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, 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. Analysis of Incidence of Pregnancy Rhinitis in a Known Population: An Observational Study
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 Pingli, B. Vijay Kumar
Abstract
Background: Noise induced hearing loss (NIHL) a preventable cause of hearing is fast growing tin the student communities. 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 awareness level of noise induced hearing loss among medical students and evidence based assessment of hearing in them. Aim of the Study: To know the awareness about hearing loss among the medical students who are using PADs and their effects on the hearing mechanism of their ears; to evaluate the audiological function of these students with the help of pure tone audiometry. Materials: 110 medical students out of 463 were included and presented with a questionnaire on awareness of NIHL and their personal hearing problems. Demographic data collected along with risk factors. Type of PAD used, its duration, and volume were recorded. Objective and subjective assessment of audiological functions in them were done, all the data analysed for comparison with other studies. Results: Out of 463, 110 students 48 (43.63%) were aged between 18 and 21 years, 62 (60%) were aged 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 NOHL 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.

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