International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

NMC Approved

Peer Review Journal

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1. Study Comparing the Efficacy of Nebulized and Intravenous Administration of 2% Lidocaine in Reducing the Sympathetic Response to Laryngoscopy
Niraj Kumar, Shikha Singh, Rishabh Ravi
Abstract
Aim: The aim of the present study was to compare the attenuation of sympathetic response to laryngoscopy and endotracheal intubation while using lidocaine in its aerosolized form and intra-venous form and establish a safer and better route of administration of the drug. Methods: The present study was conducted at Department of Anesthesiology for one year. we included 120 ASA I & II patients of both the genders who were posted for elective surgeries under general anaesthesia. Patients in all the three groups were equally distributed in variables of age (20-65 years), ASA grades and obvious difficult airway. Results: In all the 3 groups post endotracheal intubation demonstrated an increase in heart rate, systolic BP, Diastolic BP and mean arterial BP. However, the minimum change in hemodynamic and thus most effective way of attenuating the sympathetic response to laryngoscopy and intubation was seen in the subgroup where lidocaine was administered intravenously. Conclusion: In the present study we concluded that the use of lignocaine when used in combination with opioid for laryngoscopy and endotracheal intubations reduces the increase in heart rate and blood Pressure. However, the attenuation of exaggerated sympathetic response was much more in the subset of patients where intravenous lidocaine was used.

2. A Hospital Based Study to Assess the Role of Rigid Nasal Endoscope in the Diagnosis and Treatment of Epistaxis
Abhishek Kumar, Tripti kumari, Salil Kumar Sharma
Abstract
Aim:  The aim of the present study was to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding Material & Methods: 100 patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. Results: Majority of the patients were more than 51 years of age group. Gender distribution of patients as per the result revealed that 75% patients are males and 25% are females, the gender distribution is statistically significant in males (p<0.05). In our study we have 35 patients with anterior epistaxis, which accounts for 35%, 15 patients with posterior epistaxis, which accounts for 15%, and 50 patients with anterior and posterior epistaxis which accounts for 50%. After careful examination of patients the different endoscopic diagnosis was detected in the study showed the bleeding point in the crevices of the lateral nasal wall (BPCLW), posterior deviation of septum with spur (PDWS), enlarged congested significant adenoid (ECSA) and septal spur with ulcer (SSWU) were statistically significant (p<0.05) and strongly associated with age and sex distribution of patients. Endoscopic management of aspects of epistaxis, as per the descriptive statistical analysis endoscopic selective nasal packing (ESNP), endoscopic nasal cautery or bipolar diathermy (ENCD), endoscopic polypectomy (EP), endoscopic mass excision (EME) were highly associated with age and sex matched frequency of the patient and showed statistically significant with different management aspects (p<0.05). Conclusion: Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.

3. A Hospital-Based Study to Assess the Occurrence, Distribution and Histo-Morphological Aspect of Various Salivary Gland Lesions
Manish Kumar Jha, Madhu Bharti, Md. Imteyaz Alam, Poonam Kumari
Abstract
Aim: The objective of this study was to assess the occurrence, distribution and histo-morphological aspect of various salivary gland lesions. Material & Methods: This was an observational, single institutional study and materials required for the study were collected from the Department of Pathology, The surgically resected salivary gland specimens between the period of one year. The study procedure was in accordance with the principles of the Declaration of Helsinki. A total of 50 specimens of salivary gland lesions were analyzed, this study included both the non-neoplastic and neoplastic lesions of the salivary gland. Results: According to that the commonest tumor was pleomorphic adenoma which accounted for 66% (33) of all cases followed by mucoepidermoid carcinoma, accounting for 14% (7) of all cases. And the least common tumors were cavernous haemangioma (2%), adeno cystic carcinoma (4%) and SCC (2%). In present study the distribution of all cases according to age shows that 40 – 49 years of age was the commonest age group with 30% (15) of total cases were from this group followed by 30 – 39 years of age [28% (14)]. The Warthin tumors were commonly seen in 60 – 69 years of age. Also the frequency of malignant tumors was high after 40 years of age. Gender wise incidence of salivary gland tumors in males was 48% and in female was 52%. Among benign tumours, female preponderance was seen in pleomorphic adenoma. Among malignant tumours mucoepidermoid carcinoma showed a female preponderance. Parotid was commonest salivary gland involved with 74% of all tumors, followed by submandibular with 24% and minor salivary glands with 1 (2%) of salivary gland tumors. Conclusion: This study observed that parotid is most common site for the SGT. And pleomorphic adenoma and the Warthin tumors are the common benign tumors involve parotid gland the most. Among malignant tumors mucoepidermoid carcinoma are the commonest with female preponderance. While other carcinoma like adenoid cystic carcinoma and SCC are also common.

4. An Assessment of the Efficacy of Transdermal Diclofenac Sodium Patch versus Transdermal Ketoprofen Patch for Relief of Acute Post-Operative Pain in Laparoscopic Abdominal Surgery: A Randomized Clinical Study
Krishna Kumar
Abstract
Aim: The present study was undertaken in patients undergoing elective laparoscopic surgeries under general anaesthesia with an objective to evaluate the efficiency of transdermal diclofenac patch with transdermal ketoprofen patch. Methods: The present study was undertaken at Department of Anesthesiology for one year. Total 100 patients were included in the study after explaining purpose and procedure of study and written informed consent of the patients. All patients were divided equally in two groups, 50 patients in each group. Results: There was no statistically significant difference between the two groups of patients in terms of age, weight and male/female ratio (P> 0.05). The difference of mean Pulse rate per minute status and systolic and diastolic blood pressure (mmHg) of patients in Group D and Group K was statistically insignificant (p>0.05). The difference was statistically significant at 2 hr, 4 hr, 6 hr, 8 hr, and 12 hr post-operatively. The complications occurrence in both group were insignificant. Conclusion: We concluded that Transdermal Ketoprofen patch is effective and safe pain relievers in management of acute postoperative pain with early onset of pain relief, longer duration of analgesia, better in reducing the severity of pain in post-operative period, lesser adverse effects in laparoscopic abdominal surgeries under general anaesthesia.

5. A Randomized Clinical Study to Assess the Effectiveness of Lumbar Cerebrospinal Fluid Drainage (LCSFD) for Prevention of Cerebral Vasospasm and its Sequelae
Gaurav Batra, Sachin Kumar Singh, Girish K.M
Abstract
Aim: The aim of the present study was to evaluate the effectiveness of lumbar cerebrospinal fluid drainage (LCSFD) for prevention of cerebral vasospasm and its sequelae. Methods: This was a prospective, randomized control trial conducted at Department of Neurosurgery for 12 months . Patients of aneurysmal SAH (Hunt and Hess Grade II–IV) and 50 patients met the inclusion criteria and were randomly allocated to one of the two groups – thirty patients in Group I and thirty patients in Group II. Results: There were 25 patients in each group. Both groups were matched with respect to age, sex, GCS on admission, and SAH grade at admission. Clinical evidence of vasospasm and rising TCD velocities suggestive of vasospasm developed in 28% (7/25) patients in LCSFD group compared to 64% (16/25) patients in non-LCSFD group and this difference was found statistically significant (P = 0.01). Although more number of patients in Group II developed hemiparesis was more due to vasospasm compared to Group I, this difference was not found to be statistically significant. The patient outcome as quantified by GOS at the time of discharge was better in LCSFD group (median GOS = 4) as compared to non-LCSFD group (median GOS = 3) and this difference was found to be statistically significant (P = 0.01). Median GOS at 1- and 3-month follow-up was 5 in Group I compared to 4 in Group II and this difference was statistically significant (P = 0.04). Conclusion: This study has demonstrated the efficacy of LCSFD to significantly reduce clinical vasospasm and vasospasm‑related cerebral infarction in patients with aneurysmal SAH, thereby contributing to a better outcome. Lumbar CSF drainage is believed to decrease cerebral vasospasm by promoting circulation of CSF and clearance of blood from the subarachnoid spaces.

6. A Hospital Based Diagnostic Value of MCA/UA Pulsatility Index Ratio for the Prediction of Adverse Perinatal Outcome in Patients with High-Risk Pregnancy: An Observational Study
Swati Sinha, Hit Narayan Prasad
Abstract
Aim: The aim of the present study was to investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in patients with high-risk pregnancy. Methods: The study group consisted of 200 women admitted to Department of Obstetrics & Gynaecology. All patients had undergone serial color Doppler ultrasound. The Umbilical Artery color Doppler waveforms were obtained from a free-floating portion of the umbilical cord during minimal fetal activity and the absence of fetal breathing. All measurements were performed in the semi-recumbent positions with the head and chest slightly elevated. Results: 55% had vaginal delivery and remaining 45% had Caesarean delivery in the present study. 32% had pregnancy induced hypertension followed by PIH+IUGR (25%). Our results suggested that the MCA/UA PI Doppler ratio of less than 1 was a good predictive tool for neonatal outcome in preeclamptic and hypertensive pregnant women and could be used to identify fetuses at risk of morbidity and mortality. Fetuses with abnormal Doppler MCA/UA PI ratio in our study had a significantly lower birth weight, lower gestational age at delivery, l significantly higher incidence of perinatal deaths, higher incidence of admission to NICU and longer duration of treatment there, lower Apgar score at 5-minute. Conclusion: Doppler study is a noninvasive method for assessing the hemodynamic function of the fetus and mother. There is a direct correlation between high-risk pregnancy with abnormal Doppler findings in the umbilical, middle cerebral artery, and CPR compared to non-high-risk pregnancies.

7. A Hospital Based Comparative Analytical Study Evaluating the Thyroid Function Tests in Women with and Without Preeclampsia
Rakesh Kumar Ranjan, Amarendra Kumar Amar, Shabana
Abstract
Aim: The aim of the present study was to estimate thyroid function tests i.e. TSH, fT3 and fT4 levels in women with mild Preeclampsia and severe Preeclampsia. Methods: It was a cross sectional study carried out at Department of Biochemistry, Total 150 pregnant women between 18 to 35 years visiting the gynecology and obstetrics OPD were included under study. Results: The mean values of maternal age in all three are not statistically significant. Mean values Group I: 24.76 + 2.58, Group II: 23.27 + 2.88, Group III: 22.44+ 2.38). Mean gestational age at the time of serum sampling in normal pregnant women was 35.15 + 1.45 and it decreases in mild (34.36 + 2.58) and severe PE (32.12+ 1.69) having highly significant P value. While SBP and DBP increases with severity of PE as compared to normal pregnant women having highly significant P value (<0.0001). Urine protein was nil in group I and it increases with severity of PE. Proteinuria and blood pressure are used as parameters for severity of PE. The mean value of birth weight is normal in healthy pregnant women 2.76 + 0.14 but it decreases in mild PE (2.55 + 0.05) to more decrease in severe PE (2.36 + 0.04) having highly significant p value <0.0001. In our study, the mean level of TSH within normal level in normal pregnant women was 2.36 + 0.52 while in mild PE was 3.97+ 0.63 and in severe PE was 5.75 + 1.00with highly significant P value<0.0001. Conclusion: Evaluating thyroid screening during pregnancy might be of help in preventing the occurrence of low birth weight and instituting timely intervention and appropriate measures in terms of possible thyroid hormone administration in preterm infants in future.

8. A Hospital-Based Retrospective Observational Study Assessing Patterns of Dyslipidemia and Management Strategy in Newly Diagnosed Patients of Type 2 Diabetes Mellitus
Rajeev Kumar, Kumar Gaurav
Abstract
Aim: The aim of the present study was to evaluate the patterns of dyslipidaemia in newly diagnosed type 2 diabetes mellitus (T2DM) patients and to understand the initial management options utilised by the treating physician. Material & Methods: This retrospective observational study observed patterns of dyslipidemia and management strategy in newly diagnosed Patients of type 2 diabetes mellitus-2 (REMAP-2) study was conducted at department of General Medicine  in between the duration of 1 year. Clinicians at the respective center captured the data in REMAP-2 study data capture form. Dyslipidemia was considered as: total cholesterol >200 mg/dl, low density lipoprotein cholesterol (LDL-C) >100 mg/dl, high density lipoprotein cholesterol (HDL-C) <40 mg/dl, or triglyceride >150 mg/dl. Results: The patients had a mean age of 54.6±10.32 years, and majority of the patients were males (65%) while females constituted 35% of the study population. More than half of the patients were either overweight (40%, n=4000) or obese (18.6%, n=1860). The triglyceride levels were found to be high (>150 mg/dl) in 85% (n=8190) of patients. Approximately one fourth (26.90%) of newly diagnosed T2DM patients were found to be smokers in this study. Around 52.30 percentages patients had positive family history of diabetes. Most of the patients were not very physically active or lightly active. In the context of dietary pattern, majority (60%) of the patients were non- vegetarian. Hypertension (71.10%) was the most common comorbidity followed by coronary artery disease (23.50%) in patients of newly diagnosed T2DM with dyslipidemia. Statin therapy was used in 94.80% (n=9480) patients, of which atorvastatin was the most (77.74%) preferred statin therapy. Conclusion: This study on newly diagnosed T2DM patients with dyslipidemia found that majority of the patients had hypertriglyceridemia, family history of diabetes and was physically inactive. More than half of T2DM patients were either overweight or obese. More than 2/3rd of the patients had mixed dyslipidemia. Statins were prescribed to the majority of these patients and atorvastatin was the most commonly prescribed statin in Indian T2DM. patients with dyslipidemia.

9. A Retrospective Assessment of the Incidence of Maternal Complications, Perinatal Mortality and Morbidity in Postdated Pregnancies: An Observational Study
Rani Dipa, Juhi, K. Manju
Abstract
Aim: The aim of the present study was to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology for 12 months. Total 200 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with Gestational age 37-40 weeks and Study group with Gestational age >40 weeks. Results: Majority of the patients belonged to 25-30 years age group. Maximum number of patients belonged to the age group of 25-30 years both in cases (50%) and control group (50%). The maximum number of patients in the study group (82%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 65% of the patients in study group were primigravida and in the control group and 55% were primigravida. The percentage of LSCS was 30% which was higher than in the control group where it was 15%. Incidence of instrumental delivery was also higher in the study group as compared to control group (10% as compared to 5%). Among the indications for LSCS, the most common indication among the study group was acute foetal distress which includes meconium-stained liquor (10%) followed by cephalopelvic disproportion (9%). In the control group, most common indication was non progress of labour (4%) followed by acute foetal distress (01%) and non-reactive CTG (1%). Conclusion: Postdated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in postdated patients. According to our study, postdated pregnancies are related with higher rate of LSCS and instrumental deliveries.

10. A Hospital Based Observational Assessment of Thyroid Swelling and its Management: Clinicopathological Study
Tripti Kumari, Abhishek Kumar, Salil Kumar Sharmav
Abstract
Aim:  The aim of the present study was to assess the relative occurrence of various pathological conditions presenting as thyroid swelling and the clinicopathological examination of swelling. Material & methods: A prospective hospital-based study carried out on 1200 cases of thyroid swelling attending the Department of ENT, Bihar, India having adequate diagnostic and treatment facilities during the period of one year Results: In this study of 200 subjects, maximum patients were in the age group of 31 to 40 years (32%), followed by 41 to 50 years (25%). The youngest patient in our study was 12 years while oldest was 72 years. Mean age of presentation was 40.82 years. 80 (80%) subjects were females while 20 (20%) subjects were male. All cases presented with swelling in front of neck (100%). Associated complaints were 6 (6%) subjects of bulky thyroid swelling complained of difficulty in swallowing, 6 (3%) subjects complained pain in neck, 2 (1%) subject presented with cervical lymphadenopathy and 2 (1%) subjects with hoarseness of voice. Most of the thyroid swellings were firm in consistency 92 (46%) followed by nodular 40 (20%), cystic consistency in 24 (12%) cases and soft consistency in 20 (10%) cases. Hard swellings accounted for 24 (12%) cases, most of which turned out to be malignant. On USG, Colloid nodule was found in 31 (31%) cases, followed by Multinodular goitre which was 27 (27%) cases, neoplastic etiology found in 23 (23%) cases, solitary thyroid nodule found in 12 (12%) cases and colloid cyst in 07 (7%) cases. FNAC findings were colloid goitre (61%), nodular goitre (19%), follicular neoplasm (10%), papillary carcinoma (9%) and medullary carcinoma (01%). Conclusion: FNAC is an easy, rapid, reliable, cost-effective, minimally invasive and readily repeatable technique for diagnosis of thyroid swellings. The common false negative diagnosis is seen in follicular pattern cases, cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma.

11. Assessment of the Treatment of Acute Fracture Shaft Humerus: A Comparative Study
Rajdeepsinh Chauhan, Rohan Parwani, Divyesh Jetpariya, Poorv Patel
Abstract
Aim: The aim of the present study was to assess the management with interlocked nail in treatment of acute fracture shaft humerus and to compare its effectiveness with well-established method of plate fixation. Methods: The present study of management of acute humeral shaft fractures by antegrade interlocking nail fixation and dynamic compression plating was undertaken at Department of Orthopedics for the period of 3 years. The average follow-up period was one year (range 10–24 months). 50 patients were included in the study. Results: There was preponderance of male over female (35 Vs. 15) with majority population in 31-40 years age group. The youngest patient was of 24 years and oldest was of 68 years male. Mean age was 36.64 years. In our study, majority of cases were of road traffic accident (84%) followed by history of fall from height (12%) and only two cases of assault. Middle third shaft fractures were more common (52%) followed by lower and upper third (26% and 22%) respectively. Transverse fractures were maximum in number (46%) followed by oblique (30%). There were 6 spiral and 6 comminuted fractures. There were 38 (76%) close fractures and 12 (24%) open fractures.  There were 15 cases (30%) of preoperative radial nerve palsy. Out of 15 cases, 14 had recovered completely. There was no iatrogenic nerve palsy seen in our study. Out of 10 cases explored nerve was found to be intact in 9 cases and contused in one case. Most of cases (9) of radial nerve palsy were associated with fracture of middle third shaft humerus. Majority of cases of fracture shaft humerus were associated with head injury followed by lower extremity fracture and ipsilateral forearm bone fracture. Conclusion: For patients requiring surgical treatment of humeral shaft fractures, both dynamic compression plating and interlock nailing provide predictable methods for achieving fracture stabilization and ultimate healing. Plating requires extensive dissection, more blood loss and duration of surgery as compared to nailing. Antegrade interlock nailing performed properly is safe, effective and quick method.

12. Developing Biomarker for Neuronal-Instability in Epileptic Patients
Prashant Kumar Thakur
Abstract
Aim: The aim of present study was to design, develop and substantiate a modern contemporary biomarker for neuronal instability in epileptic (epilepsy) subjects (patients). Methods: The present study was conducted in the Department of Neurology. The initial study was done on 100 subjects through the application of neuronal-unpredictability and/or variability of the marked epileptic seizure onset zone (e-So Z) as a metric to envisage and foresee the epileptic operational (surgical) outcome. Results: We sought to test these theories by comparing high-frequency oscillation rates and networks in surgical responders and non-responders, with no appreciable change in seizure frequency or severity, within a retrospective cohort of the patients implanted with stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye movement sleep and semi-automatically detected and quantified high-frequency oscillations. Each electrode contact was localized in normalized coordinates. We found that the accuracy of seizure onset zone electrode contact classification using high-frequency oscillation rates was not significantly different in surgical responders and non-responders, suggesting that in non-responders the epileptogenic zone partially encompassed the seizure onset zone(s). Conclusion: In this study we attempted to develop a biomarker for the epileptic seizure onset zones. Within the eSoZ, the seizure is captured and then resection can be done accordingly. The source is highly influential on others yet extremely not affected by others. Therefore, the source and sinks within the epileptic seizure patients are the e-patients brains networks. So, think that brain is a complex yet nebulous neural-net-work, in which the nodes are connections, and the weights are the network branch edges (between node to node connection) that are dynamic. Thus, the source in the e-brain‘s neural-nets are within the sink only.

13. A Hospital-Based Study to Identify the Risk Factors for Pneumonia and Severe Pneumonia in Children: An Observational Study
Pankaj Kumar, Samir Kumar, Kumar Saurabh
Abstract
Aim: The aim of the present study was to identify the risk factors for pneumonia and severe pneumonia in children. Material & Methods: A case-control study including 200 children with ARI at Department of Pediatrics was conducted for the duration of 12 months. The source population of the study were all 2–59 months old children visiting pediatric OPD for different reasons during the study period. Results: 200 children with ARI were enrolled. According to the WHO criteria, 30 (15%) and 170 (85%) of the enrolled children had pneumonia and no pneumonia, respectively. On univariate analysis, younger age, male gender and low weight for height, were significant risk factors for pneumonia. On multivariate analysis, one-unit increase in age in months (OR = 0.97; 95% CI: 0.97-0.98) and weight for height z-score (OR = 0.76; 95% CI: 0.72-0.79) had a protective effect. Conclusion: Young age and under nutrition (low weight for height/length) in children are significant independent risk factors for pneumonia.

14. Prospective Observational Study Assessing Factors Associated with the Gall Stones at Tertiary Health Care Center
Kundan Kumar, Rahul Singh, Manish
Abstract
Aim: The aim of the present study was to assess the factors associated with the Gall stones at tertiary health care center in Bihar region. Methods: The present study was a hospital based, prospective, observational study, conducted in Department of General Surgery. Study duration was of 12 months. During study period, 200 cases were studied with confirmed diagnosis of gallstones. Results: During study period, 200 cases were studied with confirmed diagnosis of gallstones. Majority of patients were from age group 51-60 years (32%) followed by age group 41-50 years (24%). Females (63%) outnumbered males (37%). Diabetes mellitus (36%), gastro-esophageal reflux disease (34%), hypertension (26%), ischemic heart disease (20%) and renal calculus (10%) were common comorbidities noted among patients with gall stone disease. Common clinical symptoms noted among patients with gall stone disease were right hypochondrial pain (75%), nausea (50%), epigastric pain (46%), vomiting (34%) and jaundice (10%). USG findings in majority of patients multiple stones (45%), other findings were two to three stones (20%), biliary sludge (19%), single stone (12%), choledocholithiasis (3%) and carcinoma gall bladder (1%). Sedentary lifestyle (68%), female gender (63%), obesity (BMI > 25 kg/m2) (58%), age > 50 years (40%), family history (38%) was common risk factors noted in patients with gall stone disease. Less common risk factors were parity ≥ 3 (30%), h/o rapid weight loss due to fasting, illness (28%), alcohol drinking (22%), smoking (20%) and drugs like ceftriaxone, octreotide and thiazide diuretics (5%). Conclusion: Gallstone disease is one of the most common disorders among patients presenting to emergency rooms with abdominal discomfort. Sedentary lifestyle, female gender, obesity (BMI > 25 kg/m2), age > 50 years, family history was common risk factors noted in patients with gall stone disease.

15. Usefulness of CSF Lactate as a Diagnostic Marker to Differentiate Pyogenic Meningitis from Non-Pyogenic Meningitis: An Analytical Study
Nishant Kumar Singh, Arun Kumar, Pragya Shahi
Abstract
Aim: The aim of the present study was to determine the usefulness of CSF lactate as a diagnostic marker to differentiate pyogenic meningitis from non-pyogenic meningitis. Methods: A hospital based one-year prospective study was conducted in the Department of General Medicine (Emergency) for one year. Total of 50 cases of meningitis which were diagnosed upon clinical evaluation were included in the study. Results: Meningitis was common in the age group 51-60 (26%). Male patients (60%) were more than female patients (40%). Most number of cases was pyogenic meningitis (58%) while 42% were of non-pyogenic meningitis. Statistically CSF lactate levels were significantly increased in pyogenic meningitis cases when compared to CSF lactate levels in non-pyogenic meningitis patients. Fever was the most common symptom (92%) followed by vomiting (74%), headache (72%) and altered sensorium in 62% of cases. Brudzinski’s sign was observed in 70% of cases and neck stiffness in 64%, kernig’s sign in 58% and nerve palsies in 18% of cases. The mean total cell count was highest in cases of pyogenic meningitis with a mean of 842.88 and SD of 115.25 than viral and tubercular meningitis. However no statistical significance was associated with total count and types of meningitis. (‘p’ value -0.082) A clear neutrophil predominance was observed in all cases of pyogenic meningitis with a mean value of 78.22 and SD of 22.16 than among the cases of viral and tubercular meningitis. Lymphocytic predominance was observed in tubercular meningitis with mean of 75.5 and SD of 24.12 than viral and pyogenic meningitis. Both PMN and lymphocyte count had a clear statistical significance with ‘p’ value <0.001 in this study. Conclusion: This present study concluded that CSF lactate could be a reliable and valid marker in early differentiation of pyogenic from cases of non-pyogenic meningitis. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.

16. An Comparative Study to Assess the Efficacy of Undenatured Collagen Type II (NUC) and Chondroitin Sulphate (CS) in the Management of Osteoarthritis
Ashwini Gaurav, Nitin Kumar
Abstract
Aim: The aim of the present study was to assess the efficacy of nutraceuticals in the management of osteoarthritis. Methods: The present study was conducted in the Department of Orthopaedics for one year .100 patients were included in the study and the patients were thoroughly informed about the study protocol and those who were interested in participating signed informed consent. 100 patients were randomised to receive the allocated intervention, either Undenatured Collagen Type II (NUC) (N = 50) or chondroitin sulfate (CS) (N = 50). Results: The two study groups were similar in terms of demographics and clinical characteristics. There were more females in both the groups as compared to male. In the study, there were more married patients as compared to unmarried. There were no significant differences in composite WOMAC and its sub-scales between the two groups at baseline. At follow-up, scores of pain decreased significantly in both groups but patients in the NUC group had significantly lower levels of pain at follow-up as compared to patients in the CS group. Stiffness and physical function were not significantly changed, but score in the composite dimension was decreased significantly only in the NUC group. Subjects in the NUC group reported a significant decrease in pain while pain remained stable for patients in the CS group. In addition, at follow up, patients in the NUC group reported significantly lower levels of pain as compared to those in the CS group. Conclusion: The nutrition can improve the symptoms of declared OA. However, the role of nutrition in slowing down progression of the disease remains to be seen. The preliminary results of this study support the hypothesis that treatment with the newly introduced multi-compound supplement was effective, as reflected by the self-reported feeling of pain.

17. A Hospital Based Assessment of the Association of Serum Magnesium Levels, Serum Uric Acid Levels and Microalbuminuria in Patients with Type 2 DM
Shivendu, Chandan Kumar, Anjali Kumari, Anand Kishor
Abstract
Aim:  The aim of the study was to assess the incidence and association of serum magnesium levels, serum uric acid levels and microalbuminuria in patients with type 2 DM. Methods: The present study was a hospital based, cross-sectional study, conducted for a period of six months carried out on 100 patients diagnosed with type 2 diabetes mellitus and admitted to Department of General Medicine. The study was done in the department of General Medicine  .who satisfied the inclusion criteria, after taking an informed written consent from all the subjects. Results: In our study, 41% of the population belonged to 51-60 years of age group followed by 21% in 31-40 age group. There were 82 males and 18 females in the study.  Serum magnesium levels were on the lower side in 90% of the population and only 10% had levels within the normal range in our study. Serum uric acid levels were elevated in 68% of the study population whereas 32% were within the normal range or low. Out of 100, 82 were having Microalbuminuria and 14 were having macroalbuminuria. In our study, there was a strong positive correlation between, hypomagnesemia and microalbuminuria, with highly significant p value of 0.000. Out 82 study population with microalbuminuria, 75 patients had elevated serum Mg levels. In our study, there was a positive correlation between, high uric acid levels and microalbuminuria with a highly significant value of 0.000. Out of 82 study population with microalbuminuria, 56 had elevated serum uric acid levels. Conclusion: There was a significant microalbuminuria in patients with type 2 DM, with reduced serum Mg levels and elevated serum uric acid levels as compared with patients who had serum Mg and uric acid levels within the normal range.

18. Analytical Cross-Sectional Survey Assessing Stress and Psychiatric Morbidity in Pregnant and Non-Pregnant Women
Priyam Singh, Kunjal Maldebhai Odedra, Srivastava Tuhina Prakash, Vaishnavi Jhala, Sanjay Kumar
Abstract
Aim: The aim of the present study was to assess stress and psychiatric morbidity among a group of pregnant versus non-pregnant women in the reproductive age group using validated research tools. Methods: This was a comparative cross-sectional study among 500 pregnant and 200 non-pregnant at department of psychiatry using an interviewer-administered questionnaire. The study was conducted among women aged 18 to 45 years. Results: A total of 700 women of which 500 (71.43%) were pregnant and 200 (28.57%) were non-pregnant participated in the study. Their mean age was 30.1 ± 5.4 and 29.6 ± 8.4 years respectively. A significantly higher proportion 400 (80%) of the pregnant women compared with 104 (52%) were in the 25–39 age category (p < 0.001). A higher proportion of the pregnant women were married 475 (95%) compared with the non-pregnant women 120 (60%) which was statistically significant (p < 0.001). Among pregnant women, sociodemographic factors significantly associated with psychiatric morbidity. The highest proportion of psychiatric morbidity was found in women attending tertiary facilities, followed by secondary facilities and the least was in women from primary care facilities. In non-pregnant women, correlates of psychiatric morbidity were mainly family characteristics. Conclusion: The study concluded both working and non-working antenatal mothers were at more risk of developing stress. All antenatal mothers participated in this study had mild stress and there was significant difference between working and non-working antenatal mothers stress score. Psychiatric morbidity is high among women of reproductive age group with higher rates among pregnant women.

19. A Hospital Based Observational Study Assessing Corneal Astigmatism in Patients Undergoing Cataract Surgery
Gopal Prasad Singh, Pranay Kumar, Rajesh Kumar Singh, Rajiv Kumar Singh
Abstract
Aim: The aim of the present study was to assess the clinical profiles of patients with astigmatism who were scheduled for cataract surgery at our tertiary hospital and to report the prevalence of corneal astigmatism. Methods: The present study, a cross-sectional investigation, was carried out in the department of Ophthalmology, The study was carried out for the period of two years. In total 1000 patients with 1000 eligible eyes were scheduled for cataract surgery during the study period. The patients who have been scheduled for cataract surgery were included. Results: Males made up the majority (56%) of the population and a mean age of 64.6 ± 12.8. The majority of cataracts (46%) and nuclear sclerosis (37%) were of the mixed type. Other less frequent kinds included cortical cataract (2.70%), mature cataract (5.6%), posterior sub capsular opacification (8.5%), and developing cataract (0.2%). K1 and K2 had mean keratometry values of 41.19 and 42.48 D, respectively, with a range of 31 to 52 D. The range of corneal astigmatism was 0-5.34 D, with a mean of 0.48 ± 0.42 D. The range of the cylinder was 0-2.25 D, and the mean sphere was 1.28 ± 1.42 D. The mean cylinder was 0.20 ± 0.30 D. In the current investigation, astigmatism was absent in 8.5% of patients, but oblique astigmatism was present in 14.5%. With the rule astigmatism was present in the majority of instances (43%), followed by against the rule astigmatism (34%). Conclusion: For the best visual outcomes and patient satisfaction following cataract surgery, a preoperative assessment of corneal astigmatism is crucial. Astigmatism worsens with age, and a sizable portion of patients have preoperative corneal astigmatism of 1D or higher, which might impair the quality of vision after cataract surgery.

20. Assessing Hypoxemia in Patients of Acute Lower Respiratory Infections in Children: An Observational Study
Prashant Kumar, Brajesh Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of this study was to study clinical predictors of hypoxemia in patients of acute lower respiratory infections in children. Material & Methods: The observational prospective study was conducted in the  Pediatric Ward and Pediatric Intensive Care Unit. This was a hospital-based study completed for 1 year. The sample size taken for this study was 200. All children admitted with acute lower respiratory tract infections between the age group of 2 months to 5 years of age and diagnosed with pneumonia or bronchiolitis were included in the study. Results: A total of 200 cases were enrolled in the study, out of which 144 were male and 56 were female.  Out of the 200 cases enrolled, 98 were below the age of 12 months and 102 were above 12 months of age. The mean age was 15.5 months. The most common and significant symptoms were rapid breathing and difficulty breathing. The least common symptom was noisy breathing and pain in the abdomen. 72 cases out of the total 200 were diagnosed to have bronchiolitis, whereas 128 cases had pneumonia. Tachypnea (87%), pallor (85%) and nasal flaring (82%), crepitations (added sounds), and subcostal retractions had better sensitivity for detecting hypoxemia. However, these signs had low specificity for hypoxemia. Head nodding (94%), intercostal retractions (84%), and cyanosis (87%) were highly specific for predicting hypoxemia. Males 138 out of 144 were significantly more hypoxemic than females 52 out of 56. Most cases have moderate hypoxemia which includes 80%. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

21. A Comparative Assessment of Various Hemodynamic Parameters between Urban and Rural Population: An Analytical Study
Shashi Bhushan Kumar, Bijay Krishna Prasad
Abstract
Aim: The aim of the present study was to assess systolic blood pressure, diastolic blood pressure, mean arterial pressure. pulse pressure, chronic kidney disease. Methods: The present study was conducted in the Department of Physiology for nine months and involved 100 subjects both from urban and rural areas. The subjects were selected in the age group of 20 to 60 years  this was done. Results: The systolic blood pressure of both rural and urban population was compared using F test and a p value of 0.48 was obtained. The diastolic blood pressure of both rural and urban population was compared and analyzed by using F test and we got a p value of 0.0028. The pulse pressure of both rural and urban population was compared by F test which shows a p value of 0.039. The mean arterial pressure of both rural and urban population was compared by using F test where we got a p value of 0.0007. Conclusion: Obese and overweight population is significantly more in the urban area compared to the rural area. The urban population have a significantly higher S.B.P., D.B.P, M.A.P and P.P than the rural population. There is increased incidence of hypertension in the urban males and females compared to rural males and females. This clearly indicates that the urban populations are at increased risk of cardiovascular disease.

