out of which 10 cases have developmental delay. Weight and head circumference, gain velocity were greater in infants 32 weeks during the first three months of life (p<0.05). From three to six months, <32 weeks infants showed a significant increase (p<0.001) in weight and head circumference gain velocity. The length gain velocity in both groups was comparable since birth, and <32 weeks Very low birth infants demonstrated good catch-up growth, which was statistically significant (p<0.05).At six months of corrected age, 16 (40%) infants out of the total 40 infants had abnormal neuro developmental outcomes. A total of 7 (58.33%) of the <32 weeks Very low birth infants and 9 (32.14%) of the >32 weeks VLBW infants had Neuro developmental Delay (NDD). Hypoglycaemia, shock, hyaline membrane disease, and mechanical ventilation were significantly associated with an increased risk of NDD. Conclusions: Neonatal sepsis in Very low birth weight infants is associated with increased risk of neurodevelopment disability. Due to the paucity of longitudinal follow-up data beyond 6 month, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.

223. A Study of Correlation between Ultrasonographic Finding with Special reference to gallbladder Wall Thickness and Severity of Dengue Fever
Parmar Dhruv, Vaidya Chirayu Vijaykumar, Jansari Ketan, Patel Bhogilal, Singel Vinu
Abstract
Background: Dengue fever is a major public health problem with an increase incidence in recent years. Dengue fever is an acute – mosquito transmitted viral infectioncausedby1to4serotypes (DEN-1, DEN-2, DEN-3 and DEN-4) of the genus flavivirus. It is the most common arboviral disease in the world. Dengue fever has been known for more than a century in the tropical area of south East Asia and the Western Pacific regions. Dengue fever is the most rapidly spreading mosquito borne viral disease of mankind, with a 30 fold increase in global incidence over the last five decades. This study is to identify ultrasonographic findings in Dengue fever & to study the clinical significance of Gall Bladder Wall thickness in persisting the severity of Dengue fever. This is a Observational prospective study of 100 patients admitted with seropositive for dengue fever at tertiary care hospital, who fulfilled the inclusion and exclusion criteria during the period of July 2018 to June 2020. Results: Majority of cases of dengue fever was occurred in patients age range from 18 to 27 years with mean age 31.2. In present study Dengue Fever was diagnoses in 70% of all cases while Dengue Hemorrhagic Fever in 22% and Dengue Shock Syndrome in 08% of them. Fever is most common clinical feature (96%) followed by Myalgia (61%). In this study we found that in patient with dengue, in USG findings over all frequency of GBWT was 65% followed by ascites 30%, Pleural effusion 23%, Hepatomegaly 19% and Splenomegaly 16%. In the present study GBWT did not show any relation to biochemical blood test or hematological parameters. Hemoconcentration once thought to be significantly linked to increased Dengue se- verity, appears unlinked to dengue severity as measured by plasma leakage and GBWT. Conclusion: Gall Bladder Wall thickness is one of the most common finding in Dengue Fever. GB wall thickness more than 6mm is associated with severe Dengue fever with significant statistical correlation.

224. Maternal Near Miss Indicators and Analysis of Maternal Near Miss Cases in a Tertiary Care Center over a Period of One Year
Gayathrie Devi S, Malini M, Pradeeba S, Ganesh R
Abstract
Background: The World Health Organization (WHO) defines the criterion of severe maternal morbidity or Maternal Near Miss (MNM) as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within six weeks after pregnancy. Having in thought the diversity in distribution of MNM cases among several states in India, there was a curious insight to conduct a survey pertaining to the prevalence/incidence of MNM cases, to study the criteria used for identification, to tabulate and analyse the causes of MNM cases and to decode the various contributory factors such as personal/family, socio economical and administrative problems responsible for the occurrence of MNM cases in a tertiary care center. Aims: 1) To calculate the incidence of MNM cases in the tertiary care hospital. 2) To derive the indicators pertaining to maternal nearmiss for the institution. 3) To analyse the causes contributing to MNM with respect to age, parity and timing of delivery in the hospital. Settings and Design: This study was carried out in the dept of Obstetrics and Gynecology of Govt. Karur Medical College Hospital in Karur district of Tamilnadu, India, from Jan 2023 to Dec 2023 as a research work. Materials and Methods: A Maternal Near Miss Register, which is already maintained is utilised for the purpose of collection of data. In this register, all the details pertaining to the near miss cases are entered precisely and accurately so as to provide all necessary information for the study. At the end of the year, the register is consolidated and the same process performed for the entire year. Number of Live birth and maternal mortality were obtained to calculate the Near Miss Indicators, and the results are published in the form of this article. Results and Conclusion: The study reveals that there were a total of 76 MNM cases identified in the tertiary care center over a period of 12 months from January to December of 2023. On deriving at the MNM Incidence ratio, live births being 3936 births, the ratio tends to be 19.3 per 1000 live births. Also, the MNM Mortality ratio as calculated, maternal mortality for the year being 3 cases, the ratio tends to be 25.3 : 1. Formulating the causes for MNM, Haemorrhage is the leading cause, followed by Eclampsia, in similarity with the worldwide statistics. This institution handles a load of MNM cases, and provides lifesaving care.

225. Hydatid Cyst: Study of 21 Cases in a Tertiary Care Hospital of Punjab
Manmeet Kaur, Aradhna, Harpal Singh, Harleen Kaur
Abstract
Introduction:  Echinococcosis is a zoonotic disease which is caused by tapeworm of genus Echinococcus excreted in the faeces of infected dogs. Aims and Objectives: This study was done to describe the Public health burden of Hydatid disease in local population as this disease causes significant morbidity and mortality. Hydatid disease poses a great health challenge as the cases are usually asymptomatic but can cause life threatening complications if neglected. Material and Methods: This was a retrospective study done over a period of 2.5 years in a tertiary care centre in Punjab. Data was collected from the patient requisition forms in the department of pathology and included patient profile, clinical symptoms, investigations and history of exposure to dogs or farm animals. The collected data was tabulated.  Results: A total of 21 cases of hydatid cyst were diagnosed histopathologically over a period of 2.5 years. In our study, the most common site of involvement was liver (50-77%), followed by lung (18-35%), abdominal cavity and brain. There were two cases of isolated splenic Hydatid cyst in the study which is a rare site. Most common age group involved was between 20-40 years. Conclusions: The disease presents with hydatid cyst and other varied symptoms according to the site involved. Hydatid disease can be diagnosed on the basis of signs and symptoms, serological tests and imaging studies. The diagnosis of hydatid disease is however confirmed by histopathological examination. Hydatid disease is of important public health concern.

226. Surgeons Throw Pathologist Catch – A Spectrum of Histomorphological Patterns in Gall Bladder Lesions
Rekha Patil, Anjali Dhote, Amrapali Gaikwad, Sonali Datar, Pooja Shinde, Balwant Kowe
Abstract
Background: Gall bladder lesions are remaining exceedingly ubiquitous and often needs surgical intervention. The histopathological patterns represent a spectrum, ranging from cholecystitis to gallbladder carcinoma. Histopathological analysis provide definitive diagnosis on resected specimen and hence ultimately help in further future management. Amongst all lesions cholecystitis with Cholelithiasis is known to produce diverse histopathological changes in the gallbladder mucosa. The present study aims to define the occurrence of various gallbladder lesions on histology. Method: This was a prospective observational study conducted in the Department of Pathology at Teaching Institute in Central India. The study period was two year, from first January 2021 to 31st December 2022. A total of 185 patients who underwent cholecystectomy at the institute were included in the study. Gross features of cholecystectomy   specimens were recorded. Three sections each from the neck, body, and fundus were taken. Histopathological diagnosis was correlated with demographic data. Results: Total 185 patients were included, out of which 130 were females and 55 were males, with the mean age 45 years.  180 cases associated with different types of gall stones. The most common histopathological findings were chronic cholecystitis, observed in 164 patients i.e. 88.64% followed by adenocarcinoma of gall bladder 9 patients, 7 patients with acute cholecystitis, 3 patients having xanthogranulomatous cholecystitis. Conclusion: Diseases of the gallbladder often mandate prompt surgical intervention. Chronic cholecystitis, which is an established risk factor for gallbladder carcinoma, is one of the commonest presentations. Therefore detailed and meticulous histopathological examination remains crucial in the detection of premalignant and malignant lesions.

