International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

NMC Approved

Peer Review Journal

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1. A Study to Assess the Prevalence of Dehydration Fever in Newborns to Ascertain Associated Comorbid Conditions and Outcome Following Treatment
Swesh Chandra, Debasis kr Samanta
Abstract
Aim: The objectives of the study were to determine the number of newborns admitted into the SNCU with dehydration fever, to ascertain about other associated comorbid conditions, and to know the outcome of these newborns following treatment. Material & methods: It was an observational descriptive study where neonates were admitted in NICU with dehydration fever over period of 1 year and hospital-based convenience sample were taken. This observational descriptive study was undertaken at Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India. The study was conducted among 100 neonates admitted with dehydration fever. All babies born during the study period who were admitted in NICU with hyper-natremic dehydration were included in the study. Results: In the study among subjects presenting with hypernatremic dehydration, 26% of mothers were in the age group <20 years, 50% in the age group 21 to 25 years, 24% were in the age group 26 to 30 years. Mean mother age was 23.7±3.07 years and median age was 25 years. 85% were Primigravida and 15% were Multigravida. 10% had gestational HTN, 6% had preeclampsia, 12% had PROM, 8% had vaginitis. 26% had lactation failure, 74% had no lactation failure. 25% were on supplementary formula feeds. 34% presented with fever, 20% had decreased urine output, 20% had fever + decreased urine output and 26% had jaundice. Association between symptoms at presentation and neonatal factors neonates presenting on day 2, majority had jaundice, on day 3, majority presented with fever, on day 4, majority presented with decreased urine output and jaundice and on day 5, majority presented with decreased urine output. In the study, majority presented with Jaundice, decreased urine output and fever +decreased urine output respectively and fever. Conclusion: Dehydration fever occurs most commonly on day 3 or after, effective measures should be initiated for early diagnosis and prevention of complications like effective breast-feeding counselling, proper techniques, good latching and supplementation of artificial feeds if required and monitoring of daily weight and daily urine output.

2. A Retrospective Assessment of the Outcome of Repair and Resection of the Occipital Encephalocele: A Hospital-Based Assessment
Samrendra Kumar Singh
Abstract
Aim: The aim of this study was to find the outcome of repair and resection of the occipital encephalocele. Material & methods: A retrospective study of 50 exclusively occipital encephalocele patients was conducted in between the duration of 2 years at the Department of Neurosurgery and Paediatric Surgery, IGIMS, Patna, Bihar, India The medical records of all operated cases of occipital encephalocele were reviewed, and relevant data such as age, sex, location of encephalocele, the size of the lesion, operative method, seizure, and hydrocephalus along with postoperative complications were recorded for analysis. Results: Of 50 patients, 17 were males and 33 females. The average age of the patients at the time of presentation was 2.4 months, ranging (4 days to 1.33 years). Most of the patients 56% belonged to 3 months age followed by 28% in 3-6 months age group. All patients presented with swelling on the head just after birth. A visible mass was situated in either the occipital (supratorcular or infratorcular). Any overlying skin varied from a thick and wrinkled to a thin or shiny covering. 16 patients (32%) presented with enlarged head circumference with associated hydrocephalus and 3 patients (6%) diagnosed with Dandy–Walker cyst. 3 (6%) patients were suspected developmental delay and mental disorders. 30 (15%) patients also had seizure. 8 (16%) patients admitted with the complication of sac rupture with cerebrospinal fluid (CSF) leakage, 2 (4%) patients having rupture of sac after the admission and 2 (4%) patients admitted with the complaint of haemorrhage from the thin and shiny covering skin of the sac. Postoperatively, only 4 (2%) patients had CSF leakage from the repaired wound. 3 (6%) patients developed Hydrocephalus after the repair of protrude sac. Conclusion: Encephalocele is commonly seen in the practice of neurosurgery in the world. Modern neuroimaging, neurosurgical techniques, and neonatal neurological intensive care have greatly improved morbidity and mortality in the care of encephalocele.

3. Comparative Analysis of Preoperative Ultrasonography Reports with Intraoperative Surgical Findings in Cholelithiasis
Shanker Bharti, I.S.Thakur
Abstract
Aim: The aim of the present study was to identify the ability of pre-operative Ultrasonography in predicting difficult Laparoscopic Cholecystectomy. Methods: This cross-sectional observational study was done in the Department of General Surgery, Patna Medical College and Hospital, Bihar, India  for the duration of 2 years. 100 Patients diagnosed with gallbladder stones were included in this study. The study was approved by the institutional ethical approval committee. Verbal consent was obtained from each patient after full illustration of the aim and procedures related to the current study. Results: The age range of those patients was form 14 to 85 years and the mean was 42.28± 15.50 years. With respect to gender, there was 20 male patients accounting for (20%) and 80 female patients accounting for (80%); therefore, the male to female ratio was 1:4.26. Mean body mass index (BMI) was 26.24 ± 7.73 kg/m2. Pre-operative USG findings such as gall bladder wall thickness >4 mm, gall bladder size ≥5cm, impacted gall stones, CBD diameter ≥6mm, size of the calculus ≥1cm, and presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. There was statistically significant difference between pre-operative USG score and difficult or non-difficult laparoscopic cholecystectomy. Higher the preoperative USG score, higher were the percentage of difficult laparoscopic cholecystectomy. Conclusion: This study has shown that pre-operative USG findings such as gall bladder wall thickness >4 mm, gall bladder size ≥5cm, impacted gall stones, CBD diameter ≥6mm, size of the calculus ≥1cm, and presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. Gall bladder wall thickness >4 mm was the most accurate predictor for a difficult laparoscopic cholecystectomy followed by pericholecystic fluid collection and impacted gall stones.

4. A Hospital Based Comparative Assessment of the Efficacy of Direct Smear versus Liquid-Based Cytology in the Diagnostic Evaluation of Bladder Lesions
Madhu Bharti, Manish Kumar Jha, Md. Imteyaz Alam, Poonam Kumari
Abstract
Aim: The purpose of this study was to evaluate urine cytology, detect bladder lesions with two different methods (i.e., direct smears and LBC), and determine the sensitivity and specificity of these methods. Methods: This Observational study was conducted for a period of 1 year at Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. A total of 200 samples were taken from patients with suspected bladder cancer and processed for direct smear and LBC. In both methods, findings were reported according to the Paris System. Then, patients underwent cystoscopy and biopsy. Next, the accuracy of cytology methods was evaluated according to biopsy reports. The sensitivity and specificity of these methods were also calculated. Results: NUAM in LBC and DSC were 80% and 79% respectively. In this study, the largest difference was reported in patients with a diagnosis of AUC in the LBC method. In these 16 cases, 16 cases were reported as negative in DSC. Kappa statistics revealed a significant agreement between LBC and DSC in negative biopsy cases (P<0.000), Kappa value=0.650. In the frequency of biopsy findings, 80% were negative. For DSC methods, credit indices included sensitivity (61.9%), specificity (98%), positive predictive value (89.1%), and negative predictive value (91.5%). For LBC methods, credit indices included sensitivity (84.6%), specificity (99%), positive predictive value (94%), and negative predictive value (96%). Conclusion: This study showed that LBC has higher sensitivity and specificity than the direct smear.

5. A Prospective Assessment of the Clinic-Demographic Profile and Risk Factors of Diabetic Foot
Shanker Bharti, Anjani Kumar Anjan, Rajesh Narayan
Abstract
Aim: The objective of the present study was to assess association between socio-demographic, behavioural and clinical risk factors and diabetic foot and response of patients to various treatment modalities. Methods: A prospective study was conducted in the General Surgery Department of Bhagwan Mahavir institute of medical science, Pawapuri, Nalanda, Bihar, India for 7 months. 50 patients were included in the study. All patients who presented to surgical outpatient department or were admitted to the surgical wards with signs and symptoms of diabetic foot during the 7 months period were included. Results: Out of 50 patients in our study, 20 (40%) were in the age group of 51-60 years followed by 13 (26%) in the age group 61-70 years. There was a male preponderance in our study with 36 (72%) patients out of 50. Majority of the study subjects were literate with overall literacy rate being 60%. 96% study subjects belonged to low class. Among the 50 patients, 13 (26%) were unmarried showing lack of support and care and rest (74%) were married. Labourers accounted for 34% of study participants, farmers constituted 30%, businessmen 18% and others 18% of study subjects. Most of the participants had type II diabetes for >10 years. 80% of study participants had family history of diabetes. 92% of study participants were overweight (BMI 25-29.9) and remaining 8% were obese (BMI ≥30). Hypertension was present in 72% of study participants, ischemic heart disease in 60% and hypercholesterolemia in 70%. Conclusion: Diabetic foot is a common complication of long-standing diabetes. Several socio-demographic factors like advancing age, low socio-economic status, lack of family support, occupations involving risk of trauma to foot contribute to the risk of developing diabetic foot in diabetics. Hence it is essential to educate all the diabetic patients at risk about good glycemic control, risk factors, proper foot care, periodic foot examination and neurological examination of lower limbs, prompt treatment of foot lesions and regular follow-up.

6. Assessing the Diagnostic Utility of C- Reactive Protein (CRP) in Combination with Hematological Parameters of CBC in Detection Infections In Children
Bheemsen Kumar, Sanjay Kumar Nirala, Sanju Kumari, Gopal Shanker Sahni
Abstract
Aim: The aim of this study was to determine the diagnostic utility of C- reactive protein (CRP) in combination with hematological parameters of CBC as early diagnostic marker in detection infections in children. Methods: The present study was a hospital based cross-sectional study which was carried out among the Children who presented to the Paediatric OPD or Inpatients attending Skmch, Muzaffarpur, Bihar, India. All the Children who presented to paediatric OPD or admitted to Paediatric ward with history suggestive of Infection were included in the study. The study included 500 children attending pediatric OPD / Inpatients. Results: The study included 500 children attending pediatric OPD / Inpatients whose age ranged from birth to 17 years. Majority of the children 390 (78%) belonged to Under 5 age group. Out of 500, 275 (55%) were boys and 225 (45%) were girls. All the children underwent Widal test and 100 out of 500 were positive for it. The mean difference of all the components of Complete Blood Count was compared between Widal positive and negative children. It was observed that, there was mean difference observed between the groups of Widal positive children and Widal negative children for all the components of the Complete Blood Count and it was statistically significant for Packed Cell Volume, Eosinophil Count and Platelet Count. All the children blood sample was subjected to CRP testing and 180 out of 500 were positive for it. The mean difference of all the components of Complete Blood Count was compared between CRP positive and negative children. Conclusion: In conclusion, the findings of the present study confirm that the serum levels of CRP in combination with WBC counts and other hematological parameters are better indicators of infection in the early diagnosis of sepsis in childhood than isolated use of CBC and it also aids in the evaluation of the response of the disease to the antibiotic therapy.

7. A Prospective Study Evaluating the Primary Reasons and Pattern of Obstetric Cases Referred to a Tertiary Care Centre
Rashmi Kumari, Priti Kumari, Krishna Sinha
Abstract
Aim: The objective of the present study was to study the primary reasons and pattern of obstetric cases referred to a tertiary care centre and management of its complications. Material & Methods: A Prospective observational study including 100 patients within duration of two years in the Department of Obstetrics and Gynecology of JLNMCH, Bhagalpur, Bihar, India .  Written informed consent was sought from all study participants. We studied 50 patients. Results: Maximum number of cases in the present study was in the age group 20-30 yrs, comprising 76% of total cases. Out of 50 patients, 24 were primigravids (48%). The antecedent causes for admission to ICU are grouped into two – Obstetric and non -obstetric causes. The Obstetric causes accounted for 76% of the admissions in ICU and non-obstetric causes were 24%. Commonest risk factor for ICU admission was hypertensive disorders of pregnancy and obstetric haemorrhage. Other major risk factors were heart disease and sepsis. Major cause of maternal mortality was multi-organ-dysfunction and sepsis secondary to massive obstetric haemorrhage. Majority of them delivered by cesarean section (74%) and the rest were vaginally (24%). The indications of LSCS were Severe Pre-eclampsia, CPD, malposition & eclampsia. Among the total patients, MMR was 12%, 84% improved whereas 4% were discharged against medical advice. The main reasons for mortality were multi-organ-failure, sepsis, congestive cardiac failure and hemorrhagic shock following massive obstetric hemorrhage. Conclusion: The multi-disciplinary team approach in intensive care units, close monitoring, symptomatic treatment, prompt surgical intervention and safe motherhood initiative would reduce the current Maternal Mortality Rate. Development of standard referral protocol, availability of tertiary care, proper training in this regard is much needed.

8. A Comparative Outcome Evaluation of Hernia Repair using Two Different Surgical Approaches
Barun Kumar
Abstract
Aim: The present study evaluates and compare the outcome between laparoscopic inguinal hernia repair and open incisional inguinal hernia repair surgery. Methods: The present study was conducted in the Department of General Surgery, Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India for one year A total of 100 patients with uncomplicated inguinal small or medium sized, direct or indirect, unilateral or bilateral hernias undergoing elective inguinal hernia surgery, who are fit for laparoscopy and open surgery were included in the study. The study consisted of 100 patients, of which 50 were in the open surgery group and 50 were in the laparoscopic group. Results: The open surgery group had patients with a mean age of 45.15±14.36 years, with 40 males and 10 females. The laparoscopic group consisted of patients with a mean age of 46.54±16.24years, with 42 males and 8 females. 81 of the cases presented with unilateral hernia, of which 54 showed right laterality and 27 displayed left laterality. In 19 cases, bilateral representation was noted. 27 cases were of direct type, 50 of indirect type, and 23 of direct/indirect type. No statistical correlation was noted with the age, gender, laterality, type and surgical procedure employed. The VAS score values of laproscopic were always lower than that of open group at the same hour and this difference was shown to be statistically significant. Subsequently, the post-operative analgesic requirement was less in the laparoscopic method with only 2 patients requiring analgesic. Seroma was the most commonly noted post-operative complication, especially in laparoscopic cases. Conclusion: Laparoscopic hernia repair is safe and provide less postoperative morbidity in experienced hands compared to open hernia repair.

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9. Assessing Serum Sodium Levels in Chronic Liver Disease (CLD) Patients and Determining the Association with the Severity and Outcome of Disease: An Observational Comparative Study
Ashraf Azam, Vinyanand Jha
Abstract
Aim: This study was done to study the serum sodium levels in chronic liver disease (CLD) patients and establish its association with the severity of disease in such patients. Material & Methods: An observational cross-sectional study with 200 cases of chronic liver disease was done in the Department of General Medicine for 2 years. Results: All patients had abdominal distension. It was observed that patients from group A had jaundice (p<0.05) and altered sensorium (p<0.001) significantly more commonly as compared to those from group B and C. Alcohol consumption was reported by 88.5% of the patients. Serum sodium levels were not significantly associated with alcohol consumption. Among all examination findings, icterus (p<0.05) and clubbing (p<0.01) were found to be significantly more common among patients from group A, as compared to patients from group B or C. Pallor, pedal edema, signs of liver cell failure and organomegaly were not significantly associated with serum sodium levels in our study population. Portal hypertension was observed in 85.5%, hepatic encephalopathy in 23.5%, hepatorenal syndrome in 21.5%, spontaneous bacterial peritonitis in 4.5% and coagulopathy in 18%. Of these, hepatic encephalopathy (p<0.01), hepatorenal syndrome (p<0.01) and coagulopathy (p<0.01) were found to occur significantly more common among patients from group A, as compared to those in patients from group B or C. We observed that mean direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase were significantly higher among group A patients as compared to those from group B or C respectively. We observed that mean MELD score was significantly higher among group A patients as compared to those with group B and group C. We also observed that mean Child Pugh score was significantly higher among group A patients as compared to those with group B and group C. Conclusion: Patients with lower serum salt levels had a substantially higher MELD score and CPS. Low blood sodium levels were linked to more severe liver disease, greater complications, and increased death. As a result, we urge that serum salt levels be checked on a frequent basis in patients with chronic liver disease.

10. Cervical Carcinoma Screening using Colposcopy and PAP Smear: A Comparative Study
Vidya Paul, Seema
Abstract
Aim: The aim of the present study was to evaluate screening of cervical carcinoma by PAP smear and Colposcopy. Methods: This study was conducted in Department of Obstetrics and Gynecology. The study constituted 200 women as subjects who attended the Gynecology OPD as well as ones admitted in gynecology ward fulfilling the inclusion and exclusion criteria. Results: Among 200 patients, 18% belongs to age group of 20-30 years, 54% among 31-40 years, 16% among 41-50 years, 12% among 51-60 years age group. The maximum cases belong to 31-40 years age group (55=4%) with mean age 38.04 years. According to Modified Kuppu-swamy classification, 55% of women were of Upper-lower class, 25% were of Lower-middle class and 20% were of Lower class. Significant differences noted between different classifications and age at 1st coitus, therefore, premalignant lesions are commonly associated with 1st coital history at an early age of life. On colposcopy examination, most of the cases show neoplastic proliferation (112 cases, 56%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). 88 cases (44%) were non-neoplastic. Conclusion: The use of colposcopy and pap smear testing has gained widespread acceptance as a screening strategy. Cost-effective non-invasive tests for the early diagnosis of cervical cancer exist and may be efficiently used in rural locations. These interventions have the potential to significantly decrease the rates of both death and morbidity associated with cervical cancer.

11. A Randomized Clinical Assessment of the Effect of Play Therapy on Reducing Behavioral Problems, Attention Deficit and Hyperactivity in Children
Shashi Prabha, Anshuman
Abstract
Aim: The aim of the present study was to examine effect of play therapy on ADHD children. Methods: Present study was conducted at Indira Gandhi Institute of Medical Sciences (IGIMS) in Department of Paediatrics for a period of one year.  In the present study by using randomized sampling 32 children of fifth and sixth grade (average age of 11 years) were selected based on the inclusion criteria through purposeful sampling. They were randomly divided into experimental and control groups (16 individuals each) and then the experimental group underwent eight, 90- min-sessions of play therapy with the cooperation of the school’s psychological counseling officials. Results: The post-test mean score of ADHD symptoms was lower than that of the pre-test. This variable of behavioral problems has also obtained a lower average in the post-test test in different components (anxiety and depression, aggression, social incompatibility, antisocial behaviors, attention deficit disorder). Based on the obtained results the values of the significance level of the variables are more than 0.05, so it was concluded that the variables are in a normal state for the analysis of covariance. Levin’s test values are insignificant. In other words, the null hypothesis for the equality of the variances of the two groups was confirmed. Conclusion: The findings of the present study indicate that educational Play therapy is efficacious in mitigating behavioral issues and attention deficit and hyperactivity symptoms in children diagnosed with ADHD. This therapeutic approach facilitates their socialization process, enabling them to integrate into society as productive and well-adjusted individuals.

12. A Study Quantifying Protein Intake and Compare Growth Parameters in ELBW Infants in the First Two Weeks after Birth using Two Different Methods
Sanjay Kumar Nirala, Vineeta, Gopal Shankar Sahni
Abstract
Aim:  The aim of the present study was to quantify protein intake and compare growth parameters at hospital discharge (as measured by discharge weight and head circumference percentiles) in ELBW infants in the first two weeks after birth using two different methods. Material & Methods: The present study was conducted at Department of Pediatrics and all ELBW admissions to the NICU were included except those regaining BW in ≤ 3 days, those who were transferred to another facility, or those who died before reaching discharge. Results: We studied 150 infants with 100 and 50 infants in P1 and P2 periods, respectively. Mean gestational age was lower during Phase 1 (24.86 ±1.34 vs. 25.45 ±1.85 weeks). P value =0.01). However, the birth weights were not different between the two periods. The incidence of SGA at birth was higher during Phase 2. Compared to P1, babies in P2 received 1 g/kg/day more protein till BW was regained. This average daily protein deficit would have resulted in a cumulative protein deficit of 5.1 g/kg if the infant’s current weight was used for protein calculations for the duration of 1 week (P2 phase). There were no significant differences in protein and fluid intakes. However, there was a higher caloric intake in P2 compared to P1. Conclusion: The decision to utilize birth weight as the basis for nutrition calculations in extremely low birth weight (ELBW) infants, rather than their current daily weight until they reach their birth weight, led to notable outcomes. Specifically, this approach resulted in a substantial increase in protein delivery, a significant reduction in the occurrence of failure to thrive, and a decrease in head circumference percentiles at the time of discharge in ELBW infants.

13. A Descriptive Survey to Analyze the Dietary Changes among the Indian Population during the COVID-19 Pandemic
Jay Jyoti, Kumar Vikas, Dinesh Kumar, Amita Sinha
Abstract
Aim: The aim of the present study was to analyze the dietary habits and consumption of different food groups during the pandemic among the Indian population and to observe if there is any shift toward or away from the balanced diet. Methods: A cross‑sectional study was conducted among 500 participants between the age group of 18 and 60 years through an online survey among the general population for a period of 1 month during the second lockdown for COVID‑19. Participants were ensured of confidentiality and that no information was shared to any third party during and after the completion of the study. Permission from the Institutional Ethics Committee was obtained prior to conduction of the study. Results: Majority of the respondents belonged to the age group of 18‑30 years. A large number of participants were females and undergraduate students. Metropolitan cities were observed to have highest number of respondents in our study It was observed that majority participants had no change in consumption and almost 30% had raised their consumption of poultry. On the other hand, 17% reduced their intake during the pandemic. It was observed that a large number of respondents increased and less than half of respondents had no change in consumption of milk, whereas 12% decreased drinking it during the lockdown. A large number of participants turned up their consumption and 40% participants had no change in the consumption of breads and buns. In contrast, only 18% turned down their consumption during the pandemic. Change in consumption of fruits and vegetables. It was observed that almost two thirds of participants turned up their fluids consumption. In contrast, one third participants had no change and only a few participants turned down their consumption of water during the pandemic. Maximum difference was observed in case of intake of carbonated beverages where intake was lowered. Conclusion: There was a paradigm shift in consumption of certain products primarily to boost immunity and fight the COVID‑19 pandemic. Majority of the participants have increased consumption of healthy foods like milk, fruits, vegetables, and nuts which is the need of the hour given that immunity has a big role to play in fighting against COVID‑19.

14. An Observation-Based Study Assessing Clinicodemographic and Outcome of Severe Dengue Infection in Pediatric Population
Sushil Kumar Pathak, Jaymala Mishra, Saroj Kumar, Binod Kumar Singh
Abstract
Aim: The aim of the present study was to assess clinical profile of dengue infection in children less than 14 years of age and to evaluate outcome of dengue fever admitted for the duration of 12 months, in Department of Pediatrics. Material & Methods: The cross-sectional observation-based study was conducted on 100 children admitted to the Department of Pediatrics with severe dengue infection for the duration of 12 months. Results: The youngest one was 1 month of age. Majority of the patients belonged to 6-8 years followed by 3-5 years. 55 (55%) percent of patients were male and 45% of patients were female. It was observed that half of the patients (52%) maintained their normal weight followed by obese (25%), overweight (20%), and 3% of patients were underweight. The average duration of hospital stay was 4 to 6 days in 65% of patients. The mean duration was 4.8±2 days with a range of 1 to 14 days. The average ICU stay was ≤3 days in 56% of patients. The mean ICU stay was 2.2±2 days, ranging from 1 to 8 days. The total number of cases of severe dengue were 100, out of which dengue shock syndrome (DSS) was in 51% of the patients followed by dengue hemorrhagic fever (DHF) in 16% of patient and expanded dengue syndrome (EDS) was 10% of the patient. 17% of patients with DSS progressed to DHF and 6% of patients with DHF progressed to grade EDS after admission and hospital stay. B+ ve blood group was found in 43% of patients followed by O+ ve (26%), A+ ve (28%) and AB+ ve were 3%. Pleural effusion was found in 50% of the cases detected by chest X-ray. Right-sided effusion was most commonly seen in 44% followed by left-sided effusion in 6% of cases, and bilateral effusion in 2% of the cases. Among these severe dengue cases, 32% of cases had pulmonary edema and 2% cases had pericardial effusion. Conclusion: High grade fever, vomiting, abdominal pain and skin rash with normal or low platelet count were varying clinical presentation. Early clinical suspicion and diagnosis with prompt management accompanied by preventive measures can prevent morbidity and the mortality associated with dengue.

15. Randomized Clinical Parallel Trial Comparing Safety and Efficacy of Alcaftadine 0.25%, Olopatadine Hydrochloride 0.2% and Bepotastine Besilate 1.5% in Allergic Conjunctivitis
Jyoti, Sachin Kumar, Pradeep Karak, Rajnandani
Abstract
Aim: The aim of the present study was to compare the efficacy and safety of Alcaftadine 0.25%, Olopatadine hydrochloride 0.2%, and Bepotastine besilate 1.5% ophthalmic solutions in the treatment of allergic conjunctivitis. Methods: The study was an observer‑masked, randomized, prospective, parallel‑group study conducted at the Department of Ophthalmology for 18 months. A total of 270 patients were screened for the study, of whom 240 patients with mild or moderate allergic conjunctivitis, who met the required inclusion were enrolled in the study. Results: In the present study, male was predominant in all the three groups as compared to females. Baseline mean TOSS scores for Alcaftadine group, Olopatadine group and Bepotastine besilate group were (7.63±2.38), (7.68±2.40) and (7.49±2.36) respectively. The total ocular symptom score (TOSS) showed a consistent decrease in subsequent visit in all the Groups and it was statistically significant, when compared from baseline to 14th day in all the groups (p = 0.0007). The difference in mean TOSS between (Group A) Alcaftadine and (Group C) bepotastine treatment groups was observed at the third day of follow‑up. This showed early relief of allergic conjunctivitis symptoms by bepotastine (4.9 ± 1.58) compared to Alcaftadine (mean (5.2±1.57) and olopatadine (5.4±1.59) but this was not statistically significant. Conjunctival hyperaemia had reduced in all the treatment groups but there was a significant reduction in Alcaftadine and Bepotastine treatment groups at 14th day compared to olopatadine group (p = 0.0032, ANOVA––post hoc Tukey’s analysis). Conclusion: All three topical ophthalmic medications used in the study are safe and effective in the treatment of allergic conjunctivitis. However, Bepotastine and Alcaftadine appear to outweigh Olopatadine in resolving the symptoms of allergic conjunctivitis.

16. To Evaluate the Differences in Gross Morphology and Histological Architecture in Cadaveric Liver Tissues, and to Establish a Correlation with the Developmental Stages during Intrauterine Life: A Morphometric Study
Pallavi Sharma, Srikant Pandey, Rashmi Prasad, Subodh Kumar
Abstract
Aim: The aim of the present study was to assess the variations in gross morphology and any change in histological architecture in cadaveric liver specimens and correlate with development in intrauterine life. Methods: 50 livers from adult human cadavers, fixed in 10% buffered formalin solution available in the Department of Anatomy, Nalanda Medical College and Hospital, Patna, Bihar, India were studied. Results: Livers were examined on different occasions by two observers. The results obtained were compared and ratified. The distinct morphological characteristics observed were recorded on data sheets. On the basis of these descriptions, the organs were classified into ten groups. The present study showed an incidence of 28 specimens of type 1 (70%). Lingular process of left lobe categorized into three types: apical (1=2 specimen, 4%) conical (2 specimen; 4% and rounded (2 specimen; 4%). Conclusion: Comprehensive delineations of typical and atypical liver morphologies may greatly enhance comprehension of the underlying factors contributing to these alterations, hence serving as an essential precursor for achieving positive surgical outcomes.

17. Cross Sectional Observational Assessment of The association of Menstrual Cycle with Suicide in Female of Reproductive Age Group
Rohan Kumar, Nabeel Ahmad Gadi, Sudiksha Rana, Suchita Kumari
Abstract
Aim: The aim of the present study was to assess the association of menstrual cycle with Suicide in Female of Reproductive Age Group. Methods: This was a cross sectional observational study conducted in the dept. of Forensic Medicine and Toxicology for one year. Sample size was calculated as 100. Subjects were brought dead suicidal deaths within their reproductive age group (15 to 45 years). Results: Most of the victims were between 18 to 30 years age group (58%) followed by 30 to 45 years (32%) and 15 to 18 years age group (9.9%). Prevalence of suicide was more than double among married women (64%) than unmarried ones (36%). Among various methods of commission of suicide, burn was the commonest one (55%) followed by poisoning (28%) and hanging (17%). Suicide was committed in different time of the day. Approximately 2/3rd of the victims committed suicide in the day time i.e. between 6am to 6 pm whereas it was little more than 1/3rd between 6 pm to 6 am. Considering histological appearance of endometrium, it has been observed that most of the women (60%) committed suicide in secretory phase of their cycle. Late secretory phase was more frequently chosen time than early secretory phase. Association between phase of menstrual cycle according to histology of endometrium and marital status of the women was significant statistically (p value < 0.001).Association between phase of menstrual cycle according to histology of endometrium and age group of the women was significant statistically (p value = 0.012). Conclusion: The Present study established a positive relationship between suicidal attempt and secretory phase, particularly late secretory one. On the basis of Chi-square test, associations have also been noticed between phase of menstrual cycle with marital status and age of individual.