22. Evaluation of the Biomechanical Hip Variables That Contribute to Implant Failure: A Retrospective Study
Rahul Kumar Chandan, Pappu Marandi
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 retrospective study. All 40 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 Orthopedics for one year with implant failure were registered for the study. Results: In our study we registered total of 30 cases with mean age of registered cases was 62.88 + 8.52 years. 30 patients (75%) were male and 10 (25%) were females. Out of 40 cases registered, pattern of implant failure in our study were 10 cases (25%) had implant failure pattern of Z- effect , 9 cases (22.5%) had implant failure pattern of reverse Z-effect; 7 (17.5%) had breakage of nails; 6 cases (15%) had both screw breakage with varus collapse; 4 (10%) had single upper proximal screw breakage; & 4 cases (10%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Various complicated forces are there that acts on hip joint in different direction. Each force has its own direction. These biomechanical forces are due to body-weight while standing and walking. To minimize damage to joint & implant these forces vectors has to be compensated by forces generated in opposite direction either by body itself or biomechanical properties of implant either due to its specific design or due to properties of material which is used.

23. An Outcome Assessment in Surgical Site Infection in Post-Op Patients for Whom Wound Closure is Done Using Staplers and Sutures; A Comparative Study
Arnab Sinha, Avinash Kumar, Rashmi Sharma, Ajay Mahto
Abstract
Aim:  The aim of the present study was to compare skin closure using sutures versus staplers in elective orthopaedic surgery cases that are followed for 4 weeks for postoperative surgical site infection. Material & Methods: The Present study was prospective observational study, carried out in the Department of Orthopaedics for the duration of the study 24 months. A total of 100 patients were included in the study. Results: There was no significant difference in mean ages, gender, BMI, co-morbidities and smoking status (p value >0.05). The present study shows a statistically significant higher incidence of wound infection among stapler group as compared to conventional sutures in terms of type of incision and type of wound closure. Among the Suture group, 14 out of the 50 had wound infection whereas in stapler group 36 out of the 50 had wound infection and this difference was found to be statistically significant. Mean operating time did not differ among the two groups of staple and sutures while closure time was significantly higher in suture group. Prolonged wound discharged was observed more with staples while the problem was lesser in suture group. This difference was also statistically significant with p value <0.05. More pain was felt by the patients in staple group reported as number of patients with VAS score of 3 or higher. No significant difference was observed between infection rate and wound dehiscence in the current study. Conclusion: By this study it can be concluded that sutures can be used for wound closure instead of staplers in elective orthopaedic surgical procedures as the rate of surgical site infections (SSIs) were less in patients whose wound closure were done using sutures.

24. Study to Find Out Various Clinical Manifestations and Laboratory Diagnosis of Rickettsial Disease in Pediatric Age Group
Pawan Kumar Yadav
Abstract
Aim:  The aim of the present study was to find out various clinical manifestations and laboratory diagnosis of Rickettsial disease in pediatric age group. Material & Methods: A prospective observational study was conducted at Department of Pediatrics for the duration of 24 months, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. A total of 50 cases who were admitted with complaints of fever and presence of one or more of the following clinical features: Rash, edema, eschar, hepatosplenomegaly, lymphadenopathy, History of contact with pets and history of tick bite. Results: Most common age group observed was 1-5 years accounting to 34%. The youngest affected patient was 2-month-old. Males (64%) were most commonly affected group in our study. 80% of the patients hailed from rural background. Fever was the most common symptom present in all the cases enrolled in the study followed by rash in 29 (58%) cases. Eschar though a characteristic feature of rickettsial infection was found in only 5 (10%) of the cases. Clinical examination revealed hepatomegaly in 45 (90%) cases, followed by lymphadenopathy in 15 (30%) cases and splenomegaly in 12 (24%) of cases. Investigations done in our study subjects showed that out of the 50 cases, 47 (94%) had thrombocytopenia. Hypoalbuminemia was seen 46 (92%) cases and hyponatremia was seen in 43 (86%). Anemia was seen in 27 (54%) of the cases. There was no statistical significant correlation between Rickettsial score and Weil-Felix test according to our study. Complications were seen in 28 (56%) of the cases, of which meningoencephalitis was the most common seen in 8 (16%) of the cases, followed by pneumonia and hepatitis in 4 (8%) cases each. 1(2%) patient required hemodialysis. Conclusion: A proper history and careful physical examination help in the diagnosis of Rickettsial disease. Laboratory tests can be carried out to support the diagnosis. Weil-Felix test can be carried out for early detection of suspicious case in resource limited set up.

25. Outcome Assessment of Dynamic Hip Screw and Proximal Femoral Nailing in the Treatment of Intertrochanteric Fractures: A Comparative Study
Rajdeepsinh Chauhan, Poorv Patel, Rohan Parvani, Divyesh Jetpariya
Abstract
Aim: The aim of the present study was to compare the functional outcome of dynamic hip screw and proximal femoral nailing in the treatment of intertrochanteric fractures. Methods: The present study was conducted in the Department of Orthopaedics for the period of one year and all patients with type I, type II or type III intertrochanteric fractures undergoing PFNA2 or DHS fixation. A total of 100 patients were taken and patients were divided to two groups of 50 each for DHS and PFNA2. Results: There was no significant difference in gender distribution, mode of injury and Boyd and Griffin classification distribution between the two groups. The mean six weeks score in Group DHS was 33.47 ± 3.20 and in Group PFN was 34.36 ± 2.7. There was not much significant difference in the mean six weeks comparison between the two groups. The mean 12 weeks score in Group DHS was 53.67 ± 2.68 and in Group PFN was 63.19 ± 5.95. There was a significant difference in the mean 12 weeks comparison between the two groups. The mean 24 weeks score in Group DHS was 82.5 ± 7.63 and in Group PFN was 88.22 ± 6.54. There was a significant difference in the mean 24 weeks comparison between the two groups.  In Group DHS, results were excellent in 34%, good in 42%, fair in 18% and poor in 6%. In Group PFN, results were excellent in 56%, good in 34% and fair in 10%. There was not much significant difference in results distribution between the two groups. Conclusion: From the study based on the functional outcome derived from Harris Hip Score, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS fixation. This was concluded based on the final outcome, range of movements, and HHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group.

26. A Hospital-Based Study Determining the Relation between Various Biochemical Parameters in Individuals with Type 2 Diabetes Mellitus
Birendra Kumar, Gitanjali Kumari
Abstract
Aim: The aim of the present study was to determine the relation between HbA1C, Lipid profile and CRP in individuals with type 2 diabetes mellitus. Material & Methods: This was a hospital-based prospective study comprised of 100 patients with type 2 diabetes mellitus reporting to department of General Medicine for the duration of 12 months. Results: In this study of 100 patients, 70 patients were males, and 20 were females with mean CRP levels of 1.18±1.22 and 1.14±0.98, respectively. There was no significant difference between male and female patients (p>0.05). There was no significance between different age groups in this study (p>0.05). There was no significant correlation between CRP and BMI in this study. FBS and HbA1C were directly correlated. PPBS showed a direct correlation with both HbA1C and CRP in this study. There was a significant positive correlation between CRP and total cholesterol (p<0.05). There was no significant correlation between CRP and LDL cholesterol (p>0.05). There was a negative correlation between HDL cholesterol and CRP. There was significant positive correlation between CRP and triglyceride levels (p<0.05). Conclusion: In this study of 100 patients with T2DM, it was found that CRP is significantly correlated with HbA1C level.  A positive correlation was found between serum CRP and HbA1C in the initial group and in the follow-up patients, showing that CRP levels lowers with better glycemic control and correlates with dyslipidaemia profile.

27. A Case-Control Study to Evaluate the Blood Urea & Serum Creatinine with Hba1c in Diabetes Mellitus Patients: An Analytical Study
Sonal, Uday Kumar
Abstract
Aim: The aim of the present study was to evaluate the blood urea & serum creatinine with HbA1C in Diabetes mellitus patients. Methods: The present study was conducted in the Department of Biochemistry. Our study comprises of 100 subjects with age limit between 35-65 years. Our study group compared with normal healthy age matched controls. These are healthy and not having the history of diabetes. Patients with normal blood glucose and normal renal functions tests are taken as controls. Results: Out of 100 cases, we had 25 samples with increased Urea, 35 samples with more creatinine and 40 samples increased with both urea and creatinine when compared with controls. In our study group, males having more creatinine value compared to females due to presence of more muscle mass. Increased blood urea and serum creatinine values are observed in diabetic patients when compared with controls. There was no increase in blood urea and serum creatinine in controls. Mean fasting, and post prandial blood sugar was found to be higher in diabetics subjects when compared to non-diabetic. HbA1C also found to be higher in diabetics. Blood sugar and serum creatinine increases in cases compared with the controls. Both blood urea and serum creatinine shows statistically significant value (p <0.001). Conclusion: Our study showed that blood urea and serum creatinine can be used as biomarkers in the early detection of diabetic nephropathy. These parameters help in reducing the severity of renal failure.

28. A Retrospective Comparative Evaluation of Predictive Factors of Empyema in Children with Parapneumonic Pleural Effusion
Samiksha Sharma, Khodaija Mahvish, B.K. Singh
Abstract
Aim: The aim of the present study was to investigate the prognostic factors of empyema in children with parapneumonic pleural effusion. Methods: This retrospective observational study was conducted at Department of pediatrics for one year. The principles of data confidentiality based on the Helsinki statement were observed. The medical records of all the patients under 14 years who were hospitalized with a diagnosis of bacterial pneumonia, pleural effusion, and empyema were examined. Results: Empyema associated with parapneumonic pleural effusion was detected in 50 patients (33.34%) of 150 hospitalized children. 66 (44%), and 84 (56%) of these patients were boys and girls, respectively. Mean and standard deviation age of study participants were 37.9 ±17.9 months with the range of 1 to 16 months. Comparison of paraclinical laboratory parameters measured in the studied children showed that there was a significant statistical relationship between occurrence of empyema and some paraclinical measures such as leukocytosis (WBC> 15000 μl), neutrophilia > 12000 μl, Thrombocythemia (platelet=450000 μl), hypoalbuminemia (Alb <3 g/dL), high ESR and positive blood culture. The results of multivariate logistic regression modelling showed that the history of ibuprofen consumption increased the chance of empyema in children with parapneumonic pleural effusion by about 7 times (OR = 7.18; 95% CI: 1.36 to 37.83; P = 0.02). Also, having the symptoms of tachycardia (OR = 17.18; 95% CI: 1.64 to 178.82; P = 0.01), and leukocytosis (OR = 5.64; 95% CI: 2.12 to 15.25; P= 0.003) increases the empyema incidence. Conclusion: Based on the findings of this study, a history of ibuprofen use, tachypnea, and leukocytosis are predictive factors for empyema in children with pleural effusion from community-acquired pneumonia (CAP). It is, therefore, helpful to design a scoring system to predict the incidence of empyema in patients with parapneumonic pleural effusion.

29. Study the Role of Different Modalities in Making Diagnosis the Etiologies of Obstructive Jaundice
Abhay Shanker, Tushar Saini, Lajpat Agrawal, Rakesh Kumar Singh
Abstract
Aim: The aim of the present study was to assess the role of different modalities in making diagnosis the etiologies of obstructive jaundice. Methods: The present study was conducted in the surgical wards of Department of Surgical Gastroenterology, IGIMS, Patna, Bihar, India. The time period of the study was from April 2022 to March 2023. The total number of patients was 56. The subject selection was random and only Adult cases were selected for the study. No special consideration of sex of the subjects was considered. Other causes of Jaundice were excluded and only those which can be corrected by surgical intervention were included. Results: Most of the patients were in mean age of 21- 30 whereas for malignant disease patients were in mean age of 51- 60 (46.66%). The youngest patient was 18 years female presenting with CBD stone whereas the oldest patients was male patient of carcinoma head of pancreas aged 78 years. 65.38% were females in the group. In the present study, Male: Female Ratio was 1:5:1 in malignant cause of jaundice. The clinical examination of patients of Jaundice was based on detailed analysis of Symptoms and sizes of patients, accounting for prevalence of symptoms signs with study on prevalence of uncommon symptoms (as pain radiating to back).  U.S.G. detects (caused level of obstruction) in 14/26 = 53.8% of cases of obstructive Jaundice and 9/15 = 60% of cases of CBD stones. 2 patients with CBD stone (as found later on exploration) has a clinical diagnosis of peri ampullary neoplasm/ malignant Jaundice in whom CT scan was done; The Findings of CT in 2 such patients. “Classical Target Sign”: ½ Echogenic Debris in Lower 1/3 CBD 2/2 CBD Dilatation 2/2. Thus CECT has a detection rate of CBD stone as 100% (2/2). Conclusion: The result of this study suggested that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice. Primary closure of the common bile duct is safe and cost effective alternative to routine T-tube drainage after open Choledocholithotomy and associated with low complication rates.

30. Controlled Interventional Study Assessing Oxiport Laryngoscope Blade and Miller Laryngoscope Blade for Neonatal and Infant Intubations: Comparative Study
Atul Aman, Chandra Bhushan Kumar
Abstract
Aim: The aim of the present study was to compare oxiport laryngoscope blade and miller laryngoscope blade for neonatal and infant intubations. Material & Methods: This controlled interventional study conducted in the Department of Anesthesiology for one year in which 150 neonates/infants in groups of 75 each posted for surgery in paediatric operation theatre over a period of 6 months were included in the study. Results: Out of the 150 patients 75 patients in Miller group and 75 patients in Oxiport group were included. Both groups were comparable with respect to age, sex, weight, mean time to intubation and anaesthesiologist performing the laryngoscopy. The incidence of mild desaturation (SpO2 up to 90%) was 86.66% in Miller group and 93.34% in Oxiport group. The incidence of moderate desaturation (SpO2 between 85% and 92.5%) was 4% in Miller group and 6.66% in Oxiport group. Incidence of severe desaturation (SpO2 <85%) was 9.34% in Miller group and 0 in Oxiport group. Conclusion: Apneic laryngeal oxygen insufflation with Oxiport laryngoscope blade decreases the incidence and rate of desaturation with a better hemodynamic stability as compared to Miller blade while intubating neonates and infants.

31. Assessment of the Role of Mean Platelet Volume in Patients with Type 2 Diabetes Mellitus: An Observational Study
Jyoti Kumari, Amit Kumar
Abstract
Aim:  The aim of the present study was to determine the correlation of MPV with fasting blood glucose, glycosylated hemoglobin (HbA1c), body-mass index, and duration of diabetes in the diabetic patients. Material & Methods: This was a cross-sectional study carried out in Department of Pathology,  including 100 patients who were already diagnosed to have Type 2 DM and 100 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.

32. A Prospective Analytical Study Assessing Role of Colour Flow Duplex Ultrasound in Clinically Suspected Patients of Chronic Venous Insufficiency of the Lower Limbs
Rohit Kumar
Abstract
Aim: The aim of the present study was to evaluate the role of colour flow duplex ultrasound in clinically suspected patients of chronic venous insufficiency of the lower limbs. Methods: The prospective study was done at department of Radiodiagnosis for the period of six months. Total 100 cases are included in study with all clinically suspected cases of venous disease of the lower limb, referred to the department of radiodiagnosis were evaluated. All patients underwent detailed colour duplex ultrasound of the lower limb venous system. Results: The age group was wide varying from 19-80 yrs. Most common age group was 41-50 yrs (25 cases) accounting for 25% of the cases with the mean age of 46.62. 80% were male in the study. The most common side of lower to be involved was left (46 cases, 46%) as compared to right (34 cases, 34%) or bilateral (20 cases, 20%). The most common pathology in patients with chronic venous insufficiency was varicose veins (85 cases, 85%) with the remaining 7 cases suffering from deep vein thrombosis (18%). The most common site of reflex was perforator (incompetence) with 60 cases (60%) followed by mixed incompetence (both junctional and perforator) (32 cases, 32%) sapheno-femoral incompetence (3%). Most of the patients had multiple-level perforator incompetence, but the most common level was below knee medial mid 1/3rd (72 cases, 72%) and below knee medial lower 1, 3rd (68 cases, 68%). the least incompetent perforator was anterior (3 cases, 3%). All the 15 patients with deep vein thrombosis showed involvement of the proximal segment veins. Conclusion: The study concluded that colour flow duplex sonography provides a good knowledge of the anatomy and the pathophysiology of CVI in each patient, describes the pattern of incompetence at the superficial and deep venous junction the distribution of the incompetent perforation and the prevalence of deep venous reflex, also helps in ruling out DVT.

33. A Study on Absolute Eosinophil Count as a Prognostic Marker in Sepsis & Septic Shock in ICU
Nitin Kumar, Ranjeet Rana De, Akhileshwar, Akrity Singh, Saurav Shekhar, Rajbahadur Singh
Abstract
Aim:  The aim of the present study was to find out the usefulness of absolute eosinophil count as a biomarker for sepsis and septic Shock In ICU. Material & Methods: A prospective cohort study was conducted in the ICU of Subjects were recruited consecutively. 50 subjects were included in the study. The recruitment criteria were patients age ≥18 years admitted to the ICU. Results: 74% were males and 26% were females. 78% had infection on admission. 48% had sepsis on admission. These findings contrasted when compared with the CRP levels, which did not differ significantly among the study groups. Conclusion: In conclusion, the present study found an association between eosinopenia with the diagnosis of sepsis. However, considering the low sensitivity and specificity, our study did not recommend the use of absolute eosinophil count as single diagnostic tool.

34. Outcome Assessment in Intertrochanteric Fractures Management with Dynamic Hip Screw and Proximal Femoral Nailing: Comparative Analysis
Saurabh Kumar
Abstract
Aim: The aim of the present study was to compare the functional outcome of dynamic hip screw and proximal femoral nailing in the treatment of intertrochanteric fractures. Methods: The present study was conducted in the Department of Orthopaedics, for the period of 24 months and all patients with type I, type II or type III intertrochanteric fractures undergoing PFNA2 or DHS fixation. A total of 200 patients were taken and patients were divided to two groups of 100 each for DHS and PFNA2. Results: There was no significant difference in gender distribution, mode of injury and Boyd and Griffin classification distribution between the two groups. The mean six weeks score in Group DHS was 33.47 ± 3.20 and in Group PFN was 34.36 ± 2.7. There was not much significant difference in the mean six weeks comparison between the two groups. The mean 12 weeks score in Group DHS was 53.67 ± 2.68 and in Group PFN was 63.19 ± 5.95. There was a significant difference in the mean 12 weeks comparison between the two groups. The mean 24 weeks score in Group DHS was 82.5 ± 7.63 and in Group PFN was 88.22 ± 6.54. There was a significant difference in the mean 24 weeks comparison between the two groups.  In Group DHS, results were excellent in 34%, good in 42%, fair in 18% and poor in 6%. In Group PFN, results were excellent in 56%, good in 34% and fair in 10%. There was not much significant difference in results distribution between the two groups. Conclusion: From the study based on the functional outcome derived from Harris Hip Score, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS fixation. This was concluded based on the final outcome, range of movements, and HHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group.

35. A Hospital Based Epidemiological Assessment of Nutritional Status of Adolescent Girls of High Schools
Ratnesh Kumar, Sima Choudhary, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to assess the nutritional status of school-going adolescent girls in Bihar region. Material & methods: A Community-based cross-sectional study was conducted in Department of Pediatrics for 24 months  with collobration with schools in the urban area of Muzaffarpur region. A total of 500 adolescent girls attending high school and higher secondary school ranging from 15-18 years (IX-XII Standard) in Muzaffarpur were studied. 2 were studied. Results: As per WHO nutritional measurement criteria, children were classified as per their anthropometric criteria as, 32% had moderate stunting and 5% were severely stunted. 2% had severe thinness, 29% were thin and 7% were overweight. The major morbidity among study subjects was, 20% had conjunctival pallor(anaemia), 8% had dental caries, 6% had Vitamin B complex deficiency, 4% had angular stomatitis and 1% had Vitamin A deficiency. Conclusion: The present study recommends that efforts should be made to reduce the prevalence of malnutrition among adolescent girls. For this regular health check-ups should be done at schools with the help of school authorities and hospitals.

36. Clinico-Epidemiological Study Evaluating Association of Sensorineural Hearing Loss in Type 2 Diabetes Mellitus Patients
Ajit Kumar
Abstract
Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cross-sectional study was conducted in Department of ENT for period of two years. The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of <50 years. Results: In the present study, 68% were females and 32% were male. The mean age of patients of diabetic group was 40.20 ±6.36, mean fasting blood sugar was 129.41±26.54, mean PP blood sugar was 170.20±40.25 and mean HbA1c was 7.43±0.49. Mean age of patients of non-diabetic group was 38.52±7.43, mean fasting blood sugar was 107.03±3.16, mean post-prandial blood sugar was 128.52±9.81 and mean HbA1c was 6.006±0.222. The result showed that only 28 patients had normal hearing and 72 patients had SNHL whereas 12 patients in this group had minimal hearing, 19 had mild SNHL, 23 had moderate, 6 had severe SNHL and 12 patients had profound SNHL. 75 patients had DPOAE refer whereas 25 patients had DPOAE pass. Wave V grossly delayed in DM group as compared to non-DM with all frequencies (i.e. 70, 80 and 90) whereas interpeak latencies of wave I-V at 70 db frequency is almost equal in DM and non-DM group but it increase with increase in frequencies (i.e. 80 and 90 db). Conclusion: This study concluded that the diabetics are at definite risk of developing auditory dysfunction, therefore it is recommended that all newly diagnosed diabetic patients should undergo a complete audiological evaluation at the time of diagnosis and a regular half yearly or yearly follow up is warranted for early detection of damage to auditory functions. Although factors other than diabetes contribute to hearing loss, early glycemic control for type 2 diabetic patients may reduce the incidence rate of this disease.

37. A Cross-Sectional Clinical Study on Management of Venous Ulcer
Sweta
Abstract
Aim: The aim of the present study was to evaluate the different approaches of treatment modalities for chronic venous ulcers. Material & methods: A cross-sectional study was conducted at the Department of General Surgeryfor the period of one year. 100 patients were studied who were patients attending the outpatient department and casualty during the study period with venous ulcers over the leg. Results: In our study, the age varied from 24 years to 68 years. Out of 100 patients, 18 (18%) patients were from 21-30 years age group, 20 (20%) from 31-40 years, 28 (28%) from 41-50 years, 28 (28%) from 51-60 years and 6 (6%) from 60 and above years of age. The mean age was noted to be 49 years. There were 80 (80%) males and 20 (20%) females. Total 20 (20%) patients had a normal BMI, 45 patients (45%) were overweight and 35 (35%) patients were obese. All 20 females were overweight or obese. Along with ulceration, 42 (42%) patients had pain, 68 (68%) patients had edema and 70 (70%) patients had skin changes. All our patients had underlying venous abnormalities either clinically or radiologically. Of the patients, 42 (42%) patients had venous ulcer in the right leg, 54 (54%) in the left leg. 4 (4%) had bilateral venous ulcers. In our study, 72 (72%) patients had pathology of great saphenous vein, 23 (23%) patients had perforator incompetence, and 5 cases (5%) had involvement of short saphenous vein. In our study, 20 patients (20%) underwent conservative management alone and 80 patients (80%) underwent surgery. Amongst 80 patients who underwent surgery, flush ligation of Sapheno-femoral junction with stripping of GSV up to knee was done in 56 (70%) patients. All of these patients had phlebectomy below the knee also. 6 (7.5%) cases underwent subfascial endoscopic perforator ligation (SEPS). Phlebectomy alone was done in 16 (20%) patients. 6 cases were operated with SSV ligation. Conclusion: Venous ulcers are common ulcers of lower limb causing a progressive disability affecting patient with pain, disability, loss of work, and social isolation. Ulcers need prompt treatment with dressings and surgery.

38. Clinico-epidemiological Evaluation of Surgical Diseases and Surgical Outcomes in Geriatric Patients
Amrit Kumar
Abstract
Aim: The aim of the present study was to assess the demography, disease distribution and co morbid conditions, complications and mortality among elderly patients undergoing operation in general surgical wards. Methods: A prospective observational study was conducted in the Department of General Surgery, over a period of one year. A total of 100 patients were studied. Results: In our study, 90 patients were under group I and 10 in group II. Out of 100 patients, 60% were men and 40% were women. Most common surgical diagnosis in our study population was Hernias with 23 cases (23%) followed by gallstone disease (GSD/cholelithiasis) with 27%. About 16 cases were diagnosed with malignancy accounting to 16%. Diagnoses related to trauma were seen in 18 cases i.e. 18% of the population. After System-wise categorizing the diagnosis, the most common systems involved were hepatobiliary with 30 cases (30%) followed by Hernias 32 cases (32%). Post-operative complications like seroma formation in 12 cases, surgical site infections in 5 cases of study patients were observed. These were managed conservatively. Wound dehiscence was seen in one patient with sheath intact in emergency abdominal surgery. Postoperative fever was observed in one patient which resolved subsequently and hypocalcaemia was identified in patient post thyroidectomy and was managed by oral medicines. By Third week complications were resolved. Conclusion: With increasing age, the risk of co morbidities increases. Early surgical intervention in elderly patients is preferred and must be advisable after optimization of co morbid conditions for good surgical outcomes. Hernias and gallstone disease are the most common elective surgical diseases found in elderly patients. Surgically treatable causes should be corrected early, preferably electively, to avoid intervention in emergency setting, which would increase morbidity and mortality.

39. Pregnancy Outcome in Intrauterine Growth Retardation with Normal and Abnormal Cerebroplacental Ratio Assessed by Doppler Study
Ghazala Shahid, Monojit Chakraborty, Satarupa Roy, Shyamapada Pati
Abstract
Objective: To compare outcome of IUGR pregnancies of two groups – one with normal crebroplacental ratio and another with abnormal cerebro-placental ratio. Methods: A prospective observational study was performed for a period of one and a half year from February 2020 to June 2021 in a tertiary care hospital in Kolkata, India where 50 IUGR pregnancies were assessed. They were divided into two groups – 1) Normal cerebro-placental ratio, 2) Abnormal Cerebro-placental ratio and were followed up till delivery outcome and perinatal period. Results: The group with normal Cerebro-placental ratio had a better pregnancy outcome with a lesser perinatal mortality. Conclusion: Cerebro-placental ratio can be reliably used as a first hand technique with less technical complications to asses and monitor patients with IUGR and provide optimised ante-natal and perinatal care. Advances in knowledge: This study evaluates the efficiency and association of cerebro-placental ratio with intra-uterine growth retardation and role of cerebro- placental ratio to prognosticate IUGR which makes it a valuable first hand diagnostic parameter to segregate the antenatal mothers who require tertiary medical attention and monitoring their perinatal outcome.

40. Retracted

41. Study of Serum Uric Acid Level in Liver Cirrhosis and its Correlation with Child Turcotte Pugh Score
S. Geetha, D. K. Sivakumar, M. Rekha Priya, S. Malathi
Abstract
Background: Cirrhosis cannot be accurately diagnosed by serologic tests. Even though aberrant biochemical patterns in combination with the clinical picture can point to certain liver illnesses, liver function tests may not always accurately reflect hepatic function. Hyperuricemia has been found to be a risk factor for liver disease. Hence, this study was conducted to determine the serum uric acid level in liver cirrhosis and its correlation with the Child Turcotte Pugh score. Methods: This was a prospective study among 86 patients with liver cirrhosis conducted in a tertiary care centre using simple random sampling. Their serum uric acid and CTP scores were estimated and analysed using descriptive and inferential statistics in SPSS software. Results: 36.3% of patients had a Class A score, 31.3% had a Class B score, and 32.5% of them had a Class C score. The mean uric acid value was 5.621±1.861 mg/dL, ranging from 3.4 to 10.9. There was a significant (0.0001) positive correlation (r value 0.642) between serum uric acid and the Child Turcotte Pugh score among patients with liver cirrhosis. Conclusion: Serum uric acid levels increase with the Child Pugh score, suggesting that uric acid estimation may be a useful and affordable diagnostic marker for assessing the degree of liver cirrhosis.

42. Evaluating Salivary Gland Lesions: Histopathological Analysis
Arun Roy, Md. Imteyaz Alam, Poonam Kumari
Abstract
Aim: The aim of the present study was to assess the histopathological spectrum of salivary gland lesions and to know their pattern of distribution. Methods: The present study was conducted in the Department of Pathology for the period of 2 years. The source of data was from the biopsies of lesions of salivary glands that were received at Department of Pathology. A total of 50 cases were studied. The material required for the study was collected from the Department of Pathology. Results: Pleomorphic adenoma constitutes the most common lesion with 18 cases (36%) followed by Chronic sialadenitis 10 cases (20%). In non neoplastic lesion cystic lesion have slightly male predominance. In Benign lesion pleomorphic adenoma is most common. In malignant lesion Mucoepidermoid was most common. The age range was 17 to 75 years. Benign tumors are more common over malignant. Conclusion: Pleomorphic adenoma was the commonest salivary gland tumor observed in both sexes. Muco-epidermoid carcinoma was the most common among the malignant salivary gland tumors followed by adenoid cystic carcinoma.

43. Pattern of Use of Antibiotic Prophylaxis in Caesarean Section and Hysterectomy
Jaya Roy, Rohit Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the choice of antibiotics in caesarean section and hysterectomy. Methods: The present study was conducted at hospital , A Data were collected retrospectively from patients’ medical records. The subjects were all patients in the obstetrics and gynecology department who underwent caesarean section and hysterectomy. Results: The mean age of participants was 25 years. Most of the subjects in the study group belonged to upper lower socioeconomic status by modified Kuppuswami scale. Most of the women were second gravida. The study involved 100 women who underwent Hysterectomy and Cesarean Section. Overall, 100 of the 93 patients were given prophylactic antibiotics. The most commonly used antibiotics are ceftriaxone and ceftazidime. Around 70% women received the prophylactic antibiotic in the prescribed timing of 30-60 minutes before the skin incision. The only factor found associated with patient not receiving antibiotics within the prescribed time limit was delay during shifting of patient and availability of operation theatre. Conclusion: This retrospective study reveals that the most widely prescribed antibiotic prophylactic was ceftriaxone and ceftazidime instead of first-generation cephalosporin. On quantitative measurement, the highest antibiotic used was ceftriaxone followed by ceftazidime and cefotaxime.

44. A Hospital-Based Study to Evaluate the Efficacy of Intravenous Iron Sucrose for the Treatment of Iron Deficiency Anemia in Pregnancy
Swati, Ankita Kumari
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  The duration of the study was about 12 months. 200 pregnant women were enrolled for this study. Results: The results showed that the mean age of the pregnant women was 23.67±5.06 years, their mean weight was 54.56±12.28 kg, their mean gestational week was 26.84±4.08, 32 (16%) of them had gestational diabetes, 24 (12%) of them had hypertension, 14 (7%) of them had hyperthyroidism, 6% had asthma and 5% genitourinary infection whereas 8 (4%) of them had chronic kidney disease. Conclusion: This study concluded that the administration of iron sucrose intravenously (Axifer) 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 controllable safety profile clinically and enhanced Hemoglobin and ferritin level both and thus decrease complications during pregnancy due to iron deficiency anemia.

45. A Hospital Based Observational Assessment of the Influence of Parity on Bone Mineral Density and Peripheral Fracture Risk in Postmenopausal Women
Anupma Kumari, Raj Kumar, Renu Rohatgi, Lal Bahadur Manjhi
Abstract
Aim: The aim of the study was to assess of the influence of parity on bone mineral density and peripheral fracture risk in postmenopausal women. Methods: This was a hospital based cross sectional study and included 240 postmenopausal women. They had been selected randomly from a group of postmenopausal women referred to the outpatient at Department of Obstetric & Gynaecology and Department of Orthopaedics, RIMS, Ranchi, India from June 2020 to December 2020. Results: The mean age of women was 59.4 (±7.6) years and was significantly correlated with parity level. Increasing parity was associated with higher years since menopause (p < 0.001), higher BMI (p = 0.001). In contrast, increasing parity was not significantly associated with later age of menopause (p = 0.08). All the patients with six and more pregnancies had spine and hip BMD values significantly lower than values in the other groups (p < 0.001). After adjustment for age and BMI, decreased lumbar and total hip BMD were still associated to increased parity (ANCOVA, p = 0.014 and 0.023, respectively), while the relation between parity and femoral neck BMD was markedly reduced and no longer statistically significant. Conclusion: The present study suggested that the BMD of the spine and hip decreases with an increasing number of pregnancies, and this situation shows variations in different age groups. However, there was no correlation between parity level and peripheral fractures.

