International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. A Systematic Review on the Outcome of Standard Lichtenstein’s Repair of Inguinal Hernia Versus Desarda’s Biological Repair in a Tertiary Government Medical College
KVN Ramesh Kumar, Budda Kanaka Mahalakshmi, Vijay Kumar Naranji, S. Srinivasa Rao
Introduction: Hernia repair is one of the most common operations performed by general surgeons worldwide. Despite the frequency of this procedure, no surgeon has ideal results and complications such as those related to mesh repair and those related to without mesh repair such as post operative pain, nerve injury, seroma, surgical site infection, chance of recurrence with time and CGPS (Chromic Groin Pain Syndrome) suggest that hernia is a chronic disease process effecting Patients over their lifetime. The aim of present study is to compare gold standard technique of Lichtenstein’s Hernioplasty versus Desarda’s biological repair (Both by open technique) in our Medical College. Materials and Methods:  This double blinded randomised controlled study was conducted with a total of sixteen patients, including eight patients who underwent Lichtenstein’s Hernioplasty using polypropylene mesh and another eight patient underwent Desarda’s biological repair using absorbable suture material, vicryl. Using Inclusion and exclusion criteria–All the patients who underwent surgery by either method were followed up closely for eight months, possible complications and the data was recorded, analysed and synthesised narratively. Results:  Considering population sample size and age of the sample; Mean-SD were calculated. The mean for the entire sample is 39.875 and SD is 3.332; variance is 1.825; co-efficient of variation is 8.356

  Mean SD Variance CV
Lichtenstein’s 39.375 3.079 1.754 7.819%
Desarda’s 40.375 3.466 1.861 8.584%

Again, two sample paired t-test is located weather the mean of the population has a value specified in null hypothesis. t= ; Degree of freedom is n-1. By the central limit theorem; if the observations are independent and the second moment exists, then it will be approximately normal N (0-1).bHere values of student t-tests are 0.897 (total sample). Study quality is assessed by oxford quality rating scale (JADAD SCALE). Yielding two points for randomisation, one for double blinding and one for dropout rate: 4/5; suggesting high quality. However, it does not include an assessment item for allocation concealment. As a result of the growing influence of evidence based medicine Heterogeneity value is taken nil-significant (all patients from the same geography).Above data shows Mean SD of the Desarda’s group is slightly higher than Lichtenstein’s, but the difference was statistically not significant. Conclusion: Present study suggests that uncomplicated hernia repairs by means of Desarda’s technique are relatively pain free yielding the same success rate as that of Lichtenstein’s and obviously not carrying complications of mesh repair (Hernioplasty). However, O.R. time is more and also considering the limited sample size, same geographical pattern sampling- large sample size may be required to be studied along with long duration follow up as well.

DOI: 10.5281/zenodo.12740807

2. Serum Levels of Gamma-Glutamyl Transferase, Aspartate Aminotransferase (AST), alanine Transaminase (ALT), AST: ALT, and Bilirubin in Patients with Chronic Hepatitis: A Hospital Based Comparative Study
Akriti Kumari, Gishu Sweta, Kunal
Objectives: The present study was to evaluate and compared the serum levels of gamma-glutamyl transferase, aspartate aminotransferase (AST), alanine transaminase (ALT), AST: ALT, and bilirubin in patients with chronic Hepatitis with control. Methods: A detailed history of all the participants was taken on a pre-designed questionnaire. For the evaluation of blood serum GGT, AST, ALT, AST:ALT ratio, and bilirubin, 5 ml blood sample was withdrawn from the anticubital vein of all participants and were collected in a sterile, dry, and plain vial. The serum utilized in the estimation of biochemical assays was separated from the blood sample by centrifugation at 3000 rpm for 10 minutes. The IFCC method was used to estimate the serum levels of the parameter using a commercially available kit from Transasia Pvt. Ltd. The tool used was an ERBA 5 chem semi-auto analyser. Results: A total of 50 chronic hepatitis patients were enrolled in a case group and 50 healthy individuals were included as control group. Mean age of the patients in case group was 50 ± 12.87 years. And mean age of healthy individual in control group was 48 ± 14.76 years.  In case group, males were 37(54%) and females were 23(46%). And in control group, males were 28(56%) and females were 22(44%). When we compared the Gamma-glutamyl transferase between case and control. which was highly significant differences (P<0.0001). Similarly other enzymes such as Aspartate aminotransferase, Alanine transaminase, and AST: ALT were also highly significant differences (P<0.0001) between cases and control. Serum level of Bilirubin was also highly significant differences (p<0.0001) in case as compared to control subjects. When we  correlated the different parameter of chronic hepatitis patients. GGT level was not significant differences (p=0.868). ALT level was highly significant differences (p<0.000). AST level (P=0.000), AST: ALT ratio (P=0.020) and bilirubin level was significant differences (P=0.012). Conclusions: Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine transaminase, AST: ALT ratio and serum level of bilirubin was extreme significantly higher in patients with chronic hepatitis as compared to control (healthy subjects). Hence, GGT, AST, ALT, AST:ALT ratio, and bilirubin, are prominent indicators of chronic hepatitis.

DOI: 10.5281/zenodo.12740854

3. Functional Outcomes of Arthroscopic Suture Fixation for Tibial Eminence Fracture of ACL
Sourabh Cholkar, Abhishek Pathak, Santosh Mishra, Rahul Rohilla
Background: Although relatively rare, anterior tibial spine fractures are becoming more common due to increased participation in athletic activities and motor vehicle accidents. These fractures often require operative intervention for proper knee stability and functionality. Arthroscopic suture fixation is a minimally invasive technique that offers several benefits, including anatomic reduction and early mobilization. Aim and Objective: To evaluate the functional outcomes of arthroscopic suture fixation for tibial eminence fractures of the anterior cruciate ligament (ACL) using the pull-through suture technique. Materials and Methods: This prospective study was conducted at the Department of Orthopaedics, Gandhi Medical College, Bhopal, and Hamidia Hospital, Bhopal, from December 2020 to September 2022. Twenty patients aged 8 to 60 years with anterior tibial spine avulsion fractures classified as Meyers and McKeever Type II and III were included. Preoperative evaluations included knee instability tests, X-rays, MRIs, and routine laboratory investigations. Arthroscopic-assisted pull-through suture ligation was performed, followed by a structured postoperative care and rehabilitation protocol. Patients were followed up at 1, 3, 6, and 9 months. Functional outcomes were assessed using the Lysholm Tegner score. Results: The mean age of the patients was 25.4 years (SD ± 9.88), with a male predominance (90%). The right side was affected in 60% of cases. Students were the most commonly affected group (35%). The primary mode of injury was sports-related (50%). Preoperative Lysholm Tegner scores were uniformly below 65, indicating poor knee function. Postoperatively, 70% of patients achieved excellent scores (>90), and 25% achieved good scores (84-90). The mean preoperative score improved significantly from 51.05 (SD ± 8.53) to 92.10 (SD ± 4.59) at the 9-month follow-up (p < 0.0001). Complications were minimal, with only two cases of knee stiffness and one minor extension lag. Conclusion: The arthroscopic pull-through suture technique for tibial eminence fractures of the ACL is highly effective, resulting in significant improvements in knee function and stability with minimal complications. This technique offers the advantages of anatomic reduction, secure fixation, and early mobilization, making it a preferred method for managing these fractures. Further studies with larger sample sizes and longer follow-up periods are recommended to validate these findings.

DOI: 10.5281/zenodo.12740866

4. Variations of Renal Artery and its Clinical Significance in South Indian Population
N. Esther Yamuna, J.B. Linda, G.A. Jos Hemalatha
Background: Normally both kidneys are supplied by a pair of renal arteries which arises from abdominal aorta at the level of intervertebral disc between L1 and L2 vertebrae. Presence of additional renal arteries are most frequent variation which is to be considered in doing the interventional radiological procedures, renal surgeries & renal transplantation. Our Purpose of the study is to observe the presence or absence of accessory renal artery, their number, side of origin presence or absence of extrarenal branches. Materials and Method: The cross-sectional study was conducted in 50 cadaver (50 male & 50 female) fixed in a formalin which were allotted for undergraduate teaching in the Department of Anatomy, Kanyakumari Govt. Medical College, Tamilnadu, South India during the year 2018- 2021. The kidneys with the variation of renal artery, renal veins are removed along with the part of abdominal aorta & Inferior vena cava. The presence of variation of accessary renal arteries and branches to extrarenal part were noted. Result: Variations noted in 22 cadavers (44%). Bilateral variations-12% triple renal arteries on left side and in right side-16% suprarenal artery and renal artery arose as a common trunk from abdominal aorta. Unilateral double renal arteries were present on left side in 20% and right side in 8%. Branches to suprarenal gland from left aberrant renal artery seen in 4%. Right Inferior phrenic artery arose from right upper renal artery in 6%. Conclusion: Awareness of such variant is important while doing investigational and surgical procedures related to kidney.

DOI: 10.5281/zenodo.12740872

5. Variations in Musculocutaneous Nerve – A Cadaveric Study in South Indian Population
Esther Yamuna, Linda J. B., Ganga N. V., Saranya G.
Background: Musculocutaneous nerve is one of the key nerves of the upper limb which supplies the flexor muscles of arm. Its variations are commonly encountered in brachial plexus dissection. Sound knowledge of its normal anatomy and variations are clinically significant in diagnosing neurological weakness, preplanning surgeries of arm, axilla and management of shoulder joint traumatology. The purpose of the study was to observe the same and to discuss its clinical significance. Materials and Methods: The present study was conducted at Department of Anatomy, Kanyakumari Government Medical College, Tamilnadu, India. 25 right and 25 left upper limbs (50 specimens) from 25 cadavers with age ranging from 25 to 60 years irrespective of sex were studied. Results: Musculocutaneous nerve arose from lateral cord of brachial plexus and was present in all the specimens studied. It didn’t pierce coracobrachialis in 10 (20%) specimens. Coracobrachialis, brachialis and biceps brachii were supplied by musculocutaneous nerve in all the specimens. Single communicating branch to median nerve was observed in 9 (18%) specimens and it did not pierce the coracobrachialis. Venieratos Type 1and Choi Type2a pattern of communication were observed in 7 (14%) specimens. In 2 (4%) specimens Venieratos type 3 and Choi type 2 b pattern of communication were observed. Conclusion: Awareness of the variations of musculocutaneous nerve in its origin, course, muscular branches, termination and anastomoses is important to the neurosurgeons, orthopaedicians and general surgeons while examining, diagnosing and managing peripheral nerve lesions or injuries of the upper limb.

DOI: 10.5281/zenodo.12740880

6. Assessment of Clinical Profile, Mean Platelet Volume (MPV), and Platelet Distribution Width (PDW) in Thrombocytopenia
K. Hari Babu, K. Anitha, Ganesh Nallagonda
Introduction: Thrombocytopenia is characterized by a low platelet count as a result of marrow hypo proliferation or peripheral platelet breakdown. Several diagnostic techniques have been proposed to identify the underlying cause of thrombocytopenia. The aetiology might include febrile illnesses including dengue fever and malaria, as well as other infectious diseases. The purpose of this research was to assess the clinical characteristics, mean platelet volume (MPV), and platelet distribution width (PDW) of febrile individuals with thrombocytopenia. Material and Methods: Ninety-eight cases of both genders suspected with thrombocytopenia with acute febrile infections above 21 years of age were included. 5 ml of peripheral venous blood was collected to analyse the parameters including complete blood count, platelet distribution width, and mean platelet volume were estimated and recorded. Results: The severity of thrombocytopenia was severe in 24.48%, moderate in 55.10% and mild in 20.40% of cases. The mean difference of platelet value, mean platelet volume, PWD, and PWD/PLT were statistically significant (p<0.05). Infectious conditions such as dengue fever (30.61%), malaria (10.20%), leptospira (7.14%) and other conditions (52.04%) were observed in participants. Conclusion: Mean platelet volume and platelet distribution width are the potential screening tools for diagnose and differentiating the cause of thrombocytopenia. However, Early suspicion, screening, diagnosis and prompt management of thrombocytopenia will effectively lower morbidity and mortality related dreaded illness.