18. A Cross Sectional Assessment of the Treatment Modalities in Early Post-Operative Endophthalmitis
Sangeeta,  Rajesh Tiwary
Abstract
Aim: The aim of the present study was to assess treatment modalities in early post-operative endophthalmitis. Material & Methods: This was a cross sectional study in the patients with total 100 Eyes were studied department of Ophthalmology over period of 2 Years. All patients with signs and symptoms suggestive of endophthalmitis following intra-ocular surgery were enrolled into the study. Results: The majority of the patients were in the age group of 41- 50, 51-60 were 24, followed by 61-70 were 22, 31-40 were 12, >70 were 12, 21-30 were 5, 11-20 were 1. The majority patients were male i.e. 55 and female were 45. Majority of the patients undergone Pars plana Vitrectomy i.e. 48%, Aggressive Topical and Intra-vitreal injection undergone 42%, Aggressive Topical Therapy Only in 10%. As per the Associated other interventions majority of the patients undergone Anterior chamber wash In 62%, Penetrating Keratoplasty in 8%, Implant removal in 6%, Enucleation in 3%, IOFB Removal in 1%. Majority of patients with Initial Visual Acuity were having Light perception in- 42; Vision (1/60)-36, Counting Fingers -8 and Final Acuity after all the treatment majority of the patients were having Vision (1/60)- were 20, Vision (>6/60) in 6 this observed difference was statistically significant. Conclusion: It can be concluded from our study that though the Endopthamitis is dreaded complication but if it is detected early and treated with appropriately is having good outcome.

19. A Retrospective Record-Based Clinico-Epidemiological Assessment of Thalassemia Patients: An Observational Study
Suprabhat Ranjan, Sheela Sinha
Abstract
Aim: Thea aim of the present study was to assess the pattern, clinical presentations, complications, and management practices among thalassemia cases. Material & Methods: This was a retrospective record-based cross-sectional study was conducted in the Upgraded Department of Pediatrics. The secondary data of all confirmed cases of thalassemia were examined by the investigators. 100 patients were included in the study. Results: The mean age of cases was 6.4 years. The age at diagnosis ranged from 0.1 to 11 years. The majority of cases were between 1.1-5 was 36 (36%) and 64 were male. 70% were above poverty line and 85% belonged to urban area. Fever was the most common presenting symptom 17 (17%). Pallor 98 (98%) followed by hepatomegaly 94 (94%) were the most common signs among cases. Bone deformities were reported in 20 (20%) cases, all of which were beta thalassemia major cases. Conclusion: Hemoglobinopathies are the commonest hereditary disorders in India and pose a major health problem. The data on the prevalence of β-thalassemia’s and other hemoglobinopathies in different caste/ethnic groups of India is scarce.

20. Assessing Different Species of Dermatophytes Causing Dermatophytosis at a Tertiary Care Setting: An Observational Study
Rizwan Ahmad, Sanjay Nag
Abstract
Aim: The aim of this study was to identify different species of dermatophytes causing dermatophytosis at a tertiary care hospital. Material & Methods: This cross-sectional study was conducted in the Department of Microbiology,  in between the duration of 2 years.  A total of 200 patients were selected following selection criteria. Patients at any age of either sex, who attended the outpatient department of Microbiology, during the study period, were enrolled. Results: Among total number of 200 cases most common age group affected with dermatophytosis was 21-30 years age group with 70 cases and least common age group affected 51 and above years age group with 5 cases (2.5%). In the study subjects dermatophytosis was predominant in males compared to females. Tinea corporis was more common (45%) followed by Tinea cruris (27.5%).  Out of 200 clinical samples collected 168 were skin scraping, 20 were hair stubs and other 12 were nail scrapings and clippings. Fungi were demonstrated in 135 cases by direct microscopy. 70 cases were positive by both microscopy and culture. 65 cases were positive by microscopy and negative by culture. 20 cases were negative by microscopy but culture positive. Fungal culture was positive in 45% of cases in SDA medium whereas it was positive in 40% of cases on DTM medium. Conclusion: Dermatophytosis is a common infection in young adults specially females. Trichophyton mentagrophyte is more frequent type of dermatophyte. Majority of dermatophytes could be identified by both direct microscopy and culture methods.

21. Association between Vitamin D Deficiency and Asthma Control in Children
Rajnish Kumar, Binoy Shankar, Kumar Gaurav, Nitish Kumar, Avinash Kumar Sahay
Abstract
Aim: The aim of the present study was to assess the association between asthma control and serum 25-OH Vitamin D levels in children with moderate persistent asthma on preventer therapy. Material & Methods: Children aged 6-18 years, with moderate persistent asthma, on preventer therapy for ≥2 months were included. Control was categorized as good, partial or poor as per GINA guidelines. Serum 25 (OH) Vitamin D levels were measured and their relationship with the level of control was studied. Results: Children with partially/poorly-controlled asthma were significantly more likely to have vitamin D deficiency. Asthma control was well controlled in 50 children and 50 had not well controlled. Age, gender, family history of asthma, type of device, serum IgE levels and presence of co-morbidities had no relationship to the level of control. Children who were underweight or obese had poorer control but the difference was not statistically significant. Children with well controlled asthma were significantly less likely to have been born low birth weight. Conclusion: The findings of this study may have implications in clinical practice. Currently, poor control is being managed by escalation of preventer therapy. Adding more drugs or increasing the doses may over time increase the toxicity of therapy. Evaluating serum 25 (OH) D levels and correcting identified deficiencies may prevent the need for escalation of preventer therapy.

22. A Hospital-Based Assessment of the Effect of Perceived Stress on the Leukocyte Profile of Healthy Young Adults between the 18 to 21 Years of Age Group
Akash Bharadwaj, Rashmi Sharma, Abhishek Kumar, Rita Kumari
Abstract
Aim: The present study was planned and carried out with the aim to study the effect of perceived stress on the leucocyte profile of healthy, young adults. Methods: A prospective study was conducted in the Department of Physiology, Nalanda Medical College, Patna, Bihar, India, on 1st Prof MBBS students, aged 18 to 21 years,  before and during their 1st semester examination.  The study procedure and objectives of the study were explained to the students. Participation in the study was solely on a voluntary basis. All 50 students gave written informed consent to take part in the study. Results: In response to how frequently they felt nervous or stressed during the last month, 20 subjects responded “Sometimes” and an equal percentage responded “Often/Always”. Based on the PSS scores, the students were grouped as “Not stressed” (PSS score 1-10), “Mildly stressed” (PSS score 11-20), “Moderately stressed” (PSS score 21- 30) and “Severely stressed” (PSS score 31-40). None of the study participants had PSS score greater than 30. 27 subjects were found to be mildly stressed and 18 students were moderately stressed. For each group of study participants, the average N:L ratio was calculated. The Pearson correlation coefficient (r) was calculated to study the relation between the PSS score and the relative percentages of the different leukocytes as well as the N:L ratio. A positive correlation was found between the PSS score and percentage of neutrophils, monocytes and N:L ratio. A negative correlation was found between PSS score and percentage of lymphocytes, eosinophils and basophils. Conclusion: Examinations in medical school are stressful enough to produce changes in heart rate, blood pressure and differential leucocytes counts although all the students were in good health status.

23. Hospital Based Prospective Outcome Assessment Endoscopic Composite Cartilage Tympanoplasty in Patients Having Chronic Otitis Media with Safe Central Perforation
Jitendra Kumar, Badal Kumar
Abstract
Aim: The aim of the present study was to determine the functional outcome of endoscopic composite cartilage tympanoplasty in patients having chronic otitis media with safe central perforation. Methods: This prospective interventional study included 200 patients of chronic otitis media with dry and safe central perforation (small/medium), who underwent endoscopic composite cartilage tympanoplasty (type I) in the Department of ENT for 12 months. Results: In this study of 200 cases, there were 120 females and 80 males were observed. In this study, patients were selected above 12 years of age. There were 42 cases between 13-20 years of age, 68 cases between 21-30 years, 72 cases between 31-40 years of age, and 18 cases above 40 years. The mean age of patients in this study was 32.8±8.16 years. In our study, the duration of ear discharge ranged from less than 1 year to more than 5 years. Out of the total 200 cases, 30 cases had ear discharge for less than 1 year, 100 cases for 1-5 years, and 70 cases for more than 5 years. In this study, 64 cases reported decreased hearing for 1-5 years, and 116 cases had it for more than 5 years. The maximum number of subjects in our study was having medium size perforation 128 cases, whereas 72 patients had small perforation. In this study of 200 cases, 90 patients were operated on in the left ear and 110 case patients were operated on in the right ear. The pre-operative ACT was 45.5±6.4 dB whereas postoperatively it was 28.62±6.34 dB and the difference between the pre- operative and post-operative values was found to be statistically significant. Conclusion: We concluded that endoscopic composite cartilage graft type I tympanoplasty is a feasible, safe, minimally invasive, and effective procedure with successful outcomes.

24. Hospital Based Observational Assessment of Carrying Angle Changes Following Supracondylar Humeral Fractures in Children
Kumar Mayank, Ranjan Kumar Prakash, Maseeh Azam, Soman Kumar Chatterjee
Abstract
Aim: The aim of the study was to evaluate the functional outcome of carrying angle changes following supracondylar humeral fractures in children. Methods: The present study was conducted in the Department of Orthopaedic for one year and 100 patients were included in the study. Results: A total of 100 patients with a mean age of 5.2 years (SD± 2.3) were seen. 75% were male and 60% were less than 5 years of age. Most of the injuries occurred at home (64%). A total of 72% of the patients were seen within 24 hours of the injury. There was a significant difference in mean scores of PedsQL (all P values < .01) at 6 months. In the present study, pin site infection complication was seen in 5 patients. Conclusion: In this prospective study, the quality of life of patients following SCHF diminished at the time of the injury and returned to the population normal 6 months after. There was no significant difference in HRQoL scores between patients who presented early and those who presented late. The delayed presentation and management did not also affect the functional outcome and complications.

25. Clinico-Etiological Profile of Urinary Bladder Carcinoma in Patients Presenting to Tertiary Care Hospital
Shashank Gaurav, Saurabh Kumar, Shikhar Agarwal, P.K. Sachan
Abstract
Aim: The aim of the present study was to find out common causes of urinary bladder carcinoma in patients presenting to tertiary care centre. Methods: The present study was conducted in the Department of General Surgery, Himalayan Institute of Medical Sciences, Dehradun, India on all newly diagnosed bladder cancer patients for the period of six months. There were 200 patients included in the present study. Results: The average age at which carcinoma of the urinary bladder is often diagnosed is 56.34 years, with a range of 30 to 89 years. The largest proportion of individuals with this condition falls within the age range of 60 to 69 years, accounting for 24% of cases, followed by the age range of 30 to 39 years, which accounts for 21% of cases. In our research, it was observed that a majority of the patients (93%) diagnosed with urinary bladder cancer did not have a history of smoking. The historical documentation of urinary tract infections (UTIs) was found to be present in a mere 25% of individuals diagnosed with cancer of the urinary bladder. The Sikh population had the highest incidence of urinary bladder cancer, followed by the Hindu population. Farmers were found to have the highest number of patients with carcinoma urinary bladder, followed by labourers. Among the labourers, the majority were employees in industries related to dye, chemical, and fertilizer. In the subgroup of female patients, housewives constituted a significant proportion. The A+ blood group had the highest prevalence of carcinoma urinary bladder patients, followed by the B+ blood group, while the O- blood group had the lowest number of patients. Conclusion: It was shown that a significant proportion of the patients had a lack of smoking behavior and possessed blood type A positive, which stands in contrast to the notable association between smoking and bladder cancer.

26. A Hospital Based Observational Assessment of Parameters Associated with Severity of Acute Pancreatitis
Praveen Kishore, Mukesh Kumar, Sunil Kumar Ranjan, Ashok Kumar
Abstract
Aim: The aim of this study was to study the various predictors of severity know the association of the parameters with severity of disease. Methods: All consecutive cases admitted to the surgical wards of Department of General Surgery,  for a period of 24 months were studied. All consecutive patients were included in the study. A prospective observational study was carried out on 200 consecutive patients who were presented with features of acute pancreatitis between 20-80 years age group. Results: Age of the patient in our study varied from 20 to 80 years, the youngest being 26 years and oldest being 80 years. Majority cases were seen in between 41 to 50 years 88 (44%). In our study the 144 cases were mild acute pancreatitis (72%), 32 cases were moderately severe acute pancreatitis (16%) and 24 cases severe acute pancreatitis (12%). In our study the majority of cases who presented with acute pancreatitis were of alcohol induced type, 144 (72%). Gall stone pancreatitis accounted for 40 (20%) cases. Drugs, tumours, Post Endoscopic retrograde cholangiopancreatography (ERCP) and hypertriglyceridemia accounted for the rest. The mean BMI in those with mild acute pancreatitis was 25.95±0.35 (Standard error (SE)), moderately severe acute pancreatitis was 28.96±0.68 and severe acute pancreatitis was 29.01±1.66. The difference in mean values of BMI across mild, moderate and severe acute pancreatitis with F value of 19.161 and p value of 0.001 was found to be significant. Conclusion: Hence, from our study the following parameters were indicative of a severe disease and prompt treatment in terms of aggressive fluid resuscitation and supportive measures should be initiated at the time of admission. And one should not wait for any single scoring system to get scored for effective treatment.

27. A Clinicoradiological Assessment of Post Operative Patients of Cervical Spondylotic Myelopathy at IGIMS, Patna, India
Niraj Kanaujia, Samrendra Kumar Singh, Brajesh Kumar
Abstract
Aim: The aim of the present study was to critically analyze the functional and radiological improvement in patients of cervical spondylotic myelopathy (CSM) who underwent surgical decompression by an anterior or posterior approach. Material& Methods: A retrospective hospital-based observational study was conducted in the Department of Neurosurgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India from May 2019 to May 2023. A total of 100 patients of CSM who underwent surgical decompression were analysed. There were 80 males and 20 females. The mean age of patient was 52.9 years (range 30–74 years). Results: A total of 50 patients underwent surgical decompression by an anterior approach, and the remaining 50 patients had a posterior approach. Both the subgroups within the anterior and posterior approach were comparable and had a male predominance. Follow-up averaged 38.4 months (range 4–54 months). In the posterior approach, an average of 4.4 levels (range 3–6 levels) was involved in the laminoplasty group and 4.2 levels (range 3–5 levels) in the laminectomy group. Patients who underwent single- or two-level anterior cervical discectomy and fusion (ACDF) had titanium/PEEK spacer insertion, while those with anterior cervical discectomy and fusion (ACCF) had expandable cage screw fixation. In the posterior approach, laminoplasty was done by the standard Hirabayashi’s technique, and fixation was done by laminoplasty plates and screws. Patients who underwent laminoplasty showed functional improvement in Nurick grade and mJOA score at the end of 1 year which was statistically significant (p < 0.0001). Similarly, in patients who underwent laminectomy ± fusion, there was functional improvement in Nurick grade and mJOA score at the end of 1 year, which was statistically significant (p < 0.0001). Conclusion: A prompt surgical intervention in moderate-to-severe cases of CSM either by the anterior or the posterior approach is essential for good outcome.

28. A Hospital-Based Study Assessing Efficacy of Modified Triple Assessment in the Diagnosis of Breast Lump: An Observational Study
Chandra Mohan Sinha, Kumar Ratnesh, Anamica Arya
Abstract
Aim: The aim of the present study was to assess sensitivity and specificity of modified triple assessment in diagnosis of breast lump. Methods: The present study was conducted in the Department of General Surgery for the period of 2 years and randomly selected 100 female patients with breast lump attending surgery OPD and admitted in female surgical ward surgical unit during the study period. Results: Mean age was 35.45 ± 12.78 years. Youngest patient was of 16 years of age and oldest patient was 70 years of age. In present study the breast lump was present more on right side 56 patients as compared to left side 44. As from present study we observed that most common size of lump was in range of >2 cm to 5 cm in diameter in clinical breast examination are 68 patients and in 32 patients, size of lump is more than 5 cm in diameter. Most of the patients who went under clinical breast examination yield that mostly the patients with lump in firm consistency 65 patients, 1 of them had soft and other 34 patients had hard in consistency. 80% patients had well circumscribed mass with regular margins followed by Density lesion with microcalcification, irregular margins and speculation (10%). In the study, 43% patients had Fibroadenoma, 21% patients had Ductal cell carcinoma and 15% patients had Fibro adenosis. In FNAC, 64% patients had Fibroadenoma, 21% patients had Fibroadenosis and 4% patients had cyst. The sensitivity was 90.62% and specificity was 100%, positive predictive value was 100%, and negative predictive value was 96.74%. P value was significant (0.000). Conclusion: Modified triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and to detect patients with breast cancers with an overall accuracy of 98%. Modified triple assessment was useful in diagnosing breast cancers at an earlier stage, with most of breast cancers detected at stage I or stage II (T1 or T2, N0 or N1, M0). It was found that triple assessment did not require hospitalization, but was performed on OPD basis, without any complications.

29. Comparison of Efficacy of Bupivacaine Plus Tramadol with Bupivacaine Plus Dexmedetomidine as Preincisional Infiltration in Patients Undergoing Abdominal Surgery Under General Anasthesia: A Prospective Randomised Double Blinding Study
Ajit Kumar, Vikash Kumar, Pankaj Kumar, Vivek Ranjan, Vinod Kumar Verma
Abstract
Aim: The aim of the present study was to assess the efficacy of bupivacaine plus tramadol with bupivacaine plus dexmedetomidine as pre-incisional infiltration in patients undergoing abdominal surgery under general anesthesia. Methods: The Prospective randomized and double-blind study was conducted at of Indira Gandhi Institute of Medical Sciences, Patna. The study protocol, informed consent form (in Hindi & English) and case report form (CRF) were submitted to the ethical committee of Indira Gandhi Institute of Medical Sciences, Patna for approval. Study was done after taking approval from institute ethical committee. Written informed consent was taken from each participants of the study. The Data was collected between – May 2019 to November 2020. Total 60 samples were included in the study (30 in each group). Results: It was observed that maximum number of patients were in the group T  35-44  years age group (26.674%) and  group D, 55-60 years  age group (30%). Mean age ± SD of patients in Group T was 41.63±13.46 years while that of group D was 41.80±14.37 years. On comparing the data statistically observed among the groups in the height distribution. The result of Independent sample t test reveals that there was significant difference between mean VAS Score of groups in 4 hour and 6 hours. There was no significant difference in group T and Group D in mean heart rate of the patients. The mean basal MAP in Group T was 96.38±2.93 mmHg and Group D was 96.34±3.02 mmHg. Mean MBP decreased at 3 & 20 minutes interval in two groups. On statistical analysis the mean oxygen saturation among the two groups were insignificant. Conclusion: We concluded that skin infilteration of 1μg/kg dexmedetomidine 0.2 ml/kg of 0.25% Bupivacaine in abdominal surgery significantly reduces the post-operative pain and reduces the analgesic requirement in post-operative period as compared to 2mg/kg Tramadol in 0.2ml/kg of 0.25% Bupivacaine.

30. Comparative Study of Short-Term and Long-Term Use of Prophylactic Antibiotics in Post-Operative Caesarean Section
Barsha, Rahul Kumar Sinha, Anjana Sinha, Punit Hans
Abstract
Aim: The aim of the study was to evaluate the effectiveness & reduce the relative efficacy of short-term vs long-term course of prophylactic antibiotics on post-operative caesarean section wound. Material & Methods: A Prospective observational and analytical study was conducted at “Patna Medical College and Hospital, Patna, Bihar, India in the Department of Obstetrics and Gynaecology included 400 participants randomized into two groups. Each group consisting of 200 each. The participants were selected based on the inclusion and exclusion criteria. in between Dec 2019 to Dec 2021 for a period of two years. The women were explained about the nature of the study, the study outcome and written informed consent was obtained. Post operatively both the groups of patients were monitored for infectious morbidity as febrile morbidity, wound induration, wound discharge, wound gaping and any abnormal vaginal discharge. Results:  A total of 400 patients were recruited for the study with 200 patients in group 1 and 200 patients in group 2. The result showed that the total patients recruited for the study in group 1 is 200 patients consisting of 129 multi para (64.5%) and 71 primi para (35.5%), and 200 patients were recruited in group 2 which consists of 139 (69.5%) multi para and 61 (30.5%) primi para. In group 1 the Primary LSCS rate was 57.5% (115), Previous 2 LSCS 11.5% (23) and Previous LSCS was 31% (62). In group 2 the Primary LSCS rate was 58.5% (117), Previous 2 LSCS 14.5% (29) and Previous LSCS was 27% (54). Conclusion: The short course (48hrs) of antibiotics that is equally efficacious as the long course (5 or more days) of antibiotics. There was no significant the difference noted between the two groups compared in terms of febrile morbidity, wound induration, serous wound discharge, and purulent wound discharge wound gaping or abnormal vaginal discharge.

31. A Hospital-Based Study Assessing the Range of Co-Morbidities Observed in Pediatric Patients with Severe Acute Malnutrition with Unexpected Dyselectrolytemia with Diarrhea
Vineeta, Sanjay Kumar Nirala, Gopal Shankar Sahni
Abstract
Aim: The aim of the study was to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Methods: The observational study was carried out in the Department of Pediatrics for the period of 12 months. Total 100 Children upto 5 years aged, admitted in Nutritional Rehabilitation Centre of Department of Paediatrics, were include in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: Majority of children with SAM were having co-morbidity in the form of Anaemia (88%), Diarrhoea (65%) followed by pneumonia (30%), Rickets (26%), Tuberculosis (15%), Otitis media (15%), UTI (10%), Celiac (7%), Hypothyroidism (5%), & HIV (3%). 65 (65%) SAM children presented with diarrhea out of which Hyponatremia was in 43 cases & Hypernatremia was in 2 cases. No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.07). Potassium levels of children with diarrheal & non diarrheal children with SAM. Serum Potassium levels of 100 SAM children were analysed. It was found that 25% SAM children were having hypokalemia. Hypokalemia was found in 15 diarrheal cases & 10 in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.025) between Diarrheal & Non diarrheal cases. Conclusion: We concluded that dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Hence, we recommend that due care is to be given for management of dyselectrolytemia in complicated SAM children.

32. Observational Study Assessing Severity and Outcome in Patients with Head Injuries: A Hospital-Based Study
Mukesh Kumar, Praveen Kishore, Ashok Kumar, Sunil Kumar Ranjan
Abstract
Aim: The aim of study to know the pattern of injury in terms of severity and outcome in patients with head injuries admitted in trauma unit of a tertiary care Centre in Bihar region. Methods: This study included 500 patients admitted at Department of General Surgery for one year. There after a complete history of all patients of head injury sustained due to RTA or fall was taken after taking written & informed consent. Those with polytrauma and others not attending the OPD for check-ups timely were eliminated from study. After admission in head injury unit, physical examination was performed in all subjects. Results: It was observed that incidence of head injury was more in males than the females. Out of 500 cases, 450 (90%) victims were males and 50 (10%) cases were females. Out of 500 cases, maximum incidence of head injury was found in the age group of 21-30 years comprising 130 (26%) cases, followed by 31-40 years 120 (24%) and 41-50 years 110 (22%). The age group 51-60 yrs comprised of 80 (16%) cases. The other affected groups were 61-70 years and 71-80 years group comprising of 25 (5%) cases and 20 (4%) cases respectively. It was observed that road traffic accident was the commonest cause of head injury seen in 350 (70%) cases. This was followed by fall from height 90 (18%) cases and assault 50 (10%) cases. The other causes like fall of tree or wall over-head were seen in 2% cases. It was seen that most of the cases 300 (60%) died within 24 hours of admission to the hospital. 75 (15%) cases survived for 1-2 days. 50 (10%) of cases survived for 2-3 days. 50 (10%) cases survived for 3-7 days and about 10 (5%) of cases survived for more than 7 days. Thus the most fatal period was first 24 hours. It was evident that linear fracture was observed in 200 (40%) cases followed by depressed fracture in 75 (15%) and comminuted fracture in 45 (9%) cases. Thus the linear fracture was the most common skull fracture encountered at autopsy examination. Conclusion: The study showed that most head injury victims brought to a tertiary care hospital, were due to road traffic accidents and males are more prone to get Head injury. So it warrants the urgency to establish good pre-hospital care and provision of efficient and prompt trauma services at Road side to prevent mortality aroused from RTA. RTA remains the most common cause for Head injury and demands good neurosurgical care for such patients.

33. Study of Maternal and Fetal Outcome in COVID-19 Positive Pregnant Women in Anugrah Narayan Magadh Medical College and Hospital Gaya
Ranjana Kumari, Nilam Bharti, Lata Shukla Dwivedy
Abstract
Aim: The aim of the present study was to evaluate maternal and neonatal outcome among COVID-19-positive pregnant women and the effect of disease on pregnancy. Material & Methods: A retrospective observational study was carried out at Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya from March 2020 – December 2020. A total of 17 COVID-19-positive pregnant patients admitted in the corona ward were recruited in the study. Results: Study population consisted of 11 (64.71%) women from 20-25 years, 4 (23.53%) women from 26-30 years and 2 (11.76%) women from above 30 years. There was history of exposure among all (100%) pregnant women with only 4 (23.53%) having symptoms of COVID-19. The indications of LSCS were, 2 cases had previous 1 LSCS, 1 previous 2 LSCS, 2 were IUGR, 1 case of Fetal distress & Post-dated, 1 patient with obstructed labour, transverse lie and CPD each. As per gestational age, 5 (29.42%) women had pre-term delivery, 10 (58.83%) had normal-term delivery and 2 (6.45%) had post-term delivery. 7 women were primigravida and 10 were multigravida. The mode of delivery was LSCS among 9 (52.9%) and normal delivery among 8 (47.05%) women. Out of 17 patients, 5 patients were severely anaemic and 3 had Preeclampsia. 1 Patient died in 3rd Post-Operative day in level 3 Covid Ward due to Respiratory Failure. Conclusion: Most of the pregnant women infected with Covid-19 showed mild symptoms. Minimum three Antenatal check-up, Rapid intervention, treatment and intensive care support are essential for better outcome.

34. Assessing Outcomes of Retrograde Intrarenal Surgery (RIRS) for Kidney Stones: A Single Center Comparative Study
Abhishek Bose, Manish Kumar Singh, Pushpendra Kumar
Abstract
Aim: The aim of the present study was to compare the intraoperative adverse events, postoperative complications and stone free rates (SFR) of RIRS in patients with renal calculi of varying sizes. Methods: The patients who underwent RIRS at Department of Urology from  October 2019 to  October 2022. were included in the study. The informed consent was taken from all the patients included in the study. 200 patients were selected for the study. Results: The size of calculi was calculated and the smallest size of calculi came to be 3 mm and the largest size of calculi was found to be 60 mm. The average size of the calculi came out to be 22.9 ± 11.2 mm, the demographic characteristics were studied for all the patients, the features that were studied included size of the stone, its location and position in the body. Out of all the patients that were taken for study some of them were at the first step of procedure and the remaining was at the starting stage of the multifunctional procedure. There were almost 90% of the patients that refused to undergo re-surgery or any observation. There were only 10% patients that undergo repetitive RIRS to clear the stones and were later-on confirmed stone free. Conclusion: RIRS is an effective treatment option for the management of renal stones, including those greater than 20 mm in size. We observed a size dependent increase in the postoperative complications and a reduction in the SFRs. The majority of the postoperative complications were low grade.

35. Classification of Uterine and Cervical Tumours: An Observational Research with a Focus on Endometrial Stromal Sarcoma
Dipti Debbarma, Kumar Rajnish, Amarnath Kumar Nayak, Anand Prakash Anand
Abstract
Aim: The aim of the present study was to broadly categorize the tumours of uterus and cervix and at the same time look into occurrence of rare lesion like endometrial stromal sarcoma. Methods: The present study was conducted in Department of Pathology,  conducted from January 2023 to June 2023. Total 2000 cases of hysterectomy specimens received during the same period were included in the study. Results: Total 2000 cases were studied, of which 500 (25%) specimens were neoplastic. Of them, 485 (97%) cases were benign & constituted exclusively of leiomyomas. Among 15 malignant lesions, 5 cases were of endometrial stromal sarcoma and rest 10 cases included 06 cases of endometrial carcinoma and 04 cases of cervical carcinoma. The age group most commonly involved by leiomyoma was 36-45 yrs (55% cases of all cases of leiomyoma); that for endometrial carcinoma was 46-55 yrs (50% cases of all cases of endometrial carcinoma); that for cervical carcinoma was 36-45 yrs (50% cases of all cases of cervical carcinoma); and that for endometrial stromal sarcoma was 46-55 yrs (64% cases of all cases of endometrial stromal sarcoma). Thus, it was evident that all lesions are mostly common around perimenopausal age group. Conclusion: As expected, leiomyomas turn out to be most common neoplasms of uterus and cervix. Though rare, certain lesions like endometrial stromal sarcoma do come across in histopathology and such lesions being known for poor prognosis and recurrences are important to be correctly and timely diagnosed.

36. A Hospital-Based Study Assessing the Effect of Duration of Disease and Glycemic Control on Attention, Executive Function and Visual Reaction Time in Type 2 Diabetes Mellitus Patients
Suchita Kumari, Rohan Kumar, Mritunjay Kumar Azad, Abha Prasad
Abstract
Aim: The aim of the present study was to correlate duration of disease with attention, executive function and visual reaction time in type 2 diabetes patients and to correlate HbA1c with attention, executive function and visual reaction time in type 2 diabetes patients. Methods: This is a cross-sectional study done on 50 type 2 diabetes mellitus subjects of either sex under the age group of 40-60 years in the Department of Physiology for 12 months . The subjects who are able to understand English were enrolled for the study. Written informed consent was taken and each subject was explained about the whole procedure and objective of the study. Results: The mean age and BMI of the patients were 56.04±4.46 and 25.55+1.96 respectively. There were 28 male and 22 females in the present study. Duration of disease was positively correlated (r=0.32) with score of Digit Vigilance Test and p value statistically significant (0.012). A positive correlation (r=0.22) was also seen with Visual Reaction time and p value statistically significant (0.042). Stroop test score also shows a positive correlation (r=0.15) but without any statistical significance. HbA1c was positively correlated(r=0.58) with the score of Digit Vigilance Test and p value statistically significant (0.01). A positive correlation (r=0.32) was also seen with Visual Reaction time and p value statistically significant (0.01). Stroop test score also shows a positive correlation (r=0.15) but without any statistical significance. Conclusion: With increase in duration of the disease and poor glycemic control, sustained attention and executive functions are declining. Also there is an increase in visual reaction time. Diabetes is a disease which requires proper self-care and monitoring. The decline in cognitive functions can affect their activities like glucose monitoring, medications or insulin injection patterns, diet and exercise timing.