227. TNF α 308 G/A Single Nucleotide Polymorphism in Cancer Cervix: A Risk Factor for HPV Associated Cervical Cancer
Sathiya K, Vinodkumar R P, Duraisamy R, Suganya K
Abstract
Background: Cancer cervix is the second most common cancer in females in India with multi-factorial cause. Tumor necrosis factor alpha, a pro-inflammatory cytokine is implicated in the pathogenesis of cervical cancer. Aim: To analyse the presence of Single Nucleotide Polymorphism TNF α 308 G/A and to correlate its incidence in biopsy confirmed patients of cancer cervix. Methodology: A cross sectional study which included 60 subjects with age limit of 30 to 60 years (30 study group & 30 controls). Participants were selected from OPD and inpatient ward of gynaecology department.The parameters such as FBG, Urea, Creatinine, Urine Albumin, Urine Glucose & Haemoglobin were estimated. Single Nucleotide Polymorphism in TNFα 308 G/A among the study groups were done using PCR. Result: Subjects with carrier A allele had 16.7 times higher odds of having malignancy in comparison to subjects with Allele G which is statistically significant. In univariate logistic regression, the odds of having malignancy was 1.042 with every year increase in age but this association of age was not statistically significant. Conclusion: Cancer cervix incidence is found to increase with increase in age of patients. TNF α gene polymorphism at rs1800629 is strongly associated with cancer cervix patients. The risk allele “A” and genotype “ GA/AA” is more commonly associated with cancer cervix cases than healthy controls.

228. Evaluation of Serum Gamma Glutamyl Transferase Levels in Pre Eclampsia Cases
P. Ravisekar, K. Sathiya, T. Kavitha
Abstract
Background: Preeclampsia is a Pregnancy Specific Syndrome characterised by Hypertension with BP 140/90 mm Hg or more, Proteinuria and edema contributing significantly to Maternal and Foetal Morbidity and Mortality. Endothelial cell dysfunction within the Uteroplacental circulation leads to systemic release of Gamma Glutamyl Transferase (GGT). Aim and Objectives: The main aim of this study is to compare the levels of Serum Gamma Glutamyl Transferase (GGT) levels in pre eclampsia patients and normal pregnancy patients and also to predict the severity of pre eclampsia with GGT. Materials and Method: This case control study was done from November 2017 to January 2018 at Mahatma Gandhi Memorial Government Hospital, Trichy, 30 pre eclampsia patients and 30 normal healthy normotensive pregnant women (controls) were enrolled in the study. All the cases were selected in the third trimester and belongs to the age group 19-35year. Cases with any medical history of hypertension, diabetes, renal disease, liver disease were excluded from the study. Controls were selected from the patients regularly attending the Antenatal clinic (ANC) and Preeclampsia cases were selected from the patients admitted in the ANC ward. The statistical analysis was performed using SPSS version 16. Results and Conclusion: The results were presented as a mean ± SD and p value of less than 0.001 is considered as significant. In our present study, the Serum GGT levels is found to be significantly increased in Pre- eclampsia Patients compared to Normal Pregnant Women with a p value ˂0.001. GGT is also useful in predicting the severity of pre eclampsia.

229. Evaluation of Renal Dysfunction in Patients with Liver Disease to Identify Hepatorenal Syndrome
Amit Mehta, Gaurav Sharma, Navgeet Mathur, Ravi Mangalia, Shubham Agarwal, Divyang Shaileshbhai Patel
Abstract
Background: Acute renal injury can be due to hepatorenal syndrome that can occur in people with acute or chronic liver illness. The objective of present study was to evaluate renal dysfunction in patients having liver disease to identify HRS. Methods: This prospective observational study was conducted on patients of liver disease admitted in medicine ward and gastroenterology ward of tertiary care teaching hospital. Patients aged more than 18 years with clinical biochemical or ultrasonographic features of liver disease admitted to hospital were included. Central venous pressure and other investigations to exclude diseases causing liver and renal failure was performed on day of admission and patients were followed up every month till 6 months. Other relevant biochemical investigations were done to diagnose hepatorenal syndrome. Results: Total seventy consecutive patients with liver disease were enrolled.  Overall, hepatorenal syndrome was present in 27.14 percent of the patients. Among them, hepatorenal syndrome-1 and hepatorenal syndrome 2 was seen in 24.28 percent and 2.86 percent of the patients respectively. Among the 19 patients with hepatorenal syndrome, mortality was seen in 68.42 percent of the patients while among the remaining 51 patients without hepatorenal syndrome, mortality was seen in 15.68 percent of the patients. Significantly higher mortality rate was associated among patients with hepatorenal syndrome. Conclusion: This study concluded that patients with liver disease who have HRS have a substantial mortality rate. Therefore, early diagnosis and treatment can lower the rate of HRS-related mortality in patients with hepatic disorders.

230. Magnetic Resonance Imaging in Evaluation of Musculoskeletal Tumors
Nath A, Pegu BJ, Kutum T
Abstract
Bone tumors and tumor-like lesions are frequently encountered by radiologists. Although radiographs are the primary screening technique, magnetic resonance imaging (MRI) can help narrow the differential or make a specific diagnosis when a lesion is indeterminate or shows signs of aggressiveness. MRI can extend the diagnostic evaluation by demonstrating several tissue components. Even when a specific diagnosis cannot be made, the differential diagnosis can be narrowed. MRI is superior to the other imaging modalities in detecting bone marrow lesions and tumoral tissue (faint lytic/sclerotic bone lesions can be difficult to visualize using only radiographs). Contrast-enhanced MRI can reveal the most vascularized parts of the tumor and MRI guidance makes it possible to avoid biopsing necrotic areas. MRI is very helpful in local staging and surgical planning by assessing the degree of intramedullary extension and invasion of the adjacent physeal plates, joints, muscle compartments and neurovascular bundles. It can be used in assessing response to neoadjuvant therapy and further restaging. The post-therapeutic follow-up should also be done using MRI. Despite the high quality of MRI, there are a few pitfalls and limitations of which one should be aware. Applications of MRI in bone tumors will probably continue to grow as new sequences are further studied.

231. Comparison between Ultrasound-Guided Rectus Sheath Block and Local Anesthetic Infiltration of the Surgical Site for Post-Operative Analgesia in Adult Cancer Patients Undergoing Palliative Abdominal Surgery
Marie Ninu, Sonai Datta Kakati, Anupam Das
Abstract
Introduction: Minimally invasive palliative surgeries in oncology like diversion colostomy and feeding jejunostomy can cause moderate to severe pain in the postoperative period. Local anesthetic infiltration of the surgical wound is useful for providing post-operative analgesia but has a short duration of action. Rectus sheath block provides somatic analgesia for abdominal wall vertical midline surgical incisions. The ultrasound-guided rectus sheath block is a good modality for pain relief due to the reduced complications and relatively high success rate. This study aimed to compare the analgesic efficacy, duration of analgesia, rescue analgesia, adverse effects and patient satisfaction between bilateral ultrasound guided rectus sheath block and local anesthetic infiltration on adult cancer patients undergoing palliative abdominal surgery. Methodology: Following approval by the Institutional Ethical Committee, a prospective randomized controlled study was conducted in a tertiary cancer centre between September 2021 to August 2022. 60 adult patients of either sex and ASA I or II classification, who underwent colostomy or feeding jejunostomy with midline incisions were divided into two groups. Group A (RSB group) received bilateral ultrasound-guided rectus sheath block with 0.2ml/kg of 0.25% ropivacaine following the administration of general anaesthesia and group B received local anaesthetic infiltration with 0.25% ropivacaine, 0.2ml/kg towards the end of surgery. Pain was assessed by VAS score at 0, 2, 4, 6, 8 and 24 hours. Time to initial rescue analgesia following block (hours), frequency of side effects and patient satisfaction as determined by the Quality of Recovery-15 questionnaire were the secondary outcomes studied. Results: In both the groups, patient characteristics, diagnosis, ASA status, intraoperative vitals and the type and duration of surgery were comparable. Compared to the LA group, the VAS score of RSB group was significantly lower in the immediate post operative period from 2h post operative to 8h post operative (p&lt;0.001). RSB group had a longer time to first rescue after block compared to the LA group (p=0.0098). In a 24-hour period, the RSB group required fewer rescue doses than the LA group (p&lt;0.001). Three patients in each group developed adverse effects. Patients were more satisfied in RSB than the LA group (p&lt;0.001) as measured by QoR 15 score. Conclusion: Ultrasound guided rectus sheath block is an efficient, simple and secure method of providing analgesia to cancer patients undergoing lower abdominal surgeries.