DOI: 10.5281/zenodo.12740889

7. Immunological Effects of Parenteral Nutrition in Polytrauma Patients in ICU
Nabajyoti Hazarika
Background: Polytrauma patients admitted to the intensive care unit (ICU) often experience immune dysregulation and increased risk of complications. This study aimed to investigate the immunological effects of parenteral nutrition (PN) and the potential benefits of immunonutrition and early enteral nutrition (EN) in this patient population. Methods: A prospective, randomized controlled study was conducted with 50 polytrauma patients admitted to the ICU. Patients were randomly assigned to receive either standard PN (n=25) or immunonutrition PN (n=25). Immunological parameters and clinical outcomes were assessed. A subgroup analysis based on the timing of EN initiation (early EN, n=30; late EN, n=20) was also performed. Results: The incidence of infectious complications (32% vs. 56%, p=0.047), sepsis (20% vs. 40%, p=0.032), and MODS (16% vs. 32%, p=0.041) was significantly lower in the immunonutrition PN group compared to the standard PN group. The length of ICU stay (14.6 ± 5.8 vs. 18.4 ± 7.2 days, p=0.028) and 28-day mortality (8% vs. 20%, p=0.039) were also significantly reduced in the immunonutrition PN group. Early EN initiation was associated with reduced incidence of infectious complications (30% vs. 65%, p=0.012), sepsis (20% vs. 45%, p=0.025), MODS (17% vs. 35%, p=0.038), length of ICU stay (15.2 ± 6.1 vs. 19.8 ± 7.4 days, p=0.021), and 28-day mortality (10% vs. 20%, p=0.046) compared to late EN initiation. Conclusion: Immunonutrition PN and early EN are associated with improved clinical outcomes and attenuated inflammatory response in polytrauma patients admitted to the ICU. These findings support the use of immunonutrition and early EN as strategies to optimize nutritional support and improve outcomes in critically ill polytrauma patients.

DOI: 10.5281/zenodo.12741020

8. Patterns and Impact of Foot Injuries: An Observational Study at Hamidia Hospital
Rahul Rohila, Suresh Uikey, Saurabh Cholkar, Vinod Rawat
Background: Foot injuries are prevalent among active individuals, often leading to significant functional impairments. These injuries, although rarely life-threatening, require proper management to prevent long-term complications and disability. Aim and Objective: To investigate the patterns of foot injuries among patients presenting at Hamidia Hospital, Bhopal. Materials and Methods: This observational study was conducted from January 2021 to June 2022 in the Department of Orthopaedics at Gandhi Medical College, Bhopal. Patients of all ages and both genders presenting with foot injuries and who consented to participate were included. Data were collected through patient interviews, physical examinations, and medical record reviews, including demographic details, mode of injury, type of injury, location, side of injury, and severity. Radiographic assessments confirmed the presence and type of fractures and dislocations. Descriptive statistics were used to analyze the data. Results: The study included 955 patients, with a mean age of 34.97 years. The majority of patients were young adults, with the highest incidence in the 21-30 age group (24.5%), followed by the 31-40 age group (23.4%). A higher incidence was observed in males (76.6%) compared to females (23.4%). Road traffic accidents were the leading cause of foot injuries (68.8%), followed by falls from height (13.4%) and slips and falls (9.1%). Most injuries involved a single region (92.1%), with the forefoot being the most commonly affected region (55.22%). Bilateral injuries occurred in 7.64% of cases. Associated injuries were present in 46.0% of patients, and 61.6% of injuries were open. Foot fractures without dislocations were observed in 91.62% of cases, with the remaining 8.38% having single or multiple dislocations. Conclusion: Foot injuries predominantly affect young and middle-aged males, with road traffic accidents being the primary cause. Most injuries involved the forefoot and were often isolated. The high prevalence of associated and open injuries highlights the need for enhanced traffic and workplace safety measures, public awareness campaigns, and prompt medical intervention to reduce the incidence and severity of foot injuries and improve patient outcomes.

DOI: 10.5281/zenodo.12741027

9. A Clinical Comparative Evaluation of Bupivacaine and Ropivacaine for Epidural Anaesthesia in Adult Patients Undergoing Lower Extremity Surgery
Arindam Bhattacharjee, Kalyan Sarma, Anupananda Chowdhury, Nabanita Deka, Urmi Choudhury, Bandana Mahanta, Pranab Boro, PrabirPranjal Das, Jugantar Roy
Background: Post-operative pain may produce deleterious effects on respiratory, cardiovascular, neuroendocrine and gastrointestinal systems of our body. Epidural anaesthesia reduces the incidence of many major post-operative complications. The advantage of epidural anesthesia is the ability to maintain continuous anaesthesia after placement of an epidural catheter which can be extended into post-operative period for analgesia using lower concentration of local anaesthetic drugs alone or in combination with different adjuvants. Materials and Methods: 100 cases undergoing elective lower extremity surgery between ages 18-60 years of both sexes with ASA grade I were selected randomly and divided into two groups of 50 cases each. All patients received Tab Diazepam 10mg orally the night before surgery. Inj. Ondansetron 4 mg iv and Inj. Ranitidine 50 mg (slow iv drip) were given half an hour before operation. One group received 20 ml of 0.75% ropivocaine hydrochloride (Group A) and other group received 20 ml of 0.5% bupivacaine hydrochloride (Group B). Onset, duration, peak height and time taken for the sensory block to regress by 2 dermatomes was recorded. Onset, duration and degree of motor block, hemodynamic parameters and side effects were recorded. Quality of post-operative analgesia was recorded. Students t test (Unpaired t test), Chi square test or Fishers exact test were used for statistical analysis. Results: The onset and duration of sensory block , hemodynamic effects after administration of the drugs, the quality of post-operative analgesia produced and the incidence of side effects like hypotension, bradycardia, nausea, vomiting, pruritus and shivering produced by 0.5% bupivacaine and 0.75% ropivacaine are similar. The onset of motor block is similar for both the drugs, but the duration of motor block is considerably longer with bupivacaine. Bupivacaine produces a greater degree of motor block. Conclusion: Bupivacaine (0.5%) and ropivacaine (0.75%) produce similar epidural anaesthesia with the only exception that the degree and duration of motor block is less with ropivacaine.

DOI: 10.5281/zenodo.12741032

10. To Observe the Functional Changes in Pulmonary Systems among Patients With CKD Over a Period of Six Months
Padmini Sirkanungo, Ashim Kumar Mahali, Abhijit Taraphder
Background & Methods: The aim of the study is to observe the functional changes (obstructive or restrictive) in pulmonary systems among patients with CKD over a period of six months. Detailed clinical history and clinical examination of all patients fulfilling the inclusion and exclusion criteria. CBC, Serum Creatinine, USG of whole abdomen and pelvis (Size, structural abnormality of kidney etc.) Results: Majority of the cases were from stage 3 of CKD i.e.63.5% at baseline and 52.6% after 6 months. Proportion of cases from stage 4 were 25.4% at baseline and 42.4% after 6 months. Conclusion: Chest x ray was normal at baseline and after 6 months, 5 patients i.e. 4.2% had bilateral mild pleural effusion. Epworth daytime sleepiness risk assessment revealed that proportion of high-grade cases were 16.1% at baseline that increased to 35.6%. Proportion of cases from low grade were 83.9% that are decreased to 64.4% after 6 months. The difference in the proportion of cases in high grade and intermediate grade was statistically significant(<0.05). Epworth daytime sleepiness risk assessment revealed that proportion of high-grade cases were 16.1% at baseline that increased to 35.6%. Proportion of cases from low grade were 83.9% that are decreased to 64.4% after 6 months. The difference in the proportion of cases in high grade and intermediate grade was statistically significant(<0.05).

DOI: 10.5281/zenodo.12741051

11. Utilizing the Milan Scoring System for Assessing Malignancy Risk in Salivary Gland Lesions
Archana Kumari, Juli, Awadesh Kumar, Imtiaz Ahmed
Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardized system for assessing malignancy risk in salivary gland lesions, aiding in accurate diagnosis and treatment. Continuous evaluation is necessary to validate its efficacy in various clinical scenarios. Methods: This retrospective cohort study at the Bhagwan Mahavir Institute of Medical Science included 100 patients with salivary gland lesions assessed using the MSRSGC over 2 years. Data from medical records quantified malignancy risk and evaluated system accuracy using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Twenty-five percent of patients were high-risk for cancer, and 45 had histological confirmation. The MSRSGC predicted malignancy with 88.9% sensitivity, 96.2% specificity, and 94% accuracy. Conclusion: The MSRSGC is a reliable tool for assessing malignancy risk in salivary gland lesions, particularly in high-risk categories. Recommendation: While the MSRSGC shows high efficacy, it should complement clinical and histopathological evaluations, especially for intermediate-risk cases, to enhance diagnostic precision.

DOI: 10.5281/zenodo.12741053

12. Body Mass Index and Hernia Size of >2 CM Could Be the Risk Factors for Umbilical Hernia Recurrence: A Retrospective Study
Subhabrata Das, Pratibha Misra, Sukamal Das, Jyotiranjan Mohapatra
Background: Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. Aim and Objectives: To analyze the results of the umbilical hernia repair and to assess the independent risk factors influencing umbilical hernia recurrence. Materials and Methods: A retrospective analysis of patients who underwent surgery for umbilical hernia in the Shri Jagannath Medical College and Hospital, Puri over a period of two years from January 2022 to December 2023. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair umbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (only technique). Every operation was chosen individually by a surgeon. Results: A total 194 patients (62 males and 132 females) with umbilical hernia were examined. The mean age of the patients was 57.1±15.4 years, hernia anamnesis – 7.6±8.6 years, hospital stay – 5.38±3.8 days. One hundred eighty four patients (94.8%) were operated on using open suture repair technique and 10 (5.2%) patients – open mesh repair technique. Only 7% of patients whose BMI was >30 kg/m2 and hernia size >2 cm and 4.3% of patients whose BMI was <30 kg/m2 and hernia size <2 cm were operated on using onlay technique (P>0.05). The rate of postoperative complications was 5.2%. Sixty-seven patients (69%) answered the questionnaire. The complete patient’s recovery time after surgery was 2.4±3.4 months. Twenty eight patients (20.9%) complained of pain or discomfort in the abdomen, and fourteen patients (10.4%) had ligature fistula after the surgery. Ninety patients (67.2%) did not have any complaints after surgery. The recurrence rate after umbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient’s BMI was >30 kg/m2 (8.6% for < 30 vs 10.7% for >30). There were 10 recurrence cases after open suture repair and one case after onlay technique. One hundred twelve patients (83.6%) assessed their general condition after surgery as good, 18 patients (13.4%) as satisfactory, and only 4 patients (3%) as poor. Conclusions: We did not find any significant independent risk factors for umbilical hernia recurrence. However, based on reviewed literature, higher patient’s body mass index and hernia size of >2 cm could be the risk factors for umbilical hernia recurrence.

DOI: 10.5281/zenodo.12741059

13. A Hospital-Based Retrospective Study on Sociodemographic Characteristics and Risk Factors of Diabetic Foot Ulcer
Lachhaman Bag, Dibyajyoti Sahoo, Dillip Kumar Chand, Jyotiranjan Mohapatra
Background: Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Aim and Objectives: The present study was done to identify the sociodemographic characteristics and related risk factors in patients with diabetic foot ulcers. Materials and Methods: This hospital-based retrospective study was conducted on  adult patients with diabetic foot ulcers observed on their first visit to the Department of Surgery, Shri Jagannath Medical College and Hospital, Puri over a three-year period from October 2021 to September 2023. The sociodemographic charecteristics and  underlying risk factors datas were collected from the included cases. Results: A total of 137 patients presented with DFU among which majority of patients were male 98 (71.5%).Out of total cases, 64 (46.7%) DFU patients had diabetes for more than five years. Poor glycemic control was found in 109 (79.6%) of the patients. Footwear and loss of preventive foot were the most common precipitating factors. Most common site of DFU was fore foot (non-plantar 73%). Conclusions: Advanced age, duration of diabetes, and poor glycemic control are associated risk factors for developing foot ulcers. Implementing organized screening programs for diabetic foot neuropathy and promoting awareness can help address these complications.

