International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

Disclimer: Scopus and Crossref are registered trademark of respective companies.

This journal is member of Crossref. 

NMC Approved

Embase Indexed

1. Letrozole and Clomiphene Citrate Alone and Combine with Gonadotropins in Infertile Women – A Prospective Randomized Study
Pavitra Reddy Nalamaru, Gidigi Chandrakala, B. Aruna
Abstract
Introduction: Polycystic ovarian syndrome (PCOS) PCOS is a prevalent ovarian endocrinopathy that causes anovulatory infertility in over 80% of cases. Standard first-line ovulation induction drug clomiphene citrate (CC) has a pregnancy rate of 35%-40% with specific adverse effects. Letrozole, an aromatase inhibitor that lowers oestrogen production, may be a preferable option to CC. This research examined the efficacy of clomiphene citrate and Letrozole alone and with gonadotropins in infertile women. Materials and methods: A total of 180 women with infertility attending outpatient department of obstetrics and gynaecology between 18-35 years of age were considered. Cases were randomly allocated to 100 mg of clomiphene citrate daily group, 2.5 mg of letrozole twice daily, 100 mg of clomiphene citrate with gonadotropins and 2.5 mg of letrozole with gonadotropins. The details of number of follicles, endometrium thickness, ovulation rate, monofollicular development were recorded and analysed. Results: Polycystic ovary syndrome (PCOS) was found in 37.78% of individuals in group A and 33.33% of participants in group B. The endometrial thickness was 7.04mm and 7.66mm, in clomiphene citrate alone and with gonadotropins and 8.58mm and 9.12mm in letrozole alone and with gonadotropins respectively. Treatment with 2.5mg of letrozole alone or combined with gonadotropins resulted in significantly higher rates of ovulation and single follicle formation compared to 100 mg of clomiphene citrate alone or combined with gonadotropins (p<0.05) Conclusion: Letrozole and gonadotropin together was shown to be effective in triggering ovulation, facilitating the formation of a suitable endometrium, obtaining an optimal size for the dominant follicle, and inducing ovulation from a single follicle.

DOI: 10.5281/zenodo.

2. Analysis of Future Hearing Thresholds in Chronic Kidney Disease Patients Undergoing Haemodialysis
Kanika Arora, Stuti Shukla, Rohit Saxena, Sama Rizvi
Abstract
Background: Chronic kidney disease (CKD) significantly impacts various health aspects, including auditory functions. Haemodialysis, essential for CKD management, has been linked to complications extending beyond renal function deterioration, notably influencing hearing thresholds in patients. The study aims to examine the prospective changes in hearing thresholds among CKD patients undergoing haemodialysis to better understand haemodialysis ‘s impact on auditory function. Methods: The prospective cross-sectional study was conducted at Sharda Hospital over two years, involving CKD patients undergoing haemodialysis and matched controls not on dialysis. We utilized pure-tone audiometry for audiological assessment, classifying hearing thresholds from normal to profound loss. Statistical analyses were achieved, with significance set at p<0.05. Results: The study compared 60 participants divided into a haemodialysis group and a control group. The haemodialysis group, older on average (58.5 vs. 52.3 years), demonstrated significantly worse hearing outcomes compared to controls. Only 40% had normal hearing, versus 80% of controls, with 50% experiencing mild to moderate hearing loss, and 10% suffering severe impairments. Statistical analysis showed these differences to be significant (p < 0.001). There was a moderate correlation between longer haemodialysis duration and increased hearing loss severity (r = 0.432, p = 0.011). Additionally, poorer kidney function correlated with worse hearing outcomes (r = -0.367, p = 0.032), confirming that haemodialysis impacts auditory health significantly. Conclusion: Haemodialysis is associated with a greater prevalence and severity of hearing loss in CKD patients. The correlation between the period of haemodialysis and hearing loss severity underscores the treatment’s impact on auditory health. Recommendations: Regular audiological assessments should be integrated into the management plans for CKD patients undertaking haemodialysis to facilitate early detection and management of hearing loss, potentially enhancing their quality of life.

DOI: 10.5281/zenodo.

3. Comparison between Laparoscopy and Noninvasive Tests for the Diagnosis of Abdominal Tuberculosis
Santsevi Prasad, Apurva Agarwal, Bhartendu Kumar
Abstract
Background: Abdominal tuberculosis (TB) poses a diagnostic challenge due to its nonspecific symptoms and varied clinical presentations. Laparoscopy and noninvasive tests are commonly used diagnostic modalities, but their comparative effectiveness remains debated. Materials and Methods: A retrospective analysis was conducted on patients presenting with suspected abdominal TB between January 2018 and December 2022. Patients underwent either laparoscopy or noninvasive tests including imaging studies, serological assays, and nucleic acid amplification tests. Diagnostic parameters such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: A total of 150 patients were included in the study, with 75 undergoing laparoscopy and 75 undergoing noninvasive tests. Laparoscopy exhibited a sensitivity of 85%, specificity of 92%, PPV of 88%, NPV of 90%, and accuracy of 89%. Noninvasive tests showed a sensitivity of 70%, specificity of 78%, PPV of 72%, NPV of 76%, and accuracy of 74%. The difference in diagnostic accuracy between laparoscopy and noninvasive tests was statistically significant (p < 0.05). Conclusion: Laparoscopy demonstrates superior diagnostic accuracy compared to noninvasive tests for the diagnosis of abdominal TB. Although noninvasive tests may be less invasive and more cost-effective, their lower sensitivity and specificity may lead to delayed or missed diagnoses. Therefore, laparoscopy should be considered as the preferred diagnostic modality in cases where abdominal TB is suspected, especially in resource-rich settings.

DOI: 10.5281/zenodo.

4. Comparative Evaluation of Endoscopic Septoplasty versus Conventional Septoplasty in the Management of Deviated Nasal Septum
Sanjeev Kumar, Arun Kumar
Abstract
Background: Deviated nasal septum (DNS) significantly impairs nasal airflow and can diminish quality of life. Traditional management includes conventional septoplasty, but advancements have led to the adoption of endoscopic septoplasty, which may offer benefits over the conventional approach. Objective: This study aimed to compare the efficacy, recovery time, complication rates, and patient satisfaction between endoscopic septoplasty and conventional septoplasty. Methods: A randomized controlled trial was conducted at Lord Buddha Koshi Medical College & Hospital, Saharsa, involving 103 patients with clinically and radiologically confirmed DNS. Participants were randomly assigned to undergo either endoscopic septoplasty (n=52) or conventional septoplasty (n=51). Outcomes measured included recovery time, complication rates, and patient satisfaction over a 12-month follow-up period. Results: Endoscopic septoplasty resulted in a significantly shorter mean recovery time (18 days vs. 24 days), lower complication rates (4.8% vs. 13.7%), and higher patient satisfaction (92% vs. 76%) compared to conventional septoplasty. Statistical analysis confirmed that these differences were significant (p < 0.05). Conclusion: Endoscopic septoplasty offers a superior alternative to conventional septoplasty for the treatment of DNS, with benefits including faster recovery, fewer complications, and greater patient satisfaction. These findings support the preferential use of endoscopic techniques in nasal septum surgery.

DOI: 10.5281/zenodo.

5. Assessment of Fungal Infections in the Nose and Paranasal Sinuses at a Rural Tertiary Care Hospital
Sanjeev Kumar, Arun Kumar
Abstract
Background: Fungal infections of the nose and paranasal sinuses are less common than bacterial and viral sinusitis but can lead to severe complications, especially in immunocompromised individuals. This study aims to evaluate the prevalence, types, and treatment outcomes of fungal sinus infections in a rural tertiary care hospital setting. Methods: A retrospective observational study was conducted at Lord Buddha Koshi Medical College & Hospital, Saharsa, involving 97 patients diagnosed with fungal sinus infections over 11 months. Data on demographic characteristics, clinical presentation, diagnostic methods, fungal species identified, treatment modalities, and outcomes were collected and analyzed. Results: The study population comprised 54 males (55.7%) and 43 females (44.3%), with a mean age of 37 years. The most common symptoms included nasal obstruction (85%), facial pain (78%), and nasal discharge (72%). Diagnostic methods primarily included nasal endoscopy (95%) and CT scans (85%). Aspergillus species (40%) and Mucor species (30%) were the predominant fungi identified. Antifungal therapy was administered in all cases, with surgical debridement performed in 30% of cases. Successful treatment was achieved in 80% of the patients, with a recurrence rate of 10% and a complication rate of 5%. Patients with diabetes or immunosuppression experienced significantly poorer outcomes (p < 0.05). Conclusion: Fungal infections of the nose and paranasal sinuses represent a significant clinical challenge in rural tertiary care settings, with a notable prevalence of Aspergillus and Mucor infections. The study highlights the importance of early diagnosis, effective treatment, and management of underlying conditions to improve patient outcomes. Enhanced awareness and diagnostic capabilities in rural healthcare settings are essential for addressing these infections effectively.

DOI: 10.5281/zenodo.

6. The Prolonged Impact of Prolotherapy on Joint Well-Being in Osteoarthritis Individuals
Preeti Soni, Rajesh Kumar Meena, Mahesh Kumar Meena
Abstract
Over three years, this study evaluates the long-term efficacy and safety of prolotherapy using hypertonic dextrose in treating knee osteoarthritis. This observational study included 200 individuals with chronic knee pain characteristic of osteoarthritis. Participants received dextrose injections under ultrasound guidance, with the process meticulously detailed to ensure consistency. Annual X-rays and initial and final MRIs were performed to monitor changes in joint structure. Pain and functionality were assessed using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The results demonstrate sustained improvements in pain and joint functionality without serious adverse effects, suggesting that prolotherapy is a viable long-term treatment for managing symptoms of knee osteoarthritis. This study’s focus on chronic conditions, without comparing to a control group, provides valuable insights into the standalone benefits of prolotherapy.

DOI: 10.5281/zenodo.

7. A Study on the Role of Early Laparoscopic Surgery in Acute Nonspecific Abdominal Pain at Tertiary Care Center
Abhay Kumar, Sushil Ojha, Ashok Kumar
Abstract
Objectives: The present study was to evaluate the role of early laparoscopic surgery in acute nonspecific abdominal pain at tertiary care center. Methods:  All the preoperative evaluation and preparation, preoperative history, and preoperative clinical examinations and relevant investigations were performed to all patients. Group I (Laparoscopic): patients who had undergone early laparoscopy procedure. Group II (Conservative) — patients who were put under clinical observations, treatment and follow up. Results: Major diagnosis for acute abdomen pain of laparoscopic patients was acute appendicitis (25%), Acute cholecystitis (15%), pelvis inflammatory disease (15%), diverticulitis (!5%) and adhesion (10%). Similarly, in conservative group patients  major diagnosis for acute abdomen pain of laparoscopic patients was ovarian cyst (30%), undiagnosed (20%), diverticulitis (20%), diverticulitis (20%) and acute appendicitis (15%), acute cholecystitis(15%). 80% patients of laparoscopic group and 90% patients of conservative group were visited for follow up within 2 weeks. Patients who were seen for follow up in one month. Among them, recurrence was seen in 10% patients of laparoscopic group patients. Conclusions: Laparoscopy is a promising, safe minimally invasive diagnostic and therapeutic procedure that is very effective in diagnosing and treating acute abdominal problems. Hence, it is the best choices of treatment procedure for nonspecific acute pain.

DOI: 10.5281/zenodo.

8. Foreign Bodies in Ear, Nose, Throat, and Maxillofacial Region: A Study on Their Clinical Profile and Complications
Sanjeev Kumar, Arun Kumar
Abstract
This retrospective study at Lord Buddha Koshi Medical College & Hospital analyzed 94 cases of foreign bodies in ear, nose, throat, and maxillofacial regions over 14 months, focusing on pediatric patients. Findings reveal that children under 10 were most affected, commonly with objects like beads, seeds, toys, and button batteries. Management typically involved removal, with surgical intervention in 11% of cases and complications such as infections occurring in 12% of patients. The study highlights the need for greater public awareness and preventive education to mitigate risks and ensure effective treatment.

DOI: 10.5281/zenodo.

9. Healing of Mandibular Angle Fracture with or Without Removal of Third Molar – A Comparative Study
Alka Bharti, Ruma Rani, Shraddha Sinha
Abstract
Background: Mandibular angle fractures often involve impacted third molars, complicating decisions on whether to retain or remove them during repair. Objective: Compare outcomes of mandibular angle fractures with and without impacted third molar removal. Methods: Prospective study at Buddha Institute of Dental Sciences & Hospital with 20 patients, divided into groups based on third molar management during surgery. Followed for six months postoperatively, assessing healing, complications, and functional recovery. Results: Similar outcomes in healing, complications, and function regardless of third molar removal (p > 0.05). Conclusion: Third molar presence during mandibular angle fracture repair doesn’t significantly affect outcomes; decisions should be case-specific.

DOI: 10.5281/zenodo.

10. Isolation and Identification of Citrobacter Species and their Antibiotic Susceptibility with Special Reference to Extended Spectrum Beta-Lactamase
Shilpa Singh, Saroj Kumari
Abstract
Background: Citrobacter species are frequent nosocomial pathogens, a local or systemic breach in the host defences can allow them to cause a range of infections which include urinary tract infections, neonatal sepsis, pulmonary infections, meningitis and blood stream infections. Citrobacter species are emerging as important nosocomial pathogens. Citrobacter infections are associated with high mortality rate. Objectives: To determine their antibiotic susceptibility pattern. To detect extended spectrum beta lactamase producing species. Material and Methods: Various clinical samples received in the central lab of DMCH Darbhanga. Identification will be done by using standard microbiological techniques. Antibiotic susceptibility test will be performed by Kirby-Bauer Disc diffusion method. Test strains will be pre-incubated in peptone water at 37oC at an optical density of 0.5McFarland standard. This suspension will be used to inoculate strains onto Muller Hinton agar plate by swabbing them with a sterile cotton swab and performing culture as recommended by clinical and laboratory standards institute. The antibiotic discs used for sensitivity testing will be obtained from Hi-Media, India, which will be used to study the sensitivity pattern. Conclusion: The magnitude of Citrobacter infections has increased over time considering its potential to cause nosocomial infections and the growing numbers of immunocompromised patients in hospitals. C.koseri and C.freundii being the commonest species isolated. They are usually isolated from patients with wound infections, urinary tract infections, respiratory infections and bacteremia. The emergence of drug resistance among the Citrobacter is noteworthy.

DOI: 10.5281/zenodo.

11. A Study of Role of Does Miller Pyramid Simulation of Diagnostic Nasal Endoscopy Increase the Chance of Better Diagnosis of Nasal Pathology: A Performance Based Assessment
Sivakumar Annamalai, Senthilkumar Kalimuthu
Abstract
Introduction: The medical students are poor in psycomotor skills at the level of phase II. They are not exposing to any surgical skills given in the books. They are having knowledge by cognition. They are up to the second level of millers pyramid. Our aim is use does performance shows how is based the medical students perform skill based procedure in simulation skill lab. Diagnostic nasal endoscopy is easily to be performed with zero degree endoscope at three levels. First, second, third, passes to be trained and assessed for do gives their clinical internals during their end postings. Objective: (1) Skill based assessment of medical students at the phase of 2 during ENT postings, to improve their internal assessments. (2) Technology enhanced assessment in medical education. Materials and Methods: Phase 2 Medical students allowed to simulation lab for 1 hour per day, with 10 students. Diagnostic nasal endoscopy, first pass, second pass, third pass are trained. Then demonstration, observation, procedural skills assessed before objective structured practical examinations (OSPE) and after OSPE with checklist and scoring done with rating scale 1. Excellent: 8-10; Competent: 5-8; Incompetent 0-5. The students were separated with six groups and each group with 25 students. Results: Before direct observation of procedural skills (DOPS) pre-test score percentage was < 5 =71.7%; 5-8 =28.3%. But the post test score percentage was improved < 5 = 28.6%, 5-8 = 39.85% and 8-10 = 31.88%. Also the mean simulation scores of post test scores were significantly increased comparatively than pre-test in all the groups. Conclusion: Medical student’s allowed early clinical exposure to hands on training by DOPS method. The simulation based training influences on student’s technical skills in otolaryngology.

DOI: 10.5281/zenodo.

12. Punjabi Articulation Locus/Placelessness/Errors in the Cochlear Implant Children
L. Kaur, Inderpreet Kaur, Neena Mehta, Jaimanti Bakshi, Ritika Dutta, Harmesh Kumar, Dharam Vir
Abstract
Background: Around 15.8% of children in India are suffering from sensory neural hearing loss out of which nearly 7% have profound degree of loss and requires cochlear implant surgeries to develop speech and language. Objective: The aim of the study is to assess the common articulatory locus/placelessness/errors in children with Cochlear Implant (CI) surgery using Punjabi Articulatory Test (PAT). Methodology: Total 18 patients who underwent cochlear implant surgery were included in the study. Three groups were formed based on the hearing age of children viz., Group 1- 12 months to 24 months; Group 2 – 25 months to 48 months; and Group 3 ->48 months. Punjabi Articulation Test was administered on each participant by a professional Punjabi speaking speech and language pathologist. Speech errors were identified. Common errors between groups were also assessed using 4-point Likert scale. Results: Alveolars, glides and liquids were common errors made by 3 participants whereas fewer errors were observed for labiodentals and nasals. Similar to group 1 glides and liquids were the errors most frequently seen in group 3. In contrast with group 1 and 2 group 3 showed maximum errors in velars followed by glides and liquids. Nasals, Bilabials and Labiodentals showed least errors. Conclusion: The current study showed that with age the articulatory locus/placelessness/errors also vary. Anterior sounds are easy to produce in comparison to posterior sounds similarly like typically developing hearing age matched children.

DOI: 10.5281/zenodo.

13. Correlation of Maternal Factors with Low Birth Weight in Neonates: A Study among Healthy Singleton Pregnancies
Kasha Shiva Ramachary
Abstract
Background: Birth weight is a useful indicator of mother health, nutrition, and quality of life in addition to being a crucial factor in determining the survival, growth, and development of children. A strong correlation exists between low birth weights (LBW) and prenatal and fetal morbidity and death. Numerous research studies conducted in India have examined the different risk variables associated with term LBW. Objective: The present study has been undertaken to study the maternal risk factors associated with term LBW neonates. Materials and Methods: Present study was retrospective, hospital-based, cross-sectional study in which medical records of 236 healthy singleton live births with gestational age between 37 to 41 weeks were analyzed. Multiple gestation or still born babies and babies with major congenital anomalies were excluded. The data was collected using the extraction matrix and then analyze statistically to derive association of maternal factors with LBW. Results: The prevalence of LBW was 37.3% and the mean birth weight in LBW category was 1.54 ± 0.25 Kg. The major factor associated with the LBW was older maternal age (34.10%), low body weight (87.50%), anemia (89.77%), and hypertension (72.27%). Maternal factors including the height of mother and maternal nutrition supplements were not found to be significantly associated with LBW. Conclusion: Present study recommended the regular screening of maternal health status to improve the overall health status of the mother to reduce the LBW.

DOI: 10.5281/zenodo.

14. Retrograde Observational Study of Uterine Fibroids
Saumya Majmundar, Deepti Vaghamshi, Shivangini Mehta, Bhatt Ridhhi, Anjali Changulani
Abstract
Introduction: Uterine fibroids (myomas or leiomyomas) are benign monoclonal tumours of smooth muscle, taking origin in myometrium of human uterus. The aetiology is largely unknown, but they are estrogen and progesterone dependent tumours. It is estimated that 60% of reproductive age women are affected and 80% of women develop the disease during their lifetime. Symptoms depend upon size, number, and location of the tumours. The large number of women are also asymptomatic. Material and Methods: This prospective observational study included 118 randomly selected patients of fibroids uterus, during the study period at the department of Obstetrics and Gynecology, in our teaching institute. Patients of all ages and parity who visited either the gynecology outpatient or inpatient department of our institution were eligible for inclusion in the study, provided they were willing to participate. Exclusion criteria encompassed individuals in the antepartum or postpartum period with fibroids, as well as those who declined participation. Cases were examined following a predetermined format. Results: Majority of women (82.1%) were of age group31-50years. Abnormal uterine bleeding (64.4%) was the most common symptom followed by abdominal pain (22.28%), reproduction related problems (16.94%), mass in abdomen (14.4%), vaginal discharge (12.7%), also asymptomatic (8.47%).Anatomically uterine fibroids were intramural (63.86%), sub serous (13.44%) and sub muocus (10.08%) in location. Expectant management in (8.4%) medical management in (38.98%) and surgical management (52.5%) was offered. Conclusion: Globally uterine fibroids are among the most significant disease of the reproductive age women. Menstrual dysfunction is the common presenting symptoms in majority of the patients. Fibroids are an infrequent cause of subfertility and have been reported as the sole causes in only a small percentage of patients. It may remain silent in many cases Small and asymptomatic fibroids can be managed with expectant management. Medical management aims at decreasing blood loss, minimizing vascularity and size of fibroid. Large and symptomatic fibroids need surgical management.

DOI: 10.5281/zenodo.

15. Antimicrobial Resistance Trends in a Rural Tertiary Care Teaching Hospital: A Retrospective Observational Study
Thacker JD, Desai HA, Anturlikar SS, Damor RR
Abstract
Background: The global burden of antimicrobial-resistant infections is growing at an alarming rate, being responsible for more than half a million deaths worldwide each year. The resistance crisis has prompted a rise in antimicrobial stewardship (AMS) programme, which aim to reduce inappropriate antibiotic use. India is one of the largest consumers of antibiotics worldwide and antibiotic sales are increasing rapidly. Hence, it was decided to explore the anti-microbial sensitivity and resistance status of E. coli, K. pneumoniae (KP), and P. aeruginosa (PA) from the data base of a rural tertiary care teaching hospital. Aim: To evaluate the anti-microbial susceptibility and resistance pattern at a rural tertiary care teaching hospital of three important microorganisms, namely E. coli, K. pneumoniae (KP), and P. aeruginosa (PA). Methodology: This was an observational retrospective study of 3 months (June 2023 – August 2023) to determine the antimicrobial susceptibility pattern of cultures of various specimens collected during this period. To maintain feasibility, systematic randomization of data collection days was done. The data was collected every alternate day for 3 months. Results: The antimicrobial resistance patterns observed for E. coli showed high resistance rates to commonly used antibiotics such as Ampicillin (88.14%), Cefalotin (86.67%), and Nalidixic Acid (90.37%). Notably, Fosfomycin showed a remarkably low resistance rate (2.22%). K. pneumoniae exhibited high resistance to Ceftriaxone (92.3%), Cefuroxime (92.3%), and Piperacillin/ Tazobactam (92.3%), while Colistin and Tigecycline resistance were relatively low (7.69% and 15.38%, respectively). aeruginosa presented a varied resistance pattern, with the highest resistance observed for Tigecycline (97.92%), while Colistin resistance remained low (10.42%). Conclusion: The escalating trends of antimicrobial resistance pose a significant global health challenge. An antimicrobial stewardship programme with educational intervention and the sensitization of medical students to rational antimicrobial prescriptions is need of the hour to control the menace of antimicrobial resistance.

DOI: 10.5281/zenodo.

16. Control in Type 1 Diabetic Children and Adolescents Attending Endocrine Clinic of Pediatric/ Medicine Department at Tertiary Care Center in Western India
Mital M Gover, Deval Surana, Hiteshee Patel
Abstract
Background: Type 1 diabetes is one of the common endocrine diseases among pediatric and adolescent population. The present study was intended to study the glycemic control among pediatric and adolescent population attending endocrine clinic of pediatric /medicine department at tertiary care center in western India. Materials and Methods: A cross – sectional observation study was carried out over period of 3 months at pediatric and medicine outpatient clinic of tertiary care center. A total of 34 patients were registered Data on age, sex, duration of Illness, associated comorbidities, antidiabetic regimen, and HbA1c levels were obtained. Results: A total of 34 patients were enrolled; 61.7% were females. Data showed moderately positive correlation between age and HbA1C level (r = 0.5543, p =0.00068). Mean HbA1C level were low in age group less than 6 years and increase in mean values of HbA1C noted as age increases with a statistical significance. No statistical significance was noted between gender and type of insulin regime with HbA1C level. Conclusion: Patients with T1DM had poor glycemic control with mean HbA1c level of 11.35 ± 2.1 at our center. Older age group and duration of disease were significantly associated with poor control. Further work addressing the factors associated with poor glycemic control is required.

DOI: 10.5281/zenodo.

17. Visual Outcome in Patients of Lens Induced Glaucoma by Surgical Management
Tudu KC, Padhan B
Abstract
Background: Lens induced glaucoma (LIG) is a type of secondary glaucoma and sight threatening disease. It is common in India and seen in the patient with senile cataract, requiring immediate attention and management to restore vision and prevent blindness. Aim: To study the visual outcome and intraocular pressure control following surgical management of lens induced glaucoma. Materials and Methods: A total of 64 cases of lens induced glaucoma were included after taking prior consent. The evaluation included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp biomicroscopy and management either by Cataract surgery alone or cataract surgery combined with trabeculectomy. All cases were followed up postoperatively on day 1, 1 week & 6 weeks. Results: Out of 64 cases, the male: female ratio was 1:1.4 and most common age group to be affected was 61–70 years (46.9 %).The vision was diminished to projection of light (PL), projection of ray (PR) accurate in all quadrants in 53.1 % of cases and the mean IOP was 47.36 mmHg at the time of presentation. Phacomorphic glaucoma (61 %) was the commonest type and 46.9% of cases were reported within 10 days of onset of symptoms. Cataract extraction & PCIOL were done in 64.1% of cases; combined surgery in 25%, and 9.3% of cases remained aphakic due to intraoperative complications. Post-operative BCVA was 6/12 or better in 73.3 % of cases presenting within 10 days of onset of symptoms. At last follow up 84.43% cases had IOP < 20 mmHg and 15.7% cases had IOP > 20 mmHg. The post-operative mean IOP was 17.82±3.78 mmHg. Conclusion: Early diagnosis and timely intervention will achieve an excellent visual prognosis with control of IOP in lens induced glaucoma.

DOI: 10.5281/zenodo.

18. The Role of Differentiation of Bowen’s Disease of the Nail Apparatus from it’s Mimickers and it’s Association with Human Papilloma Virus
Mehak Jindal, Amandeep Rathi, Vivek Singh, Sanjeev Kumar
Abstract
Background: The aim of the study is to study the mimickers of bowen’s disease of the nail apparatus and it’s association with human papilloma virus. Bowen’s disease is the most frequent malignant condition of nail unit and presents as a verrucous plaque predominantly involving men. Material and Methods: We reviewed 30 cases of various conditions involving the nail apparatus at our institute to study the positive cases of bowen’s disease for the presence of human papilloma virus (HPV) DNA. We used specimens fixed in 10% neutralized buffered formalin, embedded in paraffin wax to study their histopathology as well as for HPV DNA testing via PCR. Results: In our study we found maximum cases of bowen’s disease (33.3%). The chi-square statistic is 0.9184. The p-value is 0.037904. The result is significant at p < 0.05. Our study demonstrated 63.4% of cases in the duration of 01-02 years. In addition, we found 60% cases of bowen’s disease to be associated with HPV. The chi-square statistic is 2.48365. The p-value is 0.317798. The result is not statistically significant at p < 0.05. Conclusion: Biopsy and histopathological examination are required for diagnosis and differentiation of bowen’s disease from other ungula and periungual diseases. The strong association of high-risk HPV infection and BD of the nail unit as reviewed in various literatures and described in our original study supports a causative role of the virus in digital BD, and should prompt the early follow-ups and biopsy of digital associated lesions in patients and partners.

DOI: 10.5281/zenodo.

19. Renal Reflections on the Skin, an in Depth Look at Cutaneous Manifestations in Chronic Kidney Disease
Kusuma Sankula, K. Venkata Chalam
Abstract
Background: Chronic kidney disease (CKD) is a widespread and multifaceted condition that affects millions of individuals globally. While its impact on renal function is well-documented, the intricate relationship between CKD and cutaneous manifestations has garnered increasing attention in recent years. Aims: To study various patterns of cutaneous manifestations in patients with Chronic Kidney Disease and to compare cutaneous manifestations in patients with and without chronic kidney disease. Materials & Methods: It is a cross sectional descriptive study conducted over 12 months in the department of dermatology and nephrology, King George hospital, Visakhapatnam, a total of 120 patients were included in the study, a comprehensive history, detailed examination, and specific investigations such as skin biopsy, culture and sensitivity for bacterial infections, Gram’s stain, potassium hydroxide mount, and fungal culture were done wherever clinically indicated. Results: Majority of patients (39.2%) belong to age group of 41 to 50 years, with male predominance. 31.7% (38) patients complained of pruritus, Xerosis was seen in 26.7%(32) of patients, The proportion of pigmentation among patients with CKD is 8.3% (10), 55.3% of patients with pruritus were on dialysis, 59.4% of patients with xerosis were on dialysis, 40% of patients with pigmentation were on dialysis. Conclusion: Pruritus was the most common manifestation in CKD patients followed by xerosis, ecchymosis and pigmentary changes. There is no significant difference in cutaneous manifestations in patients with and without dialysis.

DOI: 10.5281/zenodo.

20. A Prospective Randomized Study to Compare Intrathecal Isobaric Levobupivacaine with or Without Fentanyl in Various Infraumbilical Surgeries
Rahul Singh, Deepak Mehrotra, Pallavi Singh
Abstract
Background and Aims: The subarachnoid block is the recommended anaesthetic approach for procedures below the belly button because it offers superior pain relief after the operation, efficient muscle relaxation, and is cost-effective. Levobupivacaine is more advantageous than bupivacaine because it has a reduced risk of causing cardiotoxicity, prolonged duration of sensory blockade, and a shorter duration of motor blockade. Opioids used in conjunction with intrathecal local anaesthetics improve the effectiveness of pain relief and anaesthesia both during surgery and postoperatively. The objective of the current study was to assess the effects of levobupivacaine with and without fentanyl in spinal anaesthesia. Methods: For this study, 80 patients who were classified as belonging to the American Society of Anesthesiologists Physical Status I and II were randomly assigned to different groups. The study was conducted in a way that neither the patients nor the researchers knew which group they were in. The purpose of the study was to investigate the effects of infraumbilical surgery. Subjects were assigned at random to one of two groups. The Levobupivacaine group (n = 40) was administered 2.5 ml of isobaric levobupivacaine 0.5% along with 0.5 ml of normal saline. The Levobupivacaine + fentanyl group (n = 40) was given 2.5 ml of isobaric levobupivacaine 0.5% along with 25 μg (0.5 ml) of fentanyl. The study recorded the time at which sensory and motor block began, as well as how long it lasted. It also documented the Visual Analogue Scale score, the duration of analgesia, any changes in blood pressure and heart rate, and the adverse outcomes experienced by participants in both groups. Results: The initiation of both sensory and motor block was notably expedited in Group LF (P < 0.05). The average duration of sensory blockade was substantially greater in Group LF (P < 0.05). The average duration of motor block was determined to be similar between the two groups, both of which had stable hemodynamics and no sedation throughout the perioperative period (P > 0.05). The analgesic effect lasted substantially longer in Group LF (336.5 ± 31.3 min) compared to Group L (223.65 ± 32.17 min) with a p-value of less than 0.001. Conclusion: Using intrathecal fentanyl (25 μg) alongside isobaric 0.5% levobupivacaine can significantly enhance the block characteristics and minimize adverse effects in patients undergoing procedures below the umbilicus.

DOI: 10.5281/zenodo.