232. A Comparative Study of Functional Outcome of Dynamic Hip Screw Platting Versus Proximal Femoral Nailing in Intertrochanteric Fractures of Femur in Adults
Sagar Nakum, Rohan Doshi, Jasraj H Kothari
Abstract
Background and Aim: Intertrochanteric fractures are one of the most common and most devastating injuries in the elderly. In young patients, it generally occurs due to high velocity trauma. The incidence of these fractures has increased with the advancing age. Due to improved treatment, early ambulation is possible and better functional outcome is achieved with reduction in morbidity rates. Aim of the present study is to compare the Functional Outcome of Dynamic Hip Screw Platting Versus Proximal Femoral Nailing in Intertrochanteric Fractures of Femur in Adults. Material and Method: We have followed 50 cases of intertrochanteric fractures treated by early surgical fixation with 14 patients treated with dynamic hip screw platting and 36 patients treated with proximal femoral nailing. Functional outcome and complications were compared between both the groups. Functional outcome was assessed using Harris Hip Score. Result: Most patients were between the age of 60-69 yrs, Tronzo type 3 was the most common type of fracture classification during the whole study. Out of 14 patients operated with dynamic hip screw platting; 57.14%, 21.43%, 14.27% and 7.14% of patients had excellent, good, fair and poor Harris Hip scores. Out of 36 patients treated with proximal femoral nailing; 72.22%, 16.67%, 8.33% and 2.78% of patients had excellent, good, fair and poor Harris Hip scores. Of all these patients, 5 had limb length discrepancy, 1 had lag screw pullout, 4 had infection, 2 had malunion and 2 had delayed union in terms of complications. Conclusion: No any device is superior over the other in the treatment of intertrochanteric fractures of femur. As the number of patients involved in our study is less, there is larger confidence interval and the results can be biased and skewed. Overall, larger number of randomized control trials that include patient reported outcomes are needed to more accurately compare the outcomes of patient treated with proximal femoral nailing and dynamic hip screw platting.

233. Study of Clinical Features, Laboratory Profile, Radiological Features and Risk Factors of Sputum Positive Previously Treated Pulmonary Tuberculosis Patients
Yash Gabhawala, J. N. Patel, Kuldeep Chavda, Prashant Gohil
Abstract
Background and Aim: Mycobacterium Tuberculosis have played extremely important role in influencing society throughout its history. Nearly one third of global population, i.e. two billion people is infected with Mycobacterium Tuberculosis and is at risk of developing tuberculosis. More than eight million people develop active tuberculosis every year and about two million die. Post primary TB arise from endogenous reactivation of latent foci or exogenous re-infection. Material and Methods: The present study carried out in the Department of Pulmonary Medicine, C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India. In this study total 132 patients of adult age and either sex were included, admitted in department of pulmonary medicine ward or attended OPD during period of March 2021 to August 2022. Results: In This Study Most common symptom of previously treated pulmonary TB is cough. Patients with co-morbidities like diabetes and HIV had more chances of recurrence. Most of the patient had anemia and raised ESR. Cavitations and Fibrosis were common radiological findings. Conclusion: Male preponderance with peak age of disease was noted in 40 to 60 years age group. Majority of patients had symptoms of Cough with or without expectoration, followed by fever and Breathlessness. Co-morbidities like diabetes mellitus and HIV are most commonly associated with the recurrence. Cavitations and fibrosis were most common radiological findings associated with right sided prepordance. More than half of the patient had anemia and raised ESR.

234. Missed Factors in Maternal Near Miss: A Critical Review of Maternal Near Miss in Tertiary Care Centre- An Observational Study
D. Joycerani, S. Agnes Synthiah, A. Sakthi Priya
Abstract
Introduction: Measuring maternal mortality is crucial for evaluating the effectiveness of healthcare services. Additionally, maternal near misses serve as important indicators of the quality of care provided to pregnant women by the healthcare system. Aim: This study aimed to review maternal near-misses in tertiary care centres. Methods: This prospective observational study was conducted on 59 patients over a year at the Department of Obstetrics and Gynaecology, Govt Sivagangai medical college. The patient’s history included age, age at first pregnancy, direct and indirect causes, risk factors, and presenting complaints. Assessments were conducted for each MNM case to evaluate the primary obstetric complications leading to a near miss. Results: Of the 59 patients, 49 were aged 20–34 years, five were aged < 20 years and five were aged > 35 years. Based on the stage of pregnancy, 32 and 27 patients were in the antenatal and perinatal stages, respectively. Based on obstetric parameters, 48 patients had no history of LSCS and 18 had a history of LSCS. Twenty-nine patients had a history of a second delay, 15 had a history of a first delay, and 15 had a third delay. Based on the factors influencing maternal near-misses, 39 patients were affected by haemorrhage and 19 were affected by indirect causes. Conclusion: Maternal near-miss morbidity is linked to factors such as maternal education, antenatal care, chronic medical conditions, prior caesarean section, and initial delay in seeking obstetric care.

235. The Prevalence of Irrational Antibiotic Prescription among the Allopathic Physicians of Urban Areas of Kerala Region, India- A Cross-Sectional Survey- A Pilot Study
Antony T, Savio Vadakutt
Abstract
Antibiotics are invaluable tools in modern medicine, yet irrational prescribing practices contribute to antimicrobial resistance (AMR) globally in addition to the increased burden of treatment cost, which affects the socioeconomic status of the region. With the primary objective to determine the frequency of irrational antibiotic use, this study investigates the prevalence and determinants of irrational antibiotic prescriptions by allopathic physicians in urban regions of Kerala, India, shedding light on factors influencing this concerning trend and proposing strategies for mitigation. The Authors randomly collected one hundred prescriptions for the antibiotic agents from the urban area of Kerala, a Southern state of India, and conducted a prescription audit. The study proves the majority of allopathic antibiotic prescriptions detail rational dose, dosage frequency, and duration of treatment, according to the condition(s) mentioned in the document.

236. Antibiotic Resistance Patterns in Paediatric Microbial Infections: A Microbiological Surveillance Study
Neetu Srivastava, Abhinav Gaurav
Abstract
Background: Since antibiotic resistance is bad for kids’ health, we need to look into patterns of antibiotic resistance in more detail. The main topic of this study that looks back is antibiotic resistance in microbial infections. The study is mostly about differences in the disease between places and between children ages one month and eighteen who are more likely to get it. Methods: Microbiological surveillance was used to find patterns of resistance in 250 pediatric cases. Information about the patients, the pathogens they had, how well they responded to antibiotics, and other important information was gathered. According to statistics, the effect of age and location on resistance was looked into. Results: A review of 250 pediatric cases from the past showed that the cases were evenly split between boys and girls and mostly involved kids between the ages of one and five. It was 40% more difficult for Pseudomonas aeruginosa to grow in urban areas. Children younger than five years old were more resistant to many pathogens. In 30% of the cases, comorbidity analysis showed that other medical conditions were going on. The above results show how complicated antibiotic resistance is in microbial infections that affect kids. They also show how important it is for targeted interventions that take differences in age and location into account. Even more research is needed to figure out the mechanisms and factors. Conclusion: Antibiotic resistance in children needs to be fought right away and on an individual level, according to the study. Previous studies have also found that methods should be changed to fit different age groups and geographical areas. Our results back this up. To find out what might work in the future for long-term pediatric healthcare practices, we need to do long-term research. These studies should also look at how molecules work.