DOI: 10.5281/zenodo.12741062

14. Effect of Altered Thyroid Hormone (FT3 & FT4) and TSH Levels on Sepsis Related Neonatal Mortality
Gurjar Umesh Kumar, Kumari Sushila, Meena Kailash Kumar
Aims and Objectives: To study the effect of altered thyroid hormone (FT3&FT4) and TSH levels on Sepsis related neonatal mortality. Study Design: It was a hospital based observational, Analytical study, 32 Term babies with sepsis were taken, Thyroid hormones (FT3&FT4) and TSH levels from the blood collected between 18 and 24 hr after birth were measured by Chemiluminescence immunoassay. Outcome results were analysed using chi square, and ROC curve. P value <0.05 was considered significant. Results: Cases of Neonatal sepsis expired had significant low level of S.FT4 (1.22 + 0.27 ng/dl) as compare to discharged (1.58+ 0.38 ng/dl), but there was no significant difference observed in S.FT3 and TSH level. Cut off value of S. FT4 ≤ 1.39 ng/dl & S. TSH ≤  3.8 8uIu/ml combined was having a good predictive value ( SN- 77.2, SP- 90, PPV- 94.44 & NPV- 64.29) for Sepsis related neonatal mortality. Conclusions: Cut off value of combined S. FT4 ≤  1.39 ng/dl & S.TSH ≤  3.8 8uIu/ml have best predictive value for Sepsis related neonatal mortality.

DOI: 10.5281/zenodo.

15. Bacteriological Contamination of Toothbrushes Analysed by MALDI-TOF-MS
Suryakantha Bugge, Ramya Tupili,  Tahniyath Fatima, Shorooq Fodi Alnoomasi
Background: Tooth brushing is the most common method for maintaining oral hygiene, but it also leads to toothbrush contamination with bacteria, blood, saliva, and oral debris. This study aims to isolate and identify bacteria contaminating toothbrushes among female students at Qassim University, Saudi Arabia. Materials and Methods: This observational cross-sectional study randomly collected toothbrush samples from female students at Qassim University and included new toothbrushes as controls. Toothbrushes were divided into two groups and processed differently to optimize microbial yield. Samples were inoculated onto suitable media and incubated. Bacteria were identified using the Phoenix Automated Microbiology System (30 brushes) and MALDI T of Mass Spectrometry (32 brushes). Data analysis was performed using SPSS 20. Results: The Phoenix Automated Microbiology System isolated 6 bacterial species, with 13.3% showing growth of Micrococcus and 36.7% showing no growth. MALDI-Tof-MS detected 24 bacterial species in the second group and unused new brushes, including Enterobacter cloacae in 37.5% of used brushes and Stenotrophomonas maltophilia in 6.25% of unused brushes. Conclusion: The identified bacteria were predominantly commensal. Individuals with HIV, undergoing chemotherapy, genetic disorders, and neonates are particularly susceptible to these bacteria. Enhanced hygienic practices, such as thorough hand washing by healthcare personnel, are essential to minimize potential organism transfer, particularly from tap water.

DOI: 10.5281/zenodo.12741070

16. Detection of Thyroid Hormone Deficiency in Neonate Cord Blood
Surya Kantha Bugge, Mohd Munawar Ali Khan, Aseel Khalid Suliman Al-Duraibi
Background: Infants with Congenital Hypothyroidism (CH)  may present with subtle or nonspecific clinical signs initially, as residual maternal thyroid hormones can temporarily mask symptoms. Materials and Methods: 3ml of Cord blood was drawn after the 3rd stage of labour and Thyroid Function tests were performed by Electrochemiluminescence method, Patients were recalled if the Thyroid stimulating Hormone (TSH) Value was > 60 mIU/L. Results: 8 babies had Congenital Hypothyroidism (CH) of which 2 were Downs syndrome babies and 1 baby had heart anomalies. incidence has been calculated to be 1 in 2402 live births, in the period from April 2012 to March 2013 in Qassim region of Saudi Arabia. Conclusion: Umbilical cord blood TSH proves to be an effective screening tool in identifying congenital hypothyroidism, thereby preventing mental retardation and other adverse effects associated with untreated CH.

DOI: 10.5281/zenodo.12741074

17. To Compare the Effect of Expressed Breast Milk (EBM) Versus 10 % Dextrose on Procedural Pain in Term Neonates – A Double-Blind Randomized Control Trial in a Rural Teaching Hospital in Telangana
Sandhya Dasari, Preethi Subramanian, E. Badari Maruthi, Sulthani Sai Kalyan, Sudharshan Raj C
Objective: To compare the effect of expressed breast milk (EBM), versus 10% dextrose on procedural pain in neonates as assessed by the Neonatal Infant Pain Scale (NIPS), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying. Design: Prospective, double blind randomized controlled trial. Setting: Postnatal ward of a tertiary-care hospital. Participants: 60 neonates who required heel prick were recruited into the study according to the inclusion and exclusion criteria after written parental informed consent. Methods: The enrolled neonates were randomized into intervention groups –EBM and 10% Dextrose. Two ml of test solution was given to baby by paladay 2 minutes before heel prick by a nurse. The heel prick was later administered by one of the blinded investigators. The face and crying of baby were video graphed by another blinded investigator. The facial response to pain was analyzed from the video. Outcome variable: NIPS score, heart rates and SpO2 at pre procedure. 30 seconds, 2 minutes and 4 minutes and duration of cry were recorded. Results: 60 babies were considered for final analysis with 30 in 10% D, and 30 in EBM group. The median NIPS score of neonates in EBM group was 4 at 30 seconds while it was 6 in the 10% D group which was statistically significant. The duration of cry in the EBM group (44.53 ± 28.63 seconds) was lower than that of 10% D group (52.46±43.58) though not statistically significant. On subgroup analysis, there was a significant difference between NIPS scores (p<0.00001) across the timelines in each group. There was a significant change in heart rate across the timelines in each group (p<0.00001). Conclusions: This study has established that both 10%D and expressed breast milk are efficacious in reducing pain in neonates. More studies are required on a larger scale to identify the best non pharmacological agent/method and set up robust clinical guidelines to be followed uniformly in all NICUs.

DOI: 10.5281/zenodo.12741080

18. The Impact of Diabetes Mellitus on Nerve Conduction: A Cross Sectional Research
Raj Kumar, Shalini Rastogi, Shivani Sharma, Shams Aaghaz, Sonal Rastogi
Background and Objectives: Diabetic peripheral neuropathy is a severe condition that lowers quality of life and has social repercussions. Early diagnosis and treatment of neuropathic processes might change their trajectory and significantly lower the morbidity and death that go along with them. This research investigates the impact of long-term control of blood sugar on diabetic peripheral neuropathy in individuals diagnosed with type 2 diabetes. Material and Methods: From July to September of 2023, a hospital-based research was conducted at the NCR Medical College Hospital in Meerut, Uttar Pradesh, India. Those who had Type 2 diabetes for less than ten years and were older than eighteen were all recruited. The BMI, HbA1c level, as well as nerve conduction studies (NCS) were determined using established methods. The statistical package for social sciences (SPSS), version 25.0, was used to analyze the data. A P-value of less than 0.05 was deemed significant. Results: Fifty-two of the 95 T2DM patients were men. According to our research, the sensory velocity decreased from 64.069 ± 3.221 to 54.001 ± 5.339 and the motor nerve decreased from 63.391 ± 2.379 to 53.869 ± 2.081 (P = 0.0501, P = 0.0031, respectively) as the length of diabetes increased. Furthermore, a significant reduction in motor nerve amplitude from 8.789 ± 3.109 to 6.941 ± 1.839 (P = 0.0501) and sensory nerve amplitude from 25.711 ± 5.701 to 19.511 ± 6.509 (P = 0.0031) was seen with longer duration of diabetes. Additionally, when HbA1c was greater than 6, all NCS parameters (amplitude and velocity) reduced: motor velocity dropped from 63.001 ± 2.589 to 51.439 ± 1.661 (P = 0.021), and sensory velocity declined from 63.961 ± 2.359 to 55.489 ± 2.431 (P = 0.029). Moreover, the motor amplitude dropped from 6.879 ± 3.551 to 6.609 ± 3.289 (P = 0.0509), whereas the sensory amplitude dropped from 26.909 ± 1.261 to 20.849 ± 2.101 (P = 0.0509). Furthermore, there is a significant (P = 0.0509) link between the BMI and the motor and sensory amplitudes. Conclusion: All of the nerve conduction testing parameters were negatively impacted by high BMI and poorly treated (high HbA1c) long-term diabetes.

DOI: 10.5281/zenodo.12741085

19.  Comparative Efficacy of Serratus Anterior Plane Block (SAPB) and Fentanyl for Postoperative Pain Management and Stress Response in Patients undergoing Minimally Invasive Cardiac Surgery (MICS)
Renu Bansal, Neeru Gaur, Rahul Singh, Deepak Chandra
Background: Through the facilitation of early extubation and optimum pain management, fast tracking plays a key role in lowering perioperative morbidity and length of hospital stay following surgery. Enhancing recovery also greatly benefits from reducing the stress reaction to surgery. A novel method for chest wall analgesia has been described recently: serratus anterior plane block (SAPB). To determine the efficacy of SAPB analgesia for minimally invasive cardiac surgery (MICS), further information is needed. Aim and objectives: The purpose of the research was to evaluate the safety and effectiveness of SAPB guided by ultrasonography in comparison to fentanyl for the management of post-thoracotomy pain and stress in patients receiving MICS. Setting and Design: This was a prospective, observational, and comparative research that was time-framed. Materials and Methods: Two groups were randomly allocated to patients receiving MICS for coronary artery bypass grafting while under general anaesthesia. Patients in the SAPB group (Group A) received 0.2% of 20 ml ropivacaine before having a catheter inserted for ongoing infiltration at the conclusion of the surgery. Patients in the fentanyl group (Group B) received fentanyl intravenously as postoperative analgesics. The main result assessed how much pain was evaluated using the visual analogue scale (VAS) and how much stress response was quantified using cortisol levels in both groups. Results: In comparison to Group B, Group A’s VAS score was considerably lower (P < 0.0001). The SAPB group also had decreased cortisol levels. Group A exhibited more stability in hemodynamic measures, including oxygen saturation, pulse rate, diastolic blood pressure, and systolic blood pressure, and required fewer top-up analgesics. Conclusion: When it came to treating post-thoracotomy pain following MICS, SAPB worked better than fentanyl. The group that took SAPB had reduced cortisol levels.

DOI: 10.5281/zenodo.12741093


Histopathological Differences in Rectal Cancer between Patient (≤50 Years Age) and (>50 Years Age): a Tertiary Care Cancer Center Experience in Odisha.


Prasant Kumar Parida1, Jyotiranjan Mohapatra2, Subhransu Kumar Hota3


Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer. Recent data from Western and Asian countries have shown an increase in the number of CRC cases among patients under the screening age of 50 with late stage presentation leading to poor survival.

Aim and Objectives: To analyze the pattern of histopathological presentation in rectal cancer between patients younger than 50 years old and older than 50 years age. Material & Method: This hospital based retrospective study was conducted on patients who histopathologically diagnosed rectal cancer and came to Department of Medical Oncology, AHPGIC, Cuttack for their management over a period of five years from January 2019 to December 2023.The histopathologically details of patients were collected and compared between <50 and >50 years age. Results: During the study period, a total of 84 rectal cancer patients were encounted. Out of included cases, males were predominated 43(51%) with a male to female ratio of 1:1. The majority of patients were between the ages of 41 to 50 years old. Young age patients had more aggressive disease in terms of advance stage disease at presentation and poorly differentiated tumors; 53.6% patients had T3/T4 disease and 53.6% patients with poorly differentiated tumors in contrast to patients with age more than 50 years. Conclusion: This study found a higher number of younger rectal cancer patients (under 50 years old). These younger patients also tended to have more aggressive tumors or be in a later stage of the disease. To improve the situation, we need a combined effort (multi-sectorial approach) based on strong evidence. This should focus on catching rectal cancer early and giving the best treatment (effective management) possible.

