International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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Peer Review Journal

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1. A Hospital-Based Assessment of the Diagnostic Role of CSF C-Reactive Protein Quantitatively in Acute Meningitis and Differentiating Pyogenic Meningitis from Non-Pyogenic Meningitis
Aakash, Puja Singh, Asim Mishra
Abstract
Aim: The present study was undertaken to assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitis and differentiating pyogenic meningitis from non-pyogenic meningitis. Methods: The present study was conducted in the Department of Pathology, Anugrah Narayan Magadh Medical College and Hospital (ANMMCH) Gaya, Bihar, India for one year and patients with suspected cases of meningitis with clinical signs and symptoms of acute meningitis, aged 1 month to 18 years were included. Results: In most of the cases 58 (61.05%) of the study population were in the age group of 1 month to 5 years. The age distribution among Pyogenic meningitis (50) shows the maximum of 17 cases (34%) in the age group 1 month to 1 year followed by 13 (26%) in the age of >1 year to 5 years. Sex distribution of study population where male patients were 55 (57.90%) and female 40 (42.10%). Clinical findings of acute meningitis in the study population where all of the study population (95) were suffering from fever (95%), Headache were present in Pyogenic meningitis 15 (30%) and Non-Pyogenic meningitis 6 (24%) respectively. In 49 cases (98%) of Pyogenic meningitis had elevated CSF-CRP level >1.1μg/ml and 1 case (2%) were in the range of 0.05-0.10 μg/ml. In the case of non-Pyogenic meningitis 24 (96%) were found to have in the range of 0.05-0.10 μg/ml. CSF CRP value of >0.1 μg/ml has a good sensitivity (98.22%), specificity (96.24%), good positive predictive value (98.12%), and good negative predictive value (96.14%) and good Diagnostic Accuracy (97.43%) for Pyogenic meningitis. Conclusion: In conclusion we found that CSF-CRP level is significantly higher in pyogenic meningitis compared to non-pyogenic meningitis patients. It is a good indicator to diagnose pyogenic meningitis. It can be used to differentiate pyogenic from non-pyogenic meningitis also.

2. A Study of Effect of Motility Chewing Gum in Gut after Abdominal Surgery at NMCH Sasaram
Vikas Kumar, Seema Kumari
Abstract
Aim: The aim of the present study was to analyze the clinical outcome of effect of chewing gum mainly to avoid post-operative paralytic ileus in post-operative patients of abdominal surgeries. Methods: The study was conducted in Department of General Surgery, Narayan Medical College and Hospital, Sasaram, Bihar, India for the period of one year. Total 100 patients were enrolled, 50 were cases gum chewing and 50 were controls. This was an interventional (Experimental) prospective study. The intervention was very simple, it was allowing the cases to chew chewing gums after surgery. Results: Mean duration of hospitalization (days) was 12.8, 12.48 in cases and control groups respectively. Flatus (mean duration of first flatus passed) in hours was 50.9, 67.3 in cases and control groups respectively. Motion (mean duration of first bowel passed) in hours was 93.7, 128.2 in cases and control groups respectively. Bowel sound (mean duration first sound heard) in hours was 21.5, 35.3 in cases of routine surgery, emergency surgeries respectively. Flatus (mean duration of first flatus passed) in hours 47.3, 66.4 in cases of routine surgery, emergency surgeries respectively. Motion (mean duration of first bowel passed) hours 91.6, 119 in cases of routine surgery, emergency surgeries respectively. Bowel sound (mean duration first sound heard) in hours is 37.6, 38.2 in cases of gastric and small bowel surgeries respectively. Flatus (mean duration of first flatus passed) in hours 68.4, 72.8 in cases of gastric and small bowel surgeries respectively. Motion (mean duration of first bowel passed) in hours 123.7, 124.6 in cases of gastric and small bowel surgeries respectively. Bowel sound (mean duration first sound heard) in hours was 23.4, 35.5 in cases of traumatic surgery, pathological surgeries respectively. Flatus (mean duration of first flatus passed) in hours 53.5, 68.2 in cases of traumatic surgery, pathological surgeries respectively. Motion (mean duration of first bowel passed) in hours 100.8, 113.7 in cases of traumatic surgery, pathological surgeries respectively. Conclusion: It was observed that chewing gum has significant effect over bowel motility as bowel sounds appeared significantly earlier in cases than control and time for first flatus passed and first bowel passed were also noted significantly earlier in cases than controls. Hospital stay of cases were found significantly lesser than control hence simple intervention like chewing can decrease the burden of disease of paralytic ileus from community.

3. Assessment of Biomechanical Forces Causing Implant Failure in Cases of Femoral Fracture Fixation: An Observational Study
Aditya Kumar, Rakesh Kumar
Abstract
Aim: The Purpose of this study was to evaluate biomechanical factors working around hip which leads to implant failure. Material & Methods: This was a prospective cum retrospective study. All 50 cases below 75 years of age with proximal femoral fracture [fracture Inter-trochanteric & Sub-trochanteric included] fixed with PFN irrespective of the centre where surgery was performed attending routine out-door of Department of Orthopaedics for one year  with implant failure were registered for the study. Results: In our study we registered total of 50 cases with mean age of registered cases was 65.45 + 9.31 years. 36 patients (72%) were male and 14 (28%) were females. Out of 50 cases registered, pattern of implant failure in our study were 15 cases (30%) had implant failure pattern of Z- effect , 12 cases (24%) had implant failure pattern of reverse Z-effect; 5 (10%) had breakage of nails; 2 cases (4%) had both screw breakage with varus collapse; 8 (16%) had single upper proximal screw breakage; & 8 cases (16%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Proper implant selection is critical and should be done on an individualized patient and fracture pattern basis. Poor surgical technique, implant-related issues, delayed fracture union, and poor patient compliance and health status alone or in combination can lead to breakage of the implants requiring challenging treatment options. Prevention of such catastrophic complications is crucial for the patient’s health and quality of life. Biomechanical study of the broken implant may provide useful information regarding failure causes and guide future treatment. Surgeons and mechanics should work hand in hand for implants evolution in order to optimize patient treatment.

4. A Hospital-Based Study Assessing Knowledge Level and Practice of Lactational Amenorrhea Method (LAM) as a Method of Contraception: An Observational Study
Ankita Ranjan, Ranu Singh Kushwaha, Kumar Gaurav
Abstract
Aim: The aim of the present study was to assess the knowledge about lactational amenorrhea method (LAM) of women and determine the proportion of women use LAM was also investigated the factors determining practice of LAM. Methods: The present study was conducted at Department of Obstetrics and Gynecology for one year and the knowledge and practice of lactational amenorrhea as a form of contraception among women visiting primary healthcare facilities were investigated in a cross-sectional study. 200 women of reproductive age completed a structured questionnaire. The participants were chosen using a simple random sample. Sample size was estimated to determine a prevalence of LAM usage and knowledge among lactating women. Results: A total of 200 lactating women in reproductive age (15-49) were included in the study, the mean age was 28.34+6.4 years, 53% of them were in the age group (20-29) and 55% were from rural areas. Most of the lactating women were housewife (77%) and only (23%) were working. From the total number of studied women, 48% had attended at basic education. Concerning family size, among the studied women, 26 women with a family size 3-4 members use LAM. 30 women with a family size 5 members use LAM. 25 women with a family size of 6 members use LAM. 20 of women with a family size of 7 or more members use LAM. (p- value < 0.0001). 65% of women included in the study have used LAM, 64% have used correct LAM, 90% of lactating women know about LAM and 35% have failure of usage LAM and get pregnant. And 40% of studied women had breast feeding barriers. The mean of duration of breast feeding is 11.12 months ± 7.33 and the mean of duration of amenorrhea is 6 months ± 4.11 and the mean of exclusive BF duration 4.63±2.34. Conclusion: The large majority of the participants in this study stated that breastfeeding can be used as a technique of family planning until menstruation returns. Only about two third of the women in the study said they had ever used LAM. Women from rural areas, not working, and educated with lower socioeconomic were more likely to practice LAM.

5. A Clinical Randomized Study Assessing Long Proximal Femoral Nail versus Short Proximal Femoral Nail in Treatment of Unstable Intertrochanteric Fractures
Aditya Kumar, Rakesh Kumar
Abstract
Aim: The purpose of this study was to study and compare the effectiveness and the disadvantages of intramedullary devices, i.e. short vs long PFN in the management of unstable IT fractures. Methods: The present study was conducted at Department of Orthopaedics for 12 months and with trochanteric fractures was operated at our hospital. Out of the 200 patients, Group A patients were operated with short Pfn and Group B were operated with long pfn.  Results: The mean age of patients in both groups was 63.47±8.42 years and 65.45 ± 8.32 years respectively and did not differ significantly (p =0.619). Further, the subjects of two groups were also gender matched as the number of females and males 62% and 38% in group A and 59% and 41% in group B respectively. The mean operative time was significantly lower in group B as compared to group A (36.34 ± 6.04 minutes vs. 44.26 ± 8.20 minutes, (p <0.001). Mean blood loss was also significantly lower in group B as compared to group A (58.72±15.75 ml vs. 78.72±16.34 ml, (p<0.001). The mean number of images taken per-op was significantly lower in group B as compared to group A (19.51±3.16 vs 28.52±4.76 (p <0.001). The loss of reduction including shortening (>1 cm) (p =0.678) and varus malalignment (p =0.590) were similar between the two groups though they were relatively lower in group as compared to group A. Conclusion: Use of Long PFN has advantages over short PFN in terms of the less postoperative complications like peri implant fracture and anterior thigh pain & better functional outcome. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning and accurate instrumentation.

6. A Hospital Based Observational Study Assessing the Role of Lung Ultrasound: A Complementary Imaging Tool for Chest X-Ray in the Evaluation of Dyspnea
Archana Verma, Manish Kumar
Abstract
Aim: The aim of the present study was to assess the role of lung ultrasound: a complementary imaging tool for chest x-ray in the evaluation of dyspnea. Material & Methods: A cross-sectional study, conducted over a duration of 1 year in the Department of Radiodiagnosis. The study population comprised 50 patients of either sex, presenting with a complaint of dyspnea. All patients with a clinical history suggestive of acute coronary syndrome as a cause of dyspnea, patients on invasive ventilatory support, or with suspected/known metabolic causes of dyspnea were excluded from the study. Results: The most common non-translobar consolidation was seen in 83.33% of cases identified by “Fractal sign/shred sign.” Translobar consolidation was identified by the “Lung sign.” Six patients with “Unilateral lung rockets” were also diagnosed with pneumonia. Out of 50 cases included in our study, 45 cases showed concordant diagnosis on ultrasound and chest X-ray (90%). Chest X-ray was found to have a sensitivity, specificity, positive predictive value, and negative predictive value of 100%. Conclusion: A high concordance was noted between ultrasound and chest X-ray for diagnosis of all pathologies studied (p < 0.01), the highest noted in pneumonia/pleural effusion and diffuse interstitial syndrome (κ ¼ 0.9). Hence, ultrasound may be considered a complimentary imaging modality for Chest-X-ray in the evaluation of dyspnoea.

7. Antibiotic Resistance Pattern in MRSA: Study in Central India
Mansi Gupta, Amit Saxena, Mahendra Singh Chauhan, Anshul Gupta, Amardeep Rai
Abstract
Introduction: Infections caused by MRSA are worldwide, 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. Cefoxitin disc diffusion is considered as surrogate marker for mecA gene, and could be considered as gold standard for MR isolates. MRSA infection is of concern because it is resistant to a number of widely used antibiotics. Treatment options for MRSA are limited and less effective, than options available for susceptible S. aureus infections leading to increased morbidity and mortality in hospitalized patients. To control MRSA in hospitals, correct antibiotic treatment in infected patients is required and  prevent their spread. Object: This study is conducted to know the resistance pattern of various antibiotics in Methicillin-resistant Staphylococcus aureus(MRSA). Type of study: Cross-sectional prospective analytical study. Study time: November 2012 to April 2014. Sample size: Total of 174 S. aureus isolated from non-repetitive clinical samples from IPD and OPD of tertiary care hospital in Bhopal. Result: 174 Staphylococcus aureus strains isolated from the non-repetitive clinical samples were processed for MRSA identification. Out of 174 S. aureus isolates 69(39.65%) were found to be MRSA by cefoxitin disc diffusion test and rest 105 strains were MSSA. Among MRSA  more than 70% resistance is for Ampicillin and Erythromycin and low resistance was for Netilmycin 27.53%, Doxycycline 24.63% and 5.79% for Linezolid and no resistance for Teicoplanin and Vancomycin. Discussion: Multidrug resistance among S. aureus is a potential threat for the health care settings. Prolonged hospitalization and antibiotic therapy especially with β-lactam antibiotics predispose patients to the acquisition of MDR. To control and  prevent the spread of MRSA in hospitals, correct antibiotic treatment in infected patients is required and ad mistered.

8. A Hospital Based Clinico-Demographic Assessment of Non Proteinuric Kidney Disease in Type 2 Diabetic Patients
Gopal Prasad, Kumar Abhinav, Sujay Ranjan
Abstract
Aim: This study aimed to evaluate the demographic and clinical characteristics of non proteinuric kidney disease in type 2 diabetic patients in Bihar region. Material & methods: This study was a single-center, prospective cohort study conducted in the Department of Nephrology for the period of 2 years. Written and informed consent were taken from all participants. In this single-center, prospective observational study, 500 consecutive type 2 diabetic patients with either overt proteinuria (>500 mg/day) and/or renal dysfunction (eGFR <60 ml/min/1.73 m2) were recruited. Results: Both the groups were similar in terms of gender, duration of diabetes, comorbidities, body mass index (BMI), blood pressure control, and glycemic control. The nonproteinuric group was older, had lesser prevalence of diabetic retinopathy (P < 0.001), higher hemoglobin levels and higher cholesterol levels. We studied the predictors of progression of renal dysfunction, but no variable was found to be significantly associated with renal dysfunction. We applied logistic regression analysis to find predictors of nonproteinuric kidney disease and found that the absence of retinopathy and presence of higher hemoglobin predicted non proteinuric phenotype. Conclusion: Most patients with diabetic kidney disease (DKD) have proteinuria, but approximately 20% have chronic kidney disease (CKD) without proteinuria. Simultaneous assessment of both albuminuria and eGFR is required in all diabetic patients. Studies are required to understand the utility of newer markers either alone or in combination with proteinuria to define nonproteinuric DKD.

9. A Comparative Study Assessing Diagnostic Accuracy of Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) as a Predictor of Weaning Outcomes in Comparison to Rapid Shallow Breathing Index
Santosh Kumar, Avinash Kumar
Abstract
Aim: The aim of the present study was to evaluate to study the diagnostic accuracy of diaphragmatic rapid shallow breathing index (D-RSBI) as a predictor of weaning outcomes in comparison to rapid shallow breathing index. Methods: The current study was a prospective observational study carried out for a period of 12 months, on consecutively admitted critically ill patients in the ICU at Institute of Medical Sciences, Banaras Hindu University in Varanasi, Uttar Pradesh, India . 60 patients were included in the study. Results: There were 60% male in the study with at least one medical comorbid illness present majority being diabetes mellitus (40%). The primary indication for ventilation in 36 patients (60%) was a hypercapnic respiratory failure arising in an acute exacerbation of chronic obstructive pulmonary disease, followed by acute respiratory distress syndrome (ARDS) in 12 patients; four hypoxemic respiratory failures due to multilobar pneumonia; three pulmonary edema due to cardiac origin; two massive hemoptysis; two depressed sensorium, and one pulmonary edema due to fluid overload secondary to renal insufficiency. The baseline clinical characteristics of age, APACHE II, and SAPS II score on the day of ICU admission, the total number of days of ICU stay, and the total duration of mechanical ventilation before the first SBT were not significantly different in the two outcomes groups. The MIP, RSBI, DD, DTF, and D-RSBI were compared in the outcome groups, and the difference between the groups was statistically significant. At a cut-off of 1.740 breath/minute/millimetre, D-RSBI had a sensitivity, specificity, PPV, and NPV of 100%, 90.2%, 100%, and 68.20%, respectively. Conclusion: Diaphragmatic rapid shallow breathing index is a novel, ultrasonography-based, noninvasive, and simple bedside predictive tool for weaning guiding intensivists during weaning from mechanical ventilation.

10. A Hospital-Based Study to Assess the Lipid Profile and Oxidative Stress in Patients of Ischemic and Hemorrhagic Stroke: A Case-Control Study
Amarendra Kumar Amar, Rakesh Kumar Ranjan, Shabana
Abstract
Aim: The aim of the present study was to assess lipid profile in patients of cerebrovascular stroke and controls. Methods: The present study was carried out in the Department of Biochemistry. Informed consent was taken from patient / relative and control subjects. The study was conducted for the period of one year. Study Groups: 50 Patients (age 30-90 years) of cerebrovascular stroke referred by  hospitals  were selected. Results: The mean age of cases and controls were 56.54 ± 12.48 and 48.32 ± 7.83 years respectively Maximum number of cases was in the age group of 51-60 years (34%). On comparing mean cholesterol, TG, HDL, LDL and VLDL between cases and controls, the p value was < 0.01 in all above test parameters which was found to be statistically significant. On comparing, levels of total cholesterol, HDL cholesterol and LDL cholesterol between ischemic and hemorrhagic stroke, p value was statistically significant while difference between triglyceride level and VLDL was not significant. On comparing, the difference between mean MDA values of ischemic stroke and controls was found to be statistically significant (p<0.01). On comparison by student t test, the difference between mean SOD values of ischemic stroke and controls was found to be statistically significant (p<0.01). Also on comparison between hemorrhagic stroke and control the difference in mean MDA and SOD values was found to be statistically significant (p<0.01). Conclusion: The difference in lipid profile between ischemic and hemorrhagic stroke should be taken into consideration while starting statin therapy as primary preventive measure to reduce incidence of first stroke in high risk patients, as well as during secondary prevention in case of ischemic strokes.

11. A Hospital-Based Assessment of the Hematological Parameters in Patients with COVID-19 Infection: An Observational Study
Md. Imteyaz Alam, Madhu Bharti, Manish Kumar Jha, Poonam Kumari
Abstract
Aim: The aim of the present study was to evaluate the abnormalities in hematological parameters among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients in a tertiary care hospital. Material & Methods: This was a cross-sectional study carried out in Department of Pathology,  The study period was of 12 months. Includes all patients confirmed with COVID-19 infection. A confirmed 100 case of COVID-19 was defined by a positive result on the reverse transcriptase polymerase chain reaction (RT-PCR) assay of a specimen collected on a nasopharyngeal swab. Informed consent was obtained from all patients during blood sample collection. Results: In the present study, a total of 100 patients confirmed with COVID-19 infection were included, out of which 60 (60%) were males and 40 (40%) were females. The majority of the patients (77%) were more than 40 years of age. In this study, all the patients including both males and females were categorized into three groups based on hemoglobin levels. Out of the 100 patients, 49 cases (49%) had adequate hemoglobin levels of above 12g/dl, around 43 cases (43%) had a mild reduction in the hemoglobin value, and only 8 cases (8%) had moderate anemia with hemoglobin levels less than 10g/dl. In this study, 68 cases (68%) had a WBC count in the normal range while 22 cases (22%) had leukopenia, and 10 cases (10%) had leucocytosis. Conclusion: The common hematological abnormalities in patients with COVID-19 infection were elevated NLR, lymphopenia, thrombocytopenia, and elevated D-dimer levels. Some of the hematological parameters including elevated NLR, thrombocytopenia, and lymphopenia have been found to correlate with the clinical severity of the SARS-COV-2 infection in many patients and are useful in monitoring the patients during the course of the disease.

12. A Study to Analyse Various Clinical Presentation, Underlying Immunocompromised Condition, Complication of Invasive Fungal Sinusitis: An Observational Study
Abhishek Kumar, Tripti Kumari, Salil Kumar Sharma
Abstract
Aim: The aim of the present study was to analyze various clinical presentation, underlying immunocompromised condition, complication of invasive fungal sinusitis. Material & Methods: Total 50 cases of both types of invasive fungal sinusitis were included in this study.  The demographic profile, clinical presentation, underlying immunocompromised status, complication, mortality and management of all these 50 patients were analyzed. Results: In this study of 50 cases of invasive fungal rhinosinusitis with a male preponderance 68% (n=34). In this study, patients having Diabetes Mellitus were more susceptible to both acute and chronic variant of invasive fungal sinusitis. In Some patients multiple underlying immunocompromised conditions were observed. The patients presented with symptoms of nasal obstruction (n=32) 64%, purulent rhinorrhea (n=23) 46%, headache (n=28) 56%, facial pain (n=11) 22%, and facial swelling (n=21) 42%, epistaxis (n=27) 54%, fever (n=16) 32%, decreased vision (n=4) 8%, diplopia (n=1) 2%. The rhinology findings like mucosal necrosis, black crust or debris, and pus in middle meatus and septum involvement were shown. Orbital cellulitis was the most common complication of invasive fungal rhino sinusitis. 5 patients had intracranial extension. Out of 50 patients 3 patients expired due to complication of fungal invasive fungal rhino sinusitis. Conclusion: Invasive fungal sinusitis was most commonly observed in 3rdand4thdecade of life with male predominance. Prolonged uncontrolled diabetic mellitus was the most common underlying immunocompromised status.  Mucor was the most common isolated fungal species. Preseptal cellulitis was the most common complication.

13. Assessing the Use of Prophylactic Antibiotics in Women Undergoing Elective Caesarean Section: A Comparative Study
Rani Dipa, Juhi, K. Manju
Abstract
Aim: The objectives of the study were to audit and implement the use of prophylactic antibiotics in women undergoing elective caesarean section. Methods: This comparative, prospective, hospital-based study was conducted in the department of  Obstetrics and Gynaecology for the period of 12 months. Results: Mean age was 25.5±3.6 years in group A & 24.6±3.4 years in group B. BMI at the time of admission was 26.4±6.4 kg/m² & 27.3± 5.5 kg/m² in group A & B respectively. Mean duration of surgery was 42.8±7.3 min in group A & 46.4±5.5 in group B. Average blood loss in both groups was comparable. Mean days of hospitalization was 4.8±3.7 days & 5.7±2.9 days in group A & B respectively. History of previous laparotomy like LSCS, ectopic surgery, etc. was present in 75 & 68 patients from group A & B respectively. Most common indication for elective LSCS was previous LSCS followed (42 % and 40%) by primi with CPD (24% v/s 20%). Conclusion: This study showed single dose antibiotic prophylaxis is as effective as conventional multi dose antibiotic therapy. It is cost effective, antibiotic resistance of microorganisms can be prevented, reduces patient side effects, nursing staff work.

14. Assessing Efficacy of Copper T (Cu T) 380 A as a Contraceptive Method and the Indications of Discontinuation of Cu T 380 A: Retrospective Study
Suchandra, Renu Jha, Kumudini Jha
Abstract
Aim: The aim of the present study was to determine the efficacy of copper T (Cu T) 380 A as a contraceptive method and to determine the indications of discontinuation of Cu T 380 A. Methods: The retrospective analysis on copper T removals done at Department of obstetrics and Gynecology for the period of 12 months. A total number of 100 cases were observed and included in this study. Results: Among 100 cases, Intracesarian insertions were done in 95 (95%) cases, Interval insertions were done in 5 (5%) cases. Majority of these cases belonged to the age group of 20 – 30 years (85 cases (85%) and 15 (15%) cases belong to >30 years of age group. 55 (55%) cases belong to para 1, 40 (40%) cases belong to para 2, 5 (5%) cases belong to para 3. Most of the cases reported after 2-5 years of usage for removal 72 (72%), 20 (20%) cases reported after 1-2 years, 8 (8%) cases reported after 5 years. Major indication for removal was desire for pregnancy in 80 cases (80%). In 17 (17%) cases CuT was removed for sterilization, 1 (1%) case for failure of contraception, 1 (1%) case for abnormal uterine bleeding and dysmenorrhea, 1 (1%) case for uterine perforation. The difficulties faced during removal were non visible strings and missing CuT. Among the removals, as majority of them were inserted during intracesarian period, they were likely to be high up in the uterine fundus with coiled strings and may present with non-visible strings. Conclusion: Cu T 380 A is a safe, long-lasting, convenient contraceptive method with very few side effects. The technique of insertion and ease of removal at convenient time makes it an effective and useful contraceptive method. Intracesarean insertion of Cu T can be done easily after counselling the patients.

15. A Hospital-Based Study Assessing the Efficacy of Amantadine in Improving Cognitive Dysfunction in Patients with Severe Traumatic Brain Injury
Sachin Kumar Singh, Gaurav Batra, Girish K.M
Abstract
Aim: The aim of the present study was to study the efficacy of amantadine in improving cognitive dysfunction in patients with severe traumatic brain injury. Methods: We conducted a single institution‑based observational study at Department of Neurosurgery. We obtained informed consent from the legal representative or next of kin/relative for each patient to be enrolled and have their data published. 70 patients were included in the study. The patients who survived severe TBI were observed for 2 months with Full Outline of Unresponsiveness (FOUR) score. Results: The cognitive function improved progressively during the 4‑week treatment interval as shown by significant improvement on FOUR score, DRS, and GOS. The adverse effects included spasticity, agitation, vomiting, rash, restlessness, diarrhoea, elevated liver function tests, generalised tonic-clonic seizures (GTCS), constipation, focal convulsions, and nausea. Conclusion: Administration of amantadine is safe and associated with rapid cognitive improvement in patients with static or declining cognitive function occurring after severe TBI, which is the foundation for functional independence.

16. A Descriptive Cross-Sectional Study Assessing the Risk Factors Associated with Sensorineural Hearing Loss in Patients with Systemic Hypertension
Tripti Kumari, Abhishek Kumar, Salil Kumar Sharma
Abstract
Aim: The aim of the present study was to find the prevalence and risk factors associated with sensorineural hearing loss in patients with systemic hypertension. Material & Methods: A cross-sectional study conducted during the period of 18 months aimed at finding out the prevalence of sensorineural hearing loss and the risk factors related to hearing impairment among systemic hypertensives in Department of ENT. 100 patients attending the outpatient Department of ENT, meeting the inclusion and exclusion criteria were recruited for the study. Results: Maximum participants were in the 56-60 age group (47%). Female participants predominated in our study (66%). When right ear and left ear were studied separately, 35 patients (35%) had sensorineural hearing loss in the right ear, whereas 33 patients (33%) had sensorineural hearing loss in left ear. When hearing thresholds at individual frequencies were noted, in the right ear 42 patients (42%) had hearing loss at 250 Hz, 34 patients (34%) had hearing loss at 500 Hz. Similarly, in the left ear, 37 patients (37%) had hearing loss at 250 Hz, 33 patients (33%) had hearing loss at 500 Hz. The patients in 55-60 age group had a higher incidence of hearing loss when compared to the remaining study population. In our study we found that increasing age is a risk factor for sensorineural hearing loss in hypertensives. We studied whether duration of hypertension has any bearing on the development of sensorineural hearing loss and found out that patients with more than 10 years duration of hypertension had the highest prevalence of sensorineural hearing loss. Conclusion: Sensorineural hearing loss has a high prevalence among patients with systemic hypertension. Hence, a pure tone audiometry should be done routinely in all hypertensives, particularly in elderly patients with long standing systemic hypertension. Periodic audiological assessment should be incorporated in them to start rehabilitation as early as possible. Early diagnosis of systemic hypertension in the community and initiation of treatment can help to further hinder the progression of microvascular disease that leads to target organ damage.

17. A Hospital Based Study to Assess the Outcome of Acute Ischemic Stroke Patients Treated with Tenecteplase: An Observational Study
Prashant Kumar Thakur
Abstract
Aim: The aim of the present study was to assess the outcome of acute ischemic stroke patients treated with tenecteplase. Material & Methods: A prospective observational study of acute ischemic stroke patients treated with tenecteplase. On admission, clinical characteristics, temporal, epidemiological, imaging parameters, outcome measures including baseline National Institutes of Health Stroke Scale( NIHSS) score, NIHSS at 1 hour, 24 hours, at discharge, and modified Rankin Scale Scores (mRS) at 0, 1 and 3 months were recorded in a structured proforma. Twenty patients were included in the study. Results: During the study, a total of 20 patients underwent intravenous(IV) thrombolysis with tenecteplase. Mean age was 60.32 years with 70% of the study subjects being males. Hypertension was the commonest risk factor present in 60% of the cases, followed by dyslipidemia in 50%. Most of the patients had large artery stroke subtype, with the infarct region belonging to the territory of middle cerebral artery in all the 20 cases. The mean time from onset of symptoms to arrival at the medical emergency was 115 (±12.48) minutes (min) while mean “door to needle” time was 56 (±18.22) min. The study subjects had a mean NIHSS score of 12 (±3.14) and a median mRS score of 5 (range: 3–5) at the baseline. The primary clinical efficacy outcome was an improvement in NIHSS score of 4 or more points at 24 h. Mean NIHSS scores at 2 h and 24 h were 11.49 (±5.15) and 9.31 (±5.25), respectively. We used “one-way repeated measures analysis of variance” test and observed a significant difference between the NIHSS scores at baseline and 24 h (P = 0.012). Conclusion: Tenecteplase was found to be the safer, faster and cost- effective thrombolytic agent in acute ischemic stroke and is as much suited for the rural setting, as for the urban ones. More studies on this novel thrombolytic agent will throw light on its superiority even in the rural settings thus preventing the stroke epidemics, enhanced by its customized usage especially in this era of endovascular care.