37. Drug Utilization Pattern in Patients Reported with Epilepsy: Retrospective Observational Study
Veena Kumari, Insha E Rab, Asha Kumari
Abstract
Aim: The objective was to evaluate the prescription pattern of Antiepileptic drugs and to evaluate how rational is the prescription for various epilepsies. Methods: The present study was conducted in the Department of Pharmacology. Adult outpatients who have been diagnosed to have epilepsy were identified and prescribing pattern was studied. Totally 100 prescriptions were collected randomly over a period of 6 months. Patients demographic details, clinical diagnosis, type of epilepsy, type of AED used, drug dose and frequency were recorded. Average number of drugs per prescriptions was calculated. Prescription of all patients was entered in a preformed proforma and was analyzed using descriptive statistics. Results: In the present study, out of 100 patients 60 patients were male and 40 patients were females. Epilepsy was more commonly seen in the patients of age group of 20-40 years. The analysis of the type of seizure showed that the most common type was partial seizures (60%) and the least common type was absence seizures (3%). Regarding the mode of therapy, majority of the patients were treated with monotherapy (82%). Polytherapy was given for 18% of the study population. The analysis of prescriptions showed that the most commonly prescribed drug was carbamazepine (36%) followed by valproate (24%) and levetiracetam (23%). The other drugs prescribed were phenytoin (5%), phenobarbitone (6%), benzodiazepines (4%). The least commonly prescribed drugs were the newer drugs like topiramate and lamotrigine (2%). Conclusion: Older antiepileptic agents like carbamazepine, valproate, phenytoin are still the most commonly agents as monotherapy whereas newer ones like levetiracetam are mostly used as add on drug in cases of treatment failure with older drugs. Antiepileptic prescribing in this study population is in accordance to the standard treatment guidelines for epilepsy.

38. A Descriptive Cross-Sectional Study Determining the Prevalence and Factors of Urinary Incontinence among Postmenopausal Women Outpatient Service in a Tertiary Health Care Center
Alokkumar Binod Kumar Singh, Vinod Bagade
Abstract
Aim: The aim of the present study was to assess the type of urinary incontinence in postmenopausal women visiting outpatient in a tertiary health care sector and to determine the risk factors of urinary incontinence. Methods: A hospital‑based cross‑sectional study was carried out in the OBG Department,  Postmenopausal women of age 45–90 years, who came to the OBG department, were studied. 200 patients were interviewed in the 4 months of duration. All women with severe illness, mental illness, and those who refused to give consent were excluded. Results: In the present study, 80% were vaginal delivery followed by LSCS. In 91% cases, delivery was assisted by Obstetrician. 70% were tea drinker and 96% patients were taking diuretics. The total prevalence of urinary incontinence in our study was 20%. Stress incontinence accounted for 12%, followed by mixed urinary incontinence, contributing 6% and finally, urge urinary incontinence ‑ 2%. In this study, prevalence of urinary incontinence was more or less similar in women aged 75 and above (27%), women between 45 and 59 years (26.8%) and 60 and 74 years (25%). Of 15 variables studied, only 4 were found to be significant using bivariable analysis. These variables were chronic cough (P = 0.005), recurrent urinary tract infections (UTI) (P < 0.001), duration of labor (P = 0.025), and the type of delivery (0.032). Multivariable analysis was done using binary logistic regression ‑ stepwise backward elimination method. All the variables having P value 0.2 or less were put in the model which included age, occupation, parity, menopausal age, duration of labor, type of delivery, diabetes mellitus, chronic cough, recurrent UTI, and physical activity. Chronic cough, recurrent UTI, and duration of labor were found to be independent risk factors. Conclusion: Stress incontinence was found to be the major type of urinary incontinence in the postmenopausal women. Those having history of chronic cough, prolonged duration of labor, and recurrent UTI should be screened regularly for urinary incontinence.

39. Role of Maternal Nutritional Awareness and Risk Factors in Prevention of Nutritional Anemia in the Early Childhood
Sadhana Kumari, Dipak Kumar, B. B. Singh
Abstract
Aim: The aim of the present study was to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: This study was carried out children aged 6 months–2 years admitted at the hospital during the study period were included. Any child with chronic disorders such as hemoglobinopathies, hemolytic anemia, and treated for anemia and those on any immunosuppressants such as steroids and biologics were excluded as an indirect measure to eliminate anemia of chronic disease. Results: Majority of the mothers were aware that neural development of child could be affected by anemia. Maternal knowledge regarding cow’s milk was poor and had a faulty belief that it increases iron absorption, whereas 13% were unaware of the relationship between cow’s milk and anemia. Many mothers (71%) believed anemia to occur only in children on vegetarian diet. Around 75% mothers recognized green leaves and jaggery to be enriched with iron. Although 78% identified vitamin C containing fruits, many were not aware of its vital role in increasing the iron absorption. Mothers of children with more than one sibling had a relatively greater incidence of “poor” knowledge unlike mothers of children with single or no sibling. This implies that those with “poor” knowledge were also unaware of the importance of birth spacing. Conclusion: Recognizing the causative factors plays an essential role in preventing iron deficiency anemia (IDA). Exclusive breastfeeding must be promoted, along with avoiding excessive cow’s milk intake. Intervening at the right period with age-appropriate foods becomes a necessity. Maternal illiteracy has a positive correlation with anemia in infants. Improving maternal awareness by the physicians will pave the road toward a nation free from anemia.

40. Assessment of Endometrial Biopsy in Patients with Abnormal Uterine Bleeding: An Observational Study
Amarnath Kumar Nayak, Dipti Debbarma, Kumar Rajnish, Anand Prakash Anand
Abstract
Aim: The aim of the present study was to assess endometrial Biopsy Audit and its Clinico-Pathological Correlation in Patients with Abnormal Uterine Bleeding in Bihar region Methods: The present study was conducted in the Department of Pathology from February 2023 to June 2023. 100 cases were selected in the study. Results: In the study majority 44% were in the age group 41 to 50 years. In the study 5% were Nulliparous and majority were in para 2 (52%). In the study majority of subjects had Heavy menstrual bleeding (47%). In the study clinically, 46% were diagnosed to have fibroid, 24% had Adenomyosis. In the study 45% had Proliferative, 28% had Secretory, 12% had Endometrial hyperplasia and 8% had Endometrial carcinoma. Conclusion: Abnormal uterine bleeding is a common diagnosis and the commonest presentation is menorrhagia. Histopathological examination of the endometrium showed a wide spectrum of pathological changes ranging from normal endometrium to malignancy thus necessitating endometrial sampling as an important diagnostic tool in the management of abnormal uterine bleeding. Accurate analysis of endometrial sampling is the key to effective therapy and optimal outcome.

41. Brucellosis in Pediatric Age Group – A Tricky Diagnosis: A Case Report
Lamba Mamta, Aggarwal Akriti, Lamba Anita, Sharma Rajni, Bachhiwal Rekha
Abstract
Brucellosis is a zoonotic disease transmitted to humans by infected animals, mostly through direct animal contact or consumption of animal products. Brucella melitensis is the most common cause of brucellosis in humans. We are reporting a pediatric case of Brucella melitensis in a 1.5 year old girl child. Earlier, it was managed as a case of pyrexia of unknown origin considering it to be Salmonella spp. Brucella spp are slow growing, which needs several days for identification with the routine conventional microbiological identification methods. We processed blood culture by automated blood culture, system BacT/ALERT, which provides early growth of pathogens, as compared to the conventional blood culture system. After the growth of pathogen on Blood agar & Macconkey agar the growth was subjected to Grams stain. Due to high suspicion, the growth was also subjected to Biomerieux MALDI-TOF system which identified Brucella melitensis which led to early identification & thus helped in guiding treatment which in usual is difficult through conventional methods. Thus that being the aim of our study to contribute to literature of Pediatric brucellosis in terms of clinical features, laboratory findings, usage of MALDITOF MS and treatment.

42. An in-Vitro Study to Evaluate the Microleakage of Metallic Copings Luted with Three Different Commercially Available Luting Cements: A Comparative Study
Nikita Raman, Samir Jain
Abstract
Aim: The aim of the present study was to evaluate the microleakage of metallic copings luted with three different commercially available luting cements. Methods: The study was conducted at Department of Dentistry. 24 replicas of abutment analog having length 5 mm, width of platform 4.8 mm, taper 6°, broad chamfer finish line and three anti‑rotation grooves over it which end 1 mm above finish line were milled from titanium rods. Results: The result showed microleakage scores for specimens cemented with zinc oxide non‑eugenol, zinc polycarboxylate and zinc phosphate luting cements, respectively. All specimens exhibited microleakage to different degrees. Mean microleakage score was least for Zinc Phosphate cement (1.078±0.32), followed by Zinc Polycarboxylate cement (1.6±0.84) and most for zinc oxide non‑eugenol (2.3±0.87). On subjecting the values of mean microleakage scores to Kruskal–Wallis ANOVA followed by Chi‑square test, the value of P = 0.001 indicating that there was significant difference in mean microleakage scores of the groups tested (P < 0.05). Conclusion: Within the limitations of the study, it was found that all cements exhibited certain amount of microleakage. Zinc Phosphate cement exhibited a mean microleakage score that was significantly lower than Zinc Oxide Non Eugenol cement and Zinc Polycarboxylate cement. When microleakage scores of Zinc Oxide Non Eugenol cement and Zinc Polycarboxylate cement were compared, the difference was found to be insignificant indicating that microleakage in these cements was similar.

43. Retrospective Study of Demographic Profile and Clinical Outcome Following Laparoscopic Cholecystectomy Over One Year at NMCH, Sasaram
Vikas Kumar, Seema Kumari
Abstract
Aim: The aim of the present study was to evaluate the demographic profile and clinical outcome following laparoscopic cholecystectomy over one year at NMCH, Sasaram. Methods: This study was a retrospective study included 100 patients with gall stones and gall bladder-related disease who were admitted in the Department of General Surgery, Narayan Medical College and Hospital, Sasaram, Bihar, India for the period of one year. Results: The mean age of study population was 42.00 ± 12.00 years with a range of 20 years–80 years, median age being 40 years. Of the included patients 65 (65%) were male and 35 (35%) were female. All patients fell under an ASA2 (95%) or ASA3 category (5%). Co-morbidities outlined in table 2 from most to least common include: hypertension (32%), diabetes (30%), anticoagulant therapy (18%), respiratory disease (14%), chronic kidney disease (9%) and myocardial infarction (2%). The mean duration of symptom onset to date of surgery was 180 days. Of the 100 patient records screened, two elective laparoscopic cholecystectomies were converted to open surgery. Both of these patients were male and required open surgery due to difficulties in safely delineating the anatomy via a laparoscopic approach. Mean operative duration was 106 minutes (range: 32- 280). A surgical drain was left in situ in 20% of cases and subsequently removed in all cases prior to discharge. Conclusion: The recent literature demonstrates that LC is a feasible and safe procedure in elderly patients and, whenever possible, LC should be performed during the same hospitalization like definitive treatment of gallstone disease. Elective LC could be recommended when repeated gallstone symptoms have occurred in the elderly patient and dedicated surgical team experienced in gallbladder and biliary tract disease should treat these pathologies.

44. Assessing Outcome of Submuscular Plating for Diaphyseal Long Bone Fractures: An Observational Study
Aditya Kumar, Rakesh Kumar
Abstract
Aim: The aim of the present study was to evaluate the functional and radiological outcomes of paediatric femur diaphyseal fracture treated with locking compression plate. Material & Methods: The clinical, radiological and functional results of Submuscular plating were evaluated in 70 patients operated in between the duration of 1 years for fracture shaft humerus, shaft of femur and shaft of tibia. All the surgeries were carried out by a single surgical team at Department of orthopaedics. Results: Among the study group, 48 were males, and 22 were females. There was a male preponderance. The youngest age among patients was six years old and the oldest age was 14 years old. The average age was 11.59 (2.08) years. Right side fractures 38 (54.29%) were more compared to left side fractures 32 (45.71%). For types of fractures, 24 (34.28%) fractures were transverse, 18 (25.72%) fractures were comminuted, 21 (30%) fractures were oblique, and 7 (10%) fractures were spiral. Considering the mode of injury, road traffic accident accounted for 57.14%, other injuries like fall during playing sports were seen in 17.14%, fall from height accounted for 8.58%. In our study, the average union time in group one was 10.5 weeks. Late complications in the form of thigh pain in 9 patients. Cases of knee stiffness and delayed union were in 4 patients each. The functional outcomes were evaluated and 63 (90%) were excellent, 5 (7.14%) were satisfactory and 2 (2.85%) were poor. Conclusion: Once properly planned and executed correctly the submuscular plating for diaphyseal long bone fractures is one of the reliable treatment modality. It is minimally invasive technique that allows early mobilization with satisfactory radiological and functional outcome with minimal complications.

45. A Hospital-Based Study to Assess the Role and Efficacy of Biochemical Testing in Diagnosing the Cause of Fluid Accumulation
Puja Singh, Aakash, Binod Shankar Singh
Abstract
Aim: The aim of the present study was to examine role and efficacy of biochemical testing in diagnosing the cause of fluid accumulation. Methods: The observational hospital-based study was carried out at Department of Biochemistry, Anugrah Narayan Magadh Medical College and Hospital (ANMMCH) Gaya, Bihar, India for one year. Data was taken from medical records department. All 100 indoor patients who were diagnosed as ascites on the basis of history, physical examination, ultrasonography, and of age >18 years were included in the study after getting the informed consent. Patients who had a diagnostic paracentesis within 2 weeks (cause was already established), secondary cause of peritonitis and unwilling to participate in the study were excluded. Results: This study included 100 patients with age ranging from 20 to 78 years and majority of patients were aged between 41-50 years (n=24, 24%), only 9 patients 9% admitted with ascites of the age group between 18-30 years. 62 patients (62%) were male and 38 patients (38%). The most common clinical feature was abdominal discomfort, followed by Anorexia, Icterus, Splenomegaly and Hepatomegaly. The most common etiology of Ascites was Liver cirrhosis (39%), followed by Tuberculosis (33%) then Malignancy (9%), and Congestive Heart Failure (6%). The least common etiology of Ascites was Hypothyroidism (3%). 40 of the 60 exudates were detected using the traditional cutoff for cell count greater than 500/mm3, but using the cutoff proposed in the present paper (300 cells/mm3), the detection increased to 49/60. Of the biochemical parameters studied, the AST ratio AF/S (> 0.5) detected the greater number of exudates correctly classified 48/60, while 7 of 40 transudates were falsely classified. Conclusion: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Biochemical testing of peritoneal and pleural fluids is carried out widely, although the range of tests likely to be useful is limited in comparison to the repertoire of tests available in a modern biochemistry laboratory.

46. Randomized Clinical Comparative Assessment of Granisetron Versus Pethidine for the Prevention of Perioperative Shivering Under Spinal Anesthesia
Vikram Nath, Amrit Kumar
Abstract
Aim: The aim of the present study was to compare the efficacy of prophylactic granisetron on post anaesthetic shivering in comparison to pethidine an agent which is known to be effective in the treatment and prevention of post anaesthetic shivering. Methods: The present study was conducted in the Department of Anaesthesia for  six Months and we selected 100 patients aged 20–50-year, American Statistical Association (ASA) physical Status I and II, scheduled for lower abdominal surgery under spinal anesthesia. The patients were randomly allocated to Group P (n = 50) receiving pethidine 0.4 mg/kg and Group G (n = 50) receiving granisetron 40 mcg/kg intravenous (IV) as study drug before spinal anesthesia. Results: The three groups were comparable regarding distribution of age, weight, height, gender, duration of anaesthesia, duration of operation and ASA physical status. The number of patients with postoperative shivering on arrival in the recovery room, 15 minutes after arrival, were significantly less in Group G and Group P than in Group S (p<0.05). There was no statistically significant difference between Group P and G (p > 0.05). However, in Group G and Group P only 4 and 10 patients reached grade 3 shivering respectively. However, there were no significant differences in the core temperature amongst the patients before and after the anaesthesia. Conclusion: Prophylactic granisetron 40 mcg/kg IV is equally effective as pethidine 0.4 mg/kg in the prevention of perioperative shivering following spinal anesthesia, maintains core temperature and oxygen saturation levels above that of pethidine. Prophylactic granisetron also reduces the need of antiemetics.

47. An Observational Study Assessing the Correlation between Clinico-Radiological Profiles with Histopathological Patterns of Lung Cancer
Manish Kumar, Archana Verma
Abstract
Aim: The aim of the present study was to find out the correlation between clinico-radiological profiles with histopathological patterns of lung cancer. Methods: This was a cross-sectional observational study conducted at over a duration of 1 year patients with histopathologically confirmed lung cancer. A total of 200 histopathologically confirmed diagnosed patients with lung cancer were included in the study. Results: There were 36% and 35% of patients who belonged to age between 51-60 year and 60-70 year respectively. Out of 200 patients, 170 patients were smokers, 90 patients had a prior history of COPD, and lymphadenopathy was present in 20 patients. The ECOG performance status 37% of patients remained on scale 2, followed by 35% on scale 3. Among the  clinical symptoms, cough was present in (85%), breathlessness (60%), chest pain (56%) followed by hemoptysis, sputum production, voice change, and superior vena cava obstruction. Radiological examination showed mass lesion as the most common finding (80%) followed by collapse (9%) and pleural effusion (5%). Correlation of histopathological types with radiological findings showed that mass lesion was the major finding in both adenocarcinoma and squamous cell carcinoma. Pleural effusion was present in about more than half of the patients with adenocarcinoma. Lymphadenopathy was only present in adenocarcinoma. Conclusion: This study showed that smoking is a principal risk factor in causation of lung carcinoma. It was seen to present more frequently in elderly age groups. Patients commonly present with chief complaints of smoking and breathlessness. Further investigations should be carried out in such circumstances to confirm the diagnosis.

48. A Hospital Based Comparative Study Estimating Fetal Weight using Johnsons Formula and the Actual Birth Weight of Newborn Babies Born
Ankita Ranjan, Kumari Divyamala, Kumar Gaurav
Abstract
Aim: The aim of the present study was to regulate the fetal weight precision by means of Johnson’s formula and comparing it as per the definite birth weight. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology for 12 months . Study included a total of 200 pregnant women attending the OPD with full term pregnancy till onset of labour, fulfilling the inclusion criteria. Results: Mean birth weight Johnson’s formulae and actual birth weight was 3.16 Kg and 2.75 Kg respectively. Majority of the children were 2.5-3 kgs followed by 3-3.5 kgs. Johnson’s formulae co-relate well with actual birth weight (r-0.90; 95% CI: 0.88-0.92), though prediction of fetal weight was slightly on a higher side. The least correlation was reported in cases with weight <2.5 kg (r-0.34; 95% CI: 0.16-0.58). Between the clinical as well as the actual birth weight the mean variance was an overestimation of 0.246 Kg i.e. an error of 8%. In 58% cases the difference was within range of 10%. The mean difference in estimation was highest in the babies having low birth weight i.e. <2.5 Kg. Conclusion: The observation means there’s clearly a contribution for clinical of birthweight estimation as a device of analysis, signifying that clinical estimation is actually adequate to handle delivery and labour for a phrase pregnancy. Even in macrosomic foetus weight estimation for decision making concerning towards labour trials, no benefit appears to be there for gaining a regular sonographic birthweight.

49. A Hospital Based Randomized Comparative Assessment of Laparoscopic Cholecystectomy under Spinal Anaesthesia vs General Anaesthesia
Amrit Kumar, Vikram Nath
Abstract
Aim: The aim of the present study was to evaluate the efficacy, safety and advantages of conducting LC under SA in comparison to GA. Methods: The study was conducted in the Department of Anaesthesia for 8 months . Informed consent was obtained from all the patients who had agreed to participate in the study. A detailed explanation of the procedure and risks involved was given. A total number of 70 patients were included in the study. Results: Both the groups had similar demographic profile. In the SA group, 45 patients were females and 25 patients were males. The mean age was 46 ±12.68 years and 48.82 ±10.45 in SA and GA groups respectively. The duration of surgery was 82.98±21.99 min and 98.2±36.04 min in the GA and SA groups which was not statistically significant. For each procedure the surgeon was asked to give a score of 1-3, regarding the surgical conditions and muscle relaxation; 1 was bad, 2 good and 3 being excellent. In the SA group, 8 patients complained of shoulder pain, 3 patients required conversion to GA as the pain did not subside with Fentanyl and they were excluded from further analysis.  All the patients (100%) in the GA group had pain at operated site immediately after completion of operation and their pain score ranged from 4-7, all patients received rescue analgesic before shifting to the ward. In the first 24h tramadol required as rescue in the GA group was 84±26 mg which was significantly higher than the SA group requiring only 31±32.18 mg. Although, the GA group had more patients experiencing postoperative nausea & vomiting it was not statistically significant. Conclusion: We concluded that laparoscopic cholecystectomy can be safely performed under spinal anaesthesia using bupivacaine and clonidine as an adjuvant. Spinal anaesthesia provides stable intra-operative haemodynamic and respiratory parameters, requires less postoperative analgesics with extended duration of analgesia, with no major complications and has better patient satisfaction.

50. Comparison of Cefoxitin Disc Diffusion with Oxacillin E-Test for Detection of MRSA
Mansi Gupta, Anshul Gupta, Amardeep Rai
Abstract
Infections caused by MRSA are worldwide, resulting in increased mortality and morbidity. Detecting the mecA gene or its product by PCR is recognized as a gold standard for detection of MRSA.  In resource limited clinical settings phenotypic method which is simple, rapid, accurate and cost effective is required.  mec A gene detection considered as gold standard for MR isolates. The aim of this study was to do a comparative evaluation of  E-test MIC and Cefoxitin disc diffusion for detection  of  Methicillin resistant Staphylococcus aureus (MRSA). A total of 94 S. aureus isolates were identified, which were subjected to Cefoxitin disc diffusion and Oxacillin MIC by E-test. A total of 53 isolates were identified as MRSA by E-Test strip and 51 by Cefoxitin disc diffusion test. In this study sensitivity and specificity of E-Test is 100% while sensitivity and specificity of Cefoxitin disc as 96.23%.

51. Obstetric and Perinatal Outcomes in Term Singleton Malpresentations: A Prospective Analysis
Pramoda Kumar Sahoo, Manas Ranjan Behera, Deepa Sethy, K B subudhi
Abstract
Background: Malpresentations in obstetrics refer to any fetal presentation other than vertex, including breech, shoulder, face, brow, and compound. The management of malpresentation remains controversial, and there is a need to evaluate obstetric outcomes in term singleton malpresentation to optimize perinatal outcomes while preserving the art of conducting vaginal breech deliveries. Methods: The study was a prospective observational study conducted in the Department of Obstetrics & Gynaecology at MKCG Medical College & Hospital, Berhampur, from October 2015 to September 2017. The study included 276 term singleton malpresentations out of 17,997 deliveries during the two-year study period, with an incidence of 1.6%. Data on obstetric outcomes, including perinatal mortality, stillbirth, neonatal death, and APGAR scores, were collected and analysed. The study compared outcomes between vaginal deliveries and cesarean section deliveries, focusing on the risks of low APGAR scores and soft tissue damage in different malpresentations. Results: The study analyzed 276 term singleton malpresentations, with breech presentations being the most common (81.1%). Most cases were delivered via cesarean section (69.6%), with emergency cesarean sections accounting for 43.2%. In vaginal deliveries, breech presentations were the most common (91.6%). The perinatal mortality rate was 11.9%, with stillbirth and neonatal death accounting for 9.4% and 2.6%, respectively. Vaginal deliveries had a higher risk of low APGAR scores, with compelling indications being the largest factor contributing to perinatal mortality. Conclusion: The present study revealed that most malpresentation cases are cesarean, with breech presentations being the most common. Vaginal deliveries in term breech malpresentations have a higher risk of low APGAR scores, with brow and shoulder presentations having the highest rates.

52. Study of Carbapenem Resistant Klebsiella Pneumoniae in a Tertiary Care Hospital in Ahmedabad
Lata Patel, Sanjay Rathod, Toral Bhavasar, Anil Rajput, Sunny Chauhan, Mina Kadam
Abstract
Introduction: Enterobacteriaceae that produce resistant to carbapenem are becoming an increasing problem worldwide. Carbapenems were the choice for the therapeutic management of multidrug resistant gram negative bacterial infections. Due to a shortage of alternative medicines, multidrug-resistant (MDR) and carbapenem-resistant Klebsiella pneumoniae have become major therapeutic challenges in various countries. Material &Method: The retrospective study was conducted in the department of Microbiology, Narendra Modi medical college, Ahmedabad, Gujarat over a period of one year i.e. from January 2022 to February 2023. A total of 1790 Klebsiella pneumoniae isolated from various clinical samples were subjected for antimicrobial susceptibility patterns and further tested for carbapenemase production by phenotypic method, Modified Hodge test based on CLSI guidelines 2019. Results: Total 23,516 various clinical samples were received, of that 1790 (7.6%) Klebsiella pneumoniae isolated from various clinical samples like sputum and endotracheal secretions, wound swabs, urine, pus etc. From 1790 Klebsiella pneumoniae isolates, 760 (42.5%) were imipenem resistant. Modified Hodge test were performed of 760 imipenem resistance isolates, 267(35.1%) were positive. The predominant source of carbapenemase producer Klebsiella pneumoniae isolates were found in respiratory specimens (48.8%) and wound swab (20%). Antibiogram showing maximum sensitivity to minocycline, tigecycline. Conclusion: Early detection of carbapenemase producing Klebsiella spp. may avoid future spread of these isolates and ensure better patient care and timely introduction of appropriate infection control measures.

53. Clinico-etiologic Profile and Antifungal Sensitivity Patterns of Dermatophytosis: An Observation Study
Rakesh Ranjan Kumar Rahul, Babita Kumari
Abstract
Aim: The aim of the study was to assess the etiological prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infections, and in vitro antifungal drug susceptibility testing against dermatophytes to understand the variation in minimum inhibitory concentrations (MICs) levels of antifungals among dermatophytes. Methods: The present study was conducted in the Department of Skin and VD, for one year . All patients with dermatophyte infections visiting the outpatient department during this period were screened. A total of 150 consecutive patients aged between 18 and 65 years  with recurrent cases of tinea and other atypical presentations, receiving antifungal treatment, and willing to have minimum three days washout period before antifungal drug susceptibility testing of the clinical specimen (fungal isolate), were recruited. Results: Male preponderance was observed (60%) among 150 cases studied. The mean age of the study population was 36.6 ± 13.76 years. Most patients were in the 18–30 years group (n = 60), followed by 31 to 40 years (n = 30), > 50 years (n = 35) and 41 to 50 years (n = 25). Itching (92%), scaling (89.33%), dryness (78%) and inflammation (46%) were the most common clinical presentations. Antifungal susceptibility testing was done for all 100 culture-positive patients. Griseofulvin reported the least mean MIC values, followed by luliconazole, eberconazole, sertaconazole, amorolfine and itraconazole. The mean MIC value of terbinafine (0.05 [0.043] µg/mL) was above the reference range. However, it was noted only in 15 (15%) out of total culture-positive patients.  The individual high MIC values were reported up to 0.256 µg/ml [range: 0.001–0.03 µg/ml]. Higher MIC values were reported for terbinafine for both T. mentagrophytes (0.256 µg/ml) and T. rubrum (0.256 µg/ml). Conclusion: Dermatophytosis is a prevalent problem in the Indian scenario due to the hot and humid climate and low socio-economic status. Varied etiological agents, along with regional variations, make the management of this common cutaneous condition challenging. T. rubrum was found to be the most common, and T. mentagrophytes the emerging/codominant fungal isolate.

54. Hepatitis A: A Clinical Spectrum of the Disease in Children Admitted in a Tertiary Care Hospital
Saurabh Kumar Singh, Mala Kumar
Abstract
Introduction: HAV causes acute hepatitis worldwide, mostly through oral-faecal pathways. While rich nations have lower infection rates, injection drug users, men who have sex with males, travellers to endemic areas, and secluded populations are at risk. HAV doesn’t cause chronic liver illness like hepatitis B or C. Children over 12 months should be vaccinated. Poor sanitation causes high endemic rates in impoverished countries. Aims and Objectives: This study aims to examine the clinical spectrum of Hepatitis A in paediatric patients. Method: The Paediatric Department of Hind Medical College Ataria, Sitapur conducted this cross-sectional study from February 2022, to February, 2023, to investigate acute hepatitis in children aged 1-12. The Institutional Ethical Review Board approval had been taken for the study, excluding children with preexisting liver disease and including those with acute hepatitis symptoms lasting ≤21 days, high ALT, and parental agreement. Demographics, clinical symptoms, ELISA blood samples for anti-HAV and anti-HEV IgM antibodies, and laboratory data were collected. Results: Table 1 shows 150 youngsters with HAV-induced acute viral hepatitis. The average age was 7.3±3.0 years, with 42% aged 6-10 years. Male patients made up 53.33% and rural residents 55.33%. Maternal education varied, and 36.66% were lower-middle-class. Table 2 lists HAV-related symptoms including fever (72.66%), jaundice (65.33%), and black urine (70.00%). Table 3 shows increased bilirubin, ALT, AST, ALP, and INR, emphasizing the necessity for early medical intervention in acute HAV patients. Conclusion: The majority of HAV-induced acute viral hepatitis cases occur in 6-10-year-olds, highlighting the need for routine immunisation and public health education.