DOI: 10.5281/zenodo.12741095

21. Clinicopathological Profile of Appendicectomy Specimens: A Hospital Based Retrospective Study from a Teaching Hospital, Odisha.
Lachhaman Bag, Dillip Kumar Chand, Dibyajyoti Sahoo, Jyotiranjan Mohapatra
Background: To investigate the pathological variations in appendectomy specimens and identify potential demographic associations, a retrospective analysis was performed focusing on: (1) the range of histopathological diagnoses, (2) patient characteristics linked to these diagnoses, and (3) the incidence of ruptured appendices, unnecessary surgeries (negative appendectomy rate), and unexpected pathology discovered during appendectomy. Materials and Methods: The clinicopathological details of patients who underwent appendectomy at Shri Jagannath Medical College and Hospital, Puri, between January 2022 and December 2023 were reviewed retrospectively. Results: There were 214 cases found to have histopathology proven appendicitis among which 129 (60.2%) males and 85 (39.7%) females with the male: female ratio of 1.5:1. The mean age for male was 28.9 ±11.3 yrs with a range of 1 to 68 yrs and for female was 31.7±7.08 yrs with a range of 2 to 71 yrs and the mean age for The peak age incidence of appendicitis was found in the age group of 21 to 30 years. More than 90% cases of appendicitis occurred below the age of 40 years. Most of the positive appendicitis cases 58 (45.0%) were reported as acute appendicitis in the final histopathology report. Acute appendicitis showed a peak incidence among patients aged 11 to 30 years. Conversely, chronic, recurrent, resolving, and eosinophilic appendicitis were more prevalent in the 21 to 40 year age group. Acute appendicitis and perforated appendicitis was seen more commonly in females at the age interval of 11-30 yrs. Conclusion: Appendicitis is most common in young adults, slightly more frequent in males. Laparoscopy during appendectomy in women helps identify unsuspected pelvic issues, lowering unnecessary surgeries. Examining appendix tissue post-surgery is crucial to avoid missing other problems. Surgeons should recognize rare appendix pathologies that may require further treatment. Effective management of appendix issues requires considering clinical details, imaging (CT scans), and tissue analysis.

DOI: 10.5281/zenodo.12741101

22. Clinicopathological Study of Lower Limb Cellulitis: A Retrospective Study from a Tertiary Care Hospital in a Coastal District of Odisha
Lachhaman Bag, Dillip Kumar Chand, Dibyajyoti Sahoo, Jyotiranjan Mohapatra
Background: Cellulitis is a non-necrotizing inflammation of the dermis and subcutaneous tissues. It is scarcely reported in medical literature. Aim and Objective: To document the clinicopathological details of lower limb cellulitis at a tertiary care hospital in Odisha. Materials and Methods: This study investigated patients admitted with lower limb cellulitis between January 2022 and December 2023.We analyzed their medical records to understand factors like age, gender, underlying conditions, symptoms, treatment received, and treatment success. Results: One hundred nine (109) patients with lower limb cellulitis were admitted during the study period. Of these patients, 56 (51.3%) were males and 43(48.6%) were females. The mean age of the patients was 46.6 years (standard deviation 19.2). Among males, the majority (39%) were in their Fifth decade of life, while the majorities (41%) of females were in their fourth decade. The most of the cases were particularly among people in field jobs 57(52%). All patients presented with swelling of the lower limb, with 54(49.5%) having swelling in the left leg and 49(45%) in the right leg. followed by diabetes mellitus and smoking. The mean duration of swelling before admission was 13 days (SD 3.9). Over half 45(41.3%) of the cases were managed conservatively (Antibiotic treatment) resulted in complete resolution. However, complications occurred in 62(56.9%) of cases, requiring surgical intervention. Abscess formation was the most frequent complication, observed in 45(41.3%) of cases. The average hospital stay in this study was 8.2 ± 1.3 days. Conclusion: Lower limb cellulitis had a high complication rate influenced by duration of symptoms prior to hospitalization and antibiotic therapy.

DOI: 10.5281/zenodo.12741110

23. Transfusion Transmitted Diseases in a Blood Bank at Tertiary Care Hospital: A Retrospective Study
Archana T. Tribhuvan, Meera S. Mahajan, Chandrashekhar P. Bhale
Introduction: Blood Transfusion-transmitted Diseases (TTDs) refer to Diseases that can be transmitted through blood transfusions. Transfusion is an irreplaceable therapeutic modality, widely applied to medical care which is a life-saving procedure. The purpose of this study is to evaluate the Seroreactivity of HIV, HBV, and HCV among blood donors. Materials and Methods: A retrospective study was carried out over a period of 4 years from January 2019 to Dec 2022. Serum samples were screened for Hepatitis B surface antigen (HBsAg), antibodies to Human Immunodeficiency Virus (HIV) 1 and 2, Hepatitis C virus (HCV). Results: A total of 12498 blood donors were included out of which majority of donors were male (96.31%). The overall Seroreactivity was 1.49%, whereas the Seroreactivity of HIV, HBV and HCV were 0.45%, 0.67% and 0.37%, respectively. Conclusion: For reducing transfusion transmitted diseases, the strict selection criteria of blood donors and comprehensive screening of donor’s blood using standard methods should be highly recommended for ensuring the safety of blood for recipient and judicious use of blood products should be emphasized.

DOI: 10.5281/zenodo.12741114

24. Study the Role of Zolendronic Acid (IV Bisphosphonate) Therapy in Providing Good Pain Relief in Fragility Fractures
Sunil Kumar Mooknoor, Prathibha H
Background: Osteoporosis is decrease in the overall amount of bone. It is not at all the same as bone decalcification. It is not only prevalent among postmenopausal women but also occurs in men and women with underlying conditions or major risk factors associated with bone demineralization. Objective: To study the role of Zolendronic acid (IV Bisphosphonate)therapy in providing good pain relief in osteoporotic fragility fractures. Methods: This Prospective single arm, Observational Cohort Study was conducted among 50 Patients above the age of 40 years of either sex presenting with osteoporotic fracture to Department of Orthopedics St. Martha’s Hospital, Nrupathunga road, Bengaluru. Duration of study was December 2015 to December 2017. Results: In the initial six months, ZA provided significant improvement in back pain as depicted by VAS in patients with VCF. ZA being an IV yearly dose regimen is well accepted and tolerated by the patients compared to other oral bisphosphonates. Febrile reactions, myalgia, minor maculopopular rashes were the adverse effects noted in 2 patients who were symptomatically addressed. No other significant adverse effects noted during the study period in any of the patients. All the patients found excellent clinical improvement in terms of pain in the initial 6 months post infusion. At the end of one year, all the patients were willing for a second dose. This study noted ZA therapy had significant decrease in pain intensity. Conclusions: ZA being an annual IV dosing regimen has better compliance than other oral bisphosphonates. ZA provides significant improvement in patients backpain in the initial 6 months and also prevents the incidence of new VCF in patients having Osteoporotic VCF.

DOI: 10.5281/zenodo.12741118

25. Efficacy of Pre-Surgical Bupivacaine Infiltration in Reducing Postoperative Pain in Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial
Salma Mariyam, Heena Chowdhary, Shaleen Sharma, Cheshta Arora
Introduction: Effective postoperative pain management is crucial for patient recovery, particularly in minimally invasive surgeries such as laparoscopic gynecologic procedures. This study evaluates the efficacy of pre-surgical local infiltration of bupivacaine for reducing post-surgical wound pain, hypothesizing that bupivacaine provides superior pain control compared to placebo. Methodology: In this double-blind, randomized controlled trial at Government Medical College, Rajouri, 128 patients undergoing elective laparoscopic gynecologic surgery were randomly assigned to receive either 20 mL of 0.25% bupivacaine or a saline placebo injected at the surgical site before the incision. Pain intensity was as-sessed using the Visual Analog Scale (VAS) at multiple time points post-surgery. Patient satisfaction and the incidence of adverse events were also recorded. Results: The bupivacaine group reported significantly lower VAS pain scores at all postoperative time points than the placebo group (p < 0.001). Additionally, 53% of patients in the bupivacaine group were very satisfied with their pain management, compared to only 22% in the placebo group. The incidence of adverse events was low and comparable between groups. Conclusion: Pre-surgical infiltration of bupivacaine significantly reduces postoperative pain and improves pa-tient satisfaction in laparoscopic gynecologic surgeries without increasing the risk of adverse events. These find-ings support the inclusion of bupivacaine as a standard component of pain management protocols in similar surgical settings.

DOI: 10.5281/zenodo.12741120

26. Assessment of Work- Life Balance in the Field of Ophthalmology
Sana Perween, Amresh Kumar, Nidhi
Purpose: To assess work – life and family balance among ophthalmologist in Bihar, with significance on identifying gender differences. Material and Methods: A questionnaire based format was designed using forms app. The study included professional and personal life balance, gender biases, average income, career breaks, paper written and published, etc. Results: Among the subjects females were affected by temporary break in career (P=0.01), females earned less than males(P=0.001), males pursued fellowship unlike females(P=0.02) , female faced gender biasness at workplace unlike males(P=<0.001) these results were found to be statistically significant. Conclusion:  Hereby it is concluded that there still exist difference in the practice pattern and personal life of male and female ophthalmologists.

DOI: 10.5281/zenodo.12741124

27. Prevalence of Congenital Abnormalities on Routine Ultrasound Scan of Second Third Trimester Pregnancy in Guru Govind Singh Sadar Hospital, Patna City, Patna, Bihar, India
Shikha Rani, Rajiv Kumar
Objectives: The present study was to evaluate the sociodemographic profile of anomaly positive women, prevalence, and type of congenital abnormalities in second and third trimester on ultrasonography scanning. Methods: The Radiologist performed all the transabdominal ultrasonography on a ‘Z6- Mindray color Doppler ultrasound system’ after taking verbal consent from the patient. A questionnaire was used containing the following information e.g. women’s age, parity, gravidity, date of last menstrual period. The questionnaire form also included about the result of transabdominal USG examination which included the following: singleton or multiple, dead, or alive foetus, gestational age, and presence or absence of congenital anomalies. Results: A total 954 women of 2nd and 3rd trimester pregnancy were enrolled. Rate of prevalence of congenital abnormalities was 1.57%. Majorities of fetus anomaly positive women 10(66.67%) were in age group of 20-35 years. Most of the women had primary school level of education. Most of the women were nulliparous 7(46.67%) and primiparous 5(33.33%).  Most of the women 9(60%) were in 2nd trimester of pregnancy. Live foetus at time of scanning were seen in 13(86.67%) women. Intra uterine death foetus at time of scanning was seen in 2(13.33%) women.  Multiple pregnancy was seen in 2(13.33%) women. central nervous system anomalies 10(66.67%), gastro-intestinal anomalies 5(33.33%) and others anomalies 5(33.33%) were the most common. Anencephaly 4(26.67%) and hydrocephalus 2(13.33%) were the common CNS anomalies. Duodenal atresia 2(13.33%) was the common gastro-intestinal anomaly. Conclusions: Rate prevalence of congenital abnormalities was 1.57%. Central nervous system anomaly was the most common followed by gastro-intestinal anomalies.  Anencephaly and hydrocephalous were the most common central nervous system anomalies. Duodenal atresia was the common gastro-intestinal anomalies. Hence, the routine ultrasonography scanning is one of the best choices of diagnostic tool during the 2nd and 3rd trimester of pregnancy to detect foetal abnormalities.

DOI: 10.5281/zenodo.12741131

28. Analysing the Serum Amounts of Trace Metals Such as Zinc, Copper, Manganese, and Magnesium in Patients with Liver Cirrhosis
Vishnu Sain, Jaya Jain, Ashutosh Jain, Prachi Sharma,Shilpa Srivastava
Background: Trace elements contribute in a multitude of physiological as well as metabolic processes in humans, regardless of their source. For roughly one quarter of the body’s enzymes to accomplish their metabolic tasks, metal ions have to trigger them. It is yet unclear how trace elements contribute to the creation of liver cirrhosis and its ramifications. Materials and Methods: By applying a plasma sequential spectrophotometer, the serum amounts of zinc, copper, manganese, and magnesium were determined in 96 unaffected volunteers and 96 unhealthy individuals that is suffering from alcoholic liver cirrhosis.  Statistical analysis employing Wilcoxon and Kruskal-Wallis non- -parametric tests were carried out to evaluate the serum amounts of these trace elements amongst the individuals of both the groups. Results: Zinc levels in serum in liver cirrhosis sufferers were substantially lower than in controls (P<0.001). Patients with liver cirrhosis exhibited significantly higher serum amounts of manganese and copper with the value of P<0.001.  Between individuals suffering from liver cirrhosis and controls, there was no discernible difference in the magnesium levels (P=0.126). Zinc, copper, manganese, and magnesium concentrations were similar in patients with liver cirrhosis who were male or female. The only factor that varied substantially (P=0.027) across the Child-Pugh groups was the manganese concentration. Compared to cirrhotic individuals without encephalopathy, patients with hepatic encephalopathy had significantly lower zinc concentrations (P=0.002). Conclusion: Optimizing the amount of trace elements may help forestall complications and maybe reduce the beginning of liver cirrhosis. It would be advisable to routinely offer trace element analysis.

