International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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Peer Review Journal

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1. A Study Assessing the Association between Antibody Titers and Nutritional Status in Paediatric Population Diagnosed with Measles
Swesh Chandra, Debasis kr Samanta
Abstract
Aim: The aim of the present study was to find out any association of measles antibody titres with nutritional status in children 1 to 12 years. Methods: This hospital based cross-sectional study was conducted in the duration of 12 months on 1–12-year-old children attending the Pediatric O.P.D. of Department of Pediatrics, Department of Pediatrics, Dr.Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India with the objective of finding out the seroprevalence and anti-measles antibody levels, and studying their association with age, gender, as well as nutritional status of these children. Results: Majority (70%) of the total subjects had been vaccinated against measles. However, the relationship between age and vaccination status was not found to be statistically significant (p=0.155). No statistically significant difference was observed in the baseline characteristics of vaccinated and unvaccinated group except for mean weight for age Z score which was significantly lower in the unvaccinated group. 41% of the total subjects ≤5 years old had severe wasting (severe acute malnutrition), while 32% had moderate wasting. In children > 5 years, 22% had severe thinness, 11.60% had thinness and only 2 (0.2%) case was overweight. 42.85% of the vaccinated subjects ≤5 years old had severe wasting (severe acute malnutrition), while 34.28% had moderate wasting. A highly statistically significant relationship was observed between BMI Z scores (in subjects aged ≥5yrs) and seropositivity, with higher seropositivity being noted in children with higher BMI z scores. Similarly, a statistically significant relationship was observed between height for age Z scores and seropositivity, with higher seropositivity being noted in children with higher height for age z scores. Conclusion: Nutritional status of children has an association with measles antibody titres as well GMT of measles specific IgG antibody, with those with better nutritional status having higher measles antibody titres.

2. Intrauterine Insemination: A Retrospective Review on Determinants of Success
Bhawana Tiwary, Kalpana Singh, Shubhanti Kumari, Huma Nishat
Abstract
Aim: The aim of the present study was to determine the prognostic factors such as female patient’s characteristics and of semen parameters on the pregnancy rate following intrauterine insemination. Methods: In this retrospective study, we reviewed the medical records of women who underwent IUI at Indira Gandhi Institute of Medical Sciences, Sheikhpura Patna for one year. Records of 100 women who had undergone 100 IUI cycles using sperm from their partners were reviewed. Patients were excluded based on the lack of sufficient treatment data. Results: A total of 100 IUI cycles were analysed. The overall pregnancy rate per cycle and per couple was 4.6% (15/320) and 16% (16/100) respectively. The average female and male age was 25.5 + 5.30 years and 32.8 ± 4.6 years respectively in the participants with positive IUI result. Both were not statistically significant. Duration of infertility, type of infertility, endometrial thickness, number of follicles, size of follicles, sperm count, sperm motility and single/double IUI did not significantly affect the outcome of IUI. However, logistic regression analysis showed significant relationship between pregnancy occurrence and number of follicles and number of IUI cycles. Conclusion: The findings of this study showed that age of the couple, duration of infertility, endometrial thickness, size of the follicles, sperm count and sperm motility did not correlate with pregnancy occurrence in an IUI cycle but number of follicles and total IUI cycles correlated with the occurrence of pregnancy.

3. A Hospital Based Analytical Observational Study Assessing the Risk Factors for Cesarean Delivery in Induced Labor at Term
Priti Kumari, Rashmi Kumari, Archana Jha
Abstract
Aim: The aim of this study was to identify those factors which influence the risk of emergency cesarean delivery in induced labors at term. Material & Methods: A case–control study was conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India over a period of one year. A total of 150 women were studied, out of which 50 women delivered by emergency caesarean section and 100 women delivered vaginally. The cohort included all women with a live singleton fetus in the cephalic position and induced at term (C37 weeks). Cases were women who delivered by emergency caesarean section and controls were women with a vaginal delivery among the cohort. Informed consent was taken for all patients. Results: Factors associated with cesarean delivery were analysed. Our study had shown that maternal age C35 years, BMI C30 kg/m2, nulliparity, preinduction Bishops score less than 5, gestational diabetes mellitus, and intrauterine growth restriction are significantly associated with caesarean delivery. The presence of epidural analgesia, gestational hypertension, postterm pregnancy, and premature rupture of membranes was not associated with significant increase in cesarean delivery if labor was induced at term. Conclusion: A vaginal delivery is the best choice for both mother and child. However, it is better to take those patients with multiple risk factors for elective cesarean section rather than inducing them at term. Women with multiple risk factors for caesarean can be taken up for elective cesarean section rather than inducing them at term.

4. Observing the Morphology of Foramen Ovale in Dry Adult Human Skull Bones: Morphometric Study
Meeta Sahai, Vinita Sinha, Rajendra Prasad
Abstract
Aim: The aim of the present study was to define anatomical variations in foramen ovale. Method: The study was carried out on 60 foramen ovale using 30 dry adult human skull bones of unknown sex and the bones were taken from the Anatomy Department, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. Skulls which were fractured at the surrounding of foramen ovale were not included in the study. Results: Out of 60 foramen ovale, minimum to maximum anteroposterior diameter on left side were 3.2 mm- 8.0 mm and on right side were 3.8 mm-8.2 mm. Average anteroposterior diameter on left side was 5.8±1.420 mm and on right side was 5.6±1.385 mm. Minimum transverse diameter on left side was 2.2 mm and on right side was 2.7 mm. Maximum transverse diameter was 6.3 mm and 5.5 mm on left and right sides respectively. Majority of the foramen were oval shaped and it was seen in 24 sides (left 8, right 16), almond shape was seen in 20 sides (12 left, 8 right), round shape was seen in 12 sides (8 left, 4 right), slit like foramen was seen in 4 sides (2 left, 2 right). Out of 60 foramina, bony spine was observed in 10 followed by 5 bony plates and 1 osseous lamina. Conclusion: Morphometric and morphological anatomy of foramen ovale is very useful for medical practitioners while handling the cases of trigeminal neuralgia, tumour detection, bony outgrowths that leads to necrosis, ischaemia. The Foramen ovale is important foramina of the skull base.

5. Determine the Clinical Significance of Immature Reticulocyte Fraction (IRF) and Reticulocyte Maturity Indices in Differential Diagnosis of Anemic Patient: An Observational Study
Md. Imteyaz Alam, Madhu Bharti, Manish Kumar Jha, Poonam Kumari
Abstract
Aim: The aim of the study was to determine clinical significance of immature reticulocyte fraction (IRF) and reticulocyte maturity indices in differential diagnosis of anemic patient. Methods: The present study was conducted at the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of 1year and 200 cases were included in the study. Total of 100 cases, included 48 male and 52 female (40 cases of Iron deficiency anemia, 35 cases of anemia due to chronic kidney disease and 25 cases of thalassemia trait) were studied. Results: The table showed statistically significant decrease in values of RBC, Hb with retic count was 0.92±0.006, IRF values were also low (0.090±0.060) so as the RETL, RETM, RETH. In thalassemia trait patient, reticulocyte count was high 2.75±0.055 with IRF values were 0.112±0.090, RET L was 89.1±0.090, RET M 7.6±0.060, RET H was 3.5±0.032 observed. The table showed mean retic count of 1.2 with SD of 0.007, and in IRF mean was 0.090 with SD of 0.120 in 35 patients of anemia due to chronic kidney disease. Retic count was low in IDA compare to thalassemia patient (high- hemolytic), IRF values were low in IDA and in CKD patient compare to thalassemia group and regarding reticulocyte indices, statistically significant difference observed for RET H, RET M and RET L between three groups. Conclusion: Our study showed that with the use of automated fluorescence analyser providing IRF and reticulocyte maturity indices (LFR, MFR and HFR) was quite very useful in the early detection and for the differential diagnosis of iron deficiency anemia, thalassemia and anemia due to chronic kidney disease.

6. A Single Center Retrospective Study to Investigate the Effectiveness of Continuous Catheter Drainage in Comparison to Needle Aspiration in the Treatment of Liver Abscesses
Alok Kumar, V.K. Gupta, R.K. Ajai
Abstract
Aim: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This was a single-center retrospective comparative study conducted at department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India for the duration of 1 year. A total of 60 patients were included in the study, divided into two groups, percutaneous needle aspiration (n=30) and pigtail catheter drainage (n=30). Results: In presenting study the age group of the patients ranged from the 20-68 years. Highest incidence (60%) was found in 30-39 years age group. In this study 54 patients were male and 6 patients were female. 52 patients were from rural and 8 were from urban population and the incidence of alcohol consumption was 70%. It was observed that fever was present in needle aspiration and catheter drainage 94% and 92% respectively. There was 100% anorexia, pain and tenderness in right upper quadrant and hypochondruim in needle aspiration and catheter drainage respectively. It was observed that leukocytosis was 82% and 100% in needle syringe and catheter drainage. The patients in PCD group showed earlier clinical improvement and 50% decrease in abscess cavity volume as compared to those who underwent PNA. However, there was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

7. Analyzing the Importance of Mammography and Sonography in Fat Necrosis: Prospective Clinicopathological Study
Mamta Singh, Amar Kumar Singh, Renu Rohatgi, Usha Kumari
Abstract
Aim: The aim of the present study was to analyze the importance of mammography and sonography in fat necrosis. Methods: A prospective clinicopathological study was conducted on 100 female patients of different age groups from 30 to 60 years. Patients’ information is collected from at Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna, Bihar, India for one year. Results: 100 lesions were identified on mammograms. The predominant mammographic features of the 100 lesions apparent on mammograms were as follows, 25 (25%) radiolucent oil cyst (either with or without curvilinear mural calcification), 14 (14%) round opacity, 15 (15%) asymmetrical opacity or heterogenicity of the subcutaneous tissues 25 (25%) dystrophic calcifications 4 (4%) clustered pleomorphic microcalcifications and 4 (4%) suspicious speculated mass. 100 lesions were identified at sonography. The predominant US features of the 100 lesions apparent on sonograms were as follows 15 (15%) solid appearing masses, 16 (16%) anechoic masses with posterior acoustic enhancement (cyst), 16 (16%) anechoic masses with posterior acoustic shadowing (cyst with mural calcification), 10 (10%) cystic masses with internal echoes 5 (5%) cystic masses with mural nodule and 25 (25%) increased echogenicity of the subcutaneous tissues (small cysts inside this area±). In 13 (13%) masses, no discrete lesion could be identified on sonograms. Conclusion: In conclusion, there is a wide range of mammographic and ultrasonographic patterns of fat necrosis.

8. Association of Prolonged AMV with Fluid Balance and Pediatric Index of Mortality 2 (PIM2) Score in Children Admitted to Pediatric Intensive Care Unit (PICU)
Bheemsen Kumar, Sanjay Kumar Nirala, Sanju Kumari, Gopal Shanker Sahni
Abstract
Aim: This study was conducted to determine the association of prolonged AMV with fluid balance and pediatric index of mortality 2 (PIM2) score. Methods: This prospective observational study was conducted over a period of 12 months in the pediatric intensive care unit (PICU) at SKMCH, Muzaffarpur, Bihar, India. The study enrolled all patients admitted in the PICU of age 29 days to 12 years, who fulfill the inclusion criteria during the 12-month period. Results: This was a study of 50 participants of which infants (<1 year) were maximum (26, i.e., 52%). Males outnumbered females comprising 58% (29) of the study population. Maximum number of admissions (16) had central nervous system involvement followed by respiratory system involvement. Out of the 50 children admitted in PICU during the study period, 35 (70%) children had prolonged mechanical ventilation. 33 patients had positive fluid balance ≥ 15%. 30 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 30 patients who had PIM2 score ≥ 5 required prolonged mechanical ventilation. The Pearson chi-square test was applied to test the significance of association between positive fluid balance and prolonged mechanical ventilation. P value was 2:25 × 10−7 which is <0.05 suggesting rejection of null hypothesis and statistically significant association between two variants. Conclusion: There was a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.

9. A Hospital-Based a Single-Blind Parallel Clinical Trial Assessing the Antiplaque Efficacy of Propolis-Based Herbal Toothpaste
Priyata Ranjan, Pratyush Anshuman
Abstract
Aim: The aim of this study was to evaluate the antiplaque efficacy of an herbal toothpaste containing propolis in comparison with a control group. Material & Methods: A single-blind parallel clinical trial at Department of Dentistry, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India including 100 dental students (50 females and 50 males) All subjects were given verbal and written information about the study, and after entering the study, they signed a written consent form regarding all information received. Results: Out of 50 subjects, 25 were males and 25 were females with mean age of 20.82±1.48 years. There was no significant difference in the mean MGMPI scores between the three groups (Propolis, Dabur, Pepsodent) at baseline. But when they were compared after 24 h significantly (P = 0.01) highest mean MGMPI score was observed in Pepsodent group (46.44±5.07) followed by Dabur (38.42±2.29). Propolis showed significantly least mean MGMPI score (36.74±2.40) after 24 h. On comparing the mean difference (baseline and 24 h) of the three groups, significantly (P = 0.01) lowest mean difference was elicited by Propolis group. Conclusion: The herbal toothpaste containing propolis was more effective in reducing plaque accumulation in comparison with the control group. Considering the effect of propolis-containing toothpastes on the reduction of dental plaque accumulation, these can be used as an effective oral hygiene product.

10. A Retrospective Observational Clinicopathological Assessment Post-dated Pregnancy
Priti Kumari, Rashmi Kumari, Anupma Sinha
Abstract
Aim: The aim of the present study was to find out the incidence of maternal complications, perinatal mortality and morbidity in post-dated pregnancies. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for 11 months. Total 100 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: 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 (80%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 64% of the patients in study group were primigravida and in the control group 54% were primigravida. The percentage of LSCS was 32% which was higher than in the control group where it was 14%. Incidence of instrumental delivery was also higher in the study group as compared to control group (10% as compared to 6%). 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 (8%). In the control group, most common indication was non progress of labour (2%) followed by acute foetal distress (0.5%) and non-reactive CTG (1%). Conclusion: Post-dated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in post-dated patients. According to our study, post-dated pregnancies are related with higher rate of LSCS and instrumental deliveries.

11. A Hospital-Based Study Assessing Outcome of Intra-Articular Calcaneal Fractures Managed Surgically with a Plate in Terms of Bohler’s and Gissane’s Angle and AOFAS Score: An Observational Study
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the functional and radiological outcome of intra-articular calcaneal fractures managed surgically with a plate in terms of bohler’s and gissane’s angle, rate of radiological union and AOFAS score. Methods: The Prospective study was conducted at department of Orthopaedics Jawahar Lal Nehru medical college and Hospital, Bhagalpur, Bihar, India for the period of one year Jan 2019 to December 2019 and a total of 50 patients with intra-articular calcaneal fractures meeting the inclusion and exclusion criteria were chosen for the study. Results: In our study, patients between the ages group 18 yr and 60yr with a mean age of 33.36yr were included. The majority of the patients in the study were males, with 92% of the study population. In this study, 62% of the patients had right side involvement and 38% of the patients had left side involvement. The most common mode of injury in the study group was falling from height followed by RTA. About 76% of patients had a bohler’s angle between 10o-20o and in 24% of patients, it was <10o in the pre-operative period, with a mean bohler’s angle of 11.75o. Whereas in the post-operative period, 48% of patients had a bohler’s angle between 200-300 and 52% had it between 300-400, with a mean post-operative bohler’s angle of 29.67o. The difference between pre-operative and post-operative mean bohler’s angle was statistically significant with a p value <0.01. The difference between pre-operative and post-operative mean Gissane’s angle was statistically significant with a p value <0.01. Conclusion: We concluded that with proper pre-operative planning, the timing of surgery, intra- operative expertise of the surgeon, and post-operative care, surgical management of intra-articular fracture using a locking plate, gives a better outcome and minimal complications.