55. Evaluation of Maternal and Neonatal Risk Factors and Outcomes of EOS
Saurabh Kumar Singh, Mala Kumar
Abstract
Introduction: Maternal and neonatal risk factors affect the development of “early-onset sepsis (EOS)” in infants. Group B Streptococcus infection and preterm membrane rupture are two examples of maternal causes. Prematurity, low birth weight, and mother colonization are all factors that pose a danger to newborns. Preventing EOS and its severe repercussions, like septic shock and long-term developmental difficulties, requires prompt diagnosis and treatment. Aim and Objectives: This study aims to evaluate the impact of various maternal and neonatal variables on the outcomes of early-onset sepsis. Method: From September 2014 to August 2015, K.G. Medical University’s Lucknow NICU observed term and preterm infants at risk of Early-Onset Sepsis. Babies who left the NICU within 24 hours or died were eliminated. Antenatal, peripartum, maternal, and neonatal EOS risk factors and pre-admission antibiotic exposure were examined. For a better understanding of NICU EOS, neonates were divided into “High Suspicion of EOS (HS-EOS)” and Low Suspicion groups. Result: Figure 1 and Table 1 shows culture-positive “Early-Onset Sepsis (EOS)” and neonatal EOS isolates.  Table 2 shows antibiotic susceptibility for treatment decisions. Table 3 shows baseline commonalities in culture-proven and most probable EOS newborns. Table 4 lists frequent EOS symptoms. Figure 2 stresses TLC’s role in culture-proven sepsis detection. Figure 3 shows neonatal pneumonia risk factors. Table 5 and 6 shows maternal neonatal meningitis risk factors and early diagnosis and treatment enhance newborn outcomes for culture-positive EOS. Conclusion: Escherichia coli and Staphylococcus aureus cause most NICU early-onset sepsis; ampicillin, cephalosporin, and amoxicillin resistance is widespread; piperacillin and amikacin are first-line treatments.

56. Study on the Sex Identification using Maxillary Sinus in Northern India
Shamim Raza, Piyush Kumar Gangwar, Amrendra Kumar
Abstract
Introduction: In forensic identification, the pelvis, skull, and maxillary sinuses are used to determine sex. The comprehensive musculoskeletal imaging of “cone beam computed tomography (CBCT)” is helpful in forensic research. Post-mortem radiograph comparisons are used for radiological identification when DNA or fingerprints are unavailable. Radiological evaluation of maxillary sinus size helps determine gender in forensic anthropology and human remains because human maxillary sinuses show sexual dimorphism. Aims and objectives: The objective of this research is to examine the efficacy of maxillary sinus features in Northern India as a means of determining the sex of individuals. Methods: The cross-sectional observational study was conducted from June, 2022 to May,. 2023. 70 Northern Indian non-pathological headache patients (40 male and 30 female) were examined. The right and left maxillary sinus height, depth, and breadth were measured using SYNGO software. Calculated maxillary sinus volumes. Descriptive statistics showed male and female measures, while t-tests or ANOVA estimated gender differences. We followed ethical guidelines and acquired patient permission for ethical research. Results: Table 1 compares male and female right maxillary sinuses using Mann-Whitney U-tests. Male sinuses are higher, longer, broader, and larger than female ones. Table 2 mimics left maxillary sinus outcomes. Figures 1 and 2 show the major variations in height, length, and breadth in the right and left maxillary sinuses between men and women. It shows sexual dimorphism in maxillary sinus diameters. Conclusion: The research shows gender-specific maxillary sinus characteristics for forensic identification. Sexual dimorphism is helped by maxillary sinus measures, notably right sinus volume. CT imaging properly measures these dimensions, improving forensic investigations.

57. Evaluation of Sub-Arachnoid Block using Isobaric Ropivacaine with That of Hyperbaric Bupivacaine in Caesarean Section
Anuradha Kalyan Jogdand
Abstract
Introduction: Caesarean sections with spinal anaesthesia reduce aspiration risk and allow aware patient involvement. Limited pain alleviation, urine retention, and complications are negatives. Bupivacaine is widely used but can cause hypotension. With bupivacaine, dexmedetomidine and magnesium sulphate boost results. For spinal anaesthesia, ropivacaine, a less strong anaesthetic, is sought, with isobaric formulations becoming popular for their reliability. Aims and objectives: This study aims to compare the anaesthetic effects of isobaric ropivacaine and hyperbaric bupivacaine in the context of caesarean section procedures. Method: The study comprised 70 elective lower-segment caesarean section patients with ASA Grades I and II. Prior to surgery, thorough screening ruled out medical and obstetric difficulties, respiratory or cardiovascular issues, allergies, and other health issues Intravenous medicines, hydration preloading, and baseline vital signs were preoperative preparations. Patients were randomly randomised to hyperbaric bupivacaine or isobaric ropivacaine for lumbar punctures. An oxygen supplement was given throughout the surgery. Results: Table 1 compares Group B with Group R by numerous factors. Both groups had similar mean ages, weights, heights, and surgical times, with non-significant p-values (0.86, 0.18, 0.24, and 0.46). Table 2 shows group variations in sensory levels, timing, and analgesia. Figure 1 shows group differences in dermatome regression, sensory block length, effective analgesia, motor block start, and recovery. Group B had slightly greater rates of nausea/vomiting, hypotension, and shivering, but no significant vital sign changes (Table 3). Conclusion: For elective caesarean sections, 15 mg of isobaric ropivacaine provides adequate anaesthesia with sensory block and safety above bupivacaine.

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58. Prospective Comparative Study of Management of Inferior Turbinate Hypertrophy with Partial Turbinectomy and Submucous Diathermy
Gudise Abhinav Kiran, I Sandeep, Baddamrachna Reddy
Abstract
Background: Nasal obstruction due to hypertrophied inferior turbinate is very common. In such patients nasal obstruction is relieved by reducing the size of inferior turbinate. Many well documented procedures are available to achieve this size reduction. Aims: Study compares partial inferior turbinectomy and submucous diathermy, the 2 most commonly done procedures for reducing the size of hypertrophied inferior turbinate. Methods: This prospective comparitive study was carried out on 60 patients from July 2022 to June 2023 in the department of ENT in Malla Reddy Hospital. 30 patients underwent SMD & 30 patients partial turbinectomy with postoperative follow up on day 1, day 7 and one month by subjective & objective assessment to ascertain nasal patency, post-operative bleeding, pain and crusting. Results: Moderate to good improvement of nasal air flow is seen in 18 patients of SMD & 26 patients of partial turbinectomy at the end of 1 month. At day 1 assessment 4 patients of SMD had mild bleeding and about 18 patients had moderate  bleeding with partial turbinectomy, none of the patients of SMD had severe pain and 10 patients had severe pain with partial turbinectomy.At day 7,7 patients had moderate crusting with SMD and 22 patients had moderate crusting with partial turbinectomy. Conclusions: We found SMD to be a safer technique while partial turbinectomy was better in relieving nasal obstruction.

59. Interpregnancy Interval and Perinatal Outcome
G Sushma, Sushmitha, Divya Daniel, Vijaya Krishna
Abstract
Aims: To study the impact of inter pregnancy interval on perinatal outcome. Materials and Methods: In the Prospective observational study 100 antenatal women who were second gravida whose previous pregnancy ended in a live birth at term were studied in accordance to varying inter pregnancy intervals whose maternal and perinatal outcomes were observed. Results: Severe anaemia was seen more in short interpregnancy interval.26.6% cases in short interpregnancy interval had severe anaemia. Overt diabetes mellitus (6.6%) was seen in long interpregnancy interval.  GDM is not statistically associated with any of the interval groups. In this study, majority of Preterm, very and extremely preterm deliveries were in short interpregnancy interval is significant. Most of the cases in all intervals delivered vaginally. In long interpregnancy intervals 30% delivered by LSCS.IUD and Still births were 6.6% and 6.6% in short and long interpregnancy interval respectively. There was low APGAR babies seen in both short(6.6%) and long(6.6%) interpregnancy interval. 13.3%, 17.5%, 10% moderately low APGAR seen in short, normal and long interpregnancy intervals respectively. 36.6% and 20% women delivered low birth weight and very low birth weights respectively in short interpregnancy interval group, 30% LBW and 10% VLBW in long interpregnancy interval. There was one congenital anomaly in long interpregnancy interval which was meningomyelocele. 36.6% NICU admissions were in short interpregnancy interval and 30% NICU admissions in long interpregnancy interval. 10% and 13.3% neonatal deaths were there in short and long interpregnancy intervals respectively. Conclusions: The risks for maternal and perinatal morbidity associated with short inter pregnancy intervals underscore the importance of birth spacing to promote safe motherhood and achieve better pregnancy outcomes.

60. Neurological Manifestations of Post Covid Rhino Orbito Cerebral Mucormycosis: An Institutional Experience
D V Madhavi Kumari, K Padma, Raghunath Bhargava, C H Sivarama Krishna
Abstract
Introduction: An epidemic of Mucorales was reported following the second wave of COVID 19 in India, and intracranial extension of the same was one of the most dreadful complications. The present study was done to analyze the demographic data and provide an overview of the diverse clinico-radiological presentations of post covid ROCM. Materials and Methods: We systematically reviewed 30 patients diagnosed with post covid Rhino orbito cerebral mucormycosis admitted at our hospital during MAY 2021 to JULY 2021.Data pertaining to demographic variables, clinico-radiological features were analysed using percentage of total cases. Results: A total of 30 patients with rhino orbito cerebral mucormycosis were enrolled in the study. The majority of subjects were males. The most common age group affected was 41-50 years. History of preexisting diabetes mellitus was recorded in 15 (67.35%) patients. Most common presenting symptom was facial pain (77%), followed by drooping of eyelid and proptosis (73%) with 63% of the patients developing double vision. Diminution of vision was seen in 40 % of the patients. Focal deficits were seen in 7 patients. Altered sensorium was seen in 4 of them. Seizures were documented in two patients. Conclusion: High index of suspicion with thorough knowledge of varied clinico-radiological presentations of rhino orbito cerebral mucormycosis is necessary for prompt initiation of treatment and thereby aiding in reduction of morbidity and mortality.

61. Development and Evaluation Hydrogel of Sertaconazole
Mohit Khandelwal, Abhay Gupta, Mukesh Gupta
Abstract
The main aim of this study was to develop a topical drug delivery (Hydrogel) of Sertaconazole to reduce the dose of the active drug, to improve patient compliance, to avoid the side effects and increase local onset absorption and action. Sertaconazole interfare with 14-α sterol demethylase, a cytochrome P-450 enzyme essential for conversion of lanosterol to ergosterol. These turn in inhibition in synthesis of ergosterol and also enhance cellular permeability of fungus due to reduced amounts of ergosterol present in the fungal cell membrane. Methods: Topical Hydrogel formulations development of Sertaconazole was prepared by using Different-different polymers by enhancer stability and viscosity with their different concentrations. Six different formulations of Sertaconazole were prepared and evaluated parameters with respect to their colour, Spreadability, viscosity, determination of pH,drug content of formulations, in vitro drug release studies, and stability studies. Results: FT-IR study results that there were no any interaction between the drug, Polymers, and excipients. All the developed formulations of Sertaconazole show acceptable standard physical properties. The drug content and percentage yield were higher for F5 formulation among all formulation. F5 shows better drug release. Stability study of the best formulation F5with guar gum polymer was found with best results. Conclusion: From the above observation results that this F5 formulationmay be more effective topical formulation for the healing of fungal infections in the skin.

62. Cardiovascular Importance of Omega-3 Fatty Acids: A Depth Review
Aniketa Sharma, Saniya, Sanjeev Kumar, Sneha Tularam Khadse, Keshamma E, Minu KP, Ravi Kumar, Mukesh Kumar Meena, Megha Parashar, Suraj Mandal
Abstract
Omega-3 fatty acids are a class of polyunsaturated fats that are present in many dietary sources. They have attracted a lot of interest in the field of cardiovascular health. This extensive study offers a detailed examination of the cardiovascular significance of omega-3 fatty acids, looking at its function in the prevention and treatment of cardiovascular disorders. The introduction of the review explains the various kinds of omega-3 fatty acids, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that are present in fatty fish and supplements. Their anti-inflammatory, antiarrhythmic, and lipid-lowering actions are some of the mechanisms of action that are being examined. It provides insights into the effect of omega-3 fatty acids on risk factors for cardiovascular illnesses, such as hyperlipidemia, hypertension, and endothelial dysfunction. The study of epidemiological research randomized controlled studies, and meta-analyses are crucial. The review looks into how omega-3 fatty acids could help to lower the risk of serious heart attacks such as myocardial infarction, stroke, and sudden cardiac death. Also covered in depth are the effects of omega-3 supplementation on known cardiovascular diseases including atherosclerosis and heart failure. Omega-3 fatty acid safety, doses, and sources are examined, addressing queries about toxicity and recommended dietary ranges. The review’s conclusion highlights the expanding body of research that shows omega-3 fatty acids have positive cardiovascular effects and the possibility that these organic substances might be useful supplements to traditional cardiovascular treatments. In boosting heart health, it emphasizes the need of a balanced diet, lifestyle changes, and the prudent use of omega-3 supplements. With a thorough analysis of their methods of action and effects on cardiovascular risk factors and outcomes, this in-depth study highlights the cardiovascular significance of omega-3 fatty acids. Healthcare professionals, researchers, and those looking to improve their cardiovascular health by dietary and supplement changes can all benefit from the data reported in this analysis.

63. A Study of Serum Bilirubin in Coronaryartery Disease Patient in Age Group of 35-70 in a Tertiary Medical Centre
Goutham Kumar A.P, Suresh Kanna. S, Kosuri Akhila
Abstract
Coronary artery disease (CAD) is a major cause of morbidity, mortality, and healthcare expenditure. A number of environmental and genetic risk factors have been known to contribute to CAD. More recently, a number of studies have supported as well as opposed a possible protective benefit of bilirubin in CAD, since it has anti-inflammatory, antioxidant, and antiaggregatory properties that may reduce atherogenesis. It also shares associations with different forms of CAD, namely stable CAD, unstable angina pectoris, stable angina pectoris, and acute myocardial infarction. Lack of sufficient evidence, however, has failed to elucidate a causal relationship between serum bilirubin level and risk of CAD. Therefore, in this update, we attempted to simplify this intricate relationship between bilirubin and CAD, revisit the pathophysiology of disease, how bilirubin may be protective, and to summarize the findings of the current literature.

64. An Observational Study to Investigate the Renal Function in Patients with Acute Stroke and its Relationship with in-Hospital Mortality
Vijay Gadhia, Darshankumar Parmar, Sanket G. Makwana
Abstract
Aim: The aim of the present study was to investigate the renal function in patients with acute stroke and its relationship with in-hospital mortality. Methods: The present study was a prospective, observational study conducted at Department of General Medicine for the period of 12 months. 100 patients were considered for present study. Results: 75% were from group A while 25% were from group B. Most patients were from >65 years age group, male, BMI<30. Hypertension, smoking, diabetes mellitus, cardiovascular disease, alcohol consumption, dyslipidemia, previous history of stroke/TIA were common risk factors in both groups. On admission most patients had GCS score 5-13. 48 (64%) patients had ischemic stroke, while 27 (36%) had hemorrhagic stroke. We noted mortality within 30 days in 20 (20%) patients. We distributed patients according to Serum Creatinine concentration at time of presentation, most patients had serum creatinine in the range of 98-118 (34%) followed by 82-97 (28%). Maximum mortality was noted in >119 (40%) followed by 98-118 (35%) serum creatinine group. We distributed patients according to blood urea concentration at time of presentation, most patients had blood urea in the range of 6.8-8.9 (40%) followed by 5.3-6.7 (26%). Maximum mortality was noted in >9 (45%) followed by 6.8-8.9 (30%) blood urea group. We noted that age > 65 years, GCS score > 10 at the time of admission, smoking, diabetes mellitus and aspiration pneumonitis were predictors of death in stroke patients. Conclusion: The severity of impaired kidney function in patients hospitalized with acute stroke is associated with increased mortality independent of age, sex, and major comorbidities. Unrecognized renal insufficiency noted by low eGFR is common in patients with acute stroke and is associated with higher mortality adverse short-term outcomes.

65. A Hospital-Based Study Assessing the Thyroid Disorders Prevalence in Women during Reproductive Age
Rani Dipa, K. Manju
Abstract
Aim: The present study was undertaken to assess the thyroid disorders prevalence in women during reproductive age. Material & Methods: The study recruited 100 reproductive women of the age group of 18-45 years. Informed consent was obtained from all the participants and confidentiality of data was maintained. All participants underwent thorough physical examination. All measurements were performed using standard methods in the literature. Results: The disorder was more common in age group 40 years and older accounting for 47%. AUB was more common amongst multiparous woman contributing to 58%. The most common menstrual disorder pattern seen in AUB was menorrhagia which was 52%. Next commonest was polymenorrhea at 22%. Euthyroid, hypothyroid and hyperthyroid were 88%, 8% and 4% respectively. Majority of the hypothyroid cases were in age group >40 years accounting to 50%. The highest number of hyperthyroid cases was in age group of 21-30 years. More number of hypothyroid cases were in >40 years age group and a smaller number of cases in <20 years age group. There was high association observed between age groups and thyroid type and it is found statistically significant (p<0.001). Conclusion: The study results suggested that there was a strong association between the thyroid disorders and the reproductive functions in the women of reproductive age. The study recommends further detailed studies in this area for further understanding the relationship and to plan effective treatment strategies.

66. A Randomized Placebo-Controlled Trial Assessing the Effect of Glutamine Supplementation on Infection and Clinical Outcomes among Burn Patients
Avinash Kumar, Santosh Kumar
Abstract
Aim: The aim of the present study was to evaluate the effect of glutamine supplementation on infection and clinical outcomes among burn patients. Methods: 100 burn patients were randomly divided into two equal groups. Group I received 0.5 gm/kg/day glutamine infusion as a part of parenteral nutrition for seven days after ICU admission. Group II received an intravenous placebo by continuous infusion (24 h/day). The primary outcome was the presence of infection assessed by the wound culture over a 15-days period. The secondary outcomes were: blood culture, WBCs count, serum C-reactive protein (CRP) and procalcitonin, sequential organ failure assessment (SOFA) score, and length of stay within the intensive care unit. Results: 100 patients were enrolled in the study and allocated into two groups of 30 patients in each group, as shown in the study flow chart. Patients’ demographic data and burn were comparable between the groups with insignificant differences. As regard wound culture, there was a significant reduction of positive wound cultures in the glutamine group on day 5 (p < 0.001), there were 8 patients in group I (2 Gram –ve and 4 Gram +ve organism) and 20 patients in group II with +ve wound culture (14 Gram –ve and 6 Gram +ve bacteria). However, there was a statistically significant drop in Gram -ve bacteremia in group I than in group II (p < 0.001), whereas there was no statistically significant difference between the two groups in respect to gram +ve bacteremia. There was a significant decrease in WBC count in group I than in group II on day five and day 10 (p = 0.003 and 0.002). Conclusion: The present results proved that IV glutamine supplementation in adult burn patients can reduce the impact of infectious morbidity and improve the clinical outcome.

67. Clinico-Demographic Assessment of Nephrotic Syndrome in Children and Associated Complications: An Observational Study
Kumar Arpit, Rizwan Akhtar, Alka Singh
Abstract
Aim:  The aim of the present study was to determine the demographic profile of children diagnosed with nephrotic syndrome, to analyze the clinical presentation of children with nephrotic syndrome and to study the associated complications. Material & Methods: This hospital based observational study was conducted in the Department of Pediatrics for the duration of 12 months.  The study included a total of 100 eligible children with nephrotic syndrome. Results: A total of 100 children between the ages of 3 months to 12 years, diagnosed with NS were taken for the study. Majority of the subjects presented between 6-9 years of age (45%), followed by 3-6 years of age (30%). Among these, 70% of children were male and 30% were females. The most common presenting symptom was facial puffiness seen in 100% of patients, followed by abdominal distension (92%), pedal edema (84%), oliguria (55%), scrotal edema (45%), fever (32.5%), burning micturition (26%), abdominal pain (22%), hematuria (16%) and vomiting (12%). All subjects were evaluated for complications. Most common was observed to be ascites comprising of 64% of cases, followed by hypertension (45%), respiratory complications like pleural effusion and pneumonia (25%), thromboembolism in 5% of cases and spontaneous bacterial peritonitis seen only in 3% of the cases. Of the 100 subjects included in the study, it was noted that 76% of the children presented with first episode of nephrotic syndrome, 20% with infrequent relapses and 4% with frequent relapses. After initiation of corticosteroid therapy, it was observed that remission was achieved after 2 weeks of treatment in 58% of cases, followed by 28% responding to treatment in the 3rd week, 12% in 1st week. A very low percentage of patients (4%) respond to treatment in the 4th week. Conclusion: In the present study, clinical and demographic profile of nephrotic syndrome was congruent with nephrotic syndrome in children in other studies. The response to treatment and associated complications did not differ significantly in a rural center when compared to other studies.

68. A Randomized, Double‑Blind Clinical Assessment of the Effect of Low‑Dose Nicotinic Acid on Hyperphosphatemia in Patients with ESRD
Gopal Prasad, Kumar Abhinav, Sujay Ranjan
Abstract
Aim: The aim of the present study was to assess the effect of low‑dose nicotinic acid on hyperphosphatemia in patients with ESRD. Methods: In this randomized, double‑blind clinical trial, 100 dialysis patients referred to the Department of Nephrology, Patna Medical College and Hospital, Patna, Bihar, India for the period of six months were evaluated. Results: The difference in mean age between niacin and placebo groups was not significant. At the end of the first month, the difference between two groups in calcium level was significant. At the end of the second month, the difference between the two groups in terms of phosphorus and calcium levels was significant. At the end of the third month, mean phosphorus level was significantly different between the two groups. Conclusion: We concluded that niacin (100 mg/day) decreased phosphorus serum level and increased HDL serum level in patients on dialysis.

69. Open Label Randomized Comparative Assessment of Dexmedetomidine, Midazolam and Propofol for Sedation of Post Operative Patients on Mechanical Ventilation
Anshu Kumari, Sumit Kumar Singh, Priyanka Awasthi
Abstract
Aim: The aim of the present study was to assess the comparison of Dexmedetomidine, midazolam and propofol for sedation of post operative patients on mechanical ventilation. Methods: This single blinded, open label, randomized control trial conducted at Department of Anesthesiology for 1 year. 60 patients were equality divided into 3 groups, 20 in each groups. Primary variable will be sedation of the patient. Results: The difference in demographic profile among the three groups was not statistically significant. In our study we found that difference of mean HR at different time interval was not statistically significant but compared to group M & P, HR falls more in group D and the mean HR was less in Dexmedetomidine group. No statistical significant difference in SBP & DBP among all these groups. Conclusion: Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol.

70. An Analytical Study to Determine a Threshold Level of AFI That Could Predict an Adverse Outcome
Suchandra, Renu Jha, Kumudini Jha
Abstract
Aim: The aim of the present study was to determine a threshold level of AFI that could predict an adverse outcome. Methods: This study was conducted as an observational study on a total of 200 antenatal females presenting with term pregnancy at Department of Obstetrics and Gynecology, the study period of 2 years. Results: Out of the 200 women, the mean maternal age was 26.04 in Group 1 and 27.83 in Group 2, out of which, 26 (65%) women were nulliparous in Group 1 and 94 (58.75%) in Group 2. Gestational age was ≤37 weeks in 22 (55%) in Group 1 as compared to 56 (35%) in Group 2. Maternal weight gain during pregnancy was ≤10 kg in 14 (35%) in Group 1 as compared to 12 (7.5%) in Group 2. 29 (72.5%) patients were induced in Group 1 as compared to 80 (50%) in Group 2. Obstetric and perinatal outcomes were studied in both the groups. 6 (15%) women in Group 1 and 24 (15%) women in Group 2 had meconium-stained liquor. The difference was not statistically significant (p = 0.840). Cesarean section was performed in 22 (55%) women in Group 1 as compared to 56 (35%) in Group 2 (p = 0.043). Cesarean section for fetal distress was higher in women with oligo- hydramnios (35%) as compared to women with AFI > 5 (40%) (p = 0.047). Birth weight <2.5 kg was found in 23 (57.5%) patients in Group 1 as compared to 32 (20%) in Group 2. In Group 1, the Apgar score at 1 min was<7 in 15 women (37.5%) as compared to 16 (10%) in Group 2 (p = 0.001). An Apgar score <7 at 5 min was noted in 1 (2.5%) woman in Group 1 and 8 (5%) women in Group 2 (p = 0.860). Cord pH < 7.1 was found in 1 (2.5%) woman in Group 1 as compared to 6 (3.75%) in Group 2 and the difference was not statistically significant (p = 0.752). Conclusion: Amniotic fluid index is an important determinant of adverse maternal and fetal outcome. AFI <5 is associated with adverse maternal outcome in the form of higher operative delivery and adverse fetal outcome i.e. low birth weight, meconium stained liquor, low APGAR score and higher NICU admission.

71. A Study Assessing the Association between Clinical Findings and Electrophysiological Changes in Patients with Lumbar Disc Disease: Analytical Study
Sachin Kumar Singh, Gaurav Batra, Girish K.M
Abstract
Aim: The aim of the present study was to assess the role of the electrophysiologic studies in prolapsed lumbar/lumbosacral intervertebral discs for finding the association between clinical findings and electrophysiological changes and to compare the electrophysiologic studies pre‑ and post‑operatively. Methods: This study was conducted in the department of Neurosurgery . It was conducted prospectively with the aim of evaluating patients with lumbar disc prolapse by means of electrophysiological studies, electromyography (EMG), and nerve conduction velocity. The study was conducted for the period of 2 years on 100 patients (after taking a proper informed consent from the patient with lumbar disc prolapse, and all these patients were subjected to surgery. Results: Of the 100 patients, 75% were males and 25% were females. Low back pain was the most common symptoms seen in 95% of patients, followed by the leg pain seen in 75% in patients, numbness of lower limbs in 30% of patients, and loss bowel and bladder control was least and was present in 5% of patients. As per the EMG abnormalities, most common levels of intervertebral disc prolapse were L4–L5, accounting for 34% of cases followed by L5–S1 32%, L5–S1 level which was seen in 24% of patients with L2–L3, L3–L4, and L4–L5 prolapsed intervertebral disc (PIVD), and L3–L4 and L4–L5 PIVDs were seen in 5% of cases each. 60 patients had L5–S1 lesion, after surgery, 38 patients showed normal H‑reflex latency, while ten continued with prolonged H‑reflex, so improvement was noted in 63.34% of patients after surgery. A total of 40 patients (40%) were having delayed tibial nerve velocity after surgery. After surgery, tibial nerve velocity was delayed in 16 (40%) patients and improvement was noted in 60% (24 patients). 20 patients (20%) had delayed preoperative peroneal nerve conduction velocity. Significant improvement in NCV parameters after surgery can be observed. Conclusion: In compressive lesions of nerve roots (due to disc prolapsed), the EMG method has a high degree of accuracy in determining not only the presence of such lesions but also their exact location. EMG is accurate when correlated with the operative findings.

72. A Hospital-Based Assessment of the Spectrum and Outcomes of Crescentic Glomerulonephritis: An Observational Study
Gopal Prasad, Saurav Suman
Abstract
Aim: The aim of the present study was to identify the etiology, assess and compare the clinical features, histomorphological parameters and outcomes of patients with Crescentic glomerulonephritis (CrGN). Methods: This observational study was conducted in the Department of Nephrology, Patna Medical College and Hospital, Patna, Bihar, India for a period of 2 years. Fifty biopsy proven crescentic glomerulonephritis patients with variable presentation were analysed in this study. Crescentic glomerulonephritis was defined by crescent formation over 50% sampled glomeruli in biopsy specimen. Results: Immune-complex glomerulonephritis (ICGN) was the most common etiology (n = 40; 80%) followed by pauci-immune glomerulonephritis (PauciGN; n = 8; 16%) and anti-glomerular basement membrane disease (n = 2; 4%). The most common etiology of ICGN was IgA nephropathy (n = 13; 26%) followed by lupus nephritis (n = 10; 20%) and post-infectious glomerulonephritis (PIGN) (n = 10; 20%).There was no difference in the clinical, biochemical and histopathological parameters between these categories. Conclusion: Immune-complex glomerulonephritis is the most common cause of CrGN in this part of the country with IgA nephropathy being the predominant disease. The clinical presentation is marked by severe renal failure at presentation and comparatively lesser response rates, higher mortality and progression to ESRD in spite of strict adherence to standard immunosuppressive therapy.