18. Red Blood Cell Distribution Width and Neutrophil-Lymphocyte Ratio as a Prognostic Biomarker for Mortality in Traumatic Brain Injury
Priyanka Awasthi, Sumit Kumar Singh, Garima Sinha, Ghanshyam Yadav, Amit Kumar
Abstract
Aim: The aim of the present study was to examine the role of RDW and neutrophil to lymphocyte ratio (NLR) in predicting the prognosis of patients with traumatic brain injury. Methods: The target population in the present prospective study was patients with traumatic brain injury referred to the Department of Anesthesiology, Institute of Medical Sciences Banaras Hindu University, UP, India for 6 months. Using the random sampling method, a total number of 100 participants enrolled in the study. Results: The mean age of the study population was 62.18 (± 15.05) years. The mean NLR (p = 0.05), neutrophil count (p=0.04), platelet count (p = 0.05), and NIHSS (p<0.01) had a significant difference. Hypertension and hyperlipidemia were the most and the least common underlying diseases among the participants, respectively. The mean of the variables by patients’ outcome (death or recovery) was assessed and compared with a T-test between the two groups to investigate the effect of the variables on the mortality of patients. Higher NIHSS scores were statistically significant with death within three months (p < 0.01), while the higher neutrophil count was associated with higher survival (p= 0.02). The receiver operating characteristic (ROC) curve was utilized to compare the predictions of deaths by variables, including RBC, NIHSS, NLR, and RDW at the end of the 3-month follow-up. We found that the NIHSS (area under curve (AUC): 0.905). Conclusion: Red cell distribution width is a predictor of mortality in patients with TBI. NLR  is  a  reflection of  the degree of  the inflammatory response  (neutrophils)  and  immune status  (lymphocytes),  which shows an increase in the  recruitment of inflammatory cells and  the release of inflammatory cytokines when  NLR  level increases. According to the results of the present study, it was suggested to increase the sample size in future studies to increase the accuracy of the results, control and delete other probable variables affecting RDW in the sample, including the information about the region and volume of hemorrhage and evaluate the relationship between study variables and the prognosis of patients in different age groups.

19. Assessing the Predictive Value of 24-Hour Serum Bilirubin Levels in the Early Detection of Newborn Hyperbilirubinemia with in a Hospital Setting
Arvind Kumar Yadav, Manish Ranjan, Kripa Nath Mishra
Abstract
Aim: The aim of the present study was to evaluate the prediction of early neonatal hyperbilirubinemia using 24-hour serum bilirubin level. Methods: The present study was a prospective study and was carried out at the NICU of Department of Pediatrics. The study was carried out for one year. We enrolled 100 infants. All healthy term neonates were to be assayed for TSB levels at 24 hours (Between 24+6hours) and again at 5 days. Results: There were 55 (55%) male neonates. 70 (70%) were delivered by normal vaginal delivery (NVD) and 30 (30%) delivered by LSCS. ABO incompatibility was present in 25% neonates. A TSB of <6mg/dl at 24 +6hours was present in 65 infants (65%). Out of these only 5 infants developed hyperbilirubinemia subsequently. In the rest 35 (35%) cases the TSB at 24+6 hours was >6 mg/dl. Out of this group 10 cases ultimately went on to develop a positive study outcome. All the neonates were classified into four groups depending on the 24 hour serum bilirubin levels <3mg/dl (group-1), 3-4.9mg/dl (group-2), 5-6.9mg/dl (group-3), and >7mg/dl (group-4). Majority 52 of newborns had mean 24hr bilirubin level between 3-4.9mg/dl. 25 (25%) newborns had 24 hours blood bilirubin level between <3mg/dl. 43 newborns had 24 hours blood bilirubin level between 5-6.9 mg/d. 14 neonates had 24 hours bilirubin levels >7mg/dl. The range of bilirubin value within 24 hours was 2.1 to 8.1mg/dl. There was statistically highly significant (p<0.001) association between requirement of phototherapy and higher 24hours serum bilirubin levels. Newborn babies with 24 hours serum bilirubin level of >4.75 mg/dl had a significant risk of developing neonatal hyperbilirubinemia. Conclusion: A bilirubin level over 4.75mg/dl during a 24-hour period may serve as a dependable indicator for the presence of newborn hyperbilirubinemia in healthy term infants.

20. A Hospital-Based Observational Study Assessing Food Allergies in Children Diagnosed with Asthma
Samir Kumar, Pankaj Kumar, Kumar Saurabh
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 for one year. 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: 68% were male and 32% were females in cases and 70% were male and 30% were females in controls. Majority of the patients in both groups belonged to 6-10 years of age group. Cases had asthma develop at 10.8 compared with 28.8 months for the controls (P < .001). 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; 52% of cases had food allergy compared with only 10% of the controls (P = .006). Food allergy was found to be a significant risk factor for life-threatening asthma; 52% 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.

21. A Hospital-Based Study Assessing Debridement for Ulcer Healing by Secondary Intention by Papain Debridement versus Using Povidone Iodine Solution: A Comparative Study
Kundan Kumar, Rahul Singh, Manish
Abstract
Aim: The aim of the present study was to compare enzymatic debridement for ulcer healing by secondary intention by papain debridement versus using povidone iodine solution. Methods: The Present study was single-center, prospective, comparative study, conducted in Department of General Surgery. Study duration was 11 months. 200 patients randomly divided into two groups each after matching for confounding factors Group 1 – 100 patients treated with papain-urea Group 2 – 100 patients treated with Povidone iodine. Results: The overall mean age of patients in both groups was 48.22±12.68 in Group A and Group B 47.33±13.37. The maximum number of patients was in the age group of 56-64 years in both Group A and Group B (36 and 44 patients respectively). In Group A, there are 70 male and 30 female patients. In Group B there are 66 male, 34 female patients. The total number of diabetics in the study included 200 patients (12%) in group A, while 18% in group B. The total number of hypertensives in the study included 8% in group A and 6% in group B while patients having both DM and HTN 8% in group A, 6% in group B.  The most common site affected among group A subjects was left foot (24%) followed by right foot (20%), the least site affected was right thigh (2%) and right hand (2%). The most common site affected among the group B subjects was left leg (22%) and right foot (22%) followed by left foot (20%) The least site affected was left hand, right and left forearm (2%). The commonest organism on Culture sensitivity taken on day 1 for all patients was Staphylococcus aureus – 24 patients, Enterococci – 12 patients, no growth in 7 patients. Conclusion: There was shorter duration of hospital stay, earlier wound disinfection and a greater number of patients who underwent earlier skin grafting in papain urea group. The results were statistically significant and in favour of papain urea. Thus we concluded that use of papain urea is highly recommended as compared to povidone iodine in management of non-healing ulcers.

22. To Compare Different Doses of Magnesium Sulphate on Hemodynamic Changes in Patients Undergoing Laparoscopic Surgery
Ritu Kumari, Ajit Kumar, Bibha Kumari
Abstract
Aim: The aim of the present study was to compare different doses of magnesium sulphate on hemodynamic changes in patients undergoing laparoscopic surgery. Methods: The study was conducted at Indira Gandhi Institute of Medical Sciences, Patna, India for the period of one year after obtaining ethical clearance from the Institutional Ethics Committee, IGIMS, Patna, India. Total 78 patients were randomly divided into 3 groups. Written informed consent was obtained from all the patients before enrolling them for the study. Results: There was no significant association between gender and group (p=0.524). There was insignificant association between ASA grade and group (p=0.502). There were insignificant changes in the heart rate among all three groups at all time intervals (p value>0.05). There were no significant differences in SBP among the three groups till 5 minutes after pneumoperitoneum, but after that time SBP and DBP was significantly less in group MB compared to group MA and group C till extubation. VAS at 5 minutes and at 20 minutes post extubation was significantly less in group MB compared to group MA and also with group C (p value< 0.05). Fentanyl requirement was less in group MB (only 3 patients among 26 patients) than in group MA (11 patients among 26 patients) and group C (20 patients among total 26 patients). This difference was statistically significant. (p value < 0.05). Extubation time was less in group MB (with a mean of 7.73) compared to group MA (Mean 8.31) and group C (mean 8.88) but the difference in extubation time between the three groups was insignificant (p value> 0.05). Conclusion: The present study concluded that magnesium sulphate attenuates the increase in blood pressure during pneumoperitoneum thus provides intra operative hemodynamic stability during laparoscopic surgery. Our study demonstrated that intravenous magnesium sulphate in a dose of 50mg/kg body weight given before creation of pneumoperitoneum attenuates the hemodynamic alteration during laparoscopic surgery and also reduces the post -operative pain. There were no complications noted during our study.

23. Predictors of 1-Year Mortality in Patients with Hip Fractures: A Comprehensive Analysis
Amit Virabhai Patel, Munir Yogesh Kumar Upadhyay
Abstract
Introduction: Proximal femoral fractures are a significant contributor to morbidity and mortality in the elderly population. Despite the substantial burden of osteoporosis, the majority of existing literature originates from Western countries. Therefore, we conducted this study to identify risk factors for early mortality in hip fractures within Indian population. Materials and Methods: A total of 227 patients were included. The primary outcome assessed was mortality in elderly patients undergoing operative treatment, and secondary outcome measures examined predictors of mortality within this age group, specifically age, gender, Charlson Comorbidity Index, Injury Severity Score, preoperative ASA grading, duration between injury and surgery, and the length of hospital stay. We performed regression modelling to evaluate the impact of various variables on the time of mortality. Results: The average age of the patients was 70.25 years. The mean Charlson Comorbidity Score was 1.75. The average time from injury to the operation was 34.75 hours, and the mean length of hospital stay was 5 days. Mortality one year after surgery stood at 18.50%. Univariate and multivariate regression analyses revealed that variables significantly associated with mortality included Age, Charlson Index, Charlson Index Category, time between Injury and operation (in hours), Length of hospital stay, and preoperative ASA grade. Conclusion: Our findings underscore the importance of implementing a dedicated hip fracture protocol in resource-poor settings. Early and aggressive management to optimize patients for surgery and expedite surgical intervention lead to a swift return to pre-fracture health status and a reduction in early mortality.

24. A Prospective Study to Identify the Fungal Isolates as well as their Antifungal Susceptibility in Patients from Undergoing Chemo-radiotherapy
Abhishek Kumar, Vijay Kumar, Ranjan Kumar Srivastava
Abstract
Aim: The aim of this study was to identify the fungal isolates as well as their antifungal susceptibility in patients from undergoing chemo-radiotherapy. Material & Methods: A prospective study was conducted on 100 randomly selected patients of Head and Neck cancer undergoing treatment at Department of Microbiology and Department of Radiotherapy at Patna Medical College and Hospital, Patna for the duration of 1 year. Results: Majority of the study population belonged to age group of 51-60 years (33%) followed by 61-70 years (21%). The mean age was found to be 54.2 years. There were no cases belonging to age group of less than 20 years. Carcinoma of the oral cavity was the most common tumour present among the members of the study group, with Ca Tongue constituting (28%) and Ca Buccal mucosa (26%) followed by Carcinoma supraglottis (20%). The samples collected are urine, blood and throat swab during 0, 2 and 6 weeks of radiotherapy. 90.5% of the isolates were isolated from throat swab and 9.4% isolates from Urine. There were no isolates in blood samples. The increased incidence of fungal infections in both throat swab and urine at 6th week of radiotherapy compared to before radiotherapy was found to be statistically significant with p value of <0.001 (throat swab) and 0.04 (urine). A wide spectrum of clinical presentation was present in the culture positive cases such as Presence of white patch (52.8%), Redness in oral cavity (20.8%), Dry mouth (11.3%), asymptomatic (9.4%) and Dysphagia (5.7%). Conclusion: Oral candidiasis is a common fungal infection in patients with cancer on treatment with chemotherapy and/or radiotherapy. Candida albicans and non-Candida albicans differ significantly in their antifungal susceptibility pattern. Non-Candida albicans like Candida krusei are inherently resistant to azoles. Hence, species level identification with in vitro antifungal susceptibility pattern is essential to choose the appropriate antifungal drug and to predict the outcome of therapy.

25. A Cross Sectional Study Assessing Sexual Dysfunction in Women with Traumatic Spinal Cord Injury and its Impact on Quality of Life: An Observational Study
Ratnesh Kumar, Vijay Shankar Prasad Singh, Rajeev Ranjan Sinha
Abstract
Aim: The aim of the present study was to describe sexual life in women with spinal cord injury. Material & Methods: A cross sectional study included all women with traumatic spinal cord injury treated at spinal cord centres at hospital. Out of the 300 women, 100 were excluded: 8 due to death, 14 were recovered, 6 with language difficulties, 16 had congenital injuries, 6 due to psychiatric disease, 18 due to other severe illness and 18 because they could not be located. The total eligible sample thus comprised 200 women. Results: Mean age of the women was 44 years and the average time since injury was 12 years. Almost two-thirds were married or in a committed relationship. 56 women were tetraplegics and 96 women had paraplegics. For single women, both SCI and controls, wanting a partner, the most common reason reported for being single was that they had not met the “right” partner. Other reasons reported by the women with SCI were feelings of inadequacy, fewer opportunities to find new contacts, low self-esteem, and feelings of being unattractive, doubts about sexual abilities and fear of bladder and/or bowel leakage. Hugging, kissing and caresses were listed as important by approximately three-quarters of the women with SCI both before and after the injury, and the control women. Almost half of the women with SCI considered it important to be caressed, even on body parts with no sensation, in order to become sexually aroused. Conclusion: For women who are able to overcome the physical restrictions and mental obstacles due to injury, it is possible to regain an active and positive sexual life together with a partner. Sexual information and counselling should be available both during initial rehabilitation and later when the women have returned to their homes.

26. An Hospital Based Observational Study Assessing Factors Associated with the Incidence of Radiocarpal Stiffness Following Management of Distal Radius Fractures Surgically
Arnab Sinha, Manoj Kumar, Rashmi Sharma, Swati Sinha, Ajay Mahto
Abstract
Aim: The aim of the present study to assess factors associated with the incidence of radiocarpal stiffness following management of distal radius fractures surgically. Material & Methods: This study reviewed a series of patients who suffered from DRFs at Department of Orthopedics. The inclusion criteria were adult patients with closed DRFs confirmed by x-ray test or computed tomography (CT) scan and underwent surgical treatment with volar locking plate fixation. A total of 150 patients who underwent distal radius volar locking plate fixation were included in the current study. Results: Among these patients, 40 (26.66%) were male, and 110 (73.33%) were female. The mean age at the time of surgery was 54.6 ± 10.6 with stiffness and 52.8 ± 9.1 without stiffness. Preoperative swelling was considered to be slight in 57 patients (38%) and was severe in 93 patients (62%).  Extra-articular fractures were seen in 30 patients (20%), and intra-articular fractures were in 120 patients (80%). During surgery, 78 fractures (52%) were fixed with plate only, and the other 72 fractures (48%) were fixed with plate and Kirschner wire. The incidence of RJS, we found that age, preoperative swelling, types of internal fixation, fracture type, post-operative volar tile and improper rehabilitation exercise were potential risk factors, while gender, BMI, history of smoking or alcohol, diabetes mellitus, osteoporosis,  dominant hand, time from injury to operation, ulnar styloid process fracture, post-operative radial inclination, post- operative ulnar variance, assisted cast or splint fixation, postoperative infection, or removal of internal fixation was not. In the further multivariate logistic regression analysis, intra-articular fracture, pre-operative severe swelling, post-operative unsatisfied volar tile and improper rehabilitation exercise were demonstrated to be associated with the incidence of RJS during follow-up. Conclusion: Factors such as intra-articular extension, preoperative severe swelling, use of additional k-wire, unsatisfied volar tilt, improper rehabilitation is associated with a higher incidence of radiocarpal joint stiffness in patients with distal radius fracture. Re-operative risk notification and postoperative precautions are necessary for relevant patients.

27. A Cross-Sectional Descriptive Study Assessing Knowledge and Performance of the Parents at the Time of Fever in Children
Brajesh Kumar, Prashant Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to assess knowledge and performance of the parents at the time of fever in children and how they act when encountering children’s fever. Methods: In this cross-sectional descriptive study, the studied population included parents of children less than 10 years admitted to Department of Pediatrics for 12 months. Samples were selected using the convenience sampling method and were enrolled after informed consents were obtained. Sample size was determined as 200 parents of children under 10 years. Results: The total number of mothers included in this study was 200. 144 (72%) of them have more than three children. The majority of mothers have neither job nor sufficient income that suffices the basic needs of life, such as food and clothing. 80 (40%) mothers have good knowledge about preschool childhood fever, and 94 (47%) of them show good management practices toward childhood fever. Approximately half of all mothers responded correctly regarding the definition of fever (48%), best site for measuring the temperature of under 5-year children (51%), and types of antipyretics (55%). Better responses are observed regarding the complications of fever (60%), choosing the proper type of antipyretic (64%), increasing the antipyretic dose is not beneficial in lowering high fever (66%), and dose calculation of antipyretic (61%). Mothers show correct responses regarding diagnosing fever by forehead touch or thermometer (46%), consulting a physician or health care facility once the fever is detected (44%), and the proper site for measuring temperature by thermometer for under-five children (52%). Only 35% of the studied group can correctly calculate the dose of antipyretic. Better responses are observed regarding the proper way to administer the pre-scribed antipyretic doses, using alternative medicine such as lukewarm water compresses, and administration of antibiotics with medical advice. Conclusion: This study indicated more than one-third of mothers had good knowledge about childhood fever, and a quarter of them showed good management practices towards preschool childhood fever. The mothers’ management practices towards fever were significantly related to some factors, which are young age, fewer children, higher educational level, sufficient income, and good knowledge.

28. Assessing the Association of Anemia and Hypoalbuminemia with the Mortality of CKD Patients Undergoing Routine Hemodialysis: An Observational Study
Chandan Kumar, Shivendu, Anand Kishor, Anjali Kumari
Abstract
Aim: The aim of the present study was to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis. Methods: A retrospective cohort study was conducted in the Department of General Medicine,  for the period of six months. The inclusion criteria were CKD patients aged ≥19-year-old who had undergone routine hemodialysis at our hospital. There were 100 patients enrolled in this study. Results: Out of 100 patients, 55% of patients were male and 45% were female. The majority of patients were adults (65%) and elderly (35%). The etiology of CKD included the following: diabetic nephropathy (43%), hypertensive kidney disease (30%), obstructive nephropathy (16%) and others (11%). Regarding vascular access at dialysis initiation, 81% were induced through subclavian vein catheter, 7% through internal jugular vein catheter, 10% through femoral access, and 2% through arteriovenous fistula. At dialysis initiation, 68% of patients had anemia, and 70% of patients had hypoalbuminemia. The mean hemoglobin level was 9.145±2.24 g/dl, while the mean albumin serum level was of 3.27±0.63 g/dl. During the dialysis treatment, 28 patients (28%) died. The majority of patients had anemia and hypoalbuminemia. The bivariate analysis showed that anemia (p value=0.180), and hypoalbuminemia (p value=0.340) were not statistically significant associated with mortality among patients undergoing routine HD. Conclusion: The mortality rate was higher in patients with anemia and hypoalbuminemia. Although our study concluded anemia and hypoalbuminemia are not statistically associated with mortality outcome of CKD patients, anemia and hypoalbuminemia may still have prognostic importance for CKD patients undergoing routine HD.

29. A Hospital Based Prospective Observational Study Assessing Post-Operative Pain Management in Elective Laparotomies
Chillington Nonghuloo, Dankhara Nitinkumar Harjibhai, Dr. Sumit Sharma
Abstract
Aim: The aim of the present study was to analyze the post-operative pain management in elective laparotomies in a tertiary care centre. Methods: This prospective observational study conducted in the Department of General Surgery, GMERS Medical College and General Hospital, Himmatnagar, Gujarat, India for the period of two years. All patients who underwent elective laparotomy were provided details about the study and method. Informed written consent was obtained. A total of 200 patients were included. Detailed history of the patient, condition, surgery performed, analgesics used were documented. NRS score was calculated. Results: A total of 200 patients were included among which 40 (40%) were female and 120 (60%) were the male patients. The patients who underwent elective laparotomies were aged between 20-70 years and 80 (40%) patients were in the age group of 40-50 years. The 20 different types of surgeries were recorded. The most common surgery performed in our study was open appendectomy which included 42 (21%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 18 (9%) patients. Most common was general anaesthesia with transverse plane block which was used in 76 (38%) patients, followed by general anaesthesia with quadratus lumborum block which was used in 42 (21%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural. Severity of pain gradually reduced from post-operative days 1-3 with the use of various analgesics. Conclusion: Multimodal analgesia was used in most of the patients for management of post-operative pain combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

30. Assessing Role of Pedis Scoring in Predicting Complications of Diabetic Foot: An Observational Study
Balkeshwar Kumar Suman, Santosh Kumar, Shri Krishna Ranjan
Abstract
Aim: The aim of the present study was to assess the usefulness of PEDIS scoring in identifying the severity of diabetic foot ulcer and its management. Methods: This was a hospital based prospective observational study conducted in Department of General Surgery. Patients who came to hospitals with Diabetic foot ulcers below the level of malleolus including both outpatients and inpatients were taken into this study after getting consent. This study was conducted for 1 year. Totally 100 patients were included in the study and followed up for 6 months. Results: Out of 100, 68 (68%) were males and 32 (32%) were females. White blood cell counts were found to be elevated in 34 (34%) patients. The cut-off value for high WBC was considered to be more than 11,000/mm3. Cut-off value taken for high random blood sugar was 140 mg/dl. About 65 (65%) patients were having abnormally elevated random blood sugar. 10 (10%) patients were found to have osteomyelitis and they were tested positive for probe to bone test. Patients with score of less than 7 managed with debridement showed good results at the end. Patients with score more than 4 with high random blood sugar and elevated white cell count being showed delayed healing. Conclusion: In our study, PEDIS score helped us in identifying the severity of the diabetic foot ulcer. Patients with higher score needed amputation. Majority of the patients with low score were managed successfully with debridement alone and the outcome was good.

31. A Study to Evaluate the Test Characteristics of the Urinalysis for Diagnosing UTI in Young Febrile Infants
Pawan Kumar Yadav
Abstract
Aim: The aim of the present study was to evaluate the test characteristics of the urinalysis for diagnosing UTI in young febrile infants. Material & Methods: A prospective study of febrile infants ≤60 days old at Department of Pediatrics. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, by using 2 definitions of UTI: growth of ≥50000 or ≥10000 colony-forming units (CFUs) per mL of a uropathogen. We defined a positive urinalysis by the presence of any leukocyte esterase, nitrite, or pyuria (>5 white blood cells per high-power field). Results: 205 patients were enrolled in this study out of which 5 patients who met exclusion criteria were excluded. Of the 200 patients enrolled in this study and who met the inclusion criteria, 120 (60%) were male and 80 (40%) were female. 96% of febrile patients (n=192) showed no significant growth on urine culture. 4% (n=8) of the febrile patients had positive cultures. Out of 200 children, 20 (10%) children showed significant pyuria (>5 pus cells/HPF) in centrifuged urine sample of which 12 (60%) were males and 8 (40%) were females. Chi-square analysis was done taking urine culture as gold standard for diagnosis of UTI. Analysis was done for significant pyuria (> 5 pus cells/HPF) and the following were calculated with the standard formulas: Sensitivity=100, Specificity=96.4%, Positive predictive vale=65.5%, Negative predictive value=98.2%, Percentage of false positive=2.5%, Percentage of false negative=0%, Accuracy rates=96.4%. Conclusion: The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia.

32. A Study to Assess the Lipid Profile Abnormalities in Newly Diagnosed Type 2 Diabetes Mellitus: An Observational Study
Birendra Kumar, Gitanjali Kumari
Abstract
Aim: The aim of the present study was to assess the lipid profile abnormalities in newly diagnosed type 2 diabetes mellitus. Material & Methods: A cross-sectional study was carried out to determine the triglyceride levels in newly diagnosed type 2 diabetics in the Department of General  Medicine. A total of 200 newly diagnosed type 2 diabetics were enrolled in our study. The Study was carried out during a period of 2 years. Results: Among the total participants, 80 (40%) were males, and 120 (60%) were females. The maximum number of patients belonged to the age group of 40-50 years (52%) and the least number belonged to the age group 20-30 years (2%). Among the participants in the study, 22.5% male and 32.5% female participants had above normal triglyceride levels. The total number of female participants who had abnormal triglycerides was higher than the male participants. The p value was not statistically significant. The Gender distribution showed that 35 male participants and 58 female participants had low HDL. The P value was >0.05 and was not statistically significant. In our study, among the 200 participants, 138 (69%) participants had desirable total Cholesterol levels of <200mg/dl, 52 (26%) had borderline high levels of 200-239mg/dl and 10 (5%) had high total cholesterol levels of ≥240mg/dl. Among the total participants, according to the NCEP-ATP III criteria, 70 (35%) participants had an optimal level of LDL of which 30 participants were males and 40 were females. 68 (34%) had near optimal levels of LDL and 23 participants were males and 45 were females. 35 (17.5%) had borderline high levels of LDL out of which 15 participants were males and 20 were females. 17 (8.5%) had high levels of LDL of which 7 were males and 10 were females. 8 (4%) participants had very high levels of LDL of which 3 was male and 5 was female. Conclusion: Deranged lipid profiles are quite prevalent in type 2 diabetics with females having higher triglyceride levels. Recognition of such elevated triglyceride levels in even newly diagnosed type 2 diabetics will help in  better prevention of associated cardiovascular disease.

33. Outcome Assessment in Patients of Early Osteoarthritis Knee When Treated with Intra-Articular Steroids versus Intra-Articular Hyaluronic Acid: A Comparative Study
Pappu Marandi, Rahul Kumar Chandan
Abstract
Aim: The aim of the present study was to assess compare the pain sensitivity and functional outcome in patients of early osteoarthritis knee when treated with intra-articular steroids versus intra-articular hyaluronic acid. Methods: This study was conducted at Department of Orthopaedic, SNMMCH, Dhanbad, Jharkhand, India to analyze the pain sensitivity and functional outcome in patients of early osteoarthritis knee when treated with intra-articular steroids versus intra-articular hyaluronic acid using VAS and WOMAC scoring system for the period of 2 years. A total of 100 patients were included in the study of which 50 patients were given intra-articular steroid injection and 50 patients were given hyaluronic acid. Results: A major number of patients in steroid Group were in the age group 60 – 65 years i.e. 58%. On the other hand, 50% of patients in H.A. group were in the age group 60 – 65 years. In steroid group, male population accounted for 40% and female was 60%. In HA group, male population accounted for 48% and female was 52%. In steroid Group, 24 patients (48%) that were given treatment were right side as compared to 10 patients (20%) on left side while 16 where bi- lateral (32%). The mean Pre procedure VAS Score in steroid Group was 8.412 which had reduced to 6.8245 by the end of one year. The mean Pre procedure VAS Score in H.A. Group was 8.322 which had reduced to 5.110 by the end of one year. The mean Pre procedure WOMAC Score in steroid Group was 84.5516 which had reduced to 77.7715 by the end of one year. The mean Pre procedure WOMAC Score in H.A. Group was 85.814 which had reduced to 58.8236 by the end of one year. Conclusion:  In conclusion, our study showed that the Pain sensitivity and functional outcome of Intra articular therapy performed via H.A. group are similar till three months in comparison to Steroid group.