12. Preperitoneal Meshplasty for the Treatment of Incisional Hernias: A Prospective Clinical Evaluation
Dharmendra Kumar
Abstract
Aim: The aim of the study was to evaluate the technique of preperitoneal mesh repair of incisional hernias. Material & Methods: This prospective clinical study consists of 100 patients with incisional hernia managed by Preperitoneal mesh repair in Department of General Surgery, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India for the period of 2 years. Results: In the present study, there were 50 male and 150 females. Most of the patients belonged to 31-50 years age group. 82 (82%) patients had midlines incision causing the incisional hernia. This was followed by Pfannensteil incision in 10 (10%) and paramedian incision in 8 (8%) patients. Major wound infection was encountered in 16 patients (8%) but the mesh was not removed in any of the cases. Only 20 patients had seroma formation. There were no postoperative complications in 82% of cases. Conclusion: Preperitoneal meshplasty found to be efficient method of incisional hernia repair with less post- operative complications.

13. A Clinic-Demographic Profile and Assessment of Menstrual Problems of Adolescent Girls Attending Tertiary Care Facility
Tanu Kumari, Sneha Bhushan, Archana Jha
Abstract
Aim: The aim of the present study was to observe the menstrual disorders among adolescent girls and to observe the demographic profile and assess hygiene practices during menstruation. Material & Methods: This descriptive prospective study was conducted in adolescent girls attending gynaecology outpatient Department of obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for the period of one year. During the study period, 100 girls visiting OPD for menstrual disorders consented for study participation and were enrolled. Results: Adolescent girls age group ranged from 10-19 years. 56% of girls belonged to age group 14-16 years, with the mean age of 15.5 ±1.3 years. The mean age of menarche was 13.7 ±0.94 years. Majority of girls attained menarche between 12-14 years of age. The inter-menstrual period among majority of girls (72%) was 21-35 days, followed by more than 35 days in 16% and less than 21 days in 12%. The duration of menstruation cycle was 3-5 days in 77% girls, with moderate flow in 68% girls. In menstrual symptoms, almost all girls (94%) experienced abdominal pain/cramps. Backache (43%), body ache (32%) & irritability (27%) were other common symptoms. Sanitary pads were used by 85% girls and remaining girls used both sanitary pads and cloth. Majority of girls (71%) changed their absorbent less than 4 times. 75% girls cleaned their genitalia less than 4 times and 57% used soap & water for the same. The most common presenting complaint was dysmenorrhea (76%) among adolescent girls. Percentage of menorrhagia, irregular menses and polymenorrhoea was almost equal and ranged from 7-9%. Conclusion: Dysmenorrhoea was the commonest cause of morbidity among adolescent girls, which may affect their mental and social wellbeing. This may also result in significant school absenteeism. Though, use of sterile sanitary pads was seen in majority of the girls, hygiene practices may be further improved with the engagement of health care professionals, teachers, and community groups.

14. A Hospital Based Cross Sectional Study Assessing APR in Pediatric URTI Patients with Respect to Available Benchmark and to Decide on Interventions Required to Improve the Prescription Behavior
Ram Babu Raman, Asha Kumari, Sushil Kumar
Abstract
Aim: The current study was conducted to assess the APR in pediatric outpatient department (OPD) for URTI patients with respect to available benchmark and to decide on interventions required to improve the prescription behavior. Material & Methods: This was a cross sectional observational study at conducted in Department of Pharmacology in collaboration with Department of Pediatrics over a period of 10 months, at DMCH, Darbhanga, Bihar. The prescriptions of children diagnosed with upper respiratory tract infections and lower respiratory tract infections (LRTI) were screened. Their demographic profile and details of drugs prescribed were recorded. Total 100 patients were included in the study. Results: Out of 100 patients, boys were 40 and girls were 60. Age group 5-7 years had 15, 7-9 years had 20, 9-11 years had 35 and 11- 13 years had 30 children. Antibiotics prescribed in children were co‑amoxiclav in 34, amoxycillin in 30, Ofloxacin in 20 and cefuroxime in 16. The difference was significant (P> 0.05). Conclusion: URTI was treated using single antimicrobial whereas LRTI was treated with more than one antimicrobials or combination of antimicrobial and antiviral agent. The prescriptions were in accordance with the national treatment guidelines.

15. Evaluating the Effect of Warm versus Regular Room Temperature Seitz Bath in Perineal Wound Healing: A Retrospective Observational Study
Barun Kumar
Abstract
Aim: The aim of the present study was to compare the effect of warm versus regular room temperature seitz bath. Methods: This was a clinical retrospectively study conducted in the Department of General Surgery, Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India for 18 months after taking the approval of the protocol review committee and institutional ethics committee. Out of 104 patients 60 patients (57.70%) opted for warm water seitz bath (Group A) and others 44 (42.30%) (Group B) opted for regular room temperature seitz bath. Results: The 60 patients (57.70%) in the study group opted for warm water seitz bath as compared to 44 patients (42.30%) of regular water seitz bath from the second day of surgery onwards. The cases who opted for regular water seitz, were in poor socioeconomic background, due to easy and frequent availability of regular water as compared to warm water. All the 16 cases of episiotomy (26.66%) wounds repaired by gynaecologist opted warm water seitz only. Conclusion: The progress of wound healing and postoperative comfort in operated perineal surgical wound does not based on type of seitz bath and the antiseptic solution used for sitz bath. But it is found that the frequency of sitz bath and subsequent improvement in the local hygiene definitely give comfort to the patient and speeds up wound healing.

16. A Prospective Observational Assessment of the Effectiveness of Minimal Antibiotic Therapy and Routine Long Term Post-Operative Therapy in Elective Surgery
Shanker Bharti, Rajesh Narayan
Abstract
Aim: The aim of the present study was to evaluate the effect of three doses prophylactic antibiotic an hour before a surgical intervention with the chosen standard antibiotic with regard to the conventional use of same antibiotic for 5 to 7 days. Methods: The present prospective observational study was conducted on 100 Patients attending outpatient Department of Surgery, Bhagwan Mahavir institute of medical science, Pawapuri, Nalanda, Bihar, India for the period of 8 months. Results: The age range of the patients in group I was 18–85 years with mean and standard deviation (SD) of 44.78±15.75 and the age range of the patients in group II was 18–74 years with mean and SD of 40.82±14.66. There was no significant variation between data of the two groups based on age. In group I, 34 (68%) patients were male and 16 (32%) were female. In group II 30 (60%) patients were male and 20 (40%) patients were female. Mean hemoglobin level in group I was 12.06 with SD of ±1.60 and in group II it was found to be 11.70 with SD of ±1.25. Mean serum protein levels found to be in group I was 6.65 with SD of ±0.72 and same in group II was 6.64 with SD of ±0.74. 10 (20%) cases had diabetes in group-I and 8 (16%) cases in group II and addiction was present in 9 (18%) cases in group I and 10 (10%) cases in group II. There was no significant difference between both the groups based on diabetes and addiction. Two groups of cases with 50 cases each were evaluated for post-operative SSI, it was found that in group I, 5 (10%) cases had grade 2 SSI (3 cases on POD 3rd and 2 cases on POD 5th). In group II, 5 (10%) cases had grade 2 SSI (3 cases on POD 3 and 2 cases on POD 5). The p value is 0.90 and was not significant. There was no statistical significant difference between both the groups based on Southhampton grade. Conclusion: A minimal dose antibiotic prophylaxis is equally efficient and has added advantage of reducing the duration of hospital stay and cost of medicines for the patients. Hence minimal dose antibiotic is better than a routine long term antibiotics therapy.

17. A Hospital Based Comparative Assessment of Two Different Antibiotic Prophylaxis Regimes in Patients Undergoing for Elective Caesarean Section
Rashmi Kumari, Priti Kumari, Anupma Sinha
Abstract
Aim: The objectives of the study were to audit and implement the use of prophylactic antibiotics in women undergoing elective caesarean section. Methods: This comparative, prospective, hospital-based study was conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for the period of 12 months. Results: Mean age was 24.6±3.7 years in group A & 23.7±3.2 years in group B. BMI at the time of admission was 27.3±6.4 kg/m² & 28.2± 5.5 kg/m² in group A & B respectively. Mean duration of surgery was 43.7±7.3 min in group A & 46.4±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. History of previous laparotomy like LSCS, ectopic surgery, etc. was present in 70 & 64 patients from group A & B respectively. Most common indication for elective LSCS was previous LSCS followed (40 % and 38.34%) by primi with CPD (23.34% v/s 21.66%). In the group A prophylactic antibiotic prophylaxis was given to 24 women (40%) and was not given to 36 women (60%). In group B, out of 60 women of this 54 (90%) of women received prophylactic antibiotic before elective LSCS. Out of 24 women who received antibiotic in group A, 41.66% received antibiotic within 1 hour and 14 cases (58.34%) received more than 1 hour before procedure. Out of 54 women in group A, 45 (83.34%) women received antibiotic within 1 hour, 8 received more than 1 hour (14.81%). In the group A, majority of the women received amoxicillin clavulanic 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.

18. Efficacy of Electroconvulsive Therapy (ECT) in Psychiatric Patients
Pranaw Kumar, Nilesh B. Shah
Abstract
Aim: The aim of the present study was to evaluate the efficacy of electroconvulsive therapy (ECT) in psychiatric patients. Methods: The Prospective cohort study was conducted in the Department of Psychiatry, Lokmaanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India for the period of One year. Sample consists of patients are started on ECT for various indications and attending the psychiatry OPD or admitted in ward was included over a period of one year (n=144). Results: Out of Total of 144 patients 74 (51.39%) patients was of Schizophrenia, 45 (31.25%) patients was of MDD, 19 (13.19%) patients was of BMD in Mania, 6 (4.17%) patients was of OCD and PANSS scale, HAM-D 17 item scale, YMRS scale, Y-BOCS scale was applied respectively before the start of ECT (Baseline score) and End score was taken after one week of last ECT. Change of 51.53 Mean point (PANSS), 13.78 Mean point (HAM-D 17 item), 28.52 Mean point(YMRS) and 2.83 Mean point (Y-BOCS) occurred during the course of ECT. Conclusion: The present Prospective cohort study was conducted in a tertiary care hospital to study the efficacy of ECT. ECT has been considered the most effective intervention for different psychiatry diseases but not in common practice, there may be variety of factors that contribute to the low and uneven rate of ECT use. Perhaps the most important considerations are the stigma associated with receiving the treatment on the part of patients and in recommending or administering the treatment on the part of professionals. In the study we find Change of 51.53 Mean point(PANSS) occurred during the course of ECT in Schizophrenia group, Change of 13.78 Mean point (HAM-D 17 item) occurred in MDD group, Change of 28.52 Mean point (YMRS) occurred in BMD in Mania group and only Change of 2.83 Mean point occurred in OCD group. Indicating good acute response to the ECT in Schizophrenia (51.53 Mean point PANSS), MDD (13.78 Mean point HRSD 17 items), BMD in Mania (28.53 Mean point YMRS) and poor response in OCD (2.83 Mean point Y-BOCS) symptoms.

19. An Observational Assessment of the Unnatural Female Fatalities and Association of the Role of Socioeconomic Circumstances and Violence
Rohan Kumar, Suchita Kumari, Hasnain Hussain, Alok Pritam
Abstract
Aim: The aim of the present study was to investigate unnatural female fatalities, causes of unnatural deaths and the role of socioeconomic circumstances and violence against women. Methods: A retrospective study was conducted in the Department of Forensic Medicine and toxicology in association with Sadar Hospital, Saharsa for the period of one year. Total 100 cases of unnatural deaths referred for autopsy were evaluated in the present study. Only female’s cases of children’s and adolescents with the age group of 5 to 20 years were enrolled in the present study. The approval of the institutional ethics committee was taken before starting the study. Results: Majority of the participants belonged to 5-10 years (50%) followed by 10-15 years (30%). 49% cases had accidental deaths followed by 23% suicide. 30% road accidents, 15% drowning, 12% poisoning were the leading causes. Conclusion: Majority of the victims of ‘unnatural deaths belonged to the lower socioeconomic category. Suggestions relating to road safety, decreasing the stress of the modern mechanical life-style, educating the public in general and regarding. The availability, use and storage of poisonous substances in particular have been put forward, while highlighting the social evil of dowry system prevailing in India.

20. Role of Modified Biophysical Profile and Doppler Ultrasonography Studies in Predicting Perinatal Outcome in High-Risk Pregnancies: A Comparative Study
Geeta Rani, Sachin Kr Singh
Abstract
Aim: The aim of the present study was to compare MBPP and umbilical artery Doppler flow in high-risk pregnant women in prediction of perinatal outcome in high-risk pregnancies. Material & Methods: A prospective observational and comparative study was done on 100 high-risk pregnant women over 12 months. Antenatal women with singleton pregnancy who delivered within 48 hours of performing MBPP and Doppler USG, with presence of ≥1 high-risk factor like pre-eclampsia/gestational HTN, BOH, post-dated pregnancy, FGR, GDM, maternal heart disease, anaemia, hypothyroidism and IHCP were included in the study. MBPP (NST and AFI) and umbilical artery Doppler was performed. Perinatal outcome was measured in terms of stillbirth/IUD, LBW, Apgar <7 at 5 minutes, admission to NICU, neonatal death within 48 hours of delivery, MSL and neonatal seizures within 24-48 hours. Results: Out of 140 Patients included in our study 84 new born had adverse perinatal outcome. Umbilical artery Doppler velocimetry and MCA was done in all 140 study participants. The three categories of neonatal outcomes were healthy baby, IUGR, and neonatal death. 56 of the 70 patients with normal MBPP (70%) delivered healthy babies. 65 (72.22%) patients delivered healthy neonates. APGAR score was more than 7 in 70 (87.5%) and less than 7 in 10 cases, when Doppler studies was normal while APGAR was more than 7 in 82 patients (91.11%) and less than 7 in 8 patients when Doppler studies was abnormal this was statistically significant. It was seen that MBPP had a sensitivity of 90.60%, specificity 57.93%, PPV 61.06%, NPV 89.08% while that of Umbilical artery Doppler was 88.32%, 53.37%, 55.75% and 87.23% respectively. Conclusion: MBPP is a better predictor of perinatal outcome compared to umbilical artery Doppler USG in high-risk pregnant women. MBPP should be done in all high-risk pregnancies even if Doppler is normal. Both the tests must be performed in all high-risk pregnancies to improve perinatal outcome.

21. An Observational Study Assessing Association between Measles Antibody Titres with Nutritional Status in Children
Sanjay Kumar Nirala, Bheemsen Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to find out any association of measles antibody titres with nutritional status in children 1 to 12 years. Methods: This hospital based cross-sectional study was conducted in the duration of one year on 1–12-year-old children attending the Pediatric O.P.D. of Department of Pediatrics, with the objective of finding out the seroprevalence and anti-measles antibody levels, and studying their association with age, gender, as well as nutritional status of these children. Results: A significant proportion (66.66%) of the whole sample population has received vaccination for measles. Nevertheless, the statistical analysis did not reveal a significant association between age and vaccination status (p=0.160). There were no statistically significant differences identified in the baseline parameters between the vaccinated and unvaccinated groups, with the exception of the mean weight for age Z score, which was considerably lower in the unvaccinated group. A total of 38.34% of the individuals aged ≤5 years had severe wasting, also known as severe acute malnutrition, while 35% displayed moderate wasting. Among children aged five years and older, 23.34% exhibited extreme thinness, 13.33% displayed thinness, and a mere 0.6% were classified as overweight, with just two cases falling into this category. A significant proportion of the vaccinated individuals aged five years or less, namely 43%, exhibited severe wasting, often known as severe acute malnutrition. Additionally, 35% of the participants had moderate wasting. A strong and statistically significant correlation was found between BMI Z scores in individuals aged 5 years and older and seropositivity. The data revealed that children with higher BMI Z scores had a greater likelihood of being seropositive. In a similar vein, a statistically significant correlation was found between height for age Z scores and seropositivity. Specifically, it was shown that children with greater height for age z scores exhibited higher levels of seropositivity. Conclusion: The nutritional status of children exhibits a correlation with both measles antibody titres and the geometric mean titre (GMT) of measles-specific IgG antibodies. Specifically, children with improved nutritional status tend to have greater levels of measles antibody titres.