46. Management of Chronic Plantar Fasciitis: A Comparative Study
Surya Prakash, Manish Kumar
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 2 years. 150 patients were included in the study and divided into two groups. Group I (75 patients) received PRP injection and group II (75 patients) were given steroid injection. Results: A total of 150 patients were analyzed in this study ranging from 21 to 65 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 21.19±11.39 and 17.3±13.37 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.

47. Assessing the Clinical Presentation and Histo-Pathological Distribution of Ovarian Neoplas/ms: An Observational Study
Shipra Jyoti, Sanjeev Ranjan, Navita Sinha, Khushnuma Parween
Abstract
Aim: The aim of the present study was to find the prevalence and determine the clinical presentation and histo-pathological distribution of ovarian neoplasms. Methods: The observational study was carried out in the Department of Pathology, Narayan medical college and hospital, Sasaram, Bihar, India for the period of one year. 100 cases of ovarian tumours received in the Department of Pathology. The specimen was obtained from the Department of Obstetrics and Gynaecology. Study subjects consisted of admitted patients in gynecology ward; diagnosed as case of ovarian tumor on basis of clinical and imaging findings and confirmed by laparotomy/laparoscopy findings and histopathology. Results: Out of 100 cases of ovarian tumours, 72 were benign, 4 were borderline tumours of low malignant potential and 24 were malignant. In the present study, the youngest patient was 16 months and the oldest was 76 years forming a ranging from 16 months to 76 years. Highest incidence of ovarian tumour was noted in the fourth decade i.e. 34 cases out of 100 cases accounting for 34%. Highest incidence of benign ovarian tumour was noted in third decade i.e. 28 cases out of 72. Highest incidence of malignant tumour was noted in the fourth decade i.e. 11 out of 24 cases. 36% of the patients complained of dull aching lower abdominal pain, 28% complained of abdominal mass and 7% of the patients gave history of menstrual disturbance like menorrhagia. The cases had no specific relation to parity. Conclusion: The correct histopathological diagnosis of ovarian tumor is of prime importance in view of their behavioural predictability, clinical correlation and the proper management of patient.

48. A Retrospective Cohort Study Assessing the Cerebrospinal Fluid Leak in Posterior Fossa Surgeries with Different Dural Closure Methods
Vir Abhimanyu Pandit, Shashank Abhishek, Chandra Kant Diwakar, Debish Aanand
Abstract
Aim:  The aim of the present study was to evaluate the occurrence of cerebrospinal fluid leak in posterior fossa surgeries where different dural closure materials are used. Material & Methods: A retrospective cohort study, conducted in the Department of General Surgery, All the cases underwent posterior fossa surgeries during the period of 2 years in the department of Neurosurgery was included in the study. Consent was obtained from all patients and data collected retrospectively from medical records. Results: There was no significant difference in gender. The total patient population consisted of 20 men (40%) and 30 women (60%). The etiology of craniotomy had equal distribution as well, with a total of 38 (76%) tumors, 8 (16%) cysts, 2 (4%) chiari malformations, 1 (2%) decompressions, and 1 (2%) inflammations. The incisional CSF leak within 30 days was noted in 10 patients. Non-incisional CSF leak was noted in 16 patients. Conclusion: The study concluded that, in cases of posterior fossa surgeries, closure with pericranium has a significant protection against CSF leak.

49. Assessing Correlation between Platelet Indices and C-Reactive Protein in Infants Admitted with Acute Febrile Illness: An Observational Study
Nupur Kumari, Kannu Priya, Alka Singh, Bir Prakash Jaiswal
Abstract
Aim: The aim of the present study was to assess the correlation between platelet indices and C-reactive protein in infants admitted with acute febrile illness. Methods: This hospital based descriptive study was conducted in Department of Paediatrics . As per sample size calculation 2500 patients were included in the study. Results: Sex distribution i.e. 1050 male and 950 female was not statistically significant. Maximum and minimum age in months for male and female subjects, the maximum age was 12 months for both the groups the minimum age for males was 1.2 months and for females was 1.4 months. There was no significant difference in height and weight between male and female. The laboratory characteristics were not statistically significant in males and females. The results were statistically significant in males for platelets, CRP (p value <0.001), PCT and CR while and MPV, PDW and WBC were not statistically significant. The results were statistically significant in females for platelets and CRP (p value <0.001) and PCT while MPV, PDW, PCT and WBC were not statistically significant. The optimum cut off value of platelets and WBC showed statistically significant difference. Conclusion: CRP and platelet levels decreased dramatically as the patient’s health improved. Furthermore, our findings revealed a strong link between CRP and platelet counts in patients. Platelet count, PDW, MPV, and PCT were all influenced. Only MPV was replaced on the third day of the fever.

50. Clinico-Etiological Profile and Drug Sensitivity Patterns of Dermatophytosis: An Observational Study
Dhiraj Kumar
Abstract
Aim: The aim of the present study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. Methods: The present study was conducted at Department of Dermatology and patients with dermatophyte infections visiting the outpatient department during this period were screened. A total of 200 consecutive patients aged between 18 and 65 years (~30 from each center), clinically suspected with dermatophyte skin infection. Results: Male preponderance was observed (75%) among 200 cases studied. The mean age of the study population was 35.5 ± 12.78 years. Most patients were in the 18–30 years group (n = 80), followed by 31 to 40 years (n = 44), > 50 years (n = 40) and 41 to 50 years (n = 36). Itching (98%), scaling (90%), dryness (82%) and inflammation (42%) were the most common clinical presentations. Relatively, a lesser proportion of patients presented lesion with central clearing surrounded by an advancing, red, scaly, elevated border, erythema and pustules. Out of 200, 90 (45%) were culture positive. Trichophyton genus represented the majority of the isolates of dermatophytes. Trichophyton rubrum was the most commonly reported, followed by T. mentagrophytes and T. tonsurans. The MIC values for itraconazole were within the range; while griseofulvin had the lowest mean MIC (0.25–3.0 µg/mL). The MICs of itraconazole, luliconazole, amorolfine, sertaconazole and eberconazole were within the reference range. Conclusion: T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC.

51. A Hospital-Based Assessment of the Effectiveness of This Economical Modification of Negative Pressure Wound Therapy with Conventional Dressings in the Healing of Infected Chronic Wounds
Setubandhu Tiwary
Abstract
Aim:  The aim of the present study was to compare the effectiveness of this economical modification of negative pressure wound therapy with conventional dressings in the healing of infected chronic wounds in a Bihar region. Material & Methods: The Present study was single-center, open labelled randomised control trial conducted in the Department of Surgery. Study duration was of 12 months. 50 patients with chronic ulcers were randomly divided in two groups of 25 each as Group A (Negative Pressure Wound Therapy) and Group B (Conventional Dressing). Results: Mean age of study subjects was 53.7 and 54.66 years in Conventional and NPWT group respectively. The difference was statistically non-significant. Male Preponderance was observed in both groups (64% in Conventional and 60% in NPWT group respectively). The difference was statistically non-significant. Most common type of chronic ulcer observed in present study was diabetic ulcer (68%) followed by venous ulcers (20%) and pressure ulcers (12%). No difference was seen in the study groups on the basis of type of ulcer. At the end of 1 and 2 weeks, 52% and 96% cases of NPWT group had granulation tissue as compared to only 20% and 64% cases in conventional group. The difference was statistically significant (p<0.01). By the end of 3 weeks, 96% of the cases in NPWT group had granulation tissue as compared to 88% cases in conventional group. The wound contraction rate was significantly faster with NPWT therapy. The difference in the rate of wound contraction was apparent since 1st week. By week 3, mean percentage of wound contraction was 90.82% in NPWT therapy as compared to 75.55% in conventional group patients. The difference was statistically significant (p<0.05). Decrease in wound dimensions was significantly faster in NPWT group patients as compared to conventional group. The difference was statistically significant from week 2 (p<0.05). Conclusion: Negative Pressure Wound Therapy with its modification appears to be superior compared to conventional dressing in terms of early appearance of granulation tissue, rapid contraction, overall faster healing, decrease in hospital stay and much more cost-effective.

52. A Retrospective Assessment of the Acute Disseminated Encephalomyelitis in Children: An Observational Study
Shashank Kumar, Pallav K Chaubey, Upamanyu Goswami, Tanaya Shreeraj
Abstract
Aim:  The aim of the present study was to assess acute disseminated encephalomyelitis in children. Material & Methods: A retrospectively evaluated 20 consecutive children with ADEM and adolescents at the Department of Paediatrics for the duration of 12 months. All children had been diagnosed using reliable clinical, laboratory, and neuroimaging techniques according to the International Pediatric Multiple Sclerosis (MS) Study Group criteria. Results: There were 20 children admitted with the diagnosis of ADEM during the study period. They included 16 (80%) girls and 4 (20%) boys. 4 children were below the age of three years, 8 children in the 3-6 year age group and 8 children in the 6-12 year age group. The youngest was a six-month-old infant. All of them had first episode of the illness. The common presenting symptoms were fever, vomiting, headache, gait disturbance and generalized seizures. Neurological manifestations included altered sensorium, multiple cranial nerve involvement, quadriplegia and paraplegia, dystonia and choreiform movements, nystagmus, bladder involvement (both incontinence and retention), speech defect and double vision. Facial nerve was the most common cranial nerve involved. Both LMN and UMN facial palsy occurred. Psychological manifestations included aggressive behavior, emotional liability, and irritable, elated or depressed mood. Magnetic resonance imaging (MRI) was done in all children. The area involved in the majority of children was the parietal lobe. Lesions were noted in the subcortical white matter, mid brain, pons, corpus callosum, basal ganglia, medulla and cerebellum. One third of children had spinal cord involvement. Conclusion: Despite the serious neuropsychiatric manifestations, ADEM in children generally has a good outcome. Children with ADEM need long-term follow up for cognitive impairments and emotional problems. Clinical presentation of ADEM in the present sample is comparable to previous studies except for the female preponderance. Further studies are required to analyze the reason for this female preponderance.

53. Assessing Diverse Locations of the Greater Palatine Foramen in Regards to Several Anatomical Landmarks: An Observational Study
Chandan Kumar, Suman Kumari, Rajendra Prasad
Abstract
Aim: The aim of the present study was to measure the location of greater palatine foramen (GPF), according to clinically identifiable anatomical landmarks. Methods: The study was performed on 70 dry human skulls. The skulls were obtained from Department of Anatomy for 12 months. Results: The situation of the GPF in relation to 3rd maxillary molar was in 32 of the skulls. The average values of the distance between the GPF & midline palatine suture (MPS) & posterior border of hard palate (PBHP) were 16.4 mm (SD 1.4) & 6.4 mm (SD 1.3), respectively. Conclusion: Diverse locations of greater palatine foramen arouse difficulties in locating exact position during anaesthesia. Therefore, understanding the different positions of greater palatine foramen can help surgeons to improve their surgical procedures.

54. A Hospital Based Comparative Study to Determine the Effect of Phototherapy on Serum Magnesium Level in Term Neonates with Hyperbilirubinemia
Pallav K Chaubey, Shashank Kumar
Abstract
Aim: The aim of the present study was to determine the effect of phototherapy on serum magnesium level in term neonates with hyperbilirubinemia. Material & Methods: A prospective hospital‑based comparative study was conducted on 200 eligible neonates admitted in Upgraded  Department of Pediatrics, receiving phototherapy for the period of 2 years.  informed consent was obtained from the parents of the selected neonates. This study included 200 full‑term neonates who were subjected to phototherapy for treating neonatal hyperbilirubinemia according to the guidelines of the American Academy of Pediatrics. Results: Our study included 200 full‑term neonates with jaundice who received phototherapy for treating neonatal indirect hyperbilirubinemia, comprising 130 (65%) males, and 70 (35%) females, with the mean gestational age of 37± 0.8 weeks and mean postnatal age of 5.2 ± 1.4 days. There were 68 (34%) neonates delivered by normal vaginal delivery and 132 (66%) neonates delivered by cesarean section. Mean birth weight was 3.1 kg. The mean difference of jaundice onset age, intrauterine age, admission weight and mother’s age were not significant. The amount of total serum bilirubin decreases in all groups. Serum total magnesium level in single and double phototherapy decreases after treatment, but this decrease is significant only in the double phototherapy group (P = 0.022). In the intensive group, this parameter has slightly increased, which was not statistically significant (P = 0.530). The serum total magnesium level and its changes were reported in three groups before and after phototherapy. The serum magnesium level in new borns before treatment was normal in all three treatment groups. The status of each patient showed that single, double, and intensive phototherapy groups have magnesium content of more than 2.2 mg/dl, respectively. Conclusion: In the present study, the serum magnesium level showed a significant reduction only in the double phototherapy method and remained in the normal range in the other two groups. On the other hand, in all three treatment groups, the level of serum magnesium before the treatment was normal and did not increase significantly.

55. Role of MRI in the Diagnosis of CIDP Patients with Inconclusive Core Criteria
Sumit Kumar, Ganesh Kumar, Ved Prakash Shukla, Ashutosh Tiwari
Abstract
Summary: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a clinical entity caused by inflammatory process mediated by immune reaction that involves nerve roots, plexuses and peripheral nerve trunks. In its typical form, CIDP produces symmetrical proximal and distal muscle weakness, sensory involvement and reduced or absent deep tendon reflexes. CIDP is usually progressive at least for 8 weeks, although it can occur in a relapsing–remitting pattern. We report a case of forty year old diabetic patient presenting with 7-8 months history of weakness of all four limbs (both proximal and distal) with sensory involvement in the form of numbness (glove and stocking pattern) and tremor in bilateral hands. On evaluation, he was diagnosed as a case of CIDP with supporting radio-images with inconclusive electro diagnostic and cerebrospinal fluid (CSF) findings and responded well to the management.

56. Laparoscopic Tubal Sterilization Reversal and Fertility Outcomes
Gupteswar Mishra, Nagendra Kumar Rajsamant, Sankarsan Das, Sujit Kumar Mohanty
Abstract
Background: Although there are many different contraceptive methods available, tubal ligation is now the most common one. It plays a significant role in India’s National Family Planning Programme. Tubal sterilization techniques range from laparoscopic sterilisation to traditional Pomeroy’s fimbriectomy depending on the level of expertise available. 1% to 3% of these women later ask to have their sterilisation reversed, even though it is done as a permanent technique of sterilisation. Many western centres have showed success using improved laparoscopic methods, and this is now commonly considered as a substitute method for carrying out microsurgical reversal of a ligated tube. Purpose: The study had two objectives. First, it was determined whether the tubal recanalization was appropriate and what circumstances would lead to a successful laparoscopic recanalization. The second goal was to examine how laparoscopic tubal recanalization affected reproductive results and pregnancy rates. Methods: 43 women who were prospectively monitored and sought tubal sterilisation reversal at a tertiary care facility between May 2015 and February 2020 were included in a retrospective chart assessment. Results: Only 14 unilateral tubes were suitable and in 2 women bilateral tubes were suitable. For recanalization, all patients requiring laparoscopic tubal sterilisation were suitable, whereas all cases requiring fimbriectomy were not. Salpingostomy was used as an alternative to tubal reanastomosis in 10 (23.25%) cases. Pregnancy rates were 58.8% overall. 4 out of 12 women who had sterilisation using Pomeroy’s procedure became pregnant, compared to 5 out of 8 women who underwent laparoscopic tubal ligation (P=0.24). No patients with a final tubal length of less than 5 cm became pregnant (P=0.042). When comparing the age at recanalization, 82.3% of women less than 30 years old conceived, compared to 45% of women over 30 years old. Conclusions: Sterilisation method and the length of the tube after recanalization are significant determinants of recanalization success. Gynaecologists must sterilise patients with minimal stress while also minimizing failure rates. They must also work to maintain the length of the tube so that, should the patient’s circumstances alter, reversal is more likely to be successful.

57. Pregnancy Complications Associated with Gestational Diabetes Mellitus and Its Causes
Gupteswar Mishra, Nagendra Kumar Rajsamant, Sujit Kumar Mohanty, Aditya Narayan Sahu
Abstract
Background: GDM is the first occurrence or discovery of various degrees of glucose tolerance abnormalities during pregnancy. Global prevalence of GDM is increasing year by year as society, the economy, and living standards improve, particularly in developing countries such as India, where GDM has become one of the major chronic diseases endangering women’s health. Poor blood sugar 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 a tertiary hospital, was performed in this article. A case group and a control group of pregnant women who met the diagnostic 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: age, body mass index before pregnancy, weight and 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 necessary during pregnancy to actively understand the effects of GDM. Further understand the risk factors and their impact on pregnancy outcome, strengthen the attention of pregnant women to GDM. Correct guidance and age-appropriate pregnancy are important guarantees for the health of mothers and children.

58. A Comparative Assessment of Dexmedetomidine and Clonidine in Elective Surgical Procedures under General Anaesthesia
Ushma K Baranda, Mikita Chirag Baranda, Misha B Agarwal, Sheetal Baranda
Abstract
Background and Objectives: Introduction: Alpha-2 agonists have gained widespread usage in the field of anesthesia, serving as adjuncts. Dexmedetomidine exhibits eightfold greater selectivity for alpha-2 receptors in comparison to clonidine. The primary objective of this study was to contrast the impacts of clonidine and dexmedetomidine on hemodynamic stability, anesthetic requirements, and recovery characteristics during general anesthesia for surgeries. Material and Method: 156 participants falling within American Society of Anesthesiologists (ASA) grade I and II, aged between 18 to 60 years, scheduled for surgeries under general anesthesia, were enrolled. They were randomly assigned to two groups, each comprising 78 patients. Group C received an intravenous bolus of clonidine at a dosage of 2 μg/kg over 10 minutes, followed by normal saline infusion. In contrast, Group D received an intravenous bolus of dexmedetomidine at a dosage of 1 μg/kg over 10 minutes, followed by a dexmedetomidine infusion at a rate of 0.5 μg/kg/hr. Evaluation of hemodynamic parameters, anesthetic requirements, and recovery profiles was conducted. Results: Both clonidine and dexmedetomidine demonstrated sustained intraoperative hemodynamic stability, with no discernible statistical distinctions. Both agents exhibited comparable efficacy in reducing the requirement for anesthetic agents and minimizing blood loss. Moreover, there were no significant differences between the two groups concerning recovery profiles and adverse effects. Notably, Group D exhibited a significantly shorter extubation time compared to Group C. Conclusion: Dexmedetomidine and clonidine exert analogous effects on hemodynamic stability, anesthetic requirements, and recovery profiles in the context of surgeries under general anesthesia.

59. A Study of Caudal Epidural Dexmedetomidine with Tramadol as an Adjuvant to Ropivacaine 0.25% for Postoperative Analgesia in Children Undergoing Infraumbilical Surgeries
Hetal Chaudhari, Kinjal Ashokbhai Vaghela, Viralkumar Ashokbhai Vaghela, Krunal Gamit
Abstract
Background and Objectives: Good pain control after surgery is important to prevent negative outcomes of postoperative pain. Many different modalities to treat the paediatric postoperative pain. The main objective of the current study is to compare the caudal epidural dexmedetomidine with tramadol as an adjuvant to ropivacaine 0.25% for postoperative analgesia in children undergoing infraumbilical surgeries. Material and Method: The study was conducted in 60 paediatric patients randomly allocated in two groups each having 30 patients. All patients underwent pre anaesthetic check-up the day before surgery and all routine investigations like CBC, RBS, and Urine, if needed s. creatinine were advised. Patients were kept NBM for at least 6 hours for solid food and 2 hours for clear fluid. Child was taken in OT after psychological reassurance. All standard monitors (ECG, NIBP, and SpO2) were applied under Sevoflurane inhalation. An intravenous cannula was secured and crystalloid like DNS solution was started. General anaesthesia was given. Results: This prospective double blind study was carried out in 60 ASA I-II paediatric patient undergoing infra umbilical surgeries for postoperative analgesia in a two years. Patient in our study were demographically comparable in both groups. We have selected only infra-umbilical surgeries. Most of the surgeries were hypospadias repair and open ureteric reimplant in both groups. The type of surgery done in both group were comparable which are not statistically significant. In our study, we also used Dexmedetomidine (1μg/kg) as an additive to ropivacaine as caudal analgesia. Duration of analgesia in-group RD was 14.57±2.45hrs, which was longer than tramadol group. Conclusion: Thus we can conclude that addition of Dexmedetomidine (1μG/kg) with Ropivacaine in caudal block significantly prolong the duration of postoperative analgesia as compared to Tramadol (2mg/kg) for children undergoing infraumbilical surgeries and reduces the postoperative analgesic.

60. A Study of the Correlation of PANBIO Unit with Biochemical and Haematological Parameters of Laboratory-Confirmed Leptospirosis Cases in Tertiary Care Centre in Dadra and Nagar Haveli
Patel B C, Babariya M J, Kamath N, Patel DN
Abstract
Background: Leptospirosis, an infection caused by the spirochete Leptospira interrogans, is a neglected tropical illness. It is one of the disorders that must be reported. It is often misdiagnosed or not identified in India and other tropical nations. This research aims to establish a relationship between Panbiounit and biochemical and haematological markers in laboratory-confirmed leptospirosis patients. Material and Methods: This observational research was done from July 2019 to November 2020 at the microbiology department of a tertiary care hospital and included 80 clinically suspected and diagnosed cases of leptospirosis. Using Epi info version 7 software, socio-demographic, biochemical, and haematological data were researched and evaluated. Results: In the present study, the participants’ mean age was 38.8 ± 17.1 years. Among them, 53 (66.25%) were male while 27 (33.75%) were females, 31 (38.75%) were B positive, 24 (30.00%) were O positive, 20 (25.00%) were A positive and 05 (6.25%) were A.B. positive. HbS Antigen was reactive among 02 (2.5%) patients, while it was Non-reactive in 78 (97.5%) patients. Leptospirosis patients had significant anaemia, leucocytosis, and elevated liver and renal parameters. In the present study, there was a significant Correlation of the Pan Bio Index with Serum potassium (r=0.23, p-value 0.04), Serum Creatinine (r=0.38, p-value 0.001) and BUN (r=0.27, p- value 0.017). Conclusion: When someone presents with fever and jaundice, leptospirosis is a significant possibility in D.N.H region. Haematological abnormalities in leptospirosis patients included anaemia, leukocytosis, increased liver, and high renal parameters. There was a strong correlation between the Pan Bio Index and serum potassium, serum creatinine, and blood urea nitrogen.which indicate the severity of leptospirosis & On the basis of liver and renal functions, a hospital can develop its own clinical algorithm to suspect the case of leptospirosis.

61. A Cross-Sectional Study to Assess the Role of Ultrasound for Evaluating Adult Neck Masses
Nirvan Sharma, Bijendar Kumar, Dr Praveen Singhal, R.C.Yadav
Abstract
Introduction: In clinical practice, neck masses in adults are a common occurrence. High-resolution ultrasonography plays a crucial role in the diagnostic process for these masses. This study was conducted to assess the effectiveness of high-resolution ultrasonography in the evaluation of neck masses. Material and Methods: This study was conducted in the Department of Radio diagnosis in coordination with the Departments of E.N.T, Surgery, Department of Oncology and Pathology at the National Institute of medical sciences and research and its teaching hospital. A total of 50 patients with palpable neck masses were included in our study. Results: A total of 64 patients with a visible or palpable neck mass and had ultrasound as part of their work up met inclusion criteria; 40 were female, and 24 were male with an average age of 46 ± 16 years. The study population consisted of 76.6% from rural area and the rest 23.44% from urban settlemnets as the study seeting, NIMS Hospital is establised in rural background. Malignancy was diagnosed in 22 patients through FNA, core or open biopsies. The remaining 42 patients were classified as having benign etiologies either through tissue sampling (n = 18) or clinical impression and follow up (n = 24). Conclusion: In our research, patients who came in with a noticeable or tactile neck lump could circumvent the need for cross-sectional imaging or tissue biopsy, provided the ultrasound showed characteristics indicative of non-malignant pathology. These findings imply that ultrasound can serve as a valuable tool in the preliminary assessment and treatment plan for adults who present with a neck lump.

62. The Role of Port Site Oxytocin in Alleviating Postoperative Pain after Laparoscopic Surgery under General Anaesthesia
Sonali Naringrekar, Nitinkumar D Chaudhari, Ravi Shaileshkumar Patel, Priyanka Sondarva
Abstract
Background and Objectives: Recently, oxytocin has garnered recognition as a pivotal mediator of endogenous analgesia. This study aims to evaluate the efficacy of pre-emptive subcutaneous oxytocin infiltration at port sites in reducing post-operative pain, contrasting its effectiveness with post-operative infiltration in patients undergoing laparoscopic surgeries. Methods: This randomized controlled study involved 88 patients, selected based on predefined inclusion and exclusion criteria. Participants were randomly assigned to two groups: the study group, receiving preincisional subcutaneous Inj. Oxytocin at each port site incision, and the control group, receiving post-surgical subcutaneous Inj. Oxytocin at each port site incision. Each group comprised 44 patients. Intraoperative hemodynamic parameters, surgery duration, analgesia characteristics, and post-operative pain intensity assessed using the Visual Analogue Scale (VAS) during recovery and 24 hours post-surgery were recorded. Results: Both groups exhibited comparable demographic and general clinical characteristics. The study group demonstrated significantly lower postoperative pain intensity at 2, 4, 6, and 24 hours compared to the control group. The study group also displayed a notable attenuation of hemodynamic response (mean heart rate, systolic and diastolic blood pressure) during surgery, a response not observed in the control group. Conclusion: Pre-emptive/preincisional subcutaneous oxytocin infiltration at port sites effectively reduced post-operative pain in adult patients undergoing laparoscopic surgeries under general anaesthesia when compared to controls. Additionally, this intervention demonstrated effectiveness in blunting the cardiovascular response to intra-operative nociceptive stimuli in contrast to the control group.

63. Optic Nerve Morphometry in Individuals with Elevated Intracranial Pressure: A Prospective Study
Asheesh Kumar Gupta, Sneha Suresh, Manish Rathore, Naresh Bajaj
Abstract
Background and Objectives: Elevated Intracranial Pressure (ICP) is a frequently encountered condition in the pediatric population, arising from both neurological and non-neurological causes. Prompt identification of elevated intracranial pressure is imperative for the proper implementation of therapeutic measures. The non-invasive point-of-care tool of interest in this study is the ultrasonographic measurement of the optic nerve sheath diameter (ONSD). The primary objective of this research was to assess the ONSD in children admitted to the PICU. Methodology: This hospital-based observational study employed a complete enumeration technique, involving patients aged 2-14 years admitted to the pediatrics department for over 48 hours. Children meeting the clinical criteria for raised ICP (Muir’s criteria) and supported by neuroimaging constituted the raised ICP group. ONSD measurements were taken on Day 1 (within 24 hours of admission). Results: A total of 110 patients were enrolled. The mean ONSD was significantly higher (4.89 ± 0.79) in patients with raised ICP compared to normal children. Conclusion: Elevated ICP represents a significant neurological condition in the pediatric population, associated with substantial morbidity. Utilizing trans-orbital ultrasound to measure ONSD demonstrated excellent discriminatory performance in detecting elevated ICP.

64. Changing Maxillary Intercanine, Interpremolar and Intermolar Distance in Male and Females in the Age Range of 16 to 30 Years: A Preliminary Study of Sexual Dimorphism
Deepa V Sommanek, Sagar V Hansalia
Abstract
Objective: To determine age and sex from the maxillary dimensions. Methods: The study was conducted on 90 patients (45:45, M:F) in the age range of 16 to 30 years, each of known chronological age and sex were collected, In the group I, II and III, subjects were in the age range of 16 to 20 years, 21 to 25 years and 26 to 30 years respectively with 15 (50%) males and 15 (50%) females in each group. Maxillary plaster cast of each subject was prepared and each cast was assessed and measured, a minimum of two times using digital Vernier caliper and intercanine distance, interpremolar distance  intermolar distance and depth of palate are used to measure maxillary dimensions and to evaluate the reliability of it in age and sex determination. Results: mean maxillary intercanine width was statistically said to be significant for sex determination in group I (p value-0.0171), mean maxillary interpremolar width in 2nd premolar region was statistically said to be significant for sex determination in group I (p value-0.0323) and group II (p value-0.0503), mean maxillary intermolar width in the 1st and 2nd molar region was statistically very significant for sex determination in group I (p value-0.0068, 0.0043 respectively). Conclusion: All maxillary arch width parameters except mean interpremolar width in the 1st premolar region helps to determine sex of chronological age between 16 to 20 years while mean interpremolar width in the 2nd premolar region helps to determine sex of chronological age between 21 to 25 years. However, not a single parameter helps to determine sex of chronological age between 26 to 30 years.

65. Isolation and Identification of Fungi from Patients Suffering from Superficial Skin Infection in a Tertiary Care Hospital
Pandey GK, Kamath N, Patel B C, Babariya M J, Bin Najeeb MA, Saharan K
Abstract
Introduction: Superficial fungal infections are often seen in day-to-day clinical practice, and their prevalence continues to rise worldwide. The present study attempts to find out the distribution of superficial fungal infection with respect to socio-economic and demographic variables among a symptomatic group. Objective: The present study was undertaken with a view to isolate the fungi from patients suffering from superficial skin infection attending Dermatology OPD at NAMO Medical Education & Research Institute Silvassa, DNH and to assess the clinical profile, prevalence of dermatophytes infection in study population. Methods: A clinical and mycological study of superficial mycosis was conducted on 100 cases (65 male & 35 female). Direct microscopy by KOH mount and culture was undertaken to isolate the fungal pathogen in each case. Further, LPCB mount was performed for microscopic morphology. Result: A total of 100 patients were enrolled in the study. Dermatophytosis was the commonest superficial fungal infection in 47 cases), followed by Candidiasis in 8 (14.5%) cases. Commonest clinical presentation was T. corporis in 32 (39%), followed by T. cruris in 27 (33%) cases. The commonest dermatophyte cultured was T. mentagrophyte in 22 (22%) followed by T. rubrum in 15 (14.9%) cases. Non Dermatophytic Molds (NDM) were isolated in 3/55 (5.4%) cases. The commonest NDM isolated was Exophiala. Conclusion: We conclude that along with dermatophytes, non dermatophytic fungus are also emerging as important cause of superficial mycosis. Direct microscopy and culture both are important tools for diagnosis of fungal infections.

66. Comparison of Dexmedetomidine and Esmolol Induced Hypotension in Functional Endoscopic Sinus Surgery
Komal Joshi, Sharad Kumar Mishra
Abstract
Introduction: Functional endoscopic sinus surgery (FESS) is currently a broadly performed minimal invasive procedure and to reduce blood loss during operation, a new technique is employed called as the controlled hypotension. Different drugs are used to attain controlled hypotension with dexmedetomidine (DEX) and esmolol being two important ones among them. So, current research was aimed to compare the effectiveness of DEX and esmolol in FESS. Material and methods: Present study was a single blinded, randomized and prospective comparative study done on the patients visiting Adarsh Hospital and Superspeciality ENT Research Centre, Jamudi, Azamgarh, UP. 66 patients fulfilling inclusion criteria were included into the study and were divided randomly into 2 groups i.e. based on the drug administered. Demographic data and variables to assess efficacy of the drug were noted and analyzed. A “P-value <0.05 was considered as statistically significant”. Result: The “average category scale” for operative field quality in present study was similar in both the groups. Our study observed no any significant variation in the blood volume lost and mean duration of surgery among both the groups. DEX group in current study had significantly higher “emergence time”, sedation scores, time of total upturn from anesthesia and time of first analgesics demand than esmolol group. Conclusion: This current study proved both DEX and esmolol as effective and safe drugs for having bloodless operative field during FESS. Our study documented DEX to have more efficacy than esmolol as hypotensive agents for controlled hypotension during FESS.

67. A Comparative Study of Wound Closure by Skin Sutures versus Skin Staplers
Anupam Shukla, Rohit Kiran Phadnis, Pawan Kumar Hosamani, Abhilash Reddy. K
Abstract
Background: Wound closure holds equal importance alongside other surgical procedures. Beyond the necessity of creating a robust and healthy scar, the surgeon must guarantee its visually pleasing appearance. Skin staples provide an alternative to traditional sutures, and this study has contributed to underscoring the advantages they offer in achieving this goal. Methods: Among the 100 participants, half (50) underwent skin closure using stainless steel skin staples, while the other half (50) received non-absorbable Polyamide mattress sutures in a randomized manner. All participants received a single mandatory pre-operative parenteral antibiotic dose one hour before the incision. On the third day following the surgery, the wounds were assessed for signs of inflammation, infection, and any opening. Subsequently, participants were re-evaluated for infection, wound gap, and inflammation during a follow-up examination on the seventh day. The wounds were once again evaluated for cosmetic appearance using the Visual Analog Score at the one-month follow-up. Results: In the suture group, the majority of cases, constituting 88%, exhibited normal healing. A small percentage, 2%, displayed normal healing but with mild bruising or erythema. Additionally, 2% of cases in this group showed erythema along with other signs of inflammation, and 6% developed pus at the site of the wound. In contrast, in the stapler group, 76% of cases achieved normal healing. A slightly higher proportion, 6%, demonstrated normal healing but with mild bruising or erythema. Moreover, 4% of cases in this group displayed erythema along with other signs of inflammation. Conclusion: In this study, we compared the use of skin staplers and sutures in various wound closures. We found that the incidence of postoperative wound infection was higher with skin staplers than with sutures. Sutures also provided better cosmesis than skin staplers. Additionally, skin staplers saved operative time, but sutures took longer to apply.