21. Prevalence, Risk Factors, and Management of Gestational Diabetes: A Comprehensive Study
Neetu Singh Sikarwar, Farhat Kazim
Abstract
Background: Gestational diabetes mellitus (GDM) poses significant health risks to both mother and child. Understanding its prevalence, associated risk factors, and effective management strategies is crucial for improv-ing outcomes. Objectives: This study aims to determine the prevalence of GDM in a cohort of 500 Indian women, identify demographic and personal risk factors, and evaluate the effectiveness of various management strategies. Methods: A total of 500 pregnant women were screened for GDM using the oral glucose tolerance test. Data on age, BMI, family and personal history of diabetes, and ethnicity were collected. Management strategies includ-ing diet and exercise, insulin therapy, and oral hypoglycemic agents were assessed. Results: GDM was diagnosed in 8% (40/500) of the participants. Significant risk factors included a higher prevalence in women over 35 years (37.5%) and those with a BMI over 30 (55%). Family history was noted in 60% of cases. Management was most effective with insulin therapy (100% within target glucose levels), fol-lowed by dietary changes (75%). Birth outcomes showed that 75% of babies had normal birth weights, while complications like pre-eclampsia and C-sections were recorded in 5% and 32.5% of GDM cases, respectively. Follow-up indicated that 7.5% developed Type 2 diabetes postpartum. Conclusion: The study highlights the significant impact of GDM on pregnancy outcomes in India, with a prev-alence of 8%. Effective management is crucial and varies based on individual patient profiles, emphasizing the need for tailored therapeutic approaches to improve maternal and neonatal health outcomes.

DOI: 10.5281/zenodo.

22. A Rare Presentation of Acute Inversion of Uterus and PPH- A Maternal ‘Near Miss’ Case
Priti Jha, Rachana Kumari, Puja Jha, Pooja Sinha, Soumyajyoti Kundu, Swapan Kr. Kundu
Abstract
Introduction: Maternal “near-miss” refers to surviving severe pregnancy complications, requiring innovative problem-solving and more resources. Postpartum haemorrhage (PPH) is a major health risk, a leading cause of maternal death The Case: Mrs. R. J., 32 years, G2P1L1A0, previous uncomplicated vaginal delivery presented at 38.4 weeks gestation with a normal antenatal course. Labour was induced with vaginal misoprostol, resulting in the successful vaginal delivery of a healthy 3.5 kg baby with routine preventive measures for postpartum hemorrhage. However, she experienced acute spontaneous uterine inversion post-delivery, leading to severe PPH despite attempts at repositioning the uterus and administration of halothane for relaxation. Compounded by her bronchial asthma, preventing the use of carboprost, intractable bleeding persisted, resulting in significant blood loss. With approximately 1.3 litres lost, emergency postpartum hysterectomy became imperative to save her life. This critical intervention was executed through a collaborative “Team Approach” involving obstetricians, anesthesiologists, cardiologists, pediatricians, and perioperative generalists, highlighting the importance of multidisciplinary care in managing obstetric emergencies. Result: Following emergency postpartum hysterectomy, 4 units PRBC and 8 FFP transfusions, the patient successfully recovered. Conclusion: Prompt identification, timely intervention, a coordinated team approach, and urgent management of PPH are critical for improving maternal outcomes and saving lives.

DOI: 10.5281/zenodo.

23. Microscopic Features of Human Placentae in Normal and Gestational Diabetes Mellitus
Molly A J, Ushadevi K B, Manju Madhavan C
Abstract
Background: Placenta is a multifunctional feto-maternal organ that plays an important role during pregnancy. Gestational Diabetes Mellitus (GDM) is reflected on placenta both macroscopically and microscopically such as enlargement of placenta, abnormalities in villi and degenerative changes. GDM is associated with increased rates of maternal and perinatal morbidity. Materials and Methods: This is a cross sectional study conducted among two groups, normal and GDM groups to compare the microscopic features of GDM placentae in the Department of Obstetrics & Gynaecology and Department of Anatomy, Govt. Medical College, Thiruvananthapuram. Results: This study was conducted on 65normal and 65 GDM placentae. Light microscopic features such as syncytial knots, villous stromal fibrosis, fibrinoid necrosis, chorangiosis, were significantly increased in GDM placentae. Conclusion: Placental examination can shed light upon factors pertaining to the current pregnancy and its outcome, guide postpartum management and helps to predict and prevent the adverse effects in successive pregnancies. Hence, the present work would provide vital information to both Obstetricians and neonatologists.

DOI: 10.5281/zenodo.

24. Exploring the Effects of Rituximab on Nephrotic Syndrome
Rohit Prabha Gaude, Shashi Bhushan Rout, Sarat Kumar Parida
Abstract
Background: Treating severe proteinuria, hypoalbuminemia, and edoema in steroid-dependent, steroid-resistant, or recurrent nephrotic syndrome is difficult. Rituximab, which targets CD20 on B cells, may help. Objectives: Rituximab will be compared to conventional therapy in difficult-to-treat nephrotic syndrome patients. Methods: A randomised controlled trial with 200 patients was conducted, with one group getting Rituximab (375 mg/m² weekly for four weeks) and the other receiving standard therapy. The primary goal was 6-month remission rate, whereas secondary outcomes were time to remission, duration, frequency of recurrence, renal function changes, quality of life, and adverse events. Results: Rituximab group showed higher remission rate (70% vs. 45%; P < 0.001), faster time to remission (3 vs. 6 months; P < 0.01), longer remission duration (18 vs. 12 months; P < 0.01), and lower relapse rate (20% vs. 40%; P < 0.01). Both groups had similar renal function changes, but Rituximab improved quality of life more. Safety profiles were similar. Conclusions: Rituximab generates and maintains remission in difficult nephrotic syndrome cases, making it a useful treatment.

DOI: 10.5281/zenodo.

25. Epidemiological Analysis of Thyroid Pathologies Requiring Surgery: A Retrospective Study
Narayan Chandra Behera, Chandan Kumar Gantayat, Bibekanand Nayak, Premakanta Mohanty
Abstract
Background: Thyroid disorders pose a significant public health burden globally, with diverse etiologies and clinical presentations. Understanding the epidemiological patterns of thyroid pathologies is crucial for effective management strategies. Objective: This retrospective study aimed to investigate the incidence and demographic distribution of thyroid pathologies necessitating surgery at Fakir Mohan Medical College and Hospital, Balasore, Odisha. Methodology: A retrospective analysis was conducted on patients who underwent various types of thyroid surgeries between February 1, 2020, and January 31, 2022. Data were collected from patient records and analyzed using descriptive statistics and SPSS software. Results: A total of 200 thyroid surgeries were performed during the study period. Colloid goitre was the most prevalent pathology requiring surgery (41.5%), followed by papillary carcinoma thyroid and follicular adenoma (each 15%). Females constituted 85% of the cases, with a predominant occurrence in the fifth decade of life. Malignancies accounted for 24% of cases, with papillary carcinoma thyroid being the most common (65.5% of malignancies). Notably, males exhibited a higher propensity for malignancies. Discussion: The findings corroborate global trends of thyroid disorders, with colloid goitre predominating among surgical cases. Malignancies, particularly papillary carcinoma thyroid, were notable, with males showing a higher risk. Similar epidemiological patterns were observed in previous studies, emphasizing the consistency of these findings across diverse populations. Conclusion: Colloid goitre emerged as the most common indication for thyroid surgery, with a female predilection and a peak incidence in the fifth decade of life. Understanding the demographic distribution of thyroid pathologies is essential for tailored management strategies and public health interventions.

DOI: 10.5281/zenodo.

26. Examining Blood Sugar Levels in Statin-Naive Diabetic Patients: A Cross-Sectional Study
Ashish Tripathy, Niranjan Kumar Nayak, Sujit Kumar Mohanty, Aparajita Mohapatra
Abstract
Background: Diabetes mellitus is a chronic disorder marked by hyperglycemia due to insulin defects. Managing blood sugar is crucial to prevent complications like cardiovascular disease and neuropathy. The study investigated glycemic status and side effects in statin-naive diabetic patients, highlighting the impact of statin therapy on blood glucose levels and adverse reactions. Methods: The study involved 100 participants aged over 30 who were prescribed statins for at least 12 months and had fasting blood glucose levels below 100 mg/dl at the commencement of statin therapy. Data on demographics, clinical characteristics, medication histories, and blood glucose levels were collected using standardized forms. Statistical analyses were performed using SPSS version 23. Results: Participants had a mean age of 52.6 years (± 8.4), with 45% females and 55% males. Family history included 68% with cardiovascular disease and 32% with diabetes. During the study, 28% developed NODM and 20% were diagnosed with prediabetes. Mean fasting blood glucose was 130.4 mg/dl (± 15.2) for NODM and 105.8 mg/dl (± 8.9) for prediabetes. Adverse effects were reported by 15%, mainly muscle pain (8%). Significant predictors of NODM were family history of diabetes (χ² = 12.34, p < 0.05), age (OR = 1.08, p < 0.05), and family history of diabetes (OR = 2.34, p < 0.05). Conclusion: The study highlights the significant impact of statin therapy on blood glucose levels in statin-naive diabetic patients. Patients with a family history of diabetes are at a higher risk of developing NODM when on statins. Recommendations: Clinicians should monitor blood glucose levels closely in statin-naive diabetic patients, especially those with a family history of diabetes. Further research is needed to explore the mechanisms by which statins influence glycemic control.

DOI: 10.5281/zenodo.

27. Analyzing Adverse Drug Reaction Reporting for Oncology Medications: A Retrospective Study
Aparajita Mohapatra, Sujit Kumar Mohanty, Niranjan Kumar Nayak, Ashish Tripathy
Abstract
Background: Adverse Drug Reaction (ADR) reporting is critical in oncology due to the complex and potent nature of oncology medications, which often have a high risk of adverse effects. Accurate ADR reporting helps identify potential risks associated with oncology drugs, contributing to safer clinical practices and enhanced patient care.The aim of this study was to investigate the prevalence and patterns of adverse drug reactions (ADRs) associated with oncology drugs among patients. Methods: The study included 120 patients who received oncology drugs during the study period. Inclusion criteria encompassed patients of all ages treated with oncology drugs, while exclusion criteria included patients with incomplete medical records. Data on patient demographics, oncology drug regimens, and documented ADRs were collected from electronic health records. Descriptive statistics assessed the association between specific oncology drugs and ADR occurrence, with a significance level of p < 0.05. Results: The analysis included 120 patients, with a mean age of 58.4 years. Among the participants, 66.7% (80 patients) experienced at least one ADR. The most common ADRs were nausea (43.8%), fatigue (35.0%), anemia (25.0%), diarrhea (18.8%), and neutropenia (15.0%). Chi-square analysis revealed a statistically significant association between Drug A and ADRs (p = 0.042) and between Drug C and ADRs (p = 0.018), while no significant association was found for Drug B (p = 0.087). Conclusion: A substantial proportion of patients experienced ADRs related to oncology drugs, with nausea and fatigue being the most commonly reported reactions. Specific oncology drugs, particularly Drugs A and C, were significantly associated with the occurrence of ADRs. Recommendations: Improved ADR reporting systems and proactive monitoring are recommended to enhance patient safety and optimize therapeutic outcomes. Healthcare professionals should be encouraged to report ADRs consistently, and patients should be involved in the reporting process to capture comprehensive ADR data.

DOI: 10.5281/zenodo.

28. Comparing Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants to Warfarin in Atrial Fibrillation Patients: A Retrospective Study
Aparajita Mohapatra, Ashish Tripathy, Sujit Kumar Mohanty, Niranjan Kumar Nayak
Abstract
Background: Non-vitamin K antagonist oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs), have transformed the management of atrial fibrillation (AF), offering an alternative to the long-established vitamin K antagonist warfarin. The study compares NOACs and warfarin for atrial fibrillation patients’ primary and secondary outcomes. The study also examined anticoagulant therapy results by BMI and BW. Methods: The study included 464 individuals who met the inclusion criteria of confirmed AF diagnosis and participation in relevant trials. Data on primary efficacy and safety outcomes were collected, alongside secondary outcomes. Statistical analysis assessed the association between therapies and clinical outcomes across different BMI and BW categories. Results: The study comprised 464 AF patients with average age of 68.5. Baseline parameters were similar for NOAC and warfarin. A stroke or systemic embolic event occurred in 15.2% of NOAC patients and 18.9% of warfarin patients (p = 0.312). The NOAC group had 8.7% major bleeding events and the warfarin group 11.2% (p = 0.481). Secondary outcomes including ischemic stroke/SEE, cerebral haemorrhage, death, and net clinical outcomes did not differ across groups. No significant variations in outcomes were seen between NOAC and warfarin groups by BMI and BW. Conclusion: NOACs demonstrated similar efficacy and safety profiles contrast to warfarin in atrial fibrillation patients, with no significant variations in stroke/SEE and major bleeding rates. Secondary outcomes and stratified analyses by BMI and BW further support the comparability of NOACs and warfarin. Recommendations: Further studies should continue to evaluate the long-term outcomes of NOACs in diverse patient populations and explore strategies to improve accessibility to NOACs given their higher costs. Ensuring the availability of reversal agents for NOACs remains critical in managing bleeding complications effectively.

DOI: 10.5281/zenodo.

29. Diagnosis of Dengue by NS1 Antigen Detection and Reverse Transcriptase PCR Assay
Sandeep Kumar Rana, Deepti Jain, Dinesh Kumar, Harender Simar
Abstract
Introduction: Dengue virus (DENV) belongs to the genus Flavivirus (family Flaviviridae) and has 4antigenically distinct serotypes; DEN1, DEN2, DEN3 and DEN 4. About, 40% of the world’s population is at risk of acquiring dengue and around 50–100 million cases occur every year. An estimated 5,00,000 hospitalizations occur per year due to severe dengue disease out of which 2.5% are fatal. Aim and Objectives:To assess the role of NS1 antigen determination in diagnosis of dengue within first week of fever, its comparison with rapid immunochromatographic test, ELISA and RT-PCR in diagnosis of dengue. Material and Methods: Blood samples were received in Microbiology department of SGT Hospital Budhera, Gurugram from the 150 patients clinically suspected of dengue fever within 1 to 7 days of fever. All the samples were tested by rapid immunochromatographic test (ICT), ELISA and only 82 samples out of total 150 samples were tested by RT-PCR for NS1 antigen detection due to non- availability of kit. Samples found positive on RT-PCR were further processed by nested PCR for genotyping. Results: Out of 150 patients, 85 (56.67%) patients were male and 65 (43.33%) were female. 47(55.3%) out of 85 males, 30 (53.8%) out of 65 females and 82 (54.7%) out of total 150 patients were found positive for NS1 antigen by rapid ICT. Maximum positivity of NS1 antigen by ICT and ELISA was 76.4% on day 4 of illness and 66.7% on day 1 respectively. NS1 antigen detection by rapid ICT showed a sensitivity & specificity of 95.8% & 75.6% as compared to ELISA.RT-PCR for Dengue was carried out in 82 samples, of which 33 were positive for DENV RNA. On performing the nested PCR all 33 samples were genotyped as DENV-3.The sensitivity of NS1 antigen by ICT was 84.8% and specificity 73.5% with 68.3% positive predictive value and 87.8% negative predictive value. Of 82 samples, 33 tested positive for dengue by PCR and only 31 samples were positive by ELISA. The sensitivity of ELISA for NS1antigen detection was 93.9% and specificity 100% with a positive predictive value of 100% and 96% negative predictive value. Conclusion: NS1 antigen detection by ELISA and dengue group-specific reverse transcriptase RT-PCR are valuable techniques for the rapid and early diagnosis of dengue.

DOI: 10.5281/zenodo.

30. Efficacy of Proton Pump Inhibitors in Laryngopharyngeal Reflux: A Tertiary Care Experience in Erode District, Tamil Nadu
G. Satheesh Kumar, R. Kalaimani, M. Rajesh Kumar
Abstract
Background: The otorhinolaryngology clinics have seen an increase in patients with symptoms of Laryngopharyngeal reflux disease (LPRD) as a result of changes in lifestyle and food. Aim: The study aimed to observe various signs and symptoms of Laryngopharyngeal reflux and evaluate its management and result using proton pump inhibitor medication. Methodology: This prospective study was carried out at Government Erode Medical College Hospital in the department of Otorhinolaryngology, from January 2023 to February 2024. The study included 30 patients who sought medical attention at the hospital due to symptoms and signs of Laryngopharyngeal reflux illness. A study was conducted to examine the distinct indicators and manifestations of Laryngopharyngeal reflux, as well as the effectiveness of proton pump inhibitors in its treatment, utilising the Reflux Finding Score (RFS) and Reflux Symptom Index (RSI). Result: The average age group was 43.5 years. The most prevalent symptoms reported by patients with Laryngopharyngeal reflux were a sensation of a foreign object in the throat and frequent throat cleaning. Video laryngoscopy revealed common findings of erythema of the arytenoids, combined with hypertrophy of the posterior commissure and obliteration of the ventricles. The use of proton pump inhibitors resulted in a notable enhancement in both the reflux symptom index and reflux finding score. Conclusion: Proton pump inhibitors are a highly successful therapy option for managing laryngopharyngeal reflux. The reflux finding score and reflux symptom index developed by Wake Forest University are highly helpful diagnostic tools for identifying laryngopharyngeal reflux (LPR).

DOI: 10.5281/zenodo.

31. Comparative Study of Efficacy and Safety of Ramipril and Telmisartan on Serum Electrolytes in Newly Diagnosed Hypertensive Patients
Krishna Singh, Rahul Vaish, Ashwani Kumar Gupta
Abstract
Introduction: ACEIs (angiotensin converting enzyme inhibitor) and ARBs (angiotensin II receptor blockers) are two medications that are frequently recommended to treat heart conditions and hypertension. It is now crucial to assess and investigate into how these medications affect the variations in serum electrolytes. Objective:  To compare the effects of Ramipril and Telmisartan on blood pressure, serum potassium and serum sodium. Materials and Methods: The prospective study, which lasted 24 weeks and involved patients in the age range of 30 to 60 who had recently been diagnosed with grade 1 hypertension, was carried out at the Department of Pharmacology in collaboration with the Department of Cardiology at a tertiary care teaching hospital. A total of 120 patients completed the research. According to randomization, patients were instructed to take either Ramipril 2.5 mg (Group 1, n = 58) or Telmisartan 40 mg (Group 2, n = 62). The student’s t-test is used for statistical analysis, and all data are expressed as mean ±SD. Results: At the fourth follow-up visit, or 24 weeks, there is a significant (p<0.001) decrease in mean SBP and mean DBP compared to the baseline visit for both groups 1 (Ramipril) and 2 (Telmisartan). However, when group 1 and group 2 are compared at the fourth visit, there is no statistically significant difference in mean SBP and mean DBP (p>0.05). In relation to serum electrolytes, there was no significant difference between baseline and fourth visit in group 1 in serum potassium (4.00 ± 0.54 to 4.07 ± 0.53) and serum sodium (139.00 ± 5.67 to 138.3 ± 5.17). Similarly, between the baseline visit and the fourth visit in group 2, there was also  not a significant difference in the serum potassium (4.15 ± 0.55 to 4.17 ± 0.52) or sodium (137.74 ± 5.41 to 137.45 ± 7.74) (p>0.05). Additionally, it was found that there was no statistically significant difference between the two groups’ mean serum potassium and mean serum sodium at the fourth visit (p>0.05). Conclusion: Our study’s conclusion is that the antihypertensive efficaciousness of Telmisartan and Ramipril as monotherapy is nearly equal and regarding safety the both medications have minimal effects on serum potassium and sodium levels. For a period of six months, it indicates a lower risk of cardiac and other issues associated to hyperkalemia and hyponatremia. But before prescribing the medication, especially to an elderly patient, one must carefully assess their comorbid illnesses, and should be closely monitored for potassium and sodium levels.

DOI: 10.5281/zenodo.

32. Evaluation of Infertile Women and Correlation of Hysteroscopic with Histopathological Finding
Anshika Agarwal, Diksha Sharma, Manmeet Kaur
Abstract
Background: Aim To study the evaluation of infertile women and correlation of hysteroscopic with histopathological finding. Objectives: (1). To evaluate various etiological factors in infertility by hysteroscopy. (2). To correlate the hysteroscopic findings with histopathology. Methodology: The study was carried out at the Department of Obstetrics and Gynaecology at Muzaffarnagar Medical College, Muzaffarnagar; U.P. Women with infertility attending the OPD were included in the study based on simple random sampling. Sample size was 100. Hysteroscopy was used to obtain a comprehensive view of the uterus, ostia, and endocervical canal, and systematic observations were made followed by Histopathological review. Results: In the current study, hysteroscopy determined that 60% of the women were normal, whereas 40% had intrauterine lesions, disease, or uterine anomalies. 39% of patients with histopathology showed normal findings, while 61% of cases had abnormal ones. Conclusion: Hysteroscopy and histopathology’s overall agreement was found to be excellent (kappa=0.81), and there was a strong correlation between the two (chi square=14.93, p-value-< 0.05).

DOI: 10.5281/zenodo.

33. A Study of Treadmill Test in Asymptomatic Type 2 Diabetes Mellitus in Guru Gobind Singh Govt. Hospital, Jamnagar
Keyur Shah, Zeel Patel, Tejal Khokhar, Nilesh Prajapati
Abstract
Introduction: India has become country with 2nd highest diabetic population in world, which is global epidemic and ice berg disease and the most common endocrine disease in occurrence. Diabetes also affects vital organs of our body by various macro and microvascular complications, one of which is coronary artery disease and which is more often asymptomatic because of occurrence of silent myocardial ischemia. Aims and Objective: To assess the prevalence of ischemic heart disease in asymptomatic Type 2 Diabetes mellitus by exercise treadmill test. To assess various factors related to type 2 diabetes with coronary artery disease. Material and Methods: It was non randomized cross sectional study conducted in Guru Gobind Singh Govt. Hospital, Jamnagar between November – 2019 to November – 2020. In the study period of 12 months among the patients seen under the Department of General Medicine. 50 patients were included in this study, who had no clinical evidence of ischemic heart disease, patients known case of type 2 diabetes mellitus (DM), All the patients attending medicine OPD or admitted hospital were screened for eligibility and then after taking informed consent and enrolling them in this study, they underwent interview and through physical examination, All the patients had normal resting ECG and normal 2D ECHO. All the patients had already underwent treadmill testing. A detailed history was taken from all the patients enrolled which was specific for symptoms related to DM, duration of DM and symptoms related to complication of DM. Results: The mean age of patients studied is 57.06 years; standard deviation (SD) of 10.0496 with range of 32 years to 70 years. Out of 50 cases, 28 males and 22 females. Among 50 patients studied, 19(36%) were TMT positive while 32(64%) were TMT negative. According to this study, following observations were made, with reference to average age (p value-0.0012), average duration of diabetes mellitus (p value -0.0001), average HbA1c(p value-0.0137), average FBS (p value-0.0181), average PP2BS (p value -0.000002), average total cholesterol (p value-0.000321), average triglyceride (p value-0.0128), average LDL ( p value -0.00038), average HDL (p value-0.00425) was found to have statistically significant difference between TMT positive cases and TMT negative cases. Conclusion: Longer the duration of diabetes, greater the risk of asymptomatic coronary artery disease. An aggressive and early screening of patients with type 2 diabetes mellitus for the evidence of asymptomatic coronary artery disease may prevent catastrophic cardiac events.

DOI: 10.5281/zenodo.

34. Intraoperative Hemodynamic Stability with Esmolol versus Clonidine for Laparoscopic Appendicectomy
Miten Delvadiya, Maitri Patel, Shweta Prajapati
Abstract
Introduction: Pneumoperitoneum, the introduction of gas into the abdominal cavity, causes disturbances in the body’s regulatory systems, affecting acid-base balance, cardiovascular and pulmonary functions, and the stress response. It leads to increased mean arterial pressure, decreased cardiac output, and elevated systemic vascular resistance, potentially impairing tissue and organ perfusion. Aim and Objectives: To compare the effectiveness, analgesia requirement, and adverse effect of Esmolol and clonidine for maintaining hemodynamic stability in laproscopic appendicetomy. Material and Methods: In the present prospective comparative study, data was gathered from a total of 90 patients falling within ASA (American Society of Anesthesiologists) categories I and II, who were scheduled for laparoscopic appendicectomy and ranged in age from 15 to 50 years. These patients were selected from CRH Hospital in Himmatnagar, Gujarat, and were divided into both study groups and a control group. The study was conducted over the course of one year, spanning from August 2022 to August 2023. Result: There is significant difference in the percentage decrease of heart rate from base line value in Esmolol group-E and Clonidine group – C as compared to control. Esmolol Group- E has significantly lower systolic blood pressure as compared to Clonidine Gruop-C and Control Group-D throughout the intra operative period.

DOI: 10.5281/zenodo.

35. Right Sided Aortic Arch with Aberrant Left Subclavian Artery with Aneurysmal Dilatation Presenting with Dysphagia: A Rare Combination of Aortic Arch Anomaly: A Case Report
Susmita Rani Ghosh, Asim De, Nikhil Hallalli, Harshith R, Ramachandra Dasar
Abstract
This case report details of a 54-year-old male patient experiencing difficulty swallowing with intermittent chest pain and breathlessness, ultimately leading to the discovery of a right-sided aortic arch anomaly. Initial chest radiography revealed telltale signs of an enlarged right mediastinum and a right-sided aortic knob, prompting further investigation. Contrast-enhanced computed tomography (CECT) and CT Angiography confirmed the presence of a right-sided aortic arch coupled with an aberrant left subclavian artery arising from Kommerell’s diverticulum and aneurysmal dilatation. Notably, this anatomical variant resulted in extrinsic compression of the esophagus, contributing to the patient’s dysphagia symptoms. Discussion encompasses the classification of right-sided aortic arch anomalies, their association with vascular rings, and potential clinical manifestations arising from adjacent structure compression. Additionally, the historical significance and clinical implications of Kommerell’s diverticulum, its prevalence, and typical anatomical locations are explored in depth. This case underscores the importance of recognizing and understanding rare anatomical variations in clinical practice, particularly when presenting with atypical symptoms such as dysphagia.

DOI: 10.5281/zenodo.

36. Brachial Artery with Tortuosity, Branching Pattern and Clinical Implications
Nivargi Shubha, B. Kokati Drakshayini
Abstract
Introduction: The variations in the branching patterns of the arteries of the limbs have clinical and surgical importance. Anomalies of the arteries of the upper limb are commonly seen. The arterial development is dependent on a precise sequential pattern of the formation and the regression of some of the arteries during development. Aims and Objectives: The present work was done to study the branching pattern of brachial artery and its clinical implications. Materials and Methods: The present study was conducted by dissection of upper limbs of 20 adult human  cadavers, all aged between 35 to 65 years, out of which 15 were male and 5 were female cadavers for a period of one year. Right and left upper limbs were dissected and branching pattern of the brachial artery noted. The course, branches and relations of the artery were observed. Results and Conclusion: Out of 40 upper limbs, 2 limbs had variation in the branching of brachial artery and two limbs were seen with tortuous brachial artery and its terminal branches. Knowledge of variations of brachial artery and its branches is necessary for cardiologists, radiologists, vascular surgeons and orthopaedic surgeons during vascular or reconstructive surgeries of arm and forearm.

DOI: 10.5281/zenodo.

37. Correlative Association between Insulin Resistance and Consequences of Metabolic Syndrome among Female Patients with Polycystic Ovary Syndrome (PCOS) in Tripura: North East India
Soumyadip Sarma, Bappaditya Som
Abstract
Background: Polycystic Ovary Syndrome or PCOS is one of the most prevalent disorders of endocrine metabolic system affecting women of reproductive age group. This disorder is specialized with hyperandrogenism, dysfunction of ovulation along with polycystic ovarian features. Both insulin resistance and metabolic syndrome have several overlapping features in PCOS that produce linking factors between both of the diseases. Here in this study we implicate it to search for the prevalence of insulin resistance and metabolic syndrome among women diagnosed with Polycystic Ovary Syndrome (PCOS) in the North Eastern part of India. Aims and Objectives:  To obtain the occurrence of insulin resistance and metabolic syndrome among women diagnosed with Polycystic Ovary Syndrome (PCOS) in North East India. Materials and Methods: 100 female patients collected from Gynecology OPD diagnosed with PCOS were selected and observed for the presence of clinical and biochemical characteristics of metabolic syndrome. The duration of this study was from December 2018 to November 2020 in Tripura Medical College, Agartala, Tripura, India. Results: Metabolic syndrome was associated with women with PCOS among 31% of cases. Among these, 93.5% had HDL level < 50 mg/dl; while 90.3% had fasting glucose ≥ 100 mg/dl; 87% of women are associated with obesity and 69% PCOS women are accompanied with insulin resistance. Conclusions: PCOS itself is highly associated with prevalence of insulin resistance and metabolic syndrome. Both blood glucose and lipid parameters should be frequently checked for screening of women with PCOS in the clinical laboratories to delay or prevent the long term consequences of metabolic syndrome.

DOI: 10.5281/zenodo.

38. Clinical and Radiological Predictors of Outcome in Acute Encephalitic Syndrome: An Observational Prospective Study at a Tertiary Care Hospital in North East India
Mishra C, Mahanta A, Das M, Medhi G, Bhuyan D
Abstract
Background & Aims: Acute Encephalitis Syndrome (AES) is a major public health issue among children in India causing high mortality and morbidity. We aim to evaluate the clinical and radiological profile of AES patients and find the predictors of poor outcome. Methods: We conducted a Prospective observational study among children with AES between 1-12 years of age admitted at a tertiary care center from April 2021 to March 2023 (2 years). Clinical features, biochemical tests, CSF analysis and radiological features were studied and analyzed to evaluate the predictors of poor outcome. Results: A total of 170 pediatric cases (male: female, 1.6:1) of AES were enrolled during the study period. Infective etiology could be confirmed in 50 cases (29.5%), out of which JE was the most common (19.4%) cause. All patients admitted in our study were having fever and altered sensorium at admission. Seizure activity was present in most (94.1%) cases.  In both CT and MRI brains, the thalamus followed by the cortex was the most commonly involved areas. Poor outcome (Modified Rankin Scale, MRS ≥ 3) at discharge was observed in 39% of cases. In univariate analysis, prolonged fever and altered sensorium, multiple seizures, abnormal respiration, low GCS, focal neurological deficits, meningeal signs, abnormal neuroimaging, and prolonged hospital stay were found to be significantly (p value< 0.05) associated with poor outcome. In multivariate analysis, low GCS at admission, meningeal signs and prolonged hospital stay came out to be independent predictors of outcome. Conclusion: Low GCS, meningeal signs, and prolonged hospital stay are predictors of poor outcomes in AES.

DOI: 10.5281/zenodo.

39. A Clinico-Epidemiological Study on Melasma in North Andhra Pradesh of India
BTVN Raju, KV Chalam, D Sailaja, S Sandhya
Abstract
Background: Melasma is an acquired bilaterally symmetrical facial hypermelanosis and tan to brown(epidermal) or bluish(dermal) in colour. It is more common in women. Nowadays Melasma is one of the most common pigmentary disorder in patients attending to dermatology clinics. There is a limited number of studies regarding Clinico-epidemiological features of Melasma, that’s why we are doing this study for awareness of upcoming dermatologists. Aims: Our present study was aimed to describe clinical and epidemiological features of Melasma in patients attended to dermatology department of King George Hospital, affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Materials and Methods: In our study, total Hundred patients of Melasma attended to our DVL OPD of KGH, Visakhapatnam were included to evaluate clinical, epidemiological data and excluded patients with other causes of facial hyperpigmentation. Results: In our study, majority of the patients belong to age group of 25-45 yrs(71%). Women(82%) were more affected when compared with men(18%). In most of the patients duration is more than 3 years(69%) with recurrences after medication. Recurrences observed mainly in patients occupation with sun light exposure i.e. occupational labour. In woods lamp examination, epidermal type (superficial, 90%) and clinically centrofacial pattern(60%) observed in majority of the patients. Conclusion: According to our study, in North Andhra Pradesh, Melasma is most commonly seen in reproductive age group, especially in females. Recurrences are most common after using Kligman’s regimen (topical) in patients frequently exposed to sunlight without application of sunscreen.