22. A Study of the Efficacy of Oral Colchicine in the Treatment of Oral Submucous Fibrosis
Lakshmi Unnikrishnan, Siddharth Kumar
Abstract
Background & Objectives: Oral submucous fibrosis (OSF) is characterized by abnormal deposition of collagen and is considered to be a potentially malignant disorder by World Health Organization (WHO). It is a precancerous disorder and transforms into malignancy in 1.5 – 15% of all cases. It manifests with wide variety of symptoms like restriction in mouth opening, ulceration, xerostomia and burning sensation. Since it greatly interfere with the quality of life of the patients, proper treatment with primary focus on relieving the symptoms of OSF is necessary. The management of OSF has been a subject of controversy and no definite and widely accepted treatment is available. The aim of this study is to assess the efficacy of oral colchicine in the treatment of OSF. Methods: 60 patients presenting with OSF between December 2020 and May 2022 were included in the study. A detailed history was recorded. A thorough ENT and general examinations were performed. After investigating the patients for their Liver Function Tests and COVID-19 Rapid Antigen Testing, these patients were assessed for their mouth opening using vernier calipers and Visual Analogue Scale (VAS) was used to assess the burning sensation sensed by the patient and recorded. Then these patients were given oral colchicine therapy. The patients were followed up for a period of 6 months. They were reassessed and the results were recorded. Results: Majority of the patients were of less than 40 years, with a male predominance among those presenting with OSF. In this study, gutka was the substance mostly abused. Significant improvement in mouth opening and symptomatic relief from burning sensation in buccal mucosa was seen with oral colchicine therapy. Interpretation & Conclusion: Patients presenting with OSF need appropriate treatment. In our study, we found that early interventions gave better results. Oral colchicine could be a major leap in the treatment of OSF.

23. Hospital Based Assessment of Vitamin D Serum Levels in Indian Children with Chronic Musculoskeletal Pain with and Without Hypermobility: A Comparative Study
Mani Shankar, Babli Kumari, Rajnish Kumar, Avinash Kumar Sahay
Abstract
Aim: The aim of the present study was to compare vitamin D serum levels in Indian children with chronic musculoskeletal pain with and without hypermobility. Methods: A cross-sectional study was conducted in the Department of Paediatrics, for six months. Total 100 children were diagnosed with chronic musculoskeletal pain were included in this study. The subjects were divided into two groups, with or without hypermobility. Results: There were a total of 100 kids, with a mean age of 7.43 2.48 years old (58 females and 42 boys). The most common age range was 3-7 years old (73.6%). 45 (or 90%) of the youngsters tested positive for vitamin D insufficiency in the lab. The data was also compared between the hypermobile and non-hypermobile groups. When compared to children without hypermobility, those that suffer from musculoskeletal discomfort are younger and have a lower body mass index. When compared to children with hypermobility, those without hypermobility had lower vitamin D levels and a greater rate of vitamin D insufficiency. There was a change, but it wasn’t enough to warrant statistical significance. Conclusion: There was no statistically significant difference in vitamin D deficit between children with and without hypermobility, despite the high frequency of vitamin D deficiency among children and adolescents with chronic musculoskeletal pain.

24. Effectiveness of Locking Compression Plates for Treating Diaphyseal Fractures of Children’s Femurs: An Observational Study
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the functional outcome of paediatric femur diaphyseal fracture treated with locking compression plate. Material & Methods: The clinical, radiological and functional results of Submuscular plating were evaluated in 70 patients operated in between the duration of 2 years for fracture shaft humerus, shaft of femur and shaft of tibia. All the surgeries were carried out by a single surgical team at Department of orthopaedics, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. Results: Among the study group, 49 were males, and 21 were females. There was a male preponderance. The youngest age among patients was six years old and the oldest age was 14 years old. The average age was 11.49 (2.08) years. Right side fractures 40 (57.14%) were more compared to left side fractures 30 (42.86%). For types of fractures, 25 (35.71%) fractures were transverse, 18 (25.72%) fractures were comminuted, 21 (30%) fractures were oblique, and 6 (8.57%) fractures were spiral. Considering the mode of injury, road traffic accident accounted for 60%, other injuries like fall during playing sports were seen in 15.71%, fall from height accounted for 8.57%. The functional outcomes were evaluated and 64 (91.42%) were excellent, 5 (7.14%) were satisfactory and 1 (1.42%) were poor. Conclusion: The submuscular plating technique for diaphyseal long bone fractures is considered a dependable treatment option when well-planned and implemented.

25. A Randomized Clinical Interventional Research to Study the Effects of Play Therapy on Reducing Behavioral Problems, Attention Deficit and Hyperactivity in Children
Sanjay Kumar Nirala, Bheemsen Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to examine effect of play therapy on ADHD children. Methods: In the present study by using randomized sampling Department of Pediatrics, for 12 months and the samples were fifth and sixth graders (average age of 11 years) selected based on the inclusion criteria through purposeful sampling. They were randomly divided into experimental and control groups (16 individuals each) and then the experimental group underwent eight 90- min-sessions of play therapy with the cooperation of the school’s psychological counseling officials. Results: The post-test mean score of ADHD symptoms was lower than that of the pre-test. This variable of behavioral problems has also obtained a lower average in the post-test test in different components (anxiety and depression, aggression, social incompatibility, antisocial behaviors, attention deficit disorder). In Kolmogorov-Smirnov test, the significance level of the variables should be more than 0.5 0 to be able to express the normal distribution of the variables, therefore, based on the obtained results the values of the significance level of the variables are more than 0.05, so it was concluded that the variables are in a normal state for the analysis of covariance. Levin’s test values are insignificant. In other words, the null hypothesis for the equality of the variances of the two groups was confirmed. Conclusion: The findings of the present study indicate that educational Play therapy demonstrates efficacy in mitigating behavioral issues and attention deficit and hyperactivity symptoms among children diagnosed with ADHD. This therapeutic approach facilitates socialization skills development, enabling affected children to integrate into society as productive and well-adjusted individuals.

26. Determining the Role of Second Trimester Umbilical Artery Doppler in Predicting Adverse Pregnancy Outcomes in a Low-Risk Population: An Observational Study
Geeta Rani, Sachin Kr Singh
Abstract
Aim: The aim of the present study was to determine the utility of second trimester umbilical artery Doppler velocimetry in the prediction of adverse perinatal outcomes (intrauterine growth restriction (IUGR), low birth weight (LBW) and stillbirth). Material & Methods: One hundred low-risk nulliparous women with viable singleton pregnancies who met the inclusion criteria had umbilical artery Doppler assessment between 22 and 26 weeks gestation. RI≤ 0.76, PI≤ 1.36 and SD ≤ 4.52 were considered as normal. Each participant was monitored till delivery to assess outcome. Diagnostic performance of the Doppler indices for the prediction of adverse pregnancy outcomes were determined. Results: The mean age of the participants was 31.19 ± 4.46 years and the mean gestational age at recruitment was 24.58 ± 1.42 weeks. Average systolic blood pressure at screening was 110.5±10.6 mmHg and the average diastolic blood pressure was 69.3±8.2 mmHg. Average birth weight of the babies was 3.02 ± 0.58 kg, 2/100 babies (2%) weighed >4kg at birth while 19/100 babies (19%) had low birth weight. At least one adverse pregnancy outcome occurred in 40/100 (40%) women. Of the 40 women, 8 (20%) had preeclampsia, 7 (17.5%) had pregnancy induced hypertension without proteinuria, 13 (26%) had intrauterine growth restriction, 20 (50%) had low birth weight fetuses, and there were 2 (5%) still-births. For any adverse pregnancy outcomes, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of abnormal umbilical Doppler parameters were 16.4%, 94.0%, 62.6% and 61.9% respectively. For stillbirth, the sensitivity, specificity, PPV and NPV of abnormal Doppler indices were 67.7%, 90.6%, 16.4% and 99.1% respectively. For IUGR the sensitivity and specificity of PI were 0.0% and 88.4% respectively, while PI had 13.0% sensitivity and specificity of 90.6% for LBW. For stillbirth, the sensitivity and specificity of PI were 66.4% and 91.7%. Conclusion: Late second trimester umbilical artery Doppler velocimetry has a limited role in this low risk population for prediction of adverse pregnancy outcomes. The role of umbilical artery Doppler velocimetry in the prediction of adverse outcomes in high-risk pregnant women may be worthwhile.

27. Assessing Bacterial Etiology in the Course of Disease and Their Drug Sensitivity Pattern in Patients Diagnosed with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Ashraf Azam, Vinyanand Jha
Abstract
Aim: The study was carried out to find out the bacterial etiology in the course of disease and their drug sensitivity pattern. Methods: All hospitalized patients diagnosed with AECOPD admitted in the Department of Medicine, for the period of 2 years were evaluated. The individual bacterial isolates and their sensitive pattern to various antibiotics were also recorded in all one hundred 200 patients. The study was carried out COPD was diagnosed according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. Results: Out of 200 patients, clinically diagnosed as AECOPD, 75% were males and 25% were females. 40% patients were in the age group 56-65 years followed by 66-75 (26%) age group. Out of a total 200 cases, 96 (48%) were positive for pathogenic bacteria and 104 (52%) were non-pathogenic. Among total 48 pathogenic microbial, 62% were Gram-negative bacteria and 38% were Gram-positive bacteria. Out of 96 pathogenic bacteria, K. pneumoniae was the commonest (36.45%) followed by P. aeruginosa (20.84%), S. aureus (15.62%), S. pneumoniae (10.41%), S. pyogenes (8.33%). Among antibiotics, Amikacin was found highest sensitive followed by Azithromycin (62.5%), Amoxy Clavulanic acid (62.5%), Ciprofloxacin (58.33%) and Gentamycin (52.08%). However, Levofloxacin and Co-trimoxazole were found to be highly resistant 66.66% and 60.41% respectively among the drugs used in culture and sensitivity of 96 isolated pathogenic bacteria. Conclusion: Repeated exacerbation and hospital admission leads to a major impact on the quality of life of patients with COPD. Antibiogram helps in screening resistant pathogens and prescribing right treatment protocol.

28. A Hospital Based Observational Study Analyzing the Vaginal Birth with Previous Caesarean Section and its Outcome
Vidya Paul, Seema
Abstract
Aim: The aim of the present study was to analyze the vaginal birth with previous caesarean section and its outcome. Methods: This prospective controlled clinical study. 370 women who had undergone previous caesarean section. Out of them, 220 women (67.56%) fulfilled our criteria and were included in the study. A control group (n = 155) was matched from women without previous caesarean section. Results: In the study group, 200 out of 250 women were delivered vaginally, giving a VBAC success rate of 80%. The remaining 50 women (20%) were delivered by repeat caesarean section, mainly due to intrapartum fetal distress. Of the women who successfully delivered vaginally, 148 (74%) were admitted during the first stage of labour and 52 women (26%) in the second stage versus 80 (80%) and 20 (20%) respectively in the control group. There were no significant differences between the study group and control group in terms of age, parity, gestational age or obstetric and medical history. Oxytocin was used to augment labour in 20 cases (10%) but there was no uterine rupture recorded in these cases. Overall there were 2 cases (1%) of uterine dehiscence and 1 case (0.5%) of uterine rupture among the VBAC group. There were no maternal deaths and only 1 stillbirth after the case of uterine rupture. There was no significant difference between the groups in Apgar scores; 6% of neonates in the VBAC trial group had Apgar score < 6 compared with 5% in the control group (P > 0.05). We found 4 neonates (2%) weighed > 3500 g but < 4000 g in the VBAC group. Conclusion: Based on the findings presented, it can be inferred that in certain instances when individuals have had one previous lower segment caesarean section and are now experiencing spontaneous active labour, a vaginal delivery attempt may provide a considerable percentage of success without any notable escalation in the likelihood of adverse outcomes for both the mother and the foetus. The length of labour experienced by these ladies was comparable to that of typical births.

29. A Hospital-Based Study to Assess Acute Disseminated Encephalomylitis in Children: An Observational Study
Shashi Prabha, Anshuman
Abstract
Aim: The aim of the present study was to assess acute disseminated encephalomyelitis in children. Methods: This was a prospective hospital based clinical study conducted by the Department of Pediatrics, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India over a period of one year. Total 50 patients were included in the study. Results: Age distribution of study sample has been analyzed. It showed maximum prevalence in 5- 9-year age group (50%) with 30% in 0-4 year & 20 % in 10-14 years age group. Male predominates in the study 60% with female being 40%. Seizures were documented to occur in highest number of cases (66%). Next fever (60%) & altered sensorium (58%) followed. Encephalopathy was observed in 86%, followed by motor deficit in 68% & autonomic involvement in 40%. T1 hypointensity/isointensity was observed in 52%, T2 hyper intensity in 76%, FLAIRS changes in 72% cases. It was observed that the cases with severe presentation had lower proportion of recovery & higher proportion of mortality which was found to be statistically significant. Conclusion: ADEM is a rare autoimmune demyelinating disorder that mainly affects the CNS and is characterized by an acute inflammatory response targeting the myelin sheath surrounding fibers in the brain and spinal cord. The early recognition and accurate diagnosis of ADEM facilitate timely management and minimize neurological damage.

30. Dermoscopic Assessment of Topical Steroid-Dependent Damaged Face: An Observational Study
Birendra Prasad
Abstract
Aim: This study was undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: The present study was conducted in the Department of Skin and VD, and 200 cases were included in the study. Patients (18 years or above) with clinical symptoms and signs suggestive of TSDF (redness, itching, acne, burning, swelling, photosensitivity, pigmentation and atrophy) and with history of application of TCS on the face for a period of more than one month were included in the study after obtaining written informed consent. Institutional Ethics Committee approval was obtained before the commencement of the study. Results: Females (75%) constituted the majority as compared to males. Most of the patients belonged to the age group of 18–30 years (55%) with a mean age of 34.6 ± 8.2 years. Duration of TCS application ranged less than one year and 1-10 years was 45% patients each. 160 (80%) patients had received some form of formal education, while 40 (20%) patients were illiterate. Presenting complaints of the patients were redness in 150 (75%), itching in 140 (70%), pigmentation in 110 (55%), burning in 124 (62%) and acne in 80 (40%) patients. Clinical findings noted in the patients were erythema in 170 (85%), hyperpigmentation in 170 (85%), and hypertrichosis in 120 (60%) followed by telangiectasia in 100 (50%) and wrinkles in 70 (35%). Polygonal and Y-shaped vessels, though, are categorized under linear vessels with branches, the term Y-shaped vessel was used when only one lateral branch was visible and polygonal vessel was used if multiple branches forming a network were seen. Comparison of dermoscopy findings with their corresponding clinical finding revealed that red diffuse areas, vessels, brown globules, white structureless areas, desquamation, hypertrichosis and white hair were observed in a statistically higher proportion of cases dermoscopically. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

31. A Study to Ascertain the Early Outcomes Associated with the Surgical Intervention for Congenital Supravalvular Aortic Stenosis (SVAS): An Observational Study
Sanjay Kumar Nirala, Bheemsen Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to evaluate the early results of the surgical management of congenital supravalvular aortic stenosis (SVAS). Material & Methods: This single-center descriptive cross-sectional study was conducted at Department of pediatrics for the duration of 2 years infants and children aged one month to 15 years with a diagnosis of congenital aortic stenosis, who had undergone surgery were included. Children who had aortic valve stenosis due to acquired causes, such as rheumatic heart diseases, were excluded from the study. In the present study, 100 children with congenital aortic valve stenosis who had undergone open heart surgery were included. Results: The mean ± standard deviation of the current age of the studied patients was 9.31±1.46 years. The minimum age of the patients was 1 month and the maximum was 15 years. 55 patients (55%) were male and 45 patients (45%) were female. The average weight of the patients was 28.24 ± 20.36 kg. The majority of patients had isolated valvular stenosis (46%), followed by isolated subvalvular stenosis. Combined conditions were fewer compared to the isolated conditions. In patients who had valvular aortic stenosis, commissurotomy was performed in 28 patients, Benthal surgery in 4 patients, and Aortic Valve Replacement (AVR) in 14 cases. Web resection surgery + myomectomy was performed in patients who had only subvalvular stenosis. Only those who had supravalvular stenosis underwent aortoplasty. In patients who had ventricular outflow tract stenosis only at the valvular level, the majority of patients (83.34%) had severe aortic valve stenosis before surgery. Immediately after surgery 55.55% of the patients showed no valvular stenosis; unfortunately, three patients died in the operating room. Conclusion: The overall success rate of surgery in aortic valve stenosis was acceptable. As different surgical methods implemented in aortic valve stenosis have their own specific pros and cons, regular pediatrician visits are necessary to map-out any possible future complications.