68. A Comparative Study between Clotrimazole Drops and Acetic Acid Wash as a Treatment for Otomycosis
Ambika N, Mandagiri Naga Chaitanya, P Srithi Goud, Deepika Vantaram, C.H. Sahithi, Shalini Singh
Abstract
Background: Otomycosis is infection caused by fungi in the external auditory canal and is frequently diagnosed by clinical presentation. There was no common agent in treating otomycosis even though many studies were conducted to conclude the effective antifungal agent. Aim: This study was conducted to compare rate of improvement of otomycosis treatment with topical medications such as clotrimazole and acetic acid wash. Materials and Methods: This study was conducted in 100 patients during the period of June 2022 to June 2023. After receiving the ethical committee approval, this study was initiated. All the patients were included in the study who were referred to ENT Department Malla Reddy Institute of Medical Sciences Hyderabad. A group (Group A) of patients were treated after cleaning the ear canal with suction with 8 drops of 1% clotrimazole (ear drop) each 8 h. Other group (Group B) of patients were treated with acetic acid wash. Results: Males (56) were more than females (44) in the present study. Aspergillus Spp were observed in 60 patients and Candida Spp were observed in 40 patients. Recurrence after 14 days in group B was 4% and in group A was 6%. Between two groups, no significant difference was observed in rate of recurrence (P=0.71).  Recurrence after 21 days in group B was 8% and in group A was 6%. Between two groups, no significant difference was observed in rate of recurrence (P=0.76). Duration of treatment in group-B is significant when compared to others. Conclusion: Both clotrimazole and acetic acid have shown similar therapeutic efficacy in otomycosis treatment however, acetic acid is better suggested to be opted due to its significantly shorter duration of treatment and to reduce the indiscriminate use of antibiotics.

69. Significance of Axial Length in Retinal Venous Occlusions
Kondam Swetha, K. Bharathi, Y. Rajarajeshwari
Abstract
Introduction: Association between hyperopic refractive error and retinal venous occlusion has been demonstrated. In most of the studies, hyperopia was measured in terms of refractive errors. Aims: Present study is conducted to know whether any significance of axial length is there in retinal vein occlusions.  Materials and Methods: This is a prospective, case control study in Patients attending Ophthalmology department, diagnosed as CRVO/ BRVO. 60 patients [30 CRVO patients and 30 BRVO patients] diagnosed as CRVO or BRVO in 24 months were included in the study. Results: The mean axial length of affected eyes of CRVO patients is 22.16mm [SD 0.98] that of unaffected eyes is 22.44mm [SD 0.87]. The p-value is 0.0002. The difference between the 2 groups is statistically significant the mean axial length of right eye of the control group is 23.03 mm [SD 0.76]. The mean axial length of affected eyes of CRVO patients is 22.16mm [SD 0.98]. The p-value is 0.0004. The difference between in the CRVO affected eye and the control group is statistically significant. The mean axial length of affected eyes of BRVO patients is 22.49mm [SD 0.70] that of unaffected eyes is 22.63mm [SD 0.73]. The p-value is 0.0661. The difference between the 2 groups is not statistically significant. The mean axial length of right eye of the control group is 23.03 mm [SD 0.76]. The mean axial length of affected eyes of BRVO patients is22.49mm [SD 0.70]. The p-value is 0.0063. The difference between in the BRVO affected eye and the control group is statistically significant. The present study demonstrates that significantly shorter axial lengths in the CRVO and BRVO affected eyes than the control eyes. Conclusions: It is concluded that shorter axial length could be an additional risk factor in the pathogenesis of CRVO and BRVO. The reason could be in eyes with shorter axial lengths, the retinal vein and artery are more tightly confined as they pass through the lamina cribrosa, which may impair blood flow in the vein.

70. Bacteriological Profile in Infected Orthopedic Implants
Geetha Kaipa, Kiran Babu Reddem, Babul Reddy, K Sameera
Abstract
Aim: To study and characterize the bacterial pathogens and its current antibiotic sensitivity and resistance patterns in patients with orthopedic implant related infections. Materials and Methods: The present study on bacteriological profile and common bacterial infections in Post-operative cases with special reference to implants was carried out in department of microbiological combined with orthopedics department in tertiary care hospital. A total 428 patients who underwent orthopedic surgery with implant were recruited in the study. Informed consent was taken from the patients. Samples received in the central laboratory of the hospital were also included in the study. Results: In 77 culture positive samples, 35 samples are Gram positive cocci infection. 42 patients have Gram negative bacilli infection. Staphylococcus aureus is the most common organism isolated in culture. Gram positive organism percentage of infection is 45%, Gram negative organism percentage of infection is 54%. In Gram positive organism MRSA was isolated in culture of 17 patients (22%), MSSA was isolated in culture of 6 patients (7%), MR CoNS was isolated in culture for 5 samples (6%), CoNS was isolated in Culture for 5 samples (6%), Enterococci was isolated in culture for 2 samples (3%). In MRSA 82% of isolates are sensitive to Doxycycline, 58% were sensitive to Gentamicin, 47 were sensitive to Co-trimoxazole and 35% were sensitive to Erythromycin. All the isolates of MRSA were sensitive to vancomycin and linezolid. In Gram negative organism Pseudomonas is the most common organisms isolated in culture followed by Klebsiella, Proteus, E.coli, Citrobacter and Acinetobacter. In Pseudomonas all isolates were sensitive to Amikacin, Gentamicin, Ceftazidime. 81% were sensitive to Ciprofloxacin, 36% were sensitive to Cefotaxime. In Proteus 87% of the isolates were sensitive to Amikacin, 63% were sensitive to Gentamicin, 87% were sensitive to Ciprofloxacin, and 38% were sensitive to Cefotaxime. In E.coli 87% were sensitive to Amikacin, 75% were sensitive to Gentamicin, 63% were sensitive to Cefotaxim, 65% were sensitive to Ciprofloxacin, and 37% of the isolates are sensitive to Co-trimoxazole. Conclusions: Early intervention by proper selection of antibiotics according to culture and sensitivity will reduce the infection rate and hospital stay.

71. A Comparative Study of Wound Closure by Skin Sutures versus Skin Staplers
Anupam Shukla, Rohit Kiran Phadnis, Pawan Kumar Hosamani, Abhilash Reddy. K
Abstract
Background: Wound closure holds equal importance alongside other surgical procedures. Beyond the necessity of creating a robust and healthy scar, the surgeon must guarantee its visually pleasing appearance. Skin staples provide an alternative to traditional sutures, and this study has contributed to underscoring the advantages they offer in achieving this goal. Methods: Among the 100 participants, half (50) underwent skin closure using stainless steel skin staples, while the other half (50) received non-absorbable Polyamide mattress sutures in a randomized manner. All participants received a single mandatory pre-operative parenteral antibiotic dose one hour before the incision. On the third day following the surgery, the wounds were assessed for signs of inflammation, infection, and any opening. Subsequently, participants were re-evaluated for infection, wound gap, and inflammation during a follow-up examination on the seventh day. The wounds were once again evaluated for cosmetic appearance using the Visual Analog Score at the one-month follow-up. Results: In the suture group, the majority of cases, constituting 88%, exhibited normal healing. A small percentage, 2%, displayed normal healing but with mild bruising or erythema. Additionally, 2% of cases in this group showed erythema along with other signs of inflammation, and 6% developed pus at the site of the wound. In contrast, in the stapler group, 76% of cases achieved normal healing. A slightly higher proportion, 6%, demonstrated normal healing but with mild bruising or erythema. Moreover, 4% of cases in this group displayed erythema along with other signs of inflammation. Conclusion: In this study, we compared the use of skin staplers and sutures in various wound closures. We found that the incidence of postoperative wound infection was higher with skin staplers than with sutures. Sutures also provided better cosmesis than skin staplers. Additionally, skin staplers saved operative time, but sutures took longer to apply.

72. Prevalence of Carbapenamase Resistant Kebseilla Pneumoniae and Escherichia Coli by Modified Carbapenem Inactivation Method in a Tertiary Care Hospital of North India
Shubhdeep Kaur, Harsh Yadav, Shailesh Kawale, Arun Rajawat
Abstract
Background: Carbapenems are the last resort of antibiotics used in an infection caused by multidrug-resistant Enterobacteriaceae, but current increase in the prevalence of carbapenemase producing Enterobacteriaceae pose a clinical challenge. Therefore, early detection of these drug resistant organisms is important for instituting early end effective treatment to the patient to prevent from various complications. Therefore, rapid and accurate methods to detect these organisms in any clinical microbiology laboratory, including those in resource-limited settings, are essential to prevent and contain their spread. Methods: The present study was cross sectional descriptive study was conducted in the department of microbiology for period of six months. The samples of indoor patients were included in the study and processed by conventional microbiological methods. All the isolates of Kebseilla pneumoniae and Escherichia coli isolated from various samples, which were resistant to the carbapenems (Meropenem) were further subjected to the mCIM test to detect the carbapenemase production as per CLSI M100 2017 standards. Results:  A total 550 Gram Negative Isolates, 295 were isolates of Kebseilla pneumoniae and Escherichia coli. Out of these 295 isolates  37% and 27.4% of Kebseilla pneumoniae and Escherichia coli showed the production of Carbapenemase enzyme. Conclusions: The prevalence of CRE has been emerged worldwide. So, formulating an antimicrobial policy with its strict implementation and regular surveillance must be establish in every institution to decrease its emergence.

73. Self-Care Practices and its Effect on Glycemic Controlamong Type-II Diabetes Mellitus Patients
Rupendra Pal Singh Rathore, Ravi Shekhawat, Anubhav Sharma, Sunil Gora, Kapil Garg, Mayank Jain
Abstract
Background: Diabetes is a non-communicable disease that necessitates daily self-management through the establishment and maintenance of a continuum of care in order to achieve optimal health outcomes. It is commonly understood that diabetes self-care practice is critical in the management of the disease. However, the magnitude and determinants of self-care practices are not well evaluated at the community level. Objectives: To access the level of self-care practice and its effect on glycemic control among type 2 diabetes mellitus patients. Method: A community based cross-sectional study was conducted at Urban field practice area of Jhalawar Medical Colleg during May 2023 to October 2023 on 440 confirm patients of Type II DM. Pretested semi structured questionnaire was used for obtaining information regarding socio demographic profile, disease history, Diabetes Self-Management Questionnaire (DSMQ). Blood sample was collected following standard protocol for HbA1c to measure their glycemic control of patient. Results: Out of 440 diabetics, 58.4% were male and 41.6% were female. Mean age of the patients was 52.48±10.8 years. Mean duration of diabetes was 9.88 ± 4.34 years. More than half of the diabetics (262, 59.55%) had good glycaemic control. Most common self-care activity was taking medication (82.5%) as advised. DSMQ sum scale was significantly different among good and poor glycemic control groups (p value=0.01). Conclusion: Nearly half of patients following self-care diabetes management practices. Diabetes self-care practices are significantly associated with good glycemic control among diabetics.

74. An Institutional Study of Pancytopenia in Children
Amitabh Ranjan, Sonal Verma
Abstract
Background: The differential diagnosis of Pancytopenia varies according to the geographical distribution and still remains a diagnostic dilemma for the Pathologist and the Paediatrician both. The condition is reversible and easily treatable if identified early. Aim: To study the clinical and haematological profile of children presenting with pancytopenia and to evaluate the causes in our setting. Material and Methods: The present study was carried out in the Department of Pathology and Paediatrics of a tertiary care hospital in North India from January 2022 to June 2023. Total 61 cases of children with pancytopenia were subjected to bone marrow aspiration after routine haematological investigations (like Complete Blood Count) including peripheral blood smear examination (PBS). Results: The present study comprised of 61 children in the age group of 2 years to 14 years. Megaloblastic anemia was the commonest cause of pancytopenia and responsible for 38 cases (62.3%). Acute lymphoblastic leukaemia accounted for about 07 cases (11.5%). Aplastic anemia was responsible for 06 cases (9.8%). Kala-azar, Malaria, Disseminated tuberculosis and Enteric fever accounted for about 6.6%. 4.9%, 3.3% and 1.6% cases respectively. Conclusion: Bone marrow aspiration is crucial to arrive at a diagnosis of pancytopenia. Even in the absence of a final diagnosis, BMA can help the clinician in their approach to diagnosis and management of the patient.

75. Evaluation of the USG Guidance in Percutaneous Needle Puncture in Interventional Radiology: A Retrospective Study
Ajit Kumar
Abstract
Aim: The aim of the present study was to assess the role of USG guidance in percutaneous Needle puncture in interventional radiology. Material & Methods: A retrospectively analysed 2000 consecutive patients who underwent diagnostic or therapeutic intervention in division of Department of Radiology There were 1100 males and 900 females Age ranging from 1 month to 86 years with mean age of 46 years. All the patient had undergone vascular or other target access including non-pulsatile targets under USG guidance with single wall seldinger technique. Then patient either underwent diagnostic angiogram or interventional therapeutic procedure. Patient are assessed immediately after procedure and several days after that for any puncture site related complications. Results: We were successful in gaining the targeted access in all patients (100% success rate). Total complication rate was 1.5%.All of complications was treated conservatively. Femoral artery was the most common puncture site followed by saphenous vein over the ankle. Conclusion: The importance of image guidance comparing with historical evidence. We strongly recommend use of USG guidance for Percutaneous puncture. Future studies will optimise the technique further to maximise the benefits to the patients.

76. Assessment of Sepsis and Acute Kidney Failure Outcomes: An Observational Study
Arun Kumar, Nishant Kumar Singh
Abstract
Aim: The aim of the present study was to assess sepsis and acute kidney failure outcomes investigated in Bihar region. Material & Methods: The present study was conducted in AIIMS, Patna, Bihar, India. Among 300 patients with sepsis and septic shock, 200 patients developed AKI. We retrospectively analyzed the data of all the adult patients (>18 years of age) who visited the Emergency Department. Results: The mean age of patients with septic AKI was significantly higher than that of patients without AKI (p<0.001). Patients with AKI were more likely male (p=0.017). DM (p=0.004) and HTN (p<0.001) were more frequently associated with the development of septic AKI, whereas there were no significant differences in BMI and history of smoking and alcohol consumption. Those who developed AKI had higher baseline serum creatinine levels (p<0.001) and lower GFR (p=0.002) than those who did not developed AKI. Among medications that might affect the renal function, ACEI/ARB (p<0.001) and statins (p=0.004) were more frequently used in AKI group. Although the percentage of patients who used aminoglycosides and NSAIDs was higher in AKI group, there was no statistical significance. The frequency of septic shock was significantly higher in the patients with AKI than were those without AKI (p<0.001). Accordingly, MAP was lower in the AKI group (p<0.001). Patients with AKI had a more severe illness with higher APACHE III scores than patients without AKI had (p<0.001). White blood cell (WBC) (p=0.025) and platelet (p=0.004) counts were significantly lower in AKI group. The other physio- logic and laboratory data collected in this study indicated the tendency of more evident clinical deterioration among patients who developed AKI, although this was not statistically significant. Conclusion: AKI developed in more than half of patients with sepsis and septic shock. Old age, pre-existing CKD, presence of shock, positive blood culture results, use of ACEI/ARB, and low WBC and platelet counts were associated with an increased risk for the development of septic AKI.

77.  Paediatric Long Bone Fractures Managed with Elastic Intramedullary Nails
Patel Nihar Anilkumar, Seema Suketu Shah, Lata Jha, Mehta Rajeshri Rajendra, Patel Taralben Manishkumar
Abstract
Background and Aim: For the treatment of different paediatric long bone fractures, an alternate technique known as titanium elastic nailing, or elastic intramedullary nailing, is used. For youngsters older than six, titanium nails are favoured over stainless steel and plaster cast nails. The purpose of the current study was to examine the clinical results of children treated with elastic intramedullary nails for long bone fractures. Material and Methods: In this study, the medical records of children (ages 2 to 15) who had two years of hospitalisation and treatment for unilateral femur, tibial, or forearm fractures treated with elastic intramedullary nails were retrospectively evaluated. All of them were treated with intramedullary elastic nailing. The medical records revealed the union times and problems. Results: There were sixty patients in the trial during its duration. Of these, 66.6% were men and 51.6% were under the age of ten. Thirty percent reported a car accident, and one incidence (3.33%) involved physical abuse. With a range of 6 to 12 weeks, the average period of union was 10 weeks. For 35%, it was 6 to 8 weeks; for 33.3%, it was 9 to 10 weeks; and for 31%, it was 11 to 12 weeks.six of the patients. A functional status evaluation was conducted 24 months after surgery using the Flynn criteria. 36.6% of respondents rated it as great, 43.3% as good, and 20% as fair. There were no examples with inadequate functional results. Conclusion: Our experience leads us to believe that TEN should be the initial approach to treating paediatric long bone fractures, particularly in older children (above the age of six and up to 16). Moreover, surgical therapy with TEN may be favoured in situations where sustaining reduction with closed casting presents a difficulty or interferes with nursing care and rehabilitation.

78. Effectiveness of Topical Tranexamic Acid in Total Knee Replacement: A Case Control Study
Harshit Jain, Abhishek Kishore, Umang Agrawal
Abstract
Introduction: Total knee replacement (TKR) is a complex procedure that results in significant blood loss throughout the intraoperative and postoperative phases. The purpose of this trial was to see if tranexamic acid (TXA) could reduce perioperative blood loss and the requirement for blood transfusions in patients undergoing primary TKR. Materials and Procedures: This study included 60 patients of primary unilateral TKR performed at a tertiary care institute. The patients were divided into two groups of 30 each, at random. Patients in Group A received TXA intraoperatively before to knee closure. Group B acted as the control group, consisting of patients who did not receive TXA. They were both administered 1gm IV TXA. At 24 and 72 hours following surgery, patients were evaluated for postoperative blood loss, haemoglobin reduction, the need for blood transfusion, and any adverse effects of TXA. Result: The mean decline in postoperative haemoglobin concentration was 0.6 gm/dL (24 hours) and 1.3 gm/dL (72 hours) in group A, with a mean postoperative drain collection of 294.3 40.6 ml (24 hours) and 336 51.3 ml (72 hours). In group B, the mean decline in postoperative haemoglobin was 1.5 gm/dL (24 hours) and 2.3 gm/dL (72 hours), with a mean drain collection of 494 37.7 ml (24 hours) and 502.5 39.7 ml (72 hours) (p 0.001). In group A, four patients required blood transfusions, but 13 patients in group B required blood transfusions (p = 0.0004). Conclusion: The data from this trial show that using topical TXA preoperatively in TKR considerably lowers post-operative blood loss and the requirement for post-operative blood transfusion without significantly changing patients’ liver and renal functions or coagulation profiles.

79. Functional Outcome Assessment of Type III and IV Radial Head Fractures Treated by Radial Head Prosthesis: A Retrospective Observational Study
Randhir Kumar, Govind Mohan Jee
Abstract
Aim: The aim of the present study was to evaluate the functional outcome of type III and IV radial head fractures treated by radial head prosthesis. Material & Methods: A retrospective study included 70 patients of type III and IV radial head and neck fractures according to Mason’s classification. They were admitted and treated in the Department of Orthopaedics with radial head prosthesis over the duration of 1 year. Results: Out of 70 cases, 42 cases were <40 years and 28 cases were >40years. The mean age was 36.4 years. Maximum age was 54 years, minimum age was 30 years. Majority were females as compared to males. Mechanism of injury most of the cases i.e 70% were due to history of fall and remaining were due to RTA. 52 cases (74.28%) were right side dominant and 18 cases (25.72%) were left side dominant. In our case study group, out of 70 cases, 56 cases (80%) were under Modified Mason’s classification type Ill and 11 cases (20%) were under Modified Mason’s classification type IV. Out of 70 cases, 55 cases (78.58%) were not associated with any ligamentous injury, 7 cases of LUCL and 8 cases of MCL injury was noted. The P value of flexion, extension, pronation and supination was found to be very significant. 47 cases (67.15%) had MEPI score (Mayo Elbow Performance Index) >90 which indicates excellent result, 16 cases (22.85%) had MEPI score 75-89 which is good result and 7 cases (10%) had MEPI score 60-74 which indicates fair result. Conclusion: Radial Head Prosthesis is a viable option in communited and irreparable radial head fractures. Proper preoperative planning, good Intraoperative technique and rigorous postoperative rehabilitation give predictable results.

80. Evaluating Association of Hypocalcemia with Duration of Phototherapy in Neonates with Unconjugated Hyperbilirubinemia
Ajit Kumar Singh, Sachin Kumar, Nagendra Prasad Gupta
Abstract
Aim: The aim of the present study was to assess the prevalence of hypocalcemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcemia with duration of phototherapy. Material & Methods: A prospective observational study conducted over a period of 18 months among 100 neonates (both term and preterm) in the Department of Paediatrics. Results: The mean age of preterm and term neonates was 116.14±44.88 and 124.26±43.17. There were more males as compared to females in preterm and term neonates. Mean birth weight of preterm and term in this study were 2614.12±248.42 grams and 3264.82±372.98 grams respectively. Similarly, 10 term neonates had hypocalcemia 48 hours after starting of phototherapy. None of the preterm neonates enrolled in the study experienced hypocalcemia after starting of phototherapy. It was observed that occurrence of hypocalcemia was not significantly associated with the duration of phototherapy. On comparing the 0 hours calcium level with subsequent hours, the mean difference in total serum calcium levels in both term, and preterm babies were found to be statistically significant and the difference was seen to be more significant in term babies. Correlation analysis of a duration of phototherapy with hypocalcemia showed a negative but insignificant correlation with a coefficient (r of −0.045 and a p=0.95). Conclusion: A reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.

81. A Study to Assess the Stability of the Nasal Symmetry Achieved by NAM in Unilateral Cleft Lip and Palate (UCLP) Patients: A Longitudinal Assessment
Puja Priyadarshini
Abstract
Aim: The aim of the present study was to assess the stability of the nasal symmetry achieved by NAM in unilateral cleft lip and palate (UCLP) patients. Methods: This research was conducted in the Department of Plastic Surgery and in accordance with the Helsinki Declaration. In this retrospective study, consecutive NAM-treated UCLP patients, whose serial photographs were available, were studied. In this retrospective study, the basal photographs of 30 consecutive NAM-treated UCLP patients were studied longitudinally to evaluate the stability of NAM. Results: In the immediate postcheiloplasty period (T1), the nasal height ratio, the nasal width ratio, hemicolumella height and alar base width ratio were almost perfectly symmetrical, and the mean columella deviation angle was 88.72°. In comparison to the baseline values obtained postoperatively (T1), the loss of symmetry was significant across all parameters at all the time durations (T2, T3, and T4). The mean columella deviation angle was lost by 1.56% at the end of T2 follow-up (p-0.007), 2.80% at the T3 follow-up (p-0.003) and 3.44% at T4 follow-up (p < 0.001). The nostril height on the cleft side was lost by 14.06% at the T2 follow-up (p < 0.001), 18.88% at T3 follow-up (p < 0.001), and 21.87% at the T4 follow-up (p < 0.001). The nostril width on the cleft side increased by 38.12% at the T2 follow-up (p < 0.001), 40.44% at the T3 follow-up (p < 0.001), and 40.28% at the T4 follow-up (p < 0.001). The hemicolumella length on the cleft side was lost by 12.48% at the T2 follow-up (p < 0.001), 18.36% at the T3 follow-up (p < 0.001), and 24.86% at the T4 follow-up (p < 0.001). The alar base width on the cleft side increased by 18.82% at the T2 follow-up (p < 0.001), 26.14% at the T3 follow-up (p < 0.001), and 40.66% at the T4 follow-up (p < 0.001). Conclusion: In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of symmetry. Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides.

82. Clinico-Microbiological and Echocardiographic Assessment of Patients with Infective Endocarditis and New Onset Atrial Fibrillation
Pooja Batra, Priyadarshini Pal Singh
Abstract
Aim: The purpose of this study was to investigate patient characteristics, microbiology, and echocardiographic findings of patients with infective endocarditis and new onset atrial fibrillation. Methods: This study was conducted at Indraprasth Apollo Hospital, Sarita Vihar, New Delhi.  For purposes of analysis and comparison, we distinguished 3 groups according to the type of baseline heart rhythm during hospitalization and previous history of atrial: new onset atrial fibrillation group (n 50), patients with no previous history of atrial fibrillation and who were diagnosed as having new onset atrial fibrillation during hospitalization; sinus rhythm group (n 200), patients without a history of previous atrial fibrillation, who remained in sinus rhythm and who did not suffer atrial fibrillation during hospitalization; and previous atrial fibrillation group (n 50) included patients with previous atrial fibrillation (permanent, paroxysmal, or persistent). Results: Patients with new onset atrial fibrillation were older than those who remained in sinus rhythm. Concerning co-morbidities, chronic renal failure, and chronic obstructive pulmonary disease were more common in new onset atrial fibrillation group than in sinus rhythm group. At admission, heart failure and their radiological manifestations were more common in new onset atrial fibrillation. group, whereas stroke and systemic embolism were equally present in all groups. Interestingly, blood levels of acute phase reactants at admission (C-reactive protein) were higher in patients with new onset atrial fibrillation. The microorganisms found in patients with NAF were not significantly different from those isolated in SR group and PAF group. Vegetations were equally present in groups. Vegetation size was similar in all groups. As regard to the presence of moderate- to-severe valvular insufficiency, no differences were found between patients with NAF and those who remained in SR. Conclusion: In conclusion, the occurrence of NAF in patients with IE was strongly associated with heart failure and higher in-hospital mortality independently from other relevant clinical variables.

83. A Hospital-Based Study to Evaluate Sonographic Features of Invasive Ductal Breast Carcinomas for Prediction of Malignancy Grade: An Observational Study
Vijay Kumar, Ram Kumar Gupta
Abstract
Aim:  The aim of the present study was to evaluate sonographic features of invasive ductal breast carcinomas for prediction of malignancy grade. Material & Methods: The present study was conducted in Department of Radiodiagnosis including 200 solid breast masses which were evaluated by ultrasound for the duration of 2 years. Results: Most common age group was 51-60 years (55%), followed by 60 and more years age group (22%) and 41-50 years age group (20%). Painless mass in breast (75%), Ulceration (16%), Painful mass (24%) were common complaints seen in our study. We noted that 48% patients had duration of symptoms from 6 months to 1 year, while 22% patients had duration of symptoms less than 6 months. Irregular borders, horizontal orientation, circumscribed/lobulated/ microlobulated, hypoechoic patterns, hypovascular, abrupt interfaces, posterior acoustic shadow, microcalcifications, architectural distortion and lymphadenopathy were common findings in all grades of invasive duct carcinoma patients. Conclusion: Malignancy grade of invasive ductal carcinoma can be predicted by heterogeneous echotexture of mass, abrupt interfaces, calcifications, posterior acoustic enhancement and/or presence of reversal/lack of diastolic flow margins.

84. Echocardiographic Predictors of Ventricular Arrhythmias in Patients with Non-Ischemic Cardiomyopathy: An Observational Study
Pramod, Aishwerya
Abstract
Aim: The aim of the present study was to assess the echocardiographic predictors of ventricular arrhythmias in patients with non-ischemic cardiomyopathy. Methods: In this prospective, observational, multicenter, follow up study the study was conducted at Department of Cardiology. we consecutively included patients admitted with first time diagnosis of heart failure and LVEF <40%. We screened 200 patients in the study. The study patients were included in the heart failure subgroup of the study. Results: There were 25% females as compared to males in the study. 16% had primary prevention and 4% had secondary prevention. 80% had LVEF <35%. The primary study outcome, life threatening arrhythmia (SCD, appropriate primary prophylactic ICD shock and sustained VT) occurred in 50 patients. These patients were more frequently males, had higher prevalence of atrial fibrillation, wider QRS and larger ventricular and atrial volume. Furthermore, patients with primary outcome had worse LV systolic function by LVEF and GLS and more pronounced MD (all p < 0.05).  MD was independently associated with the primary outcome when adjusted for age, gender, atrial fibrillation and LV end systolic volume (LVESV) in a multivariate analysis (p < 0.01). By including GLS in the model, both MD and GLS were associated with primary outcome, while LVEF was not an independent marker when replacing GLS. Conclusion: Our study demonstrated that LV GLS has predictive value for VA endpoints in NICM patients, independent and incremental to LVEF. Therefore, the routine use of LV GLS should be considered to noninvasively assess the risk for VA endpoints in NICM patients. Utilising echocardiographic LV GLS may be of particular relevance when cMRI cannot be easily accessed and may provide additional value for patient risk stratification in such instances.

85. A Study Assessing Factors Associated with Anti-Depressant Medication Adherence in Women: An Observational Study
Ravikant Kumar
Abstract
Aim: The aim of the present study was to assess the factors associated with anti-depressant medication adherence in women attending an out-patient psychiatry department. Methods: The present study was conducted at department of Psychiatry  we proceeded by selecting 200 patients who were diagnosed with Depression. They attended the Psychiatry Out Patient Department. Results: Of the 200 subjects, 90 (45%) had mild depression, 94 (47%) had moderate depression and 16 (8%) had severe depression. The mean age of subjects on medication was 38.42 ±3.16 and mean age of subjects not on medication was 32.28 ± 4.36. The mean difference between two groups was statistically significant (P value < 0.001). There was no difference between these groups on any of the parameters, especially the severity of depression. Among the 150 patients who were on not taking medications regularly, 83.34% people had a low education about the nature and course of the illness, 80% people experienced some kind of side effects due to the antidepressant they were taking and 90% people had a poor family support. Conclusion: In this study, severity of depression was not associated with medication non adherence, married status and paid work status are factors associated with adherence to antidepressants. Stated reasons for nonadherence of medications include less education about the nature and outcome of depression, side effect profile and poor family support. Psychoeducation of patients & caregivers, carefully monitoring of medication adherence an ongoing follow-up are crucial to enhance adherence.

86. A Study to Analyze the Possibility of the Diabetogenic Potential of Atorvastatin among Hypercholesterolemic Patients: An Observational Study
Vikas Kumar
Abstract
Aim: The aim of the present study was to analyze the possibility of the diabetogenic potential of atorvastatin among hypercholesterolemic patients. Methods: The present study is a retrospective cohort study conducted in the Narayan Medical College and Hospital, Sasaram, Bihar, India for 6 months. . Informed written consent was obtained from all the study participants in local vernacular language before their inclusion in the study. The study was conducted according to the Declaration of Helsinki. As per the inclusion criteria, a total of 50 study participants were enrolled in the study. Results: Among the 50 study participants, 35 (70%) and 15 (30%) study participants were males and females respectively. The majority of patients were between the age groups of 51–65 years. A total of 36 (72%) of patients received Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers (ACEI/ARBs) followed by low-dose aspirin by 32 (64%) patients. The prevalence of NODM among the study participants on atorvastatin therapy based on glycosylated hemoglobin was 30%. 2% and 4% of the study participants on statin therapy for more than 12 years had shown to be prediabetic and diabetic respectively. Different strengths of atorvastatin were prescribed out of which 40 mg (48%) was commonly prescribed followed by 20 mg (36%). Conclusion: Statins are the most commonly prescribed drug in hypercholesterolemic patients to prevent cardiovascular disorder. Patients on statin therapy should be periodically monitored for glycemic status especially in patients on larger dosage of atorvastatin and also in patients with greater threat for diabetes.

87. Multiple Nonunions / Nerve Palsy / Stiffness Management Difficulties and Strategies – A Case Report
Sandeep V.P, Amar M, Karthik. V, Parithooran S K, Ashraf Jamal, Ahilan S, Roy Arokiam Daniel, Balasubramaniyam. R
Abstract
Background: Humerus Fracture with was operatively treated which complicates to Nonunion are Rare in literature as the incidence for operative nonunion rate is about 3-33%.Nonunion in segmental fractures. With onset of Multiple Injuries in a limb, the surrounding muscles go for atrophy and Joints goes for stiffness. Evaluation difficulties in neurovascular Status pose a challenge to the orthopedic Surgeon to rightly identify the injuries which guarantees a higher investigation. In this case report we are gona discuss about a patient who presented to our hospital 4 months after initial surgical procedure at a different hospital without proper rehabilitation and delay in definitive procedure due to COVID crisis , difficulties in addressing this condition and management.