DOI: 10.5281/zenodo.

40. A Clinico-Epidemiological Study on Alopecia Areata in North Andhra Pradesh of India
BTVN Raju, K Venkata Chalam, Dhanyasi Edukondalarao, D Sailaja
Abstract
Background: Alopecia areata is a common chronic inflammatory disease directed against the anagen hair follicle, causing nonscarring alopecia of the scalp, beard and/or body hair. The sex incidence is probably equal. Nowadays Alopecia areata is one of the most common hair disorder in patients attending to dermatology clinics. There is a limited number of studies regarding Clinico-epidemiological features of Alopecia areata, that’s why we are doing this study for awareness of upcoming dermatologists. Aims: Our present study was aimed to describe clinical and epidemiological features of Alopecia areata in patients attended to dermatology department of King George Hospital, affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Materials and Methods: In our study, total Hundred patients of Alopecia areata attended to our DVL OPD of KGH, Visakhapatnam were included to evaluate clinical, epidemiological data and excluded patients with other causes of hair loss. Results: In our study, majority of the patients belong to age group of 5-35 yrs (80%). Men (60%) were affected higher when compared with women (40%). In most of the patients duration was more than 3 months (70%). Recurrences observed less (40%). Recurrences observed mainly in younger patients and housewives. In clinical examination, patchy type presented as multiple patches (90%) and clinically in majority of the patients smooth bald hair loss patches were observed on scalp (80%). Severity of the disease was assessed by SALT Score, majority in S1 group (<25% hair loss). Conclusion: According to our study, in North Andhra Pradesh, Alopecia areata is most commonly seen in younger age group. Recurrences are less common in patients with no other comorbidities and also after treatment with steroids.

DOI: 10.5281/zenodo.

41. Ultra Sound Guided Bilateral Transversus Abdominis Plane Block for Post-Operative Analgesia after Laparoscopic Cholecystectomy
Ankita Gupta, Shashank Gupta
Abstract
Introduction: Pain and agitation are the most common side effects after abdominal surgeries which not only affect the recovery of the patient but also increase the hospital stay. Therefore, we decided to conduct a study in which we assess the effect of bilateral Ultra-sound guided Transverse Abdominis Plane (TAP) block used for postoperative pain relief by comparing it with the Intravenous opioids undergoing Laparoscopic Cholecystectomy. This study also assesses the intra operative as well as post-operative hemodynamic stability. Methodology: 80 patients who were posted for routine laparoscopic cholecystectomy surgeries were equally divided into 2 groups with 40 patients each (Group T and Group G). In group T (TAP block + General anesthesia) we gave bilateral USG TAP block by using 0.5% Bupivacaine 5ml & 2% Lignocaine 5ml after general anesthesia, while in group G (General anesthesia) we didn’t give any nerve block after general anesthesia. We observed intraoperative and postoperative analgesic requirements of the patient. Result: Total analgesic requirements were significantly less in group T as compared to group G both in intraoperative as well as early postoperative period. There was decrease in the time spent by the patient in postoperative anesthesia care unit in group T as compared to group G. Conclusion: Bilateral TAP block, using 0.5% Bupivacaine & 2% Lignocaine during general anesthesia for Laparoscopic Cholecystectomy will not only decrease the intraoperative and postoperative analgesic requirements but also decrease analgesic drug usage and discomfort. Therefore, we recommend giving TAP block for Laparoscopic Cholecystectomy.

DOI: 10.5281/zenodo.

42. A Clinico-Mycological Study on the Distribution of Species and Antifungal Susceptibility Profile of Candida Isolates from a Tertiary Care Hospital of a North India
Midhat Ali Khan
Abstract
Candida species are opportunistic pathogens responsible for a range of infections in healthcare settings, posing a significant clinical challenge due to their increasing resistance to antifungal agents. The study aimed to understand the distribution of Candida species and their susceptibility to antifungal agents, providing valuable insights into local epidemiology and treatment strategies. Results revealed a diverse distribution of Candida species, with varying levels of susceptibility to antifungal drugs. These findings underscore the importance of continuous surveillance and tailored management approaches to combat fungal infections effectively in the region.

DOI: 10.5281/zenodo.

43. Comparison of Intrathecal Isobaric Levobupivacaine with or without Fentanyl in Infraumbilical Surgeries: A Prospective Randomized Study
Ashwini Kumar Patel, Kanha Agrawal, Vineet Mandrah, Dinesh Kumar Thakur
Abstract
Background: The subarachnoid block is the preferred anaesthetic technique for operations performed below the belly button due to its cost-effectiveness, ability to effectively relax muscles, and improved post-operative pain management. Levobupivacaine is superior to bupivacaine due to its shortened period of motor blockage, longer duration of sensory blockade, and lower risk of cardiotoxicity. When used with intrathecal local anaesthetics, opioids enhance the efficiency of anaesthesia and pain management during and after surgery. Aim and objectives: This study set intended to evaluate the effects of levobupivacaine in spinal anaesthesia with and without fentanyl. Material and methods: Eighty patients who met the Physical Status I and II criteria for the American Society of Anesthesiologists were divided into two groups at random for this study. The way the study was carried out meant that neither the researchers nor the patients knew which group they belonged to. The study’s goal was to look at the consequences of abdominal surgery. Two groups were randomly assigned to the subjects. A combination of 0.5 ml of normal saline and 2.5 ml of isobaric levobupivacaine 0.5% was given to the Levobupivacaine group (n = 40). A combination of 25 μg (0.5 ml) of fentanyl and 2.5 ml of isobaric levobupivacaine 0.5% was administered to the Levobupivacaine + fentanyl group (n = 40). The duration of the sensory and motor block was noted in the research, along with its onset time. The study also recorded their adverse outcomes in groups, blood pressure and heart rate variations, the duration of analgesia, and their Visual Analogue Scale score. Results: Group LF experienced a significantly faster onset of both sensory and motor block (P < 0.05). Group LF experienced a significantly longer average duration of sensory blockage (P < 0.05). Both groups had steady hemodynamics as well as no sedation all throughout the perioperative phase, and the average length of motor block was found to be similar (P > 0.05). With a p-value of less than 0.001, the analgesic effect persisted significantly longer in Group LF (336.5 ± 31.3 min) than in Group L (223.65 ± 32.17 min). Conclusion: When administering isobaric 0.5% levobupivacaine in conjunction with intrathecal fentanyl (25 μg), patients having surgeries below the umbilicus can experience significantly superior block characteristics and minimal side effects.

DOI: 10.5281/zenodo.

44. The Relationship between Preeclampsia and Hypothyroidism during Pregnancy
Muskan Kumari, Aritra Maji, Chandni Sehgal
Abstract
Background: Pregnancy significantly affects thyroid gland function due to the structural similarity between serum beta-hCG and serum TSH, leading to cross-reactivity and subsequent thyroid hormone release and TSH suppression. Understanding this relationship can aid clinicians in developing targeted interventions and monitoring strategies for pregnant individuals at risk of thyroid disorders and preeclampsia. Methodology: This study involved 100 antenatal women, with 50 patients having hypothyroidism and 50 patients having normal thyroid function. These patients were monitored, and blood pressure assessments began at 20 weeks of gestation. Results: Our findings revealed that 28% (14 out of 50) of hypothyroid women developed preeclampsia, while only 8% (4 out of 50) of women with normal thyroid function experienced preeclampsia, indicating a statistically significant difference (p-value 0.009). Additionally, we observed that 35.71% (10 out of 28) of women with Anti-TPO Ab positivity developed preeclampsia, compared to 11.11% (8 out of 72) of women with Anti-TPO Ab negativity, also showing a statistically significant difference (p-value 0.004). Conclusion: This study highlights a positive correlation between preeclampsia and hypothyroidism during pregnancy, with a strong association noted with anti-TPO antibodies.

DOI: 10.5281/zenodo.

45. Diagnostic Accuracy of Frozen Section Samples of Ovarian Tumors with Histopathology of Surgical Specimens
Nataraj Y Sannappanavar, Basavaraj Ankalkoti, Savitha G, A Sravan Reddy, Vishrutha KC, Vijaya C, Veerendra Kumar K V
Abstract
Background: A pre-operative diagnosis of the nature of early ovarian masses either clinically, imaging or with tumour markers is not always reliable. Intraoperative frozen section is a valuable diagnostic tool in rapid categorization of early ovarian masses limited to the ovaries and thereby helps in planning the surgical management. Objective: To categorize ovarian neoplasms into benign, borderline and malignant on frozen sections. To determine the accuracy of the frozen diagnosis with that of surgical specimens. Materials and Methods: Frozen sections done on 46 clinically and radiologically diagnosed ovarian tumours were compared with final histopathologic diagnosis from January 2019 to December 2020 in the Department of Pathology. Results: Frozen section diagnosis of 46 ovarian specimens, showed 40(86.9%) benign tumors, 4 (8.6%) borderline tumors and 2(4.34%) as malignant tumors. The final histopathologic diagnosis revealed 39 (as benign tumors, 1 as borderline tumors and 2 as malignant tumors. The sensitivity and specificity for benign, borderline and malignant tumors on frozen section were 100%, 85.7%,66.6% and 95.3%, 40%, 100%, respectively. The positive and the negative predictive value for benign, borderline and malignant tumors were 97.5%, 100%, 50% and 97.6%, 100%,93.18%, respectively. The overall accuracy was 97.6%. There were no false-positive cases but 1 case was false negative on frozen. The 1 discordant case was serous borderline ovarian neoplasm. Conclusion: With an overall accuracy of 97.6% frozen section is valuable for intraoperative diagnosis of ovarian tumors but has limitations in serous borderline ovarian neoplasm in our study.

DOI: 10.5281/zenodo.

46. Comparison of Functional Outcomes and Complication Rates in Elderly Patients Receiving Total Hip Arthroplasty versus “Hemiarthroplasty”
Uday Shanker Bhagat, Shanu Saurabh, Om Prakash
Abstract
Background: The most common surgeries for senior hip diseases are hemiarthroplasty and complete hip arthroplasty. Comparing functional results and complication rates drives clinical decision-making. Methods: A retrospective cohort study at Bhagalpur’s Jawaharlal Nehru Medical College Hospital comprised 50 elderly patients who had THA or hemiarthroplasty. Functional results and complication rates were assessed using the Harris Hip Score (HHS). The two groups’ outcomes were statistically compared. Results: This research of 50 older people compared hemiarthroplasty with THA. With higher Harris Hip Scores (85.6 ± 7.2) than hemiarthroplasty (78.4 ± 9.1), THA showed better functional outcomes. Prosthetic dislocation, surgical site infection, and implant revision occurred in 16% of THA and 20% of hemiarthroplasty patients. These findings suggest that elder hip arthroplasty patients need individualised care. Patients who had complete hip arthroplasty had significantly higher HHS values than those who had hemiarthroplasty (p < 0.05). Hemiarthroplasty had a decreased risk of complications than THA, but the two groups were similar (p > 0.05). Conclusion: Hemiarthroplasty and THA had similar problems, although THA improved functional results in elderly patients. These data suggest individualised treatment regimens to improve geriatric hip arthroplasty results.

DOI: 10.5281/zenodo.

47. An Observational Study to Compare Interval Cholecystectomy and Early Cholecystectomy among Patients of Acute Cholecystitis
Fahim Khaled, Motilal Samanta, Srikant Gupta, Rajeev Kumar Shaw, Saurabh Kumar, Sharique Nizami
Abstract
Background: Surgery often causes acute cholecystitis, which requires immediate treatment. Doctors differ on whether early or delayed cholecystectomy is preferable. This study will compare immediate and delayed cholecystectomy in acute cholecystitis patients. Methods: The MGM Medical College and LSK Hospital hosted this observational study. Half of 100 acute cholecystitis patients had cholecystectomy shortly after diagnosis, while the other half did so later. Both groups were compared on demographics, clinical outcomes, and postoperative issues. Statistics were analysed using appropriate methods. Results: The study included 100 acute cholecystitis patients, equally split into interval and early cholecystectomy groups. The early cholecystectomy group had a shorter hospital stay (median 3 days) than the interval group (median 4 days, p=0.042), but there was no statistically significant difference in complications or open surgery rates (p>0.05). Postoperative discomfort was lower in the interval cholecystectomy group, with a mean visual analogue scale score of 3.2 versus 3.6 (p=0.087), though not statistically significant. Conclusion: According to our study, early cholecystectomy may reduce hospital stays and consequences in acute cholecystitis patients. These findings suggest early surgical intervention may help treat this prevalent surgical issue.

DOI: 10.5281/zenodo.

48. Impact of Early Enteral Nutrition on Outcome of Critically ill Children
Ena Yadav, Neeraj Anand, Sciddhartha Koonwar
Abstract
Background: The provision of optimal nutrition therapy in critically ill patients is a fundamental goal of critical care. Critically ill patients are at increased risk for gut injury and ischemia, hemodynamic instability; however it has been shown that enteral nutrition (EN) is the preferred mode of nutrient intake in patients with a functional GI system. Aim & Objective: To find out whether early enteral feeding would improve clinical outcomes for mechanically ventilated critically ill patients in our pediatric ICU. Methods: It was a hospital based Prospective observational study over a period of 1 year in 55 critically ill children aged 1 month to 18 years who were admitted to PICU, Trauma centre of a tertiary care hospital of Lucknow, Uttar-Pradesh. Out of these 28 patients (50.9%) had feeding within 48 hrs of ICU admission while in 27 feeding started after 48hrs of admission. Results: Mean duration of length of ICU stay (10.54 ± 5.95 v/s 16.85 ± 13.70 days) and mechanical ventilation (5.96 ± 3.86 v/s12.77 ± 9.81 days) in patients was significantly higher in late feeding (≥48 hrs) group as compared to patients in whom early feeding (<48 hrs) was initiated. Conclusion: Based on the finding of this study it can be concluded that early initiation of nutritional support via enteral route as soon as possible after ICU admission is beneficial.

DOI: 10.5281/zenodo.

49. Quality of Sleep & Stress: A Dynamic Correlation
Mohd Abass Dar, Nazir Ahmad Var, Saboor Ahmad Naik
Abstract
Background: As we all are aware about the fact that proper Sleep is vital for the body and mind. But unfortunately there are sufficient gestures or adequate information about the relationship between sleep quality, stress, and academic performance in the literature of medical sciences. Aim: This study was performed to determine the association and prevalence of stress with sleep quality among young adults of college going students in India. Methods: A study was done among 220 medical students of Index Hospital & Research Centre Indore using a random sampling technique. All students get intimated about an electronic self-administered questionnaire was used about the current standard and overall grade point average, and other demographic and lifestyle factors.  Kessler Psychological Distress Scale (K10) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the stress and sleep quality. Results: The total students who experienced some level of psychological stress were 64.8%. The prevalence of poor quality sleep was observed 73.4%. Study shows strong correlation between poor quality sleep & sleep (Cramer’s value was obtained V = 0.259, P < 0.001) and daytime naps (P = 0.027), and the observation clarified that the significant predictor of poor sleep quality is elevated stress. Conclusion: Increased stress levels were closely and adequately significant with the poor quality sleep in the medical students. And as per the standards of our observation no sort of correlation or a vital significance was observed with the academic performance. For future concern, as the fact our study was very small and we robustly recommend future work should be done on a large scale based sampling and we wish to establishing courses through myriad platforms focusing on guiding & educating the students about dynamic sleep, hygiene and last but not the least with harsh and day to day frustrated and stressful surrounding.

DOI: 10.5281/zenodo.

50. Comparison of Anterior Cervical Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy A Meta: Analysis of Clinical and Radiological Outcomes
Asman Ali, Angirash Bhattacharyya
Abstract
Background: Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction, and surgical intervention is often necessary for patients with moderate to severe symptoms. Anterior cervical discectomy and fusion (ACDF) and laminoplasty are two commonly used surgical techniques for the treatment of multilevel CSM, but there is ongoing debate regarding the optimal approach. Objective: To compare the clinical and radiological outcomes of ACDF versus laminoplasty for the treatment of multilevel CSM. Methods: This prospective comparative study included 120 patients with multilevel CSM who underwent either ACDF (n=60) or laminoplasty (n=60). Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, while radiological outcomes included cervical lordosis and range of motion (ROM). Intraoperative data and complications were also recorded. Results: Both groups showed significant improvements in JOA scores at all follow-up time points. At 24 months, the ACDF group had slightly better JOA scores compared to the laminoplasty group (15.1 ± 1.1 vs. 14.6 ± 1.3, p=0.025). ACDF was associated with better maintenance of cervical lordosis (15.9 ± 3.0° vs. 12.1 ± 2.7°, p<0.001), shorter operation time (148.3 ± 28.5 vs. 162.7 ± 33.2 minutes, p=0.013), and less blood loss (135.6 ± 48.2 vs. 225.4 ± 67.8 mL, p<0.001). Laminoplasty allowed for greater preservation of ROM (28.6 ± 3.8° vs. 23.7 ± 3.5°, p<0.001). Complication rates were similar between the groups. Conclusion: Both ACDF and laminoplasty are effective treatments for multilevel CSM, with ACDF showing slightly better clinical outcomes and better maintenance of cervical lordosis, while laminoplasty allows for greater preservation of ROM. The choice between these techniques should be based on individual patient characteristics and surgeon preference.

DOI: 10.5281/zenodo.

51. Audiological Screening of High-Risk Infants and Incidence of Hearing Impairment
Mubeez Mustafa Badusha, Rupanjita Sangma, Malavika Raj, Arun T Raj
Abstract
Background: Child with hearing loss looks normal with no physical characteristics and often achieves normal early milestones. If the hearing impairment remains undetected in the first year of life, far reaching disability of speech and language development will occur. If early detection and timely intervention is executed, hearing impairment is a common treatable disability of childhood. Aims and Objectives: To study the incidence of hearing impairment in high-risk infants, associated risk factors and degree of hearing impairment. Materials and Methods: This prospective study was carried out in the Department of ENT and SNCU, Department of Pediatrics in Assam Medical College & Hospital, Dibrugarh from March 2023 to August 2023. Informed written consent was taken from all the parents before the study. As per the proforma, detailed history, clinical examination including local and systemic examination was done, followed by hearing assessment with DPOAE, and BERA [where ever indicated]. OAE was taken at the time of discharge. Whoever has failed in the test was allotted for a repeat test [OAE] at one month of age. In cases that the screening is failed, diagnostic test was done by BAER at 3 months of age. Results: We found an incidence of 14.53% (n=17) of hearing impairment among high-risk infants. Higher incidence of hearing impairment among female babies compared to male (1.43:1). Bilateral hearing loss was almost two times more than unilateral hearing loss. 52.94% (n=9) babies had severe and profound hearing loss. 7 babies had three or more risk factors and this signifies that as the number of risk factors increase, the chance for hearing impairment also increases. Conclusion: There is a high incidence of hearing impairment among high-risk infants. NICU stay > 5 days, ototoxic drugs, sepsis, prematurity and low birth weight is the significant risk factors for hearing impairment in neonates. This highlights the importance of neonatal screening in such high-risk infants. In a limited resource setting, at least a targeted approach of screening program should be implemented in neonatal care units.

DOI: 10.5281/zenodo.

52. COVID-19 Infection, Diabetes Mellitus, Old Age: A Deadly Trio for Mucormycosis in a Tertiary Care Hospital, South India
Divya Teja Chimme, Praveena Basireddy, Priyanka Pudoor, Praveen Deen Kumar N
Abstract
Background: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. The aim of this study is to report the spectrum of fungi, causing Mucormycosis in RT-PCR positive COVID-19 patients, by culture on SDA and study the role of other factors responsible for the disease. Methodology: It is a prospective, observational study on mucormycosis in RT-PCR positive COVID-19 patients based on hospital records and fungal culture reports from 12th May 2021 to 21st July 2021. The study includes cultures conducted on Nasal debridement samples by 10% KOH (potassium hydroxide) mount, SDA (sabouraud dextrose agar) and LPCB(lactophenol cotton blue) mount from patients admitted in the hospital with RT- PCR confirmed COVID-19 and typical symptoms of Mucormycosis. Results: In present study total of 114 patients fulfilling inclusion criteria, with mean age of 52.47±11.20yrs with male preponderance (77.2%) and female were 22.8%. among the included participants, 58.8% were with diabetes mellitus. The fungal culture was positive in 68.4% of the patients, among them 51.8% were positive for rhizopus, 6.1% for aspergillus niger, 2.6% for lichtheimia, 1.8% with aspergillus sp, aspergillus flavus, 1 patients each with aspergillus fumigates and rhizomucor. Steroid therapy was present in 20.2%. Conclusion: Patients of Mean age 52 years with known diabetes status hospitalized for COVID-19 are at higher risk of developing Mucormycosis with the most common causative organism isolated being Rhizopus species.

DOI: 10.5281/zenodo.

53. Psychiatric Morbidity and Associated Physical Illness Patterns in Elderly Patients: A Cross-Sectional Study in a Government District Hospital in Udupi, India
Anil Kumar Pidikiti, Neelima C, Varadarajulu Boya, Vaidyanath Gottumukkula
Abstract
Background: The global increase in life expectancy has led to a rise in elderly patients seeking psychiatric care, particularly in countries like India with a significant aging population. This cross-sectional study conducted in a government district hospital in Udupi, India, aimed to assess the prevalence of psychiatric morbidity and patterns of associated physical illness among elderly patients. Materials and Methods: A total of 120 subjects aged 60 years and above were included, with a focus on demographic data, psychiatric diagnoses, and comorbid physical conditions. Results: The study found a high burden of mental behavioural disorders, notably alcohol-related disorders (42.5%) and depression (31.6%), with a higher prevalence among males. Physical illness, including hypertension, diabetes mellitus, and cardiovascular disorders, was prevalent among the elderly psychiatric patients, highlighting the need for integrated healthcare approaches. Conclusion: The findings underscore the importance of addressing social, cultural, and familial factors contributing to psychiatric disorders in this population, along with the recognition and treatment of comorbid physical conditions.

DOI: 10.5281/zenodo.

54. Comparative Analysis of Bupivacaine-Fentanyl and Ropivacaine-Fentanyl for Labor Epidural Analgesia
Megha Prajapati, Kinjal Prajapati, Vishal Prajapati
Abstract
Introduction: In the realm of labor analgesia, the choice between Bupivacaine-Fentanyl and Ropivacaine-Fentanyl for epidural administration holds significance in optimizing pain relief while ensuring maternal safety. Bupivacaine, known for its long-lasting analgesic effect, and Ropivacaine, lauded for its reduced motor block, both combined with the potent opioid Fentanyl, offer distinct profiles in efficacy and side effect profiles. This study compares bupivacaine-fentanyl and ropivacaine-fentanyl for labor epidural analgesia, assessing efficacy, safety, and obstetric outcomes. Material and Methods: In this prospective randomized comparative study conducted at the department of obstetrics and gynecology, we aimed to evaluate the potential advantages of ropivacaine over bupivacaine in terms of obstetric outcomes for parturients undergoing labor epidural analgesia. A total of 70 eligible parturients, meeting specific inclusion criteria, were randomly assigned to receive either ropivacaine-fentanyl or bupivacaine-fentanyl epidural infusions. Pain levels were assessed using the visual analog scale (VAS), while motor function, adverse effects, and hemodynamic parameters were closely monitored throughout labor. Additionally, neonatal outcomes, including Apgar scores and NICU admission rates, were recorded. Results: In this study, ropivacaine/fentanyl recipients exhibited significantly higher local anesthetic use (14.45 ± 5.6 mL/h) and lower demands (7 ± 2.0) compared to the bupivacaine/fentanyl group. VAS scores were comparable between the ropivacaine and bupivacaine groups at various time points. In the bupivacaine/fentanyl group, one patient experienced moderate motor block (score of 2 on a 0–3 scale), while no profound motor block was observed in either group. These effects were noticeable within 60 minutes post-epidural catheter insertion and remained consistent during labor. Additionally, one patient in the bupivacaine/fentanyl group exhibited motor block (score of 1 on a 0–3 scale) following the initial 1.5% lidocaine epidural test dose. Conclusion: In conclusion, the ropivacaine-fentanyl combination demonstrated lower local anesthetic requirements and reduced need for supplemental analgesia during labor and delivery, suggesting potential advantages over bupivacaine-fentanyl in terms of analgesic efficiency and resource utilization.

DOI: 10.5281/zenodo.

55. Comparing the Effects of N-Acetylcysteine and Metformin on Biochemical and Clinical Parameters in Women with Polycystic Ovarian Syndrome at a Tertiary Care Hospital
Shweta Gupta, Ranjana Kumari, Vijaya
Abstract
Background: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age featuring insulin resistance and hormonal imbalances. Due to gastrointestinal issues caused by metformin, alternatives like N-acetylcysteine (NAC) are being explored. Objective: The study assessed the effectiveness of NAC compared to metformin in treating PCOS symptoms at a tertiary care hospital. Methods: In this randomized controlled trial, 80 women with PCOS were divided into NAC and metformin groups from November 2022 to March 2024. The study monitored changes in insulin resistance, hormonal profiles, menstrual regularity, ovulation rates, quality of life, BMI, and lipid profiles. Adverse effects and discontinuation rates were also recorded. Results: Both treatments significantly improved insulin resistance and hormonal profiles. NAC was particularly effective in reducing insulin resistance and androstenedione levels. Menstrual and ovulation improvements were similar across both groups. NAC users experienced greater emotional well-being and fewer body hair issues along with lesser gastrointestinal side effects and discontinuation rates. Conclusion: NAC might be a preferable alternative to metformin for managing PCOS, offering better tolerability and improved quality of life. Further studies are needed to validate these results and assess long-term benefits.

DOI: 10.5281/zenodo.

56. To Compare P53 Gene Aberration in Oral Leukoplakia Patients and Healthy Individuals by Fluorescence in Situ Hybridization and its Associations in Indian Population
Kanika Rathore, Mohan Singh, Garima Khatri, Vikrant Shekhawat
Abstract
Introduction: Oral cancer is among the most prevalent medical conditions in India and the nations that collectively make up the Indian subcontinent. An innovative method for managing this malignancy is early leukoplakia detection. In the oral cavity, oral leukoplakia (OL) is thought to be the most prevalent premalignant oral lesion. Leukoplakia is one of several precancerous oral lesions that also includes erythroplakia, lichen planus, and submucousfibrosis. The primary cause of oral cancer is tobacco use.Other contributing factors to the development of oral cancer include the human papillomavirus, ethnicity, socioeconomic status, inadequate nutrition, and inadequate dental hygiene. The situation is particularly concerning for the Indian population because around 10% of all malignancies arise in this group each year. Oral squamous cell carcinoma aetiology may involve oncogene and tumour suppressor gene deactivation and aberrant expression. Material and Methods: This study was carried out in Department of Anatomy, S.P. Medical College and Associated Group of Hospitals, Bikaner, Rajasthan. Using an informed consent form, an overall of 50  OLP individuals as well as 50 healthy people were enrolled as controls in the study. Tissue sections were submitted to FISH analysis using the locus specific identification (LSI) TP53/CEP 17 FISH Probe Kit, a publically available probe from Vysis, after protocol optimisation. Results: Our study found that the largest number of leukoplasmic patients fell between the 40–60-year age range, and that males were more common than females in both the case and control groups. Mean age group of cases is 48.64 with SD=12.83. Mean age group of control group is 47.02 with SD=14.13. In the case group, 3 subjects (n=3) exhibited p53 gene aberrations, specifically 2 cases with gene amplification and 1 case with gene deletion while no other subjects displayed such deviations. The site of lesion in cases mainly involved was buccal mucosa, tongue and labial mucosa. Conclusion: The chromosomal structure research field entered a new era with the development of the FISH technology. Thus, the present study has been done by the FISH technique to identify the numerical aberrations in p53 gene with the patients with oral leukoplakia and to compare the data with the control group as there are very less study on the leukoplakia in the western zone of Rajasthan.

Due to less number of cases and limited aberration there is limitation in our study to establish the correlation of type of numerical aberrations with age, gender, site, habits and grading.

DOI: 10.5281/zenodo.

57. Comparison of Serum Visfatin Level in Normal Weight,Overweight and Obese Individuals
Sudipta Kumari Onkar, Rasmita Kumari Padhy, Nirupama Devi, Bishnupriya Panda, Sucheta Panda, Manaswini Das, Subrat Kumar Pradhan
Abstract
Introduction: Adipose Tissue Is Not Only The Storehouse Of Fats And Energy But Also A Major Endocrine Organ Secreting Adipocytokines. Adipocytokines Play An Important Role In Regulation Of Food Intake & Body Weight, Insulin Sensitivity,Inflammation And Vascular Haemostasis. Visfatin Is A Novel Adipokine (52kda) Predominantly Secreted From Visceral Fat. It Shows Insulin-Mimetic Effects Which Correlate With Overweight & Obesity.Our Aim Is To Compare Serum Visfatin Level In Normal Weight,Overweight &Obese Individuals. Materials & Methods: This Is A Cross-Sectional Comparative Study Of Total 162 Adults Between Age Group Of 20-60yrs Including Both The Sexes. All The Individuals Are Divided Into 3 Groups With 54 Subjects Each As Per Bmi. 3ml Of Whole Blood Is Collected With Informed Consent From All Individuals.Serum Visfatin Level Is Analyzed By Elisa. All Data Are Presented As Mean (M)& Standard Deviation (±Sd).Statistical Analysis To Be Done Using Spss Version 20. The Values Are Considered Significant At P <0.05. Results: Fasting Serum Visfatin Level Is Increased In Overweight (100.8+29.9pg/Ml) & Obese Individuals (129.1+21.4 Pg/ Ml) As Compared To Normal Weight Subjects (82.4+26.5pg/ Ml) Which Is Statistically Significant (P<0.012). Conclusion: Serum Visfatin Is Elevated In Overweight & Obese Individuals Compared To Normal Individuals.The Significant Increase Level Of Visfatin In Obese May Be Used As A Diagnostic And Prognostic Biomarker For Insulin Resistance And Metabolic Syndrome.

DOI: 10.5281/zenodo.

58. Lichtenstein Tension Free Mesh Hernioplasty under Local Anaesthesia versus Spinal Anaesthesia
Mrutyunjaya Mallick, Dushmanta Kumar Sethi, Jayanta Pattanaik, Nirod Kumar Sahoo
Abstract
Background and Aim: The surgical repair of an inguinal hernia is one of the most common general surgery procedures. The present study was undertaken to compare intraoperative and postoperative outcomes of Lichtenstein tension-free mesh hernioplasty under local anaesthesia compared to spinal anaesthesia. Materials and Methods: In this longitudinal study, 100 patients aged between 20-80 years, posted for elective mesh hernioplasty were enrolled & divided into two groups. Group- L (n=50) hernioplasty was done under local anaesthesia, & Group-S(n=50) hernioplasty was done under spinal anaesthesia. Patients were assessed for intraoperative comfort or pain felt during surgery, duration of surgery, postoperative pain score, postoperative analgesic doses required, duration of hospital stay and patient satisfaction. Results: Intraoperative pain was comparable in both groups (p=0.695). There was statistically significant difference observed in duration of surgery (p=0.001), postoperative pain at 6hrs (p=0.001), 24hrs(p=0.009) and 48hrs(p=0.047). The mean duration of hospital stay was 2.12 ± 0.172 days in Group-L and 3.9 ± 1.1days in Group-S (p=0.001). The total incidence of postoperative complications seen in Group L and Group S was 6% and 32%, respectively, which was statistically significant (p-0.001). However, in Group-L, 84% of cases responded ‘satisfactory’, and in Group-S, 80% responded ‘satisfactory’ at 6 weeks follow-up, which was statistically insignificant. Conclusion: Lichtenstein tension free mesh hernioplasty under local anaesthesia can be a safer alternative to spinal anaesthesia with the advantages of less postoperative pain and postoperative complications in uncomplicated inguinal hernia.

DOI: 10.5281/zenodo.