32. Prevalence of Depression among Patients with Chronic Illnesses: A Cross-Sectional Study
Rajesh R Patel, Amit Vaghela, Devendra Chaudhari, Kinnari P. Trivedi
Abstract
Background: Chronic illnesses have been frequently associated with a range of psychological disturbances. Depression, a leading contributor to global disability, often co-exists with chronic medical conditions. Yet, the prevalence of depression among individuals with chronic illnesses remains poorly quantified in various settings. Objective: To determine the prevalence of depression among patients with chronic illnesses. Methods: A cross-sectional study was conducted involving 300 patients diagnosed with chronic illnesses, recruited from a tertiary care hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Sociodemographic data and the nature of the chronic illness were also captured Results: Out of the 300 patients, 36.7% (n=110) were found to exhibit signs of depression. The prevalence of depression varied significantly across different types of chronic illnesses, with all major categories (Diabetes, Cardiovascular, Respiratory Disorders, and Others) showing a significant association with depression (all with p-values < 0.05). Additionally, the severity of depression, as assessed using the PHQ-9, ranged from minimal to severe among the patient cohort. Conclusion: Depression is prevalent among patients with chronic illnesses. Regular screening for depression in these patients can aid in timely diagnosis and intervention, improving the overall quality of life and medical outcomes. Healthcare providers should be vigilant to the potential coexistence of depression in patients presenting with chronic medical conditions.

33. Understanding the Prevalence of Residual Neuromuscular Blockade in the Post Anaesthesia Care Unit: A Cross-Sectional Analysis
Swati Nuna Jain, Nidhi V. Sardhara, Pratikkumar Jain
Abstract
Background: Residual neuromuscular blockade (RNMB) can lead to significant postoperative complications. Despite its clinical importance, the prevalence and associated risk factors for RNMB in the post-anesthesia care unit (PACU) are often under-recognized. Objective: To evaluate the prevalence of RNMB in the PACU among a sample of 300 patients and identify its associated clinical and procedural risk factors. Methods: This cross-sectional study was carried out over a three-month period in a tertiary hospital setting. Inclusion criteria involved adult patients who were administered non-depolarizing neuromuscular blocking agents (NMBAs) during their surgeries. RNMB was assessed using a train-of-four (TOF) ratio, with values less than 0.9 at PACU admission indicative of RNMB. Data collection encompassed patient demographics, surgical details, NMBA dosing, and intraoperative neuromuscular monitoring. Results: Of the 300 studied patients, 15% (n=45) demonstrated RNMB upon PACU entry. Notable risk factors for RNMB included extended surgical duration, larger NMBA dosages, and absence of intraoperative neuromuscular monitoring. Those with RNMB had a significantly prolonged PACU stay and heightened episodes of respiratory complications. Conclusion: The presence of RNMB in the PACU is a tangible concern, with a prevalence of 15% in our sample. Emphasizing intraoperative neuromuscular monitoring and adopting careful NMBA administration can potentially reduce its incidence, enhancing postoperative patient safety.

34. A Study of Multiorgan Dysfunction in Patients with Plasmodium Falciparum Malaria
Hiteshkumar Kanzariya, Divyesh Sherasiya, Chirag Adroja, Jalpa Bhadja Dhoriyani
Abstract
Background: Malaria is a global problem, creating a menacing health problem worldwide. Nearly all serious illnesses and deaths from malaria are caused by p.falciparum malaria. Aims & Objective: This study aimed to study the to study the multiorgan dysfunction in plasmodium falciparum malaria. Methods: A prospective study was conducted on patients, who were admitted at our Medical College Hospital to the Medicine ward and ICU under Medicine Department. The study was carried out on 108 patients admitted during the period of two years. Results: In present study out of 108 PF malaria cases 67.6% had multiorgan failure and 32.4% had single organ failure. In total cases of plasmodium falciparum cases 66.7% were male and 33.3% were female. Hepatomegaly was found in 34.3%, splenomegaly in 46.3% and 21.3% had hepatosplenomegaly, rest of the patients reported with associated illness. Conclusion: Fever with chills and rigors are the most common presenting symptom noted in all cases. Multiorgan dysfunction is more common than single organ dysfunction.

35. A Narrative Review on Formulation and Quality Attribute Considerations for Chewable Tablets
Monika, Pragi, Varun Kumar, Amit Kumar, Deepak Garg, Preeti, Ashok Kumar
Abstract
Recent advancements in novel drug delivery systems aim to improve the safety and therapeutic effectiveness of drug molecules by formulating a convenient or easy-to-administer dosage form. Patients with swallowing issues include those who are young, old, bedridden, crippled, and mentally ill. Oral administration is the most appropriate route for drug delivery because it has the highest compliance, especially in paediatrics and geriatrics. It has been cited as the most effective and secures way to administer medications. Chewable dosage forms include tablets, delicate pills, and gums. “Chewable squares” is a lengthy item in the drug specialist’s toolbox. The purpose of the chewable tablet is to provide a unit dosage that may be given to toddlers, teenagers, or the elderly who could also have difficulty swallowing a whole pill. The benefits of chewable tablet formulations include stability, palatability, precise dosing, portability, and ease of delivery. Taste masking of bitter drug candidates can be done by the aid of sweeteners, flavoring agents and by utilizing taste masking techniques. Chewable tablets can be formulated by the use of tableting methods: dry granulation, wet granulation and direct compression.

36. Study of Sublingual Misoprostol and Oral Misoprostol for Induction of Labor at Term- An Open Label Randomized Prospective Study
Zainab Ayazahmed Kharodiya, Lunat Ayaz Ismail, Shamimah Ayazahmed Kharodia
Abstract
Background: Misoprostol, an oral prostaglandin compound, is being increasingly used for induction of labor by vaginal, oral and sublingual route, though unlicensed for this use. This study was undertaken to compare the efficacy of sublingual misoprostol to oral misoprostol in induction of labor at term. Materials and Methods: This prospective study was done from 1st December 2020 to 15th September 2021. Study included total 160 patients admitted to Tata Main Hospital for induction of labor at 37-42 weeks of gestation, who were randomized into two groups of 80 women each as Group A (Oral misoprostol) and Group B (Sublingual misoprostol). Age, pre- and post- induction Bishop score, maternal side effects, dose requirement induction to delivery interval, mode of delivery, 3rd stage complication, incidence of tachysystole/ hyperstimulation/ hypertonus, gain in Bishop Score ≥6, success rate were all recorded. Results: The mean number of doses of misoprostol was significantly lower in the sublingual group (p=<0.001). Mean induction interval was significantly lower in Sublingual group when compared to the Oral group. Significantly faster gain in Bishop score was observed in Sublingual group. Success rate was similar n both groups. Conclusion: Although the Sublingual route of misoprostol led to a faster improvement of Bishop score, overall success rate of induction by both the routes of misoprostol was comparable.

37. Retracted

38. A Hospital-Based Assessment of the Management of Isolated Mild Traumatic Brain Injury (TBI) Patients Managed in the Neurosurgery Department at I.G.I.M.S., Patna
Niraj Kanaujia, Samrendra Kumar Singh, Brajesh Kumar
Abstract
Aim: The aim of the present study was to describe the neurosurgical management of isolated mild traumatic brain injury (TBI) in the Bihar Region. Methods: This study was conducted at Department of Neurosurgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India and consent for participation was obtained from each participant enrolled in this study. The study included all the patients with trauma, having clinical/radiological evidence of head injury alone or in association with other injuries admitted in the Neurosurgery department of Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for two years. A total of 200 patients of mild head injury attended the emergency services under the Department of Neurosurgery. Results: There were 148 (74%) males and 52 (26%) females. Most of the patients were healthy 184 (92%) with mild systemic diseases 16 (8%) before the injury happened. Of the patients with mild TBI, predominant mode of TBI was road traffic accidents (RTA) (50%), followed by fall from height (40%), assault and sports-related injury (3%). Of the total, 93% were from blunt injury, and injury at outermost were absent in 7% of patients. Most of the injuries occurred while at home and were accidental (40%) and were directly referred (84%) from the primary center. First aid for pain management was provided by trained personnel (doctors/paramedics) in 25% cases only and no care was provided in the rest of the cases (75%). On radiological examinations, 95% of patients with mild brain injury underwent CT scan, in which 55% were done between 2 to 4 hours after attending the ED room and 45% were performed between 4 to 6 hours. Conclusion: A high index of suspicion for TBI and an understanding of the risk factors, signs, and symptoms that are most likely to require surgical management or lead to long-term neurocognitive sequelae are the foundation of TBI care in the emergency unit. The care of these patients begins with rapid and appropriate triage, prompt recognition of TBI, and immediate stabilization of the severely brain-injured or otherwise critically ill trauma patient.

39. Paravertebral Block In Percutaneous Nephrolithotomy
Chetankumar Tikar, Pradeep Jain, Sandesh Parab, Priyank Kothari
Abstract
Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCNL). In this study we have compared two groups of PCNL surgery comprising 125 patients each, one with TPVB and one without TPVB. TPVB is effective modality in controlling early postoperative pain after PCNL surgery. However there is no effect in late postoperative pain control after PCNL surgery with TPVB.

40. Correlation between Clinical Presentation, Surgical Interventions, and Pathological Findings in Patients with Pancreatic Lesions: A Cross-Sectional Assessment
Pratikkumar N. Parker, Jigisha R. Bhoya, Ankur N Sarvaiya, Pradeep V. Mistry
Abstract
Introduction: Pancreatic lesions, an encompassing term for various pancreatic abnormalities, can range from benign cystic lesions to aggressive malignancies. The complexity surrounding the pancreas’s location and the non-specificity of early symptoms often results in delayed diagnosis, potentially worsening patient prognosis. Objectives: To assess the relationship between the clinical symptoms, the resulting surgical interventions, and the eventual pathological diagnosis in 300 patients with pancreatic lesions. Methods: In this cross-sectional assessment, 300 patients diagnosed with pancreatic lesions for the period of two years were studied. Data extracted included clinical presentations, type of surgical intervention (if any), and the definitive pathological diagnosis. Statistical analysis using chi-square tests and multivariate regression was performed to ascertain correlations. Results: Of the 300 patients, 26.7% presented with jaundice, 40% with abdominal pain, and 33.4% with other symptoms. Surgical intervention was undertaken in 60% of patients undergoing the Whipple procedure. A significant correlation was observed between patients presenting with weight loss and pancreatic adenocarcinoma. The likelihood of undergoing surgery was highest for those with jaundice. Pathological findings post-surgery aligned with preoperative clinical suspicion in 66.7% of cases, with adenocarcinoma being the most common pathological outcome. Conclusions: There exists a notable correlation between specific clinical presentations, the need for surgical interventions, and the pathological findings in patients with pancreatic lesions. Understanding these correlations can significantly influence clinical decision-making processes, potentially leading to more precise surgical interventions and better patient outcomes.

41. Assessing the Prevalence of Hypertension and Study the Risk Factors and Strength of Association between Factors and Hypertension in Young Patients in the Age Group of 20–40 Years: An Observational Study
Jay Jyoti, Kumar Vikas, Dinesh Kumar, Amita Sinha
Abstract
Aim: The aim of the present study was to study the prevalence of hypertension and study the risk factors and strength of association between factors and hypertension among 20–40 years old. Material & Methods: A cross‑sectional study was conducted among 20–40 years old residing in the urban field practice area to find the prevalence of hypertension and its association with socio‑demographic factors. After obtaining informed consent, data were collected with the help of an interview method by systematic random sampling using predesigned and pretested semi‑structured questionnaires. Three readings of blood pressure were recorded using a sphygmomanometer, and the average reading was considered. Data analysis was done using Microsoft Excel, Open Epi software, and SPSS software. Results: Our study revealed that 100 study subjects out of 500 were hypertensives and 400 (80%) were normotensives. So, the prevalence of hypertension in the area studied was 20%. Out of 500 study subjects, the majority of the study subjects (250, 50%) were pre‑hypertensive, followed by stage 1 hypertension (80, 16%) and (20, 4%) subjects belonged to stage 2 hypertension. In our study, 20 of the smokers and 80 of the non‑smokers were hypertensives and this association was not statistically significant (P = 0.24). Also, 60 of the tobacco chewers were hypertensives, whereas 40 of those who did not consume tobacco were hypertensives and the association was highly significant (P < 0.001). The prevalence of hypertension was more in obese class 2, followed by obese class 1. The association was highly significant (P < 0.001). Conclusion: The present study reveals a high prevalence of hypertension (20%) in the 20–40 years old age group, which can lead to increased cardiovascular disease burden in the population.

42. A Study Assessing the Association of Anemia with Acute Lower Respiratory Tract Infection in Pediatric Age Group of 6 Months to 5 Years: A Case Control Study
Sushil Kumar Pathak, Jaymala Mishra, Saroj Kumar, Binod Kumar Singh
Abstract
Aim: The aim of the present study was to assess the association between anaemia and lower respiratory tract infection among the under five-year-old children. Methods: This observational case-control study was performed in children in the age group of 6 months-5 years who attended the out-patient and in-patient unit of the Department of Paediatrics for the period of 18 months. 200 subjects were selected in the study. Results: Majority of the patients belonged to 7-24 months age group in case and controls respectively. In the present study, there was male predominance. Except for a few non-specific symptoms like poor feeding, vomiting which were not significantly different between the cases and controls, the major respiratory symptoms like cough, fast breathing, chest in-drawings, crepitations were significantly associated only with the LRTI group. There was no significant difference in the presence of Anemia between males and females. There was a significant difference in magnitude of anemia among various age groups. The highest level of anemia was recorded among those with LRTI in the 25-42 months age group which was significantly (p<0.001) higher than their normal counterparts. The mean hemoglobin level was much lower among the children with LRTI compared to those who did not manifest LRTI. The other blood indices like mean MCV, Mean MCHC, Red cell distribution width, serum iron, mean ferritin, TIBC were all significantly different between the cases and controls. Conclusion: The study clearly proved that anemia is an important risk factor for lower respiratory tract infection among children aged 6 months to 5 years. The early detection of anemia in children and treatment of the same or prevention of anemia using improved dietary iron intake and deworming can be ideal interventions in preventing the important risk factor converting healthy children to victims of LRTI.