237. Comparative Study between Combined Sciatic-Femoral Nerve Block and Subarachnoid Block in Lower Limbs Surgeries
Arun Kumar, Amit Kumar, Chittaranjan Mandal
Abstract
Background: Subarachnoid blocks are the most popular method of administering regional aesthetic for procedures involving the knee and lower extremities. The possible benefits of a combined sciatic-femoral nerve block, however, make it an alternative that deserves investigation. Methods: Fourty adult patients, ranging in age from 18 to 65, who were scheduled for knee or below knee surgery were randomly assigned to either Group A (which involved a subarachnoid block) or Group B (which involved a combination sciatic-femoral nerve block). Contrasted with Group A’s 12 mg of 0.5% hyperbaric bupivacaine, Group B’s sciatic and femoral blocks were each administered 20 and 30 ml of 0.5% ropivacaine, respectively. Results: Compared to the separate sciatic and femoral groups, those undergoing combined preparation and preparedness for surgery took substantially longer. The subarachnoid group achieved a perfect block rate of 100%, but the sciatic-femoral group achieved an impressive 80% success rate. Statistical analysis revealed that the subarachnoid group had higher pulse rate and significantly lower systolic and diastolic blood pressures before to surgery. Within the first day following surgery, the combined sciatic-femoral group needed less analgesic overall and less analgesic duration. Conclusion: Both methods were problem-free. Although the combined sciatic-femoral block had a slightly lower success rate than the subarachnoid block, it had benefitted such as longer analgesia and less need for postoperative analgesics. Success rates and postoperative analgesic results should be considered while choosing between these approaches.

238. Longitudinal Study of Operative Time, Intra-Op and Post-Op Bleeding of Transanal Suture Rectopexy for Hemorrhoids with Conventional Miligan Morgan Open Hemorrhoidectomy
Deepak Thakur, Deepshikha Mishra
Abstract
To compare the transanal suture rectopexy (TR) with conventional Milligan-Morgan hemorrhoidectomy (MH) in patients of grade II, III and IV hemorrhoids. Methods: From March 2018 to October 2019, 60 patients of hemorrhoids from grade II to IV were randomly selected to undergo either the transanal suture rectopexy (n= 30) or the Milligan-Morgan hemorrhoidectomy (n=30). Results were analyzed during postoperative period and at 1 month. Operative time, post-operative complications, resolution of symptoms and recurrence were taken as variables. Data was analyzed by Open EPI version 2.3. Results: Both the groups were comparable in terms of demographic data. Bleeding per rectum was the major symptom. TR group had more operative time and less intra-op blood loss, post-operative bleeding, pain, anal incontinence, hospital stay and recurrence than MH group. Data was statistically significant (p-value<0.05). In MH group, 16 patients developed postoperative bleeding while this was only 2 in TR group. In MH group 2 patients developed anal incontinence while there were none in TR group. In MH group 6 patients came with prolapse and 7 patients came with bleeding per rectum at 1 month follow up, while count was only 1 in TR group. Conclusion: Transanal suture rectopexy is unique and simple stitching technique appropriate for treating all the grades of hemorrhoids. It offers cheaper, ambulatory and effective alternative to costly newer modalities for the treatment of hemorrhoids. It is better accepted by the patients. More studies are needed to declare it as a standard procedure for the cure of haemorrhoids.

239. Prediction of Morbidity and Mortality after Early Cholecystectomy for Acute Calculous Cholecystitis
Prashant Kumar, Abhinav Kumar, Ashutosh Patel
Abstract
Background: Early cholecystectomy is often recommended for acute calculous cholecystitis to reduce morbidity and mortality. However, the outcomes of this approach can vary depending on factors such as patient demographics, comorbidities, and surgical techniques. This study aims to assess the morbidity and mortality rates following early cholecystectomy for acute calculous cholecystitis in patients treated at Netaji Subhas Medical College and Hospital, Bihta, Bihar. Materials and Methods: A retrospective cohort study was conducted on patients who underwent early cholecystectomy for acute calculous cholecystitis at Netaji Subhas Medical College and Hospital between January 2023 and December 2023. Data regarding patient demographics, comorbidities, surgical approach, perioperative complications, and postoperative outcomes were collected and analyzed. Morbidity and mortality rates were calculated, and factors associated with adverse outcomes were identified using appropriate statistical methods. Results: A total of 150 patients were included in the study, with a mean age of 52 years (range: 20-75 years). The majority of patients were female (65%) and presented with comorbidities such as hypertension (30%) and diabetes mellitus (20%). Laparoscopic cholecystectomy was the most common surgical approach (80%), followed by open cholecystectomy (20%). The overall morbidity rate was 15%, with surgical site infection being the most common complication (8%). The mortality rate was 2%, with causes including septic shock and multiorgan failure. Older age, presence of comorbidities, and open surgical approach were identified as significant risk factors for adverse outcomes (p < 0.05). Conclusion: Early cholecystectomy for acute calculous cholecystitis at Netaji Subhas Medical College and Hospital is associated with low morbidity and mortality rates. Laparoscopic approach is preferred whenever feasible to minimize complications. However, older age and comorbidities remain important predictors of adverse outcomes and should be carefully considered in treatment planning and perioperative management.

240. In Vitro Comparison of Guided Versus Freehand Implant Placement: use of A CBCT
Rakesh Sharma C, Vinay Kumar. K, Thanuja Ramadoss, Alisha Crisa Aranha,  Hemanth Kumar H R
Abstract
Background: Implant dentistry has evolved significantly, with guided implant placement emerging as a promising technique. This study aims to compare the accuracy and efficacy of guided implant placement against freehand techniques using Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: Twenty patients from SIMS Department of Dentistry, requiring single-tooth implants were randomly assigned to either the guided implant placement group or the freehand placement group. CBCT scans were utilized for treatment planning and assessment of implant placement accuracy. Surgical guides were fabricated for the guided group based on preoperative CBCT data. Implant placement deviations were measured in three dimensions: mesiodistal, buccolingual, and apicocoronal. Results: In the guided group, the mean deviation in implant placement was 0.75 mm mesiodistally, 0.5 mm buccolingually, and 0.3 mm apicocoronally. In contrast, the freehand group exhibited a mean deviation of 1.5 mm mesiodistally, 1.2 mm buccolingually, and 0.8 mm apicocoronally. Statistical analysis revealed significantly lower deviation values in the guided group across all dimensions (p < 0.05). Conclusion: Guided implant placement utilizing CBCT technology offers superior accuracy compared to freehand techniques. The use of surgical guides allows for precise implant positioning, minimizing deviations and enhancing clinical outcomes. Incorporating CBCT into treatment planning enhances predictability and facilitates optimal implant placement.

241. Prevalence of Temporomandibular Disorders’ Signs and Symptoms and Chewing Ability in Patients with Prosthodontic Prostheses
Alisha Crisa Aranha, Thanuja Ramadoss, Vinay Kumar K, Rakesh Sharma C, Hemanth Kumar H R
Abstract
Background: Temporomandibular disorders (TMD) are commonly associated with prosthodontic prostheses, impacting chewing ability and overall oral health. Understanding the prevalence of TMD signs and symptoms among patients with prosthodontic prostheses is crucial for effective management. Materials and Methods: A cross-sectional study was conducted among 150 patients in SIMS Department of Dentistry with prosthodontic prostheses, assessing TMD signs and symptoms using standardized diagnostic criteria. Chewing ability was evaluated through self-reporting and objective measures. Data were analyzed using descriptive statistics and chi-square tests. Results: Among the participants, 65% exhibited signs and symptoms indicative of TMD, with 42% reporting pain during mastication. Limited mouth opening was observed in 28% of cases. Additionally, 55% reported difficulties in chewing tough or sticky food items. Objective assessment revealed a significant correlation between TMD symptoms and chewing impairment (p < 0.05). Conclusion: The study highlights a high prevalence of TMD signs and symptoms among patients with prosthodontic prostheses, adversely affecting chewing ability. Early identification and management of TMD in this population are essential to improve oral function and overall quality of life.