34. A Single-Center Cross-Sectional Observational Study Determining the Prevalence and Predictors of Stunting in Children with Type-1 Diabetes
Khodaija Mahvish, Samiksha Sharma, B.K Singh
Abstract
Aim: The aim of the present study was to determine the prevalence and predictors of stunting in children with Type-1 diabetes. Methods: This was a single-center, cross-sectional, observational study. Children (1–18 years) with T1D along with their parents who attended the at department of pediatrics for 12 months. during the study period were approached. Parents were provided written informed consent and children gave assent for the study. 250 children were included in the study. Results: Of the 250 children studied, 120 (48%) were boys and 130 (52%) were girls. Mean age of the children in the study group was 11.8±3.8 (1.2–18) years and the average duration of diabetes was 5.0±3.7 years. The children’s mean HbA1c was 10.0±2.4%. We reported 20% prevalence of stunting in our cohort of children with T1D. Stunted children had higher cholesterol, lower hemoglobin, lower midparental height Z-scores, and higher urinary albumin creatinine ratio. Binary logistic regression revealed that pre-existing comorbidities, compromised renal function, longer disease duration, and short mid-parental height were significant predictors of stunting. Conclusion: Our study suggested that a little under one-sixth of children with T1D had short stature. Monitoring growth in these patients, especially in subjects with short parents, prolonged duration of diabetes, existing comorbidities, and deteriorating renal function are critical.

35. A Hospital-Based Study Assessing the Association and Diagnostic Effectiveness of Abnormal Doppler and Abnormal Amniotic Fluid Volume (AFV) in the Third Trimester of Pregnancy with Preterm Births: An Observational Study
Rohit Kumar
Abstract
Aim: The aim of the present study was to determine the association and diagnostic effectiveness of abnormal Doppler and abnormal amniotic fluid volume (AFV) in the third trimester of pregnancy with preterm births. Methods: The study population was recruited from at Department of Radiodiagnosis. All trimester-specific ultrasound and Doppler assessments were done. Total 500 women were included in the study. The data were collected prospectively and the study population included pregnant women with single-ton live fetuses. Results: The clinical and demographic details of the 500 women screened in the third trimester. 60% had EFW 10th–50th percentile. And 80% had no FGR. 25% had Preterm births < 37 gestational weeks. 20% had Oligohydramnios and 2% had polyhydramnios. Mean UtA PI > 95th percentile (p =0.03), UA PI > 95th percentile (p =0.03), MCA < 5th percentile (p < 0.001), and   CPR < 5th   percentile (p < 0.001) were associated with the presence of abnormal AFV. 125 (25%) of the 500 women had a preterm birth before 37 gestational weeks. These included 80 (20%) of 400 women with no FGR, 25 (50%) of 50 women with stage  1  FGR,  66.66%  of women with stage  2 (n = 3),   stage   3   (n =3),   or stage   4   (n =2)   FGR,   and   12 (28.58%)   of the   42   women with an   SGA   baby. The AUROC curves and the positive likelihood ratios for abnormal AFV and abnormal fetal Doppler parameters indicated that abnormal fetal Doppler and AFV did not have a good discriminatory ability for preterm births. Neither abnormal AFV nor abnormal fetal Doppler studies were significantly associated with preterm births in a multivariate logistic regression model that adjusted for preterm PE, EFW, type of conception, stages of FGR and SGA, and maternal age. Conclusion: In conclusion, we found that abnormal Doppler studies or abnormal AFV were not associated with preterm birth in the screened population. First-trimester identification of high-risk pregnant women and early initiation of low- dose aspirin can help reduce the pool of women at risk for preterm birth.

36. Determining the Aetiology and Outcome of Respiratory Distress in Neonates Hospitalized in the Neonatal Intensive Care Unit (NICU)
Shruti, Arunika Prakash, Manoj Kumar Singh, Bhupendra Narain
Abstract
Aim: The aim of the present study was to determine the frequency of the causes and outcomes of respiratory distress in neonates hospitalized in the neonatal intensive care unit (NICU). Material & Methods: In this descriptive and cross-sectional study, all the neonates with respiratory distress (RD), who were admitted at NICU Upgraded Department of Pediatrics were included. The study was conducted for the duration of one year. The required demographic information was extracted from patients’ dossiers. The collected data were analyzed using SPSS version 16.0. Results: About 68% of 100 neonates with RD were male. The mean neonatal age and mean birth weight were 5.22±7.18 days and 2743.9±727.9 grams, respectively. The minimum birth weight was 850 grams while the maximum was 4,500 grams. According to the results, intercostal muscle retraction,   tachypnea, grunting, cyanosis, apnea and nasal flaring were the most common symptoms of NRD while RDS and TTN were the most common causes of respiratory distress. Furthermore, about 20% of the neonates died of the disease. The outcomes of NRD had a significant correlation with respiratory failure requiring mechanical ventilation, apnea, multiple and concurrent of respiratory symptoms and mean duration of hospitalization (p˂0.05). Therefore, the variables that significantly correlated with infant mortality entered logistic regression model. Conclusion: It was found that RDS is the most common cause of respiratory distress in the hospitalized neonates. Moreover, infant mortality rate increased due to respiratory failure requiring mechanical ventilation and occurrence of apnea. It was concluded that improving the care of newborns requires mechanical ventilation and prevention of apnea leads to better outcomes and reduced infant mortality rate.

37. Ventilator-Associated Complications: A Study to Evaluate the Effectiveness of a Planned Teaching Program for Intensive Care Unit Staff Nurses
Akhileshwar, Nitin Kumar, Ranjeet Rana De, Akrity Singh, Rajbahadur Singh
Abstract
Aim: The aim of the present study was to assess the knowledge of nurses working in an intensive care unit for at least 6 months regarding ventilator-associated complications and its prevention. Methods: The present study was conducted in Department of Trauma and Emergency. All staff nurses working in the ICU were included in the study. 50 staff nurses were included in the study. Results: Age wise distribution of sample reveals that majority 74% within the age group of 22-25 years and 26% were in the age group of 26-30 years. Gender distribution of sample reveals that about 68% were female. While 32% were male. The percentage distribution of patients in educational qualification shows that among 54% were B.B.sc. and 44% were RGNM. The year of work experience was 96% between 1-5 years and 4% between 6-10 years, respectively. Most of the samples 29 (58%) were having average knowledge, 12 (22%) were having poor knowledge and 9 (18%) were having good knowledge regarding VAP. Most of the samples 47 (94%) were having good knowledge, 3 (6%) were having average knowledge regarding VAP. The pretest and post test knowledge score among staff nurses the pretest mean score was 11.519 with SD 2.648 and post-test mean score was 16.634 and SD 2.528 and the mean difference was 6.114 and calculated t value was 17.713 which was statistically significant at level of <0.001. Conclusion: The current study showed that the nurses had satisfactory total knowledge at the pre-program implementation, indicating that the respondents lacked knowledge. However, the score of total knowledge increased immediately after the planned teaching program, indicating that the nurses gained knowledge after the teaching program.

38. A Hospital-Based Study Assessing Serum Magnesium Levels and its Correlation with Glycemic Status in Type II Diabetes Patients: An Analytical Study
Sonal, Uday Kumar
Abstract
Aim: The aim of the present study was to assess the level of serum magnesium in diagnosed Type II diabetics without microvascular and macrovascular complications and correlate with glycemic status. Methods: A cross-sectional study was conducted in the Department of Biochemistry. The data was collected for finding out correlation between the glycemic index and serum magnesium was analysed and the results were obtained. The estimated sample size was 50. The sampling type was purposive sample. Results: 32 (64%) were in the age group of 41–60 years, 10 (20%) were in age group of 19–40 years, whereas 8 (16%) were between 61 and 80 years. 32 (64%) were male and 18 (36%) were female. Thus, there was male preponderance. 24 (48%) were diabetic since 11–20 years, 15 (30%) were diabetic since 0–10 years, 8 (16%) were diabetic since 21–30 years, while 3 (6%) were diabetic since >30 years. Laboratory reports revealed that there was significant difference in mean total leukocyte count, Serum glutamic pyruvic transaminase (SGPT), serum glutamic‑ oxaloacetic transaminase (SGOT), K+, Randon blood sugar (RBS), and HbA1c between hypomagnesemia patients compared to normomagnesemia patients (P < 0.05) There was no significant difference in other laboratory values between the two groups. The prevalence of hypomagnesemia in patient with HbA1c <7% was 20% as compared to that of normomagnesemia (60%), while the prevalence of hypomagnesemia in patient with HbA1c >7% was 80% as compared to that of normomagnesemia (40%). This difference of S. Mg level in relation to HbA1c was statistically highly significant. Conclusion: The study concluded that that low S. Mg level in type 2 diabetes patients may be associated with higher HbA1c level, higher incidence of retinopathy and nephropathy. Routine monitoring and correcting S. Mg levels in type 2 diabetes patients may help in better control of HbA1c and delaying progression to retinopathy and nephropathy.

39. Assess Endometrial Biopsy Audit and its Clinico-Pathological Correlation in Patients with Abnormal Uterine Bleeding in Bihar Region
Amit Kumar, Jyoti Kumari, Sujeet Kumar
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 over a period of 12 months. 200 cases were selected in the study. Results: In the study majority 45% were in the age group 41 to 50 years. In the study 5% were Nulliparous and majority were in para 2 (51%). In the study majority of subjects had Heavy menstrual bleeding (48%). In the study clinically, 48% were diagnosed to have fibroid, 25% 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.

40. A Hospital Based Prospective Randomized Control Study Evaluating the Effect of Virtual Reality on Pain during Intravenous Cannulation and Preoperative Separation Anxiety in Pediatric Patient
Rishabh Ravi, Kaiser Alam, Sujata Rani
Abstract
Aim: The aim of the proposed study was to evaluate virtual reality (VR) as a non-pharmacological intervention tool to reduce pain and separation anxiety in patients of paediatric age group undergoing intravenous cannulation and surgery. Methods: A prospective randomized control study was conducted in Department of Anaesthesiology at ESICMCH, Bihta, Patna after clearance by ethical committee. Patients with ASA physical status I, II posted for elective surgeries were included in the study which was conducted during 1 year period. Sixty patients were randomized into two groups. Results: statistical analysis of the heart rate and oxygen saturation of Children with moderate anxiety and severe anxiety and anxiety with regard to parental separation and about the unfamiliar people and environment done using paired t test. Patients using VR exhibited lower pain and anxiety score during intravenous cannulation and parental separation. Conclusion: This current study found that application of immersive VR had better pain alleviation and parent separation anxiety score when compared with non-VR group patient.

41. Intravenous Regional Anaesthesia for Upper Limb Surgeries: A Retrospective Study
Anilkumar P., Mohamed Hussain Sait A., Anzer Shah M., Sreenivasan D.
Abstract
Background: In this study we wanted to evaluate Intravenous Regional Anaesthesia with regard to effectiveness, usefulness, drugs and adjuvants used, types of surgeries done, safety and complications. Methods: This was a record based descriptive study conducted in Government Medical College, Ernakulam, for a period of 6 months among 129 patients, after obtaining IRC and IEC approval. Results: Lignocaine 0.5% along with muscle relaxants and either Dexmedetomidine or Buprenorphine or Fentanyl or Morphine as adjuvants can be used for IVRA with high success rate. Conclusion: IVRA is a safe and effective method for providing anaesthesia for upper limb surgeries of bone and forearm, Metacarpal fractures, Phalanx bone surgeries & Soft tissue surgeries of the hands and wrists. Complications with IVRA are less except for occasional Tourniquet pain, and transient Bradycardia responding to Atropine.

42. Bilateral Gynaecomastia in Hansen’s in West Godavari District of Andhra Pradesh: A Case Series
S. Dhanyasree, Gummalla Ajay Kumar, Raghuveer Tyagi, Bala Vaishnavi Lingamaneni
Abstract
Background: Leprosy is one of the causes of gynaecomastia (enlargement of the breast) and gynaecothelia (enlargement of the nipples); however, little has been published about it, and it is usually an ignored sign. Methods: This was an observational study. Herein, we report three male patients with multibacillary leprosy. Results: Two patients had gynaecomastia and one patient had gynaecothelia not associated with gynaecomastia. None of these patients were aware of it until it was detected by the treating doctor during an examination. Conclusion: Through this study, we are highlighting the fact that gynaecomastia or gynaecothelia may not be a rare phenomenon if it is observed in all cases of leprosy and the possibility of leprosy should be considered in any male patient complaining of isolated hypertrophy of the breast or nipple.

43. Influence of Anaesthesia Management Parameters on the Occurrence of Severe Morbidity and Death
Sandeep Das
Abstract
Background: There are few quantitative assessments of how anaesthesia management affects perioperative morbidity and mortality. The authors conducted a study to determine risk variables for anaesthetic care about severe morbidity and mortality within 24 hours of surgery. Methods: In a case-control study conducted in 2021–2022, anaesthetized patients were evaluated. Within 24 hours of being put under anaesthesia, some patients in the cases passed away or went into a coma; in contrast, the controls did not experience any of these outcomes. The Anaesthesia and Recovery Form was used to gather data, and confounder-corrected odds ratios were the result. Results: The cohort comprised 869,483 patients; 705 cases and 711 controls were studied. The frequency of 24-hour postoperative death was 8.8 per 10,000 anaesthetics, while the rate of unconsciousness was 0.5. Some significant anaesthetic management factors associated with decreased risk were using a checklist and protocol to check equipment (odds ratio: 0.64), recording equipment checks (odds ratio: 0.61), having a direct anaesthesiologist available (odds ratio: 0.46), having the same anaesthesiologist present during anaesthesia (odds ratio: 0.44); having a full-time working anaesthetic nurse (odds ratio: 0.41); having two people present at emergence (odds ratio: 0.69); and reversing anaesthesia (odds  Postoperative pain medicine also carried a lower risk profile, mainly when administered intramuscularly or epidurally as opposed to intravenously. Conclusions: Preoperative unconsciousness and death are associated, making postoperative mortality a severe problem. Anaesthetic management factors that impact this association include using medications during and after therapy, the type of anaesthetic care given during and after surgery, and the presence of anaesthesiologists throughout the procedure.

44. An Observational Study on Role of Oral Glycerol in Patients with Moderate Head Injury
Sushil Bhojraj Machhale, Ranjeet Kamble
Abstract
Background: This study was conducted to evaluate the benefits of oral glycerol in moderate head injury patients and assess the outcome in terms of GCS (Glasgow Coma Scale). Methods: This was a hospital based prospective, observational study conducted among 200 patients with moderate head injuries at the Department of General Surgery, LTMMC and LTMGH, Sion, Mumbai-400022, over a period of 18 months after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: We compared the GCS score over a follow-up period of 15 days in group A. We observed statistically significant improvement in the GCS scores. (The value of the F-ratio was 316.11148. The p-value was<0.00001. At p < 0.05, the outcome was significant). We compared the GCS score over a follow-up period of 15 days in group B. We observed statistically significant improvement in the GCS scores. (The F-ratio value was 147.45626. The p-value was < 0.00001. At p < 0.05, the result was significant). Conclusion: Mannitol 10% plus 10% glycerol is better than mannitol 20% because it keeps the mannitol dose the same and offers better CNS bioregulation without causing neurodeficiency.

45. Risk Factors Assessment for Moderate to Severe HIE
Manas Ranjan Mallick, Jyoti Ranjan Behera, Rashmi Ranjan Barik, Anil Kumar Jena, Narendra Behera
Abstract
Introduction: The following are risk factors for intrapartum haemorrhage: breech presentation, protracted labour, stationary labour, prolonged rupture of the membrane during term, caesarean section, home birth, and maternal fever. Preterm births, low birth weight, foetal distress, and child resuscitation are foetal risk factors.6.7 However, perinatal variables related to labour and delivery appear to have minimal effect on the prevalence of mental retardation and seizures, according to the British National Child Development Study (BNCDS). The prevalence of true intrapartum asphyxia in babies with CP was about 3–13% 8. “Successful neonatal resuscitation requires adequate preparation, accurate evaluation, and prompt initiation of support,” according to the American Academy of Paediatrics. “An appropriate preparation of an anticipated high risk delivery requires communication between the persons caring for the mother and those responsible for resuscitation of the newly born child.” Material and Method: In instances, a thorough history of the current disease is obtained, a thorough general examination, a thorough systemic examination, and staging is carried out using Levene44 staging for preterm newborns and Sarnat and Sarnat 31 staging for term babies. Complications and results have been examined in light of this information and with the aid of studies. A pre-made case report format (CRF) is used to gather information on the mother and child. Data gathered from case reports was entered into a master chart. Variables within the master chart were then analysed using SPSS software and all calculations were made in accordance with chi-square, anova, and p-value analyses. Result: The incidence of HIE Newborn is more in 18-23 yrs age group i.e. 51.5%. Primigravida has significant association with HIE Newborn constitutes 69.2%. Maternal Anemia has a significant association with HIE Newborn constitutes 56.5%. Prolonged labor and obstructed labor has significant association with HIE Newborn accounts 46.2%. There are more number of HIE Newborn cases in low socioeconomic status (65.8%) Male babies are more prone for HIE Newborns accounts 63.5%.Meconium stained liquor accounts 26.9% with HIE Newborns. Oligohydraminos accounts 19.6% for HIE Newborns. Conclusion: It appears that even with breakthroughs in foetal medicine and technology, birth asphyxia is linked to a considerable risk of morbidity and death in high-early infants. After ten years, there was no change in its mortality, morbidity, and risk factors. Research reveals that the development of HIE was mostly associated with maternal anaemia as a risk factor. Significantly higher severe grades of HIE were linked to prolonged and obstructed labour. Low socioeconomic level and severe HIE newborns are highly related. Primagravidae have a higher frequency of HIE. Most frequently, there are complications including shock and sepsis. A five-minute APGAR score of less than seven indicates a significant incidence of birth asphyxia.

46. Current Trends in the Management of Paediatric Head Injuries and Their Outcome
Mohammad Sikandar, Shaik Mohammad Muzahid
Abstract
Background: The leading cause of death and disability in children is Traumatic brain injury (TBI). Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Aim: To study the current trends in the management of paediatric head injuries and to study the outcome with the current management guidelines and followup status of the patients. Materials and Methods: This study was a prospective observational study and all patients diagnosed with head injury in Department of Neurosurgery, Osmania General Hospital, Hyderabad. This study was conducted between November 2014 to February 2017. 205 patients were selected in this study. Results: The commonest age group of paediatric head injuries is 11-14 years with the incidence rate of 39.5% i.e. 81 patients with the mean age group of 7 years. The male to female ratio is 4:3 with a male preponderance. The commonest mode of mechanism of injury is due road traffic accident with an incidence rate of 60% followed by fall. The commonest complaint the patients presented are the loss of consciousness for a period of more than 30 minutes to 24 hours with an incidence rate of 70% followed by altered sensorium with an incidence rate of 62%. Most of the patients admitted are with mild head injury with the incidence rate of 43.4%, followed by moderate and severe head injuries with the incidence rate of 37.5% and 19.02% respectively. The commonest type of injury is EDH with incidence rate of 26.8%.The patients with duration of stay less than 7 days are 180 i.e. 87.8% and the patients with duration of stay more than 7 days are 25 i.e. 12.19 %. Most of the patients admitted are managed conservatively i.e. 170 patients and only 35 patients are operated. The patients admitted in the study underwent various surgical procedures like craniotomy and evacuation of EDH, wound debridment and elevation of depressed fracture segment, endoscopic repair of fistula for traumatic csf rhinnorea, craniotomy and evacuation of SDH and decompressive craniotomy. The patients with good recovery had a incidence rate of 75.1% i.e. 154 patients and 189 cases of GOS >/=5 the patients expired are 11 with a mortality rate of 5.3%. Conclusion: In the present study, a number of interesting recent reports in the field of clinical research in pediatric TBI were studied. We believe that the field is moving forward at an accelerated pace since the publication of the first guidelines document, and that valuable innovations in our understanding of the pathophysiology, diagnosis, and monitoring have been made, along with some progress in defining optimal therapy.

47. Cardiovascular Autonomic Neuropathy in Type 2 Diabetes and Relevance of Corrected QT Interval
Gosangari Suchitra, Harish Kumar B, Neha Gala, Sandeep U
Abstract
Background: Prolonged QT interval (QT) has been identified as risk factors for sudden cardiac death. This study aimed to explore the correlation between cardiac autonomic neuropathy (CAN) and QT interval in individuals with type 2 diabetes. Methods: A total of 150 diabetic participants were enrolled, comprising 80 with and 70 without CAN. All subjects exhibited sinus cardiac rhythm, and those with conditions or medication usage leading to orthostatic hypotension (OH), cardiac arrhythmia, or QT prolongation were excluded. Following interviews and examinations, standard and continuous electrocardiograms (ECG) were recorded in the supine position during deep breathing and standing. CAN diagnosis relied on Ewing’s tests. QT, corrected QT (QTc), minimum QT (QT min), maximum QT (QT max), and mean±SD of QT (QT mean) were evaluated from standard ECG. Results: Among patients with CAN, 21.5% were symptomatic. The prevalence of abnormal QTc was 11.3%. No significant difference in long QTc was observed between patients with or without CAN. However, the mean±SD of QT max, QT mean, were higher in those with CAN. Conclusion: The prevalence of asymptomatic CAN was higher than that of symptomatic CAN. Patients with CAN exhibited higher QT max, QT mean compared to those without CAN. However, there was no discernible association between CAN and prolonged QTc.

48. Assessment of Oxidative Stress Parameters in Individuals with Chronic Obstructive Pulmonary Disease
Amit Jitendrabhai Asari, Kanneboina Karunasri, D. Keerthana, Shruthi B R
Abstract
Background and Objectives: While a majority of individuals who engage in smoking exhibit discernible signs of both pulmonary and systemic cellular and/or humoral inflammation, only a limited subset undergoes an intensified response leading to the development of COPD. Numerous investigations have substantiated the existence of systemic inflammation in COPD-afflicted individuals. This study endeavours to examine the levels of oxidative stress, antioxidant status, and TNF-α in patients diagnosed with COPD. Materials and Methods: A cohort of 89 COPD patients, matched by age and sex with an equivalent number of controls, was enrolled in the study. The assessment involved the quantification of malondialdehyde (MDA) levels, TNF-α assay, and total antioxidant levels. Results: The analysis revealed a significantly elevated level of malondialdehyde in all cases, with statistical significance observed in COPD patients. Total antioxidant levels were notably diminished in all COPD patients, exhibiting statistical significance. Similar to MDA, TNF-α levels exhibited a significant increase across all cases. Conclusion: The heightened malondialdehyde and TNF-α levels, coupled with diminished total antioxidant levels, underscore the imperative to delve deeper into the intricate interplay of trace elements and oxidative stress in the pathogenesis and complications of COPD. This necessitates the undertaking of further comprehensive clinical studies.

49. Clinical Retrospectively Evaluation of the Concept of the Warm versus Regular Room Temperature Seitz Bath in Perineal Wound Healing: A Comparative Study
Amrit Kumar
Abstract
Aim: The aim of the present study was to compare the effect of warm versus regular room temperature seitz bath. Methods: This was a clinical retrospectively study conducted in the Department of General Surgery for 24 months. Out of 100 patients 55 patients (55%) opted for warm water seitz bath (Group A) and others 45 (45%) (Group B) opted for regular room temperature seitz bath. Results: 55 patients (55%) in the study group opted for warm water seitz bath as compared to 45 patients (45%) of regular water seitz bath from the second day of surgery onwards. The cases who opted for regular water seitz, were in poor socioeconomic background, due to easy and frequent availability of regular water as compared to warm water. All the 16 cases of episiotomy (29.09%) wounds repaired by gynaecologist opted warm water seitz only. The choice of selection of sitz bath basically depends upon patient’s discussion with past treated cases of similar disease, educational background, socioeconomic status in the society and treating surgeon’s advice. Conclusion: The progress of wound healing and postoperative comfort in operated perineal surgical wound does not based on type of seitz bath and the antiseptic solution used for sitz bath. But it is found that the frequency of sitz bath and subsequent improvement in the local hygiene definitely give comfort to the patient and speeds up wound healing.

50. Clinico-Epidemiologic and Early Outcome Assessment in Traumatic Spine Injuries: An Observational Study.
Saurabh 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 present study was single-center, prospective, observational study, conducted in Department of Orthopedics for the period of 2 years. 100 patients were included in the study. Results: Out of 100 patients, most of the patients were in the age group 51-60 (32%) and 41-50 (30%). Mean age was 51.59 years. Majority of the patients were male 70% while 30% patients were female. In present study, majority of traumatic spine injuries were due to road traffic accidents (52%), followed by fall from height (45%) and assault (3%). Majority of spine fractures occurred at cervical (40%) followed by Lumbar (30%) followed by thoracic (20%) vertebral level. Out of 100 patients, 55 patients (55%) had no associated injuries. Common associated injuries were hemoperitoneum (12%), head injury (11%), fracture humerus (9%) and fracture clavicle (6%). Out of 100 patients, 54% patients had no Neurodeficit and 48=6% patients had Neurodeficit. On pre -operative assessment 50% patients had ASIA score of E, 11% had ASIA score of D, 17% had ASIA score of C, 7% had ASIA score of B and 15% had ASIA score of A. Follow up ASIA score after 2 weeks in patients was A in 14% patients, B in 8%, C in 16%, D in 12, E in 50%. Follow up ASIA score after 3 months in patients was A in 8% patients, B in 5%, C in 6%, D in 15%, E in 68%. Follow up ASIA score after 6 months in patients was A in 9% patients, B in 5%, C in 4%, D in 16%, E in 66%. Follow up ASIA score after 9 months in patients was A in 8% patients, B in 6%, C in 4%, D in 20, E in 60%. Follow up ASIA score after 12 months in patients was A in 12%, D in 28, E in 60%. Conclusion: Complication rates were higher in patients treated non-operatively. Leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long-standing bed sores.

51. An Observational Study to Evaluate the Association of Magnesium Supplement in Laryngopharyngeal Reflux Disease
Ajit Kumar
Abstract
Aim: The aim of the present study was to evaluate the association between Mg intake and the risk of reflux disease and that the addition of magnesium supplements should be considered and added to the LPRD treatment protocol for adults in accordance with the dietary reference intake (DRI). Methods: This was a hospital based prospective study done over a period of 2 years in the Department of ENT  in patients presenting with symptoms suggestive of LPR of the age group 18-65 years. A total of 200 patients were included in the study. Results: Out of total 200 cases, 120 (60%) were females and 80 (40%) were males. Out of 120 female patients, 25% (n=30) were below 30 years, 62.50% (n=75) were within 30 to 50 years and 12.50% (n=15) were above 50 years. Out of 80 male patients, 25% (n=20) were below 30 years, 60% (n=48) were within 30 to 50 years and 15% (n=12) were above 50 years. The mean RSI score in each of these age groups for females were 17.4, 18.6 and 16.4 respectively and for males were 12.8, 14.6 and 14.2. Similarly the mean RFS for females were 13.3, 14.4 and 12.6 and for males were 10.2, 13.4 and 12.3 respectively. Foreign body/sticky sensation in throat was the foremost presenting complaint found in 70% of the study population, followed by excessive throat mucus (64%) and constant throat clearing (48%). Hoarseness of voice was seen in 7% of the patients. Dysphagia and dyspnea were the least common symptoms noticed 6% and 3% respectively. Conclusion: Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.

52. A Retrospective Evaluation of the Management Modalities and Outcome of Isolated Liver Injury in Blunt Abdominal Trauma: An Observational Study
Sweta
Abstract

Aim:
The aim of the present study was to assess the management modalities of isolated liver injury in blunt abdominal trauma. Methods: A retrospective study of 100 patients of isolated liver injury due to blunt abdominal injury conducted at the Department of  General Surgery for the period of 2 years. Results: In this series, the majority of the patients (45%) belonged to 21-30 years age group, followed by 11-20 (18%) and 31-40 years age group (15%). The majority of patients were male 88% whereas female patients were only 10%. MVA was responsible for 84% of blunt abdominal trauma cases, while fall from height accounted for 16% of cases. Majority of the patients presented with abdominal pain (100%) and abdominal tenderness (100%). There were 12 cases of chest injury. 15 cases of fracture of extremities were managed by the orthopedic surgery department. In present series, most of the liver injuries due to blunt trauma abdomen were minor type (grade I, II and III), they are (92%) of the total blunt liver injuries, major injuries (grade IV, V and VI were seen in (8%) cases of blunt liver trauma. In present series, in the present series, the majority of the blunt liver injuries were grade II (38%), 1 (26%) and III (22%) injuries followed by grade IV (15%) and V injury (2%) have the lowest incidence. In the present study, 95 (95%) patient discharge and 2 (4%) patient expired. Conclusion: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.