43. To Investigate the Impact of a Brief Period of Pranayama Practice on the Cardiovascular Autonomic Function in Patients Diagnosed with Hypothyroidism
Harshwardhan, Suman Saurabh, Amitayush, Rajiva Kumar Singh
Abstract
Aim: The aim of the present study was to assess the effects of short term (1 month) practice of pranayama on cardiovascular autonomic function in hypothyroid patients. Methods: The present study was conducted on 80 volunteers at Department of Physiology for 6 months in between 18-30yrs of age. All consenting subjects meeting inclusion and exclusion criteria of the study was selected and informed written consent was obtained after thoroughly explaining the procedure. They were randomly divided into two groups with 40 patients in each group. Results: The mean age was 26.44 + 5.65 and 29.69 + 7.43 in both groups respectively. The mean BMI was 24.58 + 3.27 and 25.45 + 4.26 in both groups respectively. The mean HR was 72.48 + 7.87 and 74.36 + 8.64 in both groups respectively. Parasympathetic tests, the delta heart rate in deep breathing test and Valsalva ratio were increased in both groups however the increase in delta heart rate in deep breathing test in PG, CG. The increase in delta heart rate in deep breathing test in PG, CG were 32%, 16% and valsalva ratio in PG, CG were 8% and 4 respectively. The reduction diastolic blood pressure change in hand grip test was 18% in PG and 6% in CG. In cold pressor test, diastolic blood pressure was reduced by 12% in PG and 8% in CG. Conclusion: The results of this study demonstrated that regular practice of pranayama in addition to standard medical therapy is more beneficial to improve cardiovascular autonomic function in hypothyroid patients.

44. A Case-Control Study on Effect of Controlled Breathing on Heart Rate Variability in Newly Diagnosed Hypertensive Individuals: A Comparative Study
Amitayush, Harshwardhan, Suman Saurabh, Rajiva Kumar Singh
Abstract
Aim: The aim of the present study was to assess the cardiovascular autonomic function in newly diagnosed hypertensive individuals using HRV as a tool and to study the effect of one-minute controlled deep breathing on HRV among newly diagnosed hypertensives. Methods: This was a cross sectional Study conducted in the Department of Physiology for five months. The study consisted of two groups: 50 Newly diagnosed hypertensive patients, between the age group of 35-50 yrs, of both genders as cases and 50 age and gender matched normal healthy individuals as Controls. Results: The mean values of all the time domain parameters were found to be significantly reduced in hypertensives when compared with the controls. The mean of HRV parameters between controls and in cases before & after 1 minute controlled deep breathing showed statistically significance. In frequency domain analysis LF/HF was significantly increased in hypertension subjects. A significant increase (p<0.05)in time domain parameters was seen in hypertensive subjects after one minute controlled deep breathing. The LF/HF was also reduced following controlled deep breathing. Conclusion: Our study has shown a significant reduction of HRV in Newly Diagnosed Hypertensives compared with controls which is highly suggestive of cardiovascular autonomic impairment. HRV parameters showed a significant improvement after controlled breathing in hypertensives. Hence HRV may be used as a tool in addition to the blood pressure measurement to assess the underlying autonomic disturbances in newly diagnosed hypertensive individuals.

45. Retrospective Clinico-Pathological Associations of Fungal Keratitis in Series of Patients: An Observational Study
Jyoti, Sachin Kumar, Pradeep Karak, Rajnandani
Abstract
Aim: The aim of the present study was to analyse the causes, presentation, and clinico-pathological associations of fungal keratitis in a retrospective series of patients. Material & Methods: A retrospective analysis was conducted in the Department of Ophthalmology for the duration of 1 year. The outpatient department saw a total of 850 patients, of whom 100 cases (11.76%) of microbial keratitis and 10 cases (10%) of keratomycosis were observed. The study was performed in compliance with the Declaration of Helsinki. Patients with fungal keratitis were identified by reviewing medical records in between the duration of 1 year. Risk factors, clinical manifestation and outcome were recorded. Results: The age incidence of keratomycosis in the current study showed that the age range of 51 to 60 years has the highest incidence (4), followed by 21 to 30 years (2), 41 to 50 years (1), 31 to 40 years (3), 11 to 20 years (0) and 0 to 10 years (0). In this study, there were 6 affected males (60%) and 4 affected females (40%). In the current study, agricultural labourers have the highest incidence of fungal ulcers [8], i.e. 80%, others (20%, or 2 cases) (Rickshaw drivers, students, and business people). In the present study, aspergillus fungi were found in 5 cases. The current investigation revealed that Fluconazole is effective against Candida Albicans and Natamycin 5% eye drops are effective against Aspergillus species. All of the straightforward fungal corneal ulcers, or those lacking hypopyon, responded well to natamycin eye drops. Conclusion: Natamycin was the better option for the treatment of fungal keratitis. Filamentous fungi (Aspergillus species, fusarium, and curvularia) responded effectively to Natamycin 5% eye drops. Cases that responded well later left a corneal opacity.

46. A Hospital-Based Assessment of the Clinical Profile of Congenital Heart Disease in Children and its Correlation with Echocardiography
Sushil Kumar Pathak, Jaymala Mishra, Saroj Kumar, Binod Kumar Singh
Abstract
Aim: The aim of the present study was to assess the clinical profile of congenital heart disease in children and establishing correlation of clinical diagnosis with echocardiography diagnosis. Material & Methods: This was a prospective cross-sectional study conducted in the Department of Pediatrics, over a period of 3 years. All children between 1 month to 14 years admitted for suspected CHD were included in the study. Clinical diagnosis was made based on detailed history and physical examination supported by chest X-ray and ECG. Final diagnosis was confirmed by echocardiography and clinico-ECHO correlation was deduced. Results: During this study period of 3 years, total number of admissions was 11250 and 200 CHD cases were admitted as per the inclusion criteria. The hospital incidence of CHD found to be 1.77%. The 52% were male and 48% were female. Patients from rural area constituted 80% and urban area 20%. Maximum children belonged to age group of 1 month to 1 year with 72%. Among all CHD, most common symptom was breathlessness (80%). Among ACHD, most common presentation was breathlessness (73.34%), cough (62.5%), forehead sweating (45.83%), feeding difficulty (37.50%) and among CCHD were breathlessness (90%). Overall murmur (85%) was the commonest clinical sign among CHD. Leading clinical sign among ACHD were murmur (91.66%), chest retraction (70.83%), growth retardation (50%) and among CCHD were desaturation (100%), murmur (75%), growth retardation (55%). CCF observed in 35% in ACHD and 32.5% in CCHD. Most common complication in CHD was growth retardation in both categories of ACHD (50%) and CCHD (62.5%) respectively. Clinico-echo correlation was correlated in 34%, partially correlated in 36%, not correlated in 30% cases. Clinico-echo correlation with aid of CXR and ECG correlated in 40%, partially correlated 32%, not correlated 28% cases. Conclusion: So, echocardiography remains the gold standard for diagnosis of CHD and guiding the treatment. Clinical diagnosis alone may not detect associated CHD.

47. Assessment of Incidence of SSIs and the Prevalence of Aerobic Bacterial Pathogens Involved with their Antibiogram: An Observational Study
Anubhuti
Abstract
Aim: The present study was aimed to determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram at tertiary care hospital. Methods: This prospective study was done in the Department of Microbiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar. The study period of the study was one year. The patient details were recorded including type of surgery, type of wound infection, wound class including clean, clean contaminated and contaminated wound and total days of stay in the hospital. Results: The patients included 14 (70%) males 6 (30%) females; the age of the patients were in a range of 17 years to 70 years. 7 (35%) patients were in age group 17-34, 8 (40) patients in age group of 35-51, and 5 (25) patients in an age group of 52-70 years with mean age of 44.6 years. The duration of the surgery lasting less than 2 hours has been noticed in 16 (80%) cases and in remaining 4 (20%) cases the duration of surgery was more than 2 hours. Few cases are with the comorbidities such as 4 hypertension cases, 2 cases of chronic kidney disease, 1 case of coronary artery disease and 1 case has been admitted with road traffic accident. A total of 11 cases (55%) of SSI were culture positive out of 20 cases. The organisms isolated were Staphylococcus species which includes 4 MSSA (Methicillin sensitive Staphylococcus aureus), 2 MRSA (methicillin resistant Staphylococcus aureus) and 1 Staphylococcus hemolyticus, two Enterococcus species which includes one Enterococcus durans and another Enterococcus faecalis. Among gram negative bacteria that were isolated which are specific to SSI included Pseudomonas aeroginosa and the other showed growth of Acinetobacter baumannii. Conclusion: We emphasized on the importance of hospital infection control monitoring with proper precautions during surgeries to reduce the load of SSI and better outcome of the treatment.

48. Hospital Based Clinical and Outcome Assessment of Penetrating Keratoplasty: An Observational Study
Jyoti, Sachin Kumar, Pradeep Karak, Rajnandani
Abstract
Aim: The aim of the present study to evaluate the visual outcome of Penetrating Keratoplasty (PK) clinically in NMCH, in Bihar. Material & Methods: The study was carried out in a Department of Ophthalmology. A total of 50 patients who were willing to give informed consent and fulfilling the specified inclusion and exclusion criteria were included in the study. Results: Out of the total 50 cases, males were 32 (64%) and females were 18 (36%). Maximum numbers of cases were in the age group of 40-60 years, that is, 32 cases (64%). Out of 50 cases, maximum number of eyes had very low visual acuity as, 20 cases had VA as perception of light, and 7 eyes had VA as hand movement, 16 cases had visual acuity as Finger count close to face and only 7 cases had VA as Counting Fingers 1-2 metres. Out of 50 cases, 41 patients had clear grafts at the final, 6th month follow up, 32 were in the age group of 41-60 years, 10 were in the age group of 20-40 years and 8 were in the bracket of 61-80 years. The visual acuity at the final follow up, was good in patient with pseudophakic bullous keratopathy, as 12 cases had visual acuity >6/60. 6 cases of leucomatous opacity had visual acuity >6/60. 8 cases of adherent leucomatous opacity had final visual acuity of >6/60. Conclusion: Infective keratitis either active or healed was the major indication for keratoplasty. The visual outcome following corneal transplantation was encouraging particularly in cases of optical keratoplasty.

49. A Hospital Based Qualitative Study to Create Awareness of Dissection Skills and Tools Session in Preparing 1st Year Undergraduate Learners for Cadaveric Dissection
Pallavi Sharma, Srikant Pandey, Rashmi Prasad, Subodh Kumar
Abstract
Aim: The main objective of the study was to analyse the learner prior and after interventional sessions as to how effective the session would be helpful in improving the quality and participation of learners in dissection. Material & Methods: A qualitative prospective cross-sectional study was done in 100 Learners of I MBBS by an interventional session on the topic through General lecture and demonstration. Learners were assessed prior and after the interventional session by same validated questionnaire. Perceptions of learners were also taken. The obtained data were compared and its significance was analysed by Chi-square test using Epi info 7.1 software. Results: Significant improvement evident by P value <0.001 was seen after the interventional session on “Awareness of Dissection skills and tools in preparing I MBBS learners for cadaveric dissection”. Most of learners felt that the session was very useful to them in stimulating interest, in-depth knowledge of the subject, acquiring dissection skills, performing qualitative dissections and a worthful session to be taken for every batch. Conclusion: The findings of this research indicate that implementing intervention sessions at the early stages of learning may enhance, motivate, and enhance learners’ engagement in dissection activities with more proficiency and ease.

50. An Observational Assessment of Renal and Perinephric Space Infection among Urology Patients
Himanshu Kumar, Pankaj Kumar Choudhary, Hari Shankar Prasad
Abstract
Aim: The aim of the present study was assessing 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 9 months. 50 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 50 patients, 30 (60%) males and 20 (40%) females suffered from renal and perirenal space infections in the age group of 10-70 years. Majority (40%) were young in the age group of 21-30 years. At the time of presentation, the commonest symptom was fever (96%) followed by flank pain (40%) weakness and lethargy (70%). 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 92%. It was seen that 24 (48%) patients had renal abscess, 20 (40%) perinephric abscess and 6 (12%) emphysematous pyelonephritis. The predisposing factors were diabetes mellitus (36%), ureteric calculi (30%) and renal calculi (24%) in these patients. 30 patients were treated with antibiotics only and 10 patients were treated with antibiotics+ PCD. In 2 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.

51. A Hospital-Based Study Assessing Relationship between Glycated Hemoglobin (Hba1c) ‎and Lipid Profile Components in Newly Diagnosed T2DM‎ Patients
Manish Kumar
Abstract
Aim: The aim of the present study was to find the relationship between Glycated hemoglobin (HbA1c) ‎and lipid profile components in newly diagnosed T2DM‎ patients. Material & Methods: In the study, 50 newly diagnosed type 2 diabetes patients were included as cases and 50 non-diabetic subjects were included as controls. Blood samples were collected from the subjects of both the study and control groups and were analysed for fasting and post-prandial plasma glucose, HbA1c, TC, TG, LDL-C, and HDL-C. 84% of cases had dyslipidemia whereas only 52% of controls were found to have dyslipidemia and the difference between the two groups was statistically significant (p<0.05). Results: 84% of cases had dyslipidemia whereas only 54% controls were found to have dyslipidemia and the difference between the two was statistically significant (P < 0.05). The difference of mean age between two groups was not statistically significant (p> 0.05). Statistically significant difference (p<0.05) was found when the mean values of HbA1c, FBS, PPBS, S. Total Cholesterol, S. Triglycerides, LDL-C, HDL-C of cases and control groups, were compared. The frequency of raised blood sugar parameters (HbA1c>6.5, FBS>126mg/dl, PPBS>200mg/dl) and dyslipidemia (S. Cholesterol-total, S. Triglycerides, LDL-C, HDL-C) in cases and control groups were noted. The statistically significant (p<0.05) difference was found between the two groups, when compared. A significant positive correlation was found between glycemic parameters (HbA1c, FBS and PPBS) and lipid profile parameters (Serum Triglyceride, Serum Total Cholesterol, Serum LDL Cholesterol) with p<0.05. But insignificant correlation was found with Serum HDL-Cholesterol (p>0.05). Conclusion: Significant positive correlation of HbA1c with lipid profiles in our study suggests that HbA1c can also be used as a predictor of dyslipidemia in addition to a glycemic control parameter for prevention of complication. Furthermore, HbA1c shows a significant correlation with TC, TG, LDL, and VLDL, whereas it has a significant negative correlation with HDL. The study showed thatHbA1c might be useful for predicting dyslipidemia in T2DM patients.

52. A Hospital-Based Study Determining the Reliability of Immunochromatographic Test (ICT) for the Early Diagnosis of Typhoid Fever: A Comparative Study
Rizwan Ahmad, Sanjay Nag
Abstract
Aim: The aim of the present study was to determine the reliability of immunochromatographic test (ICT) for the early diagnosis of typhoid fever when compared to the Widal test. Methods: This prospective cross-sectional study was undertaken at the Department of Microbiology for the period of 2 years. A total of 200 clinically suspected typhoid fever cases were included in this study. Sample collection and Processing from each patient included in the study, under strict aseptic precautions 3ml venous blood was withdrawn in a well labeled plain vaccutainer tube. Results: Out of 200 patients 16 (8%) were positive and 184 (92%) were negative by slide Widal test. Out of 200 cases 18 (9%) were positive and 182 (91%) were negative by immunochromatography test. Out of 18 immunochromatography test positive cases, 3 were negative by Widal test. Sensitivity and specificity of immunochromatographic method was 100% and 97.3% respectively considering Widal as standard. Conclusion: The study concluded that ICT can be used as the suitable method for rapid diagnosis of typhoid fever. Detection of antibody from ICT method is more easy, non-invasive and highly sensitive and specific method. It is useful for small, less equipped as well as for the laboratories with fewer facilities. Since detection rate of antibody by ICT method is quite satisfactory.