DOI: 10.5281/zenodo.12741139

29. Predicting the Progress and Outcome of Labor Using a New Sonographic Index Occiput Spine Angle in a Tertiary Care Hospital, Madurai
R. Gnanapriya, Mahalakshmi P, K.S. Chitra, Ramya A, Udhayarajapriya R, Sriandaal Venkateshvaran
Background: Universal flexion is the most common attitude of the fetus at birth which allows normal progression of labor. The attitude of the fetus head during the active phase of labor is generally identified by per vaginal digital examination. Recently a newer ultrasound parameter, Occiput spine angle can aid our conventional clinical examination to assess fetal head deflection. Objectives: (1). To measure occiput spine angle during first stage of labor using Tran’s abdominal ultrasound. (2).To determine whether this occiput spine angle has a relationship with course and outcome of labor. Methods: This was a prospective observational study conducted at the Obstetrics and Gynecology department Velammal Medical College and Research Institute, Madurai from January 2024 to June 2024. Women aged 18 (or) above with uncomplicated pregnancies at term (37 weeks and above) in cephalic presentation were subjected to trans abdominal ultrasound during the first stage of labor in fetuses with occipitoanterior and occipitotransverse position. The angle between fetal C1 cervical spine and occiput of fetal head was measured in the sagittal plane using trans abdominal ultrasound by two investigators. The mean value of the two measurements was taken as occiput spine angle (OSA). The correlation between the occiput spine angle and progression of labor along with mode of delivery were evaluated. Results: A total of 200 pregnant women were assessed. Out of which 143 participants underwent normal vaginal delivery and 57 study participants required obstetric interventions (44 lower segment cesarean and 13 instrumental deliveries). The mean value of occiput spine angle was 127°.19±4°.27 during the active phase of the first stage of labor among the women who underwent normal vaginal delivery. The occiput spine angle was markedly lesser in women who underwent obstetric intervention. The mean OSA value for instrumental delivery was 111°.46±2°.93. Whereas mean value of OSA for LSCS delivery was 110°.61±3°.37. The inter observer reliability was moderate, identified by Cohen’s kappa statistics (0.41-0.61) for measuring the occiput spine angle. A larger occiput spine angle measurement >127° showed shorter duration of a first and second stage of labor which resulted in normal vaginal deliveries (P<0.001). Conclusion: Measuring occiput spine angle during first stage of labor using ultrasound is an effective predictor of course and outcome of labor. The OSA>126° was associated with more incidence of normal vaginal delivery & shorter duration of first and second stage of labor whereas occiput spine angle less than 120° was associated with higher incidence of obstetric intervention & increased duration of first stage of labor. Narrower occiput spine angle would alert the obstetrician even in primary care center regarding labor dystocia and less likelihood of normal vaginal deliveries. Hence this newer ultrasound parameter occiput spine angle may be used as an adjunct to predict the course and outcome of labor thereby the need for obstetric interventions.

DOI: 10.5281/zenodo.12741147

30. Assessment of the Relationship between Iron Deficiency and Febrile Convulsion: A Case-Control Study
Brajesh Kumar, Sujit Nath Choudhury
Introduction: Although the exact origin of FC is unknown, a number of environmental and genetic variables have been suggested. The greatest age at which FC occurs is 14–18 months, which coincides with the age at which anaemia due to iron deficiency (IDA) is most prevalent. Iron is necessary for the synthesis of myelin, which is needed for nerve cells and can alter the amplitude and sensitivity of a neuron’s excitation, as well as for the metabolic processes of the brain and neurotransmitters. Aims/ Objective: To compare the incidence of IDA and haematological parameters in children with febrile convulsion (FC) versus patients with febrile illness without convulsion (control). Materials and Method: In this observational study, 50 patients with FC and 50 patients without FC were evaluated for haematological parameters.   Children’s anaemia was classified by the Ministry of Health and Family Welfare Guidelines as Hb < 11g/dl.  For children under one year old, the normal amount of iron levels was defined as Fe greater than 40 µg/dl, and for those over one year old, Fe greater than 50 µg/dl. The TIBC normal range was defined as 210–430 µg/dl. Transferrin saturation greater than 15% was defined as normal.  Results: There were significantly greater cases with family history of febrile convulsion in FC group (p<0.05). Patients with febrile convulsions had significantly lower serum iron and transferrin saturation as compared to patients with febrile illness without convulsion (p<0.05). There were significantly more cases of iron deficiency anaemia (46%) in febrile convulsion group as compared to 22% in control group (p<0.05). Conclusion: The results indicate that low serum iron and iron-deficiency anaemia affect a significant portion of children with febrile convulsion essentially, this suggests that anaemia and low blood iron levels can reinforce febrile seizures in children.

DOI: 10.5281/zenodo.12741157

31. Clinical Profile and Outcome of Patients in Obstetric ICU in Tertiary Care Centre in Bihar
Anamika, Pushpa
Background and Objective: Though pregnancy and labor are considered a physiological process the potential for catastrophic complications is constant and may develop in a matter of minutes. One indicator of pronounced maternal morbidity is obstetric admission into the ICU. This study was done to evaluate the risk factors and maternal and fetal outcome of ICU admissions. Materials and Methods: This was a retrospective study done in 6 bedded ICU, Department of Obstetrics & Gynaecology, PMCH, Patna, Bihar over a period of 2 yrs from January 2017 to December 2018. Analysis of the causes of obstetric ICU admission, interventions required, duration of ICU stay and maternal and fetal outcome done. Results: Out of total 17147 labour room admissions 2139 patients were admitted in ICU. Patients of eclampsia / HDP had maximum occupancy followed by obstetric haemorrhage. 238 patients died while 1891 survived 10 patients were taken to other hospital, by patient’s relatives. Mean duration of ICU stay was 5.8 days. Perinatal death was 21.55%. Conclusion: The major cases admitted in ICU were of Antepartum eclampsia/HDP, pregnancy with heart disease, obstetrics haemorrhage, septic abortion, severe anaemia and severe jaundice with pregnancy. Multiparity, lack of ANC, delayed reporting to hospital were the major risk factors associated and also influencing the maternal and fetal outcome.

DOI: 10.5281/zenodo.12741173

32. Analysis of Lipids in Vascular Dementia Patients
Anil Kumar Yadav, Vijay Kumar Shrivas
This study investigates the relationship between lipid profiles and cognitive function in vascular dementia (VaD) patients. Lipid analysis revealed significant associations: higher total cholesterol and LDL-C levels correlated with poorer cognitive scores, while elevated HDL-C levels showed a positive correlation with better cognitive performance. These findings underscore the potential of lipid management strategies, such as reducing LDL-C and increasing HDL-C, to mitigate cognitive decline in VaD. Future research should focus on larger, longitudinal studies to validate these associations and develop targeted interventions.

DOI: 10.5281/zenodo.12741179

33. Association between Low to High-Density Lipoprotein Ratio and Renal Function in Elderly Hypertensives in a Tertiary Care Hospital
Manoranjan Mallick, Jagyanprava Dalai, Ashok Kumar Mangaraj, Piyush Shukla
Background: Recent evidence indicates that serum lipids, apart from hypertension, may potentially hasten the deterioration of renal function. Aim: The aim of this study is to investigate the association between low to high-density lipoprotein ratio and renal function in elderly hypertensive patients in a tertiary care hospital. Hypothesis: We hypothesize that a higher low to high-density lipoprotein ratio is associated with worse renal function in elderly hypertensive patients in a tertiary care hospital. Results: During the investigation, renal function declined by an average of 3 percent; hypertension accelerated this decline. Individuals whose low-to-high-density lipoprotein cholesterol ratio was greater than 4.5 experienced a 30% more rapid decline in cholesterol levels than those whose ratio was below 3.5. Statistical analyses revealed, both the contribution of the lipoprotein ratio and the protective effect of high-density lipoprotein cholesterol alone remained significant. The contribution of lipids to the investigation of joint effects was limited to participants who experienced concurrent increases in blood pressure and lipid levels. Conclusion: The findings indicate that blood lipids, apart from hypertension, exert an influence on the deterioration of renal function.

DOI: 10.5281/zenodo.12741182

34. Evaluation of Prescribing Pattern of Antibiotics in the Outpatient Department of Tertiary Care Hospital According to WHO Prescribing Indicators
Mohammed S, Kommareddy S, Vattem J
Background: Increasing antimicrobial resistance is a cause of concern in health care and needs to be addressed with immediate effect to prevent future consequences. Evaluation of prescribing patterns at regular intervals facilitates the identification of problems related to drug use, sensitizes physicians, and helps in formulating guidelines for the rational use of medicine. Material and Methods: This prospective, cross-sectional study was conducted in a tertiary care hospital over a period of 6 months. The WHO indicators were used to evaluate the prescriptions. Results: A total of 930 prescriptions were collected. The average number of drugs per encounter was 3.1. The percentage of antibiotics prescribed was 40.7%.  1% of prescriptions have an injectable antibiotic prescribed, and 99% of drugs were prescribed from the essential medical list. Only 12.1% of antibiotics were prescribed by their generic name. Conclusion: the prescriptions deviate from the recommended values set by the WHO. Continuous education and training activities for physicians and the appointment of clinical pharmacists in the wards are recommended to improve the rational use of medicines.

DOI: 10.5281/zenodo.12741188

35. Observational Study of Pulmonary Function Test in Patients of Thalassemia Major in a Tertiary Care Hospital
Deep Kariya, Alpa Parekh, Dimple Patel, Chandan Narwani, Dhaval Bhatt
Background: Beta Thalassemia is hemolytic disease requiring regular blood transfusion which causes iron deposition in various organs of body in this study we study affect of iron deposition on lungs through pulmonary function test. Aims & Objective: To do pulmonary function test in Thalassemia major patients to assess the association between amounts of blood transfusion with results of pulmonary function test in Thalassemia major patients to assess the association between S. Ferritin level and with results of Pulmonary Function test in Thalassemia major patients. Study Methodology: This study is Observational study where pulmonary function test is carried out on 40 patients of Thalassemia major receiving blood transfusion and various results of test are compared and with pearson correlation results were obtained. Results: The correlation of pulmonary function test parameters of Thalassemia children between the BMI, Hemoglobin, S. Ferritin and chelation therapy were statistically not significant. Meanwhile, correlation of FEV1% with age and number of blood transfusion were statistically significant Remaining parameters of PFT were not significant between age and Number of Blood transfusion.

DOI: 10.5281/zenodo.12741191

36. To Assess the Biochemical Parameters in Patients with Psychiatric Disorders
Vivek Pratap Singh, Archana Javadekar, Ekram Goyal
Aim: The aim of the present study was to assess the biochemical parameters in patients with psychiatric disorders. Methods: The cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from July 2015 to September 2017 and 126 patients were included in the study. Results: The majority of patients 78(61.9%) were in the age group of less than 40 years and there were 48(38.1%) cases who were aged more than 40 years. Majority of cases were females 67(53.2%) and 59(46.8%) cases were males. 56(44.4%) cases were illiterates, 36 patients (28.6%) were educated upto primary level, 14(11.1%) were from higher secondary level,12(9.5%) were graduates and 8(6.3%) were educated upto secondary level. 71(56.35%) cases were having elevated triglycerides and 55(43.65%) cases were having triglyceride level under normal range. 83(65.9%) patients showed reduced HDL and 43(34.1%) cases were having HDL under normal range. 86(68.25%) were having their LDL under normal range and 40(31.75%) were having elevated LDL. 91(72.22%) cases were having their cholesterol under normal range and 35(27.78%) had increased cholesterol levels. 100(79.37%) cases were normotensive and 26(20.63%) were hypertensive. Conclusion: The blood tests to be demanded for vitamin deficiencies are of high importance in terms of early diagnosis, treatment and prognosis. In clinical practice, the diagnosis of psychiatric patients it depends on physician’s clinical experiences, clinical symptoms and patient’s self-assessments. In the current study, these biochemical parameters are objective and the composite information from these routine biochemical markers may improve the diagnostic effectiveness of depressive disorder.