242. Assessment of Prescribing Pattern and Drug Use in Outpatient Department of Pulmonary Medicine at District General Hospital of Central India
Prabhakar Singh, Sanjay Tandon, Jitendra N. Chaturvedi, Balvir Singh, Raj Narayan Tiwari, Shubhanshu Kashyap, Anoop K. Patel
Abstract
Aims & Objectives: To access the prescribing pattern and use of drugs by using WHO prescribing indicators among patients visiting to the Outpatient department of pulmonary medicine. Material and Methods: Study was conducted in the department of pulmonary medicine, PCMS & RC and District hospital, Rewa, MP between Oct-23 to Dec-23. The data were collected randomly, after taking the consent from patients who attending outpatient department. The collected data were coded and analyzed by using SPSS version 21. Results: Total 383 prescriptions were analyzed; most of the prescriptions were belongs to 31-40 yrs of age group. Most of (41.51%) patients were present with URI (viral infection) followed by allergic rhinitis. Among total (1846) prescribed drugs; maximum, 17.65% were antiulcer drugs followed by multivitamins (16.46%). The cefpodoxime-200mg was the most frequently (39.17%) prescribed antibiotic followed by azithromycin-500mg (25.80%). The average number of drug per prescription was 4.81 and 100% of drugs were prescribed from essential medicine list of India and WHO. Of total prescribed drugs 97.5% were prescribed by their generic name. “Dose and dosage forms” were not mentioned (one or more drugs of each prescription) in 76.38% and 27.95% and signature of that the prescribing pattern, use of drugs and the number of prescribed drug per encounter were considerable deviated from the standards recommended by the WHO. On the other hand, generic prescribing and prescribing from the essential drug list were fulfil WHO criteria; hence it is necessary to make time to time an educational programme for prescribing physicians.

243. Study of Obesity in Children of Age Group 10 To 13 Years
Gouri Rajput, Uday Chandrapalsing Rajput, Saurabh Mutha
Abstract
Obesity is increasing at an alarming rate throughout the world. Today it is estimated that there are more than 300 million obese people world-wide.  Obesity is a condition of excess body fat often associated with a large number of debilitating and life-threatening disorders. It is still a matter of debate as to how to define obesity in young people. Overweight children have an increased risk of being overweight as adults. The aim of this study was to estimate the prevalence of Overweight and Obesity among 100 children of 10-13 years in an Urban India. Weight and height of the subject were taken and body mass index (BMI) was calculated. All subjects from the selected age group 10 to 13 years of both gender were interviewed. Each interview was done for 15 minutes. Questions were asked regarding pattern of eating, screen time, dietary pattern, and frequency of intake of junk food. 62% subjects were normal weight,15% were overweight, 23% were obese. Males were more overweight and obese than females. Awareness amongst parents on obesity and its complications is need of the hour, and routine screening for obesity on OPD basis by healthcare professionals should be done. Inculcating good habits like healthy balanced diet, daily physical activity, can be included in school curriculum.

244. To Evaluate the Role of Early Laparoscopy in Diagnosis of Acute Abdominal Pain in Tertiary Medical College and Hospital
Jai Prakash Sinha, Kunal
Abstract
Background: The majority of general surgery workload is comprised of emergency admissions for acute non-specific abdominal pain. The most popular approach previously was hospitalization followed by active clinical observation; however, this approach carries a risk of problems for patients, such as infertility and peritonitis, as well as needless laparotomy. Aside from the financial advantages, laparoscopy integration has enhanced the handling of emergency admissions. A comparison between early laparoscopy and clinical observation in cases of acute abdominal pain was done as part of the study to assess the role of early laparoscopy in the management of acute non-specific abdominal pain. Methods: Fifty patients with normal baseline tests and acute nonspecific abdominal pain were included in the study. For early laparoscopy (Group I) and clinical observation (Group II), patients were divided up at random. Within eighteen hours, an early laparoscopy was performed to confirm the diagnosis, and if possible, simultaneous intervention was carried out. Interventions, empirical treatment, and serial investigations were used to manage the clinical observation group. Records included postoperative hospital stay, complications associated to laparoscopy, hospital readmission, ultimate diagnosis, and response rate. Results: The M:F ratio was 1:2.1, and the average age at presentation was 30.5±12.9 years. Twenty to forty year olds made up 62% of the cases. The three most frequent presenting symptoms were vomiting, nausea, and discomfort. Appendicitis (32%), bands and adhesions (20%), and gynecological pathology (24%), were the results of the laparoscopic examination. Group I exhibited a lower average radiation exposure (p<0.01), a lower VAS score on days 1, 3, 5, and 7 (p<0.01), a lower average necessity for injectable antibiotics (p<0.01), a lower average requirement for injectable analgesics (p<0.01), a lower NBM status (p<0.01), and a shorter hospital stay (p<0.01). At three months (48%), six months (16%), and twelve months (8%), Group II had a higher readmission rate and recurrence rate. In 92% of cases, the final diagnosis was made. Conclusion: In the therapy of acute nonspecific abdominal pain, an early laparoscopy is helpful. It reduces the frequency of needless laparotomies, allows for early patient release, and provides substantially high diagnostic accuracy.

245. Analysis on Incidence and Etiology of Abdominal Surgical Site Infections among Emergency Postoperative Patients in Tertiary Medical College and Hospital
Jai Prakash Sinha, Kunal
Abstract
Background: Surgical Site Infections (SSI) is a common post-operative consequence that occurs worldwide. On the other hand, published statistics on SSI patterns in developing nations such as India are quite scarce. The purpose of this study is to determine the prevalence of abdominal surgical site infections in emergency postoperative patients, as well as their etiological variables. Methods: A total of 112 patients who were admitted to the Jawaharlal Nehru Medical College and Hospital’s surgical department in Bhagalpur, Bihar, between October 2022 and September 2023 were included in this prospective study. With each patient’s agreement, a series of enrollments was made, and preoperative, intraoperative, and postoperative data were gathered. The pus and wound discharge were gathered and sent for sensitivity testing and culture. Version 20.0 of the SPSS software was used for the statistical analysis, and a P-value of less than 0.05 was considered statistically significant. Results: 15.2% was the total incidence of SSI. More men (64.7%) than women (35.3%) are impacted. Most SSI cases (41.2%) were associated with appendectomy cases and underweight patients (47.1%). Between the second and seventh post-operative day, all SSIs are discovered. The majority of wounds are unclean, contaminated, and clean-contaminated. The risk of SSI rises when a surgical procedure takes longer than three hours. The most common organism was E. Coli (82.4%), which was followed by Staphylococcus aureus (5.8%) and Klebsiella pneumoniae (11.8%). Maximum sensitivity patterns were observed for amikacin (100%), levofloxacin (93.2%), and doxifloxacin (92.3%), whereas high resistance (100%) was observed for routinely used medications like ceftriaxone and cefuroxime. Conclusion: In this tertiary hospital, the prevalence of SSI is really high. The main organism in charge is E. Coli. In our institution, the most effective drugs against the microorganisms that cause SSI are amikacin, levofloxacin, and moxifloxacin.

246. Biochemical Markers of Birth Asphyxia in Neonates and Its Outcome
Prahlad Prasad Gupta, Amrita, Sude Kumar Singh
Abstract
Background: Due to unattended deliveries in rural regions, perinatal asphyxia contributes for over 29% of newborn mortality in developing countries. Even with following the recommended standards, the majority of deliveries have unsatisfactory results. This study aims to investigate the various clinical manifestations of birth asphyxia and associated biochemical derangements. Methods: This prospective study, which included 58 term neonates admitted to the neonatal intensive care unit with definite histories suggestive of perinatal hypoxic insult, was carried out from February 2023 to July 2023 in the Department of Biochemistry in collaboration with the Department of Pediatrics, DMCH, Laheriasarai, Bihar. Microsoft Excel Ver. 20 software was used to analyze the collected history, clinical characteristics, and pertinent investigations (random blood sugar, serum creatinine, blood urea, and serum electrolytes). Results: In every stage, vaginal births were more prevalent. All newborns, with the exception of those with hypoxic-ischemic encephalopathy (HIE) I, had abnormal neonatal reflex. All HIE II neonates had convulsions, primarily multifocal seizures, whereas only 22.2% of HIE III babies experienced seizures. HIE III patients had oliguria (77.8%) and congestive heart failure (55.17%), and 22 cases (37.9%) experienced acute kidney damage. As the degree of hypoxia increased, hypoglycemia was seen (HIE III 26.67 ± 2.78). In HIE III, serum urea, creatinine, and potassium increased considerably whereas sodium and calcium decreased. Conclusion: Clinical and supporting laboratory markers together can be utilized to monitor patients and direct early intervention to reduce morbidity and mortality.