53. A Prospective Observational Assessment of the Predictors of Outcome in Pediatric Septic Shock
Suprabhat Ranjan, Sheela Sinha
Abstract
Aim: The aim of the present study was to determine the predictors of the outcome and progression of pediatric sepsis and septic shock. Material & Methods: A prospective, observational study was undertaken to analyze predictors of poor outcome in septic shock in Upgraded Department of Pediatrics in a time period of 12 months (March 2012 to Feb 2013). A total of 74 patients of septic shock were admitted to the PICU during the study period of whom 60 patients were finally included as per the study protocol. Results: 50 of 60 (83.34%) cases enrolled in the study were discharged after recovery while 10 (16.66%) expired. On analysis of clinical symptoms as predictors of outcome, fever was the most common symptom present in all the patients. On analysis of the vital parameters, a delayed capillary refill time (>3 seconds) was a statistically significant (p=0.007) predictor of poor outcome with all the 10 patients having failed to survive, having a prolonged CRT on admission. Amongst the laboratory predictors, a low mean pH on admission had a statistically significant (p=0.007) association with a poor outcome. None of the other laboratory markers and Microbiological positivity of sepsis was found to have significant statistical association with outcome. Conclusion: SIRS can progress to septic shock if not identified early. The predictors of mortality were positive blood cultures, multiorgan dysfunction, late hospital admissions, severe acute malnutrition, and requirement of supportive care. The predictors of progression to septic shock were abnormal leukocyte count, culture positivity, and severe acute malnutrition.

54. A Questionnaire-Based Survey Assessing Knowledge and Awareness Regarding Various Visual Impairment Diseases: A Cross Sectional Study
Shailendra Kumar, Nilesh Gautam, Asif Shahnawaz
Abstract
Aim: The aim of the present study was to analyse and assess the knowledge and awareness of people from a given population in India about the various visual impairment diseases. Material & Methods: This cross-sectional questionnaire-based study with 200 subjects was conducted at Department of Ophthalmology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India within the duration of 1 year were taken from the camp side. The Institutional Review Committee gave approval to conduct research in the line with the Helsinki Declaration of Medical Ethics, and sign consent was taken from all the subjects. Results: In the present study, 48% were male and 52% were females. Majority of the subjects belonged to above 60 years age group (46%) followed by 35% in 40-60 years age group. The awareness about cataract was 170 (85%), glaucoma was 164 (82%). 168 (84%) participants were aware that diabetes/BP causes eye problems. 140 (70%) participants were able to treat minor eye problems at home. 132 (66%) participants were prescribed spectacles for near/far vision. 170 (85%) participants were aware that children of age 1-2 years need eye examination. 144 (72%) participants think mobile phones or laptops can cause problem to eye and 160 (80%) participants was aware of digital eye strain. Conclusion: The present study concludes that the majority of participants in this survey were aware of prevalent eye disorders and their causes; therefore, there is a need for ocular healthcare to focus on weaker areas of knowledge through intervention.

55. A Randomized Comparative Interventional Study Assessing Improvement in Lipid Profile of the Patients with Saxagliptin as Add on Therapy in Patients of Uncontrolled Type 2 Diabetes Mellitus Who Were on Metformin Alone
Ishteyaque Ahmad, Rohit Agrawal, Rajeev Ranjan Sinha, Devesh Gupta
Abstract
Aim: The aim of the present study was to assess the improvement in lipid profile of the patients with saxagliptin as add on therapy in patients of uncontrolled type 2 DM who were on metformin alone. Methods: It was a randomized, prospective, comparative, interventional study conducted in the Department of Pharmacology for 12 months. Total 50 patients were enrolled after screening for diabetes status with the help of HbA1C, FPG, PPPG. Detailed history taking, clinical examination and lab investigation including lipid profile (TC, TG, LDL, HDL) were done. Results: Out of 50 patients, 22 were males and 28 were females. The mean age (± SD) in males and females was 60.46 yrs ± 6.94 and 56.94 yrs ± 5.75 respectively. Mean change in TC and TG from baseline at 24 weeks was 13.86% and 13.92% respectively. Mean change in LDL and HDL from baseline at 24 weeks was 14.47% and 2.05% respectively. Conclusion: Saxagliptin has shown an improvement in lipid profile (TC, TG, LDL, HDL) during 6 months of treatment duration in patients of T2DM.

56. A Hospital Based Randomized Double-Blinded Controlled Study to Assess the Efficacy and Safety of Air versus Alkalinized 2% Lignocaine for Inflating Endotracheal Tube
Shweta Kamleshbhai Prajapati, Miten Rameshbhai Delvadiya, Maitriben Girishkumar Patel, Jayshri Prajapati
Abstract
Aim: The aim of the present study was to evaluate the efficacy of alkalinized 2% lignocaine with conventional air as cuff inflating media, in preventing Postoperative sore throat (POST) and coughing in patients undergoing a surgical procedure under general anaesthesia. Methods: We conducted this randomized double-blinded controlled study at Department of Anaesthesiology, GMERS Medical College, Himmatnagar, Gujarat, India for one year ( July 2022 to June 2023)in operation theatre, postoperative care unit (PACU) and wards. The risks and benefits of the procedure were explained to the patients. We initially included 120 patients as per the inclusion criteria. 20 patients were excluded. The remaining 100 patients were randomly divided into two equal groups of 50 each. Results: Mean age, gender, mean BMI, ASA grades and mean duration of anaesthesia were comparable in both the groups with no statistically significant difference. The mean volume at the start of the surgery was 5.4 mL and 5.3 mL in Group A and Group B respectively (p-value= 0.555). The mean intra-cuff pressure at the start of the surgery was 20.0 cm in both the groups. The mean volume at the end of the surgery was 7.5 mL and 4.6 mL in Group A and Group B respectively (p-value = 0.001). The incidence of coughing immediately postoperative, 12 hours and 24 hours postoperatively did not differ significantly between the two study groups, whereas the incidence of coughing at one hour postoperative was 28% and 4% in Group A and Group B respectively (p- value = 0.024) The incidence of POST at one hour, 12 hours and 24 hours postoperatively did not differ significantly between the two study groups. Conclusion: The intracuff alkalinized lidocaine is useful adjunct to endotracheal intubation. In the setting of general anesthesia with the use of N2O and O2 mixture, rise in cuff pressure with the progression of surgery is better overcome when ETT cuff is inflated with lignocaine as compared to air. Alkalinized 2% lignocaine provides an improved protective effect in preventing postoperative laryngotracheal morbidity in form of coughing and POST.

57. Outcome Assessment of Dynamic Hip Screw and Proximal Femoral Nail in Basicervical Fracture of Femur: A Comparative Study
Kumar Mayank, Ranjan Kumar Prakash, Maseeh Azam, Soman Kumar Chatterjee
Abstract
Aim: The aim of the present study was to compare the functional outcome of Dynamic Hip Screw vs. Proximal Femoral Nail in basicervical fracture of femur. Material & Methods: This Prospective study was conducted among 100 patients who were diagnosed to have Intertrochanteric Fracture of Femur of > 18 years old of either sex attending orthopaedic outpatients and inpatients Department of Orthopaedic. Patients were grouped into two groups by Convenient sampling technique. First group of patients were treated by dynamic hip screw fixation and Second group of patients were treated by Proximal femoral nailing with 50 patients in each group. Results: There were 44% male and 56% in DHS group and 64% were male and 36% were females in PFN group. The mean age 68.42±8.36 and 67.93±8.42 in DHS and PFN group respectively. Type III intertrochanteric fractures were more common because most patients had low velocity injuries and road traffic accidents. In this study, right sided intertrochanteric fractures were more common. Among 100 patients with intertrochanteric fractures, patients developed less complication in PFN group than DHS group. Superficial infections more in DHS group (8%) than PFN group (6%) Screw cut -out noted in two patients of DHS group (4%) and two patients (4%) in PFN group. Patients who were lost to follow up were more in PFN group (10%) than DHS group (6%). Varus collapse founded in two patient of DHS group (8%) but not noted in PFN group. Deep infection founded in the patient among DHS group (2%) and not noted in PFN group Limb shortening noted in two patients of DHS group (4%) and No limb shortening noted in PFN group. In Group DHS, results were excellent in 58%, fair in 14%, good in 14%, and poor in 14%. In Group PFN, results were excellent in 72%, fair in 10%, and good in 10%. Conclusion: We concluded that Proximal Femoral nailing is an appropriate device for both stable and unstable intertrochanteric fractures than dynamic hip screw in terms of minimal complication and good functional Harris hip score.

58. A Hospital-Based Case Control Study Assessing the Impact of Functional Constipation on Quality of Life of Paediatric Patients
Suprabhat Ranjan, Sheela Sinha
Abstract
Aim: The aim of the present study was to investigate the health-related quality of life (HRQOL) in preschool children diagnosed with FC and the impact of the condition on affected families. Material & Methods: This case-control study was conducted on a total of 100 children aged 7- 12 years, 50 children as case group including all patients with functional constipation selected from Upgraded Department of Pediatrics, in between the duration of 1 year(Jan 2012 to December 2012) As well as 50 children as control group selected from the children’s health care clinic clientele at the same hospital aged 7-12 years, simultaneously. Results: The mean age of both groups was 9.51 ± 1.81 and 9.48 ± 1.43 respectively. There was male predominance in constipation group. Mean QoL scores for children with constipation were compared with healthy non-constipated children in four aspects of physical, emotional, social, and school functioning. In terms of physical functioning, mean QoL scores in two groups with and without FC was 58.42±3.87 and 82.18±4.96 respectively; and the difference was statistically significant (p< 0.001). Mean emotional functioning QoL scores in group of constipated patients were lower than the control group, 56.14±4.66 against 84.46±4.86 and a statistically significant difference was found between the two groups studied (p< 0.001). Furthermore, mean social functioning QoL scores in constipated and healthy children were 48.22±7.23 and 82.78±4.36 respectively; and a significant difference confirmed between these two groups (p< 0.001). Also, mean school functioning QoL scores in children with and without FC respectively were 64.16±3.92 and 82.68±6.16 and p-value < 0.001 demonstrated statistically significant difference. Totally, mean QoL scores in children with and without constipation were 56.74±1.68 and 82.58±2.38 respectively; and a significant difference was found (p-value <0.001). Conclusion: In conclusion, duration and characteristics of symptoms of FC adversely influence the quality of life of affected children in all four aspects of physical, emotional, social, and educational functioning, and it may be a source of family agitation.

59. A Hospital-Based Observational Study Assessing Prevalence of Retinopathy in Non-Insulin Dependent Diabetes Mellitus Patients
Sangeeta, Rajesh Tiwary
Abstract
Aim: The aim of the present study was to examine the prevalence of retinopathy and its relation with various risk factors in type 2 diabetic patients. Material & Methods: This was a hospital-based observational cross-sectional study. The study was conducted in the Department of Medicine and, Department of Ophthalmology for one year. 100 already diagnosed type 2 diabetic subjects were included in the study. Results: There were 52 male and 48 females. Duration of diabetes was slightly longer in the female participants. 30 subjects i.e. 30% were having diabetic retinopathy. 70% i.e. 70 subjects were having no retinopathy. Out of 30 patients with DR, 9 patients had NPDR -30%, 4 patients had PDR -13.34%. Statistically significant changes were observed between age and stage of diabetic retinopathy. Significant association was found between diabetic retinopathy and duration of diabetes. Conclusion: Therefore, periodic screening of diabetic patients should be carried out for early detection and prevention of loss of vision.

60. Determining the Outcomes of Laparoscopic Inguinal Hernia Repair versus Open Incisional Inguinal Hernia Repair Surgeries
Shashank Gaurav, Harneet Kaur Khurana, P.K. Sachan
Abstract
Aim: The present study evaluates and compare the outcome of laparoscopic inguinal hernia repair and open incisional inguinal hernia repair surgery. Methods: The present study was conducted in the Department of General Surgery, Himalayan Institute of Medical Sciences, Dehradun, India for 7 months. A total of 200 patients with uncomplicated inguinal small or medium sized, direct or indirect, unilateral or bilateral hernias undergoing elective inguinal hernia surgery, who are fit for laparoscopy and open surgery were included in the study. The study consisted of 200 patients, of which 100 were in the open surgery group and 100 were in the laparoscopic group. Results: The open surgery group consisted of patients with a mean age of 45.18±14.32 years, including 82 men and 18 females. The laparoscopic cohort included individuals with a mean age of 46.52±16.34 years, consisting of 85 men and 15 females. Out of the total instances seen, 80 individuals were diagnosed with unilateral hernia. Among these cases, 55 individuals exhibited right laterality, whereas 25 individuals had left laterality in the open surgery group. Bilateral representation was seen in 14 instances. In the open surgery group, there were a total of 200 cases, with 50 classified as direct type, 108 as indirect type, and 42 as direct/indirect type. There was no observed statistical link between age, gender, laterality, type, and the surgical method used. The Visual Analog Scale (VAS) scores for the laparoscopic group consistently exhibited lower values compared to the open group at corresponding time intervals, and this disparity was shown to have statistical significance. Following the procedure, there was a decreased need for post-operative analgesics with the laparoscopic approach, with just two patients need analgesic medication. The occurrence of seroma, particularly in laparoscopic procedures, was often seen as a post-operative complication. Conclusion: Laparoscopic hernia repair is considered to be a safe surgical procedure that results in reduced postoperative morbidity when performed by skilled surgeons, in comparison to open hernia repair.

61. Usefulness of PEDIS Scoring in Identifying the Severity of Diabetic Foot Ulcer and its Management: An Observational Study
Praveen Kishore, Mukesh Kumar, Sunil Kumar Ranjan, Ashok Kumar
Abstract
Aim: The aim of the present study was to evaluate the usefulness of PEDIS scoring in identifying the severity of diabetic foot ulcer and its management. Methods: This was a hospital based prospective observational study conducted in Department of General Surgery. Patients who came to Hospital with Diabetic foot ulcers below the level of malleolus including both outpatients and inpatients were taken into this study after getting consent. This study was conducted for 1 year. Totally 200 patients were included in the study and followed up for 6 months. Results: Out of 200, 140 (70%) were males and 60 (30%) were females. White blood cell counts were found to be elevated in 64 (32%) patients. The cut-off value for high WBC was considered to be more than 11,000/mm3. Cut-off value taken for high random blood sugar was 140 mg/dl. About 132 (66%) patients were having abnormally elevated random blood sugar. 20 (10%) patients were found to have osteomyelitis and they were tested positive for probe to bone test. Patients with score of less than 7 managed with debridement showed good results at the end. Patients with score more than 4 with high random blood sugar and elevated white cell count being showed delayed healing. We predicted the complications of the diabetic foot based on the PEDIS scoring with factors like uncontrolled blood glucose level, grossly increased white blood cell count, additional co-morbidities and previous history of surgery in the same foot. All of the factors and management of diabetic foot ulcer showed p value of less than 0.05 expect the conservative management. Conclusion: From our study we have come to a conclusion that PEDIS scoring helps in predicting complications in diabetic foot ulcer and its management.

62. Study to Evaluate the Effectiveness of Platelet Count (Referred to as Platelets) and its Indices as Diagnostic Tools for Early Detection of Sepsis in a Hospital Setting
Vineeta, Sanjay Kumar Nirala, Gopal Shankar Sahni
Abstract
Aim: The aim of the study was to evaluate the efficacy of platelet count (Platelets) and its indices in the early diagnosis of sepsis. Methods: This was a prospective study conducted at department of pediatrics for the period of one year. Sample size of 200 patients was recruited as per hospital neonatal intensive care unit work load during the period of study. Results: The general characteristics of a study group showing 200 patients including 130 males and 70 females. On the basis of NNF guidelines, the patients were divided in three groups – 52% were clinically suspected sepsis (probable sepsis), 34% were with blood culture positive (culture positive sepsis), and remaining 14% in blood culture negative but CRP positive group (culture negative sepsis). Probable sepsis was more among preterm babies whereas culture negative and culture positive were more in term babies. Sensitivity and accuracy for Platelets were 54.6% and 60% in the culture positive group, whereas sensitivity and accuracy for Platelets in the probable sepsis group was 68% and 57.8%. Specifically, NPV and PPV was 68%, 40.7%, and 78.2% in culture positive whereas it was 68%, 21.5%, and 66.6% in the probable sepsis group. Analysis on the basis of ANOVA for three groups-culture positive, culture negative and probable sepsis was done for Platelets and its indices (MPV, PDW, and PCT). Platelets were found to be significant in all groups. Conclusion: Platelets can be considered as an early diagnostic tool for neonatal sepsis as it is cheap, rapid, and easily available and does not require additional equipment.