59. Study the Effect of Anemia on Pregnancy Outcome in Terms of Maternal Complications, APGAR Score and Perinatal Mortality
Anshika Agarwal, Puneet Agrawal, Diksha Sharma
Abstract
Introduction: Anemia is crucial among all nutritional disorder in all over the world1. Anaemia is a global public ill-health problem affecting both developing and developed countries with major consequences on human health specially women and children. According to WHO (2008) Iron deficiency anaemia (IDA) remains the most typical medical disorder in pregnancy within the developing world, with the burden of disease impacting on both the mother and therefore the newborn. Material and Methods: A total of 200 antenatal patients were included in the study based on inclusion and exclusion criteria. All the women underwent detailed history taking and clinical examination, routine. Details of the patients including clinical data and investigations were recorded in self prepared clinical data sheet. These recruited women were divided into two group’s i.e. anaemic and non-anaemic group. Results: Out of total 200 cases of deliveries, complications of labour were seen in 34 cases. Majority of cases were of PPH i.e. 13, where 8 were non anaemic while 3 were having Haemoglobin level ≤ 9.9g/dl. Equal number of cases was seen in anaemic and non-anaemic group with respect to respiratory infection and failing lactation. Mean Apgar score at 1 min were 7.88, 8, 8 and 8 for non-anaemic, mildly anaemic, moderately anaemic and severely anaemic group respectively. At 5 min mean Apgar score, univariate analysis showed 8.91,9,9 and 9 for nonanaemic, mildly anaemic, moderately anaemic and severely anaemic group respectively. Total 22 perinatal morbidity were noted, out of which 14 were foetal growth restriction babies and 8 early neonatal deaths. Conclusion: Estimation of maternal haemoglobin alone doesn’t have direct effect on the maternal and perinatal outcome if provided with effective obstetric and neonatal care.

DOI: 10.5281/zenodo.

60. Antibiotic Resistant Enterobacteriaceae in Healthy Gut Flora of a Semi Urban Community in Siddipet
Fidha Mujeeb, D. Sowmya, L. Prashanthi, Sai Sindhu, V.V. Shailaja
Abstract
Introduction: Antibiotic resistance is concerningly on the rise in our communities and hospitals, increasing the risk of treatment failure and recurrent infections. The human healthy intestinal gut flora has been altered by the improper use of antibiotics, creating a reservoir of microbes resistant to antibiotics known as the “gut resistome. Methodology: From 60 healthy Siddipet residents, 60 stool samples were taken. It was then processed using standard laboratory procedures to isolate two aerobic enteric bacteria, Klebsiella pneumoniae and Escherichia coli. The Clinical and Laboratory Standards Institute-recommended Kirby Bauer Disc Diffusion method was used for antibiotic susceptibility testing. Results: Out of the 60 subjects, 100% had E. Coli, 80% had K. pneumoniae, and 20% had a combination of both E. Coli and K. pneumoniae isolates. These two microbes have demonstrated resistance to multiple antibiotic classes. Cephalosporins exhibited the highest level of resistance (100%) followed by fluoroquinolones (50%) and aminoglycosides (43%). Conclusion: It is concerning to find commensal organisms with resistance genes. There’s a chance that this will spread and might manifest them when antibiotic pressure is present. To determine the actual prevalence of MDR in the community, more research involving environmental sampling and a correlation of local prescription patterns must be conducted.

DOI: 10.5281/zenodo.

61. A Study of Lipid Profile in Pregnant and Nonpregnant Women
Vidhya T, Grace Mary Paul, Mary Chacko P
Abstract
Introduction: Maternal metabolism undergoes numerous changes during pregnancy including lipid metabolism to ensure adequate nutrient supply to the foetus. The present study investigates alterations in lipid profile (Total cholesterol, triglycerides, LDL, VLDL and HDL) in normal pregnant women (primigravida) in the three trimesters and non- pregnant women of similar age group. The purpose of the present study is to find out the effects of pregnancy on the lipid profile in order to take steps to minimize cardiovascular complications and promote reproductive health of women. Aim: To study the changes in lipid profile during normal pregnancy. Materials and Methods:  This was a cross-sectional observational study consisting of 200 subjects that included 100 primigravida pregnant women and 100 non- pregnant women between 20-35 years. Blood samples for the estimation of lipid profile were taken and analysed using clinical chemistry analyser ERBA (XL-300). Results: Serum Low density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG) and very low density lipoproteins (VLDL) were significantly elevated in the second and third trimesters when compared to first trimester and also in comparison to normal non-pregnant women.  Serum High density lipoproteins (HDL) showed a biphasic pattern characterised by significant elevation in first trimester when compared to normal non-pregnant women and then progressively declined in the second and third trimesters when compared to normal non-pregnant women. Conclusion: An atherogenic lipid profile is observed in most women by the third trimester of normal pregnancy.

DOI: 10.5281/zenodo.

62. A  Study on Management of Distal End of Radius Fractures in Adults by Ligamentotaxis using External Fixator with Distraction: a Hospital Based Study
Kailash Karur, Sandeep Rana, Sandesh C Patil
Abstract
Background and Objectives: Preservation of the articular congruity is the principle prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixator with distractor (UMEX) method is one of the treatment for distal end of radius fracture the main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation. Method: The present study was done at Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru .Mean age of the patients was 42.5 years, external fixator with distractor (UMEX) was applied for a mean duration of 6.5 weeks and cases were followed up for an average of 9 months post operatively. Results: Assessed as per clinical scoring system of Green DP and O’Brien et al. for functional results at the end of 9 months of follow up. Excellent to good functional result was noted in 90%. Conclusion: External fixation with distractor (Umex) and ligamentotaxis provides better functional and anatomical results in comminuted intra-articular distal radius fractures. The successful use of external fixator with distractor for distal end radial fractures requires careful assessment of fracture pattern, appropriate patient selecting meticulous surgical techniques appropriate choice of fixation, careful post- operative monitoring and aggressive early institution of rehabilitation. The final functional results of treatment of distal end radius fractures not only depends on the anatomical restoration of the articular surface but also on the associated soft tissue injuries and articular damage.

DOI: 10.5281/zenodo.

63. A  Surgical Management of Comminuted Inter-Trochanteric Fractures of Femur by Using Cemented Bipolar Prosthesis in Elderly Patients
Sandesh C Patil, Kailash Karur, Sandeep Rana
Abstract
Introduction:  The management of comminuted inter trochanteric fractures of femur  in elderly patients is tricky as there is challenge of difficult anatomical reduction in osteoporotic bones, need for prolonged immobilization after surgery and more chances of screw cut out in poor quality bone. Prolonged immobilization will leads into complications like bed sores, chest infections, deep vein thrombosis, dependency and psycho social side effects, increasing the both morbidity and mortality. The aim of our study was to evaluate the functional outcome of cemented bipolar hemiarthroplasty in comminuted inter trochanteric fractures of femur in elderly patients using Harris Hip Score. Materials and Methods: This is a Prospective study conducted at Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru. Twenty elderly patients with age above sixty years having comminuted inter trochanteric fractures of femur treated by using  cemented bipolar hemi arthroplasty were evaluated for functional outcome using Harris Hip Score. Results: There were 12 female and 8 male patients with mean age of  68.82 years (60 -82)years treated by cemented bipolar hemiarthroplaty.  Patients were followed up at 6 weeks, 3 months, 6 month and 1 year.  At one year follow up with help of Harris Hip Score 8 patients (40%)  were graded as excellent, 10 patients (50%) as good and 2 patients (10%) as fair. Conclusion: The procedure offered rapid mobilization , early return to pre injury level and gave a lasting solution to elderly patients with comminuted inter trochanteric fractures of femur.

DOI: 10.5281/zenodo.

64. A Prospective Study on Treatment of Idiopathic Clubfoot by Ponseti Method
Sandeep Rana, Sandesh C Patil, Kailash Karur
Abstract
Background: From long time clubfoot has been a clinical challenge to orthopaedic surgeons. It is one of the commonest congenital deformity of the musculoskeletal system in children. Each year more than 1,00,000 babies are born with congenital clubfoot. 80% of which occur in developing countries. Methods: Data collected from the Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru 60 feet in 40 children were treated by the Ponseti method from September 2022 to august 2023. Prospective follow up for a mean duration of 18 months was undertaken. The deformity was evaluated by Pirani score before and after the treatment. At the end of treatment all feet were functionally classified into good, fair and poor. Results: The average number of casts applied before full correction was 8. 21.66% of the feets needed tenotomy before full correction. 90% of the patients showed good results, 3.3% had fair results and 6.6% of patients had poor results. There was a significant difference in the pre-treatment and post-treatment pirani score values. Conclusions: Ponseti method of manipulation and plaster casting is very effective to correct club foot deformity.

DOI: 10.5281/zenodo.

65. A Comparative Study of Feto-Maternal Outcome and Progress of Labor among Induced vs Spontaneous Labor in Nulliparous Women
Ketan P Gadhavi, Kishankumar C Kanani, Roshni R Kaneriya, Rajankumar Padasala, Prakashbhai Dhirubhai Rethaliya, Priyanka Jogia
Abstract
Background: Labor induction is a common obstetric intervention among nulliparous women. However, comparative studies evaluating induced labor versus spontaneous onset in this population remain limited. Aim and Objective: This prospective comparative study assessed feto-maternal outcomes and labor progression among nulliparous women undergoing induced labor versus spontaneous labor. Materials and Methods: The study was conducted at the Department of Obstetrics and Gynecology, GMERS Medical College and General Hospital, Junagarh, over six months. A total of 100 nulliparous women were included, with 50 undergoing induced labor and 50 experiencing spontaneous labor. Data on demographic characteristics, labor progression, mode of delivery, maternal complications, and neonatal outcomes were collected and analyzed. Results: Nulliparous women undergoing induced labor had a higher requirement for oxytocin augmentation compared to those experiencing spontaneous labor (48% vs. 20%, p = 0.003). Additionally, the induced labor group had a higher rate of cesarean section compared to the spontaneous labor group (30% vs. 16%, p = 0.041). However, there were no significant differences in the incidence of maternal complications, including postpartum hemorrhage and perineal trauma, between the two groups. Similarly, there was no significant difference in the neonatal intensive care unit admissions rate between the induced and spontaneous labor groups. Conclusion: While induced labor in nulliparous women may be associated with increased rates of oxytocin augmentation and cesarean delivery, it does not appear to confer a significantly higher risk of maternal or neonatal complications compared to spontaneous labor. These findings emphasize the importance of individualized obstetric management and shared decision-making in clinical practice.

DOI: 10.5281/zenodo.

66. The Validity of Labour Admission Test as Screening Test in Predicting Fetal Outcome
P Nithya, C.R. Anuradha
Abstract
Background: It is estimated that 20-40% stillbirths in the non-anomalous category occur as result of intrauterine hypoxia and are therefore potentiality preventable. In this context, a screening test is ideally needed at the time of onset of labour which can detect the already existing compromise on the fetus and which can predict its well-being for next hours in labour, so that timely intervention can prevent irreversible neurological damage and death. This study was undertaken with the purpose of evaluating the efficacy of labour admission test as a screening test to identify the compromised fetus or fetus at risk and to correlate with perinatal outcome. Methodology: This study was conducted as a cross sectional studies in 400 antenatal women admitted in lab our ward in a tertiary care teaching hospital for the period of one year. Mothers were selected randomly who belonged to both low and high-risk group. Low risk cases are those pregnant women with singleton term fetus in cephalic presentation, with labour pains either spontaneous or accelerated. High-risk cases are those with post-dated pregnancy, hypertensive disorders of pregnancy, gestational diabetes, IUGR/ oligohydramnios, Anemia, Rh Incompatibility, Post caesarean pregnancy and heart disease complicating pregnancy “Fetal care” fetal monitoring system (CTG machine) was used in this study.  In this study admission test was done for 400 patients at the time of admission to labour ward. Patients were followed according to the ‘AT’ results. Results: of 400 patients in our study, 255 were low risk cases and 145 were high-risk cases. CTG was done in all patients.280 cases had reassuring pattern (70%), 68 cases had non reassuring pattern (17%), and 52 cases had abnormal tracing pattern. Of the 400 cases, 280 had labour natural, 114 (29%) went for Cesarean Section and 6 cases (1%) went for Forceps Delivery. Among 280 patients who had reassuring CTG, 15 babies were admitted in NICU. 35% of the babies of non-assuring group were admitted in NICU. 56% of the babies of the abnormal CTG group were admitted in NICU. Therefore, NICU admission is more in the non-reassuring and abnormal CTG group. Sensitivity was 83.54%. Specificity was 78.55% in our study. Diagnostic accuracy of the test was 79.25%. Conclusion: An ideal screening test should have high sensitivity and negative predictive value as this test is found to have the above features in my study, it is certainly recommended as a screening test for fetal distress at the time of admission.

DOI: 10.5281/zenodo.

67. Psychological Morbidity, Quality of Life, Body Image, Concerns and Coping Mechanisms in Cervical Carcinoma Patients-A Cross Sectional Study
Anil Kumar P, Vishnu Vardhan Gandikota, J Sharada, C Neelima, Vaidyanath Gottumukkula
Abstract
Introduction: A diagnosis of cancer is shattering for patients and their loved ones. During the months after diagnosis, the cancer sufferer must attempt to come to terms with both uncertainty of the threat to life and disabling. Cervical carcinoma patients are concerned to sexuality, feminity and feeling of motherhood. The research available from India and other developing countries regarding psychosocial issues in malignancy in cancer of the cervix in particularly is meager. Materials and Methods: The study was done in the department of medical oncology at Shirdi saibaba cancer hospital and research centre, kasturba hospital, manipal. The study period is August 2009 to February 2010. Results: 30 Study subjects were selected for the study. The majority of the subjects were in the 41-50 age group.

DOI: 10.5281/zenodo.

68. Age Related Changes in the Fibromuscular Stroma of Human Prostate Gland: An Observational Study
Deepa Chandran A, Kumari T K, Latha Sreedhar L S, Sajey P S
Abstract
Background: The prostate is the accessory gland of male reproductive system. The primary function of prostate gland is to secrete a clear, slightly alkaline fluid that contributes to the formation of seminal fluid. With advancing age, the gland undergoes significant changes both microscopic and macroscopic. The aim of this study is to demonstrate the normal changes occurring in the fibromuscular stroma of human prostate glands in various age groups. Method: An observational study on age related changes in fibromuscular stroma of human prostate gland was conducted in the Department of Anatomy, Government T D Medical College, Alappuzha. 100 specimens of human prostate glands were obtained from the Department of Forensic medicine and Department of Pathology, Government T D Medical College, Alappuzha. The pattern of changes in fibromuscular stroma in different age groups was studied using Haematoxylin, Eosin and other special stains.Results: The fibromuscular stroma was predominant in pre-pubertal prostate specimens. In post pubertal and adult p rostate specimens, there was a relative reduction in the amount of stroma. In 61-75 years age group, there was an increase in the proportion of fibromuscular stroma compared to glandular tissue in 60% of specimens. Conclusions: The present study shows that significant changes occur in the fibromuscular stroma of prostate glands beginning from birth to old age. The results of this study may be helpful in histopathological correlation of various diseases of prostate gland.

DOI: 10.5281/zenodo.

69. Functional Outcome of Total Hip Replacement in Elderly Patients with Fracture Neck of Femur in a Tertiary Care Hospital
Harish Ugrappa, Roshan Iqbal, Naveen Ramanaik Hoysala, Bharathkrishna S, Mruthyunjaya T D
Abstract
Background: Femoral neck fractures, the most common injury in the elderly and presents great challenges to orthopedic surgeons. The number of elderly people is on the rise, the burden of this fracture and its squeal is challenging. Evaluation of long-term outcomes of an operative procedure is important to determine the durability of the procedures like total hip replacement (THR). This study was done to assess the functional outcome of cemented total hip arthroplasty in elderly patients with fractured neck of femur at 2 to 4 years follow up. Methods: A prospective follow up study for 5 years was conducted among elderly patients with fractured neck of femur who were treated with cemented total hip arthroplasty. By convenient sampling method 32 cases of fracture were analyzed for functional outcome by using Harris Hip Score post operatively and followed them for 2-4 years. Results: Majority 29 (90.6%) of the people had excellent and good functional outcome and only 2 (6.3%) had poor functional outcome in our study. The total HHS score was statistically better for the mid-term follow up compared to short term follow up (p<0.001). Conclusion: The cemented Total hip arthroplasty (THA) is a very useful procedure for the primary treatment of femoral neck fractures in elderly. This procedure markedly improves the functional status of the patient in terms of early mobilization, avoiding the complications of prolonged immobilization. Longer follow up studies are recommended to assess the hip function, implant survival and complication related to wear and loosening in the long term.

DOI: 10.5281/zenodo.

70. A Study on Early Detection of Breast Carcinoma by Quadruple Assessment in a Tertiary Care Teaching Hospital
P. Aruneswari, S. Senthil Kumar, Prasanth M. M
Abstract
Introduction: Breast lumps are one of the common problems encountered in women. These lumps are frequently seen in younger to middle aged women and often they go undetected for various reasons. Early recognition of malignancy plays a vital role for improving survival. The need of the hour is a system to detect malignancy earlier and minimize the time needed for the detection of malignant lumps. This study was done to determine the clinical characteristics of palpable breast lumps and with the objective of detecting malignancy earlier in patients presenting with palpable breast lumps using a quadruple assessment. Materials and Methods: This is a Prospective observational study done in 50 patients was included in this study after application of inclusion and exclusion criteria. Each patient underwent a quadruple assessment comprising of a detailed Clinical examination, Ultrasonography of breast, mammogram and Fine Needle aspiration. All the patients finally underwent surgery for their condition and the results of the quadruple assessment were analyzed individually and collectively and were compared to histopathological diagnosis. Results and Discussion: In our study breast, lumps were commonly seen in the age group of 31 to 40 years. Pain over the lump was an important symptom in our study the upper outer quadrant was commonly involved with tumor. When the clinical examination findings were examined as a whole clinical examination had sensitivity of 70 % and specificity of 87% for the detection of malignancy. Mammogram had a sensitivity of 95% for malignancy detection and ultrasound was found to have a sensitivity of 90% in detecting malignancy. In our study, sensitivity and specificity of FNAC to detect malignancy were 95% and 100% respectively. The sensitivity of quadruple assessment for the detection of malignancy was 65% and the specificity for the detection of malignancy was 100%. Conclusion: Breast cancer is the foremost cause of cancer related death in young females; hence early detection of breast cancer carries much importance it has been shown that Ultrasound is as accurate as mammography in detection and differentiation of palpable breast lumps and it can also aid in guiding the site for FNAC and biopsy. Four components of the quadruple test complemented each other and when done with experienced clinicians and Radiologists can reduce the time lag for the detection of malignancy and help us to institute early definitive treatment.

DOI: 10.5281/zenodo.

71. Effect of Class Attendance and Academic Performance of First Year MBBS Students in Biochemistry Department: A Retrospective Observational Study
Narayan B. Narwade, Amita S. Billa, Udaykiran U. Bhalge, Sachin S. Bhavthankar, Nagesh A. Bhalshankar
Abstract
The medical education in India is rapidly progressing and improving since in last decade. A CBME pattern is teaching and internal assessment mainly focuses on the context of competency. In internal assessment a lot of emphasis and weightage are given to summative assessment examination of last three internals. A new professional MBBS curriculum is vast and emphasis has been laid down by the universities and regulatory bodies on attendance policies. Attendance during their undergraduate curriculum plays very crucial role in the later professional life. In the professional courses rule are regarding the attendance during lectures and practical is compulsory. The universities have mandatory attendance policies during lectures and practical sittings. Even though, student’s absence is a continuing problem in medical education. A study was conducted in first year MBBS Batch (2021-22) of CBME pattern were included in the study. This batch had total 150 students they were further separated in two parts > 80% and < 80% class attendance in theory and practical at the time of first, second, preliminary internal and final university examinations. Students class attendances were compared with their exams result (Pass / Fail). The measureable data were analyzed by using chi-square test. The students with >80% class attendance were having more passing result as compared to those with <80% class attendance in their all internal assessments and final university examination. First MBBS student’s entire academic performance was affected by their class attendance.

DOI: 10.5281/zenodo.

72. A Study on Health Problems among Software Professionals in Hyderabad, Telangana
Y Sai Krishna, M Sheeba Apoorva, Venu Bolisetti, Anupama Pulla, Vimala Thomas
Abstract
Introduction: India emerged as a major player in the field of Software Engineering in 1990s. Software Industry has become the career option of choice for many young educated Indians because of its lucrative salary and perks. Hence, long working hours, pressure at work, night shifts and lack of sleep among the software Professionals lead them to various health problems which is the main focus of this study. Methodology: It is a cross sectional study which was done among the software professionals working in Hyderabad. The sample size was calculated by taking the prevalence of visual problems as 52% from a study conducted among software employees by Manish Prasad et al7 at 95% significance and 10 % absolute precision. Estimated sample size was 400. Three software firms were thus selected by simple random sampling and data was collected from all the software employees who were willing to take part in the study, till the desired sample size was met. Results: The mean age of study subjects was 34.04 ± 7.52 years, where mean age of males was 34.79 ± 7.72 years and mean age of females was 32.15 ± 6.66 years. Almost half of them were having complaints of visual and musculoskeletal problems. Majority (45.25%) were having low stress, according to perceived stress scale, followed by moderate stress and high stress being experienced by study subjects and around 29% of the study subjects were diagnosed with insomnia according to Athens insomnia scale. Conclusion: Majority (71.5%) of the study subjects in the study was males and females were 28.5%. Refractive errors (23.5%), Hypertension (14.6%), Diabetes (7.75%) and tension head ache (7%) were the other important health problems existent among the study population. Comparatively more number of elder (>40 years) study subjects and males were pre diagnosed with hypertension. Hypertension was more commonly occurring among the study subjects who smoked and consumed alcohol.

DOI: 10.5281/zenodo.

73. Prevalence of Azole Resistance in Various Candida Species in Various Sample Along with Its Antifungal Susceptibility Pattern in a Tertiary Care Hospital, Vadodara
Vidhi A Patel, Arpita T Parmar, Priya D. Mangukiya
Abstract
Introduction: Candida spp. is the fourth most common cause of nosocomial bloodstream infections and the third leading cause of urinary catheter related infections. In recent years there has been an increasing trend in the emergence of Candida non albicans as a potential pathogen responsible for nosocomial infections as well. The in vitro susceptibility testing of antifungal agents is becoming increasingly important because of the introduction of new antifungal agents and the recovery of clinical isolates that exhibit inherent or developed resistance to Antifungal agents. Aims and Objectives: To study the prevalence of Azole resistance in various Candida species. To study the antifungal susceptibility pattern of various Candida species. Material & Method: Various samples like urine, blood, cerebrospinal fluid, pus, tissue, sputum, body fluids, vaginal swab, broncho alveolar lavage fluid were taken from clinically suspected cases for culture and antifungal sensitivity testing was done according to CLSI guideline. A total of 90 Candida spp. were isolated from these samples, which were included in this study. Result: Out of 3137 culture positive isolates, 90 were Candida species. Prevalence rate of candida spp. is 2.86%. Out of total 90 isolates, 77% (69 isolates) were Candida non albicans and 23% (21 isolates) were Candida albicans. The rate of isolation of Candida was more in Males (51%) than Female (49%). The most frequently isolated species was Candida krusei (32%). Highest number of Candida was isolated from the Urine (51%) & in the infants (44%). Maximum Candida species were isolated from the Extramural-NICU (39%). All Candida species were highly sensitive to Voriconazole and highly resistant to Amphotericin B. Conclusion: The changing epidemiology of Candidiasis, therefore highlights the need for close monitoring of Candida species distribution and susceptibility in order to optimize therapy and outcome. We should also develop the guideline for empirical therapy based on epidemiology of India. Candida non-albicans species were more resistant to azoles compared to C.albicans, information that can be useful for clinicians dealing with non – responding cases.

DOI: 10.5281/zenodo.

74. An Analytical Cross Sectional Study of Comparison between Cell Counter Generated Red Cell Indices with Peripheral Blood Smear Examination in Diagnosing Morphological Type of Anemia
Malar Kodi R, J. Nilavu, Rengaraj T, Aadithya K M
Abstract
Introduction: Anemia affects 24.8% of the global population, and automated hematology analyzers provide accurate RBC indices. However, expertise is required for peripheral blood smear examination, and hematologists only provide incremental helpful information in 4% of cases. Aim of the Study: To correlate morphological type of anemia based on RBC indices (MCV, MCH and   MCHC) and RDW obtained from Mindray BC 6200, a 5 part automated analyzer with morphological type of anemia based on peripheral blood smear examination and to assess the concordance of both investigations in diagnosis of anemia with severity and morphological typing of anemia. Material and Methods: A total of 200 cases of anemia were studied over a period of two years between June 2019 to June 2021. Anemia typing was done by two methods –Firstly using RBC indices with RDW only. Secondly on peripheral blood smear examination. The results were then correlated. Results: Morphological typing of anemia in cases of Microcytic hypochromic anemia with normal and raised RDW shows maximum specificity and macrocytic anemia using RBC indices and RDW shows maximum sensitivity. In cases of Normocytic normochromic anemia, the cases with normal RDW showed high specificity and sensitivity but the cases with raised RDW were wrongly typed on indices had a low sensitivity and specificity indicating additional peripheral blood smear examination as an absolutely necessary tool in morphological typing of anemia. Conclusion: Automated hematology analyzers provide valuable readings for morphological typing of anemia, but peripheral blood smear examination remains the gold standard method. It helps identify the cause of anemia and requires multiple observers for accurate typing. Even today, peripheral blood smear examinations cannot be completely replaced by automated hematology analyzers, as they provide additional information like dimorphic anemia and abnormal cells.

DOI: 10.5281/zenodo.

75. Unraveling Multiple Gestation – Analysis of Risk Factors and Outcome at Tertiary Care Hospital
Triza Kumar Lakshman, Prakruthi S.M, Greeshma V. R
Abstract
Background: A pregnancy with more than one fetus is called multiple pregnancy. Multiple pregnancies are prevailing due to a dramatic increase in use of ovulation-inducing agents, ART, and  shift towards elderly primigravida and grand multiparity. Aims and Objectives: To study maternal risk factors and fetal outcomes associated with multiple gestation. Materials and Methods: This retrospective study was carried out at adichunchanagiri institute of medical sciences, Mandya. A sample of 70 mothers with multiple gestation was collected from hospital records regarding maternal age, parity, risk factors, spontaneous or assisted conception, gestational age, pregestational BMI, and family history. Fetomaternal complications that occurred during the antenatal period, labor, and mode of delivery were collected and analyzed. Results: Out of 8000 deliveries, there were 70 cases of multiple gestation over 5 years, with an incidence rate of 8.75 in 1000 deliveries. 8.5% are conceived by ovulation induction, 5.7% by IVF. 24% MCDA, 73.28% DCDA, and 2.8% are MCMA twins. Preterm labor (65.6%), anemia (46.8%), and hypertension (10.5%) were common problems. (61.4%) vaginal deliveries and (35.7%) LSCS were conducted. Fetal malpresentation leads to 32% of LSCS. Among fetal complications, FGR was seen in 11.4%.  A low APGAR score was noted in 21.4% of preterm babies. Conclusion: Maternal risk factors include multiparity, elderly pregnancy, use of ovulation induction, and ART. Maternal complications are preterm labor, PROM, PPROM, abruption, PPH, etc. Fetal complications noted are  hypoglycemia, respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis, stillbirth, low birth weight etc. Hence the restricted use of ovulation induction ART, promoting early conception. Vigilance during ANC and labor is needed in selecting the mode of delivery. Active fetal surveillance and intervention improve fetomaternal outcomes.

DOI: 10.5281/zenodo.

76. Correlation of Left Atrial Dysfunction in Patients with Duration of Type 2 Diabetes Mellitus: A Study in Rural Population of Eastern UP
Rajesh Kumar Gautam, Manoj Kumar Yadav, Uday Bhan, Brijesh Kumar, Mukesh Rana, Pooja Shukla, Praveen Prasad
Abstract
Introduction: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular complica-tions, including left atrial dysfunction. However, there is limited research on left atrial function in T2DM, par-ticularly in rural populations. This study aims to assess left atrial function in T2DM patients with a disease duration in a rural setting of Eastern UP. Methodology: Two hundred ten participants were recruited, with 105 in the T2DM group and 105 in the con-trol group. Demographic, clinical, and echocardiographic parameters were collected. Left atrial function parame-ters, including left atrial emptying fraction and peak left atrial longitudinal strain, were assessed using echocar-diography. Results: Individuals with T2DM exhibited significantly higher left atrial volume indices, maximal left atrial volumes, and minimal left atrial volumes compared to the control group (p < 0.05). Correlation analysis re-vealed associations between left atrial function parameters and clinical variables, including age, duration of T2DM, and glycated hemoglobin levels (p < 0.05). Conclusion: Our findings highlight the impact of T2DM on left atrial function in rural populations of eastern UP, emphasizing the importance of early cardiovascular assessment and risk management in T2DM patients. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions to improve outcomes in this high-risk population.

DOI: 10.5281/zenodo.

77. A Study of Various Factors Responsible for Incisional Hernia
Yagnik Jagdishbhai Vaja, Hemal J Dholakia, Alpeshkumar D Chavda, Jaykishan J Gol
Abstract
Introduction: Hernia defined as abnormal protrusion of viscus through a normal or abnormal weakness in the wall of its containing cavity. The main aim of this research was to examine incisional hernias, explicitly analyzing the variables that increase the chance of developing them, the many surgical approaches used for repair, and the problems that may arise after the operation. Material and Methods: There were a total of 100 patients involved. The study gathered data on patient demographics, previous operations, kinds of incisions, and possible risk factors such as obesity and diabetes. The repair techniques, such as onlay mesh repair or laparoscopic repair, and the surgical strategy, either open or laparoscopic, were recorded. Postoperative problems, such as the development of seromas and surgical site infections, were closely observed. Results: The age group with the highest frequency was 35-45 years old, and females outnumbered men. Past surgical interventions, namely midline laparotomy operations, were identified as prospective variables that might increase the risk. Additionally, obesity, diabetes, and wound infections were often found. The occurrence of seromas was the most common complication after surgery, followed by wound dehiscence and surgical site infections. The prevailing surgical method was open surgery, with onlay mesh repair being the most often used technique. Conclusion: This research emphasizes many aspects linked to incisional hernias. Although open surgery with onlay mesh repair is generally considered the conventional method, less invasive procedures such as laparoscopy may be used in some circumstances. The research found possible risk factors such as obesity and diabetes, indicating the need for preventive actions.

DOI: 10.5281/zenodo.

78. Investigation on the Diagnostic Utility of the Appendicitis Inflammatory Response Score and the Alvarado Score in Cases of Acute Appendicitis in Paediatric Age Group
Santoshi Prasad Adhikari, Yespal Sharma, Alok Kumar Meher, Piyush Shukla
Abstract
Background: “Acute appendicitis has a considerable influence on clinical practice, despite the fact that it may be difficult to diagnose. It is imperative that a correct diagnosis be reached on the first attempt if one wants to stay clear of potentially catastrophic outcomes. The process of clinical decision-making is influenced by both the Alvarado and Acute Inflammatory Response scores to varying degrees. Aim: This study aimed to compare and contrast the AIR and Alvarado scores for their use in diagnosing acute appendicitis. Materials & Methods: The current investigation got under way after receiving clearance from the institution’s ethical committee. Participants were followed throughout the course of time in this prospective observational research. The General Surgery Department of GMCH Sundargarh in consultation with Department of Paediatrics & Pathology served as the location for the research that was carried out. The data collection phase of the research endeavor began on August 2022 and lasted for 18 months. All of the participants in this research went to the emergency department with symptoms of acute appendicitis, and they all ended up having their appendix removed after undergoing a thorough examination & investigation. Results: Males accounted for 64% of the total population, while females accounted for 34%. Forty-three out of 80 research participants had Alvarado scores that indicated they were at an increased risk. According to the AIR score, 49 (89%of the total) individuals were at high risk for appendicitis, and HPE confirmed the diagnosis in 55 (69% of the total). As shown in Table 1, we found that the Alvarado score, AIR score, and HPE diagnosis of appendicitis did not correspond with one another in a way that was statistically significant. Conclusion: In terms of validity and reliability, the new appendicitis inflammatory response score performed much better than the Alvarado score.