DOI: 10.5281/zenodo.12741197

37. Evaluation of Postnatal Care Services Utilization in an Urban Area of Haryana: Stakeholder Perspectives and Recommendations
Bhumika Bhatt, Neelam, Awadhesh Kumar, Aarti Sharma, Devendra Kumar, J.S. Malik
Background: Labor, birth and immediate postnatal care are the most critical period for newborn and maternal survival. Unfortunately, the majority of mothers and newborns in low- and middle-income countries do not receive optimal care during these periods. Postnatal period being the first six weeks after birth is critical to the health and survival of a mother and her newborn. Material & Methods: A cross-sectional study was carried out among all women who delivered during the study period. Deliveries were traced telephonically and with the help of Anganwadi worker and health workers and were interviewed using pre-designed pretested interview schedule. Categorical data was analysed using Chi square test. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Majority (90.4%) deliveries were vaginal. Most of the deliveries (91.3%) were institutional deliveries and majority (62.0%) of them were conducted in a government institute. Majority 98.6% of new borns cried after birth. Skin to skin contact during delivery was practiced in only 34.6% of cases. Majority of new-borns, 95.7% were dried and wrapped immediately after birth. More than ninety percent babies (95.4%) were massaged and kajal was applied on eyes of 92.5% of babies. Conclusion: In the end the study concludes that though some practices like percentage of institutional deliveries, drying of baby after birth, colostrums feeding, bedding in were good but still some practices likes early initiation of breast feeding, birth vaccination, pre-lacteal feeding needs improvement.

DOI: 10.5281/zenodo.12741199

38. Impact of Hyponatremia on Clinical Outcome in Patients with Acute Cerebrovascular Accidents
Siva Sankara Reddy M, Sujatha C, Helena Rajakumari J, Swathi P, Madhavi Latha N
Background: Acute cerebrovascular accidents (CVA) have a significant social and economic impact and ranks third in terms of morbidity and mortality after cancer and coronary heart disease. Electrolyte disturbances, particularly hyponatremia, are common in patients with acute cerebrovascular accidents which significantly worsens clinical outcomes. The main objective of this study was to estimate the different serum electrolytes, sodium, potassium and chloride and to determine the degree of hyponatremia with the clinical outcome in cerebrovascular accident patients. Material and Methods: A cross-sectional study was conducted in department of biochemistry, S.V. medical college, Tirupati on 40 acute cerebrovascular accident patients. Serum electrolytes were estimated and outcome was measured in terms of discharge or death based on degree of hyponatremia. Results: Out of the 40 study participants, 24 (60%) patients had altered serum sodium levels, of these 21(87.5%) had hyponatremia, 3(12.5%) had hypernatremia. Among 21 cases, 13 (61.9%) had mild, 6 (28.6%) moderate and 2 (9.5%) severe hyponatremia. The serum sodium concentration was notably decreased in the ischemic stroke (127.17 ± 6.83 mEq/L) in comparison to the hemorrhagic stroke (139.25 ± 6.73 mEq/L) with p-value: <0.001. Whereas serum potassium level was elevated in hemorrhagic stroke (3.24 ± 0.37 mEq/L) in contrast to the ischemic stroke (3.71 ± 0.46 mEq/L) with p-value 0.02. When outcome measures (death or discharge) were stratified, the overall deaths in patients with hyponatremia were 14.28%. Of this 7.69% deaths were with mild hyponatremia, 16.7% with moderate hyponatremia and 50% with severe hyponatremia with a significant P-value <0.001. Discussion: Our study highlights the necessity for heightened awareness and proactive management of hyponatremia, a common electrolyte disturbance in stroke patients. Regardless of mild, moderate, or severe, it has been shown to exacerbate the clinical course of stroke patients, leading to increased morbidity, prolonged hospital stays, and higher mortality rates. Conclusion: Hyponatremia is a critical determinant of clinical outcomes in CVA patients. Its presence significantly increases the risk of mortality, morbidity, and poor functional recovery. Early recognition and appropriate management of hyponatremia are vital to mitigate its adverse effects.

DOI: 10.5281/zenodo.12741201

39. To Assess the Correlation between S-Adenosylmethionine Level with Severity of Hepatitis B
Jayaramu S, Kabbin JS, Nagappa S
Introduction: Hepatitis B adds to the disease burden due to increased number of cases rising from past decade and is associated with increased morbidity and mortality. S -Adenosylmethionine regulates the cellular proliferation and plays an important role in the early diagnosis of Hepatitis B associated liver disease. Objective: To assess the correlation between S-Adenosylmethionine (SAM) levels with severity of Hepatitis B and to correlate S-Adenosylmethionine levels with Aspartate aminotransferase, Alanine aminotransferase and alkaline phosphatase. Methodology: A total of 118 Hepatitis B positive serum samples were collected from Microbiology laboratory from a tertiary care hospital. Blood samples of 5cc in plain tubes were collected from all patients. The serum was separated by centrifugation method and stored at -800 C until S- Adenosylmethionine assay was done by Enzyme Linked Immunosorbent Assay (ELISA) technique and the values will be correlated with Aspartate Aminotransferase (AST), Alanine transaminase (ALT) and Alkaline phosphatase (ALP) levels of the patients. Result: Out of 118 Hepatitis B positive patients, 74 patients had normal AST , ALT and ALP levels, whereas 32 patients have deranged AST and ALT levels of more than 45 IU/L and 50 IU/L respectively and 12 patients had deranged ALP levels of above 140 IU/L. In patients with deranged Liver function test (LFT), SAM levels by ELISA showed an increase in concentration in 20 patients ( P = 0.03), whereas 22 patients had normal levels of SAM (P < 0.05). In 75 patients with normal LFT, SAM levels were within the normal range. Conclusion: The serum S -Adenosylmethionine levels can be correlated with the severity of Hepatitis B associated liver disease and it can be a potential non-invasive marker which helps in diagnosis of the patients.

DOI: 10.5281/zenodo.12741203

40. Performance Assessment of Novel Blood Culture Identification 2 Film Array Biofire Syndromic Multiplex PCR (BCID 2) with Respect to Direct Detection of Pathogens and Antimicrobial Resistance Genes in Critically Ill Cancer Patients with Blood Stream Infections: A Single Centre Retrospective Observational Study
Sujata Lall, Vivek Gajanan Bhat, Hemali Sandeep Kadu, Divya Ratheesh T
Background: Blood stream infections (BSI) lead to significant morbidity and mortality, more so in immunocompromised group of patients like cancer patients. BCID 2 was evaluated for diagnosis of BSI and identification of organisms and resistance genes by comparing it with conventional culture methods followed by identification and susceptibility testing with VITEK-2 ®COMPACT. Aims: The study aimed at evaluating the performance of BCID 2 panel and its comparison with VITEK® 2 COMPACT with a primary objective of evaluation of performance for monomicrobial cultures and polymicrobial cultures along with net reduction in time to results and secondary objective of detection of resistance genes and comparison of susceptibility results with VITEK-2 ®COMPACT. Settings and Design: It was conducted in the department of Microbiology ACTREC Tata memorial Centre, Navi Mumbai for a period of two months from 15th January 2024-15th March 2024.Retrospective analysis of database from microbiology records and hospital information system (HIS) was done for a period from 1st November 2020 to 30th November 2023. Methods and Material: Results of flashed positive blood cultures of sepsis patients from all Disease Management Groups (DMGs) and all age groups were included. Conventional agar media plating followed by VITEK® 2 COMPACT were performed on all flashed positive blood culture bottles while BCID 2 was performed only on = positive blood cultures which were requested by clinicians as a part of treatment protocol. Demographic parameters were evaluated from HIS. Statistical Analysis used: Agreement statistics between BCID2 and VITEK® 2 COMPACT methods were calculated for each BCID 2 target for monomicrobial samples with results from VITEK® 2 COMPACT as reference standard in form of  positive percent agreement (PPA) and a negative percent agreement (NPA) at 95% confidence intervals. Concordance percentage was calculated as percentage of monomicrobial and polymicrobial results reported by BCID 2 which matched with that of VITEK® 2 COMPACT and culture methods. For antibiotic resistance genes, categorical agreement, very major error and major error were calculated. Results and Conclusions: BCID 2 performed reasonably fair for identifying clinically relevant pathogens and providing reasonable concordance with the existing methodologies in our laboratory A total of 116 blood cultures were included in the study. PPA and NPA for Gram positive probes were 100% and majorly 100% for Gram negative probes accept. 91.6% for Escherichia coli and 98.9% for Enterobacter Cloacae complex. Discordance in results of 17/109(15.6%) monomicrobial samples was seen samples. Concordance was seen in 4/6(66.7%) polymicrobial samples. Total antibiotic resistance gene markers were detected in 66/116(56.9%)-63Gram negative and three Gram positive isolates. Most common resistance gene marker detected singularly were NDM 16/63(18.2%), followed by CTX-M 14/63(16%) and in combination was CTX-M +OXA-48 Like.8.16% isolates reported discordance in carbapenem resistance detection.

DOI: 10.5281/zenodo.12741207

41. Increasing Trend of Enterobacter Species Infection in a Tertiary care Centre, Puducherry
Sangeetha Munuswamy, S. Umadevi, Joshy M Easow
Introduction: Enterobacter species are gram negative bacilli  belonging to Enterobacteriaceae family.  Enterobacter spp  are one of the most common bacteria to cause nosocomial infections. Multidrug Resistance (MDR) is on increasing trend among Enterobacter spp which leads to difficulty in treating the patients that would result in increased mortality and morbidity associated with Enterobacter spp infection. Aims and Objectives: To determine the prevalence and antimicrobial susceptibility  pattern of Enterobacter spp isolated from pus samples over a period of  30 months. Materials and Methods:  This study was a cross sectional descriptive study. Enterobacter  spp was identified based on standard biochemical tests. Antibiotic susceptibility testing was done for all isolates by Kirby Baeur Disk Diffusion test as per CLSI guidelines. Results: Enterobacter spp infection was found to be increasing among pus samples and the antimicrobial resistance was  also  increasing to commonly used antibiotics and Multidrug resistance were also increasing trend. Conclusion: Therefore, the monitoring of the trend of Enterobacter spp infection and its antimicrobial resistance pattern should be done and strengthening of Hospital infection control practices should be practiced in order to prevent the nosocomial spread of highly multidrug resistance bacteria and also in the community.

DOI: 10.5281/zenodo.12741212

42. Common Mental Disorders among Inmates of Old Age Homes in the Urban Field Practice Area of Raja Rajeshwari Medical College and Hospital, Bengaluru
Suhasini KA, Murari Hemalatha, Anuradha RV, Shashikala Manjunatha
Background: Age is an important determinant of mental illness. The overall prevalence of mental and behavioural disorders tends to increase with age due to the normal aging of the brain, deteriorating physical health, and cerebral pathology. Disorders such as depression and cognitive disorders have a high prevalence in the elderly. Due to socio-demographic changes, older adults are forced to shift from their own place to some institutions/old age homes. The prevalence of these mental health disorders in old age homes is not well studied. Methods: A descriptive study was conducted in seven old age homes of Urban Field Practice Area and 265 inmates participated in the study. The data was collected using a pretested, semi structured questionnaire. It was analysed using descriptive statistics. Results: The majority of the inmates were of >80 years accounting for 38.49%. Females (63.39%) outnumbered the males (36.6%) and widows/widowers were 40.37%. 41.07% of female inmates were literate. Prevalence of diabetes mellitus and hypertension was 58.86% and 22.26% respectively. The prevalence of depression and dementia was 43.39% and 60.75% respectively. Conclusion: The inmates of old age home have a high prevalence of depression and dementia. It is important to recognize these issues and manage them appropriately in the form of counselling, psychotherapy and essential medicines for better quality of life.