73. Assessment of 3-Diferent Haemoglobin Estimation Methods: An Observational Comparative Study
Richa Sharma, Manish Kumar Jha, Sunil Kumar, Poonam Kumari
Abstract
Aim: The aim of the present study was to assess the different haemoglobin estimation methods. Methods: This study was conducted on blood samples obtained in 2 ml blood in K3 EDTA vacutainer from various indoor wards and outdoor patient departments in Pathology ,Darbhanga medical College and Hospital, Darbhanga, Bihar, India for one year. 200 adult patients sent for Hb estimation from outpatient and wards of Darbhanga medical College and Hospital, Darbhanga, Bihar, India were included in the study. Results: Repeatability standard deviations of Sahli’s method, Drabkin’s method and cell counter respectively were 0.64 g/dl, 0.40 g/dl and 0.16 g/dl. When comparing Sahli’s method with Drabkin’s method and cell counter, we found p value of <0.0001, suggesting significant difference between two methods whereas Drabkin’s method was found to be comparable with cell counter with p value of >0.05. This showed a mean difference of 0.585 and with significant p-value of <0.001. A significant difference was found in the mean values of colorimeter and 5 part (p<0.001) despite a significant correlation between these methods. Conclusion: Sahli’s method although cheap and easy, is inaccurate and has subjective bias. So it can be used for screening purpose, but not for diagnosis and follow up of anaemia, Haemoglobin measurement by Drabkin’s method is very cost effective and it is as efficient as cell counter. It is especially useful in fund deprived areas and where only haemoglobin value is required. Cell counter although highly accurate and versatile, requires good equipment, quality control, laboratory setup and trained personnel. So it should be preferably used when complete blood count is required.

74. A Hospital-Based Assessment of the Clinical and Biochemical Profile of Neonates with Seizures
Ruby Kumari, Satya Gupta, Kishore Kumar Sinha
Abstract
Aim: The aim of the present study was to assess the clinical and biochemical profile of neonates with seizures admitted to a tertiary care hospital, Bihar region. Material & Methods: A cross sectional study was conducted in all the neonates from birth to 28 days of life satisfying the inclusion and exclusion criteria who got admitted in the NICU of Department of Pediatrics, Jawahar Lal Nehru medical College and Hospital, Bhagalpur, Bihar, India in between the duration of 6 months. 100 patients were included in the study. Common presentation at the time of admission was abnormal body movements or abnormal posturing (fits), refusal to feed, fever or hypothermia, cyanosis and icterus. Results: In the present study, 56% were male and 44% were females. 52% children were delivered normally and 38% were delivered by LSCS. 75% new borns were full term and 25% were pre-term. In our study, the percentage of patients who experienced their first seizure within 24 hours was 26, followed by 24 to 72 hours (days 1 to 3), 4 days to 1 week (days 4 to 7), and more than 1 week (more than 7 days), with percentages of 44, 22 and 8 respectively. In this study, there were 100 participants, and 23 (23%) of them were found to have hypoglycemia. 18 neonates (18%) out of the study’s 100 new-borns showed hypocalcemia. Out of 100 subjects, hyponatremia was reported in 12 neonates (12%). 5 (5%) of the 100 new-borns exhibited hypomagnesemia. Out of 100 new-borns in my research, 3 (3%) had hypernatremia. Conclusion: Hypocalcemia, hypoglycemia and hyponatremia were the common biochemical abnormalities observed in our study. Subtle seizures were the common type of seizures observed among both pre term and term infants.

75. A Hospital Based Assessment of the Various Modalities of Management and Outcome in Patients of Head Injury: An Observational Study
Kundan Kumar, Rahul Singh, Manish
Abstract
Aim: The aim of the present study was to assess the various modalities of management and outcome in patients of head injury. Material & Methods: The present study was conducted in the Department of General Surgery, for one year, we have studied and analysed 100 head injury patients. Results: Out of the 100 patients who participated in the study, the Mean age was 35.5 years, majority of patients were from age group of 18-40 years (66%), followed by age group of 41-50 years (22%) and age group of 51- 60 years (10%). Majority of patients who had come were of male gender (86%). Road traffic accident was the most common cause of mode of injury (74%) followed by falls 22% and assault 4%. 40 (40%) patients had severe head injury according to GCS scoring system (GCS score ≤ 8). The remaining 60 (60%) patients had moderate brain injury (GCS score 9- 12). In our study EDH and SDH were the most common findings on non-contrast brain CT scan. EDH comprised of 26% and SDH comprising of 28% of the population. SAH was the third highest finding making up 16% of the population, followed by haemorrhagic contusion (10%) and intra-parenchymal haemorrhage (8%). In 12% of the head injured population CT scan could not be done as they were not in a stable condition.  85 patients (85%) were managed conservatively with monitoring in the surgical intensive care unit without the requirement of operative intervention. Conclusion: In this study majority of head injuries did not require surgery and could be managed conservatively, and those patients who were managed operatively with Burr Holes and Craniotomy had good outcome.

76. Clinical Profile of Isolated Lateral Rectus Palsy among Adult Population
Swetha Sankar P., Naina Jabeen Hyder, Nimi R.
Abstract
Background: The Abducens nerve/sixth cranial nerve, is responsible for ipsilateral abduction of the eye. The sixth cranial nerve is commonly affected because of its long intracranial course. Dysfunction of the abducens nerve can occur at any point of its transit from the pons to the lateral rectus muscle, resulting in sixth nerve palsy. Objectives: To analyze clinical profile of isolated lateral rectus palsy among adult population and to assess the recovery pattern in isolated lateral rectus palsy among adult population. Methodology: All adult patients diagnosed with isolated lateral rectus palsy attending Regional Institute of Ophthalmology, Department of Neuromedicine, Neurosurgery and Internal Medicine, Government Medical College, Thiruvananthapuram were included in the study after obtaining informed consent from them. A thorough clinical examination of eye including examination for head posture like face turn or head tilt or chin position change noted. Extraocular mobility, nystagmus, position of the eye and presence and amount of deviation in all cardinal positions of gaze were noted and angle of deviation recorded in prism diopter with each eye fixing; primary and secondary angle of deviation. The range and restrictions of eye movements were recorded and the under action and over action were graded 1 to 4. Neuroimaging CT scan/MRI was done in relevant cases. Results: Twenty-one patients were evaluated during the study period. Mean age was found to be 49 years of which 57% were females and 43% were males. Microvascular ischemia (63%) was the commonest etiology, of which diabetes (43%) was the major comorbidity followed by hypertension (19%). Other causes found were trauma (14%), tuberculosis (9.5%), and tumors (9.5%) and cavernous sinus thrombosis (4.8%). 81% had full recovery after 6 months, 5% had partial recovery and 14% patients were lost for follow-up. Conclusion: In our study the most common etiology was microvascular ischemia due to diabetes and hypertension. Isolated lateral rectus palsy usually has a benign course and majority has spontaneous recovery. It can be prevented to some extent by controlling the systemic risk factors.

77. Comparative Study of Effect of Intravenous Dexmedetomidine and Intravenous Lignocaine on Hemodynamic Response to Tracheal Extubation in Laparoscopic Surgeries
Sailaja K., Purva Kumrawat, Vinuth K. Murthy, Suraj H.S.
Abstract
Background: Patients go through a period of extreme physiological stress during their recovery from general anesthesia and extubation. The most common post-Laparoscopic surgical consequences are myocardial ischaemia, arrhythmias, increased intracranial pressure, cerebral edema and respiratory problems leading to postoperative morbidity. Thus, maintaining normal respiratory and cardiovascular parameters is an important part of anesthetic emergence. The aim of present study is to comparatively study the effect of Intravenous Dexmedetomidine and Intravenous Lignocaine on hemodynamic response to tracheal extubation in laparoscopic surgeries. Methods: 60 Patients in ASA Grade I and II, ages 18 to 60, who were scheduled for Laparoscopic surgery were split into two groups of 30 at random. The general anesthesia was balanced to all patients. At the end of surgery patients in Group I got intravenous (IV) injection of dexmedetomidine (0.5 μg/kg) and Group II received 2% preservative free IV injection of lignocaine (1.5 mg/kg). After extubation, measurements were made of the heart rate (HR) and mean arterial pressure (MAP) at intervals of 1, 3, 5, 10, and 15 minutes. Emergence and extubation times were recorded, and a cough grading system was used to assess the quality of the extubation. Results: MAP and HR were significantly lower in Group I than in Group II at all-time points following extubation (p<0.05). Each of the groups experienced emergence and extubation at around the same length of time. Conclusion: Compared to 1.5 mg/kg of lignocaine, a dose of 0.5 μg/kg IV dexmedetomidine administered before tracheal extubation effectively attenuates the hemodynamic response to extubation.

78. Role of MRI in Evaluation of Carcinoma of Tongue with Histopathological Correlation
Tapan Kumar Behera, Biswojeet Bisworanjan Sahoo, Krushna Chandra Pani, Subrat Kumar Rout, Mamata Singh, Seshdev Panigrahi
Abstract
Background: This study was conducted to evaluate the role of MRI (Magnetic Resonance Imaging) in the evaluation of carcinoma of the tongue with histopathological correlation. Methods: This study was a prospective hospital-based investigation that involved 50 patients who had been diagnosed with tongue carcinoma based on clinical or biopsy findings. The patients were referred for magnetic resonance imaging from Acharya Harihara Postgraduate Institute of Cancer to the Department of Radiodiagnosis at SCB Medical College and Hospital, Cuttack, Odisha, for a two-year period. The study was approved by the institutional ethics committee, and the participants provided written informed consent. Results: Almost perfect agreement (k = 0.928) was seen between MRI and histopathological N staging assessment. The mean depth of invasion by histopathology and MRI was found to be 7.848 mm and 8.664 mm respectively. Good agreement (k = 0.851) was found between radiological and pathological tumour depth. Out of fifty cases, 44 (88%) were found to be well differentiated (G1), 4 (8%) moderately differentiated (G2, and 2 (4%) poorly differentiated (G3) squamous cell carcinoma. Lymphovascular invasion was seen in 14 (28%) cases and perineural invasion was seen in 12 (24%) cases. Both lymphovascular and perineural invasions were found in 6 (12%) cases in the post-surgical histopathological study. The worst pattern of invasion was seen in 12 (24%) patients on histopathology. Conclusion: MRI is the preferred imaging modality for the assessment of tongue carcinoma due to its ability to precisely stage the tumour using the TNM classification system. This staging is essential for optimising treatment choices, such as glossectomy/marginal mandibulectomy, radiation, or both.

79. Structural and Functional Correlation in Glaucoma Patients
Afra Binti Iqbal, Sajad Khanday, Seema Malik
Abstract
Objectives: To compare retinal nerve fiber layer thickness changes on optical coherence tomography with automated perimetry indices in patients with glaucoma. Methods: Comprehensive clinical assessment, visual field testing and OCT every 6 months were done in 64 eyes of 40 glaucoma patients. Results: Moderate Positive correlation was seen between RNFL and perimetric mean deviation at all visits with r values of 0.56, 0.55, 0.52 and 0.53 at 0, 6, 12 and 18 months respectively. Correlation is found to be statistically significant at p value <0.05. Moderate negative correlation was seen between Average RNFL thickness and perimetric Pattern standard deviation with r-values of -0.43, -0.45, -0.46, -0.47 at 0, 6, 12 and 18 months. Correlation is statistically significant with p value <0.01 level (2 tailed). Conclusion: significant correlation exists between OCT RNFL and mean deviation on Perimetry in the progression of glaucoma. Structural changes documented by the RNFL scanning on OCT tend to occur earlier than the functional changes documented by Perimetry. Therefore, RNFL scanning is more sensitive for detecting early glaucomatous changes whereas Perimetry is more sensitive to subtle changes in moderate to advanced glaucoma.

80. Study of Infections among Children with Multitransfused Thalassemia Major
Karan Saradava, Kinjal Patel, Gopi Solanki
Abstract
Background and Aim: Due to the high annual expense of thalassemia treatment in India, the majority of thalassemic children receive insufficient blood transfusions and inadequate iron chelation therapy. Infection is the major cause of morbidity and mortality in thalassemia, so regular screening is required for this disease. Material and Methods: The investigation was carried out in the Pediatrics department of Tertiary care Hospital of India. The study included 75 patients with thalassemia who were between the ages of 2 and 18 at the time of their diagnosis. According to the supplied proforma, a thorough history (age, sex, history of blood transfusion, history of iron-chelation therapy) was taken. After fully disinfecting the area with the cleaner, 4 ml of blood was drawn from a vein and allowed to clot. Routine tests such the complete blood count (CBC), renal function test (RFT), and liver function test (LFT) were performed using the separated serum. Transfusions and other measures, such as calcium supplements, FA, and iron chelators, were taken. Results: There were 36 male and 39 female patients that were included in the study; the male to female ratio was 0.80:1. In the current investigation, RVD infection was more common than HCV infection (2.60%) and HCV infection (20.60%) (Table 2). Being an autosomal recessive illness, thalassemia is more prevalent in populations with high rates of consanguinity marriage. In the study conducted today, 4 patients experienced fever, 7 patients had a cough, 2 patients had headaches, and 2 patients had vomiting. Conclusion: No patient had tuberculosis infection despite increased vulnerability to infections like tuberculosis in thalassemia due to defective immune response, blood transfusion, iron overload, splenectomy, and iron chelation therapy. Patients with thalassemia who frequently need blood transfusions require better methods of eliminating excess iron from their bodies. Therefore, to reduce growth retardation in patients with transfusion-dependent thalassemia, it is crucial to have an effective iron chelation therapy in addition to maintaining haemoglobin levels.

81. A Study on Analysis of Urological Injuries in Blunt Injury Abdomen
Vyza Vishnu Vardhana Reddy, Amar Kumar Repaka, Revanth Varma Ramadugu, Arun Kuamr Vasa
Abstract
Aims: To study the various modes of injury, presentationand other distributions of urological trauma patients. Materials and Methods: This is a prospective study of various aspects of Urological Trauma encountered in 32 numbers of cases have been recorded in the study.All patients aged from 12 to 70 yearspatients admitted with blunt injury abdomen above 12 yrs patients having clinical, radiological evidence of urological injuries in blunt injury abdomen and intaoperative evidence of urological injuries in blunt injury abdomen. Results: The commonest cause of genitourinary tract injury is due to road traffic accident. Males are more often affected by road traffic accident than females due to their outdoor nature of work. Middle aged patients are the victims when compared to either extremes of age. Most common injury to the genitourinary system is lower urinary tract injury. Among these, urethral injury is most common and it is commonly associated with pelvic bone fracture. Hemodynamically unstable patients are most commonly associated with other intra abdominal visceral organ or vascular injury. Conclusions: Early resuscitation and laparotomy along with methodical exploratory technique is essential for penetrating injuries and blunt injuries. Investigations such as X ray, CT scan and blood tests are useful to diagnose urological trauma.

82. Comparison between ‘Three in One Femoral Nerve Block’ and Psoas Compartment Block for Post-Operative Pain Relief Following Lower Limb Surgical Procedures
M.Bharathi, Pavani Bussa, KVJ Suman, Shaik Vahida
Abstract
Introduction: Peripheral   nerve   blocks   are   suitable   substitutes   for parenteral   analgesics   for   post-operative   analgesia   in lower limb surgery.  Lumbar plexus block can provide good analgesia after hip, femur and knee surgery. Aims: To compare the efficacy of ‘3 in 1’ block with psoas compartment block in relieving the post-operative pain in the patients, operated for unilateral hip, femur, or knee surgery under spinal anaesthesia. Materials and Methods: The A randomized, prospective, single blinded comparative study was conducted among the patients undergoing lower limb surgical procedures for 18 months from January 2021 – June 2022. 60 patients of age 15-50 years of ASA 1 to 2 undergoing lower limb surgery in orthopaedics OT, were included in the study. Results: Majority (33.3%) of study participants in group 1 and 2 belonged to age category 21 to 30 years. In both the groups, majority (26/30) participants were males. There is no significant difference between the mean weights, height, BMI in the participants of two groups. The mean time taken for nerve block in group 1 & 2 is 328 ± 40 seconds and 329.5 ± 57.6 seconds. There is no significant difference between the mean time taken for nerve block in the participants of two groups.  The mean time taken for onset for analgesia in group 1 is 294 ± 33.7 seconds and 298 ± 36.8 seconds. There is no significant difference between the mean time taken for onset of analgesia in the participants of two groups. No significant difference between the systolic, diastolic and mean arterial pressures and pulse rate among the two groups before and after the nerve blocks.  No significant difference between the Times to First dose analgesia of both groups is noted. No significant difference is noticed between the two groups in verbal rating scale at any given points. Majority (76%) of the study participants were satisfied with analgesia produced by nerve blocks of either type. Conclusion: 3 in 1’ block and psoas compartment block are equally efficacious in relieving the post-operative pain in lower limb surgeries under spinal anaesthesia.

83. Prospective Assessment of the Pattern and Clinical Profile of Congenital Heart Disease among the Admitted Children: An Observational Study
Pawan Kumar Yadav
Abstract
Aim: This study was undertaken to find out the pattern and clinical profile of congenital heart disease among the admitted children. Methods: This was a prospective study conducted in Department of Pediatrics. The cases included all patients attending the out-patient or inpatient section of our department as well as the neonatal and Pediatric intensive care units within the age range of 0-14 years over a period of 24 months. A total of 2000 new cases of suspected CHD attended over a period of 24 months. Results: CHDs were more common among the male 1300 (65%). In present study, most CHDs (n= 1540, 77%) were diagnosed between age of 1 month to 6 years of age. Incidence of cyanotic CHD was n=500 (25%) and acyanotic CHDs was n=1500 (75%). In age-wise distribution, authors found that most diseases were diagnosed between 1 month and 6 years of age in both cyanotic and acyanotic disease groups. The most common cyanotic and acyanotic CHDs were also found between the age of 1 month and 6 years. In cyanotic disease group, majority of cases of tetralogy of Fallot were diagnosed between 1 month and 6 years. Similarly, in acyanotic disease group, maximum cases of atrial septal defect, ventricular septal defect, and patent ductus arteriosus were diagnosed between ages of 1 month and 6 years. Conclusion: Burden of CHD is highly underestimated and unrecognised, especially in this part of the country. This study can provide observed data that can help in policy making in the health sector. The contrasting result with respect to complex CHD in present study indicates need for good and effective antenatal cardiac screening in high risk mothers.

84. A Hospital Based Assessment of the Modifiable Risk Factors Which Are Responsible for the Non- Adherence among the Diabetes Population: An Observational Study
Birendra Kumar, Gitanjali Kumari
Abstract
Aim: The aim of the present study was to find out the modifiable risk factors which are responsible for the non- adherence among the diabetes population. Methods: The Present prospective cross-sectional study was performed on 500 diabetes patients who have visited Department of Medicine for the period of 1 year. Results: Mean age, weight, height and BMI of study cohort was 48.62±10.12 years, 64.96±12.08 kgs, 164.76±8.08 cm and 25.35±4.06kg/m2 respectively. Majority of the patients were males 350 (70%). Of the 500 patients, majority were T2DM patients 485 (97%) followed by T1DM 15 (3%). Only 75 (15%) patients had family history of diabetes. Majority of the patients were illiterate 200 (40%) followed by 140 (28%) patients who were graduate. Majority of the patients were married 490 (98%). Majority of the patients were on oral antidiabetic medications 475 (75%) followed by Ayurvedic plus Oral Antidiabetic medication 100 (20%). Only, 25 (5%) patients were on insulins. In present study majority of the patients were off the treatment since 1-5 months 400 (80%) followed by 60 (12%) patients who were off the treatment since 6-10 months. Most common response for the treatment interruption was long life medication period (75%) followed by the fact that majority were not aware of the consequences of missing the doses (68%), 65% due to the side effect of the medication and 58% had financial problem. Conclusion: It is very important to identify the patients with poor adherence in order to improve the factors responsible. By improving the risk factors for the poor adherence on individual basis better outcome can be obtained in terms of better glycemic control among the diabetes patients.

85. Assessing Effectiveness of various Management Strategies in the Management of Liver Abscess: An Observational Study
Balkeshwar Kumar Suman, Santosh Kumar, Shri Krishna Ranjan
Abstract
Aim: The aim of the present study was to evaluate effectiveness of various management strategies in the management of liver abscess. Material & Methods: It was an observational study carried out in 100 patients of age 12-80 years for the period of 12 months who presented to general surgery department and diagnosed with liver abscess. Results: Highest incidence was noted in age group of 51-60 years (30%) with a mean age of 46.84 years. Out of total 100 cases, 84 patients were male and 16 patients were female. Out of 100 patients 78 patients had liver abscess cavity of size 51-500cc (78%) followed by 12 patients who had <50 cc size cavity. Out of 100 cases 60 patients were treated with percutaneous needle aspiration with 16G metallic needle, 20 patients were treated with Percutaneous pigtail catheterisation, 10 patients were treated conservatively whereas 20 patients required surgical drainage. In the present study we can observe that 30 of 50 cases had volume aspirated between the range of 51-150 cc which correlates to high no of patients with residual liver abscess less than 150 cc. 26 of 50 cases (52%) were treated with a single aspiration along with antibiotics. 19 of 50 cases (38%) required second aspiration attempt. 3 of 50 cases required three attempts of aspiration and only 2 cases required fourth attempt of aspiration. 96% patients treated successfully. Conclusion: The present study concluded that conservative treatment with only intravenous antibiotics can be done for liver abscess with size less than or equal to 5 cm and volume less than 50 CC. Percutaneous needle aspiration is the best treatment modality for liver abscess measuring 5 10 cm, Percutaneous pigtail catheter drainage is a choice of treatment for large cavity size more than 10 cm and abscess having thick unliquified pus.

86. Assessing Quality of Life of the Caregivers of Children with or Without Disabilities: A Comparative Case-Control Study
Ratnesh Kumar, Arun Kumar, Nitin Joshi
Abstract
Aim: The aim of the present study was to compare the quality of life of the caregivers of children with or without disabilities. Material & Methods:  A cross sectional observational study was conducted in the Department of Physical Medicine and Rehabilitation in between the duration of 36 months. Caregivers of children with and without disabilities, who satisfied the inclusion criteria were included in the study. Total sample size taken was 200 (100 caregivers per group). Results: Out of 200 caregivers evaluated, majority of the children were in the age group 3-7 years, whereas caregivers were in the age group of 25-35 years. In both groups there was a preponderance of female child. Mother more commonly accompanied the child to the outpatient department as compared to father. More children were residing in nuclear families as compared to joint families in both case and control group. Majority of caregivers belonged to urban areas. Cerebral palsy was the most common cause of disability (77%) followed by Mental retardation (7%). Children with other disabilities were very few between 1 to 5 and thus intergroup analysis could not be done. Quality of life score was significantly lower in case group as compared to control group in all domains of WHOQoL-BREF. Quality of life scores in all the domains improved with increasing age of the child. After attaining the age of 11 years and above, scores obtained by the caregivers in both the groups were comparable. Caregivers in case group with age either less than 25 years or more than 35 years had better quality of life scores when compared to caregiver of children between 25 to 35 years in all domain except domain 2 and domain 1 within 15-25 years. Conclusion: Protocols should be framed in department managing children with disabilities to address the health issues of the caregivers. Help in the form of regular counselling, peer group interaction within the hospital and respective local communities, support including respite care services are Few things that can be incorporated in order to improve their quality of life.

87. A Single-Center Prospective Study Assessing Effectiveness of Continuous Catheter Drainage in Comparison to Needle Aspiration in the Treatment of Liver Abscesses
Dankhara Nitinkumar Harjibhai, Sumit Sharma, Chillington Nonghuloo
Abstract
Aim: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This was a single-center prospective comparative study conducted at department of General Surgery, GMERS Medical College and General Hospital, Himmatnagar Gujarat, India for the duration of 2 years. A total of 80 patients were included in the study, divided into two groups, percutaneous needle aspiration (n=40) and pigtail catheter drainage (n=40). Results: In present study the age group of the patients ranged from the 20-68 years. Highest incidence (57.5%) was found in 30-39 years age group. In this study 70 patients were male and 10 patients were female. 68 patients were from rural and 12 were from urban population and the incidence of alcohol consumption was 70%. It was observed that fever was present in needle aspiration and catheter drainage 96% and 94% respectively. There was 100% anorexia, pain and tenderness in right upper quadrant and hypochondrium in needle aspiration and catheter drainage respectively. It was observed that leukocytosis was 84% and 100% in needle syringe and catheter drainage respectively. There was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

88. A Hospital Based Prospective Comparative Study between Preprocedural Ultrasound and Real Time Ultrasound for Spinal Spaces
Kaiser Alam, Rishabh Ravi, Sujata Rani
Abstract
Aim: The aim of the present study was to evaluate comparison between preprocedural ultrasound and real time ultrasound for spinal spaces. Methods: This was a prospective Study conducted in Department of Anesthesiology at ESICMCH, Bihta, Patna after clearance from ethical committee. A total 100 subjects are included in this study and all the subjects were recruited in the study. Obese Patients with different disease and age more than 30 years were included in the present study. Results: Both the groups were comparable for gender, age, and BMI. The data distribution of all the parameters studied had at least one group with not normally distributed data. Hence, data was logarithmically transformed before applying parametric statistical tools. The median time for identifying space, the median time to achieve successful analgesia and the time taken for a successful lumbar puncture(s), was statistically significantly less in the RUS group in comparison to the PUS group. Conclusion: On the basis of the present observation it can be concluded that the space identification and number of attempts, passes are time-consuming in pre-procedure ultrasound when compared to real time ultrasound. This study suggested that real time ultrasound is good for identification of space.

89. Assessing Impact of Symbiotic Supplementation on various Biochemical Parameters in Children with Type I Diabetes Mellitus: A Randomized Clinical Study
Shruti, Arunika Prakash, Manoj Kumar Singh, Bhupendra Narain
Abstract
Aim: The aim of the present study was to evaluate the impact of symbiotic supplementation on glycemic parameters, lipid profile, and vitamin D levels in children with T1DM. Methods: This study was a single-center, double-blind, randomized, placebo-controlled clinical trial with a parallel design and random allocation of patients in two groups with a 1:1 allocation ratio at Upgraded Department of Pediatrics for one year. T1DM patients aged 4-18 were included in the study. Overall, 108 patients were invited to participate, and finally, 100 met the conditions for entering the study and completed the informed consent form. Results: Results showed no significant difference between the groups regarding sex, diabetes duration, and weight. Patients in the placebo group were older than those in the intervention group (p= 0.016). The trend of FBS, HbA1C, TG, cholesterol, HDL, LDL, and vitamin D changes was not significant over time in both groups. There was a significant difference in these variables between the two groups (p=0.046 and 0.022, respectively). However, no significant changes in TG, cholesterol, HDL, LDL, and vitamin D, were observed in the two groups. Conclusion: Our study showed that insulin treatment in combination with a synbiotic supplement had better outcomes than insulin therapy alone. It is suggested that symbiotic supplementation can improve FBS and HbA1C in T1DM children, though it had no effects on lipid profile and vitamin D levels.

90. Comparative Study of Intracuff Air versus Dexamethasone in Endotracheal Tube in Preventing Post-Operative Sore Throat
Ranjeet Rana De, Akhileshwar, Nitin Kumar, Akrity Singh, Saurav Shekhar, Rajbahadur Singh
Abstract
Aim: The aim of the present study was to compare the intra cuff air versus dexamethasone in endotracheal tube in preventing post-operative sore throat. Methods: The present study was done in the Department of Trauma and Emergency over a period of one year. The study population included 200 patients of ASA class I and II who underwent general anaesthesia with controlled ventilation with endotracheal intubation posted for elective surgeries of two to three hours duration. Results: The incidence of sore throat at 24 hours postoperative was lower in group D than in group A. 9 patients (9%) in group D had sore throat while 55 patients (55%) in group A had sore throat at 24hours. This was statistically significant (p<0.05). There was a statistically significant (p<0.05) decrease in VAS score recorded at one, six, twelve and 24hours after surgery both at rest and with swallowing in group D than in group A. 25% and 20% noted hoarseness of voice in group A and group D respectively. 43% and 15% noted cough incidence in group A and group D respectively. Conclusion: It is noteworthy to observe that when endotracheal tube cuff is inflated with dexamethasone, the incidence of post-operative sore throat and cough is reduced but not hoarseness of voice. Further studies are needed in this direction before this becomes standardized and accepted as a routine one.

91. A Cross-Sectional Study to Evaluate the Etiological and Antimicrobial Susceptibility Pattern in Children with Community Acquired Urinary Tract Infection
Vinay Kumar Yadav, Hemant Kumar, A. K. Jaiswal
Abstract
Aim: The aim of the present study was to assess the etiology and antimicrobial susceptibility pattern in children with community acquired urinary tract infection. Methods: This cross-sectional study was carried out at Upgraded Department of Pediatrics. 200 culture positive cases of UTI, who were admitted in the hospital were included in this study. Results: There were 90 (45%) males and 110 (55%) females. Their ages ranged from 2 month to 12 years. The age distribution of the patients, maximum number of children in the study group 76 (38%) were in the age group of 1 month to 1 year, followed by 46 (23%) in the age group of 2 to 4 years of age, followed by 44 (22%) in the age group of 1 to 2 years of age and 34 (17%) in the age group of more than 4 years of age. Susceptibility pattern of E. Coli was ampicillin (S=0%, R=100%), cotrimoxazole (S=88.23%, R=10%), nitrofurantoin (S=96.47%, R=3.52%), norfloxacin (S=77.64 R=23.52%), cefuroxime      (S=32.35%, R=67.64%), cefotaxime (S=4.70%, R=95.29%), ceftazidime (S=34.70%, R=61.76%), cefixime (S=60%, R=10%, IS=28.23%), piperacillin-tazobactam (S=67.64%, R=20.58%, IS=14.11%), imipenem (S=97.05%, R=0%, IS=2.94%) and meropenam (S=94.11%, R=3.52%). Maximum sensitivity was to meropenem, imipenem and nitrofurantoin. Susceptibility pattern of K. Pneumonae was ampicillin (S=0%, R=100%), cotrimoxazole (S=62.50%, R=37.50%), nitrofurantoin     (S=91.66%,     R=8.33%),     norfloxacin (S=54.16%, R=45.83%), cefuroxime (S=41.66%, R=54.16%),      cefotaxime      (S=4.16%,      R=95.23%), ceftazidime (S=33.33%, R=66.66%), cefixime (S=41.66%, R=33.33%, IS=25%), piperacillin-tazobactom (S=54.16%, R=33.33%, IS=16.66%), imipenem     (S=83.33%,     R=4.16%,     IS=8.33%)     and meropenam (S=100%, R=0%). Conclusion: UTI is a common disease in children. The incidence is more common in females than males and in age group from 1 month to 1 year. In our study, E. coli is the leading pathogen, followed by K. pneumoniae, Enterobactor and P. vulgaris. Uropathogens were mainly resistant to ampicillin and cefotaxime, thus they should not be used empirically to treat UTIs.