 

53. A Hospital Based Assessment of Neonatal Morbidity and Mortality between Late-Preterm IUGR and AGA Infants of the Same Gestational Age: A Comparative Study
Ratnesh Kumar, Sima Choudhary, Gopal Shankar Sahni
Abstract
Aim: The aim of this study was to compare neonatal morbidity and mortality between late-preterm IUGR and AGA infants of the same gestational age. Methods: The present study was conducted in the Department of Pediatrics for  two years. and we retrospectively analyzed 200 singleton pregnancies, including 100 pregnancies involving infants with a birth weight of or below the 10th percentile (IUGR) delivered between 34 weeks and 36 6/7 weeks of gestation due to maternal and/or fetal indications. The control group consisted of 100 singleton pregnancies with spontaneous preterm delivery at the same gestational age, in which the birth weight ranged from the 11th to 89th percentile (AGA). Results: There was no significant difference in maternal age which ranged from 16 to 45 years (mean±standard deviation: 25.1 ± 5.5 years) (P > .05). Among mothers of the IUGR group, 80 (80%) presented some underlying disease or obstetric complication in addition to IUGR, whereas 20 (20%) did not. Hypertensive syndromes were the most frequent condition and were observed in 49 (49%) women of the IUGR group. Heart disease was observed in 10 (10%) mothers of this group, systemic lupus erythematosus in 9 (9%), and other underlying diseases in 12 (12%) (pulmonary disease, hepatitis, thrombophilia, anemia, etc.). TTN or apnea rates did not differ significantly between IUGR and AGA infants. Late-preterm IUGR infants were found to be at a higher risk for IVH. There were only Grade 1 IVH in this sample. No respiratory distress syndrome, pulmonary hemorrhage or bronchopulmonary dysplasia was observed in either group. The frequency of sepsis or thrombocytopenia did not differ between groups. Hypoglycemia was more frequent in the IUGR group. The presence of hyperbilirubinemia was similar in the two groups (96% in the IUGR group versus 100% in the AGA group) (P = .52, Fisher’s exact test). Conclusion: In conclusion, our study showed that late-preterm IUGR infants present a significantly higher risk of neonatal complications and a significantly longer NCIU and hospital stay when compared to late-preterm AGA infants.

54. A Comparative Study of Oral Clonidine versus Oral Pregabalin in Attenuating Haemodynamic Response to Laryngoscopy and Endotracheal Intubation in Elective Surgeries
Swarbhanu Porel, Mustahsan Ali Halder, Anjan Chattopadhyay, Anirban Pal
Abstract
Background: Haemodynamic changes to laryngoscopy and endotracheal intubation during elective surgeries are a major challenge to the Anaesthesiologist. Use of oral premedicants like Clonidine (200μg) and Pregabalin (150mg) can be useful. The primary objective of this study was to compare the effects of oral Clonidine (200μg) and Pregabalin (150mg) on mean arterial pressure (MAP) and heart rate (HR) during laryngoscopy. The secondary objective was to note any changes on sedation and post-operative nausea and vomiting (PONV). Setting: The study conducted in a Tertiary Care Hospital of Kolkata, India. Methods: Sixty adults, aged 18 to 60 years, of ASA physical status I or II, undergoing elective surgeries were randomized into 2 groups. Group C received tablet Clonidine (200μg) while group P received tablet Pregabalin (150mg), 90 minutes before the induction of general anaesthesia. Their MAP, HR were noted at different time
points, and sedation scores and PONV were noted post-operatively. Statistical analysis was done using Wilcoxin test and p value < 0.05 will be considered as significant. Results: There MAP values (during laryngoscopy, intubation, one and five minutes post-intubation) in group C were significantly lower compared to group P (p < 0.05). Similar trend was noted for heart rates (HR). The sedation scores and incidence of post-operative nausea and vomiting were significantly lower in group C compared to group P. Conclusion: Oral Clonidine as compared to Pregabalin provides better control of mean arterial pressure and heart rate during laryngoscopy and intubation with lesser post-operative sedation and nausea/vomiting. Further large scale studies will be needed to corroborate these findings.

55. Seroprevalance of Dengue Viral Infection in a Tertiary Care Hospital in Kanyakumari District
Vidhya V.R., R. Nepoleon, N. Palaniappan
Abstract
Background: Dengue fever caused by dengue virus is an acute viral infection associated with significant morbidity and mortality all over the world. This study is conducted to know the seroprevalance of dengue fever in a tertiary care centre at Kanyakumari district. Aim: To determine the prevalence of Dengue in Kanya kumari district of Tamil Nadu. Methods: A total of 176 clinically suspected dengue cases attending the medical OPD of Sree Mookambika Institute of Medical Sciences from March 2021 to March 2022 were included in the study. The samples were collected after taking informed consent from the patient . The samples were screened for IgM and IgG antibody by Enzyme Linked Immunosorbent Assay. The manufacturer instructions were strictly followed. Results: Out of the 176 samples for dengue only 32 (18%) were positive for IgM only, 15 (8.5%) were positive for IgG only and 7 (3.9%) samples were positive for IgM and IgG Conclusion: A significant rise in the prevalance (18%) of primary dengue viral infection cases were reported in the Kanyakumari district of Tamil Nadu.

56. Lung Functions among Post Covid Females during Different Trimesters of Pregnancy
Kavya Sri J., Sabarinath Ravichandar, Mukunth kirubasankar, Vani
Abstract
Background: A variety of respiratory complications can be encountered in pregnancy. An understanding of the pathophysiology of pregnancy is important in the management of such complications. During healthy pregnancy, pulmonary function, ventilatory pattern and gas exchange are affected through both biochemical and mechanical pathways. [1] The normal lung function of a pregnant women changes in every trimester i.e., the lung volumes undergo major changes. Some women will have pre-existing respiratory conditions such as Asthma, TB, Cystic Fibrosis, COVID 19. The major physiologic changes that occur in pregnancy are the increased minute ventilation, which is caused by increased respiratory center sensitivity and drive; a compensated respiratory alkalosis; and a low expiratory reserve volume. The vital capacity and measures of forced expiration are well preserved. Patients with many lung diseases tolerate pregnancy well, with the exception of those with pulmonary hypertension or chronic respiratory insufficiency. The lung volume of post COVID pregnant women undergoes major changes like, ERV gradually decreases during second half of pregnancy, FRC decreases, Increased inspiratory capacity, Increased oxygen consumption and basal metabolic rate, Dyspnea. Methods: A survey was conducted with a self-prepared questionnaire among the sample size of 102 pregnant women of different trimesters coming to Obstetrics and Gynaecology department of Sree Balaji Medical College and Hospital OPD, Chromepet. The questionnaire included questions about their Covid severity (Hospitalized/ICU admission) and their pre-existing respiratory complications. The descriptive statistical analysis was carried out including frequency and percentage. The results of the study were tabulated. Data entry and analysis: Data entry was done is MS-EXCEL sheet, 2010 Graph was presented in MS EXCEL, 2010 Results: There is a significant relationship between FEV1_FVC values of patient when compared to if the patient is admitted to ICU and if she is Covid positive with P-VALUE<0.05. There is a significant relationship between FEV1 values of the patient when compared to if the patient is admitted to ICU and if she Covid positive with P-VALUE<0.05. The mean age among the study population was 27 years. 8.06% was hospitalized for covid and 2.02% was admitted in ICU during covid. Among them 25.0% of women hospitalized for Covid and 16.7% of women admitted in ICU shows decreased FEV1/FVC and 100.0% of women hospitalized for Covid and 20.2% of women admitted in ICU decreased FEV1 values. Conclusions: The present study revealed that there is a significant change in lung function of 3rd trimester pregnant women who were previously hospitalized for COVID-19 and There is also a significant relationship between the patients admitted to ICU and their FEV1 and FEV1/FVC values. The results of PFTs must be analysed with caution and considering the respiratory Comorbidities (asthma, cystic fibrosis).

57. A Comparative Study of Oral Clonidine versus Oral Pregabalin in Attenuating Haemodynamic Response to Laryngoscopy and Endotracheal Intubation in Elective Surgeries
Swarbhanu Porel, Mustahsan Ali Halder, Anjan Chattopadhyay, Anirban Pal
Abstract
Background: Haemodynamic changes to laryngoscopy and endotracheal intubation during elective surgeries are a major challenge to the Anaesthesiologist. Use of oral premedicants like Clonidine (200µg) and Pregabalin (150mg) can be useful. The primary objective of this study was to compare the effects of oral Clonidine (200µg) and Pregabalin (150mg) on mean arterial pressure (MAP) and heart rate (HR) during laryngoscopy. The secondary objective was to note any changes on sedation and post-operative nausea and vomiting (PONV).Setting: The study conducted in a Tertiary Care Hospital of Kolkata, India.Methods: Sixty adults, aged 18 to 60 years, of ASA physical status I or II, undergoing elective surgeries were randomized into 2 groups. Group C received tablet Clonidine (200µg) while group P received tablet Pregabalin (150mg), 90 minutes before the induction of general anaesthesia. Their MAP, HR were noted at different time points, and sedation scores and PONV were noted post-operatively. Statistical analysis was done using Wilcoxin test and p value < 0.05 will be considered as significant. Results: There MAP values (during laryngoscopy, intubation, one and five minutes post-intubation) in group C were significantly lower compared to group P (p < 0.05). Similar trend was noted for heart rates (HR). The sedation scores and incidence of post-operative nausea and vomiting were significantly lower in group C compared to group P.Conclusion: Oral Clonidine as compared to Pregabalin provides better control of mean arterial pressure and heart rate during laryngoscopy and intubation with lesser post-operative sedation and nausea/vomiting. Further large scale studies will be needed to corroborate these findings.

58. Seroprevalance of Dengue Viral Infection in a Tertiary Care Hospital in Kanyakumari District
Vidhya V.R., R. Nepoleon, N. Palaniappan
Abstract
Background: Dengue fever caused by dengue virus is an acute viral infection associated with significant morbidity and mortality all over the world. This study is conducted to know the seroprevalance   of dengue fever in a tertiary  care centre at Kanyakumari district.Aim: To determine the prevalence of Dengue in  Kanyakumari district of Tamil Nadu.Methods: A total of 176  clinically suspected dengue cases attending the medical OPD of Sree Mookambika Institute of Medical Sciences  from March 2021 to March 2022 were included in the study. The samples were collected after taking informed consent from the patient . The samples were screened for IgM and IgG antibody by Enzyme Linked Immunosorbent Assay. The manufacturer instructions were strictly followed.Results: Out of  the  176 samples for dengue  only 32 (18%) were positive for IgM only, 15 (8.5%) were positive for IgG only and 7 (3.9%) samples were positive for IgM and IgGConclusion: A significant  rise in the prevalance (18%) of primary dengue viral infection cases were reported in the Kanyakumari district of Tamil Nadu.

59. Chronic Neuropathic Pain in Lumbar and Lumbosacral Spinal Disorders: A Cross Sectional Study on 441 Patients.
Sanatan Behera, Tanmoy Mohanty, Gouri Shankar Patnaik, Chitrita Behera
Abstract
Introduction: Neuropathic pain is a complex, heterogeneous disorder which is prevalent world over. It is often poorly understood, under diagnosed and underrated. Though the exact mechanism involving the genesis of neuropathic pain is ill understood, nevertheless nociceptive pain and neuropathic pain often co-exist in spinal disorders. Neuropathic pain in spinal disorders remains the major anatomically plausible reported neuropathic pain. History and physical examination remains the mainstay in diagnosis, but additional questionnaires, imaging has improved the accuracy in diagnosis. Aim: To assess the prevalence of chronic neuropathic pain in lumbar and lumbosacral spinal disorders based on history and clinical examination. Materials and Method: This is a retrospective study comprising of 441 patients with data retrieved from outpatient medical records. It was conducted in Kalinga Institute of Medical Sciences (KIMS) from January 2000 to December 2021. The out patients record of patients aged between 20 years to 60 years with back pain and leg pain of at least 3 months duration were reviewed, and 441 patients fulfilling the inclusion and exclusion criteria, were included in the study. The data were analyzed using Microsoft Excel Software. Result: There were 249 males and 192 females with male and female  ratio being 1.29:1. The average age of the study population was 45.68 years. Two main clinical types such as Lumbar Radiculopathy 77.77% (n=343) and Lumbar Spinal Stenosis(LSS) 22.22% (n=98) were detected. Each type was further sub divided into two sub types. 33.10% (n=146) patients were found to have neurologic deficit of which 76.02% (111) was from lumbar radiculopathy group and 23.97% (35) was from LSS group. 63.49% of patients were categorized under Quebeck Task Force classification of which 28.11% had above knee and below knee pain with neurological deficit.  Conclusion: Neuropathic pain in lumbar and lumbosacral spinal disorder is common. Sciatica was the commonest mode of presentation in chronic neuropathic pain. Lumbar spinal stenosis was seen in older age group of patients as compared to patients with Lumbar radiculopathy. High index of clinical suspicion, detail history and physical examination are mandatory for achieving a proper diagnosis. Additional imaging and pain questionnaire may enhance in the diagnostic accuracy.

60. Bacterial Corneal Ulcer and Drug Sensitivity
Amrendra Kumar
Abstract
Aim:  The aim of the present study was to determine predisposing factors, common bacterial causes, and antibiotic sensitivity of corneal ulcers. Material & Methods: A cross-sectional observational study was carried out on 100 at Patna Medical College & Hospital, Patna, during the period of 2 years from 2012-2014. Ethical approval was obtained from the Ethical Committee of Institution. The study adhered to the tenets of the Helsinki Declaration.  Consecutive patients who consented and satisfied the inclusion criteria for corneal ulcer were recruited till the required sample size was obtained. Results: In the present study, 75% were male as compared to females. Most of the patients belonged to 31-40 years age group. 55% were having agriculture occupation and 75% were illiterate. 30% had corneal infection due to trauma. The main symptoms associated with corneal ulcer were pain (91%), red eye (81%), and decreased vision (65%). All patients had stromal infiltrate and 41% had hypopyon at presentation. Of the 100 samples investigated, 50% (50/100) were positive for etiology in both microscopy and culture, indicating that smear microscopy was highly predictive of culture positivity. Among the 50 (50%) positive samples, bacterial isolates were recovered in 60% and fungal isolates in 40% of the cases. S. pneumoniae (15/50) was the most commonly isolated bacteria followed by viridians group streptococci. Nocardia species and Bacillus species was also detected. Fusarium species were the most commonly isolated fungus followed by Aspergillus flavus and unidentified dematiaceous fungus, Curvularia, Bipolaris species and Exserohilum species. Conclusion: Bacterial corneal ulcer is showing an increasing trend in our society. Causative bacteria are showing resistance to the available drugs. Farm workers are found to be more prone to corneal ulcer development. Besides this, children from rural background are also susceptible to corneal ulcer development. Radical environmental changes and indiscriminate use of drugs have been linked to the occurrence of resistance among bacteria.

61. Clinico-Epidemiological Profile of Leprosy Cases in Post-Elimination, Post Covid Era at a Tertiary Care Center
Srishti Tripathi, Jagmohan Singh Dhakar
Abstract
Background: Leprosy continues to be a public health problem despite elimination from India in December 2005 with around 60% cases being reported from India globally. The covid pandemic has additionally disrupted case detection and treatment leading to under-reporting. The current study aims to get insights into the clinical and epidemiological profile of leprosy in post covid era at a tertiary care center. Methods: A retrospective observational study of all patients visiting leprosy clinic of dermatology department of NSCB Medical College, Jabalpur, MP over 1-year period from May 2022 to April 2023. Data regarding clinical and epidemiological characteristics were collected from patients’ records and tabulated and analyzed using appropriate statistical methods. Results: A total of 119 patients visited the leprosy clinic during the study period. Maximum patients belonged to age group 20-40 years (49.6%). There were 81 males and 38 females with male female ratio of 2.1:1. Most common clinical type of leprosy was lepromatous leprosy (LL) (40.3%) followed by borderline tuberculoid (BT) (26.9%). Nerves were involved in all patients with ulnar nerve being the most common (71.4%). Lepra reactions were noted in 13.6%, grade-2 disability 50.4%, deformity -ulcer 37% of cases. PCR test for detecting M. leprae DNA was positive in 91.6% cases. Conclusion: Our findings highlight the need for increasing leprosy case detection and early treatment through community based approaches as there in increased burden of lepromatous cases and disability patients post the covid pandemic phase due to compromised case reporting during lockdown. Also molecular diagnosis like PCR should be widely utilized for leprosy.

62.Analgesic Effect of Intrathecal Morphine for Postoperative Analgesia in Cytoreductive Surgery in Comparison with Placebo Control: A Randomnised Controlled Trial
Nicky Shah, Arun Deka, Jili Basing, Neelam Saikia
Abstract
A hospital based open label observational study was conducted in the department of Onco anaesthesia and critical care, State cancer institute, GMCH to observe the post-operative analgesia after Cytoreductive Surgeries in patients receiving intrathecal morphine. Ethical clearance was obtained from the institutional ethics committee prior to commencement of the trial. Based on the selection criteria, 40 patients were selected of ASA 2 scheduled for Cytoreductive Surgeries and were divided into 2 groups of 20 patients each. Group ITM received 300 mcg of intrathecal morphine along with standard anaesthetic care while placebo control group received the standard anaesthetic care. Injection Fentanyl 2mcg/kg was used in both the groups at the time of induction and Infusion Paracetamol 1gm was used intraoperatively in both the groups. Inf Paracetamol was also used postoperatively 12 hourly in both the groups. The parameters used in this study were age, weight, heart rate, SBP, DBP, MAP, VAS score for 48 hours. Time of first rescue analgesia. Analgesic consumption in the first 24 hours, analgesic consumption in the next 48 hours and side effects. In our study the demographic profile such as age, weight, ASA physical status were comparable in both groups and were statistically insignificant. In our study the hemodynamic status was assessed in terms of heart rate, systolic blood pressure (SBP), diastolic blood pressure(DBP) and mean arterial pressure (MAP). There was no statistically significant variation in the hemodynamic status in both the groups (p>.05). There was statistically significant difference (p<.05) in favor of ITM with respect to VAS for most part of our study. There was statistically significant difference in the use of rescue analgesic immediately after the postoperative period at 2hours postoperatively. 1 patient in ITM group (Group1) needed first rescue analgesia at 2nd hour whereas 19 patients needed in Placebo group (Group2) which was statistically significant p-value <0.0001. It was observed that total analgesic consumption in  group 1 was 46 and in group 2 was 114 in 48 hours. Total analgesic consumption in first 24 hours in group1 was 30 whereas in group 2 it was 87 which was statistically significant. There was no significant adverse effect in both the groups. Total ICU stay in both the groups were comparable and was not statistically significant

63. A Study of Outborn Referred Neonates Admitted at a Tertiary Care NICU
Parth Patel, Ashwin Dangi, Riya Patel, Jayantkumar Salvi
Abstract
Background and Aim: The survival perspective of extramural neonates significantly relies on the state of neonate at admission. This study was undertaken to analyze clinical, demographic and transport characteristics of external referred neonates. It was also designed to delineate correlation of TOPS score with outcome of referred neonates. Material and Methods: Present Prospective Observational Study conducted at NICU of a Nootan General Hospital affiliated with Nootan Medical College & Research Centre, Visnagar, Gujarat during October 2022 to September 2023. Clinico- demographic characteristics including details of pregnancy, birth history, sex, weight on admission, transport details, clinical status on admission, and indication of admission, course during hospital stay, final diagnosis and final outcome were recorded in a pre-designed proforma. TOPS score was documented as observed on arrival of neonates to NICU. Results: Out of 120 neonates 70 (58.3%) were males and 50 (41.6%) were females. Male: female ratio came to be 1.40:1. 67 out of 120 (55.83%) neonates were in early neonatal period (7 days old) including 15 neonates who were <24 hours old. 53 (44.16%) neonates were >7 days old. The main indications for admission were neonatal jaundice, probable sepsis and respiratory distress syndrome. Hypothermia was present in 37.5% (45/120) of neonates on admission. 12.5% (15/120) had poor perfusion, 11.6% (14/120) were hypoxic and hypoglycemia was detected in 2.5% (3/120) neonates.  Conclusion: In order to reduce neonatal mortality rate in the country, strengthening of neonatal services is an essential step. Establishment and strengthening of SNCUs and Janani shishu suraksha karyakram (JSSK) are important steps taken by the government in this direction.

64. Evaluation of the Risk of Gestational Diabetes Mellitus in Women with Hypothyroidism
Apoorva Singh, Vinika Nimodia, Neha Pruthi Tandon, Kamna Datta, Bangali Majhi
Abstract
Background: Gestational diabetes mellitus and hypothyroidism can affect both maternal and fetal outcome if not controlled. Thyroid disease and diabetes mellitus seems to be connected in pathophysiological aspect. Unrecognised thyroid dysfunction may cause impairment of the glycemic control. Early diagnosis and management are necessary to prevent fetomaternal complications. We aim to evaluate risk of gestational diabetes with hypothyroidism. Aims and Objectives: To find whether hypothyroid antenatal patient are high risk for developing gestational diabetes mellitus. Methods: A prospective observational study was done in a tertiary care hospital in New Delhi, India where in antenatal patients attending OPD were screened for hypothyroidism before 22 weeks of pregnancy. Thyroid function test was performed including fT3, fT4, TSH and anti-TPO antibody at the first antenatal visit and segregated into 2 groups based on their TSH value that is group A and B, with 210 patients in each group and followed up till 24 weeks of gestation after which oral glucose tolerance test by DIPSI criteria was performed and the diagnosis of gestational diabetes mellitus in these patients was made accordingly. Results: Prevalence of GDM was in hypothyroid group was 15.7% compared to 5.7% in euthyroid group. The relative risk for developing GDM was 1.98 (95% CI: 1.20-3.24). The result was statistically significant (p<0.0001). Additionally, the mean T3 and T4 level were significantly lower in GDM patients (1.89±0.81 & 0.54±0.30 respectively) compared to patients without GDM (2.27±0.90 & 0.65±0.27 respectively). Conclusion: It was observed that a significant association exists between hypothyroidism and diabetes melilites in antenatal patients. Furthermore, the study highlights the needs for vigilance in early gestation in obese and older hypothyroid patients for development of gestational diabetes mellitus.

65. Analgesic Effect of Intrathecal Morphine for Postoperative Analgesia in Cytoreductive Surgery in Comparison with Placebo Control: A Randomnised Controlled Trial
Nicky Shah, Arun Deka, Jili Basing, Neelam Saikia
Abstract
A hospital based open label observational study was conducted in the department of Onco anaesthesia and critical care, State cancer institute, GMCH to observe the post-operative analgesia after Cytoreductive Surgeries in patients receiving intrathecal morphine. Ethical clearance was obtained from the institutional ethics committee prior to commencement of the trial. Based on the selection criteria, 40 patients were selected of ASA 2 scheduled for Cytoreductive Surgeries and were divided into 2 groups of 20 patients each. Group ITM received 300 mcg of intrathecal morphine along with standard anaesthetic care while placebo control group received the standard anaesthetic care. Injection Fentanyl 2mcg/kg was used in both the groups at the time of induction and Infusion Paracetamol 1gm was used intraoperatively in both the groups. Inf Paracetamol was also used postoperatively 12 hourly in both the groups. The parameters used in this study were age, weight, heart rate, SBP, DBP, MAP, VAS score for 48 hours. Time of first rescue analgesia. Analgesic consumption in the first 24 hours, analgesic consumption in the next 48 hours and side effects. In our study the demographic profile such as age, weight, ASA physical status were comparable in both groups and were statistically insignificant. In our study the hemodynamic status was assessed in terms of heart rate, systolic blood pressure (SBP), diastolic blood pressure(DBP) and mean arterial pressure (MAP). There was no statistically significant variation in the hemodynamic status in both the groups (p>.05). There was statistically significant difference (p<.05) in favor of ITM with respect to VAS for most part of our study. There was statistically significant difference in the use of rescue analgesic immediately after the postoperative period at 2hours postoperatively. 1 patient in ITM group (Group1) needed first rescue analgesia at 2nd hour whereas 19 patients needed in Placebo group (Group2) which was statistically significant p-value <0.0001. It was observed that total analgesic consumption in  group 1 was 46 and in group 2 was 114 in 48 hours. Total analgesic consumption in first 24 hours in group1 was 30 whereas in group 2 it was 87 which was statistically significant. There was no significant adverse effect in both the groups. Total ICU stay in both the groups were comparable and was not statistically significant

66. A Hospital-Based Assessment of Platelet Counts in Pregnancy: A Case-Control Study
Sanjeev Ranjan, Shipra Jyoti, Gaurav Singh, Vinit Vaibhav
Abstract
Aim: The present study was conducted to assess the Platelet Count in the Pregnant Women. Methods: The present study was planned in Department of Pathology for a period of 12 months. In the present study 200 samples received for the platelet estimation were enrolled in the present study. All the patients were informed consents. Results: The demographic data obtained for the subjects showed that the most of the control group aged within 21 to 25 years (42%) while the majority of the pregnant women (42%) were within 26-30 years. There was a statistically significant difference in age and parity, between the cases and the control groups (p<0.0001). Although, there was an increase in mean platelet count (PLT) in the pregnant women when compared with the non-pregnant group (224.56 ± 68.72 x109 cell/L) versus 216.94 ± 53.27 x 109 cell/L), the MPV, PDW, and platelet larger cell ratio were slightly lower in pregnant women than the non- pregnant group. These changes were not statistically different between the two study groups (p˃0.05). The mean PLT count in the first, second and third trimester of pregnancy (226.64± 44.26 x 109 cell/L, 236.34± 82.38 x 109 cell/L and 210.44± 62.08 x 109 cell/L) did not differ significantly from the mean PLT count of the non- pregnant women (216.94± 53.27 x 109 cell/L) (p=0.180). Moreover, the mean MPV of pregnant women were lowest in 3rd trimester and significantly differ from pregnant women in their 1st, 2nd trimester and the control group (p=0.032). There was no significant association between pregnancy status and thrombocytopenia. Conclusion: Based on these findings, it can be inferred that platelet count and MPV decreases while PDW increase with the progression of gestation age compared to the non-pregnant women.

67. Serum Vitamin D and Serum Ferritin Levels in Children with ADHD: An Analytical Study
Pallav K Chaubey, Shashank Kumar, Tanaya Shreeraj, Upamanyu Goswami
Abstract
Aim: The aim of the study was to study the association between Serum Vitamin D and Serum Ferritin levels in children with ADHD. Methods: The study was conducted in the Department of Pediatrics, for the period of 1 year. A total of 100 children meeting the inclusion criteria were enrolled in the study. Subjects included all new or follow-up patients with diagnosed or suspected ADHD and healthy children of the comparable sex and age group attending the pediatric outpatient department (OPD) were taken as controls. Informed and written consent was taken from parents and assent from children above 12 years of age to participate in the study. Results: 50 cases were diagnosed with ADHD and their results were compared to age and sex matched controls. Serum Ferritin and Vitamin D levels were measured in both cases and controls. Since we matched age, similar age distribution was present in controls. The study found a significant difference in the mean value of serum ferritin levels in cases and controls (p=0.032). No significant difference in the mean value of serum Vitamin D in cases and controls (p=0.555) was noted. Conclusion: ADHD is a common neurobehavioral disorder presenting in pediatric OPD with higher prevalence in males than females. Combined type was found to be the most dominant type of ADHD in the study population. We observed a significant difference in the levels of Serum Ferritin in children with ADHD and controls.

68. An Observational Study Assessing the Pattern of Antiepileptic Drugs in a Tertiary Care Hospital
Jaya Roy, Md. Zamiruddin, Rohit Kumar Singh
Abstract
Aim: The objective was to evaluate the prescription pattern of Antiepileptic drugs in a tertiary care hospital. Methods: The present study was conducted in the hospital .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 14 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 (62%) and the least common type was absence seizures (4%). Regarding the mode of therapy, majority of the patients were treated with monotherapy (82%). Polytherapy was given for 18% of the study population. Monotherapy was with conventional drugs carbamazepine, valproate and levetiracetam and polytherapy was given along with conventional drugs with newer drugs like levetiracetam, oxcarbazepine, lamotrigine and topiramate. 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.

69. A Hospital Based Comparative Evaluation of Hand Grip Strength & Fine Motor Skills in Skilled & Non-Skilled Persons
Santosh Prasad, Swati Sinha, Amrita Narayan, Sarbil Kumari
Abstract
Aim: The aim of the present study was to assess the hand grip strength & fine motor skills in skilled & non skilled persons. Methods: The present study was conducted in the Department of Physiology. We recruited 100 healthy adults aged 20–40 years who had no difficulties in following the researcher’s instructions, who had sufficient muscle strength to conduct the given task, and who were without limitations in the range of motion of the joints. Results: There were no significant between-group differences in the general characteristics (p > 0.05). There were no significant between-group differences in the pre-intervention CMT time (experimental, 59.62 ±15.02 s; control, 61.91 ±15.14 s; p > 0.05) and post-intervention CMT time (experimental, 51.67 ±9.73 s; control, 50.30 ±14.50 s; p > 0.05). In the experimental group, the CMT time significantly improved from 59.62 ±15.02 s to 51.67 ±9.73 s (p < 0.05); similarly, the CMT time in the control group significantly improved from 61.91 ±15.14 s to 50.30 ±14.50 s (p < 0.05). There were no significant between-group differences in the pre-intervention PPT time (experimental, 58.13 ±10.86 s; control, 58.30 ±7.80 s; p > 0.05) and post-intervention PPT time (experimental, 52.80 ±6.31 s; control, 54.58 ±6.23 s; p > 0.05). In the experimental group, the PPT time significantly improved from 58.13 ±10.86 s to 52.80± 6.31 s (p < 0.05). In the control group, the PPT time significantly improved from 58.30 ±7.80 s to 54.58 ±6.23 s (p < 0.05). Conclusion: Fine motor skill such as FT & PDT improves by decreasing the muscle strength in skilled persons when compared to non-skilled persons.