88. Effect of Aging on Blood Components Red Blood Cells, White Blood Cells, and Platelets in the Individuals of 30 to 60 Years Age Group
Shiney M.D, Indla. Devasena, B.R. Sridevi, M. Padma Geetanjali, Pitta Paramjyothi
Abstract
Background: Aging is a progressive deteriorative change. It occurs during the adult period of life. It increases vulnerability to challenges. With an increase in age, there is a decrease in the count of red blood cells. According to different studies, the total count of white blood cells shows no correlation with age, and platelet count decreases with age. Aims: The present study was carried out to find the significant changes in the count of Red Blood Cells, the count of White Blood Cells, and the count of Platelets which are the blood components with advancing age both in males and females of 30 – 60 years age group. Objectives: To study and analyze the count of Red Blood Cells, count of White Blood Cells, and count of Platelets in three different age groups of males. To study and analyze the count of Red Blood Cells, the count of White Blood Cells, and the count of Platelets in three different age groups of females. To study and analyze the Differential leukocyte count in three different age groups of both males and females. To compare the count of Red Blood Cells, and the count of White Blood Cells, and count of Platelets between males and females in different age groups. Materials and Methods: The present study was conducted in the physiology department in collaboration with the Department of Pathology and the Department of General Medicine at Government Medical College, Srikakulam, Andhra Pradesh. Both genders of the age group of 30 -60 years are chosen for this study. The Study design is a cross-sectional study which is an analytical individual based nonexperimental/ observational type of epidemiological type of study and it is done for a duration of 18 months at the Department of Physiology, Government medical College, Srikakulam with a target population of around 300. Statistical method ANOVA was done to know whether the study was statistically significant or not, when comparing count of red blood cells, count of white blood cells and count of platelets in same gender of three different age groups and independent sample t test was used to compare count of red blood cells, white blood cells and platelets in both genders in three different age groups. Results: Means of count of red blood cells among 300 individuals is 4.94 with standard deviation of 0.593, with means of count of white blood cells among 300 individuals is0.759 with standard deviation of 0.192 and with total mean of total platelet counts among 300 individuals is 1.214 with standard deviation of 1.98. There is difference among males and females in count of red blood cells with decrease in count on increase in age. But platelet count also decreased with increase in age in males from age group of 31-40 years to age group of 41- 50 years and again slightly increased on increase in age from age group of 41-50 years to age group of 51-60 years, in female’s platelet count increased on increase in age, when compare to males’ females were presented with more platelet count. No relationship variation was seen with age in both genders in count of white blood cells. Conclusion: Based on theoretical knowledge about bone marrow changes in different age groups, various theories on aging, hormonal correlation and menstruation effects in female age groups correlated with my study results.

89. Antimicrobial and Antifungal Activity with Special Reference to Anti-Mycobacterium Tuberculosis Activity of Puffer Fish Lagocephalus Spadiceus (Gmelin, 1789) Collected From Arnala Beach Virar, West Coast of Mumbai, India
Dandge S. R., Zodape G. V.
Abstract
Background: This study aims to investigate the antibacterial and antifungal properties against the crude extract of liver, skin and intestine of Puffer fish Lgocephalus spediceous. The study specifically focuses on the crude extract and its efficacy on antibacterial, antifungal, and anti-mycobacterial activity. The Puffer fish Lagocephalus spadicoeus were collected during low tides from Arnala, Virar, West Coast of Mumbai. The liver, skin and intestine were dissected out separately. The dissected parts were weighed and were crushed separately in an equal volume of a mixture of 80 % methanol and 1 % acetic acid (w/v) for 24 hours in the water bath at 45⁰ C.  The homogenates were centrifuged at 10,000 rpm for 20 minutes in cold centrifuge at -8⁰C and supernatant was collected. The supernatant aliquots were concentrated in a rotary vacuum evaporator at 45⁰ C. The resultant extracts of liver, skin and intestine were subjected to Millipore filter system, dried in vacuum desiccator, and used for anti-bacterial and antifungal activity. From the above results it was confirms that the crude extract of liver of puffer fish L. spadecius showed more efficacy than the skin and intestine. The zones of inhibitions measured as Liver > skin > intestine. Whereas no antifungal activity was noted against both the fungal strains C. albicans ATCC 10231 and C. tropicalis. The sensitivity of crude extract of puffer fish L. spadecius against M. tuberculosis was found in skin, 6.25µg/ml, in liver 100µg/ml, and in intestine, 100µg/ml respectively.  From the above results, it is found that the sensitivity of crud extract of L. spadecius measured in terms of sensitivity as skin > liver =intestine. From the above results it was found that of puffer fish L. spadecius have strong antibacterial and anti-mycobacterial property.

90. A Mixed Cohort Study on Adverse Events Following Pentavalent Vaccine and Its Perception among Parents
Mary AN Seles Xavier, Mithila Das Mazumder, S Pavan Kumar
Abstract
Background and objective: Vaccination stands as one of the most effective strategies for disease prevention and place and pivotal role in family and public health. Vaccines significantly reduce morbidity and mortality among children. However, despite its benefits vaccination can occasionally result in some adverse effects. Furthermore, while the vast majority of children experience no adverse effects to a vaccine, a small percentage may exhibit mild to severe side effects such as fever, redness and soreness of the injection site to convulsion and encephalopathy. Being informed about these potential outcomes empowers parents to make educated decisions about their child health care. This study focuses to evaluate adverse effects post pentavalent vaccine, assess parental concern and determine continuation despite side effects. Methods: This hospital based mixed cohort study was conducted from February 2021 to August 2022 enrolling 96 children who visited pediatric OPD for Pentavalent Vaccination. Data was collected in predesigned proforma and through the phone call after 48 hours of immunization. Results: Most common adverse effect in first dose was fever (100%) and pain (100%) followed by redness (85.4%). Adverse effects in the subsequent doses were reduced. Only one participant (1%) had injection site abscess. There is significant association between the parents who are doubtful regarding vaccination and continuation of vaccination even after side effects (p-0.01). Conclusion: Most of the children had minimal side effects. Incidence of adverse effects reduced in subsequent doses of vaccination. Most of the parents who were aware of adverse effects, and continued vaccination even after side effects.

91. A Patient with Tuberculous Pleural Effusion Later Diagnosed with Massive Pancreatic Pleural Effusion Due to Pancreaticopleural Fistula – A Case Report
Jyoti Verma, Ankit Singh, Tabish Abbasi
Abstract
Massive pleural effusion due to Pancreatitis can be the missed cause when hemorrhagic effusion is being explored for just tuberculosis or Malignancy, specially when effusion is on right side. Though rare, hemorrhagic pleural effusion can be the sole manifestation of Pancreatitis, especially on the right side of thorax. Here a case is presented where a middle age male patient came primarily with the complain of dyspnea which was gradual in onset. He was cachexic and had h/o pain abdomen 10 days back which was uneventful. But later he developed massive pleural effusion . The investigations further revealed the pleural effusion was due to the complication of chronic pancreatitis.

92. A Descriptive Observational Assessment of the Temporomandibular Joint Dysfunction in Condylar Fracture of the Mandibleu the Helkimo Index
Sanjay Kumar, S. K. Jha, P. D. Verma, R. K. Ajay
Abstract
Aim: The aim of the present study was to assess the temporomandibular joint dysfunction in condylar fracture of the mandible using the Helkimo index. Methods: The present study was a cross‑sectional descriptive study from July 2019 to August 2021. A total of 20 condylar fracture treated patients were included in the study. All patients presenting to the department of plastic and reconstructive surgery with condylar fracture of the mandible with or without associated condylar dislocation (subluxation and dislocation). Results: Nearly 60% were in the age group of 18–30 years and 31–50 years accounted for another 30% of the patients. There were 90% male as compared to females. Road traffic accidents accounted for 90% and falls accounted for 5% of the cases. Around 80% had unilateral condylar fractures. Condylar dislocation was observed in 20% of patients. 25% patients underwent IMF only and 75% underwent IMF and ORIF surgery procedure. As per the Helkimo’s anamnestic index, 45% had no symptoms, 30% had mild symptoms and 25% had severe symptoms. In the clinical Helkimo dysfunction index, there was no dysfunction in 10%, mild dysfunction in 60% and moderate dysfunction in 30% of cases. None had severe dysfunction. Conclusion: The Helkimo index is a simple, effective, inexpensive, reliable screening index to assess TMJ dysfunction in condylar fractures of mandible. Due consideration regarding routine clinical use can be given in view of the lack of gold standard clinical criteria to diagnose and prognosticate TMJ dysfunction in patients with condylar fractures of the mandible.

93. A Hospital Based Study Assessing the Spectrum of Renal and Perinephric Space Infection among Urology Patients
Sajal Kumar
Abstract
Aim: The aim of the present study was to assess the spectrum of renal and perinephric space infection among urology patients. Methods: The present study was conducted in the Department of General Surgery for the period of 12 months. 100 patients were included in the study. Suspected patients were clinically evaluated and investigated using ultrasound scan of the abdomen. When the findings were suggestive of renal and perinephric space infection, plain and contrast enhanced computed tomogram (CECT) scan of the abdomen was done to confirm the diagnosis and grade the abscess. Results: Out of 100 patients, 64 (64%) males and 36 (36%) females suffered from renal and perirenal space infections in the age group of 10-70 years. Majority (38%) were young in the age group of 21-30 years. At the time of presentation, the commonest symptom was fever (97%) followed by flank pain (42%) weakness and lethargy (72%). The average duration of symptoms was 23 days (range 7-60 days). On clinical examination, all patients were febrile (range 99- 103° F) with marked costovertebral tenderness in 91%. It was seen that 49 (49%) patients had renal abscess, 41 (41%) perinephric abscess and 10 (10%) emphysematous pyelonephritis. The predisposing factors were diabetes mellitus (35%), ureteric calculi (32%) and renal calculi (23%) in these patients. 60 patients were treated with antibiotics only and 20 patients were treated with antibiotics+ PCD. In 4 patients, there was drainage of pus and debris. Conclusion: Renal and perinephric space infection continues to be a serious urological problem with high mortality rate. A high index of suspicion, prompt diagnosis, appropriate antibiotics and surgical intervention may be effective in reducing mortality.

94. Detailed Assessment of the Anatomical Location and Variations of IOF in Human Dry Skull: A Morphometric Analysis
Vinita Sinha, Meeta Sahai, Rashmi Prasad
Abstract
Aim: The purpose of the study was to obtain detailed knowledge of the anatomical location and variations of IOF in human dry skull of Bihar population which is imminent for successful regional anaesthesia and endoscopic surgeries of the maxillary region. Methods: 60 Human skull bones of unknown gender were selected from the Department of Anatomy, Nalanda medical College, Patna, Bihar, India for 12 months. Human adult skull bones without any deformity were included in the study. Results: The mean distance between ANS to inferior margin of IOF 34.22+0.55 mm on right side & 34.77+0.3 mm on left side. Mean vertical diameter of IOF 3.76 mm on right side & 3.94 mm on left side. Minimum vertical diameter of IOF is 2 mm on both sides. Maximum vertical diameter of IOF is 7 mm on both sides. Mean transverse diameter of IOF 4.18 mm on right side  4.32+15 mm on the left side. Minimum transverse diameter on right side is 3mm& 2mm on left side. Maximum transverse diameter 5mm on right side & 7mm on left side. Accessory IOF were present in 6% of skulls bilaterally. They lie medial to the IOF with mean distance between them as 5 mm on right side & 3 mm on left side. Conclusion: Thus, the data obtained in this study is at par with studies conducted by different authors of various geographical areas. So the information derived here in identifying the precise location IOF will help surgeons to reduce the adverse outcome of the surgeries centered on IOF in patients of Bihar.

95. Assessment of the Variation in Benign and Malignant Breast Lumps in Relation to Serum Uric Acid, Serum Bilirubin and Serum Creatinine Values: A Comparative Study
Sanjeet Kumar, Md Imteyaz Alam
Abstract
Aim: The aim of the present study was to compare variation in benign and malignant breast lumps in relation to serum uric acid, serum bilirubin and serum creatinine values. Methods: An observational and prospective study was conducted on all the outpatient and inpatient diagnosed to have a breast lump, admitted in the Department of General Surgery for the period of 2 years. 200 patients were included in the study and 100 patients were having benign breast lumps and other 100 patients malignant.  Approval of institutional ethics committee was provided. All the patients presented to surgery outpatient clinic with the features suggestive of breast lump were subjected to detailed history and clinical examination. Standard protocol for triple assessment was followed. Results: Majority of the patients belonged to 16-25 years with benign breast lump and in the malignant breast lump most of the women belonged to 46-55 years. On comparing, positive correlation was found between BIRADS score and serum uric acid and serum bilirubin. P value was found to be highly significant statistically. No significant correlations were found after comparing HER 2/neu positive and HER 2/neu negative, ER/PR positive and ER/PR negative and various stages of breast cancer. Although, no significant correlation was found between biochemical parameters used in this study (serum uric acid, serum bilirubin and serum creatinine) and age, BIRADS score, stage of tumor, tumor grade. Conclusion: The evaluation of serum uric acid and serum bilirubin may be useful for predicting prognosis in females with malignant breast lump and can provide help in making diagnosis during the initial assessment of the patient presenting with breast lump.

96. A Hospital Base Study to Assess the Laparoscopic Cholecystectomy in Patients with Moderate to Severe Left Ventricular Dysfunction: An Observational Study
Anshuman, Sushant Satya Priya, Narendra Kumar
Abstract
Aim:  The aim of the present study was to assess the laparoscopic cholecystectomy in patients with moderate to severe left ventricular dysfunction at a tertiary hospital. Material & Methods: The present study was single-center, open label, prospective, observational controlled study, conducted in Department of Anaesthesiology, Study period was of 1 year. 20 patients with moderate to severe LV dysfunction undergoing laparoscopic cholecystectomy were enrolled in the study. Results: In present study, mean age was 58.52 ± 8.42 years. Gender wise male (25%) were less than female (75%) patients. Medical comorbidities were Hypertension (80%), Diabetes mellitus 5 (25%) and Previous history of cardiac intervention (25%). 70% patients had moderate Left ventricular dysfunction (LVEF 36–40%) while 30% had severe Left ventricular dysfunction (LVEF<36%). No significant change in mean HR and mean MAP was seen at T2, T3, T4 or T5 from T1 was noted. From T1 to T2, there was increase in mean CVP and mean CVP values decrease from T4 to T5 and reach values approximately similar to the T1 levels. On intragroup statistical analysis, significant increase in mean CVP was seen at T3, T4 from T1. From T1 to T2, no change in mean SVR was seen, while from T2 to T3 and T4, there was an increase in the mean SVR, mean SVR values at T5 return to the approximately the T1 levels after CO2 exsufflation. From T1 to T2, there was fall in mean CO while at T3 there was fall in CO was noticed again and the CO does return to similar pre-induction T1 values at T5. The mean EtCO2 values were statistically significant when compared from P1 values. The PaCO2 values were comparable between predefined time points in the study. Conclusion: Cholecystectomy may be safely done in cardiac patients with moderate to severe left ventricular systolic dysfunction patients under the supervision of an experienced consultant anaesthesiologist. Optimization of cardiac status, administered of balanced anaesthesia and 10-12 mmHg pressure pneumoperitoneum are essential steps for patients’ safety. Life threatening complications are low and can be easily managed in hospital with adequate cardiology support.

97. A Hospital Based Evaluation of the Histopathological Spectrum of Salivary Gland Lesions and to Know Their Pattern of Distribution
Sunil Kumar, Richa Sharma, Manish Kumar Jha, Poonam Kumari
Abstract
Aim: The objective of the present study was to evaluate the histopathological spectrum of salivary gland lesions and to know their pattern of distribution. Methods: The present study was conducted in the Department of Pathology, Darbhanga medical College and Hospital, Darbhanga, Bihar, India for the period of 1 year. The study included all the cases of salivary gland neoplasm irrespective of their sites that had undergone surgery in the hospital. Total 40 cases were included. Results: Most of the cases showed male predominance and were commonly found between the age group 31-40. Most common site involved was submandibular region. Chronic Sialadenitis was the common non neoplastic salivary gland lesion accounting for 32.5% Pleomorphic adenoma was the most common benign tumor and Mucoepidermoid carcinoma was the most common malignant tumor found in the present study. Conclusion: This study concluded that pleomorphic adenoma was the commonest benign salivary gland tumors and among malignant tumors; mucoepidermoid carcinoma was the commonest. Histopathological examination remains gold standard because of their varied histomorphological features, it helps to differentiate between nonneoplastic and neoplastic lesions and deciding course of management.

98. An Observational Assessment of the Prevalent Aerobic Bacteria That Are Accountable for the Development of Chronic Otitis Media
Kumari Jyoti Mani, Tabassum Perween, Sonam Kumari, Satyendra Sharma
Abstract
Aim: The aim of this study is to identify the most common aerobic bacteria responsible for causing chronic otitis media. Methods: In this present prospective study, patients with clinical evidence of chronic otitis media attending the Outpatient Department of ENT section were studied for the period of one year. A total of 200 patients clinically diagnosed with chronic otitis media were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Results: The age group of the patients ranged from 6 months to 80 years, with highest prevalence seen in 0-20 years. Declining trend was observed as the age advances. Out of 200 cases, 110 males and 90 females were affected. Out of 200, 192 were pure bacterial isolates and 8 samples showed mixed growth. In the present study, a total of 192 aerobic bacteria were isolated, of which Staphylococcus aureus was predominant, followed by Pseudomonas species, Escherichia coli, Klebsiella pneumoniae, Citrobacter species, Proteus species, non fermenting gram negative bacilli and skin contaminants.  Staphylococcus aureus with Pseudomonas species was the most common polymicrobial growth pattern observed in the present study. Pseudomonas species is the second most common organism, which was highly sensitive to amikacin and imipenem followed by piperacillin and are least sensitive to Tobramycin. S. aureus isolates were found to be 100% sensitive to vancomycin, followed by gentamicin, amikacin, Cefoxitin and Cefotaxime.  Conclusion: Several studies have showed the predominance of different etiological agents in different geographical regions with different antibiotic sensitivity pattern. So, the knowledge of local etiological agent and its susceptibility pattern helps clinicians in treating the patients and to prevent its complications and drug resistance.

99. An Observational Assessment of the Drug Utilization, Rationality, and Cost Analysis of Antimicrobial Medicines in Sri Krishna Medical College and Hospital, a Tertiary Care Teaching Hospital of Bihar
Saima Shahnaz, Dinesh Sah, Deepak Kumar
Abstract
Aim: The current study aims at drug utilization, rationality, and cost analysis of antimicrobial medicines in a tertiary care teaching hospital of Bihar region. Methods: The observation study was conducted by the Department of Pharmacology, Sri Krishna Medical College, Muzaffarpur, Bihar, India among 250 male and female patients admitted in respective indoor department and fulfilling inclusion criteria were included in the study. A standard socio demographic and clinical features data collection proforma was prepared and the characteristic like age, gender, occupation, income group, subject IP/OP number were recorded. Results: 250 patients were prescribed one or more Anti-microbial agents were enrolled in the study. Among the 250 patients, 100 (40%) were female and 150 (60%) were male. The mean age was 42.5 years. Majority of the patients were in the age group of 18–25 years (n = 80, 32%). Diagnosis for which drugs were prescribed were Infectious disease (24%), Respiratory disorders (18.5%), CNS disorders (13%), CVS disorders (9.5%), GIT disorders (9.5%), Urinary tract disorders (6.5%), Endocrine disorders (5.5%), Poisoning (5%), Liver disorders (4.5%) and Anemia (4%). Conclusion: There is a need for formulation and implementation of an Anti-microbial agents policy as a first step to improve use of Anti-microbial agents within the hospital. A baseline data of drug utilization pattern in indoor patients in medicine department is created by this study. Prescription by generic name and from essential list, preference of oral route, and free government supply are encouraging findings. Free health services are one of the major requirements for the developing countries because cost is considered one of the important factors in making therapeutic decision with poor financial resources.

100. A Hospital-Based Study to Assess the Endoscopic Transcortical Transventricular Management of Cystic Craniopharyngioma
Rakesh Kumar, Brajesh Kumar, Samrendra Kumar Singh, Niraj Kanaujia, Brajesh Kumar
Abstract
Aim: The aim of the present study was to assess the endoscopic transcortical transventricular management of cystic craniopharyngioma. Methods: The present study was conducted at IGIMS, Patna, India and data of patients who underwent transcortical transventricular endoscopic approach and reservoir placement for cystic craniopharyngioma were reviewed retrospectively for the period of 2 years. 50 patients were included in the study. Results: The mean age was 22.6 years (range 2–49 years) with a slight female preponderance. Headache (74%) was the most common presentation followed by vomiting (56%) and vision disturbances (46%). An equal number of patients presented with motor weakness (3.4%) and memory disturbances (12%). 3 patients presented with altered behavior and 2 patients with polyuria. Most of the patients had a single cyst. All patients had hydrocephalus. The presurgery hormone evaluation showed that 10% of patients had hypocortisolemia and 6% of patients had marginally increased prolactin levels. The follow-up duration ranged from 3 to 72 months with a median of 18 months. 19 (38%) patients had improvement in vision. 10 (20%) patients required thyroid hormone replacement and 9 patients (18%) steroid replacement. 21 (42%) patients received radiotherapy. 14 (28%) cases had a cyst recurrence and required repeat intervention. Conclusion: Transventricular endoscopy is a versatile procedure that plays an important part in the management of craniopharyngioma, especially for those lesions with a predominant cystic component growing within the third ventricle. It has been used to fenestrate cystic tumors into the ventricles or subarachnoid space (ventriculocystostomy or cystocisternostomy), to establish CSF flow in case of hydrocephalus, for delivery of intracavitary chemotherapy, and to achieve variable extent of resection as a first step of combined procedure.

101. A Hospital Based Cross-Sectional Study Assessing Role of PCR in Diagnosing Tb in Children
Loveleen Kaur, Kunal Choudhary, Kirti Bala, Sanjeev Kumar Tiwari
Abstract
Aim: The aim of the present study was to assess the role of PCR in diagnosing TB in children. Methods: This cross-sectional study was carried out in the Department of Pediatrics, SRIMS and Sanaka Hospital, Durgapur, West Bengal, India and included 100 patients aged <15 years who were clinically diagnosed with TB. Results: The median (IQR) age of enrolled TB patients (N = 100) was 1.7 (0.75, 3.0) years. Most of them (88%, 88/100) belonged to the <5 years age group; only five (5%) were    10 years old. Fifty-eight percent of participants were male (58/100). The majority (90%, 90/100) had a TBS of 7 according to the TBS chart, and 45% (45/100) had a score of 5 according to the MKJ scoring system. Gastric lavage was collected from 96% of the participants, including all of the children <5 years of age and seven of the 11 children >5 years of age who were unable to produce a spontaneous sputum specimen. Pathogen detection in the children with clinically diagnosed TB, according to the age group and type of respiratory sample. Smear for AFB microscopy and conventional (solid) culture were performed on all respiratory samples collected (N = 100). MGIT culture was performed on 100 samples. Smear microscopy was positive only in three cases and all of them were from gastric lavage. All smear-positive cases were positive by both culture methods. The newer sensitive PCR technique using IS6110 primers was positive for the children and similar positivity was found among younger children. Conclusion: In conclusion, this study demonstrated that the PCR method using IS6110 primers might have greater importance when compared to the performance of smear microscopy in  the detection of MTB among younger and nutritionally compromised children, for whom bacteriological confirmation can rarely be achieved. It might also be beneficial in detecting more pathogens within a shorter period of time when compared to the gold standard culture method.

102. A Hospital-Based Study to Assess the Presurgical Nasoalveolar Moulding in Unilateral Cleft Lip and Palate
Pranav Kumar
Abstract
Aim: The aim of the present study was to assess the presurgical nasoalveolar moulding in unilateral cleft lip and palate. Methods: 100 infants (65 boys and 35 girls) with unilateral cleft lip and palate (UCLP) were recruited at department of Department of Burn & Plastic Surgery. A comprehensive clinical assessment, including facial and oral examination, was simultaneously performed by the standardized team. The study was conducted for the period of 1 year. Results: The result showed significant increases in average nostril height (CNH) in cleft side (from 1.16 + 0.34 mm to 6.74 + 2.18 mm, P < .001) and significant decreases in average nostril width in cleft side (from 20.95 + 1.52 mm to 19.07 + 1.48 mm, P < .001). Significant changes were also seen in average CD in cleft side (from 62.76◦ + 7.33◦ to 33.84◦ + 8.32◦, P < .001). Infants with complete UCLP always have a missing nasal floor, the nasal cartilage on the cleft side tilted downward, and the tip of the nose tilted to the cleft side. This research found that the nostrils on the cleft side are slightly concave. The CD is always greater than 0◦. Conclusion: PNAM has proved to be an effective adjunctive therapy for reducing hard and soft tissue cleft deformity before surgery. However, it is important that parents or caregivers become active members of the treatment plan. This study showed that PNAM therapy improved the nasal aesthetics, decreased the cleft size and aligned the maxillary arch with a reduction in cleft alveolus and palate size in UCLCP patients.

103. A Hospital Bases Study to Evaluate and Compare the Efficacy and Safety of a Single Dose of Intravenous Paracetamol and Intravenous Tramadol for Post Operative Analgesia in Infra Umbilical Surgery
Sujeet Kumar, Rajesh Kumar Choudhary, Soniya Kumari
Abstract
Aim: The aim of the present study was to evaluate and compare the efficacy and safety of a single dose of intravenous Paracetamol and intravenous Tramadol for post operative analgesia in infra umbilical surgery. Methods: The present study was conducted in the Department of Anaesthesia, BMIMS for the period of one year. Total 100 patients from both the sexes aged between 18-60 years of ASA grade I and II scheduled for elective infra umbilical surgery under spinal anaesthesia were included in the study. Results: Demographic data was comparable with respect to age, weight, ASA physical status, gender status and duration of surgery in both the groups. From 0 hour (at the end of surgery), till 2 hours postop, there was no significant difference in mean VAS scores between the two groups. However, at 4 hours and 6 hours postop, mean VAS score in Group-A was significantly lower as compared to that in Group-B. At 1 hour, 2 hour, 4 hour and 6 hour, mean sedation scores in Group-A was significantly lower as compared to that in Group-B. More number of patients from group B developed nausea and vomiting and the intergroup difference was statistically highly significant. Conclusion: Paracetamol and Tramadol both produce adequate postoperative analgesia. However, intravenous paracetamol is a safer and more effective analgesic than intravenous Tramadol for the treatment of postoperative pain in patients undergoing infra umbilical surgeries.

104. A Hospital-Based Study Assessing the Association between various Preoperative Factors with Postoperative Mortality and Morbidity in Patients Operated for Peptic Ulcer Perforation
Brish Bhan Gupta, Kavita Kumari, Amjad Zia Mallik
Abstract
Aim: The aim of the present study was to evaluate the association between various preoperative factors with postoperative mortality and morbidity in patients operated for peptic ulcer perforation. Methods: The present study was hospital based, retrospective study conducted in Department of General Surgery. Present study was approved by institutional ethical committee. 100 case records were studied. Case records of patients of either gender, age > 18 years, admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital from last 4 years were evaluated. Results: Majority was male (90%), most common age group was 51-60 years (38%) followed by 41-50 years (25%). Common clinical features at the time of admission were tachycardia (96%), abdominal rigidity (92%), abdominal tenderness (90%), absence of bowel sound (780%), dehydration (64%), abdominal distention (58%), anemia (32.58 %), fever (23%), manifestations of shock (16%). Duration from onset of symptoms to admission was 12-24 hours (33%) in majority of patients. Associated risk factors noted were smoking (54%), alcoholism (51%), previous history of PUD (18%), diabetes mellitus (16%), use of NSAIDs (15%) and stress (12%). Intra-operatively, perforation diameter was 1–5 mm in majority of cases (64%) followed by 6–10 mm (20%). Peritoneal contamination was < 1 litre in majority of cases (78%). Major postoperative complications in present study were respiratory complication (26%), paralytic ileus (20%), septicaemia (16%), wound infections (15%), burst abdomen (5%). Mortality in 6 months was noted in 15 cases (15%). In present study factors significantly associated with mortality were age > 60 years, septicemic shock on admission, size of perforation > 1 cm, delayed presentation > 24 hours, smoking, diabetes mellites and peritoneal contamination > 2 litre. Conclusion: In present study factors significantly associated with mortality in patients with peritonitis due to duodenal ulcer perforation were age > 60 years, septicemic shock on admission, size of perforation > 1 cm, delayed presentation > 24 hours, smoking, diabetes mellites and peritoneal contamination > 2 litre.

105. A Prospective Study Assessing the Role of Color Doppler Ultrasonography in Acute Scrotum: an Observational Study
Vijay Kumar, Sanjay Kumar Suman
Abstract
Aim: The aim of the present study was to assess the role of color doppler ultrasonography in acute scrotum. Methods: We did a prospective study on 70 patients who were referred to our Department of Radiodiagnosis presenting with acute scrotal pain for the period of one year. Results: In our study, we evaluated 70 patients presenting with acute scrotal pain by color Doppler ultrasonography. The results of these imaging studies were correlated with final diagnosis established by means of surgery or clinical follow-up. In our study, out of 70 patients presenting with acute scrotal pain, 15 were diagnosed to be having torsion testis by color as increased frequency, dysuria, and urgency. In our study, we diagnosed 47 cases as epididymo-orchitis by color Doppler ultrasonography who had findings with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Conclusion: We concluded that color Doppler of scrotum is must in a patient presenting in emergency department with acute scrotal pain. It can reliably rule out testicular torsion and helps in clearing clinical dilemma between torsion testis and epididymo-orchitis, and thus help in avoiding unnecessary surgical explorations.

106. A Hospital Based Clinico-Etiologic and Laboratory Profile of Acute Viral Hepatitis in Pediatric Population: A Prospective Study
Rajni Kumari, Vinod Kumar Mishra, Jeetendra Kumar, Sanjeev Kumar
Abstract
Background: Acute viral hepatitis is defined as an infection of the hepatic tissue due to hepatotropic and/ or non hepatotropic viruses causing hepatocellular inflammation which is a self – limiting illness usually resolving completely within 4-6 weeks of time. Viral hepatitis is a major public health issue throughout the world affecting millions of children. Aim: The aim of the present study was to analyze the etiology, clinical features, laboratory parameters and sonological findings of acute viral hepatitis in pediatric population. Methods: A prospective study was conducted at the Department of Pediatrics , BMIMS, Pawapuri, Bihar from May 2022 to October 2023. A total number of 100 cases of acute viral hepatitis in between 1-14 years of age after informed written consent from parents were included in the study. Results: Out of 100 cases of acute viral hepatitis, 10 (10%) in 1-5 years age group, 38 (38%) in 6-10 years age group and 52 (52%) in the 11-14 years age group. As the age increased, there were more cases. Among studied children, 55 (55%) were male and 45 (45%) were female, so there was slight male preponderance. The most common presenting complaints were jaundice (91%), loss of appetite (84%), dark colored urine (86%), vomiting (72%) and pain abdomen (62%). There was overlap of many symptoms. Unlike the adult age group 68.2% patients presented with history of fever ranging from 100-104° F. There were many cases of AVH initially investigated and treated as enteric fever and referred to us after blood test showed liver dysfunction or they developed jaundice in due course of illness. Itching was more common with increase in age. Those cases with elevated liver enzymes, PT INR of more than 3.5 progressed to hepatic encephalopathy. In ultrasound findings, hepatomegaly (92%) was found in most of the cases followed by gall bladder sludge (45%), splenomegaly (38%), gall bladder wall thickening (32%), and ascites (24%). Normal ultrasound was found in 12% cases. Conclusion: ln majority of cases hepatitis A was the most common cause of acute viral hepatitis in children. On the basis of clinical findings and biochemical characteristics the viruses cannot be differentiated. Thus, serological testing is essential for correct etiological diagnosis. It’s important to create awareness in the society regarding preventive measures including availability of vaccine especially in rural area.

107. Comparative Study to Evaluate the Outcome of Fibrin Glue versus Suture in Conjunctival Autograft for Primary Pterygium Excision
Randhir Kumar, Asif Shahnawaz, Neha Kumari, Raju, Richa Mishra, Madhuri, Kumar Ravi
Abstract
Aims and Objective: To compare the duration of surgery, post operative complication, patient comfort and graft stability between the use of fibrin glue versus sutures for fixating conjuntival autograft after primary pterygium excision. Material and Method: The prospective study was conducted in the ophthalmology department of Darbhanga medical college and hospital in Laheriasarai. Fifty patients were studied who had primary pterygium .Pterygium removal and conjunctival autografting were performed on 25 patients using nylon sutures and on 25 patients using fibrin glue. Sampling Method: Simple random sampling Result: Fibrin glue method requires significantly less time to complete as compared to suture method. Conjunctival autografting  with fibrin glue has been shown to reduce postoperative discomfort and inflammation more effectively than suturing. Stability of graft is more in fibrin glue group patients as compared to suture. Conclusion: The results indicate that outcome of fibrin glue is significantaly better than suture for fixating conjunctival autograft after primary pterygium excision.