247. Study of Biochemical Markers in Non-Alcoholic Fatty Liver Disease
Prahlad Prasad Gupta, Amrita, Sude Kumar Singh
Abstract
Background: NAFLD, or non-alcoholic fatty liver disease, is a horrifying public health issue. Affluent societies are thought to have the highest prevalence of chronic liver disease, which affects 2-10% of the general population and includes a wide spectrum of conditions from simple steatosis to nonalcoholic steatohepatitis (NASH) in adults and children. The purpose of the current investigation was to evaluate the biochemical markers in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Twenty-five normal individuals and 75 NAFLD patients had their biochemical parameters examined. The use of abdominal ultrasonography in diagnosis established the presence of hepatic steatosis. Every patient with a NAFLD diagnosis had their biochemical parameters examined, and the association between the condition and control was examined. Results: When comparing the non-fatty liver control group to the NAFLD patients, all biochemical parameters showed increases, and the differences were found to be statistically (P value less than 0.005) significant. Conclusion: In NAFLD patients, alterations in biochemical markers are linked to the disease. Early identification will be key to changing the course of the disease, postponing consequences, and contributing significantly to preventive cardiology.

248. Effect of Structured Training Program on Knowledge Regarding Radiation Safety Practices among Technical and Supporting Staff Handling Portable X-Ray Machines at a Tertiary Care Hospital in Garhwal Region of Uttarakhand
Indira Yadav, Sanjay Singh Rai, Deepshikha Pandey, Sunita D Singh, Daulat Singh, Mukesh Shukla
Abstract
Context: Portable radiography devices are utilized routinely for radiological examinations who are hospitalized, necessitating healthcare workers to possess knowledge and follow radiation safety practices. Aims:  The study was conducted to determine the effect of structured training program on knowledge regarding radiation exposure and its preventive measures among technician and supporting staff while working on portable X-ray machines in indoor settings. Subject and Methods:  A hospital based cross-sectional study was conducted among radio-technicians, nursing officers and supporting staffs who were directly involved in the process of handling and operation of portable x -ray machine. A pre-tested semi structured questionnaire was administered to all healthcare workers who consented to participate. Radiation safety practices were assessed using observatory checklist. The knowledge and practices were reassessed after three months of structured training program. Statistical analysis used: The difference in pre- and post-training knowledge and practices was assessed using paired t-test, and McNemar’s test was used for paired categorical data analysis. P < 0.05 was considered to be statistically significant. Results: Of 60 subjects enrolled in study, 22 (36.6%) were radio technicians, 20 (33.3 %) nursing officers and 18 (30.0%) were supporting staffs. Baseline knowledge score of radiation hazard and radiation protection was found significantly higher among radio technicians (7.27±2.45) as compared to nursing officer (6.28±2.01) and the supporting staff (5.31±1.20). Post-training knowledge scores were significantly higher among nursing officer and supporting staffs as compared to baseline. Favourable change in practices of supporting staff for use of thyroid shield and lead gloves was observed. Conclusions: Portable radiological examinations did not expose healthcare providers to high doses of ionizing radiation. Nurses’ radiation protection knowledge was limited and hence, they require in-service education programs.

249. Assessing Cognitive Impairment and Dementia in the Elderly Population of Chengalpattu District: A Community Based Cross Sectional Study
Raja T. K, A. Surekha, R. Karnaboopathy, Rajalakshmi. R, K. Iswariya, Janaarthanan, Kumudha G, Prasanth. K, Keerthana S
Abstract
Dementia, one of the major geriatric challenges, remains largely unrecognized in India, with over 90% of cases going unidentified due to limited physician knowledge and documentation. To address this issue, the objective of our study was to assess the prevalence of cognitive impairment and dementia among elderly patients in a rural area of Chengalpattu district, using the Mini-Mental State Examination (MMSE) and Picture Memory Impairment Screen (PMIS). Furthermore, we aimed to identify factors associated with cognitive impairment and dementia in this population. Methods: A community-based cross-sectional study was conducted between February 2023 and June 2023, involving 174 elderly individuals in the rural area of chengalpet district. Prior to the study, informed consent was obtained from all participants. The assessments were carried out using the Picture Memory Impairment Screening test and the Mini-Mental State Examination Questionnaire. Results: Out of the 174 study participants, 73% were female and 27% were male. The prevalence of dementia and cognitive impairment, as identified by PMIS and MMSE, was 22.4% and 40.8%, respectively. Notably, we observed a significant association between dementia and a history of co-morbidity, and another notable correlation between MMSE scores and the financial dependence of elderly individuals. Conclusion: Our study reveals a concerning prevalence of dementia and cognitive impairment among the elderly population in rural areas, highlighting the urgent need for early screening and proactive primary care for this vulnerable group. The combined use of PMIS and MMSE scoring can serve as valuable tools for further evaluation and management of dementia cases. By addressing this issue proactively, we can improve the quality of life for elderly individuals and promote overall well-being in our aging population.

250. Assessing the Knowledge Attitude Practice of COVID-19 among the General Population in India: A Community Based Cross Sectional Study
R. Karnaboopathy, Surekha A, V. Pragadeesh Raja, T. Muthukumar, Raja T.K., R. Rajalakshmi, K. Iswariya, Janaarthanan, Kumudha. G, Prasanth. K, Keerthana. S
Abstract
Background: The COVID-19 pandemic in India is a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case of COVID-19 in India, which originated from China, was reported on 30 January 2020.The most common symptoms of COVID-19 are Fever, Dry cough and Fatigue. Methods: A cross sectional study was conducted among 307 participants to study the knowledge, attitude and practice of COVID 19 among general population of India. The study was done by using a pre- tested, semi structured questionnaire to collect data from the participants through Google Forms. Descriptive statistics were used for statistical analysis. Result: In the study population 59% (181) were male and 41% (126) were female in the study. Among the study participants 26.7% (82) were in the age group of between 20-30 years, the mean age of the study participants is 31.12± .96.Among the study participants 72% (221) were educated up to post graduate, 26.1% (80) were educated up to diploma and under graduate. The place of residence of the study participants were distributed among various states in India with the majority coming from rural areas is 54.4%, the study participants from Tamilnadu 87.3% (268), and remaining are Pondicherry 3.3% (10) and other states. Among the study participants, about 4.6 % have been affected by COVID 19 and the remains are free from COVID 19, the study participants 29.3% (90) were in vaccinated and the remaining peoples are not vaccinated. Conclusion: The study provides valuable insights into the knowledge, attitudes, and practices of COVID-19 among a diverse sample of participants in India. The findings underscore the importance of targeted health education interventions to address knowledge gaps and promote adherence to preventive measures.

251. To Study Clinical Profile and Role of Patch Testing and Histopathological Microscopic Examination in Contact Dermatitis (CD) Due to Use of Cosmetics
Vivek Singh, Sanjeev Kumar, Meghna Walia, Mehak Jindal
Abstract
Background & Methods: The aim of the study clinical profile and role of allergens patch testing and histopathological microscopic examination in Contact Dermatitis(CD) due to use of cosmetics. A detailed history of the patients included in the study was taken. Duration and the type of occupation were noted for occupational cases of CD. Morphology of the lesions and the sites of involvement were noted down. History, symptoms and signs suggestive of Atopy were noted down. Past history of the patient for similar complaints were asked for. History of any drug intake prior and after onset of lesions is noted down. All the patients were subjected to blood investigations namely routine hemogram and blood sugar. Results: The chi-square statistic is 11.4301. The p-value is .022133. The result is significant at p < 0.05. Conclusion: We conclude that necessity for patch testing with concomitant histopathological examination and careful use of cosmetics in India. Recent studies suggest increased incidence of cosmetic dermatitis and also of newer antigens that cause allergies. Patch testing along with concomitant histopathological examination is an important investigation in patients with suspected allergic contact in a growing economy like that of India where the market for cosmetics especially fairness creams and hair cosmetics is in high demand, the reports on cosmetic dermatitis are insignificant. The authors would like to make more detailed analysis and interpretation of their study to emphasize the importance of patch testing in all suspected cases and recommend use of the suspected cosmetic itself for patch testing.