63. Epidemiological Study Assessing Clinic-Etiological Spectrum of Acute Small Intestinal Obstruction: An Observational Study
Mukesh Kumar, Praveen Kishore, Ashok Kumar, Sunil Kumar Ranjan
Abstract
Aim: The aim of the present study was to evaluate the common etiological factor related to small bowel obstruction in adult patients. Material & Methods: The cross-sectional study was conducted in the Department of General Surgery, for the duration of 24 months. Total 200 patients age above 15 years were studied after taking informed consent from patient/relatives. Results: 130 patients were male and 70 were females. All the patients were categorized in different age group, 39 patients belong to 15-25 years age group, 69 patients were in 26-40 years, 52 patients were in 41-55 years, 26 patients were in 56-70 years and remaining 14 were having age above 71 years. The cardinal signs and symptoms were present in almost all the patients. Abdominal pain was present in 192 patients, vomiting in 150 patients, tenderness in 180 patients, absolute constipation in 162 patients, abdominal distension in 186 patients, rebound tenderness in 108 patients, significant finding on per rectal examination in 108 patients, absent/decreased bowel sound in 70 patients, increased bowel sound in 130 patients and palpable mass and swelling was present in 50 patients. Out of 200 patients, Adhesions were present in 36 patients, Hernias in 40 patients, Malignancy in 20 patients, intestinal volvulus in 10 patients, diverticulum in 4 patients, strictures in 12 patients, intestinal tuberculosis in 20 patients, fecal impaction in 6 patients and superior mesenteric artery syndrome in 3 patients. Remaining patients were having non-mechanical (adynamic) intestinal obstruction. Out of these patients, 8 patients were having gangrenous ileum, two female patients were having pelvic abscess and 24 patients were having intestinal obstruction due to unknown paralytic ileus cause. Conclusion: The causes of intestinal obstruction are variable in different parts of the world. Adhesions are the most common cause of bowel obstruction. The treatment in each patient should be individualized. Atrial of conservative management should be planned in all cases before embarking to a surgical intervention except in patients where strangulation is suspected.

64. Study to Analyse Caesarean Sections Rate According to Robson’s Ten Group Classification in a Tertiary Care Centre
Nilam Bharti, Ranjana Kumari, Sweta Rani, Girija Kumari
Abstract
Aim: The present study was conducted to find out the frequency and indications for CS and to analyze them according to Robsons ten group classification. Material & Methods: All women who underwent caesarean section at Department of Obstetrics and Gynaecology were included in our study. Exclusion criteria include all mothers who underwent vaginal delivery in our institute and those women with missing records. The study population included 2035 women who underwent caesarean in our hospital over the duration of 1 year (from May 2022 – May 2023). Results: During the study interval total of 2035 women delivered via C-section. Majority of the women were between 20-30 years (90%). Out of them 68.45% were multigravida’s and 31.54% were nulliparous. 67.07% women were between the gestational age of 37-40 weeks. 46.92% of women went into spontaneous labour and 21.13% of them underwent pre labour caesarean section. Out of which 81.08% of babies had a 5 minutes APGAR above 7 and only 18.91% babies had a score less than or equal to 7.80.34% of the babies were average weight between 2.5-3.9 kg. Distribution of all deliveries performed during the study period in accordance to Robsons criteria showed majority of women (36.21%) belonged to group5 and group2(27.61%). This was followed 16.01% women in group 1. The most common indication for caesarean seen in our study was previous LSCS seen in 38.32%(780)women followed by fetal distress seen in 265(13%) women. Conclusion: According to Robsons criteria group 5 and group 2 were the groups found to be majorly contributing the most to the caesarean section in our study. There is a need to evaluate existing management protocols and further studies need to be conducted into the indications of CS and outcomes in our setting are needed to design tailored strategies and improve outcomes.

65. An Observational Study Determining Incidence and Perioperative Factors Associated with the Development of Urethral Stricture Following B‑TURP
Abhishek Bose, Manish Kumar Singh, Pushpendra Kumar
Abstract
Aim: The aim of the present study was to evaluate the incidence and perioperative factors associated with the development of urethral stricture following B‑TURP. Methods: This was a prospective observational study of patients with symptomatic BPO who underwent B‑TURP at Department of Urology from September 2019 to November 2022. A total of 200 patients underwent B‑TURP during the study period. Informed consent was obtained from all the patients before the surgical intervention. Results: The mean preoperative IPSS score and Q‑max were 21 ± 4 and 8 ± 3 mL/min, respectively. The mean total prostate volume was 56.4±31.6 cm3. The mean meatal caliber was 28 ± 2 Fr. In all the patients with a prostate volume of ≤40 cm3, a 24 Fr resectoscope was used. For the 200 patients with a prostate volume ≥40 cm3, a 26‑Fr resectoscope sheath was used in 80 patients and in the remaining 120 patients, a 24‑Fr resectoscope sheath was used as the meatal caliber was <26 Fr. The mean prostate volumes resected with a 24Fr sheath was 44.3 ± 22 cm3 and that with a 26Fr sheath was 80.2 ± 32 cm3. Perioperative complications were classified using the CCS. The most common intraoperative complication was capsular perforation. Most postoperative complications were classified as Grade 1.The present study included 200 patients who underwent B‑TURP and were followed up for at least 6 months. A significant correlation between the development of urethral stricture following B‑TURP and diabetes mellitus, prostate volume, resectoscope sheath, resection time, capsular perforation, postoperative haematuria, catheter block‑manged with flush/exchange, catheter traction, duration of catheter removal. Conclusion: We found that small meatal caliber was associated with an increased risk of urethral stricture following B‑TURP.

66. Evaluating Factors Influencing the Quality of ANC Services in Health Facilities: An Observational Study
Alokkumar Binod Kumar Singh, Jalindar Baravakar
Abstract
Aim: The objective of this study was to determine factors influencing the quality of ANC services in health facilities. Methods: The study adopted a quantitative approach to determine factors influencing satisfaction of the quality of antenatal care services in selected health facilities. Cross-sectional survey design was used in this study. A cross-sectional research design was suitable in that it facilitated for a critical analysis of the relationship of several variables that were up for evaluation. A sample of 200 expectant mothers randomly selected for the study. Results: It was revealed that most of the participants were aged between 20-34 years who accounted for 70% followed by those aged between 35-49 years, which stood at 20%. 70% were married and 60% had secondary and college education level. There was a strong positive correlation between the variables: quality of ANC service and patient satisfaction, the relationship was not very strong as most of the dimensions of ANC were influencing satisfaction slightly above. The results of tangibility show that pregnant women that were at the factor of 1.154 had higher chances of being satisfied with the service they received than those reported to have very little chances of being satisfied. Under reliability dimension, the dimension was found to be statistically significant on influencing satisfaction in health facilities. This finding showed that the chance of service satisfaction among the recipients of the service from healthcare facilities had increased with the factor of 2.678. Conclusion: The study concluded that ANC services provision has an influence on the expectant mothers’ satisfaction. Different dimensions of antenatal care services influence satisfaction differently and a combination of several dimensions posts increased satisfaction.

67. A Case Control Study to Explore the Link between Vitamin D and Cellular Senescence Measured with the Enzyme Telomerase in Pre-HTN
Suchita Kumari, Rohan Kumar, Mritunjay Kumar Azad, Abha Prasad
Abstract
Aim: The aim of the present study was to explore the link between Vitamin D and cellular senescence measured with the enzyme telomerase in pre-HTN. Methods: The present study was conducted in the Department of Physiology for one year. Inclusion criteria for the pre-hypertensive group (pre-HTN) (n =100) were both genders between 18 and 25 years of age with SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg in apparently healthy individuals. The controls (n = 100) population were healthy individuals with 18– 25 years of age with SBP between 100 and 119 mmHg and DBP between 60 and 79 mmHg. Results: The study population included 200 apparently healthy individuals. 100 were pre- hypertensive with the age of 21.59±1.58 and the age of controls was 19.91±1.26.Out of 200, 55 males, 44 females in pre- HTN group and 52 males, 48 females in the control group. A significant difference was not found between-group differences in height and waist-hip ratio. However, pre- HTN group subject’s BMI (P < 0.001) and weight (P < 0.001) was more compared to controls. In pre-HTN group, significantly higher HR (P < 0.001), SBP (P < 0.001), DBP (P < 0.001), MAP (P < 0.001), and RPP (P < 0.001) were seen when compared to controls. No significant difference was seen in PP but it was slightly high in pre-HTN group and negatively associated with Vitamin D. High telomerase levels have correlation with waist-hip ratio, SBP, DBP, MAP, and RPP but no significant correlation was seen with BMI, HR, and PP. Conclusion: It can be concluded that reduced Vitamin D levels in pre-HTN may cause derangements of cardiovascular homeostatic mechanism, enhance the speed of cellular senescence measured by telomerase.

68. A Hospital-Based Study Evaluates Various Histopathological Parameters of Chronic Gastritis using the Updated Sydney System and to Correlate it with Presence of H. Pylori
Kumar Rajnish, Amarnath Kumar Nayak, Dipti Debbarma, Asim Mishra
Abstract
Aim: The aim of the present study was to evaluate various histopathological parameters of chronic gastritis using the updated Sydney system and to correlate it with presence of HP. Material & Methods: The present study was a retrospective descriptive study conducted at Department of Pathology from January 2023 to June 2023. All endoscopic antral biopsies received in the Department of Pathology, were reviewed with reference to light microscopic findings. A total of 220 slides were analysed out of which 20 had features of malignancy and were excluded from the study. The remaining 200 cases with features of chronic gastritis were perceived. Results: A total of 100 cases of chronic gastritis were reviewed. The mean patient’s age was 42.8 (15 -80 yrs). Most of the patients (36.5%) were in the age group of 36-50 yrs. There were 110 males and 90 females. Chronic inflammation was observed in all (100%) cases of chronic gastritis. Majority around 100 (50%) of them had moderate inflammation. Activity as defined by the presence of polymorphonuclear infiltrate in the glands was seen with varying severity in 70 biopsies. Chronic gastritis cases with mild activity (17%) outnumbered the rest with moderate and severe in our study. 44 (22%) cases showed intestinal metaplasia of varying severity – 28 had mild, 14 had moderate and 2 had severe intestinal metaplasia. Atrophy was observed in only one case (0.5%) and it was of mild degree only. However, no HP was detected in gastritis case with atrophy. Lymphoid follicle was present in 36% of cases. Positivity for HP was high (89.28%) in severe grade of inflammation. A statistically significant association was accomplished between chronic inflammation and presence of HP, activity and lymphoid follicle (p<0.01). A strong positive correlation was evidenced between activity and presence of HP. The association of activity with HP, lymphoid follicle and intestinal metaplasia was found to be statistically significant (p=0.000). Conclusion: The updated Sydney classification provides an objective mean of classifying chronic gastritis and increases the likelihood of detection of HP. Presence of intense grade of inflammation activity and lymphoid follicle should hint the histopathologist to search for HP. And also, the presence of one of these features is a strong indicator for the presence of the other.

69. A Case Control Study Assessing the Association between Quality of Life of 6 to 12-Year-Old Children with Obesity
Dipak Kumar, Sadhana Kumari, B. B. Singh
Abstract
Aim: The aim of the present study was to evaluate the quality of life among 6 to 12-year-old children with overweight and obesity in comparison to children with normal weight. Methods: This case-control study was conducted on children referred for the routine pediatric check-up. The life quality of 6 to 12-year-old children with overweight and obesity were compared with that of a control group (children with normal weight). 150 children were included based on the clinical and paraclinical findings as well as inclusion and exclusion criteria (100 in overweight/obesity and 50 in normal weight). Eligible cases were enrolled, after obtaining informed consent. Results: There was no significant difference in terms of gender and age between the two groups of children (p>0.05). The results showed that the average physical (32.48 ± 7.09 vs. 31.29 ± 5.75, P=0.028) and emotional (20.28 ± 3.77 vs. 18.02 ± 4.06, P=0.042) performances in the group of normal weight children was significantly higher than those of the overweight/obese children (p<0.05). However, the total score of life quality did not differ significantly between the two groups (P=0.282). The results showed that the average daily consumption of high-fat yogurt and liquid oil in the group of overweight/obese children was significantly higher than that of children with normal weight. Also, the average daily consumption of low-fat yogurt and vegetables in the group of children with normal weight was significantly higher than that of overweight/obese children. Conclusion: The results of this study revealed that, in comparison to normal weight children, overweight and obese children scored lower in physical, academic, and mental performance; however, the total score of life quality was not significantly different between the two groups.

70. Assessing Physical Activity & and Dietary Habits among Adolescents: An Observational Study
Alokkumar Binod Kumar Singh, Praful Hulke
Abstract
Aim: The current study aimed to focus specifically on objectively assessed physical activity & and dietary habits among adolescents. Methods: The present study was conducted in the Department of Community Medicine, Government Medical College and Hospital, Miraj, Maharashtra, India Data were obtained from adolescents (12–16 years) recruited from three secondary schools in Maharashtra. Staff at participating schools selected a subset of their classes for participation. All students from nominated classes (n = 200) were eligible and received written information on the project. Consent was sought from parents prior to the study and adolescent participants provided assent before completing written surveys during class. Results: A higher proportion of boys, compared to girls, ate breakfast on more than 5 days/week (p < 0.01). A higher proportion of younger adolescents, compared to older adolescents, met the physical activity recommendations and did not meet the recommendations for fruit and vegetable consumption (p < 0.01). For adolescents with two risk behaviours, the most prevalent cluster was formed by not meeting the physical activity and fruit and vegetables recommendations. A higher proportion of girls, compared to boys, had the cluster pattern of not meeting the recommendations for physical activity and breakfast consumption. (p < 0.01). A higher proportion of boys, compared to girls, and older adolescents, compared to younger adolescents, had the most prevalent single risk factor of not meeting the recommendations for physical activity (p < 0.01). A higher proportion of younger adolescents, compared to older adolescents, had the single risk factor of not meeting the recommendations for fruit and vegetable consumption (p < 0.01). Conclusion: Many adolescents fail to meet multiple diet and physical activity recommendations, highlighting that physical activity and dietary behaviours do not occur in isolation. Future research should investigate how best to achieve multiple health behaviour change in adolescent boys and girls.

71. Effectiveness of Preoperative Zinc Lozenges for Reduction of Post Operative Sore Throat in Patients Receiving General Anesthesia – A Prospective Randomized Placebo-Controlled Study
Chiranjib Sarkar, Piyush Kanti Roy
Abstract
Background: Post operative sore throat (POST) is a very common complication among patients undergoing general anesthesia. Though not very serious but it can significantly reduce patient satisfaction and delay in discharge after day care surgery and reduce turn over. Several methods had been used in the past to reduce it’s incidence. A novel approach is use of zinc lozenges preoperatively utilizing its anti-inflammatory properties to reduce the incidence of POST. Methods: This study was designed as randomized placebo-controlled trial with hundred and eight patients, divided into two groups, each containing fifty-four patients. One group received 75 mg zinc lozenges and other group received placebo. Each patient was assessed for development of POST on a 4-point scale (0-3) at different time interval. Primary objective was to determine severity of POST at 4 hours after surgery. We also determined incidence and severity of POST at 0 minutes, 30 minutes, 6 hour and 24 hour after surgery. Result: 3.7% of patients in zinc group developed POST, compared to 48.14% in placebo group (P<0.001) in 4 hour. Overall incidence of POST was 13% in zinc group with a reduction of 52% from placebo group (64.8%). During initial hours zinc reduced incidence of mild POST, but at 4 hours reduction of severe POST occurred. At 24-hour reduction of POST was not significant. Conclusion: Preoperative oral administration of 75mg zinc lozenges reduces the incidence of POST during initial postoperative hours (up to 6 hour), with significant reduction of mild POST during first 30 minutes and severe POST in 4 hour time point.