DOI: 10.5281/zenodo.

79. Role of Semen Analysis in Diagnosis of Infertility and Factors Affecting It: A Descriptive Observational Study from Tertiary Care Centre of Karnataka
Vidyavathi Hasabi, Prem Kalagi, Nayana L, Sunita Vernaker
Abstract
Introduction: Despite the increasing incidence and the difficulty in treating male infertility, there has been limited documentation of the leading causes and risk factors for male infertility. Understanding the causes and risk factors will enable the identification of primary prevention methods, as well as effective methods for the primary treatment of male infertility. Objectives: To evaluate the seminal pattern in male infertility and factors affecting the male infertility. Materials and Methods: The present descriptive observational study was carried out at Department of Pathology KIMS, Hubli during January 2023 to December 2023 involving 100 cases for semen analysis. Results: We observed that almost 16% of the cases the sperm motility was less than 50%. 45% of the cases have oligoasthenozoospermia. 36% of the patient has oligozoospermia. Smoking and chewing affect the sperm count significantly in our study. Chronic addictions significantly affect the sperm motility. Conclusion: Chronic smoking and alcoholism as the important risk factors for low semen count and sperm motility in our study.

DOI: 10.5281/zenodo.

80. To Assess the Ratio of Height to Thyromental Distance as a Predictor of Difficult Laryngoscopy
Jaskiran Kaur, Narjeet K. Osahan, Navkiran Kaur, Christina George, Gobinder Singh
Abstract
Background and Aim: Unanticipated difficult airway and its associated morbidity can be avoided by using airway assessment tests preoperatively, in isolation or in combination. The aim of this present study was to assess the Ratio of height to thyromental distance (RHTMD) as a predictor of difficult laryngoscopy and to compare it with other indices like Modified Mallampati Test (MMT), Thyromental distance (TMD) and Upper lip bite test (ULBT). Material and Methods: This study was conducted on 215 patients scheduled for elective surgery under general anaesthesia needing endotracheal intubation. Airway was assessed preoperatively using MMT, ULBT, TMD and RHTMD. Intraoperatively, Cormack and Lehane’s classification was used to assess and grade difficult laryngoscopy. Data was analysed using SPSS version 26.0. Results: The incidence of difficult laryngoscopy in our study was 11.16%. RHTMD emerged as the best predictor with the maximum area under curve (AUC = 0.83). Of the four indices, RHTMD was found to have the highest sensitivity (91.67%), positive predictive value (30.99%) and negative predictive value(98.61%) compared to other indices. Conclusion: RHTMD emerged as the single best predictor of difficult laryngoscopy with maximum area under curve (AUC = 0.83). Predictability of difficult airway can be enhanced by combining it with other tests.

DOI: 10.5281/zenodo.

81. Analysis of Antimicrobial Utilization Patterns, Safety Profiles in an Intensive Care Unit of a Teaching Hospital
Ramadi Prameela, Bokka Naga Nandini, Boddepalli Sireesha, Bodda Deepthi Rani
Abstract
Background: Antimicrobial resistance (AMR) poses significant challenges in healthcare settings, particularly in Intensive Care Units (ICUs) where the use of antimicrobials is prevalent. This study analyzes antimicrobial utilization patterns, safety profiles in the ICU of a teaching hospital, aiming to identify strategies for optimizing antimicrobial use and mitigating AMR. Methods: A retrospective analysis was conducted on 100 patients admitted to the ICU who received antimicrobial therapy. Data on the types of antimicrobials prescribed, indications for therapy, prescribing patterns, duration of therapy, adverse events, antimicrobial resistance associated with antimicrobial therapy were collected and analyzed. Results: Broad-spectrum antibiotics, including cephalosporins, carbapenems, and fluoroquinolones, were the most frequently prescribed antimicrobials. The main indications for antimicrobial therapy were hospital-acquired pneumonia (30%), bloodstream infections (25%), urinary tract infections (20%), and surgical site infections (15%). Empirical therapy was initiated in 70% of cases, with a de-escalation approach based on culture results in 50% of these cases. The average duration of antimicrobial therapy was 10 days. Adverse events were reported in 15% of patients, with antimicrobial resistance observed in 20% of isolated pathogens. Empirical therapy followed by de-escalation was effective in 60% of cases. Conclusion: This study highlights the critical need for antimicrobial stewardship in ICUs to optimize antimicrobial use, reduce the incidence of adverse events of antimicrobial therapy. Strategic interventions, including rapid diagnostic testing and targeted therapy, are essential to improve patient outcomes and combat AMR.

DOI: 10.5281/zenodo.

82. Pterygium and Its Correlation with Dry Eye Disease: Comparing Patients from Different Geographical Locations Attending Sub-Himalayan Tertiary Institute
Charvie Gupta, Lalit Gupta, Yusaf Rizvi, Anurag Thakur, Baltaran Singh Bajwa, Prince Goyal
Abstract
Objective: The aim of this study was to evaluate the correlation between dry eye disease and pterygium and also to compare patients with pterygium from two different geographical locations in this sub-Himalayan region. Materials and Methods: A total of 80 patients, aged between 21 and 65 years, 40 each from two different geographical regions (locations) namely Transgiri and Cisgiri area were included in this study. Tear film breakup time (TBUT) and Schirmer’s test (ST) and Rose Bengal Score (RBS) results were compared in pterygium eye and contra lateral normal eye of the same patient (taken as control). TBUT, ST and RBS results were also compared in eyes with pterygium of different sizes. Pearson’s chisquare test was used to evaluate differences between groups for categorized variables. Unpaired “t” test used to calculate difference of means for quantitative variables. Paired “t” test and mcnemar test were used to analyze group -2 patients who had undergone surgery. Results: On analysis, the overall difference in the mean TBUT between the pterygium eyes, and the contra lateral control eyes was highly significant (P< 0.01). The difference in the ST between the pterygium eyes and the contra lateral eyes was highly significant for size <2 mm (P< 0.001). Most patients with pterygium complained of redness and mild-to-severe ocular discomfort. The respective scores of TBUT, ST and RBS improved after surgery significantly (p-value <0.005). Conclusion: Results of the present study strongly suggest that different geographic locations, size of pterygium, exposure to UV rays, gender, prolonged outdoor work and dusty environment leads to development of pterygium. Pterygium induces abnormal ocular surface conditions which results in development of the dry eye and dry eye is also responsible for development of pterygium. Use of protective eye wears is to be encouraged.

DOI: 10.5281/zenodo.

83. Effects of Gestational Diabetes Mellitus on Maternal Health Outcomes
Jaya Apawat, Meenakshi Samaria
Abstract
Objective: This study aims to evaluate the impact of gestational diabetes mellitus (GDM) on maternal health outcomes. Methods: A prospective study was conducted with 200 pregnant women diagnosed with GDM at RMC Ajmer over a year. Participants were categorized into controlled and uncontrolled GDM groups. Data on demographics, obstetric outcomes, and long-term health were collected and analyzed. Results: Women with uncontrolled GDM exhibited higher rates of cesarean delivery (60% vs. 35%), hypertensive disorders (30% vs. 10%), and postpartum complications. Six months postpartum, 25% of women showed impaired glucose tolerance, and 10% were diagnosed with type 2 diabetes, predominantly in the uncontrolled group. Key adverse outcome predictors included poor glucose control, obesity, and a family history of diabetes. Conclusion: GDM significantly affects maternal health, with uncontrolled GDM leading to more complications. Effective management and postpartum follow-up are essential to improve outcomes. Public health strategies should focus on early screening and personalized care to mitigate GDM effects.

DOI: 10.5281/zenodo.

84. Compressive Thoracic Myelopathy: An Unexpected Adversary Met on Table
Gayatri Brahmandam, Kumar Lakshman, Abhishek Chowdhury, Deekshitha K Aiyer, Anita Mahadevan, Triza Kumar Lakshman
Abstract
Thoracic myelopathy is a relatively overlooked cause of spinal disorders with possible diagnoses including pathological fractures, Pott’s disease, Multiple Myeloma and non-Hodgkin’s Lymphoma. In India, symptoms resembling Pott’s Spine necessitate prompt and effective action as it is the most common extranodal manifestation of tuberculosis. Additionally, it can resemble the aforementioned diseases on radiological examination leading to complications and oversight in patient care. Therefore, a thorough workup is indicated when a patient presents with symptoms of myelopathy. This case report will provide a succinct overview of the presentation and novel management of a patient with a high-grade non-Hodgkin’s Lymphoma – B Cell Subtype with investigations suggesting Pott’s disease.

DOI: 10.5281/zenodo.

85. Evaluation of Modified Alvarado Score in the Diagnosis of Acute Appendicitis at Surgery Department of AGMC and GBP Hospital, Agartala, Tripura
Biswajit Paul, Anup Kumar Saha, M. R. Debbarma
Abstract
Background: Acute appendicitis is the most common surgically treatable cause of abdominal pain; yet, it is mostly a clinical diagnosis that is still challenging to make in many cases. However, in 15–30% of cases, the normal appendix may be removed if the decision to operate was made solely on the basis of clinical suspicion. In order to decrease the likelihood of a negative appendectomy and to help in the early detection of acute appendicitis, a number of diagnostic grading systems have been developed. After Alvarado’s description, Kalan et al. made modifications to one such scoring system. The purpose of the current study is to assess the effectiveness of the modified Alvarado score in the preoperative diagnosis of acute appendicitis. Methods: For the study, 120 consecutive patients who were treated, examined, and admitted with a suspected case of acute appendicitis were included. These patients received a modified Alvarado score following a thorough evaluation and investigation. They received treatment based on the three groups to which they were assigned. Results: According to the study’s findings, high scores (7-9) in men and children had sensitivity values of 92.3% and 83.3%, respectively, whereas high scores in females had a sensitivity value of 72.7%. The sensitivity of the male and female scores (5–6) was 57% and 50%, respectively. Conclusion: When it comes to males and children, high Modified Alvarado score scores are a reliable tool for early detection of acute appendicitis; however, this isn’t the case when looking at females. Abdominal ultrasonography is a helpful tool in preventing negative appendicectomy rates, especially in females.

DOI: 10.5281/zenodo.

86. Comparative Study between Mass Closure and Layered Closure of Midline Abdominal Incisions at Surgery Department of AGMC and GBP Hospital, Agartala, Tripura
Biswajit Paul, Anup Kumar Saha, M. R. Debbarma
Abstract
Background: A laparotomy wound is typically closed in layers that co-opt the different anatomical layers. Single layer closure technique, also known as mass closure technique, is a new closure method that has gained popularity. After comparing it with previous research published in the literature, the purpose of this study is to assess the advantages or disadvantages of single layer closure and layered closure. Methods: Between 01 July 2017 and 30 June 2018, 60 patients of both sexes were admitted to the surgical wards of the Agartala Government Medical College and the GBP Hospital in Agartala, Tripura. This prospective comparative trial study was carried out on them. A comprehensive clinical and general assessment was performed on individuals who were suspected of having intra-abdominal pathology at the time of admission. To confirm the diagnosis, necessary biochemical and radiological tests were conducted. Following diagnosis confirmation, individuals underwent exploratory laparotomy. Either the mass closure technique or the layered closure approach was used to close the laparotomy wound. Following surgery, patients were monitored for three months to look for any late problems. Results: A total of sixty patients were examined. The age range of the majority of patients was 61 to 65. There were more males than females. In comparison to mass closure, the layered closure group has a higher incidence of early problems such as seroma and wound infection. In the multilayer closure group, the mean wound closure time is longer. When compared to layered closure groups, mass closure technique is more economical. Conclusion: The closure of a midline laparotomy incision can be achieved more quickly, affordably, and safely with the mass closure technique.

DOI: 10.5281/zenodo.

87. Study on Morphology of Placenta and Fetal Outcomes in Hypertensive Pregnancies
Anjani Kumari, Shilpi Singh, Deepshikha Singh, Seema
Abstract
Background: The placenta’s normal construction, complete development, and functions dictate the survival and growth of the fetus. Study on the placenta provides information on the health of the developing fetus. Methods: In all, 100 participants were involved in this study, which ran from February 2023 to January 2024 in the Department of Obstetrics and Gynecology at the DMCH in Laheriasarai, Bihar, with assistance from the Department of Anatomy. Participants were divided into two groups: those with hypertension and those without it. Results: Twenty percent of the females in the hypertensive groups were multigravida, compared to 80% of primigravida females. Preterm births increased significantly (to 35%) and lower section caesarean sections accounted for a sizable part of deliveries (to 45%) in the hypertensive group. The babies’ mean birth weights were 2.82±0.43 kg in the control group and 2.33±0.84 kg in the hypertension group. The mean placental weight was found to be 541.4±30.62g in the control group and 478.4±30.62g in the hypertension group upon morphometry analysis of the placentas. In one group, the mean placental diameter was 17.87±1.47 cm, whereas in the control group it was 19.87±1.47 cm. comparing the hypertension group to the control group, there was a substantial decrease in placental area, volume, and thickness. Mean number of cotyledons were 18.46±1.54 in control group as against 16.46±1.54 in hypertension group. Fetoplacental ratio and placental coefficient were 5.23±0.86 and 0.19±0.02 in control group and 4.88±1.79 and 0.17±0.06 in the hypertension group. Conclusion: Pregnancy-related hypertension affects the placenta’s shape and morphometry, as well as the health of the developing fetus.

DOI: 10.5281/zenodo.

88. Relationship between Body Iron Stores and Non Scarring Diffuse Hair Loss in Non-Menopausal Women: A Case Control Study
Smita Kashyap
Abstract
Background: Because iron plays a physiological role in the hair cycle, iron deficiency (ID) may interfere with healthy hair development. Numerous research have looked into the connection between body iron status and hair loss, with varying degrees of success. In order to provide evidence for the significance of iron reserves in non-scarring diffuse hair loss in non-menopausal women, this study was conducted. The purpose of this study is to ascertain how diffuse, non-scarring hair loss in non-menopausal women relates to body iron reserves. Methods: At GSMCH, Ram Nagar (Rajpura), Patiala, Punjab, from March to November 2023, 40 women aged 15 years or older with diffuse hair loss (Female pattern hair loss (FPHL) / chronic telogen effluvium (CTE)) and 40 controls without any history or physical signs of hair loss participated in this controlled study. All of the subjects’ subjective hair loss was assessed using a same questionnaire. Hemoglobin and ferritin levels in the serum were used to evaluate the iron status. Descriptive and inferential statistical analysis using Mean ± stand-ard deviation, Chi-square, Fisher Exact test and Student t test. Results: Three groups were identified through analysis: “Excessive hair loss” (17.5%), “Moderate hair loss” (82.5%), and “Absence of hair loss” (0%). When comparing the incidence of ID (Serum ferritin <40g/L and Hb <12gd/L) in nonmenopausal women experiencing diffuse hair loss to controls, which was 22.5% (n = 9), there was a statistically significant increase among the women experiencing hair loss (n = 27). Conclusion: In non-menopausal women, diffuse hair loss is related to low iron storage. In the treatment of dis-ease, screening to determine these levels in cases of hair loss and supplementing with them when deficient are effective.

DOI: 10.5281/zenodo.

89. A Cross Sectional Study of Food Allergy Test in Chronic Urticaria Adult Patients
Smita Kashyap
Abstract
Background: Chronic urticaria is a debilitating cutaneous allergy disease that can affect individuals of both adult and juvenile age groups physically and psychologically. It has a variety of clinical manifestations. One prevalent cause thought to be present in adult patients with chronic urticaria is food allergies. Reducing or elim-inating the consumption of food allergens that cause symptoms is the best way to prevent it. Suspected food allergies should be evaluated clinically, diagnosed using a skin prick test and a blood test, and treated by a qual-ified medical professional. Methods: This is a cross-sectional study that was carried out from February 2023 to January 2024 on 100 adult patients with chronic urticaria who were seen in the dermatology out-patient department at Gian Sagar Medical College and Hospital in Ram Nagar (Rajpura), Patiala, Punjab. Using a skin prick test with 32 food antigens, this study was carried out to determine the prevalence of food allergies in individuals with chronic urticarial infections. Results: In patients with persistent urticaria, food allergies accounted for nearly 99 percent of cases. Haldi (16.2%), cashew nut (14.1%), mustard (12.1%), saunf (12.1%), milk and chicken (11.1%), garlic, ginger, gram, apple and fish (9.1%), banana and coffee (8.1%) were the top food allergens that caused complaints. Conclusion: One of the most common causes of cutaneously upsetting conditions like chronic urticaria, which can harm a patient’s physical and emotional health, is food allergies. Urticarial patients can benefit from specific diagnosis, evaluation, and treatment for the aforementioned illness. Haldi (16.2%), cashew nut (14.1%), mus-tard (12.1%), saunf (12.1%), milk and chicken (11.1%), garlic, ginger, gram, apple and fish (9.1%), banana and coffee (8.1%) were the top food allergens that caused complaints. One of the least expensive and reasonably use-ful methods for diagnosing chronic idiopathic urticaria is the skin prick test.

DOI: 10.5281/zenodo.

90. Evaluation of Relationship between Placental Morphology and Adverse Perinatal Outcome in Different Conditions Affecting Pregnancy
Shilpi Singh, Anjani Kumari, Deepshikha Singh, Seema
Abstract
Background: The placenta serves as a mirror reflecting the fetus’s intrauterine condition. The placenta is thought to be a major contributor to neonatal and maternal mortality as well as a significant influence influencing fetal growth, which is typically linked to placental insufficiency. The placenta reflects pregnancy issues both macroscopically and microscopically, such as hypertension or gestational diabetes. Methods: Four kinds of placentas were used in the study: normal, pregnancy-induced hypertension, anemia, and diabetes mellitus. A total of 129 placentas were examined. Placental weight, placental surface area, fetal birth weight, placental coefficient, feto-placental weight ratio, and the result of the foetus, stillbirth or alive were among the many factors that were examined. Results: It was noted that the PIH group’s placental weight was noticeably lower than average. On the other hand, it was higher in the group with diabetes and anemia. The birth weight of the newborns in the PIH and anemia groups is significantly lower than that of the diabetes group. A stillbirth was noted in 3.33% of the de-liveries in the usual group. Pregnancy complications are associated with a somewhat increased percentage of stillbirths. Conclusion: The perinatal outcome is also impacted by these diseases. Along with fetal characteristics like foe-tal weight, placental properties are also changed. Therefore, diagnosing these risk factors in pregnancies during the antenatal stage will enhance the result.

DOI: 10.5281/zenodo.

91. Comparison of Efficacy of Intralesional 5-Fluorouracil and Intralesional Triamcinolone Acetonide with 5- Fluorouracil in Management of Keloids
Gajanand Ojha, Vinita Sharma, Manasvi Saini, Vikarn Garg
Abstract
Aim: To evaluate the efficacy of intralesional 5-fluorouracil alone, intralesional triamcinolone acetonide alone and combination of intralesional triamcinolone acetonide and 5-fluorouracil in treatment of keloids. Methodology Ninety patients who fulfilled the inclusion and exclusion criteria were enrolled. Patients were randomly divided into three groups of 30 each. In group A; Intralesional 5-fluorouracil (5 FU) 50 mg/ml alone was used. In group B; Intralesional triamcinolone acetonide (TAC) 40mg/dl alone was used. In group C; combination of intralesional triamcinolone acetonide 40mg/dl (0.1ml) and 5- fluorouracil 50mg/ml (0.9ml) was used, on monthly basis for 6 months. Patients were assessed for efficacy, after 6 months of the treatment. Observations: Efficacy was achieved in 70 cases in which 22 were from 5 FU group, 21 were from TAC group, and 27 were from 5 FU + TAC group. Statistically significant difference was found between TAC Vs 5 FU+TAC group i.e. p-value=0.02 and between 5 FU Vs 5 FU+TAC group i.e. p- value=0.04. Conclusion: The combination of 5-FU+TAC has better efficacy as compared to 5-FU alone group & TAC alone group in the management of keloids.

DOI: 10.5281/zenodo.

92. Evaluation of Clinicopathological Characteristics in Postmenopausal Bleeding Patients at a Tertiary Care Center
Renuka Keshri, Poojita, Srishti Singh
Abstract
Objective: This study aims to evaluate the clinicopathological characteristics of postmenopausal bleeding (PMB) in patients at a tertiary care center to identify the prevalence and nature of underlying pathologies. Methods: We conducted a prospective cohort study of 250 postmenopausal women presenting with PMB from April 1, 2021 to March 31, 2024. Participants underwent a standardized diagnostic workup that included transvaginal ultrasound to assess endometrial thickness, endometrial biopsy, and hysteroscopy where necessary. Data on patient demographics, medical history, and diagnostic outcomes were collected and analyzed. Results: Of the women studied, 20% were diagnosed with endometrial cancer, 15% with endometrial hyperplasia, and 40% with benign conditions such as polyps or atrophic endometritis. The remaining 25% showed no significant pathology. Diagnostic protocols involving ultrasound and biopsy demonstrated high sensitivity and specificity, particularly for detecting endometrial cancer. Logistic regression identified higher BMI and age over 65 years as significant risk factors for malignant outcomes. Conclusion: The high prevalence of significant pathologies among women presenting with PMB highlights the importance of comprehensive diagnostic evaluation in this population. The study supports the efficacy of a multi-modal diagnostic approach in accurately detecting and differentiating between benign and malignant causes of PMB, emphasizing the need for prompt and thorough evaluation to improve patient management and outcomes.

DOI: 10.5281/zenodo.

93. Role of Modified Rodwell’s Haematological Scoring System in Early Diagnosis of Neonatal Sepsis: A Study in Tertiary Care Centre of Central India
Riti Sharma, Vikash Bombeshwar, Ruchi Varma, Arvind Neral, Chandrashekhar Gupta
Abstract
Background: Neonatal sepsis is the commonest and most important cause for the morbidity and mortality in developing countries like India. Neonatal sepsis, sepsis neonatorum and neonatal septicemia are terms that have been used to describe the systemic response to infection in newborn infants. The inability of neonates to completely muster the minimum inflammatory response makes them more susceptible to bacterial invasion of the blood stream than older children and the risk are even higher in preterm infants. HSS is very significant because of its easy availability, accessibility, low cost, less time consuming and can improve the diagnostic accuracy of complete blood count and it can be employed as screening test for diagnosis of sepsis. Methods: This is cross sectional study. A total of 108 cases of neonatal age group were taken in this study. Blood culture, C-reactive protein and Modified Rodwell’s Hematological Scoring System were measured in all cases. Results: Of the 108 neonates in the present study, 35 had positive blood picture. Majority of neonates presented with early onset type of sepsis (88.57%). Individual hematological parameter like I:T PMN ratio (>0.2) and Degenerative changes is seen in most of septicemia. Hematological scoring system (HSS) >3 and >4 had better specificity and negative predictive value (NPV). Conclusion: Hematologic scoring system is a useful test to distinguish the infected from non-infected infants. The hematologic scoring system is a simple, quick, cost effective and readily available tool with high sensitivity and specificity in the early diagnosis of neonatal sepsis. So it can be very well used as a screening test for early diagnosis of neonatal sepsis.

DOI: 10.5281/zenodo.

94. Clinicopathological Profile of Haemorrhoids in North East India
Abhijit Bhoyate, Lekshmi Priya R., G. S. Moirangthem
Abstract
Background: Haemorrhoids are one of the most common benign anorectal problems worldwide. Haemorrhoids are vascular cushions within the anal canal usually found in three main locations: left lateral (3 O’ clock), right posterior (7 O’clock) and right anterior (11 O’clock) positions in the upper anal canal. Methods: In the present study, we have endeavored to profile the spectrum of hemorrhoids among the patients who underwent conventional open haemorrhoidectomy at Regional Institute of Medical Science Hospital, Imphal, from Sept 2015 to Aug 2017. We also have studied risk factors of haemorrhoids, relative frequency of different types and their clinical features. Finally, we have attempted to correlate the clinical results with histopathological findings. Results: This observational study of 48 cases who underwent open conventional haemorrhoidectomy (Milligan Morgan) was done to evaluate the spectrum of clinical pattern and histopathological findings. The histopathological examination of haemorrhoidectomy specimen, irrespective of types and degree of the lesion is found to be ‘Venous’ component only in all patients (100%), with haemorrhage (extravasation of blood) in 17 patients (35.4%) and features of thrombosis in 2 patients ( 4.2%). Conclusion: These finding is suggestive that haemorrhoidal mass is submucosal cushion of dilated and tortuous venous component only. As we did not find any arterial component in the histology, the findings of previous workers that haemionorrhoidal mass is arteriovenous malformation needs further evaluation and confirmation in larger series.

DOI: 10.5281/zenodo.

95. Prospective Analysis of Peroneal Perforator Based Propeller Flap –Single Centre Experience from Eastern India
Biswajit Mishra, Deepak Kumar Sahu, Bibhuti Bhusan Nayak
Abstract
Introduction: Propeller flap is an ideal flap for small to medium size defects because it is harvested from local tissue, has similar color, texture.  It obeys the principle of replacing like with like. It avoids the sacrifices of any nerve, muscle. It does not require microvascular anastomosis. When peroneal perforator flap is harvested with s propeller design, it avoids the drawbacks of pedicle peroneal perforator flap. There is no dog-ear formation and it has excellent cosmetic result. Primary Objective: Evaluate the safety and efficacy of peroneal perforator flap in reconstruction of lower third of leg defects. Secondary Objective: (1) Time taken for flap harvest. (2) Frequency of adverse effect i.e. Flap congestion, superficial necrosis, complete necrosis, (3) Donor site complication i.e. graft loss, infection, hematoma, seroma etc. (4) Perforator location relative to lateral malleolus. Study Design: Prospective study undertaken in Dept. of Plastic Surgery of SCB Medical College, Cuttack from 2021march to 2022 November. Inclusion Criteria: Small to medium size defects with non-healing wound on lower third of leg and ankle region. Exclusion Criteria: Patients with recent MI (60 days) or unstable angina, decompensated heart failure, high-grade arrhythmias, or haemodynamically important valvular heart disease (aortic stenosis in particular); Peripheral arterial disease; Acute infection; Uncontrolled diabetes mellitus; Heavy smokers (>25 cigarettes per day). Result:  24 peroneal perforator flap   were harvested during   the study period. One flap had complete necrosis. There was one flap with superficial necrosis which was managed with vac therapy and skin grafted. The average location of perforator was 9.19 cm from lateral malleolus with SD of 1.3 cm. Age ranged from 15 to 48 years. Flap size ranged from 24 cm 2 to 180 cm2.  Male: Female ratio was 3:1. There was no donor site morbidity.  All patients had satisfactory functional outcome. Time taken for flap harvest was 55.58 sec with SD 10.19. Conclusion: Peroneal perforator artery based propelllar flap is safe and effective for coverage of small to medium size defect when used judiciously in appropriate time interval from injury. It can be harvested rapidly   with minimal adverse effect. There is no donor site complications. It can be suitable alternative to free flap for small to medium size defects of lower limb.

DOI: 10.5281/zenodo.

96. Study of Complications Following Thyroidectomy for Benign Thyroid Disease
Thakur Vimal Singh, Siva Mandadapu, Sanjay Namadar
Abstract
Background: Thyroidectomy is a very common surgical procedure. The outcome and complication rates are largely dependent on the surgeon’s skill and experience. The complications may be anatomical, physiologic, or both. Method: 80 (eighty) adult patients aged between 20 to 60 years having cytological and radiological evidence of benign thyroid disease were studied. Every patient underwent TSH, T3, T4, and USG of the neck and aspiration of fluid for cytological study from a suspected area. CT scan in tracheal compression patients, an indirect laryn-goscopy was done under pre-operatively to assess the position of the vocal cords. Thyroidectomy was done un-der general anesthesia and administered by endo-tracheal intubation. Flexible strobolaryngoscopy was done when an indirect laryngoscope was inconclusive. Results: Benign thyroid complications were 11 (13.7%) hyperthyroidism, 20 (25%) retro-sternal extension, 5 (6.2%) tracheal compression, 27 (33.7%) firm feel, and 17 (21.2%) adhesion. The anatomical variations were: 14 (17.5%) had anterior relation to ITA, with 2 (2.5%) had palsy, 21 (26.2%) had branching of RLN with 4 (5%) had palsy, 45 (56.2%) had RLN close to anterior entry, with 5 (6.2%) had palsy. Vocal cord palsy was highest in firm gland and least in 5 (6.2%) tracheal compressions. Conclusion: It is concluded that a surgeon with skill and knowledge of the anatomy of the thyroid gland can minimize the post-surgical complications.

DOI: 10.5281/zenodo.

97. Evaluation of Mountex Test in Children of Different Age Group in North Karnataka Population
Madhu Nadagouda, Anjana S Mavinahalli, Pooja Amble
Abstract
Background: Tuberculosis in children is a chronic infectious disease caused by Mycobacterium tuberculosis. The latest technique is an ideal method to rule out TB positivity. Method: 90 (ninety) children with TB positivity were made to undergo a Mountex test and sputum for AFB. Blood examinations included CBC, ESR, and chest X-rays to confirm the findings of the Mountex test. Results: 58 (64.4%) children had tuberculosis, and 32 (35.7%) had disease relieved by symptomatic and antibi-otic treatments. 48 (53.3%) children were 4–9 years old, 12 (13.3%) were 10–12 years old, and 30 (33.3%) children were aged between 13-18 years old. Conclusion: The Mountex study, along with CBC, ESR, sputum for AFB, and chest X-ray will certainly help the pediatrician treat such cases efficiently to avoid morbidity and mortality in children.

DOI: 10.5281/zenodo.

98. Study of Acute Respiratory Infections in Breast Fed Babies between Six Months to Two Years of Age in North Karnataka Population
Anjana S. Mavinahalli, Pooja Amble, Madhu Nadagouda
Abstract
Background: Acute respiratory infections in breast-fed babies are a major cause of morbidity and mortality in underdeveloped countries like India. Various etiologies of ARI have to be ruled out and treated efficiently. Method: 90 (ninety) babies between 6 months to 2 years of age with ARI were studied and compared with the same number of controlled groups. Routine blood examinations, including CBC, ESR, PS, AEC, chest x-ray, and PFT, were done only if necessary. Results: Comparison of social-demographic parameters like gestational age, premature birth, mean weight of birth, caesarean birth, employment of mother, siblings, and habits of parents had a significant p value (p<0.001). In comparison of breast feeding 60 (± 3.6) in patients with exclusive breast feeding before onset of symptoms babies and 72 (± 5.2) in controlled, t test was 18 and p<0.00. Never breastfed patients were 25 (± 3.3) in ARI and 13 (± 2.6) in the controlled group, t test 27 and p<0.001. Conclusion: It is confirmed that malnourished babies are more prone to ARI and need to be correlated with breast-fed babies. Nutritional supplementation must be recommended along with treatment for early recovery.

DOI: 10.5281/zenodo.

99. Obesity and Physical Activity Patterns among Adolescent School Students in Kerala
Sivakumar C. P., Jose Joseph, Manjula V. D.
Abstract
Background: The pattern of inactivity begins early in life, making the promotion of physical activity among children crucial. This study was conducted in the schools of the Kottayam Municipal Area to assess the level of physical activity in adolescents. Another objective was to determine the prevalence of hypertension in this age group. Materials and Methods: The present study was conducted in an urban area of the Kottayam district in Kerala. Schools were stratified into three categories: Government, aided, and unaided. A cluster sampling technique was employed, and data were collected after obtaining informed consent. Results: The study revealed a higher prevalence of obesity among children who do not engage in school play, do not participate in Physical Education programs, and spend more time watching TV and using computers. Additionally, there was a significant association between hypertension and childhood obesity. Conclusion: School intervention programs are the most effective approach to preventing overweight and obesity. Allocating more hours to physical education is essential. Additionally, regular monitoring of blood pressure in children with obesity is crucial.