DOI: 10.5281/zenodo.12741212

43. Anemia among Patients on Hemodialysis and Response to Hematinic Agents in a Tertiary Care Hospital of Assam, India
Raktim Borgohain, Jitu Das, Gaurab Kumar Gogoi, Pradumna Pathak, Bobyjeet Goswami, Migom Doley, Kaushik Neog
Background: Medical practitioners and researchers must prioritize research on anemia because it significantly impacts hemodialysis patients’ overall prognosis and quality of life. Objective: This study set out to address this by collecting data on the frequency of anemia in hemodialysis patients and comparing the effectiveness of different iron, folic acid, and erythropoietin regimens in treating anemia in tertiary care hemodialysis patients. Hypothesis: When it comes to treating anemia, we anticipate that hematinic medications will work for many hemodialysis patients suspected of having the condition. Materials & Methods: Lakhimpur Medical College and Hospital (LMCH), located in North Lakhimpur, Assam, was where this retrospective study with a cross-sectional design was carried out. The Dialysis Register and Case sheet kept at the dialysis unit of LMCH was the primary source of documented information for patients who have had hemodialysis between 1st January 2021, and, 31st December 2023. For this study, fifty patients diagnosed with chronic renal disease and who presented with anemia was included. Results: During the research, fifty patients were incorporated into the investigation at various times. With a mean age of 48.3 years and a standard deviation of 2.54 years, their ages ranged from 15 to 70[years]. The mean age fell somewhere in the middle. The total number of individuals consisted of 31 males, which constitute 62% of the total, and 19 females, which constitutes 38% of the total. Before therapy, the mean mean corpuscular hemoglobin was determined to be 32.54 ± 3.3; after treatment, it climbed to 34.21 ± 1.8 respectively. This improvement was statistically significant since its p-value was lower than 0.05, indicating that it was noteworthy. When comparing the changes in other hematological parameters that occurred before and after treatment with the hematinic combination (iron, folic acid, and EPO), there is no statistically significant difference between the two data sets. Conclusion: In addition to highlighting the efficiency of hematinic drugs, the study reveals the prevalence of anemia and its implications in patients undergoing hemodialysis. Future research might investigate the impacts over a more extended time and customize treatment options.

DOI: 10.5281/zenodo.12741212

44. Surgical Outcomes of Trigeminal Neuralgia and Medication Cost Benefit Analysis in the Preoperative and Postoperative Period
Saravanan M, Balamurugan S, Suresh P, Rajarajan
Background: Trigeminal neuralgia (TGN) is a brief, paroxysmal intense pain syndrome which involves one or two branches of the fifth cranial nerve, triggered by cutaneous stimuli. Severity of TGN can be analysed by visual analogue scale scores (VAS) and disability adjusted life years (DALYs). The primary management of TGN is medical. Surgical management can be considered at failed medical management. Objective: To compare the VAS scoring and DALY index after surgery in refractory TGN. Also, to estimate and compare the patient medical expenses in preoperative and postoperative period. Methods: This was a prospective study conducted in a tertiary healthcare facility, Chennai, India with effect from January 2022 to March 2023. A total of ten patients were included. Patients with refractory (to medical management) idiopathic trigeminal neuralgia were enrolled and evaluated for disease severity based on VAS scores and economic burden was captured for pain management in the preoperative and postoperative period. Results: The results showed that after six months follow up, in the postoperative period, the mean VAS scores had reduced from 6.5 to 2.5 in 7 out of 10 patients with medical management. Three patients had persistence of symptoms with VAS scores more than 5. Two patients developed pseudo meningocele in the immediate postoperative period. The average expenses per month in the preoperative period was Rupees 1200 and that in the postoperative period was Rupees 800. Two patients developed 7th nerve palsy and one patient developed sensory hearing loss of nearly 60 decibels in the operated side. Conclusion: After surgery, the refractory TGN pain VAS scores had improved. Cost benefit analysis showed that postoperative expenses were economical. The surgical outcomes of the patients were good.

DOI: 10.5281/zenodo.12741212

45. Knowledge, Attitude and Practice on Dengue among Patients and Bystanders Attending General Medicine OPD in a Tertiary Care Hospital, Puducherry
Revathy E, K Suresh, Venkatesh R
Background: Dengue is the most widespread vector-borne infectious disease of humans. Over half of the world’s population now live in tropical and subtropical zones that place them at risk of infection. Objectives: To assess the level of knowledge and attitude about the cause of dengue, its spread and symptoms. Also, to assess the practices related to prevention of dengue and its complications. Methods: This was a cross-sectional study carried out in the Department of General Medicine for a period of 3 months. Both patients and bystanders who were aged more than 18 years, attending the OPD during the study period and gave informed consent were the study participants. The sample size was estimated to be 356. The data was collected using a semi structured questionnaire. Statistical analysis was done using descriptive statistics. Results: 31.4% were found to have good knowledge and 48.3% moderate knowledge. 95.6% thought dengue to be transmitted through mosquito and 84.3% had answered its common symptoms. 97.6% thought dengue to be a serious illness, and 96.3% reported it will be possible to control mosquitos. 89.9% reported to use mosquito control aids, 81.5% reported that they covered drinking water container, and 70.3% reported that they kept themselves hydrated during the illness. Conclusion: Many had good knowledge and the attitude pattern was also positive among the participants. Certain practices like source reduction activities and wearing full sleeve clothing have to be encouraged among the study population.

DOI: 10.5281/zenodo.12741212

46. Prevalence of Tobacco Use among Psychiatric Patients at a Tertiary Care Hospital in Western India
Pragna Sorani, Dip P Bhadja, Nidhi S Surani, Hemavathi Hamsa
Introduction: Tobacco use disorder is a global health concern, causing eight million deaths annually and significantly impacting disability-adjusted life years (DALYs). The prevalence of tobacco use disorder is 2–4 times higher among psychiatric patients. Youth with tobacco use disorder often have high rates of ADHD, bipolar disorder, anxiety, depression, and schizophrenia, and consume tobacco more than healthy individuals. This study aimed to examine the prevalence and severity of tobacco use and access to tobacco cessation among psychiatric patients in a tertiary care hospital in Gujarat. Materials & Methods: This cross-sectional study was conducted among 400 psychiatric patients at a tertiary care psychiatric hospital in Gujarat. A consecutive sampling technique was used, and informed consent was obtained from each participant. Demographic and clinical data were collected using a pre-designed proforma, and the Tobacco Craving Questionnaire-Short Form (TCQ-SF) was used to measure tobacco cravings. Results: The prevalence of tobacco use among psychiatric patients was notably high at 45%. Schizophrenia-related disorders were more prevalent (38.3%) compared to mood disorders (26.3%), behavioral syndromes (18.0%), and anxiety and stress-related disorders (17.5%). Higher tobacco use was observed among males, divorced or widowed individuals, those with lower education, employed individuals, and rural residents. Despite the psychiatric setting, the assessment and implementation of interventions for tobacco cessation or reduction remained suboptimal. Conclusion: To address the high prevalence of tobacco use among psychiatric patients, comprehensive screening should be enhanced across all patient groups, with targeted cessation programs for high-risk populations such as males, divorced or widowed individuals, and employed individuals. Training for healthcare providers on effective cessation strategies is essential, and inpatient admissions should be utilized as opportunities for screening and intervention.

DOI: 10.5281/zenodo.12741212

47. Assessment of Knowledge, Attitude Regarding Generic Drugs among II MBBS Students, Kurnool Medical College, Kurnool: A Cross Sectional Study
Rajeswaramma. G, Bhanuprakash. G, Haritha Pullareddy3, Lakshmikameswari. V, Rajesh. P.
DOI: 10.5281/zenodo.12741212[/su_button]

48. To Compare the Postoperative Analgesia of Ropivacaine Along with Dexmedetomidine and Ropivacaine Along with Fentanyl on Intraperitoneal Instillation in Patients Undergoing Laparoscopic Cholecystectomy
Ayushi Soni, Ruchi Tandon, Kumbha Gopi, Amisha S Keshav
Background & Methods: The aim of the study is to compare the postoperative analgesia of ropivacaine with dexmedetomidine and ropivacaine with fentanyl on intraperitoneal instillation in patients undergoing laparoscopic cholecystectomy. After explaining the procedure and obtaining written/informed consent, a total of 60 patients fulfilling the inclusion criteria, scheduled to undergo elective laparoscopic surgeries under general anaesthesia (GA), were included in the study. Results: There is not significant deference in all the vitals (pulse rate, systolic bp, diastolic bp, MAP, SpO2, Respiratory rate) before surgery. p-value in all vitals more than 0.05 which is  not significant. In this study Mean NRS score was significantly higher in fentanyl group then dexmedetomidine group during follow-up.  Conclusion: Our study is that in patients whom posted for elective laparoscopic cholecystectomy intraperitoneal instillation of 0.25% ropivacaine along with dexmedetomidine 1mcg/kg provide more effective and prolong analgesia compared to intraperitoneal instillation of 0.25% of ropivacaine with fentanyl 1mcg/kg postoperatively up till 24 hours. It also decrease the dose of rescue analgesia require and provide improved quality of analgesia in first 24 hours postoperatively.

DOI: 10.5281/zenodo.12741212

49. Clinical Profile and Outcome of Patients in Obstetric ICU in Tertiary Care Centre in Bihar
Anamika, Pushpa
Background and Objective: Though pregnancy and labor are considered a physiological process the potential for catastrophic complications is constant and may develop in a matter of minutes. One indicator of pronounced maternal morbidity is obstetric admission into the ICU. This study was done to evaluate the risk factors and maternal and fetal outcome of ICU admissions. Materials and Methods: This was a retrospective study done in 6 bedded ICU, Department of Obstetrics & Gynaecology, PMCH, Patna, Bihar over a period of 2 yrs from January 2017 to December 2018. Analysis of the causes of obstetric ICU admission, interventions required, duration of ICU stay and maternal and fetal outcome done. Results: Out of total 17147 labour room admissions 2139 patients were admitted in ICU. Patients of eclampsia / HDP had maximum occupancy followed by obstetric haemorrhage. 238 patients died while 1891 survived 10 patients were taken to other hospital, by patient’s relatives. Mean duration of ICU stay was 5.8 days. Perinatal death was 21.55%. Conclusion: The major cases admitted in ICU were of Antepartum eclampsia/HDP, pregnancy with heart disease, obstetrics haemorrhage, septic abortion, severe anaemia and severe jaundice with pregnancy. Multiparity, lack of ANC, delayed reporting to hospital were the major risk factors associated and also influencing the maternal and fetal outcome.

DOI: 10.5281/zenodo.12741212

50. Comparison of the Efficacy and Safety of Silodosin and Tamsulosin in Treatment of Benign Prostatic Hypertrophy
Jambu Kumar Jain, Sudeep Jain, Jigisha Jain
Objective: To compare the efficacy and safety of Silodosin and Tamsulosin in treatment of Benign Prostatic Hypertrophy. Methods: Our study is an observational and comparative study of 120 patients. The patients were divided into two groups of 60 patients each – Silodosin Group and Tamsulosin Group. During the study 11 patient from the Silodosin group and 12 patients from the Tamsulosin group dropped out and 49 & 48 patients respectively from the groups were available till the end of the study. Results: The mean age, mean weight and duration of symptoms in both the groups was comparable and statistically not significant. The rate of improvement in the QLS was similar in both the groups, with gradual improvement towards the end of the study period, indicating that the onset of improvement in the QLS corresponds to the decrease in IPSS. There was insignificant difference in Qmax from baseline, the mean change was 0.12 mL/s (1.07%) & 0.25 mL/s (2.11%) for Silodosin and Tamsulosin group respectively. There were no significant changes in prostate volume and postvoid residual volumes in either group. Significant improvement was observed in different parameters in both the groups by the end of the study period. Six of the seven parameters were significantly improved. Regarding adverse events in our study, both treatments were well-accepted as assessed by various parameters. The events encountered were both mild in nature and transient. The most specific adverse reaction was retrograde ejaculation found in 3 patients in Silodosin group (and none in Tamsulosin group). Conclusion: Silodosin is comparable to Tamsulosin in the treatment of symptomatic BPH in Indian men. Both offer symptom relief without affecting prostate size in the short-term. Retrograde ejaculation was encountered only with Silodosin. This may influence the choice of drug – Tamsulosin for comparatively younger sexually active men. Further clinical studies, of longer duration, are needed to confirm whether this comparability in the treatment of BPH is sustained in the long term.