252. Study on the Correlation between Hyperlipidemia and Lipoma
Ambar Prakash, Gaurav Wadhawan, Ravdeep Singh, Konark Thakkar
Abstract
Introduction: This study explores lipomas, benign tumors arising from fat cells. Lipomas, commonly found on the trunk, are usually harmless and manifest as painless lumps. While the exact cause is uncertain, potential links to stress-induced cytokines and genetic factors are explored. Lipomas, often visible, are removed for aesthetic reasons or if they affect organ function. The study also delves into familial hypercholesterolemia and Multiple Symmetric Lipomatosis, revealing associations between lipoprotein patterns, adipose tissue lipoprotein lipase activity, and abnormal lipid metabolism. The findings provide insights into lipoma development and associated genetic and metabolic factors. Aims and Objective: To find out whether the lipid profile parameters are associated with the occurrence of lipoma. Method: This observational study, conducted from September 2022 to August 2023, focused on lipoma patients and a control group of healthy individuals. Baseline characteristics, lifestyle factors, and lipid profiles were analyzed. Inclusion criteria involved patients with completed tests and no underlying chronic conditions, while exclusion criteria included incomplete data. Statistical analysis, performed using SPSS 27, employed ANOVA and t-tests, with a significance level of P<0.05. The study aimed to identify associations between lipomas and various parameters, providing valuable insights into potential risk factors. Results: The study revealed gender distribution differences between the Control and Lipoma groups, indicating a potential association between gender and lipomas. Lifestyle factors, including higher BMI, trauma history, and lower physical activity, were linked to lipomas. Lipoma patients showed elevated cholesterol, particularly LDL, and triglyceride levels compared to controls, suggesting a potential role of lipid metabolism in lipoma development. The findings underscore the need for further exploration into gender-specific risk factors and lipid metabolism’s involvement in lipomas. Conclusion: The study concluded that mainly the elevated triglyceride levels was associated with occurrence of lipoma.

253. Size-Specific Dose Estimate – A Tool for Radiation Dose Quantification and Assessment Among Renal Colic Patients in a Tertiary Care Hospital in Southern India
Nikhil Kumar, Pulagam Vamsidhar Reddy, Prakashini K, Priya PS, Arun Chawla, Ranjitha S Shetty, Basima Maisoon
Abstract
Background: The demand for well-defined CT protocols with reduced radiation dose to the patients without compromising the accuracy of the diagnostic study has been growing. Aim: The study aimed to assess and compare patient radiation dose in low and standard-dose Computed Tomography protocol by size-specific dose estimates in renal colic patients and to determine the quality and diagnostic worth of obtained images. Materials and Methods: A prospective study was conducted among180 adult patients comprising 90 cases and 90 controls over a period of 2 years. Cases included patients with renal colic who underwent low-dose Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) and controls were those who underwent plain CT abdomen and pelvis as a part of contrast study for other clinical indications. Both the groups were further divided into two groups based on their computed effective diameter (< or > 25cm). The radiation dose parameters, including size-specific dose estimate and effective dose, and image quality were tabulated and assessed using SPSS version 16.0. Results: There was a significant reduction in radiation dose descriptors in the case groups as compared to control groups by 35.6% in the group with effective diameter less than 25cmand 15.8% in the group with effective diameter more than 25 cm, in terms of effective dose, while a reduction of 30% and 7.4% was noted in terms of size-specific dose estimate, respectively without compromise in the diagnostic image quality. Conclusion: Size-specific dose estimates can be used as a standard dose descriptor of a patient’s absorbed radiation dose and has potential use in helping formulate newer CT protocol for renal colic based on the patient’s body habitus.

254. Prevalence of Audiological Impairment in Children with Cleft Palate: An Observational Study
Luzoo Prachishree, Biswakesh Panigrahy, Chandan Kumar Gantayat, Jagnyaseni Panda
Abstract
Background: Clefts of the lip, alveolus, and palate are prevalent congenital malformations, affecting various aspects of the craniofacial region. The impact of cleft palate extends beyond physical appearance, often leading to emotional, financial, and psychological challenges. Therefore, this study aims to investigate the prevalence of audiological impairment in children with cleft palate, emphasizing the importance of early detection and management. Methodology: This observational study enrolled 80 children diagnosed with cleft palate, aged between 1 and 6 years, attending the Ear, Nose, and Throat (ENT) Outpatient Department of MKCG Medical College and Hospital, Berhampur, from February 2019 to March 2020. Detailed medical histories were obtained, and each child underwent comprehensive clinical and otological examinations. Results: The study comprised 68 (85%) male and 12 (15%) female participants. Unilateral cleft palate was predominant (77.5%), followed by bilateral cleft palate (18.7%) and submucous cleft palate (3.7%). Otoscopic examination revealed signs of middle ear dysfunction in 22.5% of patients, including retraction of the pars tensa. Otitis media with effusion (OME) was the most common pathology, affecting 52.5% of children, followed by chronic otitis media in 22.5% of cases. Discussion: Consistent with previous research, our study highlights the substantial burden of middle ear disorders in children with cleft palate. Despite the predominance of facial deformity correction, auditory health remains a critical aspect of care. The observed gender disparity and high prevalence of OME underscore the need for comprehensive audiological assessment and early intervention to mitigate hearing loss risks. Conclusion: This study emphasizes the importance of thorough audiological evaluation in children with cleft palate to prevent progressive hearing loss and associated complications. A multidisciplinary approach involving ENT specialists and audiologists is essential for optimizing long-term outcomes.

255. Comparative Study on the Efficacy of Irrigating the Postoperative Fess Cavities [B/L Nasal Polyps] with Topical Nasal Solutions of Budesonide and Betamethasone
Lekha K A, Raghunath Shanbag, Rashmi Ramashesh
Abstract
Nasal polyps are benign lesions arising from the mucosa of nasal sinuses (commonly at the outflow tracts of one or more sinuses) or from the mucosa of nasal cavity. Having an uncertain etiology and a tendency to recur, they form a challenging disease to be treated. The present study compares the efficacy of irrigating the postoperative fess cavities with betamethasone and budesonide nasal douche in symptomatic relief, pain score and condition of sinonasal mucosa. A total of 30 subjects with Chronic Rhinosinusitis with nasal polyps were included in the final analysis with 15 subjects receiving Budesonide nasal douche and 15 subjects receiving Betamethasone nasal douche. The median 6 month post-operative SNOT score was 5 (IQR 4 to 6) in Budesonide group and 5(IQR 5 to 6) in Betamethasone group, with no statistically significant difference between the two groups (P value 1.00). Within each group there was statistically significant decline in the VAS score from baseline to 1 month. (P value 0.001) On comparing Modified Lund Kennedy Endoscopic grading at 6 months, Budesonide group, 2 (13.3%) participants were grade 2, 11 (73.3%) participants was grade 4 and 2 (13.3%) participants were grade 6. In Betamethasone group, 2 (14.3%) participants were grade 2 and 12 (85.7%) participants were grade 4. It was concluded that nasal irrigation of post FESS sinus cavities with diluted solutions of either budesonide or betamethasone is equally effective in providing symptomatic relief and in preventing recurrence of nasal polyps.