92. Comparing Outcome Assessment of Mesh Fixation with Metallic versus Delayed Absorbable Suture Material in Inguinal Hernia through Laparoscopic Surgery
Roshani Prasad, Binod Kumar Jaiswal
Abstract
Aim: The aim of the present study was to compare outcomes of mesh fixation with metallic versus delayed absorbable suture material in inguinal hernia through laparoscopic surgery. Material & Methods: This was prospective study conducted in the Department of General Surgery during the period of one year. Total 100 male patients who underwent laparoscopic surgery were included in the study. Results: In group 1, the patients’ mean age of 52.8 years and in group 2 mean age of 51.5 years in group 2. In group 1, 12 (24%) patients having right and 13 (26%) patients have left, 14 (28%) patients have unilateral hernias and 11 (22%) patients have bilateral hernias while in group 2 there were 18 (36%) patients having right, 10 (20%) patients have left, 12 (24%) patients have unilateral hernias and 10 (20%)  patients have bilateral inguinal hernias. There was appearance of post-operative pain in 16 patients, 8 patients, and 5 patients after 10 days, after 1 month and after 3 months, respectively in group 1 while for group 2, post-operative pain appeared in 12 patients, 5 patients, and 2 patients after 10 days, after 1 month and after 3 months, respectively. As such there was no statistical significant difference was found between two groups except for the appearance of the post-operative pain after 1 month (p<0.05). The appearance of post-operative paresthesia in both surgical groups, there was more number of patients had developed paresthesia group 1 as compared to group 2 but it was not statistical significant. Conclusion: In Laparoscopic surgery, a straightforward, safe, and efficient alternative to tension-free open mesh fixation with delayed absorbable suture material. With There are fewer odds of chronic groin discomfort and paresthesia following air knot fixation compared to the conventional way of fixation.

93. An Observational Study to Assess the Orthopaedic Management of Club Foot at Tertiary Health Care Facility
Mani Bhushan Prasad Singh
Abstract
Aim: The aim of the present study was to assess the orthopaedic management of club foot at tertiary health care centre. Methods: This was cross-sectional study carried out in the Department of Orthopaedics with idiopathic club foot less than one year age presented to the Orthopaedic Department during the two-years were included into the study. In the two-years period there were 50 patients after written explained consent were enrolled to study. All necessary details of the patients were noted like age, sex, pre interventions modified Pirani score noted. Results: The majority of the patients were in the age group of 0-3 (months) were 40%, followed by 3-6 were 32%, 6-9 were 18%, 9-12 were 10%. The majority of the patients were Female i.e. 64% and Male were 36%. In all the age groups the Post treatment Pirani score significantly differed as compared to pre-treatment score i.e. 0-3 were 5.32 ±2.18 and 1.55 ± 1.035 (t=8.82,df=72,p<0.01); 3-6 were 5.48± 0.82 and 1.58 ± 1.32 (t=12.58,df=56,p<0.001); 6-9 were 5.75 ± 2.15 and 2.18±0.96 (t=9.91df=26,p<0.05); 9-12 were 5.36 ± 1.24 and 1.86 ± 1.34 (t=10.20,df=24,p<0.001) were statistically significant. Conclusion: According to the results of our investigation, the ponsetti approach was very efficient in the management of idiopathic club foot, as measured by the Pirani score for club foot assessment almost all the patients were doing well with this treatment.

94. Evaluation of Pattern of Injury in Terms of Severity and Outcome in Patients with Head Injuries Admitted in Trauma Unit
Sandeep Yadav, Madhu Priya
Abstract

Aim: The aim of study to know the pattern of injury in terms of severity and outcome in patients with head injuries admitted in trauma unit of a tertiary care Centre in Bihar region. Methods: This study included 200 patients admitted Department of General Surgery. Thereafter a complete history of all patients of head injury sustained due to RTA or fall was taken after taking written & informed consent. Those with poly trauma and others not attending the OPD for check-ups timely were eliminated from study. After admission in head injury unit, physical examination was performed in all subjects. Results: It was observed that incidence of head injury was more in males than the females. Out of 200 cases, 175 (87.5%) victims were males and 25 (12.5%) cases were females. Out of 200 cases, maximum incidence of head injury was found in the age group of 21-30 years comprising 50 (25%) cases, followed by 31-40 years 46 (23%) and 41-50 years 40 (20%). The age group 51-60 yrs comprised of 34 (17%) cases. The other affected groups were 61-70 years and 71-80 years group comprising of 12 (6%) cases and 8 (4%) cases respectively. It was observed that road traffic accident was the commonest cause of head injury seen in 144 (72%) cases. This was followed by fall from height 32 (16%) cases and assault 20 (10%) cases. The other causes like fall of tree or wall over-head were seen in 2% cases. It was seen that most of the cases 122 (61%) died within 24 hours of admission to the hospital. 28 (14%) cases survived for 1-2 days. 20 (10%) of cases survived for 2-3 days. 20 (10%) cases survived for 3-7 days and about 10 (5%) of cases survived for more than 7 days. Thus the most fatal period was first 24 hours. Out of 200 cases, 15 cases expired. Conclusion: The study showed that most head injury victims brought to a tertiary care hospital, were due to road traffic accidents and males are more prone to get Head injury. So it warrants the urgency to establish good pre-hospital care and provision of efficient and prompt trauma services at Road side to prevent mortality aroused from RTA. RTA remains the most common cause for Head injury and demands good neurosurgical care for such patients.

95. A Comparative Study Assessing the Efficacy of Antiviral Agent Valacyclovir Compared with Famciclovir in the Treatment of Herpes Zoster
Jaya Roy, Md. Zamiruddin, Rohit Kumar Singh
Abstract
Aim: The objective was to evaluate the efficacy of antiviral agent valacyclovir compared with famciclovir in the treatment of herpes zoster. Methods: The present study was comprised of 200 patients who developed herpes zoster of both genders. All of the patients that were enrolled gave their consent.The study was carried out at hospital over a 2-year period. Data such as name, age, gender, etc. was recorded. All were divided into 2 groups of 50 patients each. Group I patients were prescribed valacyclovir 1000 mg thrice daily, and Group II patients were prescribed famciclovir 500 mg thrice daily. The treatment was given for 7 days. Results: Group I had 56 males and 44 females and group II had 48 males and 52 females. Dermatome in group I and group II involved were thoracic in 60 and 52, lumbar in 12 and 12, cervical in 16 and 20 and trigeminal in 12 and 16 respectively. The difference was non- significant (P> 0.05). The VAS scores comparison at every follow-up visit between both the groups. The mean VAS scores on the day of presentation, i.e., the baseline scores in both the groups were almost similar, and the difference was not statistically significant.  Results showed a greater number of totally pain-free patients at day 30, i. e., 82 (82%) patients in the valacyclovir group, while in the famciclovir group, 62 (62%) patients were reported to be totally pain free, although it was statistically insignificant (P > 0.05). Conclusion: In comparison to famciclovir, oral valacyclovir administered for 7 days during acute zoster infection offers significant benefit by providing a well-tolerated and greater resolution of pain while maintaining a favourable safety profile, making valacyclovir more efficacious and a better drug in the management of Herpes Zoster.

96. A Hospital-Based Study Evaluating the Impact of Umbilical Cord Abnormalities on Neonatal Outcome: A Retrospective Study
Swati, Gunjan
Abstract
Aim: The aim of the present study was to assess the impact of umbilical cord abnormalities on neonatal outcome. Material & Methods: A retrospective study was conducted in Department of Obstetrics and Gynaecology. 200 pregnant women with singleton pregnancy who delivered after 28 weeks of gestation during 1 year period, who were diagnosed and documented as having umbilical cord abnormalities either antenatally or during and after delivery were included in the study after taking informed and written consent. Results: The age of majority of patients was in the range of 21-28 years as this group is most fertile. Primigravida comprised of 40% whereas 60% were multigravida. 65% patients had normal vaginal delivery whereas 35% patients required Caesarean section. Of all the abnormalities of umbilical cord, the most common abnormality encountered is Nuchal cord (cord around the neck) with 70% cases in our study. Abnormal cord length i.e. Long (>100cm) and short (<40cm) was seen in 12% cases. Rare abnormalities like vasa previa, velamentous insertion and cord prolapse was seen in 1% cases each. Single umbilical artery was seen in 3% cases. Cord knot which includes true as well as false knots was seen in 5% cases. Coiling abnormality which includes hyper as well as hypo coiled cord was seen in 7% cases. Majority of the patients had APGAR score >7 at 1 and 5 minutes. 71% fetus had live birth without any complication and did not require NICU admission. 20% required NICU admission. 4% had early neonatal death, 2% late neonatal death whereas 3% was still birth. Conclusion: Umbilical cord abnormalities are a stress factor for fetus, where stillbirth can occur due to combination of risk factors. This is especially important because most of these still births occur relatively late in pregnancy in a setting of otherwise normal foetuses and pregnancies. Therefore, early detection and continued surveillance will help to prevent such sudden fetal loss.

97. Management of Displaced Mid Shaft Clavicle Fractures at Tertiary Health Care Centre: A Comparative Study
Manish Kumar, Surya Prakash
Abstract
Aim: The aim of the present study was to compare Conservative versus Surgical Management with Locking Compression Plate (LCP) of Displaced Mid Shaft Clavicle Fractures. Methods: This was a cross-sectional study carried out at department of Orthopedics in the patients with clavicle fracture during the two years period. During the one-year period there were 140 patients with clavicle fracture were enrolled to study out of the 140 with the written and explained consent 70 patients were managed conservatively (group A) and 70 managed surgically by Compression Plate (group B). Results: The average age was comparable in both the groups i.e. 46.14±3.14 and 43.17±3.27 and there was male predominance in both the groups. The average healing was significantly more in conservative management group i.e. 6±4.36 months versus 3.77± 2.78. The complications were Mal-union, Union with symptoms, Delayed union, Infection etc. The complications were comparable in both the groups. Conclusion: It can be concluded from our study that both the methods were comparable with respect to the complications but healing was significantly faster in the surgical method of management hence surgical management should be preferred but the manage should individualized as per the patient.

98. Voiding Pattern in Asymptomatic Indian Males Age 20 to 70 Years
Rohit Upadhyay, Khalid Mahmood, Rakesh Kumar, Shashi Prakash, Nandesh
Abstract
Aim: The aim of the present study was to assess the voiding pattern in asymptomatic Indian males. Methods: The present study was conducted at department of Urology, IGIMS Patna, Bihar, India and 200 ambulatory men who considered themselves to have normal urinary function were recruited. Interested participants were asked to complete a screening symptom questionnaire. Results: A total of 200 asymptomatic males returned interpretable 24-hour diaries. Median age was 36 years (range 18 to 68). Subjects voided a median of 7 times in 24 hours (range 2 to 21) with 95% voiding fewer than 12 times daily. Median 24-hour urine volume was 1,650 ml (range 290 to 6,840).).  Key findings were the fact that subjects reported a median of 6 voids during 24 hours (range 2 to 21) with 95% voiding fewer than 12 times daily. Of the 200 men providing QOL ratings 120 (60%) were delighted, 60 (30%) were pleased, 16 were mostly satisfied, 4 were mixed unhappy. These 271 men had recorded a total of 261 I-PSS values with a median score of 2 (range 0 to 22), and with the distribution of I-PSS values within QOL categories as expected. Conclusion: Our results broadly agree with the sparse data from other countries suggesting that the use of a cutoff of 8 daily voids to define abnormal urinary frequency may not usefully discriminate between normal and abnormal urinary function. Furthermore, since urinary diary variables depend on patient characteristics, including age and are likely also to depend on climatic and social factors the application of a single set of normative values to all men is probably inadvisable.

99. Hospital Based Prospective Comparative Assessment of the Fracture Distal End of Radius Treated with Percuteneous Multiple K-Wire
Rajeev Kumar Rajak, Barun Kumar Golwara, Randhir Kumar
Abstract
Aim: The aim of the present study was to assess the fracture distal end of radius treated with percuteneous multiple k-wire. Methods: This was a prospective, comparative observational study was conducted in the Department of Orthopaedics. About 40 patients with Distal Radial Fractures presented to Government medical College, Bettiah, Bihar, India were included in the study. 25 patients, who fulfilled the inclusion criteria, were included in the study. Results: The majority was men (60%). Majority of the patients (72%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. Majority of the patients (80%) did not have associated injuries. In our study, according to AO classification, 15 cases were of Type A, 7 were of Type B and 3 were of Type C In our study, 68% of the cases showed ―Excellent, 24% of the cases showed ―Good, 4% cases showed―Fair and only 4% cases showed ―Poor result. At final follow-up by the Gartland & Werley Criteria for Functional Outcome 17 (70%) patients had excellent result, 6 (24%) had good result, 1 (2%) had fair result and 1 (2%) had a poor result. There were no major complication noted except for pin site infection in 4 (16%) cases and pin loosening in 1 (4%) cases. Conclusion: This study demonstrated that percutaneous Kirschner wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical fracture reduction. It does not required highly skilled personnel or sophisticated tools for application. It is a suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

100. A Morphometric Analysis of Variability in Morphology of the Renal Vein: An Observational Study
Suman Kumari, Chandan Kumar, Rajendra Prasad
Abstract
Aim: The aim of the present study was to study the variability in morphology of the renal vein and to measure length of renal vein and to observe the variations in renal vein. Methods: The dissection was done in 50 embalmed cadavers at department of Anatomy. They included 35 male and 15 female cadavers. This was cross- sectional study. They were collected from the dissection hall. Results: Tributaries that emerge from the kidney and join to form renal vein are called primary tributaries. These were present in 14 in right and 20 in left specimens. 66% specimens didn’t have extra hilar primary tributaries. Statistically significant association was not found between presence of primary tributary of renal vein and side. Statistically significant difference found between length of renal vein of right and left side. Average length was more on left side (62.44 mm) than that of right side (26.98 mm). Conclusion: Detailed knowledge of variations of these vessels will definitely improve outcome of various urological, renal transplantation and laparoscopic surgeries. This knowledge will be of immense help to radiologists and oncologists who are dealing with this region. Also, a detailed knowledge and understanding of major congenital anomalies of the renal veins variations will provides safety guidelines for endovascular procedures.

101. An Observational Study Assessing Clinical Profile and Factors Associated with Uterine Fibroids at Tertiary Care Hospital
Swati
Abstract
Aim: The aim of the present study to assess the clinical profile and factors associated with uterine fibroids at tertiary health care center. Material & Methods: This was a prospective study carried out in department of obstetrics and Gynaecology  for the period of nine months . Study population were patients presenting with uterine fibroid. Total 200 patients were studied during study period. Results: Majority of the patients were in the age group of 31 -40 years followed by 41-50 years. Fibroid was not seen below 20 years. Majority of the patients with fibroid were with parity 1-2. 22 patients were having parity above 4. Majority (48%) patients were with size of uterus corresponding to 13-20 weeks followed by 21-24 weeks (32%). Uterine size >24 weeks was observed in 20% patients. 75% patients were having menstrual disturbances. 80% patients showed anaemia according to hemoglobin estimation. It can be due to excessive bleeding during menstruation.44% patients complained of abdominal lump. Other symptoms and signs observed were pain in lower abdomen (16%), Dysmenorrhoea (30%), urinary frequency (14%), dyspareunia (13%), infertility (20%) and mass protruding out of vagina (11%). Single intramural fibroid was observed most commonly (62%) followed by multiple submucosal fibroids (18%). Subserous fibroids were seen in 14 patients, cervical fibroids were seen in 11% patients and only four patients had broad ligament fibroid. Conclusion:  It was concluded that uterine fibroids are commonly seen in females of reproductive age group and present with menorrhagia and abdominal pain. Uterine fibroids are more commonly seen in 30-40 age group. Menstrual disturbances are the most common symptom.

102. Determining the Incidence of Bipolar Disorder in Patients Treated for Major Depression: An Observational Study
Farheen Fatma
Abstract
Aim: The aim of the present study was to assess the proportion of patients with features of bipolar disorder amongst those primarily diagnosed and treated as major depressive disorder and compare the symptom profile of unipolar depression and bipolar depression. Methods: The present study was conducted in the Department of Psychiatry for one year who were being treated as Major Depressive Disorder according to DSM-4 TR and were receiving antidepressant medications, were included in the study. 200 patients were included in the study. All the patients were above age of 18 years and have informant available. Participants were included in the study after taking informed consent. Results: 64% were females. Majority of selected patients were married females (78%). 19% patients were illiterate and 80% were hindus. 52% were staying in nuclear family and 85% belonged to urban area. 85% patients had no history of suicide and there was no family history of any psychiatric illness in 60%. 170 patients had bipolar disorder and 30 patients had unipolar disorder. Patients having Bipolar Mood disorder were significantly younger than unipolar depression. No significant difference was found in sex, marital status, education, religion, income, family type, occupation or locality between two groups. Number episodes of illness were significantly higher in bipolar mood disorder than unipolar. Family history of mood disorder was significantly higher in bipolar disorder group than unipolar. In clinical features, there was no significant difference in suicide attempt between both groups. Significant difference was found in diurnal variation. Psychotic features were significantly higher in bipolar mood disorder patients than unipolar depression. Conclusion: It is clear that with high index of suspicion, bipolarity is patently diagnosable in a substantial proportion of patients being treated as unipolar major depression. They have difference in clinical features from unipolar depression in the form early age of onset, positive family history for mood disorder, more number of mood episodes and presence of psychotic features during the depressive episode and course of illness.

103. Assessing Dietary Pattern and Physical Activity among Adolescents: An Observational Study
Nasim Akhter, Irshad Alam, Sazid Hussain
Abstract
Aim: The current study aimed to focus specifically on objectively assessed physical activity & and dietary habits among adolescents of Bihar. Methods: The current investigation was undertaken, and cross-sectional data were gathered. The data were collected from teenagers aged 12 to 16 who were recruited from three secondary schools in Bihar. Personnel at the schools that agreed to participate chose a smaller group of their classes to take part. All pupils belonging to the nominated courses (n = 415) were qualified and provided with written information on the project. Prior to the study, parental consent was obtained, and teenage participants gave their approval before completing written questionnaires in class. Results: A total of 393 students granted consent and successfully completed the questionnaire, resulting in a response rate of 95.85%. Out of them, 150 participants (38.16%) produced accelerometer data that could be used. There were no significant variations in age, socioeconomic status, ethnicity, or fruit and vegetable consumption between the group of 150 adolescents being compared and the group of 150 adolescents who did not produce useable accelerometer data. Nevertheless, a substantially greater percentage of individuals with valid accelerometer data were female, as opposed to male (53% versus 37%), and had breakfast on a greater number of days per week (4.7 days against 3.5 days). Hence, our data is likely to underestimate the proportion of those who do not fulfill the breakfast requirements. The ultimate sample makeup consisted of 150 adolescents, comprising 70 males, 80 females, 68 younger adolescents, and 50 older adolescents. The average age of younger adolescents was 14.3 years, whereas the average age of older adolescents was 14.6 years. Conclusion: A significant number of teenagers do not fulfill various food and physical activity guidelines, indicating that physical activity and nutritional habits are interconnected. Further study should explore optimal strategies for achieving simultaneous modification of several health behaviors in teenage males and females.

104. Assessing Diagnostic Utility of NLR to Predict Poor Functional Outcomes in Patients with Hemorrhagic Stroke and To Compare it with the Intracranial Hemorrhage (ICH) Score: A Comparative Study
Arun Kumar, Nishant Kumar Singh
Abstract
Aim:  The aim of this study was to evaluate the diagnostic utility of NLR to predict poor functional outcomes in patients with hemorrhagic stroke and to compare it with the intracranial hemorrhage (ICH) score. Material & Methods: Patients who presented to the emergency department with clinical features suggestive of stroke were evaluated with computed tomography (CT) brain to identify ICH. The ICH scores and NLR were estimated at the time of admission. Modified Rankin Scale (mRS) score equal to or greater than 3 at 90 days was used to define poor functional outcomes (major disability or death). Receiver operating characteristic (ROC) curve was plotted with NLR and the ICH score to analyze and compare their discriminative ability to predict poor functional outcomes. Results: A total of 100 patients were included in this study, 65 males and 35 females. The mean age of the study group was 64.6 years (SD = 12.6). 32% had ICH score 2 followed by 21% had ICH score 1. Of the total 100 patients, 65 subjects (65%) had mRS score greater than or equal to 3 at 90 days. These patients were categorized as the poor functional outcome group. 35 patients (35%) had mRS score less than 3 at 90 days and were categorized as the good outcome group. The all-cause mortality at 90 days was 16 (16%) in the study. The difference of Laboratory variables and the ICH score according to 90 days of outcomes were found to be statistically significant. At their cutoff values, NLR compared to the ICH score was found to be more sensitive but less specific. There was no significant difference in accuracy between NLR and the ICH score. Conclusion: In patients with hemorrhagic stroke, NLR at admission is a good predictor of functional outcomes at 90 days. When compared to the ICH score, NLR is more sensitive but less specific in predicting poor functional outcomes.

105. A Hospital-Based Study Assessing Visual Outcome Following Management of Traumatic Cataract: A Cross Sectional Study
Amrendra Kumar, Parambir Kumar Bharti
Abstract
Aim: The aim of the present study was to assess the visual outcome following management of traumatic cataract. Methods: The present study was a cross sectional study carried out in Ophthalmology outpatient Department for the period of 18 months. Study population was all the patients presenting with cataract. 80 cases from these cases of traumatic cataract were included for this study as the remaining patients did not fulfill the inclusion criteria. Results: The age group ranged from 18-62 years. More number of cases was found in the age group of 21-40 years (60%). Out of 80 cases, 60 were males and 20 were females. Out of 80 cases of traumatic cataract, 24 were blunt and 56 were penetrating trauma. Pre-operative visual acuity was recorded in all cases. In 20 cases (25%), the preoperative visual acuity was PL/PR. In 36 cases (45%), the preoperative visual acuity was perception of hand movements. Visual acuity of the uninjured eye was recorded in all the patients and was found to be within the normal limit. Out of 80 cases of traumatic cataract, 74 cases underwent ECCE (Small Incision Cataract Surgery) with PCIOL implantation, 2 cases underwent small incision cataract surgery with PCIOL implantation with corneal tear repair, 2 cases underwent small incision cataract surgery with PCIOL implantation with anterior vitrectomy, 2 cases underwent small incision cataract surgery with aphakia. Out of 80 cases, final visual acuity of 6/6 to 6/18 was seen in 20 (25%) cases. Final visual acuity of less than 6/18 to 6/60 was seen in 50 patients (62.5%). 10 patients (12.5%) had visual acuity less than 3/60. Conclusion: Traumatic cataract is a serious visually challenging sequel of trauma. In cases of traumatic cataract, to have a better visual outcome after surgery, early diagnosis followed by proper management plays an important role. Therefore stress has to be given on awareness of the public and ocular safety measures should be taken at work places to prevent the ocular hazards associated with the ocular trauma. In addition, early reporting and adequate follow up especially in cases of children needs to be emphasized.

106. A Study to Assess the Efficacy and Acceptability of Pomegranate Effervescent Granules (PEGS) in Dyspeptic Patients
Krishna Kant Nirala, Rohit Kumar Singh
Abstract
Aim: This study aimed to assess the efficacy and acceptability of pomegranate effervescent granules (PEGs) in dyspeptic patients. Material & Methods: A prospective study including 50 patients reported to ANMMCH, Gaya, Bihar, India and informed written consent was obtained from all participating individuals before screening and again before recruitment. Gastrointestinal Symptom Rating Scale (GSRS) scores to assess symptoms of acid peptic disorders at day 0, 15, and 29 along with the taste of formulation were the main study outcomes. Results: In the group treated with Punica granatum at a dosage above 500 mg/kg, the Ulcer Area (mm2) was measured to be 128.42±1.28, and the Ulcer Inhibition % was found to be 84.66. In the group receiving Punica granatum therapy at a dosage of 250 mg/kg, the Ulcer Area was measured to be 458.42±8.52 mm2, with an Ulcer Inhibition rate of 41.89%. In the group receiving omeprazole treatment, the Ulcer Area (mm2) was measured to be 622.18±12.48, with an Ulcer Inhibition of 24.56%. In comparison, the control group had an Ulcer Area of 832.00±24.86 and an Ulcer Inhibition of 14.76%. The Ulcer Inhibition percentage in the Punica granatum treatment groups was significantly higher than that of both the omeprazole treatment group and the control group (P=0.0001). Pomegranate peel exhibited significant antioxidant activity, as shown by its DPPH radical-scavenging activity percentage. The greatest zone of inhibition was seen against Y. enterocolitica and S. enterica in comparison to the other microorganisms examined. An inhibition zone of 10.5 mm was reported as the second greatest against B. cereus. Conclusion: PEGs shown their ability to effectively alleviate symptoms of dyspepsia in acid peptic diseases, while also being well-tolerated, convenient for patients, and safe.

107. A Study to Assess the Correlation of Proteinuria and Urine Protein/ Creatinine Ratio with Disease Severity in Pediatric Dengue Fever
Ajit Kumar Singh, Sachin Kumar, Nagendra Prasad Gupta
Abstract
Aim: The aim of the present study was to assess the correlation of proteinuria and urine protein/creatinine ratio with disease severity in pediatric dengue fever. Methods: The present study was a hospital based, serially enrolled, prospective one which was carried out at Department of Pediatrics  for the period of 1 year. A total of 200 children met the inclusion criteria. Children aged 1 month to 18years, hospitalized with clinical features of dengue and testing positive serology (NS1, IgM) were included in the study. Results: Of these 42 were infants, 30 between 1-8 years and 60 children were above 8 years of age of which 150 were boys and 50 girls. All the patients were grouped according to the ratio as <0.5, 0.5- 1.0, 1.0-3.0 and >3.0. 37% of children had UPCR of less than 0.5. 20 children had bleeding manifestations during course of illness, among which 10 had UPCR >3. There was a statistically significant association between high UPCR and bleeding manifestations (p<0.05). In this study, 180 children had third space collections. In this study, 25% children required inotropes. It was observed that cases who needed inotropes had higher UPCR and this association was statistically significant. The final outcome was noted as discharged or death in each group. We had 10 deaths in our study, in which 6 children had UPCR>3 and 2 had UPCR 1-3. All children with UPCR <1 were cured and discharged. The association of raised UPCR with mortality showed a positive correlation and was statistically significant. The proteinuria in urine sample was quantified by pyrogallol test, the laboratory standard value of which was 100mg/dl. Conclusion: The need of early predictors of disease severity are important. Such markers have not been well studied in the paediatric population. UPRC and proteinuria assessment are easy to perform and inexpensive tests. This study found UPRC to be an accurate marker in predicting disease severity, third space loss, bleeding manifestations, need of inotropes and adverse outcome in children with dengue fever.

108. Conservative versus Surgical Management with Locking Compression Plate (LCP) of Displaced Mid Shaft Clavicle Fractures: A Comparative Study
Randhir Kumar, Govind Mohan Jee
Abstract
Aim: The aim of the present study was to compare Conservative versus Surgical Management with Locking Compression Plate (LCP) of Displaced Mid Shaft Clavicle Fractures. Methods: This was a cross-sectional study carried out department of Orthopaedics, patients with clavicle fracture during the two years period. During the one year period there were100 patients with clavicle fracture were enrolled to study out of the 100 with the written and explained consent 50 patients were managed conservatively and 50 managed surgically by Compression Plate (LCP). Results: The average age was comparable in both the groups i.e. 43.17 ±3.16 and 42.18±4.16 and there was male predominance in both the groups. The average healing was significantly more in conservative management group i.e. 5 ± 3.47 months versus 2.88± 2.78. The complications were Mal-union, Union with symptoms, Delayed union, Infection etc. The complications were comparable in both the groups. Conclusion: It can be concluded from our study that both the methods were comparable with respect to the complications but healing was significantly faster in the surgical method of management hence surgical management should be preferred but the manage should individualized as per the patient.