DOI: 10.5281/zenodo.

100. Incidence of Molecular Subtypes in Breast Cancer & its Association with Axillary Nodal Involvement
Basavaraj Ankalkoti, Nataraj Y Sannappanavar, Vijaykumar D. K., Smitha
Abstract
Immuno-histochemical staining is used as a surrogate marker instead of gene expression analysis for classification of Breast Cancer Subtypes(BCS) and depending on these subtypes treatment is planned . Data correlating BCS & axillary nodal involvement is limited. Objective: To know the distribution pattern of Breast Cancer Subtypes  and to find the correlation between Breast Cancer Subtypes  &  axillary  nodal involvement  and  other clinicopathological  features. Methodology: All breast cancer patients  who underwent primary breast surgery (MRM or BCS) in the Surgical Oncology Department at Amrita Institute of Medical Sciences, Kochi (Kerala) from October, 2010 to  march, 2013 were included in the study. As per institutional  protocol  all the specimens were submitted for  histopathological examination  &  immunohistochemical  staining  which included  ER, PR, HER-2/neu  and  Ki-67. Tumors with 1% or more positively nuclear-stained cells were considered positive for ER and PR expression. Cut-off value of nuclear Ki-67 expression was set at ki-67=<14% as low  & with ki-67 = >14 as high. HER2 results were considered positive in cases with 3+  membranous staining of IHC or gene amplification by fluorescence in-situ hybridization (FISH). Results: The study cohort consisted of  503 patients(luminal A= 21.5%; luminal B= 46.5%; Triple negative=19.3% & Her2Type=12.7% ) of which 270 patients(53.8%) were node positive. Significant association (P value= 0.001) was noted between luminal B type and nodal positivity  where as significant association (P value= 0.028) was also noted between luminal A type and Triple negative with nodal negativity. Conclusions: Most common molecular subtype found in our study was luminal B followed by luminal A, triple negative and HER2 type in the descending order. Nodal   involvement was found more with  luminal B  and less with Luminal A  &  Triple negative. Node negative cancers are more associated with  low ki-67 & node positive cancers are more associated with high ki-67.

DOI: 10.5281/zenodo.

101. Comparative Efficacy of Ksharsutra, Fistulectomy, and LIFT (Ligation of Intersphincteric Fistula Tract) in Treating Fistula in Ano
Nishi Kumari, Anil Kumarv, Prince
Abstract
Background: Fistula in ano presents a significant clinical challenge due to its recurrent nature and impact on quality of life. Traditional surgical treatments include fistulectomy and less invasive procedures such as the Ksharsutra technique, but recurrence and postoperative complications remain concerns. Objective: This study aims to evaluate and compare the efficacy, safety, and patient satisfaction of three surgical techniques for treating fistula in ano: fistulectomy, Ksharsutra, and LIFT (ligation of intersphincteric fistulous tract). Method: Ninety patients diagnosed with fistula in ano were randomized into three groups: Group A (fistulectomy), Group B (LIFT), and Group C (Ksharsutra). They were assessed at 6 and 18 months postoperatively for outcomes including recurrence rates, postoperative pain, incontinence, and patient satisfaction using a Likert scale. Results: The LIFT procedure (Group B) demonstrated superior outcomes across all measured parameters. It showed the lowest recurrence rates and postoperative pain levels, coupled with higher patient satisfaction in terms of impact on physical and social activities. The fistulectomy group (Group A) and the Ksharsutra group (Group C) showed higher recurrence and varying degrees of postoperative complications. Conclusion: The LIFT procedure offers a significant advantage over fistulectomy and Ksharsutra in the treatment of fistula in ano, providing better clinical outcomes with fewer complications and enhanced patient satisfaction. These findings support the adoption of LIFT as a preferred surgical approach in suitable cases, aiming to improve overall patient well-being and postoperative recovery.

DOI: 10.5281/zenodo.

102. Streptococcus Pneumoniae: Identification, Antibiogram and Serotypes from Clinical Isolates: A Hospital Based Descriptive Study
Samir Alam, Rashmi Prabha, Vijay Kumar
Abstract
Background and Objectives: Streptococcus pneumoniae infection is a serious problem worldwide. It is a common cause of pneumonia, meningitis, and septicemia, and the case fatality rate remains high. Globally, India has the highest number of deaths caused by pneumococcal infections among children below 5 years of age, partly because of its large population. The incidence, severity, and mortality of the disease depend on host factors such as age, underlying disease, co morbid conditions, and immunosuppression, but also on the properties of the organism. The present study was conducted to know the extent of Pneumococcal infections in tertiary care hospitals, their antibiogram, serotyping and how many strains were covered by existing Pneumococcal vaccines Methods: A total of 51 consecutive Streptococcus pneumoniae isolates were collected and analyzed in this study. All isolates of Streptococcus pneumoniae were identified by Standard phenotypic methods from all clinical samples obtained Study duration of Two years. They were analyzed for MIC of Penicillin by E-Test method, Antibiogram by Kirby Bauer disc diffusion method and Serotyping by Multiplex PCR (Molecular method) was done in Department of Microbiology, PMCH Patna. Conclusion: The present study gave an insight regarding the extent of Pneumococcal infections in tertiary care hospitals, their antibiogram, serotyping showed diverse strains many of which were covered by existing Pneumococcal vaccines. However considering the occurrence of other serotypes though rarely which were not covered by immunization, there is a need for constant monitoring regarding Pneumococcal serotypes and also more studies of this type to be included in clinical Bacteriology research Programs.

DOI: 10.5281/zenodo.

103. Microbiological Study of MRSA Isolated from Wound Samples
Rashmi Prabha, Samir Alam, Vijay Kumar
Abstract
Background and Objectives: Staphylococcus aureus present on skin and nasal passage, enter through the cuts or invasive procedures. It is responsible for a number of infections such as wound infections, deep infections that spreads from skin to cause bacteremia with or without endocarditis. It may also involve bone, joints, deep organs and tissues. To Characterize 150 MRSA isolates from wound samples. To Study their antibiotic susceptibility patterns, to detect MRSA by Oxacillin disc diffusion, Cefoxitin disc diffusion and resistance to Oxacillin by the MIC method. Material and Methods: Total 150 isolates of MRSA collected from wound samples were characterize by different biochemical tests. Strains were tested with Mannitol salt agar out of 150 strains 145 strains were positive (96.6%), DNase test show’s 143 were positive (95.3%) out of 150 strains, Phosphatase test show’s 146 (97.6%) strains were positive out of 150 strains, Gelatin hydrolysis show’s135 (90%) were positive out of 150 strains and Urease test show’s 142 (94.6%) were urease positive and 8 (5.4%) were negative. Conclusion: Staphylococcus species is a major concern for the medical community. In the past, patients were commonly treated with various Penicillin, Clindamycin Erythromycin and /or Gentamycin for Staphylococcal infections. However, owing to many factors, including the extensive use of these antibiotics Staphylococci have developed resistance. MRSA emerged as a major nosocomial pathogen as well as community associated pathogen. Increased resistance to a number of antibiotics and acquired inducible resistance to Clindamycin has been reported. The present study also shows increasing resistance to various antibiotics.

DOI: 10.5281/zenodo.

104. A Study on Methicillin Resistant Staphylococcus Aureus Carriage in Medical Students before and after Exposure to Hospital Environment
Rashmi Prabha, Usha Kumari, Raj Kishor sharma, Vijay Kumar
Abstract
Background and Objectives: Methicillin resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that has developed resistance to methicillin and other beta lactam antibiotics as well as cephalosporins and monobactams. It harbors a gene, mecA, coding for altered penicillin binding protein (PBP 2a). Exposure to hospital environments is known for MRSA carriage. Health care workers (HCW) have often been implicated in outbreaks of MRSA associated hospital acquired infections due to MRSA carriage in their anterior nares, hands, axillae etc. To evaluate the prevalence of MRSA carriage in among the medical students. To assess the impact of hospital environment on the colonization by MRSA in students with no previous exposure to the organism. Materials and Methods: A total of 86 students were involved in the study. Nasal swabs were taken before exposure to the hospital, 6 months and 1 year after the exposure to the hospital environment. Swabs were cultured onto mannitol salt agar and blood agar. Standard microbiological methods were followed to identify S. aureus and methicillin resistance was checked for, using cefoxitin discs. Results: No MRSA carriage was seen before hospital exposure. At the end of 6 months 2 students (2.3%) were colonized with MRSA and 3 students (3.48%) were colonized at the end of 1 year. The male: female ratio at the end of 1 year was 2:1. Conclusion: Increasing rate of colonization with MRSA was seen with increase in duration of exposure to the hospital environment. Since MRSA is one of the major causes of Hospital acquired infections (HAI) and HCW are considered the source of the infection, periodic screening and treatment of the carriers will go a long way in controlling HAIs caused by MRSA.

DOI: 10.5281/zenodo.

105. Serological Evidence of Chronic Chlamydia Pneumoniae Infection in Coronary Artery Disease
Rashmi Prabha, Vinita Prasad, Spriha Smirti, Vijay Kumar
Abstract
Background and Objectives: Cardiovascular disease, resulting from atherosclerosis, is a leading cause of global morbidity and mortality. Genetic predisposition and classical environmental risk factors explain much of the attributable risk for cardiovascular events in populations, but other risk factors for the development and progression of atherosclerosis, which can be identified and modified, may be important therapeutic targets. Infectious agents, such as Chlamydia pneumoniae, have been proposed as contributory factors in the pathogenesis of atherosclerosis. Hence present study was conducted to determine the seroprevalence of C.pneumoniae antibodies and to study the association of chronic C.pneumoniae infection with Coronary artery disease. Methodology: The study was performed on patients attending the outpatient department as well as on patients admitted for coronary angiogram at PMCH Patna, over a period of one year in the department of Microbiology, PMCH Patna. 3 ml of blood was collected aseptically from 90 angiographically proven coronary artery disease (CAD) patients and 90 number of age and sex matched healthy control subjects. Enzyme linked immunosorbant assay was performed for all the 90 CAD patients and 90 controls to detect the presence of IgG and IgA antibodies to Chlamydia pneumoniae  ESR, CRP, Blood glucose, lipid profile was analyzed for all the cases and controls. Conclusion: In the present study, the seroprevalence of IgG and IgA Cp antibodies was found to be higher in coronary artery disease patients compared to controls and this difference was statistically significant. The present study supports the association between Chlamydia pneumonia infection and Coronary artery disease.

DOI: 10.5281/zenodo.

106. Study of Microbiological Profile and Antibiotic Susceptibility Pattern in Patients with Cholangitis
Rashmi Prabha, Raj Kishor Sharma, Babita Kumari, Vijay Kumar
Abstract
Background and Objectives: Cholangitis represents a surgical emergency which has to be managed without delay. Surgical decompression and antimicrobial therapy remain the cornerstones of this condition. However, it is important to institute the correct antimicrobial therapy considering the local resistance patterns. The resistance β-lactams has become very rampant and is mostly due to Extended Spectrum Beta lactamases (ESBL). Carbapenems are commonly used in these cases but resistance to these agents by carbapenemase enzyme production is rising. Such strains are resistant to all β-lactams and might carry plasmid-borne genes for resistance to other classes of antibiotics as well. There are a limited number of agents available for treatment of such organisms. To isolate bacteria causing cholangitis from bile samples. To determine the antibiotic susceptibility pattern of the isolates. To screen for ESBL (extended spectrum beta lactamase) producing bacterial strains. Methods: It was a prospective study of 100 bile samples in patients of infective biliary diseases. All the cases of cholangitis due to diverse etiology in the Department of Surgical Gastroenterology at PMCH (PMSSY), Patna.  were studied. Samples were collected from patients of cholangitis or acute cholecystitis during Endoscopic Retrograde Cholangiopancreatography / Percutaneuous transhepatic biliary drainage/Cholecystectomy/Laparotomy. Conclusion: The empirical therapy for cholangitis should be based upon resistance patterns in the population. Also, phenotypic detection of resistant isolates by CDT and carba NP test is reliable and helps in identifying ESBL- and carbapenemases-producers. Chromagars are sensitive for the same and can be used as screening methods.

DOI: 10.5281/zenodo.

107. Comparison of Efficacy of Intralesional 5-Fluorouracil and Intralesional Triamcinolone Acetonide with 5- Fluorouracil in Management of Keloids
Gajanand Ojha, Vinita Sharma, Manasvi Saini, Vikarn Garg
Abstract
Aim: To evaluate the efficacy of intralesional 5-fluorouracil alone, intralesional triamcinolone acetonide alone and combination of intralesional triamcinolone acetonide and 5-fluorouracil in treatment of keloids. Methodology: Ninety patients who fulfilled the inclusion and exclusion criteria were enrolled. Patients were randomly divided into three groups of 30 each. In group A; Intralesional 5-fluorouracil (5 FU) 50 mg/ml alone was used. In group B; Intralesional triamcinolone acetonide (TAC) 40mg/dl alone was used. In group C; combination of intralesional triamcinolone acetonide 40mg/dl (0.1ml) and 5- fluorouracil 50mg/ml (0.9ml) was used, on monthly basis for 6 months. Patients were assessed for efficacy, after 6 months of the treatment. Observations: Efficacy was achieved in 70 cases in which 22 were from 5 FU group, 21 were from TAC group, and 27 were from 5 FU + TAC group. Statistically significant difference was found between TAC Vs 5 FU+TAC group i.e. p-value=0.02 and between 5 FU Vs 5 FU+TAC group i.e. p- value=0.04. Conclusion: The combination of 5-FU+TAC has better efficacy as compared to 5-FU alone group & TAC alone group in the management of keloids.

DOI: 10.5281/zenodo.

108. Role of Curcumin and Aloevera in Oral Submucous Fibrosis
Rizvi D, Hasan R, Faiz SM, Meherunisa
Abstract
Background: Oral Submucous fibrosis is a condition characterized by inflammatory changes in oral cavity and buccal mucosa. It is caused by excessive chewing of arecanut, tobacco and nutritional deficiencies. Steroids are the main treatment for it, but now Curcumin & Aloevera are considered as newer adjuvant modalities. Materials and Methods: This is a prospective randomized trial aimed to compare the effectiveness of Curcumin & Aloevera gel in Oral Submucous Fibrosis conducted on 105 patients of OSMF. Patients were divided in 3 groups and given vehicle as control, Aloevera and Curcumin as test drugs. Results: On intragroup comparison in Aloe Vera and curcumin groups there was statistically significant improvement in Interincisal Distance (IID) and Tongue Protrusion (TP) at 1, 2 and 3 months. On intergroup comparison for IID and TP between Control and Aloe Vera, Control and Curcumin and Aloe Vera with Curcumin the difference was not statistically significant. On comparing Aloe Vera with Curcumin group for burning sensation in mouth, they were comparable for two visits, but Curcumin group showed statistically significant improvement at 3 months. Conclusions: There was reduction in Burning Sensation and improvement in Interincisal distance and Tongue Protrusion with both the drugs after 3 months of treatment when compared to Day 0. Curcumin was found to be better than Aloe Vera and it improve all the three parameters but more effectively the Burning Sensation. Hence, Curcumin is more effective in improving the symptoms of OSMF.

DOI: 10.5281/zenodo.

109. Evaluation of Laparoscopic Approach in the Management and Outcome of Benign Adnexal Masses
Basabdutta Nayak, Radhakanta Panigrahi, Rabindra Naik, Madhusmita Hembram, Tushar Kar
Abstract
Background: Adnexal masses are one of the most common diseases affecting women of all ages. Adnexal masses are frequently accompanied by symptoms such as dyspareunia, bloating, increased abdominal girth, pelvic pain, irregular vaginal bleeding, and abdominal pain. This study assessed the feasibility of laparoscopic management of adnexal masses predicted to be benign. Methods: A cross-sectional study was conducted on 50 women presenting with adnexal masses which were benign at the Department of Obstetrics and Gynaecology, SCB Medical College, Cuttack, Odisha, India. The duration of the study was 12 months. All the women fulfilling the inclusion and exclusion criteria were then taken up for laparoscopic management. Results: Laparoscopy was completed in 49/50 patients (98%) and converted to laparotomy in one case. Most common indication of procedure was ovarian cyst; others were dermoid cyst, endometriotic cyst, hydrosalpinx, and adnexal mass. There were mild adhesions (16%) and dense adhesion (2%). Three patients had intraoperative blood transfusion as they were anaemic preoperatively. Mean duration of surgery ranged from 50 minutes to 100 minutes. Most patients were discharged after 2 days and advised to abstain for 2 months, avoiding heavy work. Histopathological reports correlated with laparoscopic findings. Patients were called for follow-up visit after 6 weeks of surgery or earlier if any problem occurred. None of the patients had any major complaints. Conclusion: Laparoscopy is effective in the management of benign adnexal masses. It helps in reducing hospital stay as well as reducing hospital-acquired infections. It is cost-effective, thus reducing hospital stays and reducing early discharges. It is also cosmetically better than laparotomy. However, selecting cases for laparoscopic management of adnexal mass is important.

DOI: 10.5281/zenodo.

110. Assessing the Impact of Body Mass Index on Lipid Lowering Treatment Choice: Fenofibrate vs. Atorvastatin in Atherogenic Dyslipidemia Patients
Manoj Kumar, Chandresh Kumar Gupta, Gyanendra Kumar, Laxman Verma
Abstract
The impact of Body Mass Index (BMI) on the choice between Fenofibrate and Atorvastatin as treatments for patients with atherogenic dyslipidemia (AD). A total of 156 patients with AD were split into two groups, one receiving Atorvastatin and the other receiving Fenofibrate for a period of three months. The initial results indicated that BMI plays a significant role in the decision of which lipid-lowering treatment to use for patients with AD. An analysis of the lipid profile among different BMI categories revealed that atorvastatin was effective in reducing LDL-C, TC, and TG levels, while fenofibrate was more effective in improving HDL-C and reducing TG levels in AD patients. After the three-month period, it was found that atorvastatin was more successful in lowering the lipid profile (TC, TG, and LDL-C) compared to fenofibrate. A positive relationship was identified between higher BMI and the preference for fenofibrate over atorvastatin. Furthermore, patients who were classified as obese or overweight showed better responses to fenofibrate compared to atorvastatin, resulting in improved lipid profiles. It is essential for healthcare providers to consider BMI when determining the appropriate lipid-lowering medication for patients with AD. Additional research is needed to confirm and expand upon the results of this study.

DOI: 10.5281/zenodo.

111. Unraveling the Puzzle: A Case Report on Kartagener Syndrome with Young’s Syndrome
Megha K. Airao, Mox V. Mehta, Keyur M. Patel, Amritlal T. Leuva, Dineshkumar C. Patel, Naiya Bhavsar
Abstract
Primary ciliary dyskinesia is an autosomal recessive disorder associated with abnormal ciliary structure and function, which results in retention of mucus and bacteria in respiratory tract, leading to chronic oto-sino-pulmonary disease, situs abnormalities and abnormal sperm motility. Kartagener syndrome is rare genetic disorder characterized with classical triad of situs inversus, chronic sinusitis and bronchiectasis whereas Young’s syndrome is characterized by chronic rhinosinusitis, bronchiectasis and azoospemia. We present the case of 19 year male patient with recurrent sinusitis and respiratory infection. His semen analysis revealed azoospermia without any evidence of obstruction in epididymis or vas deferens. He was diagnosed with both kartagener syndrome and young syndrome based on history, clinical presentation and radiological features. He was treated with oral antibiotics, mucolytics and chest physiotherapy. He was symptomatically better with the treatment and was put on long term low dose antibiotic. An early diagnosis of this syndrome is crucial to avoid future complications and improve the quality of life of patient.

DOI: 10.5281/zenodo.

112. Meigs’ and Pseudo-Meigs’ Syndrome in Patients Having Unexplained Pleural Effusion: A Case Series
Akansha. P. Singh, Varsha. D. Patil, Keyur. M. Patel, Amritlal. T. Leuva, Dineshkumar. C. Patel, Sachin. P. Trivedi
Abstract
Introduction: Meigs’ syndrome is characterized by the co-occurrence of ascites, pleural effusion and an ovarian tumor (fibroma or fibroma-like tumor). Pseudo-meigs’ syndrome is associated with malignant or benign ovarian tumor (other than fibroma or fibroma-like) or uterine or fallopian tumors with similar triad. Meigs’ syndrome is an uncommon occurrence, with only 1% of ovarian tumors being the cause. Case Description: We are describing here in sequence one case of meigs’ syndrome and two cases of pseudo-meigs’ syndrome. First, second and third cases are in second, fifth and sixth decade of life respectively. Common clinical presentations were abdominal pain and shortness of breath. The clinical examination and various blood and radiological investigations were suggestive of raised CA 125, right sided pleural effusion, ovarian tumor with evidence of ascites in all three cases. Pleural and ascitic fluid tapping were done which were exudative in nature in all three cases. In first case 19 year old female, second case 41 year old female and third case 52 year old female, histopathology report of ovarian tumor were consistent with  likely fibroma, bilateral serous cystadenocarcinoma and adenocarcinoma respectively. Conclusion: Ascites, pleural effusion and elevated CA 125 in an elderly female raises the possibility of an ovarian tumor. Meigs’ and pseudo-meigs’ syndrome is typically diagnosed definitively after surgery, when the tumor is confirmed by histopathology and ascites and pleural effusion have resolved.

DOI: 10.5281/zenodo.

113. Clinicopathological Presentation and Management of Splenic Trauma: A Hospital Based Study
Pratibha Misra, Jyotiranjan Mohapatra, Subhabrata Das, Madhusmita Nayak
Abstract
Background: The management of a traumatized spleen is primarily influenced by several factors. Aims and Objectives: To assess the efficacy of different management procedures and outcomes. Materials and Methods: A retrospective study on splenic trauma was conducted at S.L.N Medical College Koraput, between January 2022 and December 2023. Thirty-six patients with splenic injuries were admitted to the Department of General Surgery during this period. Results: In this study, 36 patients (26.67%) were diagnosed with splenic injuries. All patients were between 6 and 62 years old. The age group with the most patients was 21-30 years old (10 patients, 27.78%). Additionally, 12 patients were from the pediatric age group, with an average age of 26.97 years. The gender distribution showed a male predominance: 26 males (72.22%) and 10 females (27.78%) with a male: female ratio of 2.6:1. Blunt abdominal trauma was the cause of splenic injury in 32 cases (88.89%), with road traffic accidents being the most common culprit (19 cases, 52.78%). A fall in hematocrit was observed in most cases (30 out of 36, 83.33%). Associated injuries were present in 17 patients, with the liver and kidney being the most frequently injured organs (4 cases each).Regarding injury severity, most cases fell into the grade III (13 cases) and grade II (11 cases) categories. Treatment breakdown revealed that 16 patients (44.44%) underwent splenectomy, 10 (27.78%) underwent splenorrhaphy, and 10 (27.78%) received conservative management. Non-operative management was preferred for low-grade (grade I) injuries in children with blunt trauma, while splenectomy was more common for high-grade injuries and in adults. Splenorrhaphy was used for some moderate-grade injuries, particularly penetrating trauma. Overall, non-operative management and splenorrhaphy had successful outcomes with minimal complications, while splenectomy resulted in more complications and higher mortality, especially for patients with severe injuries. Conclusion: Non-operative care and splenic repair techniques are favored in stable patients, but splenectomy remains crucial for unstable or high-risk cases.

DOI: 10.5281/zenodo.

114. Echocardiographic Assessment of Left Ventricular Hypertrophy in Patients with Chronic Renal Failure: A Descriptive Study
S Narasimhamurty, S S V V Narasinga Rao, T.V.S.R. Raghu
Abstract
Background and Objectives: Chronic Renal Failure (CRF) prevalence has increased, leading to increased admissions and decreased life expectancy. Causes include infection and cardiovascular events, with Left Ventricular Hypertrophy being a major finding. However, there’s limited information on its prevalence and nature. The study aims to estimate Left Ventricular Hypertrophy prevalence in patients with Chronic Renal Failure using Echocardiography and determine its correlation with the severity of the condition. Methods: The study involved 100 Chronic Renal Failure patients admitted or visiting GMC, GGH, SRIKAKULAM over two years, undergoing detailed history, clinical evaluation, laboratory investigations, and Echocardiography. Results: The study found that Left Ventricular Hypertrophy (LVH) prevalence in chronic renal failure patients increased with severity, with 17% in mild cases, 26% in moderate cases, and 57% in severe cases, primarily among patients aged 51-60 years. Conclusion: The study reveals that patients with chronic renal failure have a higher left ventricular mass index and a higher prevalence of left ventricular hypertrophy, particularly in severe cases. This suggests the need for early cardiovascular evaluation and prevention efforts.

DOI: 10.5281/zenodo.

115. A Crossover Design on Effectiveness & Comparison of 3 Different Innovative Teaching Method in Case Based Learning for First Year MBBS on Biochemistry at CIMS, Chikkamagaluru
Manasa D.R, Shabnam S, Ramkrishna B.Yadgude, Avinash S.S, Srinivas Deshpande, Drisya Kaladharan6, Hitaish Kumar R.N
Abstract
Objective: Fishbowlw Case Based Learning (CBL), forms a bridging gap between theory & and practice, to achieve reasoning skills and competence we introduced 3 different teaching techniques Fish Bowl (FB), Jigsaw (JS), and Flipped Classroom (FCR) among MBBS students. Methodology: A crossover design study was done among first-year MBBS students for a period of 6 weeks at CIMS, Chikkamagaluru. A total of 150 students were divided into 3 groups (50 in each group) and underwent 3 rounds so that each group was exposed to all 3 techniques. Assessment was done by conducting pretest and post-test MCQs. Feedback was taken from both students and facilitators. Results: The difference in the means of analysis between two-time points in the same group was tested by paired t-test. Significant improvement in performance pre v/s posttest. Difference of means analyzed by ANOVA & F testing. 1st & 2nd round showed FCR had higher mean (7±1.7, 7.8±1.2) compared to JS (6.3±2.1, 7.4±1.6) and FB (6.6±2, 7.5±1.7) whereas 3rd round showed FB & FCR were had higher mean (6.2±1.9, 6.2±1.7) which was statistically significant at (p<0.001) compared to jigsaw (6.1±2). Conclusion: Our study showed there is a positive reinforcement & and improvement in the student’s performance among FCR & FB teaching techniques compared to the JS method.

DOI: 10.5281/zenodo.

116. Morbidity Pattern and Outcome of Patients Admitted in Paediatric Intensive Care at Late Shri Lakhi Ram Agrawal Memorial Government Medical College Raigarh Chhattisgarh, a Tertiary Care Hospital
Laxmaneshwar Kumar Soni, Gourav Claudius
Abstract
Background: This study was carried out with the objectives to estimate prevalence and distribution of various types of diseases among Paediatric patients admitted in Paediatric ICU of Late Lakhi Ram Agrawal Memorial Govt Medical College from Aug 2022 to Dec 2023 and to estimate outcome of these patients during study period. Methods: A retrospective study was carried in children admitted in PICU from Aug 2022 to December 2023 when a total of 831 patients were admitted. Results: Of 837 cases studied, 445(53.2%) were males and 392 (46.8%) were females. The male to female sex ratio in the entire study group was 1.2:1.0. Of 837 cases studied, 231(27.6%) had age below 1 year, 268 (32.0%) had age between 2-5 years, 222(26.5%) had age between 6-10 years and 116(13.9%) had age above 10 years. Maximum number of patients 499 (59.6%) belonged below 5-year age group. The most common system involved was central nervous system which was observed in 196(23.4%) cases. This is followed by respiratory system 190 (22.7%) and Haematology 149 (17.8%). Among the cases the most common diagnosis was Seizure which was observed in 170 (20.3%) of cases, followed by Pneumonia that was observed in 125 (14.9%) of cases. Conclusions: Of 837 cases studied, 706 (84.4%) were discharged, 66 (7.9 %) were referred, 47(5.6%) expired and 18 (2.1%) went leave against medical advice (LAMA). Majority of mortality occurred among children aged <1-year olds 7.8% followed by 1-5 years old 5.8% deaths.

DOI: 10.5281/zenodo.

117. Ki-67 Expression in Premalignant and Malignant Lesions of Gallbladder in Southern Part of Assam
Dey Poulami, Sarkar Ritu, Deka Monoj Kumar, Das Arindam
Abstract
Introduction: Gallbladder cancer is the most common malignancies of the biliary tract and among the gastrointestinal malignancies. Gall stones, pyloric and intestinal metaplasia have been found to be associated with gall bladder carcinoma. Ki-67 is a good marker for cell proliferation and its expression is correlated with various lesions of gall bladder. Aim: The aim of the study is to assess the ki-67 expression in different malignant and premalignant lesions of gall bladder. Materials and Methods: The retrospective study included 212 cases of gall bladder lesions, out of which 22 cases were malignant and 75 premalignant lesions. Immunohistochemistry was done for ki-67 expression. A percentage of >20% stained cells was considered to be positive regardless of the intensity of staining. Results: It was observed that out of 212 cases, 179(84%) cases were female and 33(16%) cases are males. The incidence of gall bladder lesions was highest in 41-50 years (36%) and malignant cases were highest in >50 years (55%). In the malignant groups, Ki-67 expression was <20% in 59% cases, 20-30% in 27% cases and >30% in 14% cases. Ki-67 expression was highest in moderately and well differentiated gall bladder carcinomas than poorly differentiated carcinomas. Conclusion: Ki-67 can be used as a good marker of aggression of various lesions of gall bladder.

DOI: 10.5281/zenodo.

118. The Study of Association of Serum Ferritin Levels in Metabolic Syndrome
Abhijeet, Ramya M R, Rangaswamy
Abstract
Background and Objectives: Metabolic syndrome is a collection of metabolic disorders that raises the risk of diabetes and cardiovascular disease. Obesity, especially abdominal obesity, is linked to resistance to insulin’s effects on the use of fatty acids and peripheral glucose, frequently resulting in type 2 diabetes mellitus. In cardio metabolic disorders like hypertension, type 2 diabetes, and dyslipidemia, which are considered to be inflammatory diseases, evidence suggests an increase in serum ferritin. Since metabolic syndrome is thought to occur due to several causes, including chronic inflammation, numerous researches has been undertaken worldwide with mixed outcomes. Therefore, this study is conducted to assess the relationship between serum ferritin and components of metabolic syndrome. Methodology: A cross-sectional study was conducted in a government tertiary care hospital in Mysuru city between November 2023 May 2024. The study population was patients with metabolic syndrome per the National Cholesterol Education Program, Adult Treatment Panel III criteria. The sample size was estimated to be 106. A predesigned, pretested and semi-structured proforma was used for data collection. Data were entered in a Microsoft excel spreadsheet. To describe the data frequencies, percentages and graphs were used. Pearson’s correlation was used to address the second objective. Results: The study on metabolic syndrome patients showed a significant correlation with serum ferritin levels. Of the five components of metabolic syndrome, FBS and waist circumference showed a significant positive correlation with serum ferritin levels. Conclusion: Serum ferritin levels are elevated in patients with metabolic syndrome, suggesting that these patients exhibit a certain degree of inflammation which in future may increase the risk of developing cardiovascular disease.

DOI: 10.5281/zenodo.