108. Study to Determine Causes of Respiratory Distress, Pattern of Respiratory Modality Used and its Outcome among Admitted Preterm Newborns
Rupesh Kumar, Juli, Akhilesh kumar
Abstract
Aim: The aim of the present study was to determine causes of respiratory distress, pattern of respiratory modality used and its outcome among admitted preterm newborns. Methods: A retrospective descriptive study was conducted in the Department of Neonatology, over a period of two years targeting all neonates admitted to neonatology department. A Total of 100 patients were admitted in NICU during the study. Results: Mean gestational age was 32.38±2.48 weeks. Most of the newborns (62%) belonged to the gestational age within 28 – <34 weeks category. Mean birth weight was 1635.45±570.55 g among them very low birth weight infants were 42%. Male out numbered female newborns (55% vs 45%). Total 6 (6%) infants had Apgar scores <7 at 5 minutes who required some degree of resuscitation just after birth. After admission 4 (4%) patients got single dose of surfactant. Most of the mother (66%) was multiparous and 51% of them did not receive even a single dose of antenatal corticosteroid. All of them were inborn and cesarean section was the mode of delivery for 80% of the enrolled neonates. Maternal hypertension and diabetes mellitus were present in 70 (70%) and 32 (32%) of mother respectively. Maternal risk factors for sepsis were present in 24 (24%) of infants admitted to the NICU. The respiratory distress syndrome (RDS) was the most common   cause   51 (51%)   following   TTN   23 (23%), congenital pneumonia 20 (20%) and PNA 6 (6%). Conclusion: Respiratory distress syndrome is the commonest cause of respiratory distress.Two third of preterm newborns required respiratory support. Most common mode of respiratory support was non invasive mode in the form of supplemental oxygen, Heated humidified high flow nasal cannula and continuous positive airway pressure. Short term morbidities like nasal trauma, sepsis, septic shock, disseminated intravascular coagulation, necrotising enterocolitis and intraventricular haemorrhage were more common in newborns who required invasive respiratory support (p <0.05). Retinopathy of prematurity and mortality was significantly higher in invasive respiratory support group.

109. Is Routine Stenting Required in Uncomplicated Ureterolithotripsy For 10-20mm Lower & Middle Ureteric Stones? A Randomised Prospective Study
Nitesh Kumar, Shivanand Prakash
Abstract
Purpose: Ureteroscopic Lithotripsy (URSL) is the standard treatment for the ureteric calculi which is a minimally invasive and very effective procedure commonly associated with placement of stent across the ureter. Stent placement is associated with increased morbidity, complications, cost and need for removal. The objective was to study the need for stenting in uncomplicated URSL in stones larger than 10mm. Methods: A prospective randomized controlled study was conducted in the Urology department of Osmania Medical College and Hospital from October 2016- December 2019 comprising of 153 cases. All patients with ureteric calculus of size 10-20 mm (largest dimension) were included. URSL with 6 f Ureteroscope was performed and patients without any complications were randomized in the stent and no-stent groups. Patient demographics, stone characteristics and treatment parameters were recorded. Post operative symptoms and complications were recorded using a questionnaire. Results:  The patients of both groups were comparable to demographics, stone characteristics and location. SFR was 100% in both the groups, zero stricture rates. The fever, re-hospitalization rate, and the mean hospital stay were similar but operating time was higher in the stented group. Flank pain, duration of analgesic use, macroscopic hematuria, irritative and voiding symptoms were significantly higher in the stented group (p < 0.05). Patients without stents had a better quality of life. Conclusion: Routine use of a ureteric stent is not necessary after an uncomplicated URSL done without ureteric dilatation even in stones larger than 10mm. Placement of stent increases morbidity, cost and harms the quality of life.

110. A Study to Investigate the Association of Homocystine Level and Lipid Profiles with Ischemic Heart Disease: An Observational Study
Mani Shankar Pandey
Abstract
Aim: The aim of the present study was to investigate the association of homocystine level and lipid profiles with ischemic heart disease. Methods: This prospective case control study was conducted over a period of 18 months in the Department of Cardiology, Patients of Ischemic Heart Disease (IHD) admitted in Department of Medicine were included. 150 patients were selected in the study. The data for the study was collected from the inpatients and outpatients of the hospital, who fulfilled the inclusion and exclusion criteria. Normal healthy population was selected from people who came for routine health checkup and staff members of the hospital. Results: There was a significant difference between homocysteine levels of cases and controls. Thus we found that higher homocysteine levels were significantly associated with IHD in our study. By using chi-square test p-value >0.05, there was no significant difference between cholesterol levels among the cases and controls. Thus we did not find a strong association between hypercholesterolemia and IHD. There was no significant difference between triglyceride levels among the cases and controls. There was no significant difference between HDL levels among the cases and controls. Conclusion: Based on the outcome of the present study we conclude that Hyperhomocysteinemia status is independently associated with hypertriglyceridemia, high total cholesterol level, high LDL level and low HDL levels in the blood.

111. An Investigation of the Variables That Put Children at Risk for Nutritional Anaemia and the Critical Part That Mothers Play in Preventing the Condition in Young Children
Manoj Kumar Ram, Sanjiv Kumar Sinha, Binod Kumar Singh
Abstract
Aim: The aim of the present study was to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: This study was carried out at department of pediatrics  and children aged 6 months–2 years admitted at the hospital during the study period were included. Any child with chronic disorders such as hemoglobinopathies, hemolytic anemia, and treated for anemia and those on any immunosuppressants such as steroids and biologics were excluded as an indirect measure to eliminate anemia of chronic disease. An informed written consent was obtained from the mothers of these children. A total of 200 participants were included. Results: Majority of the mothers were aware that neural development of child could be affected by anemia. Maternal knowledge regarding cow’s milk was poor and had a faulty belief that it increases iron absorption, whereas 16% were unaware of the relationship between cow’s milk and anemia. Many mothers believed anemia to occur only in children on vegetarian diet. Around 75% mothers recognized green leaves and 70% women recognised jaggery to be enriched with iron. Although 78% identified vitamin C containing fruits, many were not aware of its vital role in increasing the iron absorption. Mothers of children with more than one sibling had a relatively greater incidence of “poor” knowledge unlike mothers of children with single or no sibling. This implies that those with “poor” knowledge were also unaware of the importance of birth spacing. Conclusion: Recognizing the causative factors plays an essential role in preventing iron deficiency anemia (IDA). Exclusive breastfeeding must be promoted, along with avoiding excessive cow’s milk intake. Intervening at the right period with age-appropriate foods becomes a necessity. Maternal illiteracy has a positive correlation with anemia in infants. Improving maternal awareness by the physicians will pave the road toward a nation free from anemia.

112. A Retrospective Assessment of Clinical Profile of Peptic Ulcer Disease: An Observational Study
Dheeraj Kumar, Sonal, Vishwamohan Dayal
Abstract
Aim: The aim of the present study was to understand the distribution of peptic ulcers. Methods: The present study was conducted in the Department of Gastroenterology. Informed consents were taken from patients. The 50 peptic ulcer disease patients were enrolled in to the study. The age group of the patients was from 20-70 years. Results: The age and the type of ulcer it can be clear that the more ulcer prone age was from 30 years & above. The ulcers were found in all age groups. The majorly observed site of the ulcer pain is the epigastrium. The burning & the hunger was the commonest type of pain observed in the Duodenal ulcer. All patients suffering from the ulcers are doing smoking as well as alcohol consumption. The previous regular consumptions of the NSAID’s & Steroids are the also one of the factors for the duodenal & gastric ulcers. Conclusion: Duodenal ulcer perforation is the second most common abdominal emergency in our study. After invention of the H2 blockers and proton pump inhibitors the role of elective surgery for duodenal ulcer has been drastically decreasing, but the incidence of perforation is not much changing.

113. An Observational Study Assessing Correlation between Phacoemulsification Effective Time and Anterior Chamber Depth in Uncomplicated Cataract Surgery
Kumar Parmanand, Deepak Kumar Sinha, Mrityunjay Kumar
Abstract
Aim: The aim of the present study was to correlate between phacoemulsification effective time and anterior chamber depth in uncomplicated cataract surgery. Methods: This was a single-center prospective observational study conducted in cataract surgeries done for the period of one year in which patients were grouped according to preoperative anterior chamber depth. The outcome measures included total ultrasound time for phacoemulsification in cataract surgeries. 75 patients were in nuclear grade 3 cataract category. Results: The difference in the means of anterior chamber depth was compared using the student t- test. There was a significant (<0.01) difference between pre and post- surgery anterior chamber depth values. Comparison of ACD and ACD difference shows a statistically significant negative correlation when compared in overall spherical refractive error and also when compared separately. A significant (p<0.001) negative association between overall postoperative spherical refractive error and difference in anterior chamber depth was reported in the present study with r value of -0.43. It was seen that there is statistically significant inverse correlation of anterior chamber depth to phacoemulsification ultrasound time. Similarly, the correlation of anterior chamber depth difference was studied with specific postoperative spherical refractive error. The results were inconsistent to that of the overall correlation for all spherical refractive error. Conclusion: This study concluded that after cataract surgery, the anterior chamber deepens. Eyes with larger preoperative anterior chamber depth had a smaller amount of deepening of AC and resulted in more post op hyperopic spherical errors. Eyes with smaller preoperative anterior chamber depth had a larger amount of deepening of AC and resulted in more post op myopic spherical errors.

114. A Retrospective Study Assessing Type III & IV Radial Head Fractures Treated with Radial Head Prosthesis
Abhishek Anand, Abhinav Kumar, Swati Singh, Puja Sinha
Abstract
Aim: The aim of the present study was to evaluate the functional outcome of type III and IV radial head fractures treated by radial head prosthesis. Material & Methods: A retrospective study included 40 patients of type III and IV radial head and neck fractures according to Mason’s classification. They were admitted and treated in the Department of Orthopaedics with radial head prosthesis over the duration of 12 months. Results: Out of 40 cases, 24 cases were <40 years and 16 cases were >40years. The mean age was 36.4 years. Maximum age was 56 years, minimum age was 32 years. Majority were females as compared to males. Mechanism of injury most of the cases i.e 70% were due to history of fall and remaining were due to RTA. 30 cases (75%) were right side dominant and 10 cases (25%) were left side dominant. In our case study group, out of 40 cases, 32 cases (80%) were under Modified Mason’s classification type Ill and 8 cases (20%) were under Modified Mason’s classification type IV. Out of 40 cases, 30 cases (75%) were not associated with any ligamentous injury, 4 cases of LUCL and 6 cases of MCL injury was noted. The P value of flexion, extension, pronation and supination was found to be very significant. 27 cases (67.5%) had MEPI score (Mayo Elbow Performance Index) >90 which indicates excellent result, 8 cases (20%) had MEPI score 75-89 which is good result and 5 cases (12.5%) had MEPI score 60-74 which indicates fair result. Conclusion: Radial Head Prosthesis is a viable option in communited and irreparable radial head fractures. Proper preoperative planning, good Intraoperative technique and rigorous postoperative rehabilitation give predictable results.

115. Hospital Based Retrospective Study to Investigate the Safety and Effectiveness of Open Simple Prostatectomy (OSP) in Octogenarians
Rohit Singh, Arshad Hasan
Abstract
Aim: The aim of the present study was to investigate the safety and effectiveness of open simple prostatectomy (OSP) in octogenarians. Methods: The present study was conducted in the Department of Urology. Our retrospective review revealed that 200 patients underwent OSP during the study period. Patients were grouped based on their age: Group 1 included patients older than 50 and younger than 65, Group 2 consisted of patients between the ages of 65 and 80, while Group 3 included those aged ≥80 (i.e., octogenarians). Results: In the present study, 32% were in ASA I and 20% had hypertension. Among these patients, 50 were in Group 1 (i.e., aged between 50 and 65), 100 in Group 2 (i.e., aged between 65 and 80), and 50 in Group 3 (i.e., age≥80). The rate of hypertension was significantly higher in Group 2 and Group 3 (i.e., octogenarians) than compared to Group 1. Although there was no difference between the groups regarding preoperative serum PSA levels, the rate of prostate biopsy rate was significantly higher in Group 1 and Group 2 than in compared to octogenarians. On the other hand, preoperative persistent AUR frequencies were significantly higher in octogenarians compared to others. Mean preoperative Qmax values were 5.57 ± 1.51, 6.84 ± 3.93 and 5.95 ± 2.04 ml/s in Group 1, Group 2 and Group 3, respectively. The mean PVR values were calculated as 136 ± 34, 137 ± 34, and 156 ± 29 in Group 1, Group 2, and Group 3, while the mean IPSS scores were 21.8 ± 4.37 in Group 1, 21.0 ± 6.41 in Group 2, and 22.5 ± 4.43 in Group 3. The complication of Hemorrhage requiring blood transfusion was managed by blood transfusion. Urethral stenosis was managed by Internal urethrotomy, Urethroplasty. Conclusion: The present study concluded that OSP is a safe procedure, and its effectiveness is limited compared to the other groups in terms of urethral catheter duration, length of hospital stay and IPSS scores. Before OSP However, perioperative management should be individualized for each patient.

116. Autopsy Evaluation of Pattern of Fatal Cases of Poisoning: A Retrospective Study
Abuzar Rizwi
Abstract
Aim: The aim of the present study was to analyze the autopsy findings of fatal cases of poisoning retrospectively. Material & Methods: This retrospective study was conducted on 200 poisoning victims whose autopsy was done in Department of FMT for a period of one year. Results: Majority of the people who died of poisoning belonged to the age group 21 to 30 years (30%) and the least number of victims were found to belong the age group >60 yrs (1%). When classified according to sex, the population was found mostly of males (65%). The females made up remaining 35% of study population. Physical illness (40%) was the commonest reason for suicidal poisoning followed by marital dispute (21%) and economic crisis (12%). Other reasons for poisoning were accidental (6%), conflict with parents (4%), family dispute (3%), mental illness (3%), academic failure (3%) and others (2%). The external findings such as stains (0.50%), vomitus (3%), smell (3%) were observed on the bodies of some of the victims. Internal findings revealed that the content of stomach (28%) was the most common internal finding. Others were smell in the stomach, contents of small intestine and smell of the same, corrosion and perforation of oral cavity, perforation of stomach and small intestine. Conclusion: Chemical analysis may fail to detect certain poison in the viscera preserved for chemical analysis. Therefore, evidences of the symptom, post mortem examination is important.

117. A Retrospective Observational Study Assessing the Risk Factors and Clinico Radiological Pattern of Stroke Patients at a Tertiary Care Center
Manish Kumar, Prashant Kumar Thakur, Krishna Kumar Jha
Abstract
Aim: The aim of  present study was to assess the risk factors and clinico radiological pattern of stroke patients at a tertiary care center in Darbhanga. Methods: This observational study was carried out among 200 stroke patients who satisfied the inclusion and exclusion criteria and were admitted in medicine ward of DMCH Darbhanga, India for the period of one year. The case sheets of the patients were retrieved from the medical records department of the hospital and relevant data extracted and analyzed. Results: 90 (45%) patients had ischemic stroke and 110 (55%) patients had hemorrhagic stroke. The incidence of stroke was maximum in 46-60 years of age group which comprises of 40% of total patients, followed by 61-75 years of age group which comprises of 32% of total patients. 17% patients were of age ≤45 years. In our study, the youngest patient was 19 years old and oldest was 90 years old. Out of 200 patients, 120 were males and 80 were females. The most common risk factor was hypertension in 78% followed by dyslipidemia (54%), tobacco chewing (34%), renal dysfunction (24), smoking (22%), alcohol (18%), H/O of previous cerebrovascular accident (8%), diabetes (7%). The most common site of hemorrhage was ventricular (20) followed by thalamus (16%), basal ganglia (13%), external capsule (12%) and internal capsule (9%). Also shows 4 (2%) cases among all cases of stroke. The most common site of infarct was parietal (18%), followed by peri ventricular (10%), occipital lobe (7%), basal ganglia (7%) and frontal lobe (5%). Thus, findings were favoring middle cerebral artery territory involvement which is most commonly   involved   in   thrombotic   stroke. Conclusion: In India like other developing countries there is a huge burden of stroke with significant regional variations of stroke. The occurrence rises with age with peak between 60 to 75 years. Young patients (age ≤45 years) were 16% of patients which is more dangerous in view of productive year lost. This study showed male predominance in stroke cases. Cerebral hemorrhage was more than infarction. Hypertension was amongst leading risk factors for both types.

118. Assessment of Neuropathological Spectrum of all the Surgically Resected Vascular Malformations of Central Nervous System: An Observational Study
Sandeep Yadav, Madhu Priya
Abstract
Aim: The aim of the present study was to assess the neuropathological spectrum of all the surgically resected vascular malformations of central nervous system. Material & Methods: The present study was conducted at department of General Surgery for one year and patients with neurological, neurosurgical, and psychiatric disorders were included.  All VMs diagnosed in the department of neuropathology over a period of 1 year  were retrieved from the archives. The study included a total of 100 cases of surgically resected VMs. Results: Among 100 cases, CCMs were most common (44%), followed by AVMs (39%), capillary telangiectasia (11%), venous angioma (2%), and AVFs (4%). Clinical presentation varied from focal deficit to features of raised intracranial tension. Conclusion: Imaging and histopathology plays an important role in the diagnosis and management of VMs. Histopathological examination is essential for characterization of the VMs, which influences the prognosis.

119. A Hospital Based Clinicopathological Profile of Meningiomas: An Observational Study
Rajeev Ranjan Raman, Anurag Sahu
Abstract
Aim: The aim of the present study was to access the clinic-pathological characteristics of meningiomas. Methods: This was a retrospective study conducted in the Department of Neurosurgery . The study period was of 3 years. All the patients diagnosed as meningiomas in our department were included in the study. A total of 100 patients were included in the study. Results: In total, we had 70 females and 30 males, with 60% brain and 40% spinal meningiomas. Transitional, psamommatous, and meningothelial meningiomas were prevalent histological types. 90% of patients had WHO Grade I tumours, 5% had Grade II, and 5% had Grade III. Statistically, Simpson grade of excision was associated with recurrence. The 100 patients were 70% female and 30% male. Females outnumbered males in the 4th, 5th, and 6th decades, but this was less pronounced in elderly and paediatric patients. Parasagittal meningioma was second most common after convexity. Males are more likely to have WHO Grade II and III meningiomas than females, and the difference is statistically significant. Conclusion: Meningiomas are noncancerous growths that occur more often in females. Meningiomas located above the tentorium are more often seen than those located below it. In paediatric cases, meningiomas tend to be aggressive. The likelihood of meningioma recurrence is influenced by both the histological grade and the Simpson grade of excision.

120. Efficacy of Extracorporeal Shock Wave Lithotripsy in the Management of Lower Ureteric Stones ≤ 2 CM
Sanjay Kumar Gupta, Gaurav Mishra, Ahsan Ahmad, Rajesh Kumar Tiwari, Rohit Upadhyaya, Vijoy Kumar
Abstract
Background: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteric stones by analyzing the clearance rate. Materials and Methods: This prospective observational study was conducted in patients with lower ureteric stones. Patients were divided into two groups according to stone size (mm); group A (up to 10 mm) and group B (11- 20 mm). Dornier Compact Delta II (Dornier MedTech Systems) was the ESWL lithotripter used to fragment ureteric stones. Results: A total of 41 patients (mean [SD] age: 33.7 [12.16] years) were included in the study. The average clearance rate, irrespective of the stone size, was 90.19% for lower ureteric stones, (p>0.05). The ESWL was more successful in group A (stone size <10 mm)    Group B patients (stone size 11-20 mm) faced more failure. The average retreatment rate was 45.18%. The most common complication was hematuria (8.02%), followed by transient colic and pyrexia (4.93%). Conclusion: ESWL is a safe, effective, non-invasive, and well tolerated treatment for the management of lower ureteric stones, regardless of the stone size. ESWL can be done in patients with smaller stones up to 10 mm and with overall success rate of 90.19% irrespective of location and size, it is equally good option for stone size 10-20 mm.

121. An Assessment of Efficacy and Viral Resistance Rate of Entecavir
Asif Iqbal, Namira Azmi, Neeraj
Abstract
Aim: The aim of the present study was to investigate the long-term efficacy and viral resistance rate of entecavir and explore the factors associated with virologic response, including quantitative hepatitis B surface antigen (qHBsAg) levels. Methods: The present study was conducted in the Department of Gastroenterology, Mediversal hospital, Patna and 200 consecutive treatment-naïve HBV-infected patients, whose treatment was initiated with 0.5 mg of daily entecavir were enrolled. Results: The majority of patients were male (65%) and the median patient age was 49 years old (range, 18 to 80). The patients were followed up for a median of 29.0 months (range, 6.0 to 77.4). 110 (55%) patients were HBeAg-positive and 90 patients (45%) were HBeAg-negative. The mean baseline HBV DNA load was 6.47 ± 1.40 log10 IU/mL and 36% of the patients had liver cirrhosis at initiation of entecavir treatment. Univariate analysis revealed that older age, presence of liver cirrhosis, lower HBV DNA load, HBeAg negativity, lower platelet count, and prolonged PT were statistically significant factors associated with virologic response. In multivariate analysis, only HBeAg-negativity and lower HBV DNA load were independently associated with virologic response. Conclusion: In conclusion, continuous treatment with entecavir for treatment-naïve, genotype-C, CHB patients showed an excellent virologic response rate and a low rate of resistance, which is comparable to results from registration trials. Baseline HBV DNA loads, qHB-sAg levels, and HBeAg status were predictors of virologic response during entecavir treatment.

122. A Cross-Sectional Assessment of the Academic Passion, Perceived Stress and Sleep Quality Estimated among Undergraduate Medical Students of Government Medical College in Jharkhand
Surendra Sahu, Sushil kumar singh, Vidya Sagar, Kumari Asha Kiran, Shubhashish Sircar, A. K. Biswas, Dhananjay kumar, Kumari Jaishree Ragini
Abstract
Aim: The aim of the present study was to determine the academic passion, stress and sleep quality among medical students and explore the associations among them, which helps to create awareness to improve the mental and physical health of future doctors. Methods: This cross-sectional study was done at SBMCH, Hazaribagh, Jharkhand, India. A total of 250 students who were in the 1st, 2nd and 3rd year of MBBS were selected obtaining the institutional head’s permission. Students who had university examinations within a month were excluded from the study. Out of the 250 questionnaires distributed, 50 had incomplete forms hence, they were excluded from the study. 200 participants who completed forms were finally included. Results: 105 were females and 95 were males in the study.A majority of the study participants were interested in clinics. It was also found that 21% participants were not interested in pursuing higher studies. There was a significant association between the ability to handle personal problems with passion and interest in clinics. There was no significant association between the development of passion and the presence of a doctor in the family. 69% of the participants self-reported good sleep quality with severe stress. 22% non-passionate participants had moderate stress.Passion showed a positive association with interest in the pursuing post-graduation, satisfaction in thestudent’s life and negative association with duration of sleep and stress. Interest in clinics showed association with satisfaction with results with respect to their efforts. Perceived stress showed significant association with both passion and sleep. Conclusion: Our study found that passion has behavioral and psychological outcomes similar to previous research. Parental pressure and other factors influenced students to choose MBBS as a career. There is a high prevalence of stress and poor sleep quality among medical students. Depending on the type of passion, students can be positively or negatively influenced, so it is of prime importance to have a harmonious passion in life.

123. Analysis of Fertility Sparing Surgery Outcomes in Ovarian Malignancy at Department of Gynaecologic Oncology Tertiary Care Centre
Mala Sinha, Maneesh Kumar, Tarini Sonwani, Rashmi Rekha Bora
Abstract
Aim: The aim of the present study was to assess the reproductive and oncological outcomes of women who have undergone fertility sparing surgery (FSS) in ovarian malignancy. Methods: The present study was conducted in the Department of Gynecologic Oncology, Fortis Memorial Research Institute, Gurugram from January 2018 and September 2022. A retrospective review of a clinical database of patients who underwent fertility sparing surgery done in Department of Gynaecologic Oncology was included. A total of 13 patients underwent FSS. Results: The mean age was 31.6 years (range 23 to 37.0 years) and the mean BMI was 22.22 (range 18-30 kg/m2). In pre-operative diagnosis, 10 had suspicious ovarian mass and 3 underwent biopsy. In frozen section, 8 were at borderline serous and one each had germ cell and granulosa cell tumor respectively. During the study period, 7/13 (53.8%) of the women had attempted to conceive following surgery, with a successful pregnancy of 6/7 (86%) and 5/6 (83.3%) were spontaneous conception, live birth rate of 4/13 (30.7%) and 2/13 (15.3%) at 34 and 36 weeks of period of gestation. The Complete surgery as done in one patient, after completion of child bearing. (Robot assisted hysterectomy and right salpingo oophorectomy). One patient (germ cell tumor) received neoadjuvant chemotherapy followed by interval cytoreductive surgery with fertility preservation done. There was no recurrence during study. Median disease free survival was 31 months. Conclusion: Fertility sparing surgery is feasible with good oncologic outcome and satisfactory conception and live birth rates in patients with early stage. Careful counselling is required when considering the type of surgery to be performed based on the histology, stage of disease and tumour grade.

124. A Retrospective Assessment of the Outcome of Repair and Resection of the Occipital Encephalocele: An Observational Study
Dhiraj Kumar, Mukesh Kumar, Anil Kumar Peethambaran
Abstract
Aim: The aim of this study was to find the outcome of repair and resection of the occipital encephalocele. Material & methods: A retrospective study of 200 exclusively occipital encephalocele patients was conducted in between the duration of 2 years at the Department of Neurosurgery, Medical College Trivandrum Thiruvananthapuram, Kerala, India. The medical records of all operated cases of occipital encephalocele were reviewed, and relevant data such as age, sex, location of encephalocele, the size of the lesion, operative method, seizure, and hydrocephalus along with postoperative complications were recorded for analysis. Results: Of 200 patients, 72 were males and 128 females. The average age of the patients at the time of presentation was 2.6 months, ranging (4 days to 1.33 years). Most of the patients 56% belonged to 3 months age followed by 27% in 3-6 months age group. All patients presented with swelling on the head just after birth. A visible mass was situated in either the occipital (supratorcular or infratorcular). Any overlying skin varied from a thick and wrinkled to a thin or shiny covering. 70 patients (35%) presented with enlarged head circumference with associated hydrocephalus and 8 patients (4%) diagnosed with Dandy–Walker cyst. 8 (4%) patients were suspected developmental delay and mental disorders. 30 (15%) patients also had seizure. 36 (18%) patients admitted with the complication of sac rupture with cerebrospinal fluid (CSF) leakage, 4 (2%) patients having rupture of sac after the admission and 4 (2%) patients admitted with the complaint of haemorrhage from the thin and shiny covering skin of the sac. Postoperatively, only 4 (2%) patients had CSF leakage from the repaired wound. 12 (6%) patients developed Hydrocephalus after the repair of protrude sac. Conclusion: Encephalocele is commonly seen in the practice of neurosurgery in the world. Modern neuroimaging, neurosurgical techniques, and neonatal neurological intensive care have greatly improved morbidity and mortality in the care of encephalocele.

125. Anatomic Study to Evaluate the Measurements of Diameter of Common Bile Duct at Porta Hepatis
Neelam Sinha, Zeba Alam, Rashmi Prasad
Abstract
Aim: The aim of the present study was to evaluate the measurements of diameter of common bile duct at porta hepatis. Methods: The present study was conducted in the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India and 100 cases were included in the study group. After examining the abdomen by ultrasound expert, if no hepatobiliary, portal vein pathology is detect then the case is included in the study. Results: The mean age was 36.96 years with standard deviation of 14.96 years. 95% Confidence limit of age are 31.96-37.92 yrs. The mean height was 162.04 cm with standard deviation of 12.88 cm. 95% Confidence limit of height are 5.13-5.33 feet. The mean weight was 54.66 kg with standard deviation of 13.37 kg. 95% Confidence limit of weight are 49.53 – 54.05Kg. Mean Diameter of portal vein in age group 18-30 years (n=45) was found to be 3.3 mm, Mean Diameter of portal vein in age group 71-80 years (n=5) was found to be 4.0 mm. Mean measurement of diameter of common bile duct in the group of 120-135 cm (n=3) was 3.1 mm, Mean measurement of diameter of common bile duct in the group of 136-150 cm (n=22) was 3.2 mm, Mean measurement of diameter of common bile duct in the group of 151-165 cm (n=52) was 3.5 mm, Mean measurement of diameter of common bile duct in the group of 166-180 cm (n=23) was 3.6 mm. Conclusion: Ultrasonic evaluation of common bile duct is important, valuable and diagnostic in most of the biliary disorders such as cholelithiasis and obstruction in jaundice. No parameter like age, height or weight has any impact on size of diameter of common bile duct.

126. Anatomical Changes of Thoracic Vertebrae in Asymptomatic Adults: A Ct Based Study
Anjali Rai, Arvinder Pal Singh Batra, Shalini Choudhary, Chiranjeev Gathwal
Abstract
Background: The knowledge and occurrence of osteophytes in thoracic spine in human population is one of concern topics for anatomists, clinicians, anthropologists, and radiologist. These studies gave idea about normal and pathological changes in thoracic spine. Aim: The aim of the present study is to investigate frequency and severity of osteophytes and its correlation with age and BMI in thoracic vertebrae in adults. Study design & Setting: Cross sectional study was done in premises of department of Anatomy and department of Radiodiagnosis at BPS GMC (W), Khanpur Kalan, District Sonipat, Haryana. Materials and Methods: A total of 100 adult patient aged between (18-60) year, undergoing CT scan for chest were examined over a period of one year. Results: Statistically significant co-relation was found between age, BMI and osteophytes. The study showed that there are many degenerative changes seen in the thoracic spine at thoracic levels T4 to T10. The maximum number of osteophytes is seen with increase in age and BMI. The frequency of osteophytes increases by 60 percent and 80 percent in patients above the age of 40 and 60 years, respectively. Conclusion: Thus, the present study showed that prevalence and severity of osteophytes increases with advancement of age and it was found that prevalence and severity of osteophytes increase regardless of the age in obese patient.

127. An Observational Descriptive Cross-Sectional Study Evaluating Prevalence of Overweight and Obesity and its Determinant
Kundan, Birendra Kumar Rajak, Sudhir
Abstract
Aim: The aim of the present study was to assess the prevalence of obesity and overweight and to find out predictors for obesity. Methods: This cross-sectional study was carried out among adult individuals (aged 18-55 years) in the Department of Community Medicine, for period of 12 months. All the individuals were residents of the rural and urban areas. Results: Most of the participants were males 200 (66.66%) and 100 (33.34%) were female. Out of total study subject 264 (88%) were resident of urban area and 36 (12%) from rural area. Maximum number of participants was non worker 125 (41.66%). Socioeconomic status assesses most of them from upper class category 170 (56.66%). The age specific prevalence of obesity 55 (18.33%) in 36-55 years and 46 (15.33%) in 18-35 years, however the prevalence of and overweight was 35 (11.66%) in 18-35 years and 20 (6.66%) in 36-55 years. it was found to be statistically significant. Prevalence of obesity and overweight among males was 76 (25.33%) and 47 (15.66%) and among females 28 (9.33%) and 14 (3.33%) respectively. it was found to be statistically significant. The mean weight and height were highly significant among both the sexes. (p<0.001) slightly greater mean of BMI was found among males (23.7±3.14 kg/m2) as compare to females (22.8±3.67 kg/m2). The overall prevalence obesity (≥25 kg/m2) was 105 (35%) and overweight (≥23 kg/m2) 58 (16.66%). The prevalence of obesity was observed higher among males 75 (25%) and 30 (10%) female. However, the prevalence of overweight was also higher among the males 40 (13.33%) than female 10 (3.33%). Conclusion: Suitable health care strategy and intervention programs along with health education are needed to reduce the impact.  These results suggested that overweight and obesity may be serious public health problems. It is important to carry out further studies in order to explore the potential relationship between overweight and obesity on the one hand, and behavioral variables, such as smoking and alcohol consumption, on the other.

128. A Comparative Assessment of Peripheral Blood Smears (PBS) and Automated Cell Counter Generated Parameters in Different Types of Anemias
Santosh Kumar, Akhalesh Kumar, Pradeep Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate and compare the results obtained through two different methods: examination of peripheral blood smears (PBS) and automated cell counter generated parameters. Methods: The present study was a prospective study conducted in Department of Pathology,  over a period of one year.  The cases included were newly diagnosed cases undergoing treatment and follow up. 200 cases were included in the study. Results: Our study included that out of total 2000 cases; males were 960 cases (48%), while females were 1040 (52%). Among the study population, the largest proportion of patients (34%) fell within the age group of 31-45 years, followed closely by those aged 16- 30 years (31%). In this study 1400 cases (70%) were diagnosed as microcytic anemia by automated analyzer which constituted major portion of study population. In our study normocytic, dimorphic and macrocytic cases were found 14%, 7.8% and 4.5% respectively by automated analyzer. In our study on peripheral smear examination maximum number of cases (51%) belonged to microcytic anemia and normocytic anemia 30% and 8.1% cases belonged to dimorphic anemia, 3.1% cases belonged to macrocytic anemia and 3.1% hemolytic anemia and 0.3% Red Cell Agglutinins (cold) and 0.2% cases belonged to Thalassemia. Specifically, a left shift was observed in 75% of cases, while a right shift was present in only 4% of cases. Bimodal histograms were observed in 2.3% of cases, and multiple peaks were seen in only 1% of cases. Conclusion: Histograms are an essential tool for the initial morphological analysis of blood samples, especially when combined with the concept of the normal curve and knowledge of CBC parameters like RDW and red cell indices. By examining the shape of the histograms, potential pathology can be identified, providing hints for cases that require detailed peripheral smear examination. Moreover, the histograms offer insight into RBC count, MCV, and RDW through their shape and shift in different directions.