DOI: 10.5281/zenodo.12741212

51. Use of Tranexamic Acid in Preventing Postpartum Hemorrhage Following Vaginal Delivery
Harvy Nigam Shah, Vidhya Raghavan, Jitendra Shukla, K Padma Sandeepti
Introduction: Tranexamic acid (TXA) injections due to its antifibrinolytic properties can be used as a treatment for postpartum hemorrhage (PPH) on a global scale along with uterotonics. Aims and Objectives: The purpose of this study was to evaluate the safety and effectiveness of TXA and to identify potential side effects if any in preventing PPH following vaginal delivery. Material and Methods: This randomized controlled trial, conducted in a multispecialty Dhiraj hospital in Vadodara, India, involved 300 term patients over one year from February 2023 to March 2024. Subjects were randomly assigned into two groups. Each cohort received 10 prophylactic units of oxytocin. One group received 1 gm of intravenous TXA, while the other received 10 mL of normal saline intravenously within 2-3 minutes after delivery. Blood loss was measured using calibrated drapes, and mean changes in hemoglobin (Hb) and packed cell volume (PCV) were assessed from pre-delivery to postnatal day 2. Data analysis was done using SPSS (Statistical Package for the Social Sciences) software. Results: Patients in the research had an average age of 23.43 years with a standard deviation (SD) of 3.26 years. The occurrence of PPH was observed in 10 individuals (6.66%) in the TXA group and 17 individuals (11.33%) in the placebo group (p = 0.226). Furthermore, the mean blood loss was significantly lesser in the TXA group, measuring 250.10 mL with an SD of 133.54 mL, compared to 334.2 mL with an SD of 141.78 mL in the placebo group (p < 0.0001). Conclusion: Tranexamic acid can serve as a supplementary treatment alongside uterotonics during the third stage of labor, as demonstrated in this study.

DOI: 10.5281/zenodo.12741212

52. Diagnostic Dilemma in a Salivary Gland Lesion on FNAC: A Case Report
Manjari Kishore, Ritu Priya Choudhary, Sarwat Fatma, Saba Hassan Shah, Divyanshi Govil
Fine needle aspiration cytology is an easy and quick procedure to make a diagnosis in variety of lesions, especially in differentiating a benign lesion from a malignant one. Histopathology remains the gold standard in making a definitive diagnosis. Warthin’s tumor is the second most common benign salivary gland tumor of the major salivary glands. It mostly occurs in the 6th to 7th decade of life. It is more common in male patients (4:1 male: female ratio). It is histologically characterized by bilayered oncocytic epithelium with a lymphoid stroma. Superficial lobe of parotid gland is more commonly affected by warthin’s tumor. This case report discusses a case of a 58-year-old patient with warthin’s tumor where there was a diagnostic dilemma on cytological evaluation. The diagnosis was confirmed after histopathological examination. This paper highlights a discussion on differentials on cytology in the current case and emphasizes the importance of histopathological examination in the definitive diagnosis of this benign entity.

DOI: 10.5281/zenodo.12741212

53. The Study of Outcomes in Neonates Born to ABO and Rhesus (D) Incompatible Mothers
Sumathi Kotapuri, Adari Mounica, Sudharshan Raj Chitgupikar
Background: In this study, we wanted to study the outcomes and follow up of ABO and Rh(D) incompatible neonates, to Study the incidence of ABO and Rh(D) incompatible setting, to follow up the neonates with ABO and Rh(D) Incompatible setting, to study the clinical outcomes among them and to initiate a prompt treatment, to propose a discharge plan for neonates with ABO and Rh(D) incompatible setting. Methods: This was a Hospital Based Prospective Observational Study conducted among 166 neonates with ABO incompatibility and 28 neonates with Rhesus (D) incompatibility between 24 to 44 weeks of gestational age delivered at Mediciti Institute of Medical Sciences, from 1st January 2021 to 30th June 2022, after obtaining clearance from Institutional ethics committee and written informed consent from the study participants. Results: The prevalence of ABO blood groups in mothers was O > B > A > AB. The prevalence of ABO blood groups in neonates was B > O > A > AB. SGA neonates are more prone to higher serum bilirubin levels. Neonates in whom elder siblings received phototherapy are prone for higher serum bilirubin levels. There was no correlation between mean serum bilirubin value and sex of the neonate. There was no correlation between mean serum bilirubin value and maternal factors like mode of the delivery and age of the mother. There was no significant difference in hyperbilirubinemia between OA and OB incompatible setting. Severity of hemolysis was more among neonates with Rh(D) incompatible setting than ABO incompatible setting. Maximum number of admissions among neonates with incompatibility is within the first three days of life. After 3rd day of life, maximum admissions are on 6th day of life. Early identification of ABO and Rh(D) incompatibility reduced the mortality and morbidity due to hyperbilirubinemia. Phototherapy as a mode of treatment was found to be effective in the management of hyperbilirubinemia. However, longer duration of phototherapy was required in neonates with evidence of positive DCT among ABO incompatibility. Cord bilirubin level above 2.6mg/dl has statistically significant association with the need for phototherapy with area under curve showing 0.77. Conclusion: As maximum number of admissions is on day 3 of life, the neonates with ABO and Rh(D) incompatible setting should be observed in the postnatal ward or should be followed up every day for at least 3 days of life. As serum bilirubin again peaks on day 6 of life, there should be a follow-up visit on day 6. As cord bilirubin is a reliable predictor of hyperbilirubinemia, it should be done all neonates born to Rh negative mothers.

DOI: 10.5281/zenodo.12741212

54. A Descriptive Study on Demographical, Haematological and Biochemical Profile of Weedicide Poisoning At Tertiary Health Care Centre
Suresh Chand Meena, Mahendra Singh Rawat, Vinod Kumar Nagar, Amit Kumar
Background: Across the world, poisoning from pesticides and other chemicals used in agriculture is a serious public health hazard, especially in poor countries. Weedicides such as paraquat, 2,4-D, and glyphosate have been shown to be among the several compounds that significantly contribute to higher rates of sickness and mortality. Publications about weedicide toxicity are few. Aims and Objective: To investigate the biochemical, haematological, and demographic characteristics of weedicide poisoning. Materials and Methods: The current study, which is a retrospective observational study, involves individuals who suffered weedicide poisoning and were admitted at a tertiary health care facility. From the patient’s medical records, the researchers collected information on biochemical markers, clinical presentations, haematological parameters, and demographics. Result: There were a total of 28 cases of weedicide poisoning, of which 19 (67.86%) included paraquat, 7 (25%), and 2 (7.14%) used 2,4-D. In terms of results, 10 (35.74%) of them were discharged, 6 (21.43%) of them died, 12 (42.86%) got referred to a higher centre for hemoperfusion/hemodialysis, and 1 (3.57%) absconded. Conclusion:  There is evidence linking weedicide consumption to high rates of sickness and fatalities. The prompt underscores the need of expeditiously detecting and executing preemptive actions to tackle instances of weedicide toxicity, considering the lack of a specific remedy.

DOI: 10.5281/zenodo.12741212

55. Causes of Thrombocytopenia in Patients above 50 Years and Distinguishing Chronic Idiopathic Thrombocytopenic Purpura from Refractory Thrombocytopenia of Myelodysplastic Syndrome
Fazna N., Shamla P., Sheela Thomas, Sathi P. P.
Background and Objectives: Thrombocytopenia is a problem commonly encountered in the elderly with a variety of etiology. Causes of thrombocytopenia is not well studied in the elderly. Both Chronic Idiopathic Thrombocytopenic purpura and Myelodysplastic syndrome are two hematological conditions that can present as chronic persistent thrombocytopenia. Both these entities have different prognosis, predictive survival and treatment. The objective of this study was to find the causes of thrombocytopenia in patients above 50 years and to distinguish Chronic Idiopathic Thrombocytopenic purpura from Refractory thrombocytopenia of Myelodysplastic syndrome in patients coming to Department of Clinical Pathology, Govt. Medical College Kozhikode during the study period. Materials and Methods: In this descriptive observational prospective study, a total of 150 cases of thrombocytopenia coming to clinical pathology department were selected by simple random sampling. Study group was patients above 50 years. Study period is from January 2017 to September 2018. Morphological study of peripheral smear, Bone marrow aspirate, imprint, and trephine biopsy was done in these patients. Special stains PAS and Perls were done, on marrow aspirate IHC for CD34 on bone marrow Trephine to look for increase in blasts in Myelodysplastic syndrome. Results: The most common cause of thrombocytopenia in this study was infections 35(23%) followed by Chronic persistent thrombocytopenia, Acute Leukemia and Megaloblastic Anemia. The commonest infections were Dengue fever, Leptospirosis, Sepsis, etc. On follow up there were 28 cases of Chronic Persistent Thrombocytopenia. Out of these there were 20 cases of Chronic ITP where thrombocytopenia persisted and 8 cases which can be either Chronic ITP or MDS. Micromegakaryocytes was observed in 13 cases (65%) of Chronic ITP compared to Chronic ITP/MDS (p value 0.06). Megakaryocyte proliferation was observed in 10 (50%) cases of Chronic ITP compared to cases of Chronic ITP/MDS. Conclusion and Limitation: From this study it was found that the most common cause of thrombocytopenia above 50 years was infections. Both ITP and MDS can cause morphological alterations in the megakaryocytes. In true cases of ITP, majority of megakaryocytes are micro or hypolobated forms, whereas in MDS, majority are normally lobated and hypolobated forms. A better distinction is possible only with a long follow up and cytogenetic study.

DOI: 10.5281/zenodo.12741212

56. Analysis of Risk Factors of Stillbirths using Recode Classification at a Tertiary Care Centre in Andhra Pradesh
Vanapalli Jhaswanda Lokeshwari, Dasari Mary Manjula, Kodali Venkata Ramana, Gujju Rajalakshmi, Eeshita Badiya, Prasad Usha
Stillbirths are a cause for concern globally. Stillbirth rate is a key indicator of quality of care given during antenatal and intranatal period. High prevalence of stillbirths in India necessitates analysis of risk factors of stillbirths both at national and local level. Aim: To determine the  maternal and fetal factors causing stilbirths. Methods: The present study was conducted in the department of Obstetrics and Gynecology, Andhra Medical College, Visakhapatnam. It was a hospital based observational study for a period of one year from January 2023 to December 2023. Case sheets were analysed for risk factors of stillbirths. Results tabulated and analysed using Microsoft excel. Results: A total of 5,912 births occurred during the period of one year and 146 were stillbirths. The still birth rate was 24.69 per 1000 births. The maximum number of still births occurred in the age group below 20 years (54.1%). Multigravida had increased risk of stillbirths with 87 cases (59.58%). Still births were maximum in low socioeconomic status  (56.16%). Stillbirths were highest in gestational age 28-32 weeks and was 58(39.72%).The maximum number of cases seen in the birth weight category above 2000-3000 grams, 68 cases (46.57%). Conclusions: The corner stone of preventing stillbirths is good antenatal care. Prevention of anemia by iron folic acid supplementation, early identification of hypertension in pregnancy and its appropriate management is essential.

DOI: 10.5281/zenodo.12741212

57. Qualitative Study on Perception of First Year M.B.B.S. Students toward Orientation   Program and Foundation Course at Entry Level
Bhavna Gupta, Chhaya Batham, Shilpa Waghmare, Pratibha Verma
Orientation and foundation program for MBBS students at the entry level, as suggested by the MCI, helps reduce students anxiety and boosts their confidence. It facilitates their smooth transition from high school to an undergraduate medical course. The enthusiastic participation of newly admitted students in various sessions during the program and their feedback was very encouraging. The feedback undoubtedly indicated that students were very happy and satisfied with the program. Similar results were obtained by various previous studies. A structured foundation course, such as ours, can help alleviate students worries, and help them cope with forthcoming professional demands.

DOI: 10.5281/zenodo.12741212

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