109. Assessment of the Association between Bone Metabolic Markers and CAD Risk Score: An Observational Study
Aishwerya, Pramod
Abstract
Aim: The aim of the present study to analyze the association between bone metabolic markers and CAD risk score in the general population of Bihar region. Material & Methods: The present study was conducted at Department of Cardiology, Total 2000 participants were included in the study. Results: There were 60% females and 40% males. Participants had co-morbidities like diabetes mellitus, dyslipidaemia, hypertension. The median Suita score was 43 points, and the median baPWV was 1,432 cm/s. TP1NP level was negatively associated with the CAD high-risk subgroup (Suita score ≥ 56) (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.69–0.82, P < 0.001). There were significant differences in age, sex, history of smoking, history of diabetes, history of CAD, body mass index (BMI), SBP, DBP, baPWV, Suita score, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, creatinine, uric acid, corrected calcium, phosphorus, hemoglobin, hemoglobin A1c, and N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP). Significant differences were observed in age, sex, smoking history, dyslipidemia history, hypertension history, BMI, SBP, DBP, baPWV, Suita score, total cholesterol, tri- glyceride, HDL cholesterol, LDL cholesterol, creatinine, eGFR, uric acid, corrected calcium, phosphorus, hemoglobin, and hemoglobin A1c. Significant differences were observed in age, sex, smoking history, diabetes history, hypertension history, CAD history, BMI, SBP, DBP, Suita score, total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, creatinine, uric acid, corrected calcium, phosphorus, hemoglobin, and hemoglobin A1c. Conclusion: This study demonstrated that TP1NP levels decreased in participants with high Suita scores and high baPWV, suggesting that TP1NP down regulation may indicate future CAD risk and atherosclerosis progression in the general population of Bihar.

110. A Cross Sectional Study Assessing the Psychological Distress and Caregiver Burden among Care Givers of Schizophrenia Patients
Ravikant Kumar
Abstract
Aim: The study was conducted with the aim of assessing the psychological distress and caregiver burden among care givers of schizophrenia patients. Methods: The cross-sectional study conducted in the Department of Psychiatry. A total of 100 subjects were included in the analysis. Primary Caregivers of psychiatric inpatients and outpatients in Jay Prabha Medanta Hospital, Patna, Bihar, India with a diagnosis of Schizophrenia with duration of illness >2yrs classified under F20 according to ICD-10 and aged more than 18 years were included in the study. Results: The majority of patients were female (68%). 85% were married. The majority of the patients had low educational level with 12% of them being illiterate and 35% of the patients were unemployed. 90% were in the nuclear family. The odds of psychological distress were 1.075 times increase with each year increase age which was statistically significant (P value 0.044). The odds of psychological distress were 1.392 times increasing with each one hour increase in total caregiving giving time which was statistically significant (P value 0.039). The odds of psychological distress in caregivers were 1.087 times more in patients who had negative symptoms compare to those with positive symptoms. The association was statistically significant (P value 0.045). The odds of psychological distresswas1.083 times increased with one unit increase in PANSS total score and was statistically significant (P value 0.013). The odds of psychological distress was1.117 times increased with one unit increase in Care Giver Burden Schedule score which was statistically significant (P value 0.001). The presence or absence of psychological distress among the study population was determined using Self-reporting questionnaire 20. After adjusting for the effect of other variables in the equation, only one parameter had shown statistically significant association with psychological distress in the study. Conclusion: Caregivers of schizophrenic patients suffered from significant burden. It thus becomes important to plan interventions that would reduce their burden of care and thus improving their psychological well-being.

111. Prospective Study Determine Etiology, Risk Factors of Non-Traumatic Small Intestinal Perforation
Asik Ikbal Mazumder, Faizan Ahmad, Zaid bin Afroz
Abstract
Aim: The aim of the present study was to assess the etiology and risk factors of non-traumatic small intestinal perforation. Material & Methods: This prospective study was conducted in the Department of General Surgery, 50 patients were included. The patients with intestinal perforations due to trauma, mesenteric ischemia and obstruction or strangulation because of hernia, volvulus or intra- abdominal adhesions, and peptic ulcer perforations of the duodenum were excluded from the study. Results: Patients were of 20-30 years of age followed by 20% who belonged to 10-20 years age group. Mean age of the patients who presented with perforation peritonitis was 35.5 years that shows age was not a confounding factor. Among patients who presented with perforation peritonitis, majority (84%) of the patients were males. Only 9 out of 50 patients were females suggesting gender was not a confounding factor. Out of the 50 cases, 42% were caused by peptic ulcer, 22% by tuberculosis, 18% by typhoid, 10% by ischemic bowel disease, 2% by malignancy, 4% by intussusception, and 4% by worm infestation. The p-value cannot be determined from this table alone as it only provides the frequency distribution of the etiology of the disease. Abdominal tenderness was present in all patients, signs of peritoneal irritation were present in 38 (76%) patients. The other patients had moderate localized or generalized tenderness but relatively soft abdomen. Out of the total of 50 cases, 68% underwent primary repair, 12% underwent resection with primary anastomosis, 12% underwent resection with exteriorization of the bowel, another 6% underwent resection with anastomosis and proximal stoma, and 2% received palliative drainage. Conclusion: Non-traumatic small bowel perforation is a serious condition associated with significant morbidity and mortality. The etiology, clinical presentation, and outcomes can vary depending on geographical location and patient population. Prompt recognition, appropriate investigations, and early surgical intervention remain crucial in managing this condition effectively.

112. A Study to Assess the Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: A Retrospective Study
Puja Priyadarshini
Abstract
Aim: The aim of the present study was to assess the closed Incisional Negative Pressure Wound Therapy at Flap Suture Line. Material & Methods: A retrospective analysis for the duration of 12 months of patients who underwent ciNPWT at the flap suture line was included in the study at department of Plastic Surgery. 30 patients were included in the study. Results: There were no significant differences between the two groups in terms of patient baseline information such as age, gender, ASA classification, and preoperative laboratory indices (including haemoglobin, alanine transaminase, aspartate transaminase, creatinine, prothrombin time, activated partial thromboplastin time, and D-dimer). Within the NPWT group, all patients obtained scores below 20 score. Conversely, within the Control group, a significant majority of patients demonstrated ASEPSIS scores surpassing 20 score. There was no statistical difference in ADLS scores, LEFS scores, and VAS scores between the two groups. Conclusion: Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.

113. A Hospital Based Observational Study Evaluating Outcomes of Nasal Reconstruction by Local Flaps and Full Thickness Skin Graft
Setubandhu Tiwary, C. M. Narayan
Abstract
Aim: The aim of the present study was to assess the outcomes of nasal reconstruction by local flaps and full thickness skin graft. Material & Methods: 20 cases of nasal injury attending to RDJM Medical College & Hospital, Muzaffarpur have been evaluated for the age, sex, size, depth, and etiological factor of these injuries. In this prospective study of nasal reconstruction by local flap v/s full thickness graft, to give the best management protocol to the patient and evaluate the outcome in term of function and aesthetics, e.g. patient satisfaction with a particular management. Results: There were 40% patients who were more than 51 years of age. 75% were male and 25% were females. 70% belonged to rural area. According to etiology, 45% were traumatic followed by malignancy 35%. 50% had tip, Supratic, Part of ala, (Lower 1/3 of the nose) location of defect. 45% had size of defect more than 4 cm. 70% had full thickness in terms of depth of defect. In 50% cases, forehead flap was used followed by nasolabial flap. For method of internal lining, in 71.42% hinge flap was used. In the present study, 60% showed excellent results followed by 20% who showed good results. Conclusion: It can be concluded that the local flap is the most versatile and reliable tool for reconstruction of small to large nasal defects but one cannot ignore the usefulness of FTSG in nasal reconstruction. One must consider the patient’s condition, functional needs as well as their expectations regarding the result. Additionally, the patient’s tolerance for single –or multi-stage procedures should be determined.  The patients should be allowed to have active role in decision making, particularly if it involves undertaking a complex multi-stage procedure.

114. A Study to Assess the Maternal and Fetal Outcome in Women with Valvular Heart Disease or Prosthetic Heart Valve Replacement Secondary to Rheumatic Heart Disease: An Observational Study
Sania Akhtar, Abu Huraira, Geeta Sinha
Abstract
Aim: The aim of the present study was to assess the maternal and fetal outcome in women with valvular heart disease or prosthetic heart valve replacement secondary to rheumatic heart disease. Methods: This was a prospective study which included consecutive pregnant women with valvular heart disease or prosthetic heart valve replacement secondary to rheumatic heart disease referred at department of cardiology for the period of one year. 100 pregnant women with rheumatic heart disease or prosthetic heart valve visited the hospital. Results: 42% women belonged to primigravida and 47% belonged to NYHA class II. 82% had known cases of RHD. The maternal adverse event rate was 2%, 2%, 34%, 27% and 35% in patients with modified WHO score risk stratification of I, II, II-III, III and IV respectively. The adverse event occurred in 4%, 36%, 54% in patients with CARPREG score of 0, 1 and ≥ 2 respectively. Pregnancy with predominant mitral regurgitation and mild to moderate mitral stenosis were tolerated well with no maternal or fetal event. Pregnancy with predominant mitral regurgitation and mild to moderate mitral stenosis were tolerated well with no maternal or fetal event. 4 patients of combined severe MS and MR were in NYHA IV, all underwent MVR during delivery. All 4 mitral valve replacement surgeries were done concomitant with lower segment caesarean section (LSCS) at the time of delivery. Abortion was induced in 5 cases due to fetal malformations and 3 due to underlying maternal cardiac disease (2 cases were of combined lesion of mitral stenosis with mitral regurgitation and severe pulmonary arterial hypertension and 1 case of DVR). Conclusion: Women with rheumatic heart disease carry a high risk both for mother and fetus. Early diagnosis, close follow-up during pregnancy, early recognition of deterioration in symptoms and timely cardiac intervention can lead to good maternal or fetal outcome. Multidisciplinary evaluation by cardiologists and obstetrician, proper pre-conception and antenatal care are the key measures to improve the outcomes of these patients.

115. An Observational Study to Estimate Prevalence and Severity of Diabetic Retinopathy in Recently Diagnosed Type 2 Diabetes Mellitus Patients
Abhishek Kumar, Shilpi Agrawal
Abstract
Aim: The aim of the present study was to estimate prevalence and severity of Diabetic Retinopathy (DR) in recently diagnosed type 2 Diabetes Mellitus (DM) patients. Material & Methods: A study was conducted in the Department of Ophthalmology of Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for the duration of 1 year. This observational, prospective study was conducted in patients who visited the diabetic clinic and were recently diagnosed (less than 3 months from first diagnosis) for type 2 DM. In present study total 100 patients were evaluated for diabetic retinopathy. Results: In present study total 100 patients were evaluated for diabetic retinopathy. Most of patients were from 61-70 years (25%), followed by 51-60 years (22%) and 41-50 years (20%) age group. Male patients (58%) were more than female patients (42%). We noted 10% prevalence of diabetic retinopathy in study patients. Prevalence was more in males (66.66%) as compared to females (33.33%). In present study diabetic retinopathy was noted in 15 patients, divided as mild nonproliferative diabetic retinopathy (66.66%), Moderate nonproliferative diabetic retinopathy (20%), Severe nonproliferative diabetic retinopathy (6.66%) and proliferative diabetic retinopathy (PDR) (6.66%). Macular edema was noted in 5 patients. 60% of them had non centre involving diabetic macular edema while 40% had centre involving diabetic macular edema. Conclusion: Screening for diabetic retinopathy is important for newly diagnosed diabetic patients. A systematic screening program in the community is needed for early detection and to reduce blindness in diabetic patients due to DR.

116. A Retrospective Study to Assess Spectrum of High-Resolution Computed Tomography Chest Findings in COVID 19 Patients
Vijay Kumar, Sanjay Kumar Suman
Abstract
Aim: The aim of the present study was to assess the role of high-resolution computed tomography chest findings in COVID 19 in Bihar region. Methods: This retrospective study was conducted in 50 patients aged 22 to 83 years who were tested positive for COVID-19 by RT-PCR along with simultaneous conduction of HRCT chest in Radiology Department for the period of 10 months. Results: Out of total 50 patients, 28 (56%) were males and 22 (44%) were females. Age ranged from 22 to 83 years with mean age of 51 years±15 years. Fever was seen in 49 (98%), cough in 34 (68%) and shortness of breath in 32 (64%) patients. Diabetes and hypertension were the major comorbidities 6 (12%). The most frequent finding on HRCT chest was combined GGO and consolidation 24 (48%) with posterior and sub-pleural distribution 41 (92%). Among two patients of early stage (0-2 days), one had normal HRCT, while  other  had  GGO alone. Consolidation, crazy-paving and vascular enlargement was absent. Of 12 patients of progressive stage (3-5 days), combined GGO and consolidation 8 and GGO alone 5 were seen. During late stage (6-12 days), among 33 patients, combined GGO and consolidation 16, sub-pleural lines/bands 17, vascular enlargement 15 and crazy paving pattern 13 were noted. The distribution of disease was posterior, sub-pleural in 33, bronchovascular in 25, peri hilar in 14 and diffuse in 7 during late stage. Conclusion: HRCT chest evolving  characteristics  are effective  in  understanding  variation  in  pattern of coronavirus disease. Identification of imaging patterns with respect to infection time course is an effective paramount for disease diagnosis, understanding progression and potential complications of disease. CT-SS  plays  an important role in predicting disease severity, prognosis and clinical outcome. We recommend that early HRCT chest scan will leads to better diagnosis and management of COVID-19 patients.

117. Clinico-Etiologic Profile Assessment of Conversion Rate of Laparoscopic Cholecystectomy to Open Cholecystectomy: An Observational Study
Sajal Kumar
Abstract
Aim: This study was conducted in an effort to determine the conversion rate and also identify the factors responsible for conversion of laparoscopic to open cholecystectomy. Methods: This was a prospective clinical study consisting of 100 patients undergoing laparoscopic cholecystectomy at department of General Surgery. Results: In 100 cases, 32 were males and 68 were females. The mean age in this study was 43.7 years. The age group of the patients ranged from 18 years to 76 years. The maximum incidence was seen in the age group of 41-50 years followed by 31-40 years of age.  Out of 100 patients, 74 patients (74%) had a chief complaint of pain in the right hypochondrium, 20 patients (20%) presented with epigastric pain and the remaining 6 patients (6%) were asymptomatic (incidental cholelithiasis). 32 patients presented with nausea along with pain abdomen and 11 patients presented with vomiting, whereas 15 patients presented with both. 10% of patients suffered from Diabetes mellitus whereas 16% of patients were Hypertensive. On ultrasound, single calculi were noted in 72 patients whereas remaining 28 patients presented with multiple calculi. Difficult anatomy at Calot’s triangle accounted for near one half of conversions; we observed that individual anatomy was obscured primarily by dense adhesions (40%) and aberrant anatomy (10%) was also noted.

Conclusion: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low (7.5%) in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.

118. A Prospective Evaluation of the Effectiveness of Ad Hoc Posterior Tibial Vessels Perforator-Propeller Flaps for the Reconstruction of Small and Medium Sized Soft Tissue Defects in the Lower Third Leg
Pranav Kumar
Abstract
Aim: The aim of the present study was to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. Methods: A prospective study was conducted in the department of plastic and reconstructive surgery, over a period of 12 months (January 2022 to December 2022). All patients with small to large sized soft tissue defects affecting lower third of tibia were included in the study. A total of 20 flaps were used for the coverage of defects localized at the lower third of the leg. Results: Among the affected areas that required coverage of soft tissues of the leg, lower third leg was involved in all the patients. Flap dimensions ranged from 12 to 156 cm2, with an average size of 50 cm2 with interquartile range of 30 and 60 cm.2 The flap rotation was 180 degrees in 16 cases (80%), 140 degrees in 2 cases (10%), and 160 degrees in 2 cases (10%). The flaps were based on a single perforating vessel of the posterior tibial artery in 10 cases (50%) of the cases; on the anterior tibial artery in 8 cases (40%), and in 2 cases (10%) the peroneal artery was chosen. Complications were present in 20% of the flaps. These included 3 partial necrosis less than a 15% of the flap, which were all based in the posterior tibial artery, and 1 case with an epidermolysis of the flap based in the anterior tibial artery without a statistical difference with respect to the artery used to base the flap.  Primary closure of the donor site was performed in 14 cases (70%). Conclusion: Based on the results obtained in our study, we consider that the perforator-based propeller flaps are ideal in reconstructing small-medium defects of the lower third of the leg with the advantage of being safer options, replacing the defect with tissues similar in texture and thickness, flap can be elevated easily with lower incidence of donor-site morbidity.

119. An Observational Study to Evaluate the Prevalence, Clinical Characteristics, and Initial Prognosis of Traumatic Spinal Injury
Rahul Kumar, Nishant Kashyap, Santosh Kumar, Indrajeet Kumar
Abstract
Aim: The aim of the present study was to assess the epidemiology, clinical features and early outcome in traumatic spine injuries at a tertiary hospital in Bihar region. Material & Methods: The current investigation was a single-center, prospective, observational research undertaken at the Department of Orthopedics. The trial lasted from October 2019 through August 2022.  The research had a total of 200 participants. Results: Among the sample of 200 patients, a significant proportion of individuals were between the age range of 51-60 years (32%) and 41-50 years (30%). The average age of the participants was 53.57 years. The study population consisted mostly of male patients, accounting for 75% of the total, with the remaining 25% being female patients. In the current research, a significant proportion of traumatic spinal injuries were attributed to road traffic accidents (53%), with falls from heights (45%) and incidents of assault (2%) being other causes. The preponderance of spine fractures was seen at the cervical vertebral level (42%), with the lumbar vertebral level accounting for the second highest proportion (28%), and the thoracic vertebral level representing the third highest proportion (20%). The prevalence of injuries at various vertebral levels was as follows: 2% at both the thoracic and lumbar levels, 4% at both the cervical and thoracic levels, 3% at the lumbar and sacral levels, 0.50% at both the cervical and lumbar levels, and 0.50% at both the cervical and sacral levels. Among the sample of 200 patients, it was observed that a majority of 116 patients, or 58% of the total, did not exhibit any concurrent injuries. The prevalent injuries seen in conjunction with the condition were hemoperitoneum (10%), head injury (10%), fracture of the humerus (8%), and fracture of the clavicle (6%). Among a cohort of 200 patients, it was observed that 52% of the patients exhibited no signs of neurodeficit, whereas the remaining 48% of patients had neurodeficit symptoms. During the pre-operative examination, it was seen that 50% of the patients had an ASIA score of E. Additionally, 12% had an ASIA score of D, while 16% had an ASIA score of C. Furthermore, 8% of the patients had an ASIA score of B, and 14% had an ASIA score of A. Conclusion: Patients who had non-operative treatment experienced greater incidence of complications. Respiratory failure emerged as the primary cause of mortality at the cervical level, whereas secondary problems arising from persistent bed sores were identified as the primary contributors to mortality at the thoracic and lumbar vertebral levels.

120. A Prospective Study Determining the Impact of Spinal Anaesthesia on Perioperative Hyperglycemia in Diabetic Patients Undergoing Lower Limb Orthopaedic Surgeries
Sujeet Kumar, Rajesh Kumar Choudhary, Vijayendra Prasad
Abstract
Aim:  The aim of the present study was to assess the effect of spinal anaesthesia on perioperative hyperglycemia in diabetic patients undergoing lower limb orthopaedic surgeries and also to state the trend of perioperative hyperglycemia. Material & Methods: A prospective study conducted in the Department of Anaesthesia for the duration of 12 months including 100 patients having either Type I or Type II Diabetes Mellitus controlled on either oral hypoglycaemic drugs or injectable insulin aged 30 to 65 years, belonging to either sex and American Society of Anesthesiologists (ASA) physical status II and III undergoing elective lower limb orthopaedic surgeries under spinal anaesthesia. Results: The mean age, weight, height and duration of anaesthesia was 50.52±12.68 years, 62.8±5.6 kg, 160.8±4.6 cm and 104.6±10.5 respectively. Mean BG value preoperatively or 10min before induction was 111.58±11.084. Then at SI, there was statistically significant decrease in BG value to mean value 106.84±13.57. 30min after SI, mean BG value was 108.72±18.92. This value was lower as compared to the pre-operative BG value, but not statistically significant. 1hr after SI, BG value was 110.60±12.228. This value was also lower as compared to the pre-operative BG value, but not statistically significant. 2hrs after SI, BG value increased to mean value 121.86±18.442. Even, 3 hrs after SI, BG value continued increasing and the mean value became 124.12±16.004. 4 hrs after SI, BG value was maximum with the value being 126.24±15.385. There was statistically significant difference (p=.000). Blood glucose (BG) value decreases till 1hr after surgical incision (SI), and then increases till 4th hr after SI. This change in blood glucose values is statistically significant at SI, 2nd hr after SI, 3rd hr after SI and 4th hr after SI. Conclusion: Spinal anaesthesia blunts surgical stress response and hence, at SI, BG values decrease. But BG values increase at other times in perioperative period owing to the regression of sensory analgesia.

121. Assessing Prevalence and Associated Risk Factors for Anaemia in Under Five-Year-Old Children: A One Year Study in a Tertiary Care Hospital, Bihar: Observational Research
Rajni Kumari, Sanjeev Kumar, Dheeraj Kumar, Vinod Kumar Mishra, Dhananjay Kumar
Abstract
Background: Anaemia is a condition characterized by a decrease in the concentration of haemoglobin (Hb) in the blood. It adversely affects children’s mental, physical and social development. The aim of this study is to determine the prevalence of and the associated risk  factors for anaemia in under five -year -old children in a Tertiary Care Hospital, Bihar. Material & Methods: This was a prospective observational study  conducted in Department of Paediatrics, BMIMS, Pawapuri, Nalanda, Bihar for the duration of one year. Total 200 anaemic children were enrolled into the study. Results: A higher proportion of boys (n=104, 52%) had greater effects in comparison to females (n=96, 48%). Based on the classification of anaemia severity, it is seen that among the sample of children, 100 individuals (50%) exhibit mild anaemia, 90 individuals (45%) exhibit moderate anaemia, and 10 individuals (5%) exhibit severe anaemia. According to the categorization based on age categories, it was observed that a higher prevalence of anaemia was seen among children aged 2-5 years (n=110, 55%) compared to children aged 6 months-2 years (n=90, 45%). The findings indicate that a significant proportion of mothers with anaemic children had a primary level of education (n=112, 56%), whereas a smaller proportion had attained a secondary level or higher education (n=64, 32%). Out of the total sample size, it was observed that 24 women, constituting 12% of the population, were identified as illiterate, in the context of having children diagnosed with anaemia. A majority of the children, namely 59%, are affiliated with lower socioeconomic classes, which may be further broken down into Class IV comprising 54 children (27%) and Class V including 64 children (32%). Among the whole cohort of 200 children, a notable proportion of 30 cases (15%) had a dimorphic blood picture, which is indicative of a shortage in iron and other crucial hematological components, namely folic acid. Conclusion: Anaemia burden remains high particularly in developing countries. The primary cause of anaemia in the current research is nutritional deficit, namely iron deficiency. In conjunction with dietary insufficiency, socioeconomic variables including as gender, maternal education, and socioeconomic status significantly contribute to the onset and progression of anaemia.

122. Neutrophil-to-Lymphocyte Ratio: is it an Indicator of Spontaneous Passage of Ureteral Stones
Nitesh Kumar, Shivanand Prakash
Abstract
Objective: Conservative management of ureteral stones is affected by many factors of which Location and the size of stones are most important. Inflammation around the stone has been identifies as an important variable related to spontaneous passage of stone (SPS). Our aim was to investigate the role of neutrophil-to-lymphocyte ratio (NLR) for SPS. Methods: A prospective study was performed on 74 patients who attended urology outpatient clinic and emergency department between January 2018 and December 2018. Non-contrast-enhanced computed tomography (NCCT) was done in all patients for confirmation of ureteral stones. History, physical examinations and needed blood investigations, plain x-rays were done in all patients. SPS was confirmed by either patient noticing stone passing during urination or by NCCT done 3 weeks after the first stone episode. XLSTAT was used to analyze the data. Results: SPS was observed in 56 (75.6%) of patients out of 74 enrolled in the study. SPS rates within 3 weeks according to stone size were 61% (5-10 mm) and 86% (≤5 mm). NLR (<2.4) (odds ratio (OR), 8.96; p: 0.002), smaller stone size (≤5 mm) (OR: 9.28; p: 0.001) and lower stone location (OR: 10.86; p: 0.001) were independent predictors of SPS. Conclusion: A low NLR (< 2.4) may be a predictor of SPS for ureteral stones <1.0 cm size and ureteral inflammation is independent factor in SPS. So, early intervention may be considered in patients with high NLR ( ≥2.4).

123. A Hospital-Based Study to Evaluate the in-Hospital Mortality in AMI Patients According to DM Status and its Duration
Mani Shankar Pandey
Abstract
Aim: The aim of the present study was to evaluate the in-hospital mortality in AMI patients according to DM status and its duration. Methods: The present study was conducted in the Department of Cardiology for the period of one year. Our study included a population registry with demographic data of all residents and detailed information on hospital records. Our study comprised 5000 and 2000 DM and No-DM patients, respectively. Results: Patients with DM had more cardio-cerebro- vascular comorbidities and were treated with a higher proportion of chronic cardiovascular medications in comparison with those without DM.  Comorbidities and exposure to insulin and cardiovascular medications increased in parallel with DM duration. Patients with DM, especially those with the longest DM duration, developed more complications than patients without DM (all p < 0.0001). Conclusion: Our study demonstrated that the duration of DM parallels mortality risk in patients hospitalized with AMI, highlighting that DM duration should be considered as an important early prognostic risk factor in patients with AMI.

124. An Observational Study to Assess the Predictive Value of CRP and Albumin Ratio in Neonatal Sepsis
Rupesh Kumar, Juli, Akhilesh Kumar
Abstract
Aim: The aim of the present study was to assess the predictive value of the CRP vs Serum albumin in earlier identification and as a prognostic indicator of neonatal sepsis. Methods: This was a prospective study conducted in the Department of Neonatology. In this study, a total of 200 neonates were enrolled. Neonates include term and preterm with a risk factor for sepsis aged-from birth to 28 days postnatally. Results: There were 120 neonates of female and 80 neonates of males. The subjects were divided into 3 groups based upon the presence of severity of sepsis as a control group, mild sepsis group, and severe sepsis group. The majority of them were diagnosed with mild sepsis severe sepsis and a control group. Compared to control, neonates with sepsis were older and had a higher body temperature, respiratory rate, and heart rate (p<0.05), Biochemical analyses showed that the levels of CRP and CAR were significantly increased in neonates with sepsis (p<0.001). Further analysis showed that neonates with severe sepsis exhibited significantly higher levels of CRP and CAR (p<0.05), compared to neonates with mild sepsis. The prevalence of overall sepsis increased significantly from tertile 1 to tertile 3 (p<0.001), moreover, the prevalence of mild sepsis and severe sepsis, also showed a progressive increase from CAR tertile 1 to tertile 3, while the control group was more likely to be in tertile 1 and tertile 2 (p<0.001). After adjusting age, temperature, heart rate, respiratory rate, and weight, CAR was proved to be an independent risk factor for the presence of sepsis. Meanwhile, CAR tertiles were also independently associated with an increased prevalence of neonatal sepsis. Furthermore, our data also showed that CAR and CAR tertiles were independent risk factors for the presence of severe sepsis. Conclusion: The present study demonstrated that CAR was an independent predictor for the presence and severity of neonatal sepsis. Higher CAR was positively associated with an increased prevalence of sepsis and the sequence of serum albumin level was found to have a good sensitivity in identifying the prognosis.

125. A Retrospective Study to Evaluate the Efficacy of Combination of Daily Tadalafil and Solifenacin in Patients with Storage Symptoms
Rohit Singh, Arshad Hasan
Abstract
Aim: The aim of the present study was to evaluate the efficacy of tadalafil 5mg+solifenacin 5mg combination in terms of lower urinary tract symptoms (LUTS) and erectile functions in benign prostate hyperplasia patients with predominant storage symptoms. Methods: The present study was conducted in the Department of Urology . Male patients over the age of 40 who presented with LUTS with predominant storage symptoms were included in the study. A total of 100 patients were included in the study. Demographic data of the patients were recorded. Results: The patients’ mean age was 48.6±13.6 and the mean BMI was 25.5±8.2 kg/m2. The mean IIEF-EF score of the patients was 13.6±6.4, the mean OABSS was 8.2±2.6, the IPSS-Voiding mean was 5.4±2.3. The mean IP- SS-Storage was 13.3±1.8, the mean IPSS total score was 18.6±2.8. The mean PSA value of the patients was 1.3±0.7 ng/ml. When the symptom scores and bladder diaries of the patients before and after 12 weeks of treatment were compared, significant decrease in IPSS scores (both Voiding, Storage and total) (p<0.001 for each) significant increase in IIEF-EF scores (p<0.001) significant increase in Qmax value elevation was observed. When the bladder diaries were compared, the number of daytime micturitions, the number of nocturia and urgency decreased in the 12th month after tadalafil+solifenacin treatment (p<0.001). Among the patients participating in the study, dry mouth developed in 7 patients (7%), constipation in 6 patients (6%), dyspepsia in 4 patients (4%), and muscle pain in 3 patients (3%). Conclusion: The combination of tadalafil 5mg and solifenacin 5mg daily is a safe and effective therapy for male patients with storage symptoms predominant LUTS/ED. Especially in patients suffering from storage functions, this combination therapy will be a good alternative if resistance is encountered in monotherapy. Prospective randomized controlled studies with large participation are needed to evaluate the efficacy of daily tadalafil+solifenacin treatment.