119. Role of Optical Coherence Tomography in Parkinson’s Patients: A Comparative Study in a Tertiary Care Centre
Aswin G, Arun Raj Ezhumalai, R Kishore, A Prabhu
Abstract
Introduction: Parkinson’s disease is characterized by loss of dopaminergic neurons in the substantia nigra. Dopamine which is found in amacrine and interplexiform retinal cells is the major mediator neurotransmitter of retina. In the follow-up of Parkinson’s disease, the thinning of the retinal nerve fibre layer may be a critical marker to monitor progression of the disease. Aim: This study aimed to evaluate and compare the retinal nerve fibre layer (RNFL) thickness and macular thickness in Parkinson’s disease (PD) patients and control group and to correlate with disease severity and duration of illness. Materials and Methods: A total number of 40 PD patients and 40 controls were recruited during the study period of 9 months. Patients up to stage 3 PD were recruited based on Fulfilment of the UKPDS Brain Bank Criteria. RNFL thickness and macular thickness and volume were measured using OCT. UPDRS scores were calculated in PD patients. Results: There was a statistically significant reduction in RNFL thickness in average (adjusted mean 94.34 vs 99.99, p ≤ 0.001), superior (adjusted mean 118.15 vs 124.13, p ≤ 0.001), inferior (adjusted mean 104.95 vs 126.55, p ≤ 0.001) and temporal (adjusted mean 67.11 vs 74.36) PD group compared to the control group. The macula thickness also was significantly reduced in inner superior (adjusted mean 313.7 vs 312.41, p < 0.001), central (adjusted mean 238.15 vs 251.51, p < 0.001), outer superior (adjusted mean 267.61 vs 277.09, p = 0.014), outer inferior (adjusted mean 256.80 vs 272.00, p ≤ 0.001) PD group compared to the control group. Conclusion: The mean superior, inferior, temporal and average RNFL thickness was significantly lower in the PD group compared to control. The mean macular volume, central, inner superior, outer superior, outer inferior macular thickness was significantly lower in the PD group compared to the control.

DOI: 10.5281/zenodo.

120. Anatomical Variations of Medial Sural Artery and Its Perforators in Indian Population: A Prospective Clinical Study
Vishvendu Gaur, Jaskirat Singh
Abstract
Introduction: MSAP flap is a versatile fasciocutaneous flap and has been being effectively used in treatment of small to moderate size defects especially in head and neck region by plastic surgeons worldwide. It is thin and pliable; therefore, it is a suitable alternative to Radial Forearm flap with much lower donor site morbidity. Previous anatomic studies have sought to identify the location of the medial sural artery and its perforators. This study’s detailed metrics offer a user-friendly insight into the distribution of perforators and the branching pattern of the medial sural artery. Objective: The present study was undertaken to describe the anatomical variations of medial sural artery and its perforators in the Indian population. The information gleaned from this clinical study on the vascular anatomy of the medial sural artery will aid plastic surgeons in developing practical approaches for harvesting the MSAP flap. Methods: A prospective observational study for a period of 2 years was devised. 19 individuals (17 males and 2 females) who underwent reconstruction of tissue defects with MSAP flap were included in the study. Subjects were of ages ranging from 6 to 71 years. Results: An average of 1.47 perforators (range 1 to 3) were found to pierce the medial gastrocnemius muscle in each lower limb. At least one major perforator (>/ = 1mm) was identified in all individuals. Average pedicle length from division of medial sural artery up to emergence of perforators was 7.42 cm (range 4.5 to 10 cm). Average perforator distance from popliteal crease was 9.18 cm (range 4 to 16 cm). The distance of perforators from the posterior midline was 2 cm. Discussion: Despite benefits of MSAP flap, reservations hindering its application relate to the variability in vascular anatomy of medial sural artery and the necessity for intramuscular dissection. Thus, understanding the anatomy of the medial sural artery is crucial for effectively raising a sufficient MSAP flap. The utilization of handheld Doppler emerges as a valuable tool for identifying primary perforators at anatomical sites. Conclusion: Challenges associated with the MSAP flap include the extensive intramuscular dissection and the need to ligate muscular branches, contributing to the potential tediousness of the procedure. Another limitation is that the vascular anatomy of medial sural artery perforators was not consistent and exhibited variability among different patients.

DOI: 10.5281/zenodo.

121. Clinicopathological Study of Non-Malignant Lesions of the Larynx
Hemant J Shah, Kaushal Prajapati, Shilpa N Parmar, Dharmendra M Solanki
Abstract
Background and Aim: Benign vocal cord lesions often develop due to vocal trauma caused by the abuse and misuse of the voice, leading to ulceration and changes in the healing process. Various factors, including social and occupational vocal use characteristics, medical conditions, psychological structures, smoking, and reflux, can all disrupt the epithelial defense system on the vocal cord. Our study focused on analyzing the epidemiological details, incidence, clinical presentation patterns, and risk factors associated with non-malignant lesions of the larynx. Material and Methods: The study site is a department of ENT Tertiary Care Teaching Institute in India, where the research will be conducted for a period of one year. The principal investigator completed all the necessary information in a structured study proforma. This form includes important demographic information, clinical features, ENT examination results, findings from flexible video laryngoscopy and stroboscopy, voice handicap index, diagnosis, and management details. Utilizing statistical methods and analyzing data Our study aimed to provide a comprehensive analysis of the data collected from the patients who participated in our research. We employed appropriate statistical methods and principles to ensure accurate and reliable results. Results: Among the 100 patients studied, vocal cord polyp was found to be the most common non-malignant lesion, followed by vocal cord cyst as the second most common. The presence of hoarseness in patients with nonmalignant lesions was found to be statistically significant, with a p value of 0≤0.05. A significant finding was observed in patients experiencing difficulty in breathing and non-malignant lesions, with a p value of < 0.05. When analyzing the stroboscopic results of different lesions, it was observed that all cases of vocal nodule displayed a glottic closure in the shape of an hourglass. Conclusion: Vocal cord polyps were found to be the most common non-malignant lesion associated with hoarseness, followed by vocal cord cysts. Individuals who engage in voice abuse, smoking, alcohol consumption, dyspepsia, and exposure to fumes have a higher likelihood of developing nonmalignant lesions in the larynx, according to clinical observations.

DOI: 10.5281/zenodo.

122. A Prospective Study to Compare the Safety, Efficacy and Short Term Outcome of TURP (Transurethral Resection of Prostate) and ThuLEP (Thulium Laser Enucleation of Prostate)
Pankaj Trivedi, Vishwas Baheti, Vaibhav Lakhanpal
Abstract
Background: Transurethral resection of prostate (TURP) has been the gold standard for the surgical management of BPH but has complication like bleeding and dilutional hyponatremia which can progress to transurethral resection syndrome (TURS). Thulium laser enucleation of prostate (ThuLEP) provides a bloodless field with minimal energy exposure of pericapsular tissue. The present study aimed to compare the safety, efficacy and clinical outcomes between ThuLEP and TURP for treating symptomatic benign prostatic hyperplasia. Methods: Total 57 patients were included in this study of which 27 underwent ThuLEP and 30 underwent TURP. All patients underwent thorough preoperative evaluation and were assessed during the perioperative period and on 3 months follow up. Results: The operative time in ThuLEP group was significantly more as compared to TURP group (96.29 ± 23.72 min vs 65.00 ± 19.02 min). ThuLEP had significantly lower mean volume of irrigation fluid used in the immediate post-operative period, duration for which irrigation was run, time to clearance of hematuria, catheterisation time and post- operative stay. Fall in hemoglobin and serum sodium levels was also found lower in ThuLEP group.On 3 month follow up, there was improvement in all three functional parameters (Qmax, PVR and IPSS) in both groups and were comparable in both the groups. Conclusion: ThuLEP is as safe and efficacious procedure as TURP which has long been considered the gold standard for the surgical treatment of BPH. Thus, ThuLEP can be considered as a genuine alternative to TURP in present times.

DOI: 10.5281/zenodo.

123. Comparative Analysis of Anterior and Posterior Component Separation Techniques for Treating Large Ventral Hernias
Nishi Kumari, Anil Kumar, Priyanka
Abstract
Background: Large ventral hernia surgery is difficult. This study evaluates the ACS to the PCS in hernia surgeries involving transversus abdominis release. Methods: At Darbhanga Medical College & Hospital, 60 hernia patients were studied prospectively and were  assigned to ACS or PCS. We tracked operating time, postoperative complications, hospital stay, and hernia recurrence for one year. Results: PCS had a slightly longer operative time (260 vs. 240 minutes) but resulted in shorter drain removal time (6 vs. 22 days), reduced hospital stay (10 vs. 14 days), fewer complications, and no recurrences, unlike ACS, which had two recurrences. Conclusion: PCS proves to be more effective for managing large ventral hernias, offering quicker recovery and fewer complications, making it preferable for complex cases. Further research is needed to confirm these findings.

DOI: 10.5281/zenodo.

124. Demographic, Environmental and Clinical Profile of Dengue Fever in Diphu Medical College and Hospital, a Tertiary Care Hospital of Diphu – A Record Based Study
Gobil Thapa, Jangmi Derapi, Pankaj Bayan, Pushpita Barman, Swagata Dowerah, Prabir Pranjal Das
Abstract
Background and Objectives: Dengue is a  mosquito‑borne viral disease which is endemic in several countries in the tropical and subtropical regions of the world. Diphu, the capital of Karbi Anglong is not an endemic region for dengue infection. It experienced its 1st major dengue outbreak in the month of September to November 2022. We conducted a study on this outbreak to understand the clinical profile, demographic and environmental conditions of dengue cases. Methods: All cases registered under Diphu Medical College and Hospital from 25th September to 25th November 2022 were studied. Records from Medical records department (MRD) and bed tickets from Medicine (Dengue ward) were analysed. Home visits were made for 10% of the total cases, where clustering of cases was observed to study the environmental factors related to dengue. A preformed proforma was used for the collection of data. Descriptive statistics were used to analyse the data. Results: 419 cases of Dengue were reported in Diphu. Of these, majority  were male(55.1%) and in the age group of 11-20 years (34.8%). All cases had fever, nausea, malaise, joint pain while headache was reported in 98.1%, vomiting in 92.3%, diarrhea in 3.8% and bleeding in 1.9% cases. Thrombocytopenia was seen in majority of cases (76.8%), other abnormalities recorded were deranged liver and renal function. No fatalities were reported. Majority of cases were from urban areas and peak was at mid-November. Regarding Environmental risk factors related to dengue, all had artificial water holding container surrounding home, 1% had  water tank without cover. No household practiced cleaning and drying of breeding area once in a week. Conclusion: We reported the first ever outbreak of Dengue in Diphu, Karbi Anglong. Vector surveillance and control policies need to be initiated with a plan for rapid diagnosis and treatment of cases  and also to prevent future outbreaks.

DOI: 10.5281/zenodo.

125. The Use of Abdominal Drain in Laparoscopic Cholecystectomy: A Comparative Study
Syed Ameenudddin Ali, Sanjay Khandagale, Abrar Khan
Abstract
Aim: To assess the need of intraperitoneal drain placement in laparoscopic cholecystectomy. Materials and Methods: Our study was carried out at JIIU’S IIMSR, Warudi Jalna, India, a rural tertiary care center from August 2021 to September 2023 and includes 130 patients who underwent elective laparoscopic cholecystectomy. Drain was used for selective cases and data of post-op recovery in all patients was analysed and compared to non-drain placement. Results: Although there was slightly more discomfort noted in patients who had drain placement, there was no significant difference on comparison of the 2 groups based on various parameters including operative time, post-op pain, paralytic ileus, suture site infection and duration of hospital stay. There was also no significant collection noted in patients who did not have drain placement. Conclusion: The use of drains following laparoscopic cholecystectomy does not lead to significantly different outcomes compared to not using drains. The decision to place a drain should be should be reserved for selected cases based on the surgeon’s judgement and the individual patient’s condition, rather than routine practice.

DOI: 10.5281/zenodo.

126. Association of Retinal Vein Occlusion with Hematological and Systemic Biomarkers
Bharti Badlani, Priyanka Singh, Divya Tripathi, Pankaj Kushwaha
Abstract
Background and Objectives: Retinal Vein occlusion (RVO) is the second most common retinal vascular disorder, after diabetic retinopathy which causes painless visual impairment. Multiple systemic, local, and hematologic disorders can contribute to the multi-factorial etiology of RVO. Recent researches have revealed that some inflammatory biomarkers and hyperlipidemia are associated with RVO more frequently. Our study aims to determine the relationship between hematological and systemic biomarkers with RVO. This association can help patients with RVO identify other systemic illnesses and prevent the development of RVO in additional eyes. Material and Methods: In this case control study, 50 patients were enrolled in the Department of Ophthalmology, S.S. Medical College and associated Gandhi Memorial Hospital, Rewa (M.P.) after receiving institutional ethical committee permission and informed written consent. Data collection included detailed history; a comprehensive ocular examination was performed for all the subjects under the study followed by laboratory investigations of inflammatory markers (CRP, Homocysteine), lipid profile (Cholesterol, Triglyceride, VLDL, LDL, HDL levels, MHR) parameters and hematological markers (NLR, PLR, MPV). SPSS version 24 was utilized for statistical analysis. Data was presented as mean with standard deviation or proportions as appropriate. Results: Demographic profile was comparable between the two groups. The mean CRP and Homocysteine levels were significantly higher among the cases as compared to the controls. Among the hematological parameters taken into account, Neutrophil count, Lymphocyte count, Monocytes count, and the Mean Platelet Volume and Platelet-Lymphocyte ratio was significantly higher in cases; whereas Platelet count, and Neutrophil-to-Lymphocyte Ratio was studied to be statistically non-significant. The lipid profile parameters were also significantly increased, except, HDL which was decreased in RVOs and MHR which was not significantly associated with the implication of RVO. Conclusion: Present study reflects an association of RVO with the inflammatory markers, CRP and Homocysteine, which can be considered as risk factor in the development of RVO. Present study concluded that all individuals with retinal vascular blockage should have their serum cholesterol levels checked. While it’s yet unclear whether restoring normal serum lipid levels will enhance vision and stop RVO in the other eye from happening, or whether it may lessen problems and RVO recurrence in the same eye. NLR and PLR parameters can be utilized as independent risk factors in BRVO patients.

DOI: 10.5281/zenodo.

127. Comparative Study of Efficacy of Racemic Bupivacaine 0.0625%-Fentanyl and Levobupivacaine 0.0625%-Fentanyl for Epidural Labour Analgesia
Chethanananda T N, Avinash Shastri H, Madhu N, Amitha Nagaraj
Abstract
Background and Aims: To provide good labour epidural analgesia, this study compares the analgesic efficacy of racemic bupivacaine (0.0625%) with 2 µg/ml fentanyl and levobupivacaine (0.0625%) with 2 µg/ml fentanyl in pregnant women at more than 37weeks of gestation in spontaneous labor and normal fetal heart rate monitoring. Methodology: Sixty pregnant women who requested for labour analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 µg/ml and Group L (n = 30) received levobupivacaine 0.0625% and fentanyl 2 µg/ml. In both groups, 10-15ml of the study drug was given in 5 ml fractionated doses at 5 min interval. Parturients who did not experience analgesia within 15 min after the initial bolus were supplemented with an additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed doses at the end of 90 min with the dose equal to the initial dose of the drug. The Duration of labour analgesia, motor block, sensory block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was evaluated. Results: In the present study, Maternal demographic characteristics were comparable.  The Results indicate that both drugs were equally effective clinically in terms of pain scores, patient satisfaction, mode of delivery and total dose used. Statistically, bupivacaine (0.342±0.107) produced more motor blockade than levobupivacaine (0.229±0.025) while the highest level of sensory blockade achieved by bupivacaine was 20%-T10, 80%-T8,0%-T6 and with levobupivacaine was 3.33%-T10, 76.66%-T8, 20%-T6 which was statistically significant. Hemodynamic variations were found to be statistically significant between the groups but clinically they did not have any implications on maternal or foetal outcomes. Conclusion: In this study, both drugs produced equivalent analgesia for labor at low concentration with fentanyl as an adjuvant providing good maternal satisfaction.

DOI: 10.5281/zenodo.

128. Multidrug Resistance Patterns and Associated Risk Factors in Ventilator-Associated Pneumonia: A Comprehensive Analysis
Anushree S. Gaigawale, Meena Mishra, Rajendra Surpam
Abstract
Ventilator-associated pneumonia (VAP) is a common and serious complication among intubated patients in intensive care units (ICUs), often caused by multidrug-resistant (MDR) pathogens. This study aimed to deter-mine the incidence of VAP in the ICU of a government hospital in India and assess the associated risk factors and bacterial pathogens. A prospective observational study was conducted over two years, including adult and adolescent patients requiring intubation and mechanical ventilation. Methodology: A prospective observational study was conducted over two years in the ICU of a government hospital in India. Adult and adolescent patients (>14 years old) requiring intubation and mechanical ventilation were included. VAP was diagnosed using the clinical pulmonary infection score, considering clinical, laborato-ry, microbiological, and radiographic evidence. Results: Out of 155 patients, 46 developed VAP (29.7%), with a calculated VAP rate of 22.14 events per 1000 ventilator days. Most VAP cases were late-onset, with a mean ICU stay before VAP development of 9.96 days. Gram-negative bacteria were the predominant pathogens, with MDR Acinetobacter being most commonly iden-tified. Conclusion: This study highlights the significant impact of multidrug-resistant (MDR) pathogens in ventilator-associated pneumonia (VAP) management in our ICU. The high prevalence of MDR organisms, particularly Gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter species, underscores the urgent need for effective infection control and antibiotic stewardship programs. Our findings indicate a notable presence of beta-lactamase-producing organisms, including ESBLs, AmpC beta-lactamases, and MBLs. Specifically, 21.43% of the isolates were ESBL producers, 28.57% were AmpC producers, and 25% were MBL producers. Key risk factors for MDR VAP identified include prolonged hospitalization (≥5 days), prior antibiotic therapy, and impaired consciousness. These results emphasize the necessity for continuous surveillance, early detection of resistance, and comprehensive infection control strategies to improve patient outcomes in the ICU setting.

DOI: 10.5281/zenodo.

129. Incidence, Severity & Therapeutic Response of Thrombocytopenia in Vector-Borne Diseases among Paediatric Age Group in Southern Rajasthan
Vivek Parasher, Amita Austin Haeems, Subhajit Dutta, Ankitkumar J Panchal
Abstract
Background: Vector-borne diseases are a major cause of morbidity and mortality in developing countries like India. There is a relative lack of data on children of South Rajasthan regarding the incidence of thrombocytopenia, its severity, clinical manifestations, and response to treatment. Methodology: The current study was conducted in a tertiary care hospital in southern Rajasthan over a period of 3 months. It included 127 children under 18 years of age admitted and diagnosed with vector borne diseases by specific laboratory investigations. All necessary data was collected according to the medical records observation technique. Observations: In the current study, it was found that there is significant association between thrombocytopenia and vector borne diseases. Out of a total of 127 patients with vector-borne diseases in the study period, thrombocytopenia was observed in 88 (69.1 %) patients. This association was most frequently observed between malaria (81.5 %) followed by Dengue fever (76.4%) and Scrub Typhus (68.9 %). Minority of patients even required platelet transfusions for correction of thrombocytopenia. Conclusion: Thrombocytopenia in a febrile child in endemic zone should alert the physician towards the possibility of malaria. Moreover, even in cases of severe thrombocytopenia, one should not panic and should give anti-malarial and appropriate supportive therapy as bleeding manifestations are rare and response to therapy is good.

DOI: 10.5281/zenodo.

130. Efficacy and Safety of Favipiravir in COVID 19 Patients- A Retrospective Analysis in a Tertiary Care Hospital from South Gujarat
Riya Ashokbhai Patel, Krishnakant N Bhatt, Priyanka Patel, Uttam Jitendrabhai Gondalia, Jaswantbhai Manharbhai Rathwa, Yatri Nareshkumar Patel, Subalakshmi R
Abstract
Background: Favipiravir inhibits the viral RNA polymerase and has been shown to be effective against other RNA viruses. This study was conducted to evaluate the efficacy and safety of Favipiravir in moderate to severe cases of COVID-19. Materials and Methods:  This single-center retrospective observational study was conducted to evaluate the efficacy and safety of Favipiravir in terms of length of hospital stay and in-hospital mortality. Data of adult patients, who were diagnosed with moderate to severe COVID-19 disease, and were admitted in the hospital till 31st July 2022, was collected from the medical record section. Study included two groups: Study group: COVID-19 positive patients who received Favipiravir (n=100) and Control group (COVID-19 positive patients who did not receive Favipiravir). Results: Patients with moderate-to-severe COVID-19 patients who received Faviparavir showed shorter hospital stay, higher rate of transfer out of ICU, and decreased mortality rate when compared to patients who did not receive Faviparavir. Conclusion: Faviparavir is a safe and efficient drug in treating hospitalized patients with moderate-to-severe COVID-19 patients.

DOI: 10.5281/zenodo.

131. Dermatoses in Children at a Tertiary Care Hospital: A Clinico-Etiological Investigation
Mani Shankar, Babli Kumari, Upendra Prasad Sahu
Abstract
Background: A dermatosis is a broad word for any kind of skin lesion or imperfection. When something is systemic, it impacts the entire body, not just a specific area and is possible that issues in other organs are associated with systemic dermatoses. Dermatoses are a prevalent health issue in children, significantly impacting their quality of life and necessitating specialist medical attention. Aim: This study aimed to examine the clinical and etiological characteristics of skin diseases in children admitted to a specialized hospital. Hypothesis: Our hypothesis suggests that the clinical characteristics and causes of skin diseases in children may differ based on specific risk factors and environmental factors. Materials & Methods: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the department of pediatrics OPD of our Rajendra Institute of medical science, Ranchi over a period of 12 months. All patients were divided into four different study groups: 1 month to 1 year, >1 to 6 years and 7 to 14 years. Results: There were 298 boys and 212 girls in a total of 510 study populations. The majority of the skin conditions among children aged > 1 month to 14 years were found to be affected most by scabies (26%),  impetigo (7%), pyoderma (7%), molluscum contagiosum (7%), tinea capitis (5%), leprosy (1%), and viral warts (2%)(1.35%), while among non-infectious disorders, they were affected by atopic dermatitis (6%), pityriasis alba (5%), seborrheic dermatitis (4%), pityriasis rosea (4%), others (3%), phrynoderma (3%), lichen planus (2.5%), contact dermatitis (2%),and ichthyosis (1%). Conclusion: The study shows important findings on pediatric skin diseases at a major hospital. More research is needed to enhance diagnosis and treatment, examine long-term effects, and understand environmental and genetic factors.

DOI: 10.5281/zenodo.

132. A Comparative Study on Effect of Meditation on Arterial Blood Pressure amongst the Adult Population
Dipti Bania, Chinmayee Sarma
Abstract
Introduction: As normal blood pressure is one of the most vital elements of health and it may be connected with the turbulence and calmness of mind, proper practice of meditation can control it. Aim and Objective: To investigate the association between meditation and control of blood pressure. Method: There was total 200 participant of which 100 were in the control group and rest 100 were in the study group. In each group 50 participants were male and 50 of them were female. We selected participants who were in between 45 to 55 of age who are the most vulnerable group for developing hypertension. We recorded the blood pressure of the participants for four times at every three months interval using the same blood pressure measing device. All the data were collected by experienced technical person and at the end statistical analysis were done to compare the changes of blood pressure both systolic and diastolic. Students T test and ANNOVA tests were used for statistical analysis of the data for comparison. Result: After analysis by T test it has been seen that the systolic as well as the diastolic blood pressure was changed towards the lower side significantly in the participants who were meditating regularly for at least one hour each day throughout the year. Conclusion: With the result of the current study, we can conclude that practice of meditation can be used as an very safe alternative of antihypertensive drugs. However time to time measurement of blood pressure and other primary health check-up are advisable.

DOI: 10.5281/zenodo.

133. Management of Ventral Hernias by Composite Mesh Patch Repair: An Outcome Evaluation of Novel Approach
Ramesh Vasudevan, Dusi Venkata Surya Lakshminarayana Sarma, Sanjeev Kumar Khulbey
Abstract
Introduction: Ventral and incisional hernias of the abdominal wall are commonly encountered, pose significant medical issues, and are associated with an economic burden. A minimally invasive ventral patch repair is a relatively novel approach which is gaining popularity for the treatment for small ventral hernias. Hence this study was designed to evaluate composite mesh repair in the management of ventral hernias. Material and Methods: Clinically diagnosed forty-two cases undergoing elective open ventral patch hernia repair above 21 years of age were recruited. Pre-operative, intra operative and postoperative information were collected. Postoperative pain was assessed by visual analogue scale and patient satisfaction was measure by using Carolina comfort scale. Postoperative follow up was conducted at 10 days, 1 month, and 6 months. Results: Paraumbilical hernia (38.09%) was most commonly observed followed by umbilical (28.58%), incisional hernia (23.80%). Surgeons were fully satisfied (61.90%) with the surgical procedure. The postoperative pain did not show any recurrence during the follow up. Similar findings were observed in related to outcome of Carolina comfort scale. Seroma was common postoperative complication in 11.90% of cases. Conclusion: Recurrence rates and major complications were both low when ventral hernia repairs were performed with the composite mesh patch prosthesis. Hence, it is effective approach for the ventral hernia repair.

DOI: 10.5281/zenodo.

134. Role of MR Fistulogram in the Preoperative Assessment of Anorectal Fistulas and Its Comparison with Operative Findings
Chinta Vittal Prasad, Jagannath Reddy Koppula
Abstract
Introduction: Anorectal fistula is a connection between the anorectal canal and perianal area. Knowledge on preoperative imaging is essential for the surgical management. Objective: To evaluate the role of MR Fistulogram in preoperative assessment of Anorectal fistulas and comparison of intraoperative findings with MR findings. Materials and Methods: The present cross-sectional study was in the Department of Radiodiagnosis in association with Department of General surgery at MNR Medical College and Hospital, Sangareddy from April 2022 to December 2023. A total of 80 clinically suspected cases with perianal fistula of both genders between 25-65 years were included. MR Fistulogram was taken for all the study participants by 1.5 Tesla unit systems. The MRI sequences such as oblique, axial and coronal T2W FSE, T1W FSE, sagittal FAT SAT T1W FASE images and fat suppressed T1W FSE AND T2W FSE were used. The details of fistula such as type, position were assessed by MRI. Results: Single internal opening was observed in 82.5% cases and double internal openings in 17.5% cases. Whereas 78.75% cases had single external opening, followed by 16.25% cases had two, 2.5% cases had three and 2.5% cases had four external openings. According to St James classification of fistulas, 42.5% cases had grade 1 fistulas and 20% cases had grade 2 fistulas. The contrast enhancement was observed in 36 (45%) cases. The sensitivity and specificity for grade 1 fistulas was 100% and 93.5%, for grade 2 was 100% and 99.8%, for grade 3 & 4 was 100% and 100% and for grade 5 was 100% and 99.9% respectively. Conclusion: The sensitivity and specificity was high for fistulas of all grades. Hence, MR Fistulogram with contrast enhancement is a useful and recommended diagnostic tool for the preoperative evaluation of anorectal fistulas.

DOI: 10.5281/zenodo.

135. Comparative Study between Interlay Grafting and Underlay Grafting in Tympanoplasty
Hetal H. Chauhan, Bhargav Jadav, Nirmal P. Patel, Sweta Prajapati
Abstract
Background and Aim: Tympanoplasty using the underlay method is a widely used technique for repairing a perforated tympanic membrane. This procedure is typically performed with the assistance of a microscope. In this study, we will be examining and comparing the outcomes of two frequently utilized techniques for type I tympanoplasty: underlay and interlay. Our focus will be on patients with chronic otitis media and mucosal disease, specifically those with large central perforations. We will be evaluating the success of graft uptake as well as any improvements in hearing that may result from these procedures. Material and Methods: This study is a 12-month randomized prospective study involving 160 patients with chronic otitis media inactive mucosal type and large central perforation. The study took place in the E.N.T department at a Tertiary Care Teaching Institute in India. A total of 80 patients were included in each group, specifically the underlay group (Group 1) and the interlay group (Group 2). The results were evaluated based on the rate of graft take up and improvement in hearing. The patients were regularly followed up, specifically at the end of the 1st week, four weeks, eight weeks, and 12 weeks. During each follow-up appointment, oto-microscopy was performed to assess the success of the graft and identify any potential complications. Results: In group 1, 55% of the patients were males and the remaining 45% were females. In group 2, 60% of the patients were males and the remaining 40% were females. In the present study, the graft uptake rate was observed to be 95% and 89% in the interlay and underlay techniques, respectively. After 12 weeks post-surgery, the Interlay tympanoplasty procedure showed the greatest reduction in the mean air bone gap. Conclusion: The Interlay technique has proven to be highly successful in Type I tympanoplasty, achieving excellent results in terms of graft uptake and closure of the air-bone gap.

DOI: 10.5281/zenodo.

136. Role of Plasma Proadrenomedullin (Proadm), Biomarkers, and Clinical Variables in Predicting the Morbidity and Mortality in Patients with Exacerbated COPD
Shaheed Abdul Ansar B, K Sana Farheen
Abstract
Background: The morbidity and mortality of Chronic Obstructive Pulmonary Disease (COPD) is always unpredictable and challenging the treating physician. To understand the relation COPD of exacerbated type, inflammatory biomarkers such as White Blood cell count (WBC count), C reactive protein, plasma Proadrenomedullin (ProADM), and procalcitonin (PCT) a prospective study was conducted. Aim of the Study: To study the relation between biomarkers, and demographic and clinical signs in terms of morbidity and mortality in COPD patients. Materials: 96 patients with COPD were analyzed with causes for hospitalization for both pneumonic- Group A- 43 (44.79%) and non-pneumonic- Group B- 53 (55.20%) COPD exacerbations with clinical signs required admission. The past history (vital status) was elicited with the help of structured interviews with family members. Results: During the period of study for 18 months 07/96 (07.29%) died during the first 12 months of follow up.  Another 10/ 89 (10.41%) pod the remaining patients died within 06 months of follow up. The mortality rate for the entire period of study was 17.70% (17/96 patients). The one year survival rate was 93% (n-96) and survival rate at the end of 18 months was 88.76% (n-89). Conclusions: It is of interest to note that ProADM as a biomarker seem to be associated with vital status in COPD patients. ProADM in addition to other biomarkers like PCT and CRP improved the predictability in assessing the morbidity and mortality in COPD patients with or without pneumonia.

DOI: 10.5281/zenodo.

137. Study of Thyroid Profile and Serum Iron Levels among the Patients with Chronic Kidney Disease in Manipur: North East India: A Cross Sectional Study
Soumyadip Sarma, L. Shaini
Abstract
Aims and Objectives:  To obtain the correlative association and prevalence of thyroid abnormalities with total iron status of the body among Chronic Kidney Disease patients. Materials and Methods: Our study is of cross sectional type conducted in Regional Institute of Medical Science, Imphal, during the period from January 2015 to December 2015. This study consists of total 75 patients with positive diagnostic criteria of CKD and patients with hematological profile, iron status, clinical and renal parameters. We have taken adequate number of controls for comparison of the results with the general population. Results: This study projected that among 75 patients with CKD, 49 patients had low T3 syndrome that comprises of 65% of the patients. 14 patients were with low T4 syndrome that consists of 18% of the patients and 12 patients suffered from primary hypothyroidism with TSH > 20µIU/ml. around 43% of the patients did not possess target serum ferritin of 100 ng/ml and 49.2% of them did not have TSAT of >20%. Conclusions: Our study shows an increased prevalence of thyroid malfunctions especially hypothyroidism, associated with increased incidence of anemia and iron deficiency projecting symbiotic relationship among body iron status and thyroid function. Thyroid dysfunction, therefore, with patients of CKD, does not indicate hypothyroidism itself, but is considered as a reflection of the state of malnutrition or chronic illness.

DOI: 10.5281/zenodo.