70. A Retrospective Study Assessing the Incidence of Traumatic Spinal Cord Injury (TSCI) and Mortality Risks: An Observational Study
Vir Abhimanyu Pandit, Shashank Abhishek, Chandra Kant Diwakar, Debish Aanand
Abstract
Aim: The aim of the present study was to describe the incidence of traumatic spinal cord injury (TSCI) and mortality risks, based on the characteristics of the patient, anatomical level of the lesion, setting/cause of the injury, and type of healthcare support received within the regional trauma network. Material & Methods: All patients with acute TSI with or without SCI who were admitted in Department of General Surgery,  over the duration of 2 years were retrospectively selected from trauma registry for all ages and all spinal injuries. Total 200 patients with traumatic spine injury were included in study. Results: Out of 200, 140 were male and 60 were female. The most prevalent age group in our study was 30-39 years in 50 cases (25%) followed by 20-29 years in 40 cases (20%). In our study most common mode of injury was fall from height like unprotected roof, uncovered well, construction work, tree, electric pole in 90 cases (45%), followed by road traffic accident in 84 cases (42%). other cause of injuries were assaults in 16 cases (8%) and sports in 10 cases (5%). In our study lumber spinal column was fractured in 108 cases (54%) followed by thoracic spine in 46 cases (23%). Cervical spine injuries noted in 40 cases (20%). Sacral spine injuries noted only in 6 cases (3%) but it associated with abdominal and pelvic injuries. Out of 200 cases of traumatic Spinal Injuries 64 cases (32%) found to be had other associated injuries. Most common of them was head injuries in 20 cases (10%) and extremities injuries 20 cases (10%) followed by chest injuries 12 cases (6%), abdominal injuries 6 cases (3%) and pelvic injuries 6 cases (3%). Conclusion: Traumatic spinal injury is major source of morbidity and mortality throughout the world. Younger age group and Male are more commonly affected as compare to older age group and female. Accidental fall and RTA are major cause if TSI. Prevention remains the most effective way to reduce the burden of the traumatic spinal cord injuries. Government should work to strength the neurosurgical capacities for traumatic spinal cord management and rehabilitation.

71. A Hospital-Based Study Assessing Renal Functions in Perinatal Asphyxia and Various Stages of Hypoxic-Ischemic Encephalopathy (HIE) in Term Neonates
Kannu Priya, Nupur Kumari, Alka Singh, Bir Prakash Jaiswal
Abstract
Aim: The aim of the present study was to assess renal functions in perinatal asphyxia and various stages of Hypoxic-Ischemic Encephalopathy (HIE) in term neonates. Material & Methods: This observational study included 150 full-term perinatally asphyxiated neonates admitted in Neonatal Intensive Care Unit (NICU) of Department of Pediatrics. Serum urea, creatinine and urine output were assessed on 1st, 3rd and 10th day of admission. A total of 75 newborns with normal Renal Function Test (RFT) and urine output were kept in Group A, while 75 newborn with abnormal RFT and urine output were kept in Group B. Results: There was no significant difference between studied groups as regarding gestational age, weight, sex, maternal age and parity. There was statistically significant difference among Apgar score at 1 and 5 minutes between cases and controls. Assisted vaginal delivery and emergency caesarean section were more common among cases (13.34%, 41.33%) as compared to controls (8%, 16%). Urine parameters like creatinine clearance, urine output, urinary creatinine, Ph, urinary sodium, fractional excretion of sodium, renal failure index and osmolality all showed statistically significant difference between cases and controls except urine potassium and urine specific gravity. In this study as HIE stage progressed from stage-I to stage-III there was increase in values of blood urea, serum creatinine, urinary sodium, FeNa, RFI, along with fall in creatinine clearance and this difference was statistically significant (p<0.001). Conclusion: Renal dysfunction correlates well with increasing severity of asphyxia in terms of HIE staging and it can be used as a marker to assess the severity of perinatal asphyxia.

72. An Observational Hospital Study of Severe Acute Malnutrition with Unanticipated Dyselectrolytemia in Diarrhoea and its Co-Morbidities
Shashank Kumar, Pallav K Chaubey
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 Upgraded Department of Paediatrics, for the period of 1 year. Total 200 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 (90%), Diarrhoea (64%) followed by pneumonia (30%), Rickets (27%), Tuberculosis (16%), Otitis media (16%), UTI (10%), Celiac (8%), Hypothyroidism (5%), & HIV (3%). 140 (70%) SAM children presented with diarrhea out of which Hyponatremia was in 100 cases & Hypernatremia was in 5 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 200 SAM children were analysed. It was found that 45 SAM children were having hypokalemia. Hypokalemia was found in 30 diarrheal cases & 15 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.

73. A Hospital-Based Assessment of the Effects of Various Centrifugation Speeds and Inclusion of the Buffy Coat in Platelet-Rich Plasma Preparation: A Comparative Study
Dhiraj Kumar
Abstract
Aim: The aim of the present study was to analyze the centrifuge spin rates at which to attain an ideal platelet-rich plasma yield and also to study the effect of inclusion of the buffy coat after the first spin on the final platelet concentration in platelet-rich plasma. Methods: A cross-sectional observational study was conducted at Department of Dermatology, over a period of 12 months. Results: Among the three centrifugation methods, the highest rise in platelet concentration was seen with 100g/400 g speeds which were higher than the output of the other two methods. The difference was statistically significant. Among the three spin variations with buffy coat included, the 350 g/1350 g spin showed a higher percentage rise in platelet concentration from whole blood. This increase was more consistent (with less standard deviation) as compared to the other two variations. The 100 g/400 g variant also showed a mean rise in platelet counts and the difference between the two variations was not statistically significant. The difference between the 800/1600 g spin (lower mean increase in platelet concentration) versus the 100/400 g and 350/1350 g variations (higher values) was statistically significant. When compared to pure platelet-rich plasma (leukocyte-poor platelet-rich plasma), inclusion of the buffy coat layer for the second spin (leukocyte-rich platelet-rich plasma) resulted in 175%, 1220% and 512% higher platelet concentrations in the 100 g/400 g, 350 g/1350 g and 800 g/1600 g spin variations, respectively. Conclusion: An ideal platelet yield in platelet-rich plasma can be achieved with both the 100 g/400 g as well as the 350 g/1350 g spins while using the buffy coat (leukocyte-rich-platelet-rich plasma), and the 100 g/400 g spins method for pure platelet-rich plasma (leukocyte-poor- platelet-rich plasma) accomplishes a near-ideal platelet count along with low contamination with other cells.

74. A Study to Assess the Maternal and Perinatal Outcomes among Women with Pregnancy Induced Hypertension with Normal and High Serum LDH Levels
Swati, Reshita
Abstract
Aim: The aim of the present study was to assess the maternal and perinatal outcomes among women with pregnancy induced hypertension with normal and high serum LDH levels. Material & Methods: This was a prospective observational study conducted in Department of Obstetrics and Gynaecology for one year. 100 patients were studied in present study. Results: The maximum number of patients of pre-eclampsia were from age group 20-24 years (52%), next being 25-29 years (32%). Maximum number of cases was primigravida (52%), G2 were (32%), G3 were (11%). Maximum number of cases was > 38 weeks of gestation (48%), cases between 36-38 weeks were 26% and between 32-34 weeks were 14%. In our study with serum LDH <600 with urine albumin 2+ was in 7 patients, 1+ in 15 patients, nil in 10 patients, traces in 5 patients and 3+ in 8 patients. Serum LDH between 600 to 800 with urine albumin 1+ was in 7 patients, 2+ was in 8 patients and nil was in 5 patients. Serum LDH >800 with urine albumin 1+ and 2+ was 9 patients each, with 3+ and nil in 1 patient each. P value is 0.001 which was statistically significant. In our study serum LDH <600 had abruption with PPH, DIC, eclampsia and PPH were noted and p value was 0.80 which was statistically not significant. In our study serum LDH <600 had a IUGR in 3 patients, fetal distress in 2 patients, neonatal death in 2 patients. Serum LDH between 600-800 had IUGR and LBW in one patient each. Serum LDH with >800 had IUGR in 2 patients. P value was 0.512 which was statistically not significant. Conclusion: Higher LDH levels are indicative of maternal and fetal complications. higher serum LDH levels more than 500 IU/L to 600 to 800 IU/L have closer association with severe preeclampsia. Pre-eclampsia patients with raised LDH levels should be closely monitored.

75. A Hospital Based Comparative Study Assessing Calcium Homeostasis Comparison in Thermal Burn Patients–Early Tangential Excision and Grafting versus Conservative Management
Setubandhu Tiwary
Abstract
Aim: The aim of the present study was to identify whether early wound closure in the burnt state corrects the deranged parathyroid function, which is attributable to the proinflammatory state, thereby optimizing overall calcium homeostasis. Material & Methods: A prospective observational case control study was performed in Department of Surgery. A study cohort was formed composed of 50 burn patients admitted to the Burns Unit for the duration of 12 months. Results: The average burn surface area under treatment in Group A was 35.82 percent and in Group B group was slightly higher at 37.72 percent. However, difference was not statistically significant. There was a significant improvement in serum calcium, magnesium and phosphorous levels in the tangential excision group. For serum calcium levels, p value became statistically significant on day 15 and at first and second month of follow-up. The serum magnesium improved in the tangential excision group compared with the conservatively managed group, which was statistically significant at day 15 of in-patient stay and at 1st and at 2nd month of follow-up. Serum phosphorus levels in the tangential excision group improved on day 12, 15 of admission and at 1st month and 2nd month and were statistically significant. The mean serum parathormone in Group B was significantly higher in Group A. It remained persistently high during admission and entire follow-up, which correlated with increase calcium loss in Group A at the end of follow-up period. The 24-hour urinary calcium levels were remarkably low in tangential excision group (Group A) as compared with the nonoperative group. This corroborated with the finding of low-parathormone levels, which were also found in Group A. Conclusion: Early tangential excision and grafting in burns plays an important role in maintaining serum parathormone and calcium levels, leading to prevention of hypercalciuria and optimization of other factors affecting calcium homeostasis.

76. Epidemiological and Histopathological Study of Renal Cell Carcinoma – A Single Center Experience
Rohit Upadhyay, Amit Kumar, Khalid Mahmood, Shashi Prakash, Nandesh
Abstract
Aim: The aim of the present study was to assess the epidemiological and histopathological study of renal cell carcinoma. Methods: The present study was conducted at department of Urology, IGIMS Patna, Bihar, India and included all patients who have received the diagnostic code of RCC in agreement with the International Classification of Diseases (ICD-10) system and underwent contrast-enhanced computed tomography of the abdomen and nephrectomy over 5-years using the electronic hospital information system (HIS). The study included 100 patients with histologically confirmed renal cell carcinoma. Results: 45% of the cases were elder (≥60 years), and 40% were between 40–59 years, while 15% of the patients were younger than 40 years. The gender distribution of RCC was 70% male and 30% female. The right kidney harbored most of the masses in 58%, 40% in the left, while 2% were bilateral involvement. Clear cell RCC was the most common histological type in about 69%, followed by papillary RCC (14%), unclassified RCC (10%), and Chromophobe RCC was the least common in 7% of the cases. Half of the patients held tumor stage 2, followed by T1 in 22%, 15% in T4, and 13% in T3. WHO/ISUP grading system revealed that 47% patients had high-grade tumors (G4 in 27% and G3 in 20%), while the remaining 53% had low-grade tumors (G2 in 45% and G1 in 8%). Assessment of gender variation of tumor stage, grade, and comorbidities revealed a statistically significant difference between the pattern of stage and grade of RCC and gender group. Conclusion: The young patients had a higher tumour stage. Clear cell RCC was the most common histologic type, though less common than that is reported in literature. Less access to the health services and facilities, the absence of the awareness of the population, limited availability of endourological equipment, inadequate expertise and imaging modalities, a far distance from health services, and the low socioeconomic status lead to most of the patients living in low-income countries presenting with advanced diseases.

77. Locking Humerus Plating for Early Mobilization of Fractures of Proximal Humerus in Adult: An Observational Study
Manish Kumar, Surya Prakash
Abstract
Aim: The aim of the present study was to role of locking humerus plating for early mobilization of fractures of proximal humerus in adult at tertiary care center. Methods: The Present study was single-center, prospective, observational and descriptive study, conducted in Department of Orthopaedics Study duration was of 1.6 years. In present study, 80 cases satisfying study. Results: Majority were males (70%), > 60 years age (52.5%), mode of injury due to RTA (72.5%), injury on right side (60%) and had co-morbidities such as hypertension (32.5%), diabetes mellitus (20%), coronary artery disease (15%). Majority were 2 part fracture (47.5%) as compared to part 3 (30%) and part 4 (22.5%). The Neer’s scoring system of the severity of pain, function, range of movement, anatomy, was done to determine the end results. In present study excellent, satisfactory and unsatisfactory results were noted in 25%, 60% and 15% patients. Complications noted were Plate impingement (7.5%), Varus malunion (6.25%) and Stiffness (6.25%). Conclusion: Locking compression plate for management of fractures of proximal humerus is beneficial mainly due to stable fixation, angular stability and early functional aftercare is possible. It helps patients for early mobilization, to regain good shoulder function and resume normal activities much earlier.

78. A Retrospective Observational Assessment of the Segments of Humerus: A Cadaveric Analysis
Suman Kumari, Chandan Kumar, Rajendra Prasad
Abstract
Aim: The present study was conducted for morphometric study of segments of humerus. Methods: Our study was a retrospective study conducted at department of Anatomy for 20 months.  The present study was performed on 50 cadaveric humeri (25 left sided and 25 right sided). All were of unknown age and gender. Results: The length of humerus of right side was more as compare to left side. AP diameter of head is almost equal of both sides. Mediolateral diameter of head was more of left side whereas head height was more of left humerus. Conclusion: The morpho-metric dimensions of right side of humerus were more than that of left side. There was variability in dimensions which was found in different studies. Proper measurements are required when surgical procedures are to be done. More studies should be conducted measuring head heights.

79. Periodic Paralysis with Multiple Clinical Marker is it Sjogren’s Syndrome
Sumit Kumar, Ganesh Kumar, Ved Prakash Shukla, Ashish Yadav, Ashutosh Tiwari
Abstract
Sjogren’s syndrome is a chronic, autoimmune disease. It can occur alone or in association with other autoimmune conditions like rheumatoid arthritis (RA) or lupus. Along with common glandular manifestations, Sjögren syndrome may also cause several extra glandular manifestations. We report a case of 38 year old female presenting to Neurology ICU having periodic paralysis with recurrent dental caries  and intermittent waxing and waning purpuric non blanchable macular rash in bilateral lower limb. On evaluation, she was diagnosed as a case of Sjogren’s syndrome with associated RA. Our case report illustrates the importance of  recurrent dental caries and non-blanchable macular skin rash as clinical clue or biomarkers for etiological evaluation of cases with periodic paralysis or suspected Sjogren syndrome.

80. Comparing Vildagliptin SR 100mg and Teneligliptin 20mg in Type 2 Diabetes Study
Preshita Prakash Vanjare, Prashant Kumar Dhakad, Mayank Bansal, Arindam Chatterjee, Yogesh Sharma, Ashutosh Sharma
Abstract
Diabetes Mellitus is an entity of considerable morbidity comprising a spectrum of multisystem dysfunctions stemming from the combination of insulin resistance and inadequate insulin secretion. Management of diabetes, akin to a tightrope walk, requires a comprehensive understanding of various factors such as over-all clinical picture, adverse effect profile, the complex of inter-play of drugs, etc. More than two-thirds of people with type 2 diabetes will eventually require more than one oral agent, with or without insulin. Diabetes is emerging as a global epidemic, imposing enormous humanitarian and economic burdens on society. According to a WHO projection, by 2030, approximately 190 million people will be affected in the Asia-Pacific region alone. Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease. Evidence suggests that patients with type 2 diabetes mellitus (T2DM) increasingly require multiple pharmacological combinations to reach treatment goals. Clinical inertia, with failure to advance therapy despite persistently elevated HbA1c levels above target, has become a major problem for the stepwise approach to treatment. Initial combination therapy using two oral anti-diabetic drugs (OAD) with complementary mechanisms of action is an alternative approach that may provide better or more sustained glycemic control. It may also allow the use of lower doses of the component OADs and thus minimize any dose-related adverse events (AEs). Vildagliptin is a selective and reversible inhibitor of Dipeptidyl peptidase 4 (DPP-4), the enzyme which inactivates the incretin hormones, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP), hormones which significantly contribute to the maintenance of glucose homeostasis. Vildagliptin improved glycaemic control when given as monotherapy or when used in combination with Metformin, a sulphonylurea, and a thiazolidinedione, as measured by clinically relevant reductions in HbA1c from baseline at study endpoint. In clinical trials, the magnitude of HbA1c reductions with Vildagliptin was greater in patients with higher baseline HbA1c.

81. Continuous Intravenous N- Acetylcysteine in iNon Acetaminophen Acute Liver Failure In Children
Manas Ranjan Mallick, Jyoti Ranjan Behera, Alok Kumar Meher, Rupashree Behera, Rupak Kumar Giri
Abstract
Introduction: Assessing How Long-Term Intravenous N-Acetylcysteine Infusions Can Improve a Child’s Non-Acetaminophen Acute Liver Failure (Nai-Alf) Outcomes. Material and Methods: A predesigned proforma is used to conduct this observational research. N-acetylcysteine at a dosage of 150 mg/kg/day in 3 split doses by continuous intravenous infusion for up to 7 consecutive days was given to 41 instances with non-acetaminophen caused acute liver failure in the age group of 3 months to 14 years who came to VIMSAR’s OPD & IPD, Burla. From the hospital registry, 37 patients were chosen that did not receive N-acetylcysteine and had acute liver failure not caused by acetaminophen. Software called SPSS16v was used to analyse all of the data. Results: When compared to patients who did not receive NAC, those who had lower grades of hepatic encephalopathy (HE I & HE II) showed a reduction in the length of their ICU stay as well as an earlier recovery in their liver function. In patients presenting with grades III or IV hepatic encephalopathy, NAC was found to be ineffective in reducing hospital stays or ICU deaths. NAC use in youngsters has been determined to be safe. Conclusion: The current study’s safety profile suggests that intravenous NAC should be investigated for patients with early stage NAI-PALF. Nevertheless, further research is required to identify response predictors and the ideal dosage and duration of NAC treatment.

82. Clinico-Epidemiological Profile of Leprosy Cases in Post-Elimination, Post Covid Era at a Tertiary Care Center
Srishti Tripathi, Jagmohan Singh Dhakar
Abstract
Background: Leprosy continues to be a public health problem despite elimination from India in December 2005 with around 60% cases being reported from India globally. The covid pandemic has additionally disrupted case detection and treatment leading to under-reporting. The current study aims to get insights into the clinical and epidemiological profile of leprosy in post covid era at a tertiary care center. Methods: A retrospective observational study of all patients visiting leprosy clinic of dermatology department of NSCB Medical College, Jabalpur, MP over 1-year period from May 2022 to April 2023. Data regarding clinical and epidemiological characteristics were collected from patients’ records and tabulated and analyzed using appropriate statistical methods. Results: A total of 119 patients visited the leprosy clinic during the study period. Maximum patients belonged to age group 20-40 years (49.6%). There were 81 males and 38 females with male female ratio of 2.1:1. Most common clinical type of leprosy was lepromatous leprosy (LL) (40.3%) followed by borderline tuberculoid (BT) (26.9%). Nerves were involved in all patients with ulnar nerve being the most common (71.4%). Lepra reactions were noted in 13.6%, grade-2 disability 50.4%, deformity -ulcer 37% of cases. PCR test for detecting M. leprae DNA was positive in 91.6% cases.  Conclusion: Our findings highlight the need for increasing leprosy case detection and early treatment through community-based approaches as there in increased burden of lepromatous cases and disability patients post the covid pandemic phase due to compromised case reporting during lockdown. Also, molecular diagnosis like PCR should be widely utilized for leprosy.

83. Study on Role of Probiotics in Recurrent Respiratory Infections
Rajesh Khanna Pulmamidi, Ramya Madhuri Yendamuri
Abstract
Introduction: Children’s respiratory tract infections (RTIs) are one of the most common health issues. Probiotics are live bacteria that invade the intestines and modify the microbiota of the host. A growing body of research indicates that taking probiotics may alter or reduce the frequency of RTIs. Aims: The aim of this on health effects of probiotics in patients with RTI, with a focus on viral respiratory infections. Materials and Methods: A randomized, double-blind, placebo-controlled investigation was carried out. given daily probiotics including lactobacillus acidophilus and bifido bacterium over the 6-month intervention trial period.  400 participants, ages 3 to 6, were chosen for the research. Results: When compared to the placebo group, the active group’s overall RTI symptom duration (measured in days) was significantly shorter. Without the use of probiotics, the incidence rate of RTI symptoms is considerable. Conclusion: Probiotic supplements offer a way to lower the prevalence of RTIs in preschool-aged children who visit day care centers.

84. A Study of Effects of Atropine 0.01% on Progression of Myopia
Vineet Pradhan
Abstract
Background: Myopia, commonly referred to as short sightedness is a form of refractive error and is a very common cause of visual disability throughout the world. Methods: it is a hospital based prospective study conducted on 200 patients of Myopia and 200 controls attending to Department of Ophthalmology, Mahatama Gandhi Medical University, Sitapura, Jaipur, Rajasthan, India from July-2021 to June-2022. Results: There was no significant difference in the age, gender distribution, baseline myopia progression or follow-up duration between patients who use atropine and not use atropine drop. No significant difference of effectiveness was in atropine application. Conclusion: Data from this study supports the use of atropine 0.01% eye drops in the progression of myopia. The atropine 0.01% eye drops provided non-significant reduction of increase in axial length and increase in refractive error as compared with control, with no side effects.

85. A Hospital-Based Study to Assess the Findings of Ultrasonography in Patients with Ovarian Tumour: An Observational Study
Ajit Kumar
Abstract
Aim: The aim of the present study was to assess the findings of ultrasonography in patients with ovarian tumour. Material & Methods: A prospective study carried out on 100 patients of ovarian tumours referred to radiology department at a tertiary health care centre. Sociodemographic data, clinical history and clinical examination findings were taken from OBGY department records. Ultrasonography findings were noted. Data analysed with appropriate statistical tests. Results: In present study, most of the patients (35%) with ovarian tumour were in the age group 51 year old and above, followed by age group of 41-50 years (28%). Mean age of the patient was 45.35±3.4 years. In our study, most common symptom was abdominal pain 94 (94%) followed by abdominal mass 65 (65%). Backache was seen 32 (32%) patients. pressure symptoms were seen in 20 (20%) patients. Pressure symptoms included increased frequency of micturation, retention of urine and GI symptoms like constipation. Majority of the patients 34 (34%) were having cystic + solid consistency followed by cystic consistency 32 (32%). Solid consistency on ultrasonography was seen in 30 (30%). Liver metastasis was seen in 4 (4%) patients. In present study, based on ultrasonography findings most of the benign ovarian tumours were having cystic consistency. Most of the malignant tumour was having both cystic and solid consistency. 4 patients with malignant ovarian tumour had liver metastasis. Association between tumour type and ultrasonography finding was found to be significant (p<0.001). Conclusion: On ultrasonography benign ovarian tumours are having cystic consistency and malignant tumours were having cystic+ solid consistency.

86. A Hospital-Based Analytical Cross-Sectional Study to Assess the Clinical Profile of Patients Subjected for Cervical Cytology
Ravi Ranjan Singh, Kumari Pallavi, Supriya sharma, Vinit Vaibhav
Abstract
Aim: The aim of the present study was to assess the clinical profile of patients subjected for cervical cytology. Methods: The present hospital-based analytical cross-sectional study was conducted at Department of Pathology for the period of 12 months. 200 patients were included in the study. Results: In the present study, 90% were home-makers and 32% had higher education. 68% belonged to rural area and 52% were above poverty line. Stage‑wise distribution of cervical cancer patients shows that a very small percentage of patients (12%) were diagnosed at early stage. Majority of the patients were diagnosed with Stage 2 (36%) or 3 (44%) disease. The findings of performance status reveal that about 70% of patients were able to carry out all normal activities without restriction. Moreover, only a very small proportion (<1%) were bedridden. History of hypertension, diabetes, heart disease, AIDS (HIV+ve), hepatitis (HBsAG+ve), asthma, and chronic pulmonary diseases was considered as the presence of comorbidity. Among 200 patients, 40 were found to have abnormal cervical cytology. Moreover, 160 smears were negative for any intra-epithelial lesion or malignancy, 12 (7.5%) showed normal cytological findings. 100 (62.5%) showed nonspecific inflammation, rest 10 (6.25%) had evidence of candida, bacterial, and Trichomonas infections. Diagnosis of atypical squamous cells of undetermined significance (ASC-US) was made in 10 (6.25%) cases. Atypical glandular cells (AGC) were seen in 3 (1.25%) cases, and 2 (2.5%) patients had a low-grade squamous intraepithelial lesion (LSIL) exhibiting koilocytic atypia in most of the smears. Conclusion: Cervical cancer is a favorable site for an effective control programme with its ease to access and a long latent period of intraepithelial neoplasia which is easily recognizable by the Pap smear. Thus, there is a need for initiation of community screening and educational programs through awareness campaigns.

87. A Cross Sectional Survey to Identify the Rate and Predictors of Utilization of Rehabilitation Services among People with Psychotic Disorders
Farheen Fatma
Abstract
Aim: The aim of the present study was to identify the rate and predictors of utilization of rehabilitation services among people with psychotic disorders. Methods: A cross-sectional survey was conducted to investigate the utilization of psychiatric rehabilitation among individuals aged over 15 years with severe mental disorders and their caregivers for the period of one year. The survey employed a multistage stratified, clustered sampling scheme. Results: A total of 500 severe  mental  disorder  patients (64% male) aged over 15 years and  300  caregivers were  interviewed.  The  mean  age  of  the  patients  was 42.6 ± 12.0 years and the caregiver was 54.6 ± 14.6 years. 52% were single. 65% were engaged in agricultural work. Median scores of positive, negative and general symptoms of the PANSS were 12, 15 and 25, respectively. The utilization rate for any rehabilitation service was 20%. There were no significant differences between those who ever utilized and those who had never utilized any rehabilitation service in terms of gender, age group, marital status, occupation, disease duration and caregiver’s gender. However, statistically significant differences were found in educational level, type of psychoses, having a caregiver and PANSS scores. Conclusion: It is important that the government formulate relevant mental health policies and incorporate them into public health and social policy that suits the needs of severe mental disorder patients and their families. Psychiatric rehabilitation service operates as a whole system which includes many other  institutions  and  organizations.  Therefore, the collaborative and partnership network should be developed and the links with local community resource to facilitate services should be strengthened.

88. A Hospital Based KAP Study Regarding Breastfeeding among Recently Delivered Women: A Cross Sectional Study
Irshad Alam, Sazid Hussain, Ghazala Perween
Abstract
Aim: The aim of the present study was to assess the Knowledge, Attitude and Practices on Breastfeeding among recently delivered women in Bihar region. Methods: It was a cross-sectional observational study .Women who delivered vaginally or by caesarean section in Department of Obstetrics and Gynaecology, were included in this study. 500 women were selected in the study. Results: 94% women knew that areola should be inside the mouth and 96% women knew about the burping after feeds. 60% women had knowledge about early initiation of breastfeeding and its benefits and 96% knew that breastfeeding remains child healthy. 4% women thought that Breastfeeding is old fashioned and 90% women thought that Breast milk is best milk. 70% of women-initiated breastfeeding within 1 hour of delivery. Maternal Age, sex of child, religion, area of residence, and type of delivery (vaginal or caesarean section) are the factors which determines initiation of breastfeeding and to be eliminated, while maternal educational status, maternal employment status, socioeconomic status, number of ANC visits and antenatal counselling are the factors which are associated with initiation of breastfeeding and to be improved. Conclusion: Our study concluded that targeted and well-coordinated breastfeeding policies and interventions by healthcare workers, eliminating myths regarding prelacteal feeds and promotion of EIBF will improve early initiation of breastfeeding practices for all Indian mothers.