126. A Retrospective Study to Evaluate Upper Gastrointestinal Endoscopy in Patients with Liver Cirrhosis
Dheeraj Kumar, Sonal, Vishwamohan Dayal
Abstract
Aim: The aim of the present study was to describe the different types of lesions that can be found in patients with liver cirrhosis during upper gastrointestinal endoscopy. Methods: This retrospective study was conducted at the endoscopy in the Department of Gastroenterology. Consecutive patients with liver cirrhosis who gave their consent to participate in the study were recruited. The diagnosis of liver cirrhosis was made by clinical and radiological features, and a total of 50 patients were recruited. Results: A total of 50 patients comprising 37 (74%) males and 13 (26%) females participated in the study. The mean age was 46.4 ± 12.8 years with a range of 20-77 years. Analysis of the age groups showed that 19 (38%) patients were less than 40 years of age, 14 (28%) were between 40 years and 49 years, and 17 (34%) were 50 years and above. The most common symptom presented by the patients was abdominal swelling in 42 (84%) of them. This was followed by leg swelling in 26 (52%) patients. Clinical examination revealed that 27 (54%) patients had ascites, 21 (42%) had hepatomegaly, and 17 (34%) had prominent anterior abdominal wall veins. Stigmata of chronic liver disease observed in the patients were Dupuytren’s contracture in 19 (38%) patients, palmar erythema in 11 (22%) patients and sparse axillary  hair  in 11 (22%) patients. In terms of the number of columns, the most frequently observed was three columns, which were seen in 18 (36%) patients followed by a single column observed in 14 (28%) patients. Analysis of the color of   the   varices   showed   that blue varices were observed in 32 (64%) patients while white varices were seen in 12 (24%) patients. The most frequent form of the varices was f0, which was observed in 18 (36%) patients followed by f1 in 14 (28%) patients. A combination of various forms of the varices was observed in the patients with the most frequent combination being f2 and f3. Conclusion: Upper gastrointestinal endoscopy has revealed a different pattern of lesions in patients with liver cirrhosis, apart from varices. This underscores the importance of this procedure in the diagnosis of these additional lesions so as to prevent the complications that can arise from these lesions if not diagnosed and treated appropriately.

127. An Observational Study to Investigate the Association between the Detrusor Muscle Function and the Level of the Spinal Cord Injury
Kumar Gaurav Mishra, Ahsan Ahmad, Sanjay Kumar Gupta
Abstract
Aim: The purpose of this study was to investigate the association between the detrusor muscle function and the level of the spinal cord injury. Material & Methods: An observational study including 50 patients was conducted in the Department of Urology, ESICMCH, Bihta, Patna, Bihar, India . Written informed consent was obtained from all participants. Results: There was a total of 50 individuals with traumatic SCI, of whom 25 (50%) had cervical injury, 12 (24%) had thoracic injury, 8 (16%) had lumbar injury, and 5 (10%) had sacral vertebral injury. Among these individuals, 29   had   neurologically   complete   injuries   and   21 incompletes (according to ASIA) at the time of examination. All but one cervical patient with DO and detrusor sphincter dyssynergia were negative for sacral cord lesion. Only one of the 12 patients with thoracic-level injuries had normal urodynamic findings and sacral cord lesion, whereas none of the patients had detrusor areflexia. None of the 8 patients with lumbar cord injuries with DO and detrusor sphincter dyssynergia had positive sacral cord lesion, whereas all four patients with detrusor areflexia were positive for sacral cord lesion.  Low bladder compliance was seen in 15 cases with DO, 14 cases with detrusor sphincter dyssynergia, while in only four cases with detrusor areflexia and one with normal bladder. Most of the patients with suprasacral cord lesions had high detrusor leak point pressures. Conclusion: Bladder function differs according to the level of injury. It is, therefore, important to define the neurological lesion to appreciate the voiding dysfunction  and thereby to develop an appropriate  management  plan for long-term urologic care. Bladder management should be directed towards protection of upper tracts, prevention of infection, autonomic dysreflexia, and encouraging bladder emptying at low pressures, as the first and foremost goal. Despite consistent data regarding classic voiding dysfunction with complete injuries, multiplicity of injury may contribute to complicated urodynamic findings. Therefore, urodynamic evaluation is crucial to correctly identify  the type of voiding dysfunction and to optimize long-term management.

128. A Retrospective Assessment of the Outcome of Repair and Resection of the Occipital Encephalocele
Rajeev Ranjan Raman, Anurag Sahu
Abstract
Aim: The aim of this study was to find the outcome of repair and resection of the occipital encephalocele. Material & Methods: A retrospective study of 200 exclusively occipital encephalocele patients was conducted in between the duration of 2 years in the Department of Neurosurgery. The medical records of all operated cases of occipital encephalocele were reviewed, and relevant data such as age, sex, location of encephalocele, the size of the lesion, operative method, seizure, and hydrocephalus along with postoperative complications were recorded for analysis. Results: Out of 200 patients, 72 were men and 128 women. Patients’ presentation ages ranged from 4 days to 1.33 years, with a mean of 2.6 months. Most patients (56%), were 3-months old, whereas 27% were 3-6 months old. Each patient had postnatal cranial edoema. It was either above or below the eye socket. Overlaying skin was thick, wrinkled, thin, or shiny. Out of 70 patients, 35% had hydrocephalus and an enlarged head circumference. Additionally, 8 individuals (4% of the sample) had Dandy-Walker cysts. Eight patients (4%), were suspected of developmental delay and mental illness. Seizures occurred in 30 individuals (15%). Due to sac rupture with CSF leaking, 36 (18%) patients were hospitalised. Four (2%) individuals had sac ruptures after admission, and six (3%) had bleeding from the sac’s thin, glossy surface. Only 6 individuals (3%) suffered CSF leakage from the repaired wound after surgery. After sac repair, 12 patients (6% of cases) developed hydrocephalus. Conclusion: Encephalocele is a commonly observed disorder in the area of neurosurgery globally. The utilisation of current neuroimaging, neurosurgery operations, and neonatal neurological critical care has considerably advanced the treatment of encephalocele, resulting to a remarkable decrease in both morbidity and death rates.

129. To Investigate the Prevalence of Risk Factors of Kidney Stones: An Observational Study
Rakesh Kumar, Archana Sinha, Purushottam Kumar
Abstract
Aim: The aim of the present study was to investigate the prevalence of risk factors of kidney stones. Methods: The present study was conducted in the Department of Urology and we recruited a total of 200 participants of both genders aged 35–70 years. Results: We compared the distribution of lifestyle- related variables, as well as, history of diabetes and high blood pressure between the two groups. The prevalence of kidney stone was associated with alcohol drinking and smoking. Moreover, kidney stone was more prevalent in the people with middle-high WSI, high BMI, and with a history of diabetes and blood pressure. Majority of the case group (people with kidney stone) was male and had significantly higher alcohol consumption and middle to higher WSI in comparison to the control group (people without kidney stone). Consumption of purified drinking water was considerably lower in the case group com- pared with the control group. In addition, the cases were more likely to have a high BMI, history of diabetes and high blood pressure compared with the study controls. The related factors associated with kidney stone in Univariate analysis were also assessed and the subjects with kidney stone were compared with the normal subjects. The odds of having kidney stone were estimated for twelve factors: gender, age, education level, WSI, cigarette smoking, alcohol drinking, opium consumption, hookah smoking, BMI, consumption of purified water in lifetime, and history of chronic disease (diabetes and hypertension). It was found that all of these factors with the exception of cigarette smoking were significantly associated with kidney stone in the Univariate analysis. Conclusion: According to the results of the present study, factors such as gender, hypertension, obesity, diabetes and personal habits like alcohol consumption and cigarette smoking are related with the development of kidney stones. So, by identifying the susceptible patients and teaching them, the burden of the disease on society and the individual can be reduced.

130. Study to Investigate the Seroprevalence of Hepatitis B Surface Antigen (HBsAg) and Possible Risk Factors for Perinatal Hepatitis B Virus (HBV) Transmission in Pregnant Women
Manish Kumar Bhaskar
Abstract
Aim: The aim of the present study was to investigate the seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women and possible risk factors for perinatal hepatitis B virus (HBV) transmission. Methods: The study was carried out in the Department of Gastroenterology for 12 months. Women in any trimester of pregnancy with or without jaundice attending the antenatal clinic were included. After a complete general, systemic and obstetrical examination, 4 mL blood was collected after consent. Sera were tested for HBsAg using ELISA (Span Diagnostic Ltd, India). Of 2,000 women studied, 18 (0.9%) tested positive for HBsAg. Results: Seroprevalence of HBsAg was found to be 0.9% (18/2,000). The highest prevalence rate was observed in the age group of 21–25 years followed by the 26–30 year age group. The difference in HBsAg prevalence rates in different age groups was not significant. Of 2 women with acute hepatitis B, 1 transmitted infection to their babies. Conclusion: In conclusion, seroprevalence of HBsAg in antenatal women was found to be 0.9%. HBeAg and HBV DNA positivity was associated with a significantly higher chance of vertical transmission.

131. A Hospital Based Study to Determine the Minimally Invasive Nephrectomy for Inflammatory Renal Disease
Mohammad Arshad, Amrit Kumar
Abstract
Aim: The aim of the present study was to determine the minimally invasive nephrectomy for inflammatory renal disease. Methods: This was a observational study conducted in the Department of Surgery for the period of 2 years and we included 100 patients. Results: In the present study, 70% were women and 30% were men. Left side nephrectomy was performed in 65% of the cases. A positive history of urolithiasis was present in 54% of the cases, followed by urinary tract infections (UTI) (44%), high blood pressure (HBP) (32%) and Type II diabetes mellitus (DM II) (10%). Mild complications consisted in 6 cases of surgical site infection (SSI) that were treated with antibiotics, 4 dehisced the skin incision and 4 presented ileum that resolved with medical treatment. The mean operative time for patients who did not required conversion to open surgery was 204±86 min, for the conversion ones was 386±174 min. The mean estimated blood loss for patients who did not required conversion to open surgery was 214±220 mL, for the conversion ones was 1477±748mL and for all the patients was 256±422 mL, with a range of 55-3275 mL. The mean length of hospital stay after surgery was 2.9± 2.2 days, being longer for the converted ones compared to the no converted ones ranged between 1 and 14 days. Conclusion: Laparoscopic nephrectomy for IRD is a reproducible technique with low risks and complication rates despite the surgical challenge it represents. Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue. There were minimal surgical and post-surgical complications, few conversions to open nephrectomy, blood loss, operative time and days hospitalized.

132. A Retrospective Assessment Cerebrospinal Fluid Leak in Posterior Fossa Surgeries with Different Dural Closure Methods
Dhiraj Kumar, Mukesh Kumar, Anil Kumar Peethambaran
Abstract
Aim:  The aim of the present study was to compare the occurrence of Cerebrospinal fluid leak in posterior fossa surgeries where different dural closure materials are used. Material & Methods: A retrospective cohort study, conducted in the Department of Neurosurgery, Medical College Trivandrum Thiruvananthapuram, Kerala, India. All the cases underwent posterior fossa surgeries during the period of 2 years in the department of Neurosurgery was included in the study. 100 patients were included in the study. Consent was obtained from all patients and data collected retrospectively from medical records. Results: There was no significant difference in gender. The total patient population consisted of 35 men (35%) and 65 women (65%). The etiology of craniotomy had equal distribution as well, with a total of 75 (75%) tumors, 15 (15%) cysts, 6 (6%) chiari malformations, 2 (2%) decompressions, and 2 (2%) inflammations. The incisional CSF leak within 30 days was noted in 6 patients. Non-incisional CSF leak was noted in 15 patients. Conclusion: The study concluded that, in cases of posterior fossa surgeries, closure with pericranium has a significant protection against CSF leak.

133. Assessment of the Cardiovascular Profile in Pre- and Post-Menopausal Women: An Observational Study
Sweety Kumari, Kuldeep Kumar Kaul
Abstract
Aim: The aim of the present study was to assess the abnormalities in the cardiovascular profile in postmenopausal women. Material & Methods: A cross-sectional comparative study on 100 women who were either postmenopausal or premenopausal and were between the age group of 40 to 55 years was carried out over a period of ten months in the Department of Obstetrics and Gynaecology. Results: Out of 100 women, 40 belonged to <45 years, 50 belonged to 45-52 years and 10 women belonged to >52 years. There were 15% CHD cases and 3% stroke cases based on self-reporting. Women with early menopause (<45 years) tend to have lower educational level (P for trend <0.001), and higher parity (P for trend <0.05). 16 patients had diabetes who belonged to <45 years. There was a decreased trend toward CHD presence with increasing age at natural menopause (P for trend <0.05). Each one year delay of age at menopause was associated with 3% reduction in CHD presence compared with women with menopause at ages 45−52 years. Our findings also showed a linear relationship between menopausal age and the presence of stroke (P for trend <0.001). Each one year delay in age at menopause was associated with 5% reduction in stroke presence. Women with early age at menopause (<45 years) had higher prevalence of stroke than those with menopause at ages 45−52 years after adjustment for potential risk factors. In the age adjusted model, women with later age at menopause (> 52 years) was inversely associated with presence of stroke compared with those with menopause at ages 45−52 years. However, the association was no significant when we further adjusted other confounding factors. Conclusion: Our study demonstrated that early age at natural menopause is associated with the presence of CHD and stroke among women. The effect of menopausal age on cardiovascular disease can be taken into consideration for the prevention.

134. Determine the Effect of Acute Bout of Moderate Exercise in Cognitive Processing in Young Women during Different Phases of Menstrual Cycle
Mritunjay Kumar Azad, Abha Prasad, Malti Kumari
Abstract
Aim: The aim of the present study was to determine the effect of acute bout of moderate exercise in cognitive processing in young women during different phases of menstrual cycle. Methods: The cross-sectional observational study was conducted  on 100 young women who were menstruating properly and had normal auditory function. Results: The post-exercise session showed significant changes in all cardiovascular parameters as compared to the pre-exercise session. These alterations were seen throughout both phases of the menstrual cycle. Following the workout session, there was a significant decrease in P300 latency when evaluated at both the Cz and Pz positions. This phenomenon was seen throughout both phases of the menstrual cycle. However, the P300 delay measured at the Fz site did not exhibit any notable disparity between the pre-exercise session and the post-exercise session in any phase of the menstrual cycle. Conclusion: An acute bout of moderate exercise significantly reduced the latency of P300 ERP in both stages of the menstrual cycle, according to the current study’s participants. In other words, the brain benefits from even brief bursts of moderate activity.

135. An Observational Study to Assess the Prevalence of PVD in Type 2 Diabetes Measuring Ankle Brachial Index using Duplex Doppler Ultrasound of the Lower Limbs
Rajnish Kumar, Rajeev Kumar Khetan
Abstract
Aim:  The aim of the present study was to assess the prevalence of PVD in type 2 diabetes measuring ankle brachial index using duplex Doppler ultrasound of the lower limbs and to correlate its occurrence with various risk factors. Material & Methods: A cross-sectional, prospective and observational study, conducted in Department of Medicine,  Study period was of 2 years. 200 patients were included in the study. Results: The age of the patients ranged from 40 to 80 years with a mean age of 61.08±7.13 years. The duration of diabetes ranged from 1 to 25 years with a mean of 9.21±3.96 years. More than half of the patients (53%) had history of hypertension and 18.66% were smokers. Family history of diabetes was present in 59%. In the present study, hypertension, diabetes, BMI>25kg/m2, HbA1c>7% etc. were the risk factors. The differences between the PAD and the non-PAD groups in terms of risk factors were assessed using Student’s t test for continuous variables and chi square test for discrete variables. CAD was found in 10 PVD patients as compared to 25 non-PVD patients (p=0.046). Binary logistic regression was used to assess significant independent predictors of CAD. Old age, high HbA1c level, and dyslipidemia (total cholesterol and HDL) (p<0.05) were found to be significant predictors of CAD. Conclusion: Risk factors associated with PVD were age, duration of diabetes, systolic and diastolic blood pressure, smoking, HbA1C, high total cholesterol low HDL and CAD and correlation was significant. This study also showed a higher prevalence of CAD in patients with PVD.

136. A Study to Assess the Indications and Outcome in Previous Caesarean Section: An Observational Study
Simpi Shilpa, Sweta Kumari, Seema Singh
Abstract
Aim: The aim of the present study was to assess the and fetal indications and outcome in previous caesarean section. Methods: This prospective study was done in Department of Obstetrics and Gynaecology over a period of 2 years. The study has been done on women admitted for safe confinement with previous cesarean section.  During the study period, there were total 12000 admissions. Results: Cesarean section was done for 1800 women, include primary and repeat cesarean section (rate of CS 15%). There were 800 women with history of previous one CS. Elective CS was done for 500 cases. Successful vaginal delivery was conducted for 200 cases and failure of trial among 100 cases. Cesarean section was done for 1800 women, include primary and repeat cesarean section (rate of CS 15%). There were 800 women with history of previous one CS. Elective CS was done for 500 cases. Successful vaginal delivery was conducted for 200 cases and failure of trial among 100 cases. Fetal distress was the major indications for emergency repeat CS (52%), followed by non-progress of labour (34%). In elective repeat CS, major indication was CPD (40%), followed by fetal distress (16%). 12% had adhesions followed by 8% with obliterated UV fold. Conclusion: The overall maternal risks are increased in repeat CS, but successful vaginal delivery is possible if women are managed well. They should be counseled about maternal and perinatal risks and benefits of planned vaginal birth after cesarean section and elective repeat CS. Elective repeat CS should preferably be done at 39 completed weeks of gestation to avoid the risk of preterm birth.

137. A Descriptive Study Assessing Knowledge on Uterine Prolapse among Reproductive Age Group Women
Sweta Kumari, Simpi Shilpa, Seema Singh
Abstract
Aim:  The aim of the present study was to assess women’s knowledge regarding uterine prolapse. Material & Methods:  A descriptive cross-sectional study design was adopted for the study to assess the knowledge on uterine prolapse among reproductive age group women. The study was conducted at department of obstetrics and Gynecology. The Study population was Reproductive age group (15-49 years) women attending Gynecological OPD in BMIMS. Results: More than half of the respondents (55%) were age 15-30. Educational status among the most of respondents (53%) was higher secondary level and 60% of the participants were housewife. Majority of respondents (75%) belonged to nuclear family. Regarding income (50%) of the respondents had more than 30000. Most of the respondents (90%) were married. Majority of them (40%) had two children. 100% respondents had heard about uterine prolapse. Among them majority of respondents (65%) replied uterine prolapse as something falling out of vagina, (90%) replied uterine prolapse was not a communicable disease. Majority of respondents (80%) replied causes of uterine prolapse was carrying heavy loads, (65%) replied sign and symptoms of uterine prolapse was white vaginal discharge, (95%) replied uterine prolapse was preventable and out of (95%) majority of participants replied prevention of uterine prolapse was non lifting heavy loads during postnatal period.100% respondents goes hospital for treatment of uterine prolapse and majority of respondents (52%) replied treatment of uterine prolapse was ring pessaries and surgery, (65%) replied complication of uterine prolapse was cancer. Conclusion: There was significant association between educational status, family income, antenatal and postnatal visit. Uterine prolapsed related health awareness programs should be targeted in all women’s of ethnic groups, age groups, and education status nationwide, including both urban and rural communities and Screening test program for uterine prolapsed can be organized by government.

138. A Hospital Based Cases-Control Study Assessing the Effect of Tranexamic Acid on Blood Loss after Vaginal Delivery
Niharika, P. Usha Rani, Radhika Yadati
Abstract
Aim: The aim of the present study was to find out the effect of tranexamic acid on blood loss after vaginal delivery. Methods: This study was prospective observational study at Department of Obstetrics and Gynecology, carried out over a period of 2 years in the hospital. Hundred pregnant women entered the study. There were 50 subjects in control group and 50 in the study group. Prior to enrolment, written informed consent was attained from all women participated in the study. All women were explained purpose of study and consent was taken in the language that they understand. Results: The two groups matched in terms of socio-demographic, and also in terms of reproductive, delivery characteristics, newborn weight and the results were not statistically significant. The amount of blood loss in study and control group was 248 ml and 326 ml respectively which was significant (P<0.01). There was a significant difference in the post-delivery Hemoglobin (P<0.01) and PCV (P <0.01) between the groups. The difference of Hemoglobin and PCV decline in the study group and in control group was statistically significant (P <0.01). No adverse effects were observed with the use of tranexamic acid in the study. Conclusion: From our study it was clear that use of tranexamic acid would help to reduce blood loss during delivery. It’s a cheap and readily available drug. Its use along with Oxytocin would help in reducing blood loss during delivery. Hemorrhage being the commonest cause of maternal mortality its use would help a long way in preventing maternal mortality due to bleeding.

139. Unusual Malignancies Involving Pleural Fluid with Cytomorphology and Ancillary
Vandana, Roushini Kumari, Swarnim Kumari, C.P. Jaiswal
Abstract
Aim: The aim of the present study was to analyse the spectrum of these unusual malignancies involving pleural fluid with cytomorphology and ancillary studies. Methods: The retrospective study was conducted in the Department of Pathology. The pleural effusion samples submitted to cytology section of department of pathology. A total of 1000 samples were reviewed. Results: The total number of pleural fluid samples received during the study period was 1000. Out of them, 300 samples were positive for malignancy. Among 300 malignant samples, 250 were positive for metastatic adenocarcinoma and 50 cases were positive for uncommon malignancies. The age of these patients ranged from 2 to 63 years with 30 male and 20 female cases. The infiltrations were classified into hematolymphoid (36/50 cases) and non hematolymphoid neoplasms (14/50). Among the hematolymphoid neoplasms, 22 cases of Nonhodgkin lymphoma, 10 cases of acute lymphoblastic leukemia, 3 cases of chronic myeloid leukemia and 1 case of multiple myeloma infiltration were noted. Conclusion: There are malignancies other than adenocarcinoma which can infiltrate pleural cavity and present with effusions but their occurrence is unusual. Cytomorphological features play a significant role in detecting these uncommon malignancies in pleural fluid. However in certain rare cases, clinical history and ancillary studies help in confirming the diagnosis.

140. Post Operative Analgesic Effect of Adductor Canal Block, Peri–Articular Injection or Infiltration between Popliteal Artery and Posterior Knee Capsule with Adductor Canal Block in Total Knee Arthroplasty: A Comparative Study
Shruti Kirti, Rajeev Krishan, Krishna Kumar
Abstract
Aim: The aim of the present study was to compare the adductor canal block, peri–articular injection or infiltration between popliteal artery and posterior knee capsule with adductor canal block in total knee arthroplasty. Methods: The present study was conducted at Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar, India in a total of 100 patients undergoing unilateral total knee arthroplasty. Results: The entire study group included 65 male patients and 35 female patients. The mean age of the patients in the study group was 62 years with patients in ACB + IPACK group having a mean age of 61 years and patients in ACB group with a mean age of 63 years. The overall demo- graphic and perioperative characteristics in both the groups were similar. VAS score at rest after 8 h postoperatively, on day 1 and day 2 showed significantly (p < 0.005) better values in ACB+IPACK group compared to the ACB group. However, patients in both the groups did not experience severe pain that required any rescue medication. The mean range of movement (ROM) of knee on POD 2 was 72.86 degrees in ACB + IPACK group, which was significantly better (p < 0.05) than the ACB group (ROM = 64.26°). Conclusion: In conclusion, ACB + IPACK is a promising technique that offers improved pain management in the immediate postoperative period without effecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.

141. An Observational Evaluation of Visual Evoked Potential in Diabetics: a Case Control Study
Kumari Ranjana
Abstract
Aim: The aim of the present study was to analyse visual evoked potential in diabetes and age matched controls. Methods: The study was conducted in the Department of Physiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. In this study, diabetics (total 50) between 25 to 55 years attending medical outpatient department of Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India were selected and 50 normal age matched subjects were selected randomly from the general population. Results: The patients with diabetes mellitus have subclinical visual impairment as revealed by impaired visual evoked potential. Diabetics showed delayed latencies and reduced amplitude of various parameters of VEP. There was a positive correlation between prolongation of latencies and duration of diabetes and FBS levels. Conclusion: VEP abnormalities in diabetes initially seem to appear due to central impairment of visual pathway. Thus, VEP can be of clinical importance for diabetes, as it reflects the degree of neural affection and may alert patients for adequate glycemic control, which can resist neuropathic progression any further. Although from our study we can say that duration of illness and poor glycemic control are definitive risk factors for the development of central neuropathy, a larger sample size would have had a significant outcome. It is recommended to perform VEP initially on all diabetic patients and to keep this as an “initial record of visual examination of patients”.

142. A Hospital Based Observational Assessment of the Food Related Allergies in Children with Asthma
Chandan Kumar, Ruby Kumari, Brajesh Kumar, Kishore Kumar Sinha
Abstract
Aim: The aim of the present study was to estimate the proportion of children with asthma who have food related respiratory symptoms and to correlate it with (a) skin prick test (SPT) results and (b) level of asthma control. Material & Methods: This cross-sectional study involved children with asthma, aged ≥6 years attending the department of pediatrics  at Jawaharlal Nehru medical College and Hospital, Bhagalpur, Bihar, India from February 2022 to December 2022.Basic demography and clinical details were recorded. In subjects with a history of food allergy, skin prick test (SPT) was done using Allergo SPT according to guidelines recommended by British Society of Allergy and Clinical Immunology (BSACI). Asthma control was assessed using asthma control test (ACT) and childhood ACT questionnaire. Results: The onset of asthma in the first year of life was significantly associated with life-threatening asthma (OR, 6.48; 95% CI, 1.36-30.85; P = .016); cases had asthma develop at 10.8 compared with 28.8 months for the controls (P < .001). Furthermore, cases had been more frequently admitted with asthma than controls (P = .014). Cases and controls were sensitized to an average of 3.9 and 1.9 allergens, respectively. The presence of sensitization to 4 or more allergens was found to be a risk factor for life-threatening asthma. In the univariate analysis, only sensitization to dog or foods was significantly associated with life-threatening asthma. Food allergy was found to be a significant risk factor for life-threatening asthma; 50% of cases had food allergy compared with only 10% of the controls (P = .006). Conclusion: Our findings have important implications for children with coexistent asthma and food allergies. Food allergy is seen in the first few years of life and is potentially a useful marker that would allow increased supervision of this group of high-risk children with asthma to reduce subsequent asthma morbidity and mortality.

143. Determining the Role of Primary Cemented Hemiarthroplasty in the Treatment of Unstable Trochanteric Fractures in Elderly and Physiologically Elderly Patients
Sanjeet Kumar, Rajeev Kumar Rajak
Abstract
Aim: This study evaluated the role of primary cemented hemiarthroplasty in the treatment of unstable trochanteric fractures in elderly and physiologically elderly patients. Methods: 20 elderly patients who were above 60 years of age with unstable osteoporotic intertrochanteric fractures, who underwent cemented bipolar hemiarthroplasty were studied prospectively in the Department of Orthopedics, Government medical college West Champaran, Bettiah, Bihar, India for one year. Patients who were less than 60 years of age, non-ambulatory before injury and patients with stable intertrochanteric fractures, pathological fractures cognitive impairment were excluded from the study. Fractures were classified based on Boyd and Griffin classification. All the patients were treated with cemented bipolar prosthesis through direct lateral approach by coxofemoral bypass with standard non modular fixed bipolar prosthesis. Mean follow up period was 12 months. Patients were assessed using modified Harris hip score. Results: In our study, mean age of the patient was 69.4 yrs,18 cases were of type 2 fractures, 2 cases were type 3 fracture.8 patients had limb shortening of less than 2 cm, whereas1 patient had limb shortening of 3 cm. 5 patients had abductor weakness. As assessed by modified Harris hip score, excellent to fair results were obtained at 12 months follow up in 15 cases (75 %), 2 cases (10%) had poor results. 3 patients died postoperatively due to unrelated causes. One patient had superficial infection and was treated with I.V. antibiotics. In our series, we had no complications like stem loosening, periprosthetic fractures, and prosthetic dislocations. Conclusion: Primary cemented hemiarthroplasty for unstable osteoporotic elderly trochanteric fractures appears to be a good alternative treatment modality. Early full weight bearing and rehabilitation is a definitive advantage of this method.

144. Prospective Observational Evaluation of Pregnancy Induced Hypertension (PIH) and Intrauterine Growth Restriction (IUGR) in Primigravida using Doppler
Sweety Rani, Abha Rani Sinha, Renu Bharati
Abstract
Aim: The aim of the present study was to assess the role of doppler study in evaluation of pregnancy induced hypertension (PIH) and intrauterine growth restriction (IUGR) in primigravida. Methods: This Prospective observational study was carried out in the Department of Obstetrics and Gynaecology at Patna Medical College and Hospital Patna, Bihar , India from January 2017 to December 2017 In our study a total of 100 Primigravida patients between 18 to 35 years of age, attending antenatal outpatient department, were screened at 18 to 22 weeks of gestation with USG along with Doppler study. Results: All the patients’ age ranged from 19 years to 35 years. 15% were in the age group of ≤20 years, Majority of the patients (49%) were in the age group of 21-25 years, 29% were in the age group between 26-30 years, least number of patients (7%) were seen in the age group of 31-35 years. The mean maternal age was 23.57 years. The study group included patients whose gestational age ranged from 18-22 weeks of gestation. Mean gestational age at the time of 1st scan was 22.18 weeks. The study group included patients whose gestational age ranged from 30-38 weeks of gestation. Mean gestational age at the time of 2st scan was 32.48 weeks. 8 patients developed only PIH (3 PE + 5 GH); 9 patients had only IUGR and 7 patients were complicated by both PIH and IUGR. Conclusion: Elevated uterine artery PI and presence of diastolic notch appears to be more significantly superior to other parameters in prediction of Preeclampsia. Umbilical artery Doppler findings are better predictor of perinatal outcome than abnormal MCA in early weeks of gestation whereas MCA PI Doppler is more useful than Umbilical PI or uterine artery in predicting the adverse perinatal outcome in later weeks.

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