256. A Study on the Association between Serum Phosphorus and Carotid Intima-Media Thickness in Chronic Kidney Disease Patients
Vajed Mogal, Sandeep Sanap, Lalruatfeli
Abstract
Background: Elevated serum phosphorus emerges as a notable risk factor for increased carotid intima media thickness (CIMT), alongside established conventional risk factors. Renal impairment may further influence the elimination of phosphorus, potentially contributing to the calcification of major arteries. Aim: To establish the association between serum phosphorus levels and carotid intima-media thickness in individuals with chronic kidney disease. Material and Methods: In this prospective observational study, we studied 400 cases of chronic kidney disease to analyze carotid intima-media thickness (CIMT). Utilizing B-mode ultrasonography with a 5 MHz transducer, CIMT measurements were performed at 0.5, 1, and 2 cm below the carotid bifurcation of the common carotid artery on each side. The carotid intima-media thickness (CIMT) for both sides was computed, and statistical analysis was conducted using the average of these two values. Results: The correlation analysis between serum phosphorus and carotid intima-media thickness (CIMT) across all four stages of chronic kidney disease (CKD) yielded no statistically significant findings (p-value 0.503). However, when comparing different groups, it was found that serum phosphorus levels were the highest in stage III (4.5±1.18 mg/dl) and the lowest in stage Vd (4.5±1.18 mg/dl). Conclusion: A significant positive correlation was seen between carotid intima-media thickness and serum phosphorus levels in the overall sample. Emphasizing the correction of hyperphosphatemia may play a crucial role in preventing the progression of arteriosclerosis and mitigating vascular calcification in individuals with chronic kidney disease (CKD).

257. Outcome of Laparoscopic Hernia Repair with and Without Pseudo Sac Management
Foram Modh, Jayshriben R Majithiya, Bharatkumar M. Chaudhari, Rajeshkumar H. Majithiya, Nihal Sabbirbhai Kugasia
Abstract
Aims and Objectives: To evaluate the outcome of laparoscopic hernia repair with and without pseudo sac management. Material and Method: The study was conducted OPD of department of surgery, Banas Medical college And Research Institute, Palanpur. Results: Highest number of patients was 46-55 years. Mean age is 42.48±14.41 years. 96% patients were male and only 4% patients were female. 76% patients have bilateral site and 24% patients have unilateral site. 84% patients have given TAPP approach. Pseudo sac Fixation and Pseudo sac without Fixation was done 50%. Conclusion: There is no significant pain at 48 hours and 3 month follow up in both study group. Duration of hospital stay in fixation group is also not significant. There is more urinary retention in fixative groups but not significant. Seroma formation is most significant complication in non-fixative groups. It is statically significant. There is no recurrence.

258. Evaluation of Early Complications of Uncemented Total Hip Arthroplasty for Avascular Necrosis of Femoral Head: A Prospective Study
Amit Rahangdale, Anita Harinkhede, Surendra Kumar Padarya, Ajay Singh
Abstract
Background and Objectives: Avascular necrosis takes place by a compromised supply of blood to the bone. Fractures, dislocations, coagulopathy, long-term steroid usage, long-term alcohol use, congenital causes, and several other conditions can all contribute to it. The hip joint, or femoral head, is most affected. It can be managed in an invasive or conservative manner. For both cemented and uncemented cases of 3rd and 4th stage avascular necrosis, total hip replacement is the preferred course of therapy. The purpose of this study was to evaluate any early clinical complications that could arise from uncemented total hip arthroplasty. Material and Methods: 30 patients (34 hips) with avascular necrosis of the femoral head who underwent uncemented total hip arthroplasty between the ages of 18 and 45 are included in the study. At the moment of the discharge process, at 4 weeks, 3 months, 6 months, and 1 year, patients had been followed up prospectively, and the Harris Hip score was used to evaluate the results. Results: The Harris hip score at the last follow-up was 87.852 ±8.784 (Min. 61 and Max. 98), while the mean preoperative score was 45.088 ± 16.190 (Min. 15 and Max. 76). Mean VAS pain score at the final follow-up visit was 12.529 ± 5.748 (Min. 5 and Max. 25) and mean preoperative VAS pain score was 72.441 ± 13.614 (Min. 65 and Max. 90). Heterotopic ossification and limb length disparities were the most frequent postoperative surgical complications. Conclusion: Even though a number of joint-preserving techniques have been quite successful in certain patients, total hip replacement is still the gold standard for treating advanced stages of femoral head avascular necrosis, and following conventional surgical protocol can help prevent some complications.

259. Acne Vulgaris: Association with Metabolic Syndrome
Yaswanthi Reddy K, Shruthi Shree, Poojitha Y, Kallappa C H
Abstract
Introduction: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit resulting in lesions like comedones, papules, pustules, nodules. It is mainly caused due to androgen dependant sebum production and propiobacterium acnes proliferation. Metabolic syndrome is a cluster of condition that increases the risk of heart disease, stroke, and diabetes. Analysing the association of acne vulgaris with metabolic syndrome (MetS) is the primary aim of this study. Methods: This is a cross sectional study of 40 cases of acne vulgaris and 40 controls who are matched with age and sex. Acne severity grading was taken from IADVL 5Th ed textbook of Dermatology. We used the criteria for the diagnosis of Met S according to the joint consensus of 2009. Results:  Grade 2 acne vulgaris is the most prevalent on clinical examination. Increased MetS observed in case group than in control group. As increased parameters of HDL, fasting blood glucose and abdominal waist circumference observed among cases. Conclusion: patients with acne vulgaris are more prone to metabolic syndrome. Therefore, carefully systemic examination and anthropometric examination is required to prevent and treat MetS in acne vulgaris patients.

260. Superficial Surgical Site Infection: An Analysis of Compliance with Good Infection Control Practices in a Tertiary Care Institute
Meenakshi Sharma, Mohd Asif Nagori, Areena Hoda Siddiqui
Abstract
Aim: To determine the incidence of SSI and evaluate the role of presurgical infection control practices in preventing superficial surgical site infection. Methodology: This study was conducted for a period of 3 months from January 2023 to March 2023. A total of 200 surgical cases were included in the study. Active surveillance for superficial surgical site infections was done along with the analysis of presurgical infection control practices. Results: The incidence of SSI in our study was 6.5 per 100 surgical cases. Surgeries done by the Obstetrics and gynecology department and Emergency surgeries were found to be significantly associated with the occurrence of SSI. Escherichia coli were the commonest pathogen, followed by coagulase-negative staphylococcus.

261. Anticonvulsant Effect of Ketamine in Electroshock and Chemo shock Seizure in Albino Rats
V Ramkumar, R Gnanasekaran, Vijay Anand Sivakumar
Abstract
Background: In this study, we wanted to evaluate the anticonvulsant effect of ketamine in electroshock and chemo shock seizure in albino rats. Methods: This was a Randomized Controlled Prospective study, parallel group designed, animal experimental study, where 42 male adult albino rats of age 7 months weighing about 150 to 200 gm were selected and conducted in the Institute of Pharmacology and Central Animal House attached Madurai Medical College, Madurai, for a period of nine months from January 2020. Results: In MES study the latency phase time were noted. The mean duration of latent phase was control I 2.66±0.747, standard I 2.5±0.5, Test I 2.83±0.687. No latent phase in test II since no seizure occurred in test II. On comparing with the control there was a no significant difference in the duration of Latent phase between the standard I (p < 0.05 ) and test group I (p < 0.05) but a significant difference in the test II (p < 0.0001) Time taken from latent to THLE duration of control group I 24 ± 1.632, Standard group I 0, Test I ±7.5±0.9573 and Test II 0 respectively. There was complete abolition of extensor phase in standard I and test II. On comparing with the control there was a significant difference in the THLE between the standard I (p < 0.00001), test group I (p < 0.00001) and test II (p < 0.0001. The mean duration of latent phase after injection PTZ were control II 67.16± 2.114 standard II 0, Test III 106.66±3.944, Test IV 104±2.516. There was complete abolition of latent phase in control group II. On comparing with the control there was a significant difference in the duration of latent phase between the standard II (p < 0.00001), test group II (p < 0.00001) and test II (p < 0.0001). Conclusion: More studies on ketamine on Refractory Status Epilepticus (RSE) and Super Refractory Status Epilepticus (SRSE) patient may be helpful to recognize ketamine as one of the first line drugs to treat Refractory Status Epilepticus (RSE) and Super Refractory Status Epilepticus (SRSE).