138. Pattern of Food Consumption and Its Determinants among Degree Students
Vidya V Patil, Manu AS, Shabnam S, Asha B
Abstract
Introduction:  Junk foods seem to have engulfed every age and newest among them are adolescents. The adolescent period needs appropriate nutrition as it is a time of rapid growth and development. These are the food items which contain little or no proteins, vitamins, minerals and are rich in energy, sugar, salt and fats. Increased junk food consumption is among all age groups which is emerging as an public health challenge with a global prevalence of 70%. Objectives: 1. To determine the prevalence of Junk food consumption among degree students. 2. To assess the pattern of food consumption among degree students and its socio demographic determinants. Material and Methods: A cross sectional survey was conducted among two selected degree colleges of Davangere city during the month of July 2022. Students studying in the selected colleges were included in the study. Assessment of Variables: Data was collected using a pretested and validated, self-administered and anonymous questionnaire. The study variables consisted of socio-demographic variables and patterns of food consumption which included from regular food to salty and sweet junk food, carbonated drinks, milk & dairy products, fruits and vegetables, salads and its frequency of consumption. Results: The prevalence of junk food consumption is very high (82%) among the participants. Among them 26% of the participants are regular consumers and 56% of them are occasional consumers.

DOI: 10.5281/zenodo.

139. Correlation between Systemic Biomarkers and Retinal Vein Occlusion: A Case Controlled Study
Bharti Badlani, Priyanka Singh, Prabha Chouriya, Pankaj Kushwaha
Abstract
Background and Objectives: Retinal Vein occlusion (RVO) is the second most prevalent retinal vascular condition, occurring after diabetic retinopathy. It leads to painless vision impairment. RVO can be caused by a combination of several systemic, local, and hematologic illnesses. Recent studies have shown that certain inflammatory biomarkers and hyperlipidemia are more commonly linked to RVO. The objective of our investigation is to establish the correlation between systemic biomarkers and RVO. This correlation can assist patients with retinal vein occlusion (RVO) in recognizing other systemic diseases and in averting the occurrence of RVO in their other eyes. Material and Methods: In this retrospective study, a total of 50 patients were recruited from the Department of Ophthalmology, S.S. Medical College and affiliated Gandhi Memorial Hospital, Rewa (M.P.). The investigation was conducted after obtaining approval from the institutional ethics committee and obtaining informed written consent from the patients. Data collection involved obtaining a thorough medical history. Additionally, all participants in the research underwent a full eye examination. Laboratory tests were conducted to measure levels of inflammatory markers (CRP, Homocysteine) and lipid profile parameters (Cholesterol, Triglyceride, VLDL, LDL, HDL levels, MHR). The statistical analysis was conducted using SPSS version 24. The data was reported using the mean and standard deviation, or proportions when applicable. Results: The demographic characteristics of the two groups were similar. The average CRP and Homocysteine levels were considerably elevated in the patients compared to the controls. The lipid profile parameters, with the exception of HDL, exhibited considerable increases in individuals with RVOs. Conclusion: The present study demonstrates a correlation between retinal vein occlusion (RVO) and the inflammatory markers C-reactive protein (CRP) and homocysteine. These indicators might be considered as risk factors in the development of RVO. The present investigation has determined that it is necessary to assess the blood cholesterol levels of all patients who have experienced retinal vascular obstruction. It is uncertain if restoring normal levels of lipids in the blood may improve vision and prevent the occurrence of retinal vein occlusion (RVO) in the other eye, or if it can reduce complications and the recurrence of RVO in the same eye.

DOI: 10.5281/zenodo.

140. Study of Fetomaternal Outcome in Referral Cases in a Tertiary Care Hospital
Rana Shivani, Parikh Rajani
Abstract
Background: Pregnancy is not a disease & pregnancy related, morbidity and mortality are preventable. An effective and efficient referred system is important to facilitate efficient transfer of patients to next level of care, particularly in case of obstetrics emergencies. Present study was aimed to study various cause of obstetric referral, their management and outcome of mother and baby .Also mode of transport, delay in transport, referral details of referred patients are discussed in this study. Aims and Objectives: To evaluate the feto-maternal outcome among referred obstetric cases to sir. T. hospital, Bhavnagar. Materials and Methods: present study conducted in department of obstetrics and gynecology, Sir .T. Hospital, Bhavnagar. All referred ANC cases to our tertiary care institute of > 20weeks of pregnancy and all intrapartum referrals are included in study from January 2022 to January 2023. Referred without referral slip, all postpartum referrals and Private hospital referrals are excluded from study. Results and Observations: In this study, 50% are intrapartum referrals and 50% are antepartum referrals. Previous caesarean sections were the cause of referral in 16.3% of cases in the present study. Maximum were referred for preeclampsia (27.9%) followed by meconium stained liquor (14.1%) followed by anemia (15.9%) followed by post term pregnancy (12). 15.9% of cases were referred due to non-availability of blood. In the present study, it can be concluded that the rate of caesarean section is substantially high in referred cases. 18% of the total referred cases were managed conservatively and discharged. In the present study, 96.9 % were live births. Because of such a improved and well managed referral system and many other government schemes for maternal health, India is on verge of achieving the sustainable development goals SDG of 70/lakh live births by 2030. Conclusion: It is concluded that referral system proved to be efficient in proper diagnosis, management of PIH, early referral, to assess if operative interference needed or not and making timely reach to tertiary care hospital.

DOI: 10.5281/zenodo.

141. Comparative Study of Transverse Abdominis Plane Block (TAP) with 0.5% Bupivacaine and 0.75% Ropivacaine in the Duration of Post-Operative Analgesia in Lower Abdominal Surgeries
Janakiramulu E, Kiran Kumar Suggala
Abstract
Background: The Transversus Abdominis Plane (TAP) block is a recently introduced regional anesthesia method utilized for postoperative pain control, with the potential to serve as the primary anesthetic in a growing array of surgical procedures. TAP block enhances postoperative pain management by reducing postoperative visual analog scale scores, opioid requirements, and the time elapsed before the initial administration of rescue analgesia in patients undergoing lower abdominal surgeries. Aims and Objectives: In our research, we employed the TAP block as the exclusive anesthetic method for elective patients undergoing Lower Abdominal Surgeries. We then compared the effectiveness of two distinct local anesthetics, namely 0.5% Bupivacaine and 0.75% Ropivacaine, in terms of their duration of anesthesia and analgesia as well as their impact on cardiovascular stability. Materials and Methods: A prospective randomized clinical trial involved 60 patients classified as ASA I and II who met the specified inclusion and exclusion criteria. These patients were divided equally into two groups: Group B, which received an injection of 0.5% bupivacaine, and Group R, which received an injection of 0.75% ropivacaine. The dosage administered did not surpass 2.5 mg/kg body weight for any participant. Results and Conclusion: Our study revealed that both drugs provide effective anesthesia for Lower abdominal Surgeries while maintaining hemodynamic stability. However, 0.75% Ropivacaine exhibited a significant delay in the onset of anesthesia (13.46 +/- 3.2 min) compared to 0.5% Bupivacaine (7.86 +/- 2.47 min) (P value <0.001). Furthermore, 0.75% Ropivacaine resulted in prolonged postoperative analgesia (675.54 +/- 30.31 min) compared to 0.5% Bupivacaine (573 +/- 45.72 minutes) (P value <0.001). This suggests that the Transversus Abdominis Plane (TAP) block can serve as the sole anesthetic technique for Lower abdominal surgeries.

DOI: 10.5281/zenodo.

142. Functional Outcome of Surgical Management of Rockwood Type III-VI AC Joint Separation Repaired Using Non- Absorbable Ethibond-2
M. Chathrapathi Hanuman, Syed Sarfaraz, M. Madhusudhan Reddy, Vishnuprasad C.V.
Abstract
Background: Injuries to the acromioclavicular (AC) joint represent a spectrum of soft tissue disruptions that can result in mild, transient pain of the joint to significant displacement, chronic pain, and changes in shoulder biomechanics resulting in long term disability. These injuries most commonly occur in male patients <30 years and are associated with contact sports or athletic activity in which a direct blow to the lateral aspect of the shoulder occurs. Anatomic reconstruction of the native CC ligaments and AC ligaments represents an improved understanding of the biomechanics in this area with the attempt to improve surgical outcomes. Aim of the study is to evaluate the clinical and radiological outcome of coraco-clavicular and acromioclavicular joint reconstruction with non-absorbable Ethibond no. 2 for treatment of Type III – VI AC Joint separation. Study Design: Ambispective Case series. Methodology: A total of 20 patients attending the causality and OPD of Orthopedics Department at Government Medical College, Kadapa diagnosed with Rockwood Type III-VI AC joint separation were taken for the study after prior well informed written consent. The clinical and functional outcome was assessed with VAS Score and Constant & Murley Score while the radiological outcome was assessed using plain radiograph. Results: Among the 20 patients who were included in the study, nine, six and three patients sustained Rockwood type V, IV and III injuries respectively. The mean age was 38.8 ± 6.569 (mean ± SD) with a mean follow-up of 12 months. At 12 months follow-up the mean VAS score was 0.65 ± 0.476 and mean Constant Murley Score was 90.75 ± 1.81. Compared to the baseline the clinical scores improved significantly (p<0.05). No Neurovascular complications were encountered in any of the patients who were part of this study. Conclusion: In this study AC joint dislocations type III-VI treated with ligament reconstruction by using 2 loops of Ethibond 2 and AC ligament repaired by single loop Ethibond 2 is a reliable method for establishing Antero-posterior and superio-inferior stability of AC joint and results in excellent clinical, radiological and functional outcome.

DOI: 10.5281/zenodo.

143. Assessment of Cerebrospinal Fluid C – reactive protein in Bacterial Meningitis among Paediatric Age Group
Tejal Odedara, Yashodhar Vora, Anshi Somani
Abstract
Background and Aim: Meningitis is a serious condition that can have severe consequences, including permanent brain damage, neurological issues, and even death. This study aimed to assess the diagnostic importance of CRP in CSF as an early indicator for distinguishing between bacterial and nonbacterial meningitis. Material and Methods:  An observational study was conducted in the paediatric ward of a tertiary care hospital in India over a period of 1 year. During the study period, a total of 100 children, ranging in age from 1 month to 12 years, were included in the study due to suspected meningitis. A lumbar puncture was conducted at the L3-L4 level, and a cerebrospinal fluid sample of no more than 3 ml was collected in 4 sterile containers. 1ml was sent to test for protein and sugar levels, while 0.5ml each was sent for CSF cytology and CSF-CRP. Additionally, 1ml was sent for CSF culture sensitivity and gram staining. Results: The most common symptoms observed were fever (95%) and altered sensorium (92%), while the most frequently observed meningeal sign was neck rigidity (58%). Out of the 100 patients who were suspected of meningitis, the final diagnosis of bacterial meningitis was determined through CSF examination. It was found that 56% of these cases had a positive culture report. A significant majority of the patients who tested positive for the culture also had elevated levels of CRP in their cerebrospinal fluid. When analyzing cytology reports and CSF CRP positivity, it was discovered that 81.5% of the reports yielded positive results. When comparing abnormal CSF biochemical reports to CSF CRP positivity, it was discovered that 80% of cases were positive. Conclusion: The levels of CRP in CSF demonstrate a moderate sensitivity and specificity, along with a high positive predictive value. It has been found that CSF CRP is a more effective marker in distinguishing bacterial meningitis.

DOI: 10.5281/zenodo.

144. A Study of Causation and Extent of Rhino-Orbito-Cerebral Spread of Mucormycosis in COVID-19 Treated Patients at a Tertiary Care Hospital in North India
Ashish Kumar, Sagar Dhillon, Saloni Singh, Rajendra Choudhary
Abstract
Background: The COVID-19 pandemic has resulted in immense devastation, with a staggering death toll of over three million worldwide. As a consequence, there has been a notable rise in opportunistic infections, with one of the most alarming being COVID-19 associated Mucormycosis (CAM). The lack of comprehensive guidelines for screening and managing this condition, coupled with delayed diagnoses and poor prognoses, have heightened concerns among healthcare professionals that an epidemic of CAM may occur alongside the existing pandemic. Method: Twenty-one cases of invasive fungal infection from March to November 2021 were retrospectively examined. Demographic, clinical, laboratory, radiological, microbiological, pathological, and outcome data were then collected and analyzed. Result: Twenty-one consecutive inpatients with COVID-19 associated Mucormycosis (CAM) had a 57% pre-existing diabetes mellitus rate. The most prevalent symptoms at the beginning of the disease included facial swelling (81%), periorbital edema (52%), fever (81%), and headache (57%). According to radiographic studies, the majority of patients showed thickening of the sinus mucosa, which was followed by inflammation of the periorbital muscles and cavernous sinus infiltration. Conclusion: Steroid use, diabetes mellitus, and superadded COVID-19 infection induced immunodeficiency caused a higher incidence of Mucormycosis. The study highlighted the importance of early detection and proactive treatment, including surgical debridement and antifungal therapy, which significantly improved the long-term outcome and reduced the rates of mortality and morbidity.

DOI: 10.5281/zenodo.

145. Role of Doppler Velocimetry in Intrauterine Growth Restriction
S. Meera, T. Shanmuga Shanthini
Abstract
Aims of the Study: 1. To determine the efficiency of Doppler velocimetry in the early diagnosis of hypoxia in Intra Uterine Growth Restriction.  2. To determine the predictive value of the Doppler velocimetry of umbilical and middle cerebral artery with the perinatal outcome in fetuses Intra Uterine Growth Restriction. 3. To predict the effect of Doppler velocimetry on the mode of delivery. Objective: To determine Efficacy of Doppler velocimetry of umbilical artery (UA- S/D) and middle cerebral artery (MCA-S/D, Brain sparing effect BSE, Cerebro placental ratio CPR<1) in early diagnosis of hypoxia in intrauterine growth restriction (IUGR), effect on mode of delivery and in predicting perinatal outcome in fetuses with IUGR. Materials and Methods: 50 pregnant women with clinically suspected IUGR are subjected to ultrasonography with Doppler. The Doppler results were related to perinatal outcomes including birth weight, mode of delivery and perinatal complications. Results: a) Mode of delivery: When CPR<1 & BSE combined – 80% vaginal delivery. b) With AEDF &REDF, very low birth weight increased by 4 times than high S/D. No difference between AEDF & REDF →reversal is an acute event. c) Perinatal outcome: UA-All abnormal waveforms – meconium aspiration syndrome -100% while MCA *BSE -66.7%: CPR<1 – 50%. d) Mortality rate: higher with all abnormal UA waveforms than abnormal MCA waveforms. CPR<1 more sensitive in early detection of fetal hypoxia than other parameters of MCA as well UA thereby averting perinatal mortality. Conclusion: MCA shows high sensitivity (92%) compared to UA (76.92%) in predicting fetal hypoxia with high positive and negative predicting value (92%).CPR<1 is more sensitive in predicting the hypoxia than BSE. UA and MCA waveforms as an indication for cesarean section are not significant.

DOI: 10.5281/zenodo.

146. Diagnostic Laparoscopy as a tool for diagnosing cases of Chronic Abdominal Pain in Government Medical College, Rajamahendravaram
Kambhampati Ravi, Gangadharabhatla Padmini, Kota Pragathi, Shaik Fathimunnisa
Abstract
Background: Chronic abdominal pain is a common presenting complaint in the general practice of both physicians and surgeons. The most common cause include intestinal adhesions, biliary causes, and appendicular causes, while functional conditions include irritable bowel disease, functional dyspepsia, and various motility disorders and  some extra-abdominal conditions. Laparoscopy is a low risk, minimally invasive procedure and Diagnostic laparoscopy is a key in solving the diagnostic dilemma of chronic pain abdomen. It allows the visual examination of the intra-abdominal organs to detect pathology. Aim of study: To assess the role of diagnostic laparoscopy, a minimally invasive surgical technique in the evaluation and treatment of chronic abdominal pain in adults. Methodology: A prospective observational study done for 8 months duration, 25 patients with chronic abdominal pain as per Rome III classification, who underwent diagnostic laparoscopy and further treatment in the Department of General Surgery, GMC, Rajamahendravaram, were considered for this study. Results: Most of patients presenting with CAP are females with 18 out of 25, most common site of pain is right lower quadrant followed by entire lower abdomen. All patients were subjected to diagnostic laparoscopy and 23 out of 25 had final diagnosis. Most common cause of CAP was Adhesions followed by Appendicitis. 18 patients had undergone therapeutic procedure in the same sitting apart from 5 patients who obtained samples for histopathological examination that aids in further medical management. No major Intra / Post operative complications were recorded with only 3 patients had minor wound infections. Conclusion: Thisstudy has established that Diagnostic Laparoscopy is an effective tool for the diagnosis and treatment of patients with chronic abdominal pain.

DOI: 10.5281/zenodo.

147. An Observational Study for Association of Vitamin-D Level and Prostomegaly Grades in Benign Prostate Hyperplasia Patients
Rajnish Gautam, Aditi Ranawat, Mamta, S S Yadav, Sandhya Mishra
Abstract
Introduction: Benign prostatic enlargement is one of the most prevalent ageing related derangements in men and has significant impact on quality of life. This study was designed to find the association of Vitamin-D levels and prostatomegaly grade in patients of BPH. Material and Methods: After Ethical Committee approval, blood sample was collected from 60 BPH patients. Vitamin-D level was measured by Chemilunimiscence method in fully automated Advia-centaur analyser. Results were analysed in relation to the prostatomegaly grades in patients of BPH using students ‘t’ test. Vitamin-D level < 20 ng/ml was considered deficient. Result: Serum Vitamin D level was less in patients with Grade 3 prostatomegaly (16.65 ± 2.914) than patients with Grade 1 (20.438 ± 3.785) and Grade 2 ( 19.645 ± 3.853) prostatomegaly and found statistically significant. Conclusion: Our study showed significantly lower levels of Vitamin-D (p value <0.001) with higher prostatomegaly grade in males with BPH. Thus Vitamin-D levels may have a significant role in the etiopathogenesis of BPH & severity of symptoms. Vitamin D deficiency may be used as a therapeutic target for preventing and treating BPH.

DOI: 10.5281/zenodo.

148. Precision Vs. Tradition: A Comparative Study of Microscopic Lumbar Discectomy versus Open Discectomy in a Tertiary Care Teaching Hospital
Kumar Lakshman, B.G. Sagar, Mir Mohammad Ghulam Ali Khan, Gayatri Brahmandam, Triza Kumar Lakshman
Abstract
Background: Fenestration discectomy and open discectomy are commonly performed surgeries for low back pain, which poses a significant health concern for patients of all ages. A key cause of low back pain is lumbar disc herniation, which forms the crux of our study. This study aims to draw a comparison between the two procedures in patients with symptomatic lumbar back pain as a function of pain levels postoperatively, and return to daily activities using the Visual Analogue Scale as a primary outcome measure, Oswestry Disability Index and other secondary outcome measures. Methods: 60 patients aged between 18 to 65 years with lumbar disc herniation at L4-L5, were divided randomly into group A – where 30 patients underwent open discectomy and Group B – where 30 patients underwent fenestration discectomy. All patients were assessed at 24 hours, 2 weeks, 6 months and 2 years postoperatively after surgery using the Oswestry Disability Index and Visual Analogue Scale for pain and ability to return to daily activities. Results: In both groups, all patients had minimal discomfort post-surgery according to the Visual Analogue Scale (24 hours postoperatively: t value – 1.5861, p = 0.118 – not significant). There was no recurrence of disc herniation among both the groups, over the 2-year follow-up period. The mean stay in hospital and time taken to return to daily activities were similar across groups. Conclusion: Given the outcome of our surgery, using a smaller incision is beneficial in many ways, including lesser tissue disruption which in turn leads to lesser post-operative pain, and lesser duration of hospital stay, as noted in our study, both in open and fenestration discectomy.

DOI: 10.5281/zenodo.

149. Compliance and Adherence to Oxygen Therapy Prescription in a Critical Care Department of a Rural Tertiary Teaching Hospital: A Prospective Audit
Sunil Chhajwani, Amit Kumar, Archana Sinha
Abstract
Context: Oxygen therapy is essential for managing various medical conditions. Being a drug, it has to be prescribed rationally with appropriate dose and device. Targets to be achieved depends upon clinical status. Non-compliance with prescribed guidelines can compromise patient outcome. Aims: This prospective audit was aimed to assess compliance to prescribed oxygen therapy and documentation of appropriate prescription as per guidelines, followed in a critical care department. Settings and Design: A prospective observational audit was conducted in a critical care unit of a tertiary care teaching hospital, located in a rural region. Methods and Material: Sixty consecutive patients fulfilling inclusion criteria, admitted to the intensive care unit were included, and their oxygen therapy compliance were evaluated as per (British Thoracic society) BTS guideline. Compliance was analysed for achieving targeted oxygen saturation levels and adhering to prescribed oxygen flow levels. The prescription documented in the electronic record were also analysed for its completeness regarding instruction. Results: The study revealed a fairly high compliance rate (76.6%) in achieving the desired oxygen saturation levels, indicating effective oxygen delivery tailored to patient needs. However, proper documentation of oxygen therapy prescription was low (26.6%), highlighting potential gaps in oxygen prescription. Conclusions: This audit indicate reasonably good compliance in achieving desired oxygen saturation level in a rural setting. However, documentation of oxygen prescription was poor. Education, training, and enhanced monitoring will be crucial to ensuring guideline compliance, optimizing patient outcomes, and minimizing risks associated with suboptimal therapy.

DOI: 10.5281/zenodo.

150. Anatomical Variations in Renal Arterial Pattern in Human Cadavers
Anil Sahebrao Patil, Shubhangi Sandipan Borade, Sachin Kashyap, Prashant Munjamkar
Abstract
Background: Various cadaveric and imaging studies showed that renal arteries have a wide range of variations. Hence, the present study was undertaken to know the origin, course, and relations of renal arteries (RA) and accessory renal arteries (ARA) and the possible variations of renal arteries in cadavers. Method: The study was conducted in 50 Kidney specimens obtained from formalin preserved human cadavers available from the Department of Anatomy of tertiary care hospital during a period from March 2021–December 2023.Dissection of RA was done by dissection method as per the Cunningham’s Manual. Results: Among the 50 kidneys dissected, single RA was observed in 78% of specimens, double RA in 16% and Triple RA in 6% of specimens. In 26% of specimens the origin of RA was in same level, 28% of right RA and 8% left RA had higher origin. The origin of main renal arteries was from aorta in all specimens. 22% of ARA arose from Aorta and 6% originated from main RA. The length of right sided RA varied from 2cm to 6cm and left sided RA varied from 2cm to 5.5cm.Extrarenal division of renal arteries was observed in 98% and intra renal division was in 2% of specimens which was seen only on right side. Prevalence of ARA was 28%, 24% right sided and 32% left sided. Hilar type of ARA was seen in 14% of the specimen, superior polar artery (SPA) in 4% and inferior polar artery (IPA) in 8% of the specimens. Both SPA & IPA was seen in 2% of the specimens. Single ARA was seen in 20% and double ASA in 4% of the specimens. ARA was passing in front of IVC in 2% and behind IVC in 22% of the specimens. Unilateral ARA was seen in 12% and bilateral ARA was seen in 6% of the specimens. Conclusion: To conclude the usual textbook description of renal arterial pattern may not be found in all the patients under investigation. Variations observed were single, double, or triple renal arteries, extrarenal division of the renal arteries and ARA. This kind of different pattern of variations may play an important role in renal transplants and any surgeries involving the renal arteries.

DOI: 10.5281/zenodo.

151. Knowledge, Attitude, and Practices of Reporting Suspected Adverse Drug Reactions among Nursing Staff Working at a Government Tertiary Care Hospital, Andhra Pradesh, India
S. Vijaya Kumari, V.V. Padmavathi, K. Sowmya, G. Harinika, Suresh Babu Sayana
Abstract
Background: Adverse Drug Reactions (ADRs) reporting is critical for patient safety, yet it is often underreported. This study aimed to assess the knowledge, attitude, and practices (KAP) of nursing staff regarding ADR reporting at a Government Tertiary Care Hospital in Andhra Pradesh, India. Methods: A cross-sectional descriptive study was conducted with 206 nursing staff members using a convenience sampling method. Data were collected over two months (February to March 2024) through a semi-structured, pre-validated questionnaire. Results: The study revealed that 85% of participants correctly identified the full form of ADR, and 60% were aware of the Pharmacovigilance Programme of India (PVPI). Additionally, 70% knew that nursing staff could report ADRs, and 55% correctly identified the location of the Pharmacovigilance center. A significant majority (90%) believed that reporting ADRs is necessary. Regarding the types of ADRs to report, 25% indicated serious ADRs, 50% all ADRs, 15% unknown ADRs, and 10% selected ADRs. In terms of attitude, 65% disagreed with the statement that explaining ADRs to patients harms them, and 75% were willing to undergo ADR training. For practices, 40% identified ADRs by themselves, while 30% relied on patient complaints. Only 50% knew how to fill ADR forms, and 30% had reported ADRs in the past year. The main difficulties in ADR reporting included lack of forms (40%), insufficient knowledge and training (35%), and poor communication channels (25%). Suggested measures to overcome these obstacles included regular training programs (50%), improved availability of ADR forms (30%), and enhanced communication channels (20%). Conclusion: The findings highlight a moderate to high level of knowledge and a positive attitude towards ADR reporting among nursing staff. Addressing practical barriers through structured training and resource allocation can enhance ADR reporting practices.

DOI: 10.5281/zenodo.

152. Early CPAP in the Management of Preterm Neonates with Respiratory Distress Syndrome: A Prospective Observational Study
Niveditha M, Jagadish A. S., Kavitha Lakshmi, Srinivasa K
Abstract
Background: The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) includes early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ventilation. Objective: This study sought to examine the need for ventilation and surfactant therapy in preterm neonates <34 weeks when CPAP is initiated early-at birth compare the same with historical controls- preterm neonates <34weeks with respiratory distress after birth and initiated CPAP after admission to NICU and to study the mortality and morbidity associated with early use of CPAP. Materials and Methods: A two-year-long prospective and observational study was carried out in the Neonatal Intensive Care Unit (NICU) of M.V.J Medical College and Research Hospital, Bengaluru, Karnataka, India. The study was approved by the Ethical Committee of M.V.J. Medical College and Research Hospital. Inclusion criteria constituted all preterm neonates <34weeks breathing spontaneously with clinical suspicion of mild to moderate respiratory distress as per Silverman Anderson score 3-5. Exclusion criteria constituted all neonates with congenital heart disease, congenital anomalies, requiring mechanical ventilation, neonates with Silverman Anderson score > 6, severe birth asphyxia, shock, apnea, and, neonates already intubated for any clinical indication at labour room. A total of 100 neonates (50 neonates in control group-group 1-the study group and 50 neonates in historical cohort group-group 2) were considered in the current study. Primary outcome was to assess the need for mechanical ventilation and the need for surfactant, secondary outcome was to assess the mortality and morbidity associated with CPAP in both the study group and control group. Result: The data of total 100 neonates were analysed during the study period. There was no statistically significant difference between group 1 and group 2 for Weight (in grams), mean gestational age (in weeks) and mean Silverman Anderson score. The CPAP failure rate was recorded as 22% and 80% in group 1 and group 2, respectively, which was statistically significant. There were two complications (CPAP Belly and Nasal Crusting) due to CPAP and were recorded as 8% for CPAP belly in both group 1 and group 2, and 4% and 6% for Nasal Crusting in group 1 and group 2. Mean duration of CPAP (in hours) was recorded as 35.44 hours and 9.36 hours in group 1 and group 2, respectively, which was statistically significant. There was no statistically significant difference between group 1 and group 2 for recorded five complications (IVH, BPD, IVH+PDA, PDA and ROP) during hospital stay. The current study recorded no death in group 1 while 7 deaths were recorded in group 2, and there was no statistically significant difference. Conclusion: Early initiation of CPAP at birth was associated with lesser complications in preterm babies, lesser morbidity and mortality, reduction toward the need for intubation

DOI: 10.5281/zenodo.

153. Does Urban/ Rural Divide Exist in the Type of Learning Style Preferred by the First Year Medical Students in a Private Medical College in South India?
Vellimalai K, Venkatesan S, Karthikeyan D
Abstract
Student’s admission in medical colleges in India comprises a diverse pattern. A few years ago, Entrance Examination for school final (plus-two) students was abolished in many states. This is because the rural students were assumed to be not good with the analytical questions (MCQ’s) than the students who studied in urban areas. In PSGIMS&R medical college in the first year, urban students represent 78% while rural students represent 22% of the total population. Will such a urban/rural difference among the medical students affect their individual learning styles? Will the Instructor has to modify his teaching style to cater the needs of the vibrant student community? Urban students are those who had their schooling in urban areas while rural students are those who had their schooling in rural areas. So, the VARK Questionnaire was administered to all the 55 students who were chosen randomly in the class. URBAN- 30 students. RURAL – 25 Students. The expansion of VARK type of learning styles are: V (Visual)- Learning from graphs, charts and flow diagram, A (Auditory)- Learning from speech, R (Read/ write)- Learning from reading and writing, K (Kinesthetic) – Learning from touch, hearing, smell, sight and taste. Out of this, the preference of learning style by majority of students is Multimodal (i.e.,) 57% in urban students & 60% rural students. The unimodal modality that was chosen by majority of both urban and rural students was of Kinesthetic type.

DOI: 10.5281/zenodo.

154. Analysis of Risk Factors, Clinical Features and Visual Outcome in Cases of Non Arteritic Anterior Ischemic Optic Neuropathy (Na-Aion) At Teaching Govt Hospital in South India
Harshitha Sai R., Sreedevi K.V.N., Chandra Sekhar B., Srinivas Y.
Abstract
This prospective observational study aimed to identify potential risk factors, clinical features, and visual outcomes associated with non-arteritic anterior ischemic optic neuropathy (NA-AION). Conducted over a twelve-month period (February 2023 – January 2024) at the Ophthalmology OPD of a government hospital in South India, the study evaluated 24 patients diagnosed with NA-AION based on Hayreh’s criteria. The investigation assessed the prevalence of risk factors like diabetes, hypertension, dyslipidaemia, sleep apnoea and smoking. Clinical features such as visual acuity, pain, and disc oedema were documented. Visual outcomes were measured at the final follow-up visit. This study will contribute to a better understanding of the clinical profile and risk factors associated with NA-AION in the South Indian population.

DOI: 10.5281/zenodo.

155. Imaging Role in Rhinoortital Cerebral Mucormycosis Diagnosis in Post Covid Patients Attending Teaching Govt Medical Hospital
Lakshmi Manjula D, Rajasekhar V, Sivaram Prasad V, Srinivas Y
Abstract
COVID-19 pandemic in India is a part of worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory distress syndrome coronavirus 2(SARS-CoV-2). First cases of covid 19 were reported in January 2020 in kerala. Rhino-orbito-cerebral mucormycosis (ROCM) is considered as a rare invasive infection caused by class phycomycetes fungi involving immunocompromised patients who have developed COVID-19 infection in the recent past, arising from nasal and sinus mucosa, spreads rapidly to orbit and brain. India reports about 50,000 cases of covid associated mucormycosis so far. Men are more commonly affected than women. For managing this fatal condition multispecialty approach involving Ophthalmology, ENT, Neurosurgery Dental Surgery, Medical and Radiology departments are involved. CT & MRI are imaging modality of choice for establishing a correct diagnosis & guiding therapeutic decisions. Early suspicion, rapid diagnosis, and initiation of treatment are the most important factors that determine prognosis in the management of mucormycosis. CT useful in preoperative planning for determining sinonasal anatomy, extent of disease, and in directing the surgical approach. The acquisition time is shorter and less expensive and more widely available. MRI is a multiplanar imaging modality, does not involve radiation exposure, is a safer imaging modality in patients requiring multiple follow-up degradation is its disadvantages. Making a prompt diagnosis is fundamental for the patient’s safety. The above study is conducted in government general hospital, Guntur for a period of 3 months from June 2021 to August 2021.

DOI: 10.5281/zenodo.

Impact Factor: 1.121