89. A Hospital Based Study to Evaluate Clinic-Epidemiological, Etiology and Outcomes of Severe Community-Acquired Pneumonia (CAP)
Nishant Kumar Singh, Arun Kumar
Abstract
Aim: The aim of the present study was to investigate the epidemiology, causative agents and outcomes of severe community-acquired pneumonia (CAP). Methods: This was a retrospective cohort study of patients with severe CAP admitted to an adult ICU  for the period of 1 year.  The medical records of patients with APACHE IV admission diagnosis of “viral pneumonia”, “bacterial pneumonia”, and “sepsis, pulmonary origin” within this period were identified. Totally 100 patients were identified  to  be  admitted  to our ICU for pneumonia. Results: Their age ranged from 19 to 92 years old and there was male preponderance. The severity of illness is reflected by the APACHE IV score. Most of the patients had no chronic medical problems and the most common comorbidity was diabetes mellitus. Moreover, C-reactive protein level was marked elevated with mean of almost 200 mg/dL. More than three quarters of the patients required invasive mechanical ventilatory support while more than 80% needed vasopressors for hemodynamic support. About one third of them developed renal failure with institution of renal replacement therapy. However, nitric oxide and ECMO were uncommonly employed for support of such patients. Streptococcus pneumoniae was the most commonly isolated organism. It was detected by one or more of the following methods: blood culture, sputum/endotracheal aspirate/pleural fluid culture or urine antigen test. The common agents included Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Other bacterial organisms identified were Staphylococcus aureus, Streptococcus pyogenes and Mycobacterium tuberculosis. Conclusion: The common etiological organisms included Streptococcus pneumoniae and Influenza A. Pneumococcal and influenza immunizations may be effective to reduce the incidence of CAP. Such vaccine should be provided to the high risk group so that it may improve the outcome of severe chest infection.

90. A Prospective Study: To Evaluate the Efficacy of VAC in the Management of Wounds with Exposed Bones/Tendons in Children
Puja Priyadarshini
Abstract
Aim: The aim of the present study was to evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children. Methods: The present prospective observational study was conducted in the Department of Plastic Surgery for the period of one year. VAC dressing was used in 50 patients. Results: Out of 50 patients, 34 were male and 16 were females with the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (56%), with most of the wounds located over extremities. The most common site of wounds in our study was legs, presents in 12 patients (24%) followed by thigh in 8 patients (16%) and foot in 6 patients (12%) making the lower limb the most common area of the body involved. In our study road traffic accidents (RTA) comprised the most common mode of injury present in 16 patients (32%) followed by necrotizing fasciitis in 12 patients (24%) and fall from height in 10 patients (20%). In our study number of VAC dressing changes ranged from 1 to 6 with majority of the patients i.e., 24 (48%) required two VAC dressing changes before definitive wound coverage. The most common post VAC procedure in our study was STSG done in 40 patients (80%) followed by various local, regional or distant flap covers in 5 patients (10%). Most common complication in study patients while being on VAC therapy was feeling of pain, which was present in 24 patients (30%). Maximum no. of patients 34 (68%) in study had a hospital stay of between 10- 19 days followed 11 patients (22%) with 20-29 days. Conclusion: In conclusion, our study supports the VAC therapy as a relatively atraumatic technique to manage soft tissue defects in complex extremity wounds in pediatric patients. The VAC therapy proved to be an effective, safe, cost effective, easy to learn, and simple technique that managed the complex soft tissue defects in children without the morbidity and complications associated with flap procedures.

91. A Study to Explore the Association between Sexual Dysfunction and Various Alcohol-Related Variables: A Case Control Study
Ravikant Kumar
Abstract
Aim: The aim was to estimate the prevalence and correlates of sexual dysfunction in alcohol-dependent patients and to explore the association between sexual dysfunction and various alcohol-related variables. Methods: The cross-sectional, case-control study was conducted in the de-addiction centre of the department of psychiatry. The study sample consisted of two groups, recruited through convenience sampling: 100 in-patients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) diagnosis of alcohol dependence and 50 controls enrolled from medical wards admitted for management of transient febrile illness. Results: Men with alcohol dependence were different from controls with regard to socio-demographic data of age, domicile, religion, and family type. They were older than controls. The majority of the controls were from rural, joint, Islamic families compared to cases. There were no differences between them in education, occupation, and socio-economic status (SES). 77% of the patients in the case group initiated drinking alcohol before 25 years of age, with 32% of them started before 18 years of age. However, only 10% developed dependence before 25 years of age. 70% of patients were having nicotine use compared to 26% in controls with significant difference. 3/4th of the patients in the case group had a family history of alcohol use, with half of them amounting to dependence. The prominent SD among men with alcohol dependence was low desire followed by premature ejaculation. Low sexual desire was reported by 16% and premature ejaculation by 10%. Every aspect of sexual functioning was disturbed in men with alcohol dependence. 12% reported more than one sexual dysfunction. Premature ejaculation was a prominent type of dysfunction among controls. Conclusion: The study highlights the global nature of sexual dysfunction in men with alcohol dependence. It emphasizes the need for clinicians to routinely assess the sexual problems in their alcohol drinking patients, especially those with liver disease.

92. Assessment of the Outcome in Patients with Glaucoma Treated with Trabeculectomy Done with and without the Use of Mitomycin C: A Comparative Study
Parambir Kumar Bharti, Amrendra Kumar, Anita Ambastha, Gyan Bhaskar, Bibhuti P Sinha
Abstract
Aim: The aim of the present study was to compare surgical outcome in patients with glaucoma treated with trabeculectomy done with and without the use of mitomycin C at a tertiary hospital. Material & Methods: This was a prospective, interventional, comparative study carried out, Regional Institute of Ophthalmology. Study duration was of 2 years. During study period total 50 patients were operated for glaucoma. Results: 25 patients were each randomly assigned to trabeculectomy only and trabeculectomy with mitomycin C groups. General characteristics such as age, gender, laterality and glaucoma type were comparable in both groups. In both groups statistically significant reduction was noted for intraocular pressure (IOP) and IOP lowering medications post-operatively. Characteristics such as preoperative intraocular pressure (IOP), IOP at 6 month, IOP at 1-year last visit and number of IOP lowering preoperative medications were comparable in both groups. Trabeculectomy with mitomycin C did not required any IOP lowering medications at 6 month and 1 year. A statistically significant difference was noted for number of IOP lowering medications at 6 month and 1 year between two groups. Post-operatively failed trabeculectomy and iritis were common complications in both groups. Other complications were hyphema, hypotony and hypopyon. Conclusion: Mean intraocular pressure (IOP) was reduced significantly at 12 months in trabeculectomy with MMC group compared to trabeculectomy without MMC. No significant difference was noted in complications from both groups.

93. A Study to Determine the Magnitude and Factors Associated with Inter-Hospital Outcome Variations for out of Hospital Cardiac Arrests
Pooja Batra, Priyadarshini Pal Singh
Abstract
Aim: The aim of the present study was to determine the magnitude and factors associated with inter-hospital outcome variations for out of hospital cardiac arrests. Methods: This was a prospective, multi-centre cohort study of consecutive out of hospital cardiac arrests (OHCA) cases presenting at 5 restructured hospitals. 30 patients were selected in the study. Results: Out of a total of 30 patients, 20 (66.66%) were male, and had ages ranging from 22 to 90, with a median age of 64.2 years. In terms of cause of arrest, the most common was cardiac, followed by respiratory and traumatic with frequencies of 21 (70%), 2 (6.66%), and 1 (3.33%) respectively. The most common first arrest rhythm was asystole, followed by PEA, VF, and then VT, with frequencies of 16 (53.33%), 8 (26.66%), 5 (16.66%), and 1 (3.33%) respectively. In terms of pre-hospital management, 17 (56.66%) were witnessed arrests, and 11 (36.66%) received bystander CPR. TTM and PCI usage varied significantly (P<0.001). Hospitals B, C, D had a lower survival to discharge or 30 days post arrest. Hospitals B, D had lower survival to discharge with good neurological function. After subsequent multivariate analysis to eliminate known confounders, it was noted that as compared to Hospital E the study benchmark, Hospitals B, C, and D had a lower survival to discharge or 30 days post-arrest. Survival to ED admission also varied from 15.0% to 23.8% with Hospitals B, C, D, and E experiencing lower survival to ED admission. Conclusion: TTM and PCI usage, and OHCA outcomes vary between hospitals. This is associated with teaching status, bed number, and post-resuscitation care.

94. A Hospital Based Study to Assess the Morbidity of Lichtenstein Mesh Hernioplasty in Treating Obstructed Inguinal Hernias
Asik Ikbal Mazumder, Faizan Ahmad, Zaid Bin Afroz
Abstract
Aim:  The aim of the present study was to assess the morbidity of Lichtenstein mesh hernioplasty in treating obstructed inguinal hernias. Material & Methods: It was a retrospective randomized controlled trial study (CONSORT). This study was undertaken in the Department of General Surgery for the duration of 1 year. Fifty patients were operated & included in the study. Results: Age of the studied patients ranged from 18 to 86 years with mean age 48.62 ± 17.023 years. About 68% of the studied patients had no comorbidity. 34 of the studied patients had no postoperative complications. There was statistically significant decrease in postoperative VAS pain score over time, which decreased two hours postop to 1 in the first postoperative week. Conclusion: Standard lichtenstein mesh hernioplasty for obstructed inguinal hernia is a safe operation with acceptable risks of complications. However, patient selection and surgeon experience are important factors for the outcome.

95. Assessing Co-Morbidities in Severe Acute Malnutrition with Unexpected Dyselectrolytemia in Diarrhea: An Observational Study
Ajit Kumar Singh, Sachin Kumar, Nagendra Prasad Gupta
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 in the Department of Pediatrics, for 15 months. Total 100 Children upto 5 years aged admitted in Nutritional Rehabilitation Centre of Department of Paediatrics were included 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 (91%), Diarrhoea (62%) followed by pneumonia (32%), Rickets (33%), Tuberculosis (15%), Otitis  media  (11%),  UTI  (11%),  Celiac  (4%), Hypothyroidism (3%), & HIV (1%). 60 (60%) SAM children presented with diarrhea out of which of Hyponatremia was in 54 cases (54%) & Hypernatremia in 2 cases (2%). No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM. It was found that 25% SAM children were having hypokalemia. Hypokalemia was found in 45 diarrheal cases & 30 non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM between Diarrheal & Non diarrheal cases. Conclusion: Burden of co-morbid conditions is very high in SAM children. In order to break disease – under nutrition cycle, not only nutritional management but early detection of co- morbid conditions is a must. Co-morbidities identification and treatment in SAM children is key step in reducing morbidity and mortality associated with SAM.

96. Antioxidant and Antiulcer Activity of Sesamum Indicum Leaves Extract in Experimental Rats: An in-Vitro Study
Vikas Kumar
Abstract
Aim: The aim of the present study was to estimate phytochemical screening, in vitro antioxidant activity, and gastroprotective activity of Sesamum indicum Linn ethanolic extract. Methods: The study was conducted at Narayan Medical College and Hospital, Sasaram, Bihar, India. Results: The high dose of S. indicum extracts (group-5) significantly reduced gastric mucosal lesion. The low dose test group (group-4) showed significantly reduced gastric mucosal lesion. The statistical significant changes noted only in ulcer size, number and index. The high dose of S. indicum extracts (group-5) significantly reduced mucin content, volume of gastric juice, gastric pH, free and total acidity (group-3) when compared to positive control group. The low dose test group (group-4) showed significantly reduced mucin content, volume of gastric juice, gastric pH, free and total acidity (group-3) when compared to positive control group. The high dose of S. indicum extract (group-5) showed comparable results in parameters like free acidity and total acidity with the standard group. Conclusion: Although the high dose sesame (1mg/kg) group showed significant gastric protection against ulcer induced by cold restraint method. However no clear inference can be drawn at this stage and hence we consider the work for further extensive research.

97. Comparative Assessment of the Efficacy of Autologous PRP Injection and Corticosteroid Injection in Treatment of Plantar Fasciitis (PF)
Randhir Kumar, Govind Mohan Jee
Abstract
Aim: The aim of the present study was to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in treatment of plantar fasciitis (PF). Methods: The study was conducted in the Department of Orthopaedics for the period of one year. 100 patients were included in the study and divided into two groups. Group I (50 patients) received PRP injection and group II (50 patients) were given steroid injection. Results: A total of 100 patients were analyzed in this study ranging from 22 to 64 years of age. In both groups, females outnumbered males, right sided involvement was more than the left side. The average duration of symptoms at the time of presentation was observed to be 23.17±12.48 and 18.4±14.48 in group A and group B respectively. The clinical improvement in chronic plantar fasciitis in this study was evaluated by comparing the values of functional outcome indices at 6th month follow-up with the baseline values recorded prior to administration of injection. The patients showed a statistically significant improvement in both groups with respect to AOFAS Score, VAS scores and plantar fascia thickness and this improvement was significantly more in Group A (PRP). Both the groups do not differ significantly at baseline and posttreatment at 6 months (p > 0.05). Conclusion: This study concluded that both PRP and corticosteroid (methyl prednisolone) injections provide symptomatic relief in the treatment of chronic plantar fasciitis. Though the corticosteroid (methyl prednisolone) injection was effective for immediate pain relief, PRP injections are more effective than corticosteroid (methyl prednisolone) injections on long term basis.

98. A Hospital-Based Assessment of the Impact of the COVID-19 Pandemic on Gender Disparities in Acute Coronary Syndrome Patterns
Pramod, Aishwerya
Abstract
Aim: The aim of the present study was to evaluate the incidence of ACS before and after the onset of the COVID-19 pandemic and analyse differences in gender distribution, and type of presentation. Material & Methods: A retrospective, observational study performed in Department of Cardiology. In this study, 2250 consecutive patients were identified. Of these, 1750 patients without ACS were excluded from the analysis. Ultimately, 500 patients were included in this study. Based on these circumstances, we divided our study population into pre- (before the outbreak of COVID-19) and post-pandemic (after the outbreak of COVID-19) groups. Results: The median age was 64 years [interquartile range (IQR): 58–78], 75% were men, and 30%, 70%, and 65% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were no significant differences in gender, body mass index (BMI), past history, chief complaint, Killip classification, blood pressure, or heart rate between the groups. Patients in the post-pandemic group had higher levels of serum creatinine and longer time from an EMS call to hospital arrival than those in the pre-pandemic group. There were no significant differences between the groups in the number of patients with ACS receiving CABG. There were no significant differences in the use of intra-aortic balloon pumping or extra-corporeal membrane oxygenation between the groups. Overall, in-hospital death occurred in 20 patients (4%), including 18 with myocardial infarction (MI), one with bleeding, and one with sepsis. There was no significant difference in the in-hospital mortality between the groups. Conclusion: Patients presenting after the onset of the pandemic had elevated cardiac markers, representing higher severity and potentially presenting later in the disease course. The number of total ACS cases and percentage of females presenting to the catheterization lab before the COVID surge almost remained stable. This comparison data provides validity that the drop in ACS case volume and females is more likely due to the pandemic and not due to improvements in overall cardiovascular health metrics. Reasons for this disparity are likely multifaceted and deserve further investigation.

99. A Hospital-Based Assessment of Yang’s Onion Flap Technique for Release of Scarred Eponychium and Nail Fold Reconstruction in Burn Patients: An Observational Study
Sanjay Kumar, S. K. Jha, P. D. Verma, R. K. Ajay
Abstract
Aim: In the present study, we used an onion flap to release scarred eponychium and nail fold reconstruction in a single stage without using soft tissue from another area. Methods: We conducted a prospective interventional study from December 2017 to August 2020. A total of 50 fingers (20 patients) were operated on. Results: The mean age of patients was 32.8 years. The mean time interval since burn injury to surgery was 18.6 months, with a range of 7 to 47 months. 38 fingers had flame burns, while 12 had scald injuries. Out of 50 patients, 12 (24%) were operated on for other contractures under general anesthesia, and Yang’s flap was done simultaneously, while 38 patients (76%) were operated under local anesthesia under digital or wrist block. Of 20 fingers with symptoms, 16 fingers (80%) reported a symptomatic relief, while six fingers reported no symptomatic relief at the end of follow-up period. Conclusion: Yang’s flap is a good option for the correction of nail deformity in burn patients. It was associated with a low complication rate and improved nail appearance in the patients. There is also significant symptomatic relief in performing daily activities after surgery.

100. A Randomized Controlled Assessment of Levobupivacaine and Levobupivacaine with Dexemedetomidine in Transeversus Abdominis Plane Block for Caesarean Delivery for Post-Operative Analgesia
Vishwanath Ankad, Rohit Kumar, Mohan, Ramesh Babu
Abstract
Aim: The aim of the present study was to assess the TAP block with levobupivacane with or without dexmedetomidine was compared with control group for post‑operative analgesia following cesarean delivery. Methods: This was a double‑blind randomized control trial conducted over a period of 1 year in ESIC Medical College and Hospital  Bihta, Patna, Bihar, India. 120 consenting pregnant women scheduled for elective cesarean delivery under spinal anesthesia were enrolled in the study. The normal uncomplicated pregnancies (ASA 2) and age between 21 and 40 years with body mass index (BMI) 18.5 to 34.9 kg/m2 were considered as inclusion criteria. Results: The time for first request for analgesia was significantly longer in Group LD when compared to Group L and control group, Group C had shortest period. There was significant difference between Group C versus Group L and Group LD (P < 0.05), however, there was no difference between Groups L and LD. The difference between Groups L and LD were significant (P < 0.05) at 12 h. There was no difference between the groups at 24 h. On enquiring about the VAS rating of postoperative analgesia satisfaction score in the first 24 h, Group C women gave a score of 6.08 ± 1.72 (mean ± SD), Group L women gave 7.74 ± 1.26 and Group LD women gave a score of 8.86 ± 0.64. Conclusion: TAP block with levobupivacaine provides good immediate postoperative analgesia and addition of dexmedetomidine to levobupivacaine prolongs the duration of analgesia and improves quality with better patient satisfaction.

101. Dimensions (Maximal Width and Length), the Size and the Shape of the Piriform Aperture (PA) and Nasal Bone: A Morphometric Study
Vinita Sinha, Meeta Sahai, Rashmi Prasad
Abstract
Aim: The present study was undertaken to evaluate the dimensions (maximal width and length), the size and the shape of the piriform aperture (PA) and nasal bone. Methods: 70 adult dry skulls of were collected from the Department of Anatomy, Nalanda medical College, Patna, Bihar, India for one year. All measurements were taken using digital Vernier caliper accurate up to 0.001 mm. Nasion and anterior nasal spine was marked. Then nasomaxillary and internasal sutures were traced. Results: It is evident from Table 1 that height, upper width and lower width of piriform aperture were greater in male as compared to female. This difference was not statistically significant for upper width of piriform aperture (p=0.59) and for lower width of piriform aperture (p= 0.75) while the difference in height of piriform aperture was statistically significant. (p <0.0001). Conclusion: The width of piriform shows an equal average for both sexes. The results obtained in this study showed the importance of the morphological knowledge of the piriform aperture.

102. Assessment of the Clinical Profile of Alpha two Agonists Dexmedetomidine and Clonidine as An Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block: A Comparative Study
Rajesh Kumar Choudhary, Sujeet Kumar, Vijayendra Prasad
Abstract
Aim: The aim of the present study was to compare the clinical profile of Alpha two agonists Dexmedetomidine and Clonidine as an adjuvant to Ropivacaine in supraclavicular brachial plexus block with respect to sensory and motor blockade, level of sedation and duration of analgesia. Methods: The present study was conducted in the Department of Anaesthesiology  for the period of one year. The study was carried out in 50 adult patients admitted in the department of Orthopaedics, with age in the range of 18-60 years, ASA Grade I and II posted for elective upper limb surgeries under Supraclavicular brachial plexus block. They were included in the study only after obtaining a written informed consent. Results: The mean onset time of sensory block was achieved significantly earlier in group D (4.97 ± 1.67 minutes) than in group C (8.64 ± 2.36 minutes) (p=0.000). The mean (SD) time for complete sensory block in Group D (12.0 ± 2.07 minutes) was earlier as compared to Group C (17.13 ±5.97 minutes) (p=0.000). The mean total duration sensory block in Group D (718.32 ± 52.78 minutes) was significantly prolonged as compared to Group C (464.66± 56.64 minutes) (p=0.000). The mean time for total duration of analgesia in Group D (736.00 ± 56.84 minutes) was prolonged as compared to Group C (516.00 ± 52.78 minutes) (p=0.000). The mean (±SD) onset time of motor block in Group C (Clonidine) was 15.35 (± 5.40) minutes and in Group D (Dexmedetomidine) was 9.81 (± 4.26) minutes which was statistically significant (p=0.000). The mean time for complete motor block in Group D (16.94 ± 3.97 minutes) was earlier as compared to Group C (25.45 ± 8.02 minutes) (p=0.000). The mean (± SD) total duration of motor block in Group C (Clonidine) was 428.12 (± 50.95) minutes and in Group D (Dexmedetomidine) was 610.40 (± 52.48) minutes which was statistically significant (p=0.000). Conclusion: We concluded that Dexmedetomidine is a better adjuvant to Ropivacaine for supraclavicular brachial plexus block when compared to Clonidine as it provides earlier onset of sensory and motor blockade, prolongs the duration of sensorimotor blockade and postoperative analgesia with stable vitals and minimal side effects.

103. An Observational Study to Investigate the Incidence and Diagnostic Validity of Difficult Airways in Emergency Department
Sushant Satya Priya, Anshuman, Krishna Kumar
Abstract
Aim: The aim of the present study was investigating the incidence and diagnostic validity of difficult airways in emergency department. Methods: The present study was conducted in the Department of Anesthesiology. Emergency physicians were able to perform intubation independently. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). 500 patients were included in the study. Results: 350 (70%) of 500 patients intubated were male. Elderly patients aged 60 to 80 years old accounted for 45% of all cases. Intubation indications varied. The most common reasons were central nervous system diseases in 175 cases (35%), followed by cardiopulmonary arrest in 125 (25%), respiratory diseases in 100 (20%), and circulatory failure in 185 (18.8%). Emergency medicine physicians conducted most ED intubations 475 (95%). 390 patients (78%) were intubated immediately upon arriving at the ED. We utilized several kinds of simple examination methods (neck mobility, narrow oral opening, “3-3-2” evaluation, external look) to predict the possibility of difficulty. Given that different intubation devices may cause different ease of arriving at a satisfactory glottic exposure, we divided patients into two groups: those who underwent video laryngoscopy vs. those who received traditional direct laryngoscopy. The related parameters between the two groups were a sensitivity of 0.50 vs. 0.41, specificity of 0.80 vs. 0.72, AUC of 0.66 vs. 0.58 respectively. The combined test had a sensitivity of 0.72 (95% CI: 0.47–0.89), a specificity of 0.78 (95% CI: 0.76–0.81), a LR+ of 3.5 (95% CI: 2.5–4.6), a LR− of 0.38 (95% CI: 0.18– 0.71). Conclusion: Despite an insufficient predictive ability for current difficult airway evaluation methods, there were relatively low rates of difficult airways during ED intubations. Continuing focus on the difficult airway problems and optimizing airway assessment are required.

104. An Observational Study Assessing the Association between Deviated Nasal Septum and External Nasal Deformity
Sonam Kumari, Saurabh Yadav, Kumari Jyoti Mani, Satyendra Sharma
Abstract
Aim: The aim of the present study is to correlate the association of nasal septal deviations with external nasal deformities. Methods: A total of 200 patients between age group of 18 to 50 years, attending the OPD of department of ENT for 2 years, were included in our study. Inclusion criteria for the study were patients with deviated nasal septum and external nasal deformity. Results: Out of 200, 106 patients had external nasal deformity with deviated nasal septum while 94 patients had deviated nasal septum without external nasal deformity. Mean age of patient was 26 years. Maximum number of patients was in the age group of 21-30 years (40%). Out of 200 patients, 140 were males and 60 were females. Nasal obstruction (75%) was the leading chief complaint followed by nasal discharge (45%), headache (18%), epistaxis (12%) and postnasal drip (5%). According to Mladina classification, most common type in our study was Type 4 nasal septal deviation. According to Yong Ju Jang classification, Type 1 was the most common type of external nasal deformity observed in our study. By sequential correlation of the type of septal deviation associated with each type of external nasal deformity, it was found that Type 1, 2 and 3 were not associated with any external nasal deformity. Type 4 septal deviation was associated more frequently with Type 1 external nasal deformity. Conclusion: According to our study, it can be concluded that there is a close correlation between nasal septal deviation and external nasal deformity. Both entities have to be analysed together so as to have a better functional and cosmetic outcome.

105. Anterior Communicating Artery Aneurysm Clipping: Experience at a Tertiary Care Center with Respect to Intraoperative Rupture
Brajesh Kumar, Rakesh Kumar, Samrendra Kumar Singh, Niraj Kanaujia, Brajesh Kumar
Abstract
Aim: The aim of the present study was to evaluate various factors (size, wall morphology, and fundus direction) associated with intraoperative rupture (IOR) of Acomm aneurysm. Methods: This was a retrospective study conducted at the IGIMS, Patna, India. Data were collected from medical records of the department for the period of 24 months. We reviewed the case of 20 operated patients diagnosed to have ruptured Acomm aneurysm. Results: The mean age of patients was 59.2 ± 6.24. Of 20 patients, 9 (45%) were male and 11 (55%) were female. All the patients underwent surgical clipping of the ruptured Acomm aneurysm. According to Hunt and Hess grade, majority of the patients were under grade 2. 80% had headache and 55% had surgical timing >14 days. Patients in whom unilateral and bilateral A1 visualized were 5 and 14, respectively. A2 was visualized unilaterally in 1 patient and bilaterally in 20 patients. However, A1 and A2 of both sides were found intraoperatively in all cases. Aneurysm neck width was classified into <4 mm or ≥4 mm sizes and this difference was statistically not significant. Aneurysmal dome size was divided into three categories and this correlation came to be significant. Aneurysmal wall was simple or smooth and multilobed or irregular and this   difference   was   statistically   significant. Aneurysm direction was classified   into   anterior, superior, posterior, and inferior based on CTA and intraoperative findings and these differences in IOR were found to have statistical significance. In our study, proximal A1 was clipped bilaterally, unilaterally and no clipping was done. Patients with bilaterally clipped A1 experienced no IOR, while in unilaterally clipped aneurysm and these values   were   statistically   significant on correlation. In our study, 1 patient belonged to age group <20 years, 3 patients from ≥20 to 39 years of age group, 8 patients from ≥40 to 59 years of age group, and 8 patients from ≥ 60 years of age group. Although correlation these findings were not significant. Conclusion: We concluded that various factors remarkably associated with increased risk of IOR are: Aneurysm size >4 mm, multilobulated or irregular aneurysm wall, posteriorly and/or inferiorly directed aneurysms.

106. Assessing Radiological, Clinical, and Patient-Reported Outcomes of Patients with Surgically Repaired Intraarticular Calcaneal Fractures: An Observational Study
Rahul Kumar, Wasim Ahmed, Santosh Kumar, Indrajeet Kumar
Abstract
Aim: The aim of the present study was to evaluate the radiological, clinical and patient-reported outcomes of patients with intraarticular calcaneal fractures treated surgically. Methods: The current investigation was a single-center, prospective, and observational study undertaken at the Department of Orthopaedics . The study focused on patients with calcaneal fractures. The study from December 2019 to Nov 2021. In the current research, a total of 44 patients, with 50 calcaneal fractures, underwent surgical intervention. Follow-up assessments were conducted for a duration of 18 months after the surgical procedure. Results: The average age in the current research was 44.6 ± 14.46 years. The prevalence of male cases was 72.72%, while female cases accounted for 27.28% of the total. The majority of fractures seen in the study were classified as Sander’s type 2, accounting for 84% of the cases. The majority of fractures seen were unilateral, accounting for 81.81% of cases, whereas bilateral fractures accounted for 8 (18.18%) cases. In 36.6% of instances, concurrent injuries were seen. The mean duration till surgery was found to be 5.5 ± 1.3 days, while the average length of hospital stay was determined to be 8.2 ± 3.7 days. In the current investigation, it was observed that 10% of the patients had a pre-operative Bohler’s angle of 20° or more, while the remaining 90% of the cases had a pre-operative Bohler’s angle below 20°. The majority of patients had a commendable AOFAS (American Orthopedic Foot and Ankle Society) score at the 18-month postoperative assessment (p>0.05) The prevalence of Allmacher grade 0 and 1 was seen in the majority of patients from both groups (p>0.05). The study included a comparison of Bohler’s angle before and after surgery, namely at the 18-month postoperative follow-up. In instances where the pre-operative Bohler’s angle was equal to or more than 20 degrees, it was observed that the post-operative Bohler’s angle ranged from 25 to 29 degrees in 80% of cases. In instances where the pre-operative Bohler’s angle was less than 20°, a post-operative Bohler’s angle of 25-29° was seen in 84.44% of cases (p<0.05). Conclusion: The preferred approach for treating joint depression type and Sanders Type II/III fractures of the calcaneus is surgical care using open reduction with internal fixation. This treatment method has shown favorable outcomes during short-term follow-up.