129. A Hospital Based Study Evaluate the Factors That Affect the Acceptance of PPIUCD
Sweety Kumari, Kuldeep Kumar Kaul
Abstract
Aim:  The aim of the present study was to evaluate the acceptance, safety, side effects and complications and failure rate of associated with immediate post-partum intrauterine contraceptive device (PPIUCD) insertion. Material & Methods: A Prospective Study was conducted on all Adult ANC women attending Department of Obstetrics and Gynaecology and as well as admitted in hospital wards or Labour Room who fulfil the inclusion criteria within the duration of 18 months. Results: Out of 11,550 patients who delivered during this period, 1155 (10%) patients had agreed for PPIUCD insertion after counseling, but only 500 (43.30%) patients reported for follow up. Distribution of patients according to time of insertion of PPIUCD which shows that 48.32% patients got PPIUCD inserted post placental after normal vaginal delivery and 40% after LSCS. Most of the patients were in the age group of 25 to 35 years and with two or three parity. Out of 500 patients who came for follow up, 270 patients came with one or other complaints while 230 patients reported for routine follow up. The continuation rate of PP IUCD in our study was 90% (450/500) while 50 (10%) patients got it removed due to various reasons. Conclusion: Immediate PPIUCD is safe and effective method of contraception with a high retention rate. Though acceptance in initial months was less but it gradually increased over time with increasing awareness, counselling of patients and training of health personnel.

130. Histopathological Correlation with Clinico-Radiological Diagnosis of Bone Tumours
Md. Akil Azher Siddique, Arundhati, Rashmi Singh
Abstract
Histological examination of bone tumors is considered to be a challenging field in pathology. Bone tumors and tumor – like lesions are very rare. The low incidence of these tumors and the resulting limited experience in dealing with them adds to the diagnostic difficulties. Clinico–radiological evaluation of bone tumors and tumor – like lesions is an essential part of patient management. Histopathological diagnosis should be given after proper review of clinical and radiological findings. There is very good correlation between clinico – radiological and histopathological diagnosis in bone tumors. However, many benign bone tumors and tumor – like lesions mimic malignant lesions radiologically. Hence, histopathological confirmation of radiological diagnosis should be always done before definitive treatment. A close co – ordination between the orthopaedician, radiologist and pathologist is the best approach to treat a patient with bone tumor.

131. A Randomized Study to Determine the Effect of Priming Principle on the Induction Dose Requirement of Propofol and Associated Haemodynamic Changes
Amit Kumar Prasad, Asim Shekhar, Rajesh Kumar Jha, Uday Kumar
Abstract
Background and Aims:  Propofol as an induction agent has many advantages. But one major side effect of propofol as an induction agent is hypotension. The aim of this study was to determine the effect of ‘Priming Principle’ on the induction dose requirement of propofol and associated haemodynamic fluctuations. Material & Methods: This study was carried out on 100 patients of either sex aged 20 to 60 years belonging to American Society of Anaesthesiologists physical status I/II scheduled for elective surgery under general anaesthesia. Patients were randomly allocated into two groups of 50 each. Group A (Priming) (n=50) patients were induced using priming principle. 20% of the calculated dose of propofol (2 mg/kg) was injected IV initially followed by remaining dose after 30 seconds till loss of eyelash reflex. Group B (Control) (n=50) patients were induced with total calculated dose (2mg/kg) of IV propofol till loss of eyelash reflex. Total dose of propofol required for induction and haemodynamic parameters were recorded in both the groups. Results: The demographic profile of the patients with respect to age and sex were comparable in both the groups with no statistical significant difference. The mean total dose of propofol required for induction was 79.21 mg in the group A (priming) and 93.7 mg in group B (control). This difference in the induction dose required was statistically significant. Statistically significant difference in the values of heart rate, systolic blood pressure and diastolic blood pressure was also noted between the two groups one minute after induction. Haemodynamic stability was better in group A (priming). Conclusion: The results of this study shows that the induction dose of propofol can be significantly reduced by using priming principle. Using priming principle also results in haemodynamic stability in the immediate post induction and peri-intubation period.

132. A Comparative Study of Maternal & Neonatal Outcome and Patient Satisfaction with Intravaginal Misoprostol versus Intravenous Oxytocin in Patients with Premature Rupture of Membranes beyond 36 Weeks Gestation
Anuradha Kumari, Alpna Bansal
Abstract
Aim: The aim of the present study was to compare the outcomes of misoprostol versus oxytocin with respect to the maternal and neonatal outcomes and patient satisfaction. Methods: The Prospective, randomized study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College & Maharani Hospital, Jagdalpur (C.G.), India for two years. 100 women which were admitted in the Department of Obstetrics and Gynecology, Government Medical College & Maharani Hospital, Jagdalpur (C.G.), India with prelabour rupture of membranes beyond 36 weeks of gestation enrolled for the study out of which 50 cases allotted to 2 groups. Results: There was not much difference of PROM cases in different age groups. Maximum cases were primigravida (62%) others were 38%. There was no statistically significant association found. Vaginal deliveries were 42% in misoprostol group, where as 44% in oxytocin group. Whereas LSCS were 7% in misoprostol  group  and  5%  in  oxytocin  group. There was one and five minutes APGAR score between two drugs under study. Incidence of hyperbilirubinemia with oxytocin was 10% as compared to misoprostol (4%). Conclusion: Labor induction with oxytocin infusion for PROM beyond 36 weeks in an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with transvaginal misoprostol. Misoprostol is an effective and safe agent for induction of labor in women with term premature rupture of membranes. When compared with oxytocin, the risk of contraction abnormalities and the rate of maternal and neonatal complications were similar among the 2 groups. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction.

133. Study to Investigate the Clinical Outcomes of Manchester-Fothergill’s Operation in Patients with Uterine Prolapse Caused by “True Cervical Elongation,” Compared with Vaginal Hysterectomy (VH)
Neha Gangane, Poonam Varma Shivkumar, Shuchi Jain, S Chhabra
Abstract
Aim: The aim of the present study was to investigate the clinical outcomes of Manchester-Fothergill’s operation in patients with uterine prolapse caused by “true cervical elongation,” compared with vaginal hysterectomy (VH). Material & Methods: The present study was conducted in the Department of Obstetrics and Gynecology, MGIMS, Sewagram, India for the period of three years, and during the study period, 30 patients underwent Manchester-Fothergill’s operation and 200 patients underwent VH. After matching with age, parity, and preoperative POP-Q stage, we divided 25 patients each in Manchester-Fothergill’s operation and vaginal hysterectomy respectively. Results: Of the baseline characteristics, BMI, postmenopausal status, and smoking history were not statistically different between Manchester-Fothergill’s operation and VH groups after PS matching with age, parity, and preoperative POP-Q stage variables. All subjects included in this study had advanced stages of POP that were preoperative POP-Q stage II, III or IV after matching. After matching, no recurrence of POP was reported in the Manchester-Fothergill’s operation group, and one case of POP recurrence was confirmed on pelvic examination in the VH group. No statistically significant difference in the recurrence rates of POP was found between the Manchester-Fothergill’s operation and VH groups. The duration of hospital stay and blood loss during surgery was not significantly different between the two groups. No statistically significant difference in postoperative complication rates was found between the Manchester-Fothergill’s operation and VH groups. The results from second subgroup analysis of preoperative POP-Q indicated high BMI and not having a concurrent anterior colporrhaphy to be significant risk factors for recurrence of POP within 1 year after surgery. Age and parity failed to attain statistical significance in relation to recurrence of POP. Conclusion: The Manchester-Fothergill’s operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.

134. An Observational and Analytical Assessment of FVC and PEFR and its Correlation with Progesterone Levels in Pregnancy
Jhillmill Kumari, Abha Mishra, Sunita, Shashikant Sharma
Abstract
Aim: This study was conducted to assess FVC and PEFR and to correlate with Progesterone levels in pregnancy. Material & Methods: This was an observational and analytical study included a total of 200 subjects were taken for the study. The subjects were from the obstetrics OPD.  Written informed consent was taken from the subjects. These subjects were divided into four study groups. Each group consisted of 50 subjects. Results: In the present study, weight and BMI showed significant difference in anthropometric measurements. Decrease in FVC in 1st (p<0.000), 2nd (p<0.000) and 3rd (p<0.000) trimesters of pregnancy when compared to control group was significant. In between the three trimesters there was no significant decrease (p> 0.05) in FVC values. There was significant and positive correlation of FVC and progesterone in the first and third trimester of pregnancy. Decrease in PEFR levels in 1st (p<0.000), 2nd (p<0.000) and 3rd (p<0.000) trimesters of pregnancy was significant when compared to control group. Amongst the three trimesters there was significant decrease (p<0.001) in third trimester when compared to 1st and 2nd trimester. There was significant and positive correlation with the progesterone in the first trimester of pregnancy. There was a positive correlation in all 3 trimesters of pregnancy and significant in 1st and 3rd trimester. Conclusion: The progesterone levels did not have any significant association with the pulmonary function test during gestation.

135. A Study to Investigate the Association of CRP with Systolic and Diastolic Blood Pressure: A Case Control Study
Suman, Robina Shamim, Jyoti Priya, Rita Kumari
Abstract
Aim: The aim of the present study was to evaluate the CRP levels of hypertensive cases with respect to that of normotensive controls and to investigate the association of CRP with systolic and diastolic blood pressure. Methods: A cross-sectional case-control study was carried out on 75 hypertensive and 75 normotensive subjects at Nalanda Medical College, Patna, Bihar, India. Both genders were included in the study. The cases were randomly sampled from the patients visiting our hospital, whereas the controls mostly belonged to our hospital staff members. Results: The hypertensive and normotensive groups were age and sex-matched, and data represented as mean ± SD. Systolic blood pressure, diastolic blood pressure and CRP levels were all significantly higher in the hypertensive cases than the normotensive controls. CRP levels were positively correlated and significant with both systolic blood pressure and diastolic blood pressure. Conclusion: CRP levels which are an extensively and widely used inflammatory marker may be used to detect high risk hypertensive patients and help prevent complications of hypertension such as arrhythmias and sudden cardiac death. Especially developing countries like India should realize and acknowledge its value in screening, risk prediction and prognosis of hypertension.

136. A Study to Access the Association between Prior Caesarean Delivery and Subsequent Development of Placenta Previa and Adherent Placenta
Ranu Singh Kushwaha, Khushboo Yashmin, Dipti Roy
Abstract
Aim: The aim of the present study was to find the association between prior caesarean delivery and subsequent development of placenta previa and adherent placenta. Methods: A descriptive study was conducted on 500 antenatal women with post cesarean pregnancy at department of Obstetrics and Gynaecology for a period of 1 year. Results: Placenta previa was found in 3% that is 15 of the study group compare to 2%, that is 10 of the comparison group. It was statistically significant with 2 times risk. According to type of placenta previa type 4 or central previa was the most common type. Altogether anterior previa occurred at a frequency of 44% compared to posterior previa which was 27%. Central previa occurred in 29.4%. Total major previa were 56% and minor previa was 44% in the study group. Placental adherence was found only in previous caesarean group which constituted 0.4% of previous CS group. Majority comes in the para 1 group. In those with placenta previa, multipara (≥para 2) was more (33.3%) compared to those without previa (14.44%) and is statistically significant. Previous history of placenta previa was present in 13.33% of patients with previa where as it was not present in those without previa. In both groups majority did not have a history of abortion. Multiple sections were more in previa group (26.67%) compared to 8.66% in those without previa which was statistically significant with a p value of 0.004. History of wound infection is more (26.67%) in those with placenta previa compared to 6.18% in those without previa which was statistically significant. Inter pregnancy interval of less than 2 years were more (33.33%) in those with placenta previa compared 15.46% of those without previa and is statistically significant. Conclusion: We concluded that pregnant women with previous caesarean delivery must be regarded as high risk for placenta previa and must be monitored carefully.

137. A Hospital Based Assessment of the Histological Patterns of the Endometrium in Women with Abnormal Uterine Bleeding (AUB) and Distinct Histopathological Patterns among Various Age Groups: An Observational Study
Drishti, Afsara Khatoon
Abstract
Aim: The aim of the present study was to evaluate the histological patterns of the endometrium in women with Abnormal Uterine Bleeding (AUB) and determine the distinct histopathological patterns among various age groups of women with AUB. Methods: The present prospective study was done in the Department of Pathology. The period of study was one year. A total of 200 endometrial specimens with a clinical diagnosis of AUB were analysed by histopathological examination in the present study. Results: Of 200 instances, 116 (58%) were perimenopausal, 64 (32%) were reproductive, and 20 (10%) were postmenopausal. AUB was most common in multiparous women (60%). In 200 AUB patients, 68% were normal weight, 22% overweight, and 7% obese. Most women with AUB had hypertension (35%), diabetes (24%), and thyroid problems (16%). Age-specific analysis. Menorhagia was the most prevalent bleeding pattern in perimenopausal and reproductive age groups (p = 0.00). Metrrohagia was the second most prevalent bleeding pattern in reproductive and perimenopausal women. Perimenopausal and postmenopausal women had the highest postmenopausal haemorrhage and were strongly linked. Functional causes of AUB with histological patterns in decreasing order were proliferative, secretory, disorganized, menstrual, and atrophic endometrium in all age groups. Conclusion: It is essential to conduct endometrial studies on women who are in the perimenopausal and postmenopausal age groups in order to facilitate the early detection of endometrial disease and the treatment of instances with adenouterine bulge (AUB). One of the most common comorbidities related with AUB was obesity, followed by hypertension, diabetes, and hypothyroidism.

138. Study of Serum Uric Acid Levels with the Severity of Kidney Injury in COVID Disease
Mamta Padhy, Manisha Singh, Rashmi Upadhyay, Devesh Sharma, Surabhi Puri, Pranshi Tripathi, Utkarsh Singh
Abstract
Aim: The aim of the present study was to assess the Serum uric acid levels with the severity of acute kidney injury. Methods: This study enrolled patients who developed AKI within 48 h of hospitalization at the Government Institute of Medical Sciences (GIMS), Greater Noida from March 2020 and February 2021. According to the inclusion and exclusion criteria, 1200 patients with AKI within 48 h after hospital admission were included. Results: Among all patients, the mean age was 58.1 years, and 640 (53.34%) were men. Compared with the lowest SUA group (≤3.6 mg/dL), the highest SUA group (>6.9 mg/dL) had a higher proportion of patients with CKD and hypertension. Regarding laboratory parameters, patients with higher SUA levels also had higher BMI, creatinine and triglyceride values Moreover, they were more likely to require RRT than patients with lower SUA (≤3.6 mg/dL). In multivariable analysis of model 1, which was adjusted for age, sex and BMI, the ORs were 1.46 (95% CI, 1.01–2.12) in the SUA level >5.0–6.9 mg/dl group and 3.16 (95% CI, 2.25–4.45) in the SUA level >6.9 mg/dl group compared with the reference group (SUA ≤3.6 mg/dl). After adjustment for age; sex; BMI; emergency status; AKI stage; the presence of CKD, diabetes, hypertension, heart disease, or cancer; creatinine; albumin; cholesterol; tri- glyceride; Hb; eGFR; RRT requirement; and the use of ACEIs, ARBs, beta blockers, CCBs, furosemide and UA- lowering agents, a similar trend was observed in analysis of model 2. A higher SUA level was associated with an increased risk of in-hospital mortality in AKI patients. Conclusion: We found that the SUA concentration appeared to be an independent prognostic marker of in-hospital mortality in AKI patients within 48 h after hospital admission and that elevated SUA levels were associated with an increased risk of in-hospital mortality and rate of non-recovery of renal function in these patients.

139. Role of Score for Neonatal Acute Physiology & Score for Neonatal Acute Physiology with Perinatal Extension-Ii Score Topredict Morbidity and Mortality in Newborn Admitted to Neonatal Intensive Care Unit
Dharm Raj Maurya, Anchala Bhardwaj, Mahima Mittal
Abstract
Aim: The aim of the present study was to compare between Score for Neonatal Acute Physiology-II (SNAP-II) and Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) in predicting morbidity and mortality in Neonatal Intensive care unit (NICU). Methods: It was a prospective observational study and study population was (preterm or term babies) born during our study period (July 2018 – June 2019) at NICU, Department of Pediatrics, (Nehru Hospital)  B.R.D. Medical College, Gorakhpur, (U.P.). 311 patients were included in the study. Results: Out of total 311 neonates enrolled in study, 64.3 % are male and 35.7% are female. Higher mortality is seen among males 8% and in females 3.9%, and (p = 0.570) shows no significant correlation with outcome. Out of total 311, 45% new born are delivered at B.R.D. Medical College, 31.2% delivered at peripheral government hospitals (PHCs, CHCs, Block hospitals, District hospitals), 19.9% delivered at private hospitals and rest 3.9% delivered at home. The mortality compared shows, 6.4% among inborn babies, 1.9% outborn government hospital,3.2% among private hospital, 0.3% among home born babies. There was no significant correlation between maturity (as per gestation weeks) and outcome. The result showed no significant correlation between values of APGAR at 5 minutes and outcome. Conclusion: SNAP-II and SNAPPE-II both are the good predictor of severity of disease and of mortality  with cut-off value for SNAP-II being 27 (sensitivity 75% and specificity 79%) and for SNAPPE-II is 39 ( sensitivity 67% and specificity 87%) and may help in prioritizing the treatment of sick as well counselling of parents about disease severity.

140. An Observational Study to Identify and Treat Intraoperative Injuries to Prevent Postoperative Neurological Deficits in Cervical Spondylotic Myelopathy (CSM): A Retrospective Study
Gaurav Srivastava
Abstract
Aim: The aim of the present study was to need to identify and treat intraoperative injuries to prevent postoperative neurological deficits in cervical spondylotic myelopathy (CSM). Methods: The present study was conducted at department of Neurosurgery, Kashi Neuron Multispeciality Hospital, Ramnagar, Varanasi UP, India. A retrospective analysis of patients who underwent surgical fusion for CSM and IONM was performed. 50 patients showed an IONM change. Results: A total of 312 patients who had a diagnosis of degenerative myelopathy and whose case involved neuromonitoring were identified; 167 were excluded for various reasons, 50 patients showed an IONM change and 95 showed no IONM change. The mean age was 57.3 ±15.3 and 52% were females. 96% had degenerative pathology of myelopathy. According to Nurick grade, 50% were in grade 1. Among the 50 patients with neuromonitoring changes, 4 patients showed postoperative neurological deficits. For the 90 patients without IONM changes, 5 patients showed some postoperative deficit that, although mostly mild, persisted up to last follow-up. Sensitivity of 43.87%, specificity of 69.52%, positive predictive value of 8.16%, and negative predictive value of 96.52% were identified for IONM in predicting postoperative neurological changes. Conclusion: Our study showed that IONM was efficacious as a surgical adjunct but showed limited accuracy in predicting postoperative outcome in contrast to some previous studies. Moreover, we describe how a standardized multidisciplinary collaboration using the best available evidence may serve as the most effective method to optimize patient care in light of the limitations and controversies of IONM.

141. Evaluating the Impact of Obesity on Electrocardiographic P-Wave Dispersion in a Population of Healthy People
Gaurav Sinha, Sandeep Kumar, Pandurang M. Narhare
Abstract
Aim: The aim of the present study was to investigate the dispersion of P–wave in healthy young adults. Methods: The study was conducted in the Department of Physiology, ESIC Medical College & Hospital, Bihta, Patna. Design of the study was cross – sectional observational and a total 200 young healthy adults both male and female aged between 18 to 40 years participated voluntarily in the study. Written informed consents were taken from all the participants after explaining the study protocol. Results: There was no significant difference in age, sex and height between obese and non –obese group but a significant difference were found in weight and BMI between groups. Obese group had higher SBP, DBP, HR, maximum P-wave duration, minimum P-wave duration and P-wave dispersion compared to non-obese and statistically significant (p<0.001) was found. Conclusion: It can be concluded that apparently healthy obese individuals may have higher anthropometric values and abnormal P–wave findings. Hence the present study gives an insight on the variations in P-wave in healthy adults who are obese and thereby helps in creating awareness so that; they can change their lifestyle in order to prevent the onset of the deleterious effects of obesity on their health.

142. A Hospital-Based Study to Evaluate the Efficacy of Intravenous Iron Sucrose for the Treatment of Iron Deficiency Anemia in Pregnancy
Sweta Kumari, Simpi Shilpa, Seema Singh
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. The duration of the study was about 12 months. 100 pregnant women were enrolled for this study. Results: The study results showed that the mean age of the pregnant women was 24.76±5.08 years, their mean weight was 58.52±11.29 kg, their mean gestational week was 27.83±4.08, 15 (15%) of them had gestational diabetes, 12 (12%) of them had hypertension, 7 (7%) of them had hyperthyroidism, 6% had asthma and 5% 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 (Orofer S) 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 controllable safety profile clinically and enhanced Hemoglobin and ferritin level both and thus decrease complications during pregnancy due to iron deficiency anemia.

143. A Hospital-Based Evaluation of the Causative Agents and Their Antibiotic Susceptibility Patterns in Pyodermas
Alpana Singh, Ajay Kumar
Abstract
Aim: The aim of the present study was to find out causative organisms and their latest antibiotic susceptibility patterns in pyodermas. Methods: This hospital based prospective cross-sectional study was conducted in department of Microbiology for a period of 15 months, a total of 8915 cases were examined in the outpatient and inpatient wings of the Dermatology Department and of them 100 cases were diagnosed to have pyoderma, which comprised the study population. Results: Pyoderma was found all age groups mainly affecting 0-30 yrs age group constituting 55% of cases. There were 54% males as compared to females. There were 66% monomicrobial and 24% were polymicrobial. 60% had primary pyoderma and 40% secondary pyoderma. In the present study, lower limb was affected followed by upper limb, face, trunk and scalp. Majority of the patients had nil risk factors. The predominant isolate obtained was Staphylococcus aureus, followed by Beta hemolytic Streptococci. All the Staphylococcus aureus strains isolated were sensitive to vancomycin and 95% were sensitive to linezolid. Sensitivity to penicillin was 10%, to amikacin it was 74% and to doxycycline it was 82%. Conclusion: Pyoderma is a major cause of morbidity among patients. In recent times, emerging drug resistant strains are posing difficulties in treating pyoderma. Staphylococcus aureus is most common organism causing pyoderma. Impetigo was found to be the most common type followed by furunculosis, folliculitis & ecthyma.

144. A Hospital-Based Evaluation of the Causative Agents and Their Antibiotic Susceptibility Patterns in Pyodermas
Ram Prakash Bairwa, Jigyasa Gothwal, Sameer Jagrwal, Mamta M Jagrwal, Yash Jain
Abstract
Background: Retinopathy of prematurity (ROP) is a vascular disease of the premature retina and the incidence of ROP varies significantly across countries depending on the socio-economic developments and healthcare systems quality. The most critical risk factors for ROP are advanced prematurity, low birth weight (LBW), and small for gestational age (SGA). Pathogenesis is initiated with delayed retinal vascular growth after premature birth (phase I). Insufficient vascularisation of the developing retina creates hypoxia, which precipitates the release of factors stimulating new and abnormal blood vessel growth (phase II). The most vital part of ROP management is reducing modifiable risk factors such as blending protocols for oxygen delivery, rigorous infection control, restrictive blood transfusion strategies, and parents education. Laser remains a highly effective therapeutic modality and the gold standard of care in most ROP cases. On the other hand, Anti-VEGF agents emerged as a potential solution to clinical situations where laser delivery is not feasible, as in poor pupillary dilatation with advanced tunica vasculosa lentis (TVL), vitreous haze, corneal opacification, rubeosis iridis, and vitreous hemorrhage. The current recommendations indicate surgery for ROP stages 4-5. For stage 4, surgical modalities incorporate scleral buckling and lens-sparing vitrectomy (LSV).

145. Self-Care Practices and its Effect on Glycemic Control among Type II Diabetes Mellitus Patients
Rupendra Pal Singh Rathore, Ravi Shekhawat, Anubhav Sharma, Sunil Gora, Kapil Garg, Mayank Jain
Abstract
Background: Diabetes is a non-communicable disease that necessitates daily self-management through the establishment and maintenance of a continuum of care in order to achieve optimal health outcomes. It is commonly understood that diabetes self-care practice is critical in the management of the disease. However, the magnitude and determinants of self-care practices are not well evaluated at the community level. Objectives: To access the level of self-care practice and its effect on glycemic control among type 2 diabetes mellitus patients. Method: A community based cross-sectional study was conducted at Urban field practice area of Jhalawar Medical Colleg during May 2023 to October 2023 on 440 confirm patients of Type II DM. Pretested semi structured questionnaire was used for obtaining information regarding socio demographic profile, disease history, Diabetes Self-Management Questionnaire (DSMQ). Blood sample was collected following standard protocol for HbA1c to measure their glycemic control of patient. Results: Out of 440 diabetics, 58.4% were male and 41.6% were female. Mean age of the patients was 52.48±10.8 years. Mean duration of diabetes was 9.88 ± 4.34 years. More than half of the diabetics (262, 59.55%) had good glycaemic control. Most common self care activity was taking medication (82.5%) as advised. DSMQ sum scale was significantly different among good and poor glycemic control groups (p value=0.01). Conclusion: Nearly half of patients following self care diabetes management practices. Diabetes self-care practices are significantly associated with good glycemic control among diabetics.

146. Top of FormA Study on the Incidence of DNS and Chronic Rhinosinusitis in Patients with Concha Bullosa
Kavitha Chunduru, Meka Pavani Rao, Kesavarapu S N V Ravi Kiran, Sai Lakshmi Kudupudi
Abstract
Aims: To study the association of concha bullosa with deviated nasal septum and chronic rhinosinusitis. Materials and Methods: A cross sectional study was carried out on 70Patients with concha bullosa who attended the Dept of ENT at GSL Medical College and general hospital Rajamahendravaram. Results: Out of 70 patients with concha bullosa 64i.e 91.4 % had DNS to the contralateral side and 40 patients i .e 57.1 % had sinus disease. Out of 70 patients, 48(69%) were males and 22 (31%) were females with male female ratio being 2:1. Conclusion: It is concluded that there is a significant association between concha bullosa and a contralateral deviated nasal septum and that concha bullosa does play a role in the development of chronic rhinosinusitis though not all the patients with concha bullosa have sinus disease.

147. An Observational Assessment of Surgical Management of Complications of Peptic Ulcer Diseases among High-Risk Patients and with Irregular Treatment
Purnendu Paul, Swapan Choudhury, Ahsan Ulla
Abstract
Aim: The aim of the present study was to assess the complications of peptic ulcer Diseases and surgical management of complications of peptic ulcer diseases among high-risk patients and with Irregular treatment. Methods: The present study was conducted at department of General Surgery, Jagannath Gupta Institute of Medical Sciences & Hospital, Budge Budge, Kolkata, West Bengal, India and patients admitted with a primary diagnosis of peptic ulcer disease complications such as haemorrhage, hollow viscus perforation, and gastric outlet obstruction, and who underwent surgical management for the above, were included in this prospective study. After applying inclusion and exclusion criteria, a minimum of 200 patients were chosen for this research. Results: In our study majority of the subjects were between the age group of 31 to 60 years. 90% of the patients were male with 70% hailed from rural community.60% had high school education or above. Out of the 200 patients in our study 72% had perforation, 5% had Bleeding, 23% had Gastric outlet Obstruction complication related to Peptic ulcer Diseases. Among Patients with Perforation, 70 out of 144 cases had previous history of peptic ulcer disease in which 64 (44.44%) patients on irregular treatment and 8 (5.55%) patients on regular treatment. 10 out of 10 patients with Bleeding complication gave history of off and on pain in abdomen and taken regular treatment for peptic ulcer disease. 46 out of 46 cases of gastric outlet obstruction had previous history of peptic ulcer disease, all of them on irregular treatment. Conclusion: Complications are more common in people who get irregular medical therapy for peptic ulcer disease and are less common in patients who receive regular medical care. Medical therapy has a critical and important role in treating the majority of patients with peptic ulcer disease in the current age of effective PPI and anti-H.Pylori medication. Surgical care is required for individuals with refractory and complex peptic ulcer disease, despite dramatic breakthroughs in the conservative management of the condition.

148. A Hospital-Based Study Assessing the Effect of Intrauterine Instillation of Autologous Platelet Rich Plasma and G-CSF on Endometrial Thickness and Pregnancy Rate in Frozen Embryo Transfer for Women with Thin Endometrium: A Randomized Clinical Study
Niharika, Kalpana Singh, Shubhanti Kumari, Huma Nishant, Bhawana Tiwary
Abstract
Aim: The aim of the present study was to evaluate the effect of intrauterine instillation of autologous platelet rich plasma and G-CSF on endometrial thickness and pregnancy rate in frozen embryo transfer for women with thin endometrium. Methods: The present retrospective cohort study was conducted in the department of reproductive medicine, IGIMS, Patna, Bihar, India. All the patients of age group 22 – 40 years coming to OPD for ART during the period of 9 months from March 2022 to November 2022 was selected after randomization into two groups for this study after fulfilling the inclusion & exclusion criteria. Sample sizes of 100 subjects were included in the final analysis. Results: The mean age, BMI, S AMH in both the groups were not statistically significant. The most frequent factor for thin endometrium is AKT-or patients on anti-kochs treatment followed by uterine anomalies. The distribution of various other factors have been discussed here like RIF, RPL, endometriosis and ashermanns syndrome which are commonly associated with thin endometrium. Both the groups have similar distribution of factors. The mean of the endometrial thickness before and after are compared in both the groups with injection GCSF showing higher increase in endometrial thickness than intrauterine PRP after 48 hours of administration. It was found that for chemical and clinical pregnancy rates, the p values were 0.77 and 0.37 respectively and hence statistically not significant. Conclusion: Through the analysis done in this study it becomes evidently clear that injection GCSF is superior in its action as compared to intrauterine Platelet Rich Plasma in increasing the endometrial thickness in patients diagnosed as thin endometrium for infertility.

149. An Analytical Study Assessing the Role of Colposcopy and Paps Smear in Cervical Carcinoma Screening in Tertiary Care Facility
Hena Jabin, Sneha Bhushan, Abha Sinha
Abstract
Aim: The aim of the present study was to assess the role of colposcopy and paps smear in cervical carcinoma screening in tertiary care facility. Methods: The prospective observational comparative study was conducted at Department of Obstetrics and Gynaecology for 18 months. 200 patients were included in the study. Results: In this study, 34% women belong to age group 41-50 years. 23% women belong to 51-60 years of age. 3% women belong to 20-30 years of age, 19% women belong to 31-40 years of age and 21% women are more than 60 years of age. In this study population, majority 62% presented with white discharge, 16% presented with post-coital bleeding, 12% each of irregular cycles and intermenstrual bleeding, 8% were asymptomatic, 6% each presented with pain in abdomen and postmenopausal bleeding, 1% presented with dyspareunia and 4% presented with other complaints. In this study there were 2 % with parity 1, 22% with parity 2, 28% with parity 3, 25% with parity 4, 8% with parity 5, 7% with parity 6, 7% with parity 7 and 1% with parity 8. In present study the per vaginum findings 60% bulky uterus was seen while in 40% women it was normal. In this study, PAP smear has showed maximum 80% women having inflammatory, in 1% it showed LSIL, in 2% HSIL was the finding, in 15% it showed ASCUS and in 2% findings were suggestive of bacterial vaginosis. In this study, authors found that colposcopy showed 33% acetowhite area, 36% metaplasia, 6% mosaic, 7% punctuate, 10% abnormal vascularity, 5% polyp, and in 3% the findings were suggestive of polyp/growth. Conclusion: Colposcopy is definitely more sensitive and accurate than pap smear. By combining Pap smear with colposcopy, we can maximize the sensitivity and specificity of cancer cervix screening.

150. A Hospital Based Assessment of Thyroid Disorders in Women during Reproductive Age: An Observational Study
Sneha Bhushan, Hena Jabin, Anupama Sinha
Abstract
Aim: The aim of the present study was to assess the thyroid disorders prevalence in women during reproductive age. Methods: An Observational study including 200 reproductive women of the age group of 18-45 years was conducted in the Department of Obstetrics and Gynecology, for one year. Informed consent was obtained from all the participants and confidentiality of data was maintained. Written informed consent was obtained from all the parents of the participants before the commencement of the study. Results: The disorder was more common in age group 40 years and older accounting for 45%. AUB was more common amongst multiparous woman contributing to 58%. The most common menstrual disorder pattern seen in AUB was menorrhagia which was 54%. Next commonest was polymenorrhea at 20%. Euthyroid, hypothyroid and hyperthyroid were 87%, 9% and 4% respectively. Majority of the hypothyroid cases were in age group >40 years. The highest number of hyperthyroid cases was in age group of 21-30 years. More number of hypothyroid cases were in >40 years age group and a smaller number of cases in <20 years age group. There was high association observed between age groups and thyroid type and it is found statistically significant (p<0.001). Conclusion: The study results suggested that there was a strong association between the thyroid disorders and the reproductive functions in the women of reproductive age. The study recommends further detailed studies in this area for further understanding the relationship and to plan effective treatment strategies.

151. A Hospital Based Observational Study Assessing Association between Maternal Education and Birth Weight of the Baby
Sunil Kumar Singh, Anil Kumar
Abstract
Aim: The aim of the present study was to find out the correlation between maternal education and birth weight of the baby. Methods: A hospital based cross-sectional study was conducted in the Department of Pediatrics, during the study period of 1 year. The total of 500 mothers who were admitted in the postnatal wards of GMCH, Bettiah, Bihar, India during the study duration were enrolled in the study. Results: The present study shows that 65% mothers were educated up to high school, 10% were graduated and only 2% were post graduated. Mean education was 9th standard. 58.07% mothers had height between 150-159 and 0.39% mothers were < 130 cm tall. Mean height of mother was 145.11 cm. In our study, we found that rate of LBW babies was significantly high among uneducated women. Maximum women belonged to 150-159 cms followed by 140-149 cms. Most of the women had weight between 40-49 kgs followed by 50-59 kgs. Conclusion: Poor health at birth is greater among babies of mothers with low education. Our study shows that, in a setting where healthcare system provides essential health services to all women, irrespective of their socioeconomic status, mother’s education is strongly associated with adverse perinatal outcomes, including preterm birth, SGA. These findings merit attention from a public health perspective.

152. A Hospital-Based Study to Determine the Effect of Phototherapy on Serum Magnesium Level in Term Neonates with Hyperbilirubinemia
Prem Kumar, Rakesh Kumar, Sujit Kumar
Abstract
Aim: The aim of the present study was to determine the effect of phototherapy on serum magnesium level in term neonates with hyperbilirubinemia. Material & Methods: A prospective hospital‑based comparative study was conducted on 200 eligible neonates admitted in Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India receiving phototherapy for the period of one year. Informed consent was obtained from the parents of the selected neonates. This study included 200 full‑term neonates who were subjected to phototherapy for treating neonatal hyperbilirubinemia according to the guidelines of the American Academy of Pediatrics. Results: Our study included 200 full‑term neonates with jaundice who received phototherapy for treating neonatal indirect hyperbilirubinemia, comprising 130 (65%) males, and 70 (35%) females, with the mean gestational age of 37± 0.8 weeks and mean postnatal age of 5.2 ± 1.4 days. There were 68 (34%) neonates delivered by normal vaginal delivery and 132 (66%) neonates delivered by cesarean section. Mean birth weight was 3.1 kg. The mean difference of jaundice onset age, intrauterine age, admission weight and mother’s age were not significant. The amount of total serum bilirubin decreases in all groups. Serum total magnesium level in single and double phototherapy decreases after treatment, but this decrease is significant only in the double phototherapy group (P = 0.022). In the intensive group, this parameter has slightly increased, which was not statistically significant (P = 0.530). The serum total magnesium level and its changes were reported in three groups before and after phototherapy. The serum magnesium level in new borns before treatment was normal in all three treatment groups. The status of each patient showed that single, double, and intensive phototherapy groups have magnesium content of more than 2.2 mg/dl, respectively. Conclusion: In the present study, the serum magnesium level showed a significant reduction only in the double phototherapy method and remained in the normal range in the other two groups. On the other hand, in all three treatment groups, the level of serum magnesium before the treatment was normal and did not increase significantly.

153. Assessment of the Use of Prophylactic Antibiotics in Women Undergoing Elective Caesarean Section: A Comparative Study
Simpi Shilpa, Sweta Kumari, Seema Singh
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 Gynecology for the period of 24 months. Patients were randomly divided on alternate number basis in 2 groups (Group A and Group B) each consisted of 100 patients. Results: Mean age was 25.5±4.6 years in group A & 24.6±3.4 years in group B. BMI at the time of admission was 26.4±6.3 kg/m² & 27.3± 5.4 kg/m² in group A & B respectively. Mean duration of surgery was 41.9±6.4 min in group A & 47.3±5.5 in group B. Average blood loss in both groups was comparable. Mean days of hospitalisation was 4.8±3.7 days & 5.7±2.9 days in group A & B respectively. Most common indication for elective LSCS was previous LSCS followed (42% and 38%) by primi with CPD (24% v/s 22%). In the group A prophylactic antibiotic prophylaxis was given to 20 women (40%) and was not given to 30 women (60%). In group B, out of 50 women of this 45 (90%) of women received prophylactic antibiotic before elective LSCS. Out of 20 women who received antibiotic in group A, 40% received antibiotic within 1 hour and 12 cases (60%) received more than 1 hour before procedure. Out of 45 women in group A, 38 (84.45%) women received antibiotic within 1 hour, 8 received more than 1 hour (15.55%). In the group A, majority of the women received amoxicillin clavulanic acid 1.2 gm IV /Inj cefotaxime based on the policy formulated based on the antibiogram of the hospital. 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.

154. A Study Determining the Etiology of Thrombocytosis and Analyze Various Platelet Parameters in Children
Arvind Kumar Yadav, Manish Ranjan, Kripa Nath Mishra
Abstract
Aim: The aim of the present study was aims to determine the etiology of thrombocytosis and analyze various platelet parameters in children. Methods: This was a prospective observational study carried out in the Department of Pediatrics, Darbhanga medical College and Hospital.All children of age group 1–14 years of age attending pediatrics outdoors and indoors of DMCH were included in the study. A total of 272 children presented with thrombocytosis. Results: Age group ranged from 1 to 14 years out of which majority were in 1–2 years age group (45%). 70% children had mild thrombocytosis whereas moderate and severe thrombocytosis was seen in 24% and 3%, respectively. Etiology was secondary or reactive in 99.5% cases whereas only one case of primary thrombocytosis was encountered. Primary or clonal thrombocytosis was seen in one case of Philadelphia positive pediatric CML. No cases of ET were encountered. Etiological spectrum of secondary thrombocytosis was extremely varied. Infection was the most common cause for secondary thrombocytosis, with the highest number attributed to respiratory tract infections alone. For analyzing the association of platelet indices with the severity of thrombocytosis, the cases were grouped into three categories (mild, moderate, severe + extreme) and mean value, standard deviation and P value was calculated. On analysis, an inverse relationship between the platelet indices and the degree of thrombocytosis was observed. With increasing platelet counts, there was a decrease in MPV which had a significant negative correlation (P < 0.05). Mean PDW of children with mild and moderate thrombocytosis was 10.96 fl and 10.26 fl, respectively. Conclusion: Thrombocytosis in children is predominantly secondary and primary (clonal) thrombocytosis is extremely rare. The most common etiology of secondary thrombocytosis in children is infections and is a transient phenomenon with no major clinical implications. However, if no secondary cause is found for increased platelet count or if it persists even after treating the primary cause, a search for underlying primary thrombocytosis should be done.

155. An Observational Study to Examine the Effectiveness of Eye-Light Therapy in Improving the Dry Eye Symptoms
Gautam Garg, Sujata Kumari, Alok Ranjan, Nageshwar Sharma
Abstract
Aim: The aim of the present study was to examine the effectiveness of eye-light therapy in improving the dry eye symptoms. Methods: The present study was conducted in the Department of Ophthalmology. where medical records of subjects who had undergone Eye-light® therapy were analyzed and adheres to the tenets of declaration of Helsinki. Since this was retrospective study, informed consent was not obtained. Results: We noted significant negative association between OSDI and NBUT. We also noted borderline significant negative association of OSDI with lipid layer thickness and tear height. OSDI was positively associated with upper lid meibography and lower lid meibography. We noted reduction in OSDI score post therapy however it did not reach statistical significance. NBUT was similar post therapy. The lipid layer thickness and tear height was found to increase post light therapy however the difference was not statistical significant. Meibography of upper lid was reduced post therapy however meibography of lower lid did not alter much. In grade 2 there was significant improvement in tear height however did not found any significant changes in NBUT, LLT, meibography of Upper and lower lid. In grade 3, we did not find significant improvement in any of the parameters. Conclusion: Eye-light therapy is effective in reducing dry eye related symptoms with minimal immediate effect on tear film parameters post therapy. Eye-light therapy acts as an adjunct to ameliorate MGD, which being a chronic disease requires sustained topical medication with environmental changes. Long term evaluation is required to assess the tear film changes and the pattern of efficacy of light therapy.

156. An Outcome Assessment of Intramedullary Interlocking Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis: A Comparative Study
Rahul Harish, Shashank Kumar
Abstract
Aim: The aim of the present study was to evaluate the functional outcomes of intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis. Methods: This present study was conducted in the Department of Orthopaedics for the period of 2 years. During this timeframe, 120 patients were recruited for surgical procedures.  Patients were randomly allocated into two groups, each containing 60 patients. Results: Out of these 120 patients, 66 were male and 54 were females. The mean age of the plating group was observed as 43.17 years while the average age of the nailing group was reported as 38.342 years. In the plating group we observed 40 cases of OA type 1, 16 cases were diagnosed as type 2 and only 4 cases were identified under the category of OA type 3. Meanwhile, in the nailing group 41 cases of type 1, 17 were of type 2 and 2 cases of type 3 was managed. The mean duration of surgery was reported as 62.78 ± 8.52 hours in the nailing group while 58.424 ± 8.92 hours in the plating group with no statistical difference. We observed that the IMIL group attained fracture union in an average duration of 26.84. But no statistical difference was observed between both groups. IMIL procedure has less duration of hospital stay when compared with MIPPO. We observed 5° malunion in the MIPPO group whereas the IMIL group reported 10° malunion with a significant difference of 0.001. The average duration of weight-bearing was reported as 7.33 in plating and 7.03 in the nailing group. We observed that 6 cases of the IMIL group reported knee pain with a statistical difference of 0.025 between both groups. Conclusion: We observed the reliability of both procedures in managing the distal tibia fractures. Both procedures provide a favorable environment for healing fracture sites by preserving the bony vascularity and fracture hematoma. However, our study concluded that the plating technique can better restore the distal tibia alignment but also had chances of postoperative complications which would be manageable.

157. Clinico-Etiological Evaluation of Acute Febrile Illness with Thrombo-cytopenia: An Observational Study
Amit Kumar Nirmal, Rajeev Kumar, Abilesh Kumar
Abstract
Aim: The aim of the present study was to determine the clinical and etiological profile of acute febrile illness with thrombocytopenia. Material & Methods: This was a hospital-based prospective observational study conducted in the JLN Medical College and Hospital, Bhagalpur, Bihar, India. The study included 100
consecutive patients who were admitted during the period of one year. Results: Majority of the patients (65%) were from the age group of 18-40 years followed by 25% from the age group of 41-60 years, 10% from the age groups >60 years. The mean age of the patients was 38.22±10.20 years. In this study 60 (60%) patients were male while female patients constituted 40% of the study group. The causes of febrile thrombocytopenia were dengue (62%), Septicemia (15%), Malaria (9%), Enteric fever (4%), Kala azar (3%), Scrub typus (2%), other viral fever (5%). Among 20 (20%) patients had bleeding manifestations. Petechiae was the most common site of bleeding manifestation (40%) followed by Epistaxis (20%), Malena (15%), Haematuria (15%), Haematemesis (5%) and Gum bleed (5%). In this study 67 (67%) patients had platelet count of >50,000/µ Followed by 20 (20%) patients with platelet count of 21,000-50,000/µL, 8 (8%) patients with platelet count of 11,000-20,000/µL and 5 (5%) patients with platelet count of ≤10,000/µL. Conclusion: The study showed that acute febrile thrombocytopenia is an important seasonal syndrome. The common causes are dengue fever and malaria. Early identification of these diseases and prompt treatment decreases complications and reduces mortality. Special consideration should be given to patients having bleeding manifestations, hepatic and renal dysfunction to reduce mortality.

158. A Hospital-Based Assessment of the Association of Anatomical Variations of Nasal Osteomeatal Complex with Sinusitis: An Observational Study
Manish Kumar, Md. Tausiful Haque, Chandra Shekhar
Abstract
Aim: The aim of the present study was to assess the correlation of anatomical variations of nasal osteomeatal complex with sinusitis. Methods: The present observational study was conducted in the department of ENT. Based on inclusion and exclusion criteria total 100 patients suffering from nasal septal deviation were enrolled in the study and informed written consent was obtained. Results: It was observed that out of 200 cases, majority of the patients were in age group of 21-30 years (55%), followed by 31-40 years (30%). The mean age of the study subjects was 31.19±8.92 yrs. It was seen that majority of the patients were male. The most common presenting symptom observed in the present study was nasal obstruction (91%) which was followed by nasal discharge (73%), headache (48%), hyposmia (12%) and nasal bleeding (5%). There was not significant association of septal deviation with sinusitis on opposite side was observed. There was not significant association between the type of conchabullosa and sinusitis on same side of disease. It was seen that there was no significant association between anatomical variation and sinusitis on same side. There was no significant association between anatomical variation and sinusitis on opposite side. Conclusion: We concluded that there was a significant association of septal deviation with the sinusitis on same side while there was not significant concha bullosa and its association with sinusitis on same side. The association of other anatomical variation and sinusitis on same side was not significantly associated.

159. Self Care Practices and its Effect on Glycemic Controlamong Type Ii Diabetes Mellitus Patients
Rupendra Pal Singh Rathore, Ravi Shekhawat, Anubhav Sharma, Sunil Gora, Kapil Garg, Mayank Jain
Abstract
Background: Diabetes is a non-communicable disease that necessitates daily self-management through the establishment and maintenance of a continuum of care in order to achieve optimal health outcomes. It is commonly understood that diabetes self-care practice is critical in the management of the disease. However, the magnitude and determinants of self-care practices are not well evaluated at the community level. Objectives: To access the level of self-care practice and its effect on glycemic control among type 2 diabetes mellitus patients. Method: A community based cross-sectional study was conducted at Urban field practice area of Jhalawar Medical Colleg during May 2023 to October 2023 on 440 confirm patients of Type II DM. Pretested semi structured questionnaire was used for obtaining information regarding socio demographic profile, disease history, Diabetes Self-Management Questionnaire (DSMQ). Blood sample was collected following standard protocol for HbA1c to measure their glycemic control of patient. Results: Out of 440 diabetics, 58.4% were male and 41.6% were female. Mean age of the patients was 52.48±10.8 years. Mean duration of diabetes was 9.88 ± 4.34 years. More than half of the diabetics (262, 59.55%) had good glycaemic control. Most common self-care activity was taking medication (82.5%) as advised. DSMQ sum scale was significantly different among good and poor glycemic control groups (p value=0.01). Conclusion: Nearly half of patients following self-care diabetes management practices. Diabetes self-care practices are significantly associated with good glycemic control among diabetics.

160. A Comparative Study between Vitamin C and Thiamine Vs Vitamin C and L Carnitine in Sepsis Patient: A Randomised Prospective Study
Vivek Ranjan, Akhileshwar, Nitin Kumar, Ajit Kumar, Uzma Raihan
Abstract
Aim: The aim of the present study was to investigate the effects of high dose vitamin C, thiamine, L-carnitine supplementation on and compare which group is more effective in inflammatory mediators, oxidative stress, clinical outcomes, and the rate of mortality in ICU septic patients. Methods: This study was a randomized controlled study conducted in the Department of Trauma and Emergency over a period of one year. Total 100-patients of sepsis, admitted in the intensive care unit of our hospital during this period were selected, as defined by the Sepsis 3 guidelines. We excluded patients with chronic kidney disease, chronic alcoholics and immunocompromised patients. The patients were divided 100 randomly into 2 groups of each and were followed through till discharge or death, Results: The mean age of the subjects was 62.8 ± 16.4 and 56.4 ± 15.0 in group 1 and group 2 respectively. 51 (51%) were male and the mean APACHE3 score was 81.1 ± 23.6 and 56.9 ± 22.7 in group 1 and group 2 respectively. Liver failure was noticed in 5 patients in group 1 and in 7 patients in group 2. There was no statistically significant relationship between a patient’s initial thiamine level and vitamin C level. Conclusion: We found that mean ascorbic acid and thiamine levels were lower than normal range but that there was no relationship between these levels and outcomes, including 28 day mortality.

161. An Observation Cadaveric Assessment of Abdominal Aorta in Low Socio-Economic Group
Md. Afzal Hussain
Abstract
Aim: The aim of the present study was to assess the abdominal aorta in low socio-economic group. Methods: The Observation study was conduct on approximately 50 cadavers which were brought to the dissection hall of the Department of Anatomy and also on bodies brought to the forensic Medicine and Toxicology Department for post mortem examination. Results: In male group, short length varying range from 9 -10 cm with mean of 9.8 cm was measured in 10 cases. In females in this category the range of length was observed varying from 9 -9.5 cm. with mean of 9.4 cm in 8 cases. (b) Median length varying with mean value of 10.9 cm were found in 8 cases of males and median length was observed 10 cm in 6 cases with mean value of 10 cm. (c) Large length: in males the range observed was 11-12.5 cm. with mean value 12.48 cm in 9 cases. In females, it was observed varying from 11-12 cm with mean value of 11.2 cm in 7 cases. Conclusion: The study of abdominal aorta was conducted on 15 male and 15 female cadavers of age group varying 25-55 years from low socio-economic group, brought to the dissection hall. Dimension of aorta was carefully measure and its length, thickness of the wall, diameter, volume and extent were observed with differences in accordance with those of the workers of another field.

162. Effectiveness of Different Music-Playing Devices for Reducing Preoperative Anxiety
Shanta Kumari, Harshwardhan, Rajiva Kumar Singh
Abstract
Aim: The aim of the present study was to determine the anxiety-relieving effect of broadcast versus headphone music playing for patients awaiting surgery. Methods: The present study was conducted Department of Physiology. To contrast the effect of music intervention in our study, control group was considered in addition to broadcasting and headphone groups.150 subjects were included in the study. It is required to assess patients’ anxiety and pain on admission and each significant event such as surgery and procedure. Results: There were no significant differences between the two groups in age, gender, waiting time, methods of anesthesia, or types of surgery. The mean anxiety score of the control group was significantly higher than that of the headphone group and the broadcast group. The average heart rates of the broadcast group, head- phone group and control group were not significantly different. Time-domain heart rate variability parameters in the broadcast group were all higher than those in the headphone and control groups, but the differences were not significant. There was significant difference in high frequency HR variability among the three groups. Conclusion: Listening to music is effective for reducing the anxiety of preoperative patients. Such patient anxiety can be indicated by a decrease in VAS scores, and a decrease in the low- and an increase in the high-frequency parameters of HR variability. Both headphone and broadcast music are effective for reducing the preoperative patient’s anxiety in the waiting room.

163. Gastrointestinal Endoscopic Biopsy: Histopathological Spectrum
Vandana, Swarnim Kumari, Roushini Kumari, C.P. Jaiswal
Abstract
Aim: The aim of the present study was to assess the histopathological spectrum of gastrointestinal endoscopic biopsy. Material & Methods:  A prospective study was conducted on the GIT endoscopic biopsies and their histopathological assessment was done at Department of Pathology. Endoscopies were performed using an endoscope. The biopsy specimens received were fixed in 10.0% formalin and routinely processed in H & E stain. Results: Out of 200 cases, most of the patients were in the age group of 51-60 years followed by the age group 61-70 years. Out of 200 patients, 120 were males and 80 were females. Out of 200 cases, inflammatory lesions were most common in 51-60 years of age. Benign lesions were most common in 21-30 years of age. Premalignant lesions were most common in 51-60 years of age. Malignant lesions were most common in 51-60 years of age. Out of 200 cases, the stomach was the most common site for endoscopic biopsies of which 48 cases were there. 37 cases were from the esophagus among which 22 cases were males and 15 cases were females. 35 cases were from the duodenum among which 25 cases were males and 10 cases were females, 23 cases were from rectum among which 13 cases were males and 10 cases were females, 25 cases were from colon among which 15 cases were males and 10 cases were females, 13 cases were from gastroesophageal junction among which 5 cases were males and 8 cases were females, 10 cases were from rectosigmoid junction among which 2 cases was male and 8 cases were females, 9 cases were from ileum among which 4 cases was male and 5 cases were females. Conclusion: Endoscopic biopsy correlation reflects important advances in understanding the pathophysiology of disease and prognosis and survival rates after staging in the case of carcinomas. It provides diagnostic information and aids in improving patient management.

164. Clinico-Etiological Profile of the Urethral Stricture in Adult Patients: An Observational Study
Mukesh Jaysawal, Amit Ranjan, Khursheed Alam
Abstract
Aim: The aim of the present study was to assess the etiological spectrum of urethral stricture in adult patients. Methods: The present study was conducted in the Department of Surgery. We prospectively collected a data- base on all male patients with urethral stricture disease who underwent urethroplasty. In all patients, stricture was diagnosed and evaluated by retrograde urethrography combined with voiding cystourethrography. A total of 250 male patients underwent urethroplasty. Of the patients 150 were 45 years old or older and 100 were younger than 45 years. Results: In the penile urethra hypospadias surgery, idiopathy, urethral catheterization and lichen sclerosus were the main causes. Hypospadias surgery was significantly more important as an etiology than etiologies at all other locations (p <0.005). Lichen sclerosus was the cause of stricture making it by far the most important etiology of stricture in the distal penile area. In the bulbar urethra idiopathic strictures were most prevalent, followed by TUR. Idiopathic strictures were significantly more prevalent in the bulbar urethra than at other locations (p <0.001). The main cause of multifocal or panurethral anterior stricture disease was urethral catheterization. Respectively 58 and 125 were strictly located at the penile or the bulbar urethra. Panurethral or multifocal anterior urethral involvement was present in 32 patients. Posterior urethral strictures accounted for 35 cases. Conclusion: Iatrogenic causes such as TUR, urethral catheterization, cystoscopy, prostatectomy, brachytherapy and hypospadias surgery account for about half of the cases of urethral stricture disease treated with urethroplasty. Further research is needed on the cause of these so-called idiopathic strictures. Pelvic fracture was the main cause of posterior urethral stricture and an important cause in young patients. The etiology is significantly different in younger vs older patients and among stricture locations.

165. A Hospital Based Assessment of the Normative Data for VEP P100 Latencies and Amplitude in Normal Subjects
Kumari Ranjana
Abstract
Aim: The aim of the present study was to assess the normative data for VEP P100 latencies and amplitude in normal subjects. Methods: The study was conducted by the Department of Physiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. The study comprised of 50 healthy subjects within the age group 40-60 years, in which there were 25 males and 25 females. Results: The mean latency of P100 wave in normal subjects was 97.63+5.65 milliseconds. The mean P100 amplitude was 7.43+1.145 µV. Conclusion: We concluded that normative P100 waveform peak latencies and amplitudes will help evaluate and interpret VEP anomalies. The values depend on the equipment, recording technology, and lab conditions. The normative values of any neurophysiological laboratory conducting VEP research should aid clinical interpretation.

166. Efficacy and Adverse Effects of Topical Application of 2% Diltiazem Gel With That of Lateral Internal Sphincterotomy: A Retrospective Study
Pravin Kumar Agrawal, A. K. Jha
Abstract
Aim: The aim of the present study was to assess and compare the efficacy and adverse effects of topical application of 2% Diltiazem gel with that of Lateral internal sphincterotomy. Material & Methods: A retrospective study including cases of chronic anal fissure admitted/operated in the Department of General Surgery, Anugrah Narayan Magadh medical College and hospital Gaya, Bihar, India. This study includes 100 patients presenting with chronic anal fissure for the duration from January 2016 to December 2016. Results: Majority of the patients belonged to 21-40 years. Majority of the patients had pain followed by bleeding. In male and females, site of fissure was posterior. In diltiazem group, pain was relieved at the end of 8 weeks and in LIS group, pain was relieved at the end of 4 weeks. In diltiazem group, headache was the complication and in LIS group, post operative pain was the complication. Conclusion: The current study shows results in favour of lateral internal sphincterotomy with a healing rate of 100% with a faster pain-relief and minimal complications if performed by the experienced surgeon. However topical 2% diltiazem gel is an effective agent can be safely prescribed for patients having contraindications for surgery.

167. Assessment of Different Surgical Management Modalities in Local Complications of Acute Pancreatitis
Ajeet Kumar, Bhartendu Kumar, Amit Kumar
Abstract
Aim: This study aims to evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methods: A hospital-based retrospective study was conducted in the Department of General Surgery. A purposive sampling method was utilized to recruit the patients. 383 patients were admitted to the surgery department with the diagnosis of acute pancreatitis or with complications of acute pancreatitis. Among them, 50 patients had local complications due to acute pancreatitis. Results: Out of 50 patients, 46% were females and 54% were male. 50% had ethanol etiology and 32% had pseudocyst pancreatic fluid collection. According to the location, 70% were at body or tail. According to Clavien-Dindo classification, 30% were in grade 2 followed by grade 1 (26%) and grade 4 (22%). Conclusion: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

168. Determine the Association between Iron Deficiency Anemia and Febrile Seizures
Amit Kumar, Vibhas Ranjan
Abstract
Aim: This study was aimed at evaluating the association between iron deficiency anemia and febrile seizures. Methods: This was a prospective hospital based study and Cases (n=50) were patients with typical febrile convulsions between 1 year to 5 years (AAP clinical practice guidelines) was conducted in the Department of Pediatrics, DMCH, Darbhanga, Bihar, India. A control group (n=50) was selected from age and sex matched children admitted with febrile illness but without a seizure. Results: The result shows that 86% (n=43) children had Hb <11 gm/dl from the case group as compared to 24% (n=12) in control group with significant p-value (p <0.01). The proportion of cases with anemia was significantly higher as compared to that of controls (p=0.012). The result shows, mean hemoglobin level and MCV in cases were significantly lower as compared to that in controls (p <0.04). RDW value is significantly higher in cases as compared to control (p <0.04). No significant difference between the two groups was observed with respect to mean MCH levels (p >0.04). Serum ferritin and serum iron levels in cases were significantly lower as compared to that in controls (p <0.01). TIBC value is significantly higher in cases as compared to control (p <0.01). Conclusion: The findings suggest that a considerable percentage of children having febrile seizures suffer from iron-deficiency anemia and low serum iron. This means the low serum iron and the presence of anemia can serve as a reinforcing factor for febrile seizures in children.

169. Relationship between Serum Vitamin D and Serum Ferritin Levels in Children Reported with ADHD in A Tertiary Care Facility
Shahnawaz Hasnain Warsi, Ashutosh Kumar, Kripa Nath Mishra
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, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of February 2020  January 2021. 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.

170. A Clinico-Epidemiological Assessment of Patients Presented with Eosinophilia using Peripheral Smear Method
Rachna Kumari, Naveen Kumar Bariar
Abstract
Aim: The present study aimed to evaluate the prevalence and symptoms in patients with eosinophilia. Methods: The study was done in the Department of Pathology, Patna Medical College and Hospital, Patna, Bihar, India. It was done for one year. The study included total of 100 patients based on the inclusion and exclusion criteria. All the patients were explained study protocol and informed consent was obtained. Results: The study included 100 patients. 25 patients were in the age group of 41-50 years. 22 patients were between 51-60 years. 3 patients in each had age between 1-10 and 2 patients in 81-90 years. Male (n=60) were more compared to females (n=40) in this study. A total of 21 symptoms observed in the study population. Fever was the most common (n=20) symptom compared to others. 14 patients showed cough and 152 had breathlessness. 10 had chest pain and 10 had skin lesions. Least number of patients showed hemoptysis, hydrocele, headache, bleeding per rectum and history of snake bite. 60 patients in mild, 30 in moderate and 10 in severe eosinophilia categories were observed in this study. Conclusion: The study showed middle age with male sex is more prone to eosinophilia. Fever and cough are the most common symptoms.

171. A Descriptive Cross-Sectional Analysis of the Menstrual Cycle and Associated Issues in Adolescent Girls
Amit Kumar, Jayant Prakash
Abstract
Aim: Analysis of the menstrual cycle and associated issues in adolescent girls. Material and Methods: This is a cross-sectional study was conducted in the Department of Pediatrics, IGIMS, Patna, Bihar, India. All the girls in the age group of 11-16 years, who had attained menarche & were willing to participate in the study, were included as study participants were included in the study. Pretested, semi-structured questionnaire consisted of issues like age at menarche, patterns and problems and hygienic practices related to menstruation. Results: Mean age of menarche was 13.45±0.86, only one girl attained menarche at 11 year and majority attained menarche at 12to 14 years age group. When analyzed for inter-menstrual gap, majority 159 (75.7%) girls were in the group of 21-35 days. Days of flow of blood was classified as less 3 days, 3-5 days and more than 5 days. Most of the girls were in 3-5 days 155 (73.8%), few girls 10 (4.7%) in less than 3 days group and remaining were having blood flow for more 5 days. In menstrual symptoms (Table 2), abdominal pain or cramps was experienced by most of the girls 176 (83.8%), body ache was experienced by 64 (30.4%) and 56 (26.6%) were irritable during cycle. Adolescent school girls were analyzed for hygienic practices during their cycle (Table 3). Sanitary pads were used by 174 (82.8%) girls and remaining used both sanitary napkins and cloth. Majority 160 (76.2%) changed their absorbent less than 4 times and remaining changed more than 4 times. Majority 150 (71.5%) cleaned their genitalia only with water during cycles and remaining cleaned with soap and water. Dysmenorrhea was experienced by 160 (76.1%) adolescent girls (Table 4). Irregular menstrual cycle was observed in 12(5.7%) and polymenorrhea in 11 (5.2%). Some girls had experienced menorrhagia 14 (6.6%). Conclusion: The timely onset of menarche is a significant milestone in adolescence, indicating the proper functioning of the female reproductive system. Three-fourths of the teenage females had normal blood flow length and cycle interval. Adolescent females often have menstrual issues. Dysmenorrhoea was the most prevalent issue among teens. Adolescent females endure their suffering and see it as a typical occurrence.

172. Comparative Assessment of Two Different Treatment Approaches of Supracondylar Humerus Fractures in Pediatric Patients
Sujit Kumar, Mukesh Kumar, Ranjit Kumar Singh
Abstract
Aim: To compare the efficacy of closed reduction vs k-wire fixation in the treatment of supracondylar humerus fractures in pediatric patients. Material and Methods: This study was conducted in the department of Orthopaedics, NMCH, Patna, Bihar, India.  Children with Type II and Type III fresh supracondylar fracture of humerus aged between 3-13 years. Patients with Type II and III supracondylar fractures. Total 30 children with Type II and III of supracondylar fracture of humerus were estimated.: All cases of Type II and III supracondylar fractures of humerus were selected for the study. Clinical history was taken from patients or their relatives regarding onset and duration of injury, with particular emphasis on the distal neurovascular status. Radiographic Investigations: The patients radiograph was taken in Antero-posterior and lateral views and the reduction was assessed. Results: Most of the study subjects had a value of 71-75° or 13 (43.3%), followed by 65-70°accounts for 23.3% (7) patients, 76- 80° involving 16.7% (5) patients, >80° constituted 10% (3) patients and 2 patients (6.7%) had a value less than 65°. The average value was 73.2 ±4.88°. The humerotrochlear angle was measured on lateral image and passing of the anterior humeral line through capitulum. Mean humerotrochlear angle observed was 34.1 ±6.38°. The largest number of study subjects were 10 (33.3%) who had a value in the range of 36-40°, followed by 26-30° and >40º involving 6 (20%) patients each; lower than 25° and 31-35° value was observed in 4 (13.3%) patients each. Anterior humeral line normally passes through the middle third of the capitulum. In our study, in the majority of patients i.e. 14 (46.7%) had anterior humeral line passing through the anterior third of capitulum followed by 7 (23.3%) had anterior humeral line passes in front of the anterior third, 6 (20%) had anterior humeral line passes through middle third and the least 3 (10%) had humeral line passed through the last third of the capitulum. Distribution of study subjects according to the type of fracture and pinning method is mentioned in Table 9. Out of 22 patients who had Grade III fracture, 15 (50%) underwent criss-cross 2 K-wire fixation and 7 (23.3%) underwent lateral 2 K-wire fixation. In our study 8 patients had Grade II fracture among them 6 (20%) underwent criss-cross 2 K-wire fixation and 2 (6.7%) underwent lateral 2 K-wire fixation. Conclusion: The closed reduction and percutaneous pinning with crossed krischner wires in the treatment of supracondylar fractures of humerus in pediatric age group is the biomechanically stable and effective. We observed that closed reduction and K-wire fixation is a simple, cheap and effective method of treatment of displaced supracondylar fractures (type II and type III) humerus in paediatric age group with relatively fewer complications.

173. A Retrospective Observational Study Evaluating Partogram in Management of Labor in Patients with Previous LSCS
Sweety Rani, Abha Rani Sinha, Renu Bharati
Abstract
Aim: The aim of the present study was to assess the progress of labor in all ANCs with previous LSCS consenting for vaginal delivery using partogram and to note the feto-maternal outcome. Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India for June 2016 to May 2017 in 100 patients with previous LSCS for trial of labor who fulfilled the inclusion criteria. Detailed history regarding age, parity, duration of pregnancy and labor pain was taken from every patient. Results: Our study included a total of 100 patients with average age 26.04 years with minimum age of a patient being 20 years while the maximum age was 34 years. Majority of the women belonged to 18-24 years. In present study 62 out of 100 patients delivered at the gestational age of 37-40 weeks (82%). Out of these the patients who underwent repeat LSCS were 62 (62%) and those who delivered vaginally were 28 (28%). Out of 62 patients who undergone repeat LSCS, 8 patients had scar dehiscence, 14 patients were taken for LSCS due to non-progression of labor and 40 patients had fetal distress. Conclusion: The partogram was able to reduce feto-maternal complications and help in early detection of deviation from normal labor thus guiding in timely intervention. The subjects who crossed alert line in partogram were taken for LSCS thus indicating higher efficacy of partogram. With the use of partogram maternal complications in patients with previous LSCS like obstructed labor, prolonged labor, scar dehiscence and scar rupture and other complications like PPH, cervical tears/vaginal lacerations etc. can be prevented.

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