107. An Outcome Assessment of Management in Traumatic Cataract Cases: An Observational Study
Asif Shahnawaz, Randhir Kumar, Neha Kumari, Raju, Richa Mishra, Madhuri, Kumar Ravi
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 of DMCH, Laheriasarai, Darbhanga, Bihar, India for the period of two years. Study population was all the patients presenting with cataract. 100 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 (56%). Out of 100 cases, 65 were males and 35 were females. Out of 100 cases of traumatic cataract, 32 were blunt and 68 were penetrating trauma. Pre-operative visual acuity was recorded in all cases. In 32 cases (32%), the preoperative visual acuity was PL/PR. In 43 cases (43%), the preoperative visual acuity was perception of hand movements. In 12 cases (12%), the preoperative visual acuity was 3/60 to counting fingers ½ meters. Visual acuity of the uninjured eye was recorded in all the patients and was found to be within the normal limit. Out of 100 cases of traumatic cataract, 95 cases underwent ECCE (Small Incision Cataract Surgery) with PCIOL implantation, 3 cases underwent small incision cataract surgery with PCIOL implantation with corneal tear repair, 1 case underwent small incision cataract surgery with PCIOL implantation with anterior vitrectomy, 1 case underwent small incision cataract surgery with aphakia. Out of 50 cases, final visual acuity of 6/6 to 6/18 was seen in 15 (30%) cases. Final visual acuity of less than 6/18 to 6/60 was seen in 30 patients (60%). Five patients (10%) 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.

108. A Clinical and Echocardiographic Assessment of Patients with Atrial Fibrillation: An Observational Study
Mani Shankar Pandey
Abstract
Aim: The aim of the present study was to assess the clinical and echocardiographic assessment of patients with atrial fibrillation. Methods: The present study was conducted in the Department of Cardiology for 15 months. 100 patients were included in this study. Results: The most common symptom was dyspnoea 76% followed by Congestive cardiac failure 71%. There was history of mild to moderate chest pain in 13% of patients. 18% of patients had history of syncope/dizzy spells. Fatigability was noticed in 21% cases. There were 55% males and 45% females in this group.  Majority of patients, 55% had RHD as underlying cause of atrial fibrillation. 9% patients had  coronary artery disease. Hypertension alone was present in 7% of patients. 9% of patients had COPD as a risk factor. 8% of patients had cardiomyopathy Hyperthyroidism was found in 3% of patients. 70% patients had heart rates >100. Fibrillary P wave was seen in 22% patients and absent p waves in 78% of patients. LVH was seen in 11% patients, RVH in 30% patients, RBBB in 4% patients, and LBBB in 5% patients, ST depression and T wave inversion in 58% patients. The maximum number of patients i.e. 37% had LA dimension between 4.1-5.0 cm2. Conclusion: In our study dyspnoea was the commonest symptom in atrial fibrillation and rheumatic heart disease was the major aetiological factor. Patient with left atrial dimension >4.0 cm had sustained atrial fibrillation. Thromboembolic phenomenon was more common in chronic AF and all the patients had mitral valve disease.

109. Cross Sectional Study Assessing Visual Outcome Following Management of Traumatic Cataract: An Observational Study
Kumar Parmanand, Mrityunjay Kumar, Deepak Kumar Sinha
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 one year. Study population was all the patients presenting with cataract. 50 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 (56%). Out of 50 cases, 35 were males and 15 were females. Out of 50 cases of traumatic cataract, 15 were blunt and 35 were penetrating trauma. Pre-operative visual acuity was recorded in all cases. In 15 cases (30%), the preoperative visual acuity was PL/PR. In 22 cases (44%), the preoperative visual acuity was perception of hand movements. In 11 cases (22%), the preoperative visual acuity was 3/60 to counting fingers ½ meters. Visual acuity of the uninjured eye was recorded in all the patients and was found to be within the normal limit. Out of 50 cases of traumatic cataract, 47 cases underwent ECCE (Small Incision Cataract Surgery) with PCIOL implantation, 1 case underwent small incision cataract surgery with PCIOL implantation with corneal tear repair, 1 case underwent small incision cataract surgery with PCIOL implantation with anterior vitrectomy, 1 case underwent small incision cataract surgery with aphakia. Out of 50 cases, final visual acuity of 6/6 to 6/18 was seen in 15 (30%) cases. Final visual acuity of less than 6/18 to 6/60 was seen in 30 patients (60%). Five patients (10%) 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.

110. A Descriptive Observational Study Assessing Socio-Demographic Profile of Head Injury Victims Due to Fatal Road Traffic Accidents
Abuzar Rizwi
Abstract
Aim: The aim of the present study was to assess the socio-epidemiological profile head injury victims due to fatal road traffic accidents in Bihar region. Material & Methods: A retrospective study was conducted including all cases of road traffic accidents involving fatal head injuries which underwent autopsy at over a period of  two years. Out of the 250 cases of RTA autopsied from Mangalore jurisdiction, 200 cases (80%) were found to have sustained fatal head injuries. Results: In this study, total 200 cases were analysed which clearly demonstrated the male preponderance (85%) in all age groups. It was observed in the study that most affected age group was between 21-30 years having total 64 cases (32%), followed by 20% belonged to the age group 31- 40 years. Individuals in the age group less than 10 years were the least affected (2%), followed by elderly people i.e. 60 years and above in 8% of total cases. 92% belonged to hindu religion and 75% were married. Majority of the victims belonged to rural areas (65%), whereas 35% were from urban area.  Most of the victims i.e. 128 cases (64%) were educated up to secondary school or below and rest 72 (36%) were educated up to senior secondary and above. 30% were laborers and 29% were farmers. Most of the victims were two wheeler users (62%). Pedestrians and four wheeler victims were 25% and 8% respectively. Conclusion: The present study revealed that most victims were of younger age group. This situation can be improved by educating public through the mass and media initiating road safety training campaign. Most of the deaths from RTA take place either on the spot or within 24 hours of sustaining injury. So an effort should be made to provide timely and proper medical services to RTA victims via mobile emergency services, quality trauma centers and proper rehabilitation services.

111. Retrospective Comparative Assessment of the Clinical Efficacy of Cold Snare Polypectomy using a Thin-Wire Snare and Thick-Wire Snare for Small Colorectal Polyps
Dheeraj Kumar, Sonal, Vishwamohan Dayal
Abstract
Aim: The aim of the present study was to compare the clinical effectiveness of thin-wire mini-snares and thick-wire mini-snares during CSP for small colorectal polyps. Methods: This was a retrospective comparative study conducted in the Department of Gastroenterology. Patients who underwent CSP for 5 to 9 mm polyps were enrolled. CSP was performed on 80 patients, resulting in the removal of 100 polyps. Results: There were no significant differences between the thin-snare group and the thick-snare group in terms of various factors, including age, the indication for the procedure, the size of the polyp, the morphology of the polyps and the pathological findings. The en bloc rate and resected specimen retrieval rate were 100% in both groups. The CRR was 78% in the thin- snare group and 84% in the thick-snare group, with no statistically significant difference between the two groups. There were no significant differences in specimen size and the rates of specimens containing submucosal tissue between the two groups. The depth of submucosa in resected specimens was 500.8 ± 403.8 μm in the thin-snare group and 409.3 ± 196.5 μm in the thick-snare group, with no statistically significant difference between the two groups. In the univariate analysis of independent factors related to CRR, the pathologic diagnosis of the polyp was the only factor statistically significantly associated with the CRR. In contrast, no statistically significant associations were found for other factors, such as snare type, polyp size polyp morphology, polyp location. In the multiple logistic regression analysis, the pathologic diagnosis of the polyp was the only independent factor related to the CRR, and the CRR was significantly lower in SSLs than in adenomas. Conclusion: In conclusion, when performing CSP for small polyps, the snare thickness does not seem to have a significant effect on the clinical outcomes, including CRR and the occurrence of complications. Among the factors associated with the CRR, the histologic finding of the polyp, such as SSL, was the only risk factor for in- complete resection.

112. Role of Lactic Dehydrogenase as a Biochemical Marker in Hypertensive Pregnant Women [Preeclampsia– Eclampsia] Archana Kumari, Anupama
Abstract
Preeclampsia is a disorder of vascular endothelial malfunction and vaospasm that occurs after 20 weeks gestation and can present as late as 4-6 weeks. It is clinically defined by hypertension and proteinuria, with or without pathologic edema. Eclampsia is an acute and life-threatening complication of pregnancy, characterized by the appearance of tonic-clonic seizures, usually in a patient who has developed pre-eclampsia. These, as causes of maternal mortality and morbidity is increasing worldwide both in developed and developing nations, currently the contribution being 15-20%.

113. Study to Evaluate the Feasibility, Stone‑Free Rate, and Complications of RIRS in Children <5 Years of Age
Shivanand Prakash, Nitesh Kumar, Karthik Maripeddi, Sunil Palve, Sanath T
Abstract
Aim: The aim of the present study was to evaluate the feasibility, stone‑free rate, and complications of RIRS in children <5 years of age. Methods: All children less <5 years of age with a stone size <2 cm (renal/proximal ureteric), who underwent RIRS for the period of three years were included in this retrospective study. A total of 100 children with 64 renal units met the inclusion criteria. From our hospital database, demographic data, complete history, clinical examination findings, laboratory reports of complete hemogram, serum biochemistry, urine analysis, and urine culture were retrieved. Results: A total of 100 pediatric patients were evaluated, out of whom, 8 had bilateral renal stones (108 renal units). Out of these 100 renal units, 8 patients had multiple stones in the same renal unit. The youngest child was a 4‑month‑old boy who presented with anuria due to bilateral upper ureteric stones. The most common location of the stone was the pelvis and the lower pole. Stones were most commonly of the mixed composition (46%), followed by calcium oxalate dihydrate (22%). UAS 9.5/11.5 Fr could be successfully inserted only in 60 out of 100 renal units (60%) even after prior stenting. Conclusion: Pediatric RIRS is a promising option in young children as it offers an acceptable stone free rates and a low incidence of high grade complications. However, it requires expertise and should be offered at tertiary care centres.

114. A Retrospective Clinicoradiological Assessment Following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Observational Study
Sandeep Yadav, Madhu Priya
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 at department of General Surgery within the duration of 18 months. A total of 200 patients of CSM who underwent surgical decompression were analysed. There were 150 males and 50 females. The mean age of patient was 52.9 years (range 30–74 years). Results: A total of 100 patients underwent surgical decompression by an anterior approach, and the remaining 100 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 or Paramesh along with plating and screw fixation. In the posterior approach, laminoplasty was done by the standard Hirabayashi’s technique, and fixation was done by laminoplasty plates and screws. There was increase in CD and CSA in patients of both anterior and posterior subgroups which was statistically significant. 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.

115. An Analytical Cross-Sectional Study Assessing Correlation of MPV with Fasting Blood Glucose, Glycosylated Hemoglobin (Hba1c) and Duration of Diabetes in the Diabetic Patients
Akhalesh Kumar, Santosh Kumar, Pradeep Kumar Singh
Abstract
Aim:  The aim of the present study was to determine the correlation of MPV with fasting blood glucose, glycosylated hemoglobin (HbA1c) and duration of diabetes in the diabetic patients. Material & Methods: This was a cross-sectional study carried out in Department of Pathology, including 200 patients who were already diagnosed to have Type 2 DM and 200 nondiabetic subjects without known coronary artery disease in between the duration of 12 months. Results: There were more male as compared to females in both groups. MPV was significantly raised in the diabetic population in comparison to controls. Similarly, we also observed significantly higher MPV among diabetics with vascular complications in comparison to those without vascular complications. Among diabetics with microvascular complications, MPV showed a significant association with Diabetic Nephropathy and Diabetic retinopathy. Similarly, among those with macrovascular complications, MPV showed a significant association with Peripheral Artery Disease. MPV showed significant positive correlation with HbA1C, fasting blood sugar, and duration of diabetes in our study. All three correlations are reflected by their positive “r” values. Conclusion: Results showed significantly higher MPV in diabetic patients than in the nondiabetic subjects. This indicates that elevated MPV could be either the cause for or due to the effect of the vascular complications. Hence, platelets may play a role and MPV can be used as a simple parameter to assess the vascular events in diabetes.

116. A Hospital-Based Study to Assess the Impact of Diabetes and Chronic Kidney Disease on Outcomes for Small Renal Masses: An Observational Study
Kumar Gaurav Mishra, Ahsan Ahmad, Sanjay Kumar Gupta
Abstract
Aim: The aim of the present study was to investigate the relationship between DM, CKD, and other risk factors affecting the rate of progression to delayed intervention (DI) and overall survival (OS). Material & Methods: The present study was conducted in the Department of Urology, ESICMCH, Bihta, Patna, Bihar, India. Our study identified 100 patients on AS protocols for SRMs within the small kidney tumor database who met the inclusion/exclusion criteria. A waiver of consent was obtained before study start. The procedures adhered to the ethical guidelines of Declaration of Helsinki and its amendments. Results: Gender was closely distributed with 55 male patients (55%) and 45 (45%) females. There were 11 patients less than age 60 years who opted for AS versus initial surgical intervention. DM was present in 35 (35%) of the patients. Following placement on AS, 15 (15%) patients died. In total, 25 (25%) patients crossed over to DI. On average, DI patients were significantly younger at 69.5 years old as compared to 76.6 among non-crossover patients (P = 0.01). DI patients had a faster tumor GR of 0.44 cm/year (SD 0.35) as compared to 0.11 cm/year (SD 0.10; P = 0.01). DI patients had a higher mean eGFR at 78.3 mL/min/1.73 m2 (SD 22.44) as compared to 63.8 mL/min/1.73 m2 (SD 22.6) among non-DI patients (P = 0.01). There was a trend toward larger tumors and the likelihood of intervention in cross-over patients (mean size = 2.55 cm, P > 0.05) compared to non-DI patients, although this was not statistically significant. BMI was not a significant predictor of conversion to DI, although both groups had a mean BMI > 29. Diabetes was significantly associated with worse OS. The following factors correlate with decreased OS on univariable analysis: diabetes (OR 5.84, 95% CI 1.84–18.42, P = 0.01), CCI (OR 1.38, 95% CI 1.08–1.76, P = 0.01), tumor size (OR 1.56, 95% CI 1.14–2.11, P = 0.01), and tumor GRs (OR 8.24, 95% CI 1.52–44.5, P = 0.01). Conclusion: Patient-level factors – such as diabetes and eGFR – are associated with the rate of DI and OS among SRM patients. Consideration of these factors may facilitate better AS protocols and improve patient outcomes for those with SRMs.

117. A Prospective Descriptive Study on Clinical Presentation and Management of Ectopic Pregnancy
Mala Sinha, Harvinder Kaur, Rita Ranjan
Abstract
Aims and Objectives: To study the incidence, clinical presentation, diagnostic modalities and different management approaches for treatment of ectopic pregnancy and to analyze outcome with respect to morbidity & mortality. Materials and Method: A total of 100 cases of ectopic pregnancy presenting to gynecology emergency department from April 2015 to March 2016 were enrolled. Depending upon the clinical presentation, serum β – human chorionic gonadotropin level and trans vaginal sonography (TVS) finding, management of ectopic pregnancy was done. Outcome was studied in terms of morbidity and mortality. Results: Incidence of ectopic pregnancy was 0.43%. Most common age of presentation was 26-30 yrs. More patients presented around 6th week of pregnancy (34.7%) ;57% of cases presented with rupture. Lower abdomen pain was present in all cases. Among various predisposing factors; infection, abortion, infertility, tubal surgery were present in 48%, 28%, 11%and 5% respectively. Expectant management and medical management were successful in 9% and 10% cases respectively. Surgical management was employed in 80% cases.Salpingectomy, salpingo-oophorectomy and salpingostomy were done in 72.83%, 18.51% and 8.64% cases respectively. Post operative blood transfusion was required in 63% and ICU admission in 14% cases. No maternal mortality was noted. Conclusions: Ectopic pregnancy should be suspected in reproductive age women with lower abdominal pain regardless of missed period or vaginal bleeding or even absence of risk factor. Along with high clinical suspicion, β-hCG and transvaginal sonography should be considered earliest in high risk women to make early diagnosis and prevent the morbidity and mortality associated with ectopic pregnancy.

118. An Observational Study to Assess the Urinary Incontinence, Mental Health and Loneliness among Community-Dwelling Older Adults
Rakesh Kumar, Archana Sinha, Purushottam Kumar
Abstract
Aim: The aim of the present study was to assess the urinary incontinence, mental health and loneliness among community-dwelling older adults. Methods: The present study was conducted department of Urology for one year In brief, TILDA was a nationally representative survey of community-based adults aged 50 and above. The target sample included every household resident meeting this age criterion. 200 patients were included in the study. In the current study, the analysis was restricted to participants aged 50 years and above and those who completed the self-completion questionnaires (SCQ). Results: Majority of the patients was belonged to the age groups 50-59 years and 52.5% were females in the study. 42.5% had secondary education level and 47.5% had chronic conditions more than two. 40% were moderately integrated. In the unadjusted model, the OR (95% CI) was 1.74. This was attenuated when the model was adjusted for sociodemographic factors, chronic conditions, and ADL  disability but remained statistically significant. Further adjustment for the SNI had little effect on  the  association. The OR became non-significant when depression was included in the model but not when anxiety was included. When the frequency of UI or activity limitations due to UI were taken into account, compared to no UI,  having activity limitations due to UI was associated with particularly high odds for loneliness even in models adjusted for either depression or anxiety (Model 4 and 5) although the OR was no longer significant when depression and anxiety were included simultaneously in the model (Model 6). Frequency of UI was not as strongly associated with loneliness as activity limitations due to UI and became non-significant in the models where depression and anxiety were included. In the analysis restricted to those with UI, a higher frequency of UI was not associated with elevated odds for loneliness, but activity limitations due to UI were associated with significantly higher odds for loneliness in all models except those which adjusted for depression. Conclusion: UI is associated with higher odds for loneliness among older community-dwelling adults but this association is largely explained by comorbid mental health problems, in particular, depression.

119. An Observational Assessment of the Level of Self-Care Practices and Perception of the Position in Life among Individuals with Type 2 Diabetes Mellitus (T2DM) in Rural Field Practice Areas in Jharkhand
Kumari Asha Kiran, Surendra Sahu, Shalini Sunderam, Kumari Jaishree Ragini, Anit Kujur, Syed Hedayetullah, Dilip Kumar Paswan, Chandramani Kumar, Shailesh Hembrom
Abstract
Aim: The aim of the present was to assess the level of self-care practice and perception of position in life among individuals with type 2 diabetes mellitus (T2DM) in rural areas Jharkhand. Methods: A community-based cross-sectional survey was conducted in the rural field practice area of tertiary care hospital in Jharkhand for individuals clinically diagnosed with T2DM for more than 6 months. A total of 200 participants were analyzed who were clinically diagnosed with diabetes for more than 6 months. We excluded people who had co-morbidities like cancers, mental illness, or any diseases that were debilitating in nature, as we expected those conditions to affect our outcome variables. The study period was one year. Results: The participants were almost equal with respect to gender, the majority of the participants 66% belonged to the age group between 41-60 years, 31% of them had education up to high school level and the majority 52.6% of the participants reported their diabetes duration as more than 5 years. But 55% of the participants were living with hypertension as a comorbidity. On analysis of the BMI, one-third of the participants were either overweight or obese, majority of the participants had stage 2 hypertension. Of the study population, almost half (47%) of the participants had glycaemic levels well above 125 mg/dl.The WHO quality of life BREF scale responses were analysed. The mean score of overall quality of life was calculated to 62.68±15.45, and it was also observed that the mean score of physical quality of life was lowest among all the domains of quality of life, at 56.04±7.73.On analyzing the total quality of life 17% of participants reported having poor overall quality of life. Conclusion: In conclusion, this survey study sheds light on the practices and quality of life among individuals with T2DM. The findings reveal that while there are areas of concern, such as poor physical activity, foot care, and blood glucose monitoring practices, participants demonstrated better adherence to diet and medications. Importantly, despite these challenges, the quality of life among the participants was reported as good. These results emphasize the need for targeted interventions and education programs to promote healthy lifestyle practices and further enhance the overall well-being of individuals living with T2DM.

120. An Observational Study to Determine the Importance of Oesophago-Gastroscopy in the Diagnostics of Laryngopharyngeal Reflux (LPR)
Asif Iqbal, Namira Azmi, Praveer Prakash
Abstract
Aim: The aim of the present study was to determine the importance of oesophago-gastroscopy in the diagnostics of laryngopharyngeal reflux (LPR)  induced pathology. Methods: The present study was conducted in the Department of Gastroenterology, A total of 50 patients (30 women, 20 men) with laryngopharyngeal problems in whom GERD was suspected were included in the  study.  They  were 17 −/78  years  old,  with  a  mean  of  45  years  and  a standard deviation of 14.6 years. Results: The VHI results showed that patients with vocal fold polyps assessed their voice problems as being worse in comparison to the voice problems of the LPR patients, but the significant difference appeared only in the physical subtest of VHI. The subjective VHI test performed in the LPR patients after the treatment showed a significant improvement in the overall results and in the results of all the subtests in comparison to the results of the test performed before the treatment. The acoustic analysis of the voice samples detected almost no change in F0 and JIT and a statistically significant improvement in SH and NHR. On the basis of videoendolaryngoscopy, the lesions of the laryngeal mucosa were evaluated using the BRFS before and after the treatment with esomeprasol. In all the LPR patients the BRFS was more than 7 before the treatment, indicating LPR. After the treatment, the BRFS significantly decreased. Conclusion: LPR can cause serious voice disorders, globus pharyngeus sensation, or frequent coughing. The voice problems can be compared to the problems of patients with vocal fold polyps. Oesophago-gastroscopy supplemented with a biopsy of the oesophageal mucosa can be a suitable method to prove the occurrence of GER. Videoendolaryngoscopy and the BRFS are superior in the diagnostics of LPR and correlate very well with the histological findings of the oesophageal mucosa specimens. The combination of all three procedures is supposed to be a very successful method in the diagnostics of GERD and especially LPR. Esomeprasol proved to be very effective in the treatment of LPR.

121. Hospital Based Descriptive Cross-Sectional Survey Assessing Knowledge, Attitude, and Practice towards Breast Cancer and Breast Cancer Screening among Women
Birendra Kumar Rajak, Kundan, U. N. Sharma, Sunil Kumar
Abstract
Aim: The aim of the present study was to assess the knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women in Gaya region. Methods: This was a facility-based, descriptive, cross-sectional study, conducted in the Department of Community Medicine. Detainees from all age groups and backgrounds were eligible to be included in this study. Out of 520 selected detainees, 500 participants responded to the questionnaire with a response rate of 96.15%. Results: The mean age was (34, standard deviation (SD): 12.4) years, and the ages of more than half of them 290 (58%) are from 18-30 years. 200 (40%) of them were illiterate and 180 (36%) had primary education. Regarding their marital status, the majority of them 300 (60%) were married. Additionally, 375 (75%) were housewives. About the participants’ knowledge about breast cancer, the majority of them 300 (60%) agreed that breast cancer is the most common cancer among females, and 300 (60%) said that breast cancer is a curable disease. Moreover, nipple discharge was the most commonly chosen symptom by the participants 220 (44%), and smoking was the most commonly selected risk factor for breast cancer 260 (52%). Furthermore, 260 (52%) of the participants did not know the methods of breast cancer diagnosis. The overall score of the participants’ revealed that more than half of them had poor knowledge about breast cancer, poor knowledge about breast cancer was significantly associated with low educational status, however it was not associated with the occupation of the participants and wasn’t associated with neither their marital status, nor their age. In this study, it was also observed that 72% of the study participants had positive attitude toward breast cancer screening. Despite having good knowledge and attitude toward breast cancer screening, the practice levels were still seen to be very low among study participants. Conclusion: The majority of the respondents think about breast self-examination as an important issue but they have poor practice. Thus, we recommend more health campaigns and educational sessions in such facilities.

122. Anatomic Assessment of Coronary Ostia in Human Cadavers by Dissection Method: A Morphometric Study
Neelam Sinha, Sanjay Kumar Sharma, Rashmi Prasad
Abstract
Aim: The aim of the present study was to assess the coronary ostia in human cadavers by dissection method. Methods: The present study was conducted on 60 hearts of human cadavers fixed with 10% formalin, collected from the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India. Results: It was observed that the mean diameter of left coronary ostium was greater than right coronary ostium which was statistically significant (p-value<0.0001). There was decrease in diameter from coronary ostia to the roots of coronary arteries which was statistically significant (p-value=0.050). Decrease in diameter from left coronary ostium to root was 0.58 mm and right coronary ostium to root was 0.45 mm. Number of coronary ostia in anterior aortic sinus was single ostium in 50 (83.33%) specimens, double ostia in 6 (10%) specimens, triple ostia in two (3.33%) specimen and also absence of ostium in two specimens. Number of coronary ostia in left posterior aortic sinus was single ostium in 57 (95%) specimens and double ostia in 3 (5%) specimens. Conclusion: The advances made in coronary artery bypass surgeries and modern methods of myocardial revascularisation makes it necessary for thorough complete knowledge of coronary ostia. Understanding variations in morphology of coronary ostia should be sought before surgical interventions. The present anatomical data may help the cardiac surgeons to modify their surgical reconstruction of the aortic root in order to achieve satisfactory recovery.

123. A Hospital-Based Study to Assess the Management of Isolated Mild Traumatic Brain Injury (TBI)
Dhiraj Kumar, Mukesh Kumar, Anil Kumar Peethambaran
Abstract
Aim: The aim of the present study was to describe the emergency department (ED) management of isolated mild traumatic brain injury (TBI). Methods: This study was conducted in the Department of Neurosurgery, Medical College Trivandrum Thiruvananthapuram, Kerala, India and consent for participation was obtained from each participant enrolled in this study. The study included all the patients with trauma, having clinical/radiological evidence of head injury alone or in association with other injuries admitted in the ED of Medical College Trivandrum Thiruvananthapuram, Kerala, India for one year. A total of 100 patients of mild head injury attended the neuro-surgery ED. Results: There were 75 (75%) males and 25 (25%) females. Most of the patients were healthy 91 (91%) with mild systemic diseases 9 (9%) before the injury happened. Of the patients with mild TBI, predominant mode of TBI was road traffic accidents (RTA), followed by fall from height, assault and sports-related injury. Of the total, 92% were from blunt injury, and injury at outermost were absent in 8% of patients. Most of the injuries occurred while at home and were accidental (42%) and were directly referred (85%) from the primary center. First aid for pain management was provided by trained personnel (doctors/paramedics) in 25% cases only and no care was provided in the rest of the cases (75%). The events following the injury included episode of loss of consciousness (LOC) in 6% cases, vomiting in 3% cases, LOC with ear nose throat (ENT) bleed in 1%, and LOC with vomiting in 20 cases. On examination, 6% cases had abnormal pupillary response, but in 94% patients, pupillary responses were found normal. The majority of TBI cases showed some form of upper body injury on head/face and neck region. Conclusion: A high index of suspicion for TBI and an understanding of the risk factors, signs, and symptoms that are most likely to require surgical management or lead to long-term neurocognitive sequelae are the foundation of TBI care in the emergency unit. The care of these patients begins with rapid and appropriate triage, prompt recognition of TBI, and immediate stabilization of the severely brain-injured or otherwise critically ill trauma patient.

124. A Hospital Based Study to Evaluate the Efficacy of Intrauterine Insemination in the Management of Infertility
Sweety Kumari, Kuldeep Kumar Kaul
Abstract
Aim:  The aim of the present study was to evaluate the efficacy of intrauterine insemination in the management of infertility. Material & Methods: A retrospectively analysed patients with surgically confirmed moderate-to-severe endometriosis (ASRM stages III and IV) with at least one patent Fallopian tube receiving IUI treatment. Patients were selected from the electronic patient database of the IVF centre of NMCH, Sasaram, Bihar, India. 50 patients were selected in the study. Results: The age of couples in our study ranged from (21- 42) years, 18 (36%) with primary infertility and 32 (64%) with secondary infertility. 38% cases had infertility. 36% had 3-5 years duration of infertility and 4% had 8-11 years duration of infertility. Out of 30 patients, 70% were at term and 3.34% had ectopic pregnancy. Conclusion:  Intrauterine insemination is useful for the treatment of infertility in women with unexplained causes of infertility.

125. Gestational Diabetes Mellitus, its Causes and it’s Maternal and Fetal Effect, A Retrospective Study in a Tertiary Care Hospital
Gupteswar Mishra, Nagendra Kumar Rajsamant, Sujit Kumar Mohanty, Sankarsan Das
Abstract
Background: various degrees ofabnormalities in glucose tolerance during pregnancy detected for the first time is known as GDM. Global prevalence of GDM is gradually increasing, particularly in developing countries such as India, where GDM has become one of the major chronic diseases endangering women’s health. Poor glycemic  control during pregnancy not only harms the mother but also the new born. Methods: A retrospective analysis of pregnant women, specifically those who gave birth in an obstetric ward of Hi-tech medical college and hospital, Bhubaneswar, was performed in this article. A case group and a control group of pregnant women who met the diagnotic  criteria for GDM were chosen for a controlled study. From January 1, 2020 to December 31, 2020,1,038 pregnant women were admitted to a tertiary hospital’s obstetric ward for delivery and 965 pregnant women who were eventually included in the study. Case and control groups were chosen. The case group consisted of all 125 pregnant women who met the diagnostic criteria for GDM, while the control group consisted of all 840 pregnant women who gave birth at the same time but did not have GDM and met the inclusion criteria. This study used a retrospective analysis method to collect data on the relevant conditions of pregnant women in both case and control groups in order to investigate the risk factors for GDM and pregnancy outcomes. Results: Out of the 1038 number of pregnant women one hundred twenty-five pregnant women were diagnosed with gestational diabetes and the incidence rate was 12.04%. Comparing the blood glucose levels of pregnant women between the case and control, the average fasting blood glucose level of 75gOGTT was 4.8343±0.4338 mmol/L in the case group and (4.3775±0.3688) mmol/L in the control group. Which is statistically significant. In this paper we considered the following risk factors:  body mass index before pregnancy, age, weight  gain during pregnancy, and family history of diabetes, comparison of which is statistically significant. Out of 204, 27 preterm births, with an incidence rate of 13.27%, are including 12 cases in the case group and 15 cases in the control group; 7 cases of premature rupture of membranes, with an incidence rate of 3.43%, including 3 cases in the case group and 4 cases in the control group. Similarly hypertension, preterm delivery, polyhydramneous, IUGR, Macrosomia, PPH, congenital anomally are also studied and found significant. Conclusion: It is very important to understand the effects of GDM on pregnancy. And the understanding of the risk factors and their impact on pregnancy and it’s outcome, strengthen the attention of pregnant women to GDM. Correct guidance and age-appropriate pregnancy are important  for the health of mothers and children.

126. A Hospital-Based Study Assessing the Efficacy of Intravenous Iron Sucrose for the Treatment of Iron Deficiency Anemia in Pregnancy
Neha Gangane, Poonam Varma Shivkumar, Surekha Tayade, Shuchi Jain
Abstract
Aim: The aim of the present study was to evaluate the efficacy of intravenous iron sucrose for the treatment of iron deficiency anemia in pregnancy. Methods: The present study carried out in Department of Obstetrics and Gynaecology, MGIMS, Sewagram,  India. The duration of the study was about 6 months. 50 pregnant women were enrolled for this study. Results: The study results showed that the mean age of the pregnant women was 23.57±4.08 years, their mean weight was 59.61±12.28 kg, their mean gestational week was 28.72±4.08, 8 (16%) of them had gestational hypertension, 5 (10%) of them had gestational diabetes, 4 (8%) of them had hypothyroidism, 6% had asthma and 6% genitourinary infection whereas 4 (4%) of them had chronic kidney disease. The study results further showed that both the hemoglobin (p<0.001) and ferritin levels (p<0.001) of females were significantly increased at term after receiving intravenous iron sucrose as compared to the baseline. Furthermore, significant difference was observed in PCV (p<0.001) and MCV as well (p<0.001). Conclusion: This study concluded that the administration of iron sucrose intravenously is a secure and effective choice in the management of iron deficiency anemia in pregnant women particularly for those who had inadequate response to oral iron supplementation. Intravenous iron sucrose is well accepted along with a controllable safety profile clinically and enhanced Hemoglobin and ferritin levels thus decreasing complications during pregnancy due to iron deficiency anemia.

127. A Cross-Sectional Assessment of the Relaxation Techniques in Reducing Stress Levels by Measuring Heart Rate Variability
Suman, Robina Shamim, Jyoti Priya, Rita Kumari
Abstract
Aim: The aim of the present study was to assess the use of Relaxation Techniques in Reducing Stress Levels by Measuring Heart Rate Variability at tertiary health care centre. Methods: This was a cross-sectional study carried out in the apparently normal individuals to study the effect of various relaxation techniques like Breath focus, Body scan, Guided imagery, Mindfulness meditation, Yoga, taichi, and qigong, Repetitive prayer etc. on heart rate variability during the 12-month period at Nalanda Medical College, Patna, Bihar, India. There were 100 individuals who given written consent to be part of the study. Results: The average age in both the age group was 36± 3.97 and 34± 4.26 was not statistically significant (p>0.05). The baseline parameters in both the groups were comparable (p>0.05) but the HRV after 12 weeks therapy High Frequency HRV increased in Group A as compared to Group B was significant (P<0.05); The Low frequency waves increased in Group B as compared to Group A (p<0.05) decreased Low frequency HRV and LF/HF ration after 12 weeks intervention was statistically significant (P<0.05). Conclusion: It can be concluded from our study that after 12 weeks training with various relaxations techniques the autonomic function measured by HRV i.e. High frequency Increased and low frequency decreased hence the parasympathetic dominance increased with the relaxations techniques.

128. Prospective, Observational Study to Investigate the Renal Function in Patients with Acute Stroke and its Relationship with in-Hospital Mortality
Rajnish Kumar, Siddharth Singh
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 Medicine  for the period of 2 years. 200 patients were considered for present study. Results: 80% were from group A while 20% 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. 104 (65%) patients had ischemic stroke, while 48 (30%) had hemorrhagic stroke. We noted mortality within 30 days in 24 (15%) patients. We distributed patients according to Serum Creatinine concentration at time of presentation, most patients had serum creatinine in the range of 98-118 (32%) followed by 82-97 (30%). 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 (25%). 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.

129. Assessing Common Etiologic Agents of Blood Stream Infections in COVID-19 Patients Admitted to ICU: An Observational Study
Alpana Singh, Ajay Kumar
Abstract
Aim: The aim of the present study was to find the common causative agents of blood stream infections in Covid 19 patients admitted to ICU of tertiary care hospital. Methods: The present cross-sectional study was carried out at department of Microbiology for the period of 12 months. 200 patients were included in the study. Results: Out of 200 samples, we got growth in 48 (24%) samples and no growth in 152 (76%) samples. There were 62.50% gram negative bacteria followed by 29.16% gram positive bacteria. The predominance of male gender (77%) of patients were affected, where 23% female were affected. The Staphylococcus hemolyticus and enterococcus faecium was the most common Gram positive bacterial isolates in patients. E. coli was the most common Gram negative bacterial isolates in patients. 8.33% were candida tropicalis in the study. Conclusion: Covid 19 has complex disease pathogenesis.   Patients on immunosuppressive therapy are at risk of developing secondary blood stream infections. Initially most of the secondary BSI were endogenus as Enterococcus spp was most prevent organisms. Patients admitted to the ICUs are also at risk of developing nosocomial infections. The patients on mechanical Ventilator are at risk of Ventilator associated infections.

130. An Observational Research Looking at Variables That Affect the Likelihood of an Emergency Caesarean Birth in Induced Labours at Term
Simpi Shilpa, Sweta Kumari, Seema Singh
Abstract
Aim: The aim of this study was to identify those factors which influence the risk of emergency cesarean delivery in induced labors at term. Material & Methods: A case–control study was conducted in the Department of Obstetrics and Gynaecology over a period of one year A total of 350 women were studied, out of which 150 women delivered by emergency caesarean section and 200 women delivered vaginally. The cohort included all women with a live singleton fetus in the cephalic position and induced at term (C37 weeks). Cases were women who delivered by emergency caesarean section and controls were women with a vaginal delivery among the cohort. Informed consent was taken for all patients. Results: Using logistic regression analysis, all comparisons are estimated and expressed as OR with 95 % CI. Factors associated with cesarean delivery were analysed. Our study had shown that maternal age C35 years, BMI C30 kg/m2, nulliparity, preinduction Bishops score less than 5, gestational diabetes mellitus, and intrauterine growth restriction are significantly associated with caesarean delivery. The presence of epidural analgesia, gestational hypertension, postterm pregnancy, and premature rupture of membranes was not associated with significant increase in cesarean delivery if labor was induced at term. Conclusion: A vaginal delivery is the best choice for both mother and child. However, it is better to take those patients with multiple risk factors for elective cesarean section rather than inducing them at term. Women with multiple risk factors for caesarean can be taken up for elective cesarean section rather than inducing them at term.

131. To Evaluate the Effectiveness of Percutaneous Coronary Intervention (PCI) and to Forecast the Prognosis in Patients with Acute Myocardial Infarction (AMI) by Learning the Role of Blood Pressure (BP) and Serum Electrolytes
Gaurav Sinha, Sandeep Kumar, Indira Jha, Pandurang M. Narhare
Abstract
Aim: This study aims to find out the role of BP and serum electrolytes in patients of Acute Myocardial Infarction (AMI) and to assess the efficacy of percutaneous coronary intervention (PCI) as well as to predict the prognosis in AMI patients. Methods: A total of 100 patients of AMI were included in this study. We included those patients who visited to cardiology department and medicine ward for treatment. All patients were male. This study was a longitudinal, interventional study. Results: Half of individuals have normal systolic blood pressure, 40% have high, and 10% have low. Every patient has normal diastolic blood pressure. EF improved in 80% of normal, 80% of low, and 75% of high SBP patients after percutaneous coronary intervention (PCI). Thus, abnormal SBP patients improved less in EF. Despite 12% tachycardia and 8% bradycardia, 80% had normal pulse rates. In 58% of patients, serum calcium levels are normal, 40% have hypocalcemia, and 2% have hypercalcemia. Serum sodium was normal in 84% of patients and potassium in 68%. Conclusion: Elevated blood sodium and potassium levels are correlated with unfavourable prognosis, but younger age and normal BMI are linked with enhanced prognosis in AMI patients after PCI.

132. Assessment with Pap Smear and Cervical Biopsy in a Woman with Unhealthy Cervix Attending Tertiary Care Hospital
Sweta Kumari, Simpi Shilpa, Seema Singh
Abstract
Aim:  The aim of the present study was to assess the Pap Smear and Cervical Biopsy in a woman with unhealthy cervix attending tertiary care centre. Material & Methods: This study included 100 married women aged 20-65 years attending Department of Obstetrics And Gynaecology, over the duration of 18 months. Results: In this study, 43% women belong to age group 31-40 years. 30% women belong to 41-50 years of age. 15% women belong to 20-30 years of age, 12% women belong to 51-60 years of age and 2.7% women are more than 60 years of age. In this study 39% women were para 3, 31% women were para 4, 15% women were para 5, 6% women were para 2, 4% women were para 6 and 2% women were primipara. In this study population, white discharge was the most common chief complaint (48%), followed by lower abdominal pain in 25%, low back ache in 11%, postcoital bleeding in 10% and postmenopausal bleeding seen in 6%. In this study, association of Pap smear with histopathology was found to be statistically significant (p value <0.001). Conclusion:  PAP smear can be used as screening test for detecting premalignant lesions of cervix. Cervix biopsy has got better specificity than Pap smear, so all symptomatic women should be subjected to cervix biopsy to detect carcinoma at early stage.

133. A Retrospective Assessment of Traumatic Posterior Fossa Extradural Hematoma: An Observationla Study
Gaurav Srivastava
Abstract
Aim: The aim of the present study was to assess the traumatic posterior fossa extradural hematoma in UP region. Methods: The present study was conducted at Department of Neurosurgery, Kashi Neuron Multispeciality Hospital ,Ramnagar ,Varanasi UP, India  for one year . We found a total of 596 cases of EDHs, of which only 50 (8.38%) were located in the posterior fossa. The records were retrospectively analyzed for clinical presentation, admission Glasgow Coma Scale (GCS), mode of injury, radiological findings, any other associated intracranial traumatic lesion, type of intervention and postoperative outcome. Results: The mean age of patients was 29.7 years (4–43 years). 20 (40%) of them were below 18 years. 14 (28%) of them were females. Most common mode of injury was road traffic accident (n = 35, 70%), rest were either fall from height (n =12, 24%) or assault (n = 3, 6%). Post-resuscitation admission GCS varied from GCS 15 in 31 (62%) cases, GCS 13–14 in 9 (18%), GCS 9–12 in 7 (14%), and GCS 3–8 in 3 (6%) cases. Two patients died. Mean follow-up duration was 68.2 months. At 6 months follow-up, 44 (88%) patients had a good recovery (GOS 5) and at 12 months follow-up, 45 (90%) patients had GOS 5. In addition, patients with isolated PFEDH (n = 43) had a much better outcome. 30 out of 43 were discharged with GCS 15. At 6 months and 12 months follow-up, all 43 had good recovery (GOS 5). Conclusion: PFEDH are rare. They may be rapidly fatal due to the expansion of hematoma and compromise of the posterior cranial fossa space leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early diagnosis and emergent evacuation lead to good outcome. They are usually associated with occipital bone fractures and may also have associated injuries in form of supratentorial or infratentorial subdural hematoma, intraparenchymal hematoma or intraventricular hemorrhage.

134. Effect of Intravenous Tranexamic Acid on Blood Loss during and After Caeserean Delivery: A Prospective Randomised Study
Niharika, P. Usha Rani, Radhika Yadati
Abstract
Aim: The aim of the present study was to document the efficacy of intravenous (IV) tranexamic acid in reducing blood loss during and after caesarean section (CS). Material & Methods: The present study was conducted in the Department of Obstetrics and Gynaecology for one year. 100 women were included in the study. Patients were divided into two groups: Control group A: (n=50) IV placebo i.e.10 ml of Ringer Lactate and Study Group (B):(n=50)  IV intravenous tranexamic acid 1g (10 ml). Results: The mean age, weight and height of both the groups were not statistical significant. Majority of the respondents were parity 0, 33 (66%), followed by gravida 1, 28 (56%), and gravida 2, 20 (40%). The most common indication for LSCS was CPD 27 (27%), followed   by   Post-dated pregnancy with high floating head 25 (25%), Previous one/two caesarean section 20 (20%). The mean total blood loss was 499.75 ± 111.20 ml and 690.85 ± 198.41 ml in TXA and the control group respectively. The result was found to be significant (p=0.001). Tranexamic acid significantly reduces bleeding from the time of delivery of placenta to 2 hours postpartum. According to post-operative vitals, the mean pulse rate showed statistical significant difference. APGAR scores did not show any significant difference in both the groups. The most common side effect was nausea followed by vomiting in both the groups which was non-significant. Conclusion: Pre-operative IV tranexamic acid significantly reduced blood loss during & after elective CS without any significant adverse effects.

135. Evaluating the Risks and Potential Outcomes of Functional Endoscopic Surgery: Observational Research
Priyanshu Shekhar, Sumit, Shudhanshu Shekhar Prasad, Satyendra Sharma
Abstract
Aim: The current study set out to evaluate tertiary hospital-acquired sequelae after functional endoscopic surgery (FESS). Methods: The Present investigation was single-center, prospective, observational study, done in Department of ENT. The study lasted for two years. The current study included 200 patients who met the study criteria during the study period. Results: The patients’ ages ranged from 19 to 30 years old, making up 46% of the total, with those between 31- and 40-years old accounting for 29%. More male patients (68%) than female patients (32%). For FESS patients, the number of procedures done all at once ranged from uncinectomy (100%), middle meatal antrostomy (100%), anterior ethmoidectomy (100%), posterior ethmoidectomy (76%), sphenoidectomy (32%), frontal recess surgery (26%), and reduction of the middle turbinate (1%). In this research, endoscopy was able to successfully handle the two significant problems that occurred, one of which was a cerebrospinal fluid leak (1%). After careful and effective management, a small number of problems such as periorbital emphysema (3%), sinus infection (1%), periorbital ecchymosis (1%), and synechiae (5%), which required treatment, were effectively addressed. Conclusion: Although FESS has a low complication rate and is often a safe surgery, it does have the hazards of any surgical intervention and serious problems may happen. It is one of the most frequently done procedures in otorhinolaryngology.

136. An Observational Study Evaluating Cadaveric Liver and its Clinical Implications: A Morphometric Study
Md. Afzal Hussain
Abstract
Aim: The aim of the present study was to assess the morphometry of liver and its clinical implications. Methods: The study consisted of 50 forma line fixed cadaveric liver of unknown age and sex selected from the Department of Anatomy. Morphological features of the liver were studied and discussed under the following parameters. All the measurements are taken in inches using a measuring tape. Vertical and transverse diameters of Right lobe, left lobe, caudate lobe, quadrate lobe of the Liver was taken. Fissure, accessory lobe and external surface of the liver were observed in detail and variations were noted. Results: The mean measurement across the vertical dimension was 6.36 inch and transverse dimension was 8.2 inch. Fissures were seen in the caudate, quadrate, right and left lobe of the liver. Caudate lobe, Quadrate lobe, right lobe, left. Conclusion: The wide range of occurrence of morphological variations will contribute to the evolving document of liver morphology and ultimately will be helpful for anatomists. Additionally, this may aid interventions and surgeons to plan hepatobiliary surgeries, liver transplantation, and maximize targeted approach and curtail confusion, thereby mitigating morbidity.

137. A Comparative Evaluation of Venous Blood Gas between Arterial and Venous Blood Samples in Patients of Acute Breathlessness
Prashant Kumar Gupta, Uma Shankar Kumar, Parmod Kumar Sinha
Abstract
Aim: The aim of the present study was to compare venous blood gas assessments for variables such as pH, pCO2, bicarbonate and base excess between arterial and venous blood samples. Methods: This Prospective study was conducted at ANMMCH Gaya by Department of Emergency Medicine for the period of 2 years. 70 patients were included in the study. Results: It was observed that the mean respiratory rate of the study conducted came out to be 32.2 breaths per minute. The mean SpO2 of the patients observed to be 88.4 at room air. The mean pH in arterial blood came out to be 7.43. The mean pH of venous sample observed to be 7.35 with p value of .028. The mean pCO2 values of arterial blood observed to be 33.07. The mean pCO2 value of the venous blood samples was observed to be 39.51. The mean arterial HCO3 level in the sample came out to be 17.63. The mean venous HCO3 value in the sample came out to be 20.07. The mean PO2 level of arterial blood came out to be 92.76. The mean PO2 level of venous blood came out to be 65.46. Conclusion: The blood gas values for pH and HCO3 showed excellent agreement and correlation and can be considered clinically interchangeable with arterial values. On venous pCO2 we found differing results and therefore suggest the possible implementation of arterialization of venous blood gas which will make all these values even more accurate and will allow the use of venous pCO2 in the clinical setting.

138. A Three-Year Retrospective Study Assessment of the Cytological Grading of Lymphocytic Thyroiditis and its Correlation with Thyroid Hormonal Status
Vandana, Chandan Kumar, Swarnim Kumari, C.P. Jaiswal
Abstract
Aim:  The aim of the present study was to evaluate thyroid fine needle aspirates for cytological features of lymphocytic thyroiditis; to grade lymphocytic thyroiditis cases based on predefined cytological criteria and to correlate cytological grades with thyroid hormonal status. Material & Methods:  A three-year retrospective study conducted in the Department of Pathology, Thyroid fine needle aspirates from 100 patients presenting with thyroid swelling during this period were retrieved from the archives of our department. May Grunwald-Giemsa (MGG) and Papanicolaou (PAP) stained smears from these patients were examined under light microscopy. Results: In the study, 88 (88%) were female participants and 12 (12%) male participants. The age categories of 21–30 years (25%), 41–50 years (20%), and 31–40 years (30%) had the highest proportion of patients, respectively. With ages ranging from 7 to 80, the mean age was 35.99 years. Grading revealed that grade II thyroiditis accounted for the majority of cases (65%), followed by grade I (30%), and grade III (5%). Thyroid hormonal profiles were obtained for 48 out of 100 patients. The majority of patients (25; 52.08%) had hypothyroidism, which was followed by euthyroidism (13; 27.08%) and hyperthyroidism (10; 20.84%). The majority of individuals with thyroiditis of grade II also had hypothyroidism. Grade II thyroiditis, grade I thyroiditis, and no cases of grade III thyroiditis were responsible for the majority of the euthyroid cases. There was no patient with grade III thyroiditis who had a normal hormonal status and a thyroid profile was available. The majority of the cases of lymphocytic thyroiditis associated with hyperthyroidism (Hashitoxicosis) had grade II thyroiditis (4 cases), followed by grade I thyroiditis (6 cases), with only 1 case having grade III thyroiditis. Conclusion: The gold standard test for diagnosing lymphocytic thyroiditis is still the FNAC. However, in our investigation, there is no statistically significant link between the cytological grades and thyroid hormonal condition.

139. An Assessment of Three Different Plane Block Techniques in the Management of Post-Operative Pain Relief after Thoracotomy: A Comparative Study
Rajeev Krishan, Shruti Kirti, Krishna Kumar
Abstract
Aim: The aim of the present study was to compare the ultrasound guided thoracic para vertebral block, serratus anterior plane block and thoracic erector spinae plane block for post-operative pain relief after thoracotomy. Methods: The present study was performed at department of Anesthesia for the period of one year. During the study period, 150 patients were assessed for eligibility. The study enrolled patients who were 18 to 80 years old, American Society of Anesthesiologists class I and II and scheduled for non-emergent lobectomy under VATS. Results: The average age of the study population was 57.33 ± 11.53 years and 60.66% of study participants were female. There was no significant difference among the 3 groups in demography and intra- operative characteristics, including age, gender, weight, BMI, American Society of Anesthesiologists classification, smoking history, surgery duration and chest tube placed (P > 0.05). The sufentanil consumption and supplementary analgesic requirements were comparable in the 3 groups. A total of 14 patients (7%) required supplementary analgesic, and 17 patients (8.5%) experienced PONV within 48 h. There was no difference in the incidence of PONV and supplementary analgesic requirements within 48 h postoperatively. The length of stay in PACU, ambulation time and postoperative days in hospital was similar in the 3 groups. Two patients from Group B developed hematoma at the site of puncture, but there was no difference in the incidence of hematoma among the three groups and no other side effects was observed during the study period. Conclusion: In our study, we concluded that the SAPB, applied safely and rapidly as a part of multimodal analgesia in patients who will undergo VATS, is not inferior to the TPVB and can be an alternative to it.

140. Clinical Profile and Outcome Assessment of Management of Perforation Peritonitis
Pravin Kumar Agrawal, A .K. Jha
Abstract
Aim: The aim of the present study was to assess the clinical profile, management of   perforation peritonitis and its surgical outcomes. Methods: The study was carried out in the setting of tertiary care hospital in the Department of General Surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. All patients admitted with   perforation peritonitis were included in the study. A total of 500 patients with perforative peritonitis were included in the study admitted from February 2017 to January 2019. Results: The underlying aetiology of the perforation peritonitis among the patients was evaluated and it was observed that acid peptic disease was the common cause accounting for 35% of the patients, followed by typhoid (16%), trauma (13%), obstruction (11%) and tuberculosis (6%). In about 15% of the cases the etiology was not defined. The commonest site of perforation was found to be duodenum accounting for 36% of the cases followed by appendicular (20%), Ileum (16%), Jejunal (13%), large bowel (11%) and gastric (4%). All the patients were followed up for a period of 6 months and the surgical outcome of the patients was assessed where in the mortality rate among the patients was at 10% and the rate of complication was at 48% and remaining 42% of the patients recovered completely. Among the complications wound infection (32%) and respiratory complication (23%) were common, followed by abdominal collection (10%), Obstruction (14%), dislectrolymia (8%), burst abdomen (5%) and anastomotic leak (5%). Conclusion: GI perforations are one of the most common surgical emergencies. Duodenal perforations are most common. Ileal perforations have the highest morbidity and mortality. Mortality depends on the age and general condition of the patient, associated pre-operative co- morbidities, site of perforation and etiology.

141. Hospital Based Prospective Observational Assessment of the Role of Intra-Abdominal Pressure Monitoring in the Management of Patients with Blunt Injury Abdomen
Ajeet Kumar, Bhartendu Kumar, Mahima Srivastava
Abstract
Aim: The aim of the present study was to assess the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen. Methods: The Hospital based prospective observational study was conducted in the Department of General Surgery in SKMCH, MUZAFFARPUR, Bihar, India with blunt injury abdomen, over a period of 12 months and 50 patients were included in the study. Results: Out of 50 patients, 29 were treated conservatively, 21 required surgical intervention. 8 patients required ventilator support in our study. 2 patients expired. Out of 50 patients, 42 were male (84%), 8 were female (16%). Overall hospital stay (considering both conservatively managed and surgically intervened patients) increased significantly as IAP increases at 0, 3, 6, 24, 48, 72, 96 hours, except at 12 hours. Hospital stay decreased as IAP increases in surgically intervened group because IAP returned to normal after surgical decompression, but this finding was statistically significant only at 72 hours (p value was 0.0001) in our study. Conclusion: There was no significant correlation regarding hospital stay and increased IAP in our study as hospital stay increased both in conservatively managed and surgically intervened patients except at 72 hours in surgically intervened group. Before development of IAH and ACS, the potential candidates should be offered surgical decompression at proper time.

142. Prospective Observational Assessment of the Efficacy of Role of C-Reactive Protein and Gastric Aspirate Polymorphs in Early Onset Neonatal Sepsis
Chandan Kumar, Ruby Kumari, Khalil Ahmad, Ankur Priyadarshi, Kishore Kumar Sinha
Abstract
Aim: The aim of the present study was to evaluate the role of C-reactive protein and gastric aspirate polymorphs in early onset neonatal sepsis. Methods: This was a prospective observational study conducted in the Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India.  study period from February 2022 to January 2023. 70 babies who had clinical symptoms and signs of suspected neonatal sepsis/high risk factors for developing the sepsis, were included in the study. Results: Only 15 patients had TLC more than 25000 /dl. Maximum TLC value in the study was 42500 /dl. 55 patients showed positive CRP values. 45 patients had polymorphs in the GA more than 5 per high power field. By combination of any CRP and TLC specificity increased to 81%. While sensitivity approached to 100% when TLC with GA polymorphs and CRP with GA polymorphs were combined with significant p values of 0.001 and 0.015 respectively. When all the three parameters were combined together, both the sensitivity and specificity increased to 100% and 92.68% respectively with p values of 0.001. Conclusion: CRP showed high sensitivity while GA polymorphs showed high specificity. GA cytology as a screening tool for neonatal sepsis with intermediate sensitivity, specificity, positive predictive value and negative predictive values serves as good tool, added to a detailed antenatal history and clinical examination of the neonate.

143. Evaluating the Role of Hysteroscopy in Abnormal Uterine Bleeding and its Histopathological Association: A Retrospective Study
Sweety Rani, Abha Rani Sinha, Renu Bharati
Abstract
Aim: The aim of the present study was to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding. Material & Methods: This retrospective study was conducted on 200 patients attended in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India  and to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding. Results: Majority of the patients belonged to 31-40 years age group. Of the 200 patients, majority, 86 had symptoms for more than 1 year, 64 patients had symptoms for 6 months to 1 year and 50 patients had symptoms for less than 6 months. Majority of the patients presented with menorrhagia. The second commonest was post-menopausal bleeding in 32 cases. There were 30 cases with polymenorrhagia and 26 patients with Hypomenorrhea. Out of 200 patients, 54 had proliferative followed by 44 secretary. Histopathology findings corroborate the hysteroscopic ally detected cases of hyperplasia, atrophic endometrium and endometritis. Both hysteroscopy and curettage were accurate when an abnormality was diagnosed, giving a specificity of 97.3% and 97.3% respectively and positive predictive value of 94.3% and 95.5% respectively. The ability to diagnose a lesion was more with hysteroscopy i.e. sensitivity in comparison to curettage, (91.9% versus 78.2%) while a negative diagnosis was less wrongly made with hysteroscopy in comparison to diagnostic curettage. Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment.

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