72. A Rare Case of Neuromyelitis Optica Spectrum Disorder (NMOSD) Complicating Pregnancy
Krishna Saketh Athmakuri, Saketh Vinjamuri, Garuda Lakshmi, Malathi Ponnuru, Kousalya Chakravarthy
Abstract
Neuromyelitis Optica spectrum disorder (NMOSD) is an antibody mediated neuroinflammatory disorder characterized by recurrent myelitis and optic neuritis. We present a case of pregnant lady presented with hyperemesis gravidarum at 16weeks of gestation. The patient had a rapid course of recurrent episodes of bladder and bowel retention and quadriparesis. MRI brain & spinal cord was suggestive of longitudinal extensive transverse myelitis and aquaporin 4 ab (AQP4-Abs) was positive. Patient was treated for Neuromyelitis Optica Spectrum Disorder (NMOSD).

73. Intensive Care Unit in a Tertiary Care Center – A Retrospective Study
S Anita, Preeti Banerjee, Swetha Mude, Priyadarshini
Abstract
Introduction: The characteristics of these patients admitted to intensive care unit (ICU) including the sociodemographic factors are useful in better management of these patients in future. Also, the admission of the obstetric patient to ICU and their outcome is an indirect indicator of health care status of a country. Aims: To find out the booked and referral, indications, Maternal and fetal outcome among the cases in the maternal ICU. Materials and Methods: It is a Retrospective observational study in all pregnant women who were admitted in obstetric critical care unit in a government Tertiary care centre. All women who were admitted in obstetric critical care either due to obstetric complications or any other systemic comorbidities during the pregnancy are included in study.Results: In our study, total of 1500 patients were admitted in the maternal ICU 61 of whom were cases of ectopic pregnancy 5 with severe thrombocytopenia, 6 were acute fatty liver of pregnancy. 22 patients died and 37 patients were maternal near miss. Out of 22 maternal deaths. It was found statistically significant that as the time to reach the hospital increased the maternal mortality and morbidity increased. 316 patients were less than 20 years of age, among whom 17 were near miss and 12 died, in between 20 to 35 years of age 870 were admitted out of whom 7 were near miss and 5 deaths. Statistical significance was not found in between parity and maternal mortality. 857 who were admitted in MICU, were singleton pregnancies, out of whom 31 were near miss and 19 deaths, 375 were twin pregnancies. 986 patients needed <2 weeks of hospital stay,368 patients had hospital stay in between 2 to 4 weeks, 146 patients had to stay beyond 4 weeks. Out of 1235 antenatal cases that were admitted in MICU, 432 patients had vaginal delivery, 223 had hysterotomy and 580 had LSCS. It was statistically significant that as the weight of the babies increased, the number of deaths were reduced. Conclusions: It was found that highest mortality was found with acute fatty liver, IC Bleed, placenta accreata and PPCM and near term babies, weight of more than 2 kgs babies had better chances of survival. At the same time, pre term deliveries were found common in patients admitted in MICU.

74. Thyroid Dysfunction in Pregnancy: Impact on Maternal and Foetal Outcome
Laxmi M, S Swetha Reddy, Badugu Vijetha, Srujana Nandyala
Abstract
Aims To know the prevalence of Thyroid Disorders in antenatal women and abnormal Thyroid function on the maternal and foetal Outcome. Materials and Methods: The present study was conducted in Prathima institute of medical sciences, Karimnagar from November 2014 to October 2016. It is a prospective study included screening of 1000 pregnant women coming to routine antenatal check-up in first trimester. TSH level was estimated, If it is deranged, then FT3 & FT4 levels estimated. Patients were managed accordingly and followed till delivery. Their obstetric and perinatal outcomes were noted. Results: The prevalence of thyroid disorders in our study was 13% with a CI of 11.05- 15.23%.The prevalence of subclinical hypothyroidism in our study was 7.1%. The prevalence of overt hypothyroidism in our study was 3.6%. The prevalence of subclinical and overt hyperthyroidism in our study was 1.9% & 0.4% respectively. In our study, subclinical hypothyroidism was associated with complications like Pre-eclampsia (14.1%), Abruptio placenta (4.2%), Preterm delivery (11.2%), Abortions (4.2%), Anaemia (35.2%), OLIGO (14.1%) IUGR (7%), Low birth weight (5.6%), still born (1.4%). Overt hypothyroidism was associated with complications like Pre-eclampsia (19.4%), Abruptio placenta (2.8%), Preterm delivery (13.9%), Abortions (11.1%), Anaemia (33.3%), OLIGO (16.7%), IUGR (11.1%), Low birth weight (11.1%), Still born (2.8%). Subclinical hyperthyroidism was associated with complications like Pre-eclampsia (10.5%), Preterm delivery (10.5%), Abortions (5.2%), Anaemia (31.6), OLIGO (21.05%), IUGR (10.5%), and Low birth weight (5.2%). Overt hyperthyroidism was associated with complications like Abortions (50%), Pre-eclampsia (25%), Anaemia (25%), Preterm delivery (25%), OLIGO (25%), IUGR (25%). The incidence of Anaemia was significantly high in subclinical hypo, overt hypo, and subclinical hyper and overt hyper groups. Prevalence of thyroid dysfunction was high in this study, with subclinical hypothyroidism in (7.1%) and overt hypothyroidism in (3.6%) women. Overt hyperthyroid were prone to have miscarriage (50%) which was significantly high. Conclusion: All women with thyroid disorders should be counselled about the importance of achieving euthyroidism before conception to avoid poor outcomes. In patients with ↑TSH and normal FT3, FT4 antibody testing for thyroid peroxidise (TPO) should be offered routinely. Early universal screening in first trimester will optimise fetal outcome.

75. Correlation of Anxiety & Depression Among Medical Students with the Use of Social Networking Sites
Sopan Sardesai, Vaibhav Chaturvedi, Aditya Shrivastava, Suvaran Sagar Bajpai
Abstract
Introduction: Social networking sites (SNS) can be defined as “a group of Internet-based applications that allow the creation and exchange of user-generated content.” In past decade, there is a rapid development of social networking. It has a huge effect on the way people interact with each other. In research conducted in 2015, adolescents are avid users of social networking sites, with approximately 71% of them using more than one online site, and Facebook was the most (41%) widely used SNS. SNSs are used for academic purposes. On the other hand, the unrestricted use of online SNS can cause internet addiction and dependence, sleep disorders, and depression. Aims & Objectives: (1) To determine the prevalence of anxiety in students. (2) To determine the prevalence of depression in students. (3) To determine the pattern of use of social networking sites among students. Material and Methods: A cross-sectional study was done among the medical students who enrolled in the college from 2017 to 2021 sessions in a medical college in Indore during the period of May–July 2022. The study tool used in the study is: 1. Becks Anxiety Inventory (BAI) 2 Becks Depression Inventory (BDI) 3 Structured Questionnaire. Results: The final analysis was performed with a filled-in questionnaire of 1000 medical students enrolled in college. More than half of the students were aged 17–25. Around half of students (51.7%) used SNS at least once an hour, while 37% used it at least four hours a day. Around 83.4% of the students accessed SNSs for at least 4 hours a day, and 52.0% of the students remained available on SNSs all day. About one-third of study participants (41.0%) often used SNS in the early morning or went to bed late at night to spend time in them, and another 42.6% did it sometimes. 68% of students were either not sure or expressed their inability to spend a day without SNSs. Two-fifths of the study participants had mild-to-moderate depression, and another 3.0% had severe depression. 63.0% had mild to moderate anxiety, and 8.8% had severe anxiety at the time of assessment.

76. Comparative Evaluation of Therapeutic Approaches for Liver Abscess Management: Catheter Drainage versus Needle Aspiration
Mritunjay Kumar, Satyendra Kumar, Rajesh Narayan
Abstract
Aim: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This was a single-center prospective comparative study conducted at Department of General Surgery for the duration of two years. A total of 70 patients were included in the study, divided into two groups, percutaneous needle aspiration (n=35) and pigtail catheter drainage (n=35). Results: In presenting study the age group of the patients ranged from the 20-68 years. Highest incidence (60%) was found in 30-39 years age group. In this study 62 patients were male and 8 patients were female. 63 patients were from rural and 7 were from urban population and the incidence of alcohol consumption was 74.28%. It was observed that fever was present in needle aspiration and catheter drainage 94% and 92% respectively. There was 100% anorexia, pain and tenderness in right upper quadrant and hypochondruim in needle aspiration and catheter drainage respectively. It was observed that leukocytosis was 80% and 100% in needle syringe and catheter drainage. The patients in PCD group showed earlier clinical improvement and 50% decrease in abscess cavity volume as compared to those who underwent PNA. However, there was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity. Conclusion: Percutaneous catheter drainage is considered a more favorable modality when compared to percutaneous needle aspiration, particularly in cases involving larger abscesses that exhibit partial liquefaction or contain thick pus.

77. Outcome Assessment of the Management of Fractures of Distal End Radius with Open Reduction and Internal Fixation using Volar Locking Compression Plate
Aditya Kumar, Rakesh Kumar
Abstract
Aim: The aim of the present study was to assess functional outcome of fractures of lower end radius treated with surgical management with locked compression plate (LCP) followed by early mobilization of wrist joint. Material & Methods: This study is a prospective, time-bound, hospital-based study that was conducted in Department of Orthopaedics between the duration of 12 months. The study included a total of 50 cases of distal end radius fractures that were operated with open reduction and internal fixation with volar Locking Compression Plate (volar LCP). The fractures were classified according to Frykmann classification and were followed up at regular intervals. Functional outcome was assessed using the Gartland and Werley demerit scoring at each follow up visit. Results: In the study, 26% were in 20 – 30 Years, 22% were in 31-40 years, 32% were in 41 – 50 Years and 20% were > 50 Years. Mean age of subjects was 40.5 ± 14.26 years. 46% were Female and 54% were male. 52% had injury in left and 48% had in right. In the study, mode of Injury in 32% was FOOH, 68 % was RTA. In the Study, Frykman/AO type I/A2 was 12%, II/A3 was 10%, III/B3 was 20%, IV/B2 was 10%, V/B3 was 16%, VI/C2 was 10% and VII/C2 was 22%. In the study, 52% got surgery done in 1 day, 32% in 2 days, 12% in 3days and 4% in 4 days. In the Study, 84% had follow-up after 6 months, 12% after 9 months and 4% after 12 months. In the study, Mean Palmar flexion (PF) was 71.67 ± 9.81, Dorsiflexion (DF) was 76.4 ± 10.02, Radial deviation (RD) was 14 ± 3.40, ulnar deviation (UD) was 22.6 ± 5.55, Supination was 81.49 ± 8.52, Pronation was 72.48±10.06 and G&W Score was 4.96 ± 3.14. In the Study, 4% had Arthritis and 4% had EPL Tendon rupture. Conclusion: Based on the findings of this study it may be concluded that, locking plate fixation for distal radius fractures provided favourable outcome in patients requiring operative intervention with early mobilization of wrist joint.

78. Evaluation of Cases of Surgical Jaundice Correlating Imaging Investigations and Operative Findings
Abhay Shanker, Sanjeeva Kumar Choudhary, Aditya Anand, Piyush Kumar
Abstract
Aim: The aim of the present study was to assess the clinical history and presentation of obstructive jaundice. Methods: The present study was conducted in the surgical wards of Department of Surgery, Mata Gujri Memorial Medical College & Lions Seva Kendra Hospital, Kishanganj, Bihar. The time period of the study was from October 2018 to August 2020. 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). For, benign causes of Jaundice CBD stones are the commonest. CBD stone were 33% of all cases (5 of CBD Stones out of 15 cases) in the study. In cases CBD Benign stricture – 2 cases out of 4 presented with cholangitis (50%). 23/26 patient of Benign causes of Jaundice were persistent in nature and 22/30 (73.3%) showed progressively increasing Jaundice. Conclusion: The diagnosis of Jaundice depends upon taking detailed clinical history and examination performing baseline investigations to confirm cholestatic jaundice and to use diagnostic tests as and when necessary to detect cause and level of Jaundice. A definite planned management protocol with attention to correct choice of investigations should be adopted in planning treatment of a patient of obstructive jaundice.

79. Evaluating the Role of TNF α –308 G/A Polymorphism and Thyroid Autoimmunity in Alopecia Areata in the Gujarat Population
Patel D, Vara N, Jadeja SD, Singh M, Begum R, Marfatia YS
Abstract
Background: The etiopathogenesis of alopecia areata (AA) remains unclear but the role of autoimmunity in genetically predisposed individuals is highly advocated. Polymorphisms in TNFα promoter have been broadly associated with susceptibility to various autoimmune disorders including AA. Objectives: To investigate the etiological factors in terms of (1) thyroid autoimmunity in AA and its correlation with disease severity (2) to compare the TNFα -308 G/A polymorphism in AA cases and controls, and to determine the association with disease severity & pattern. Materials and Method: A case-control study was conducted in the Skin-VD OPD of a medical college. Ninety cases of AA between 0-45 years and 150 healthy volunteers were included. Thyroid function test, anti-TPO antibodies and Polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) were done to genotype TNF-α gene. Results: Thyroid function abnormalities were found in 20(22.22%) cases and positive anti-TPO antibodies in 11(12.22%) cases with no statistically significant association with the severity of disease (p=0.65). Variant genotype (TNF A/G +TNF A/A) was detected in 26 (28.88%) AA cases and 30 (20%) controls with no statistically significant difference. There was no significant association between TNFα -308 G/A polymorphism and the disease severity or pattern (p=0.28). Conclusion: The incidence of thyroid function abnormalities in AA is higher in our study as compared to previous reports with no significant relevance to disease severity. TNFα -308 gene polymorphism is not a marker for the risk of developing AA and it is not significantly associated with disease severity and pattern of AA.

80. A Hospital Based Study to Assess the Prognostic Implications of Admission Hyperglycemia in Non-Diabetic Acute Myocardial Infarction Patients
Vijay Gadhia, Darshankumar Parmar, Sanket G. Makwana
Abstract
Aim: The aim of the present study was to assess the prognostic implications of admission hyperglycemia in non-diabetic acute myocardial infarction patients. Methods: The study was conducted on 100 non diabetic STEMI patients admitted in Jeevandeep Hospital, Gujarat, India. The study was conducted on 100 non diabetic STEMI patients admitted in Jeevandeep Hospital, morbi, Gujarat, India for the period of one year. There were 50 patients in group I and 50 patients in group II. Results: There were total 58 males and 42 females in the study. Group I had 20 females and 30 males. Group II had 22 females and 28 males. There was no significant difference between the number of males and females in two groups (p= 0.850). The mean age of patients in Group I and Group II were 63.47 ± 12.28 and 62.16 ± 11.36 respectively. Median age in group I and group II were 65 and 62 years respectively. There was no significant difference in patients’ mean age in between the groups (p= 0.612). There were total 22 (22%) smokers in the study of which 11 were in group I and 10 in group II. History of smoking was present in 22% and 20% of patients of Group I and Group II respectively. There was no significant difference in number of smokers in between the two groups (p= 0.314). There were total of 30 patients with history of alcohol consumption in the study. Group I and Group II, both had 15 patients and there was no significant difference in number of patients with history of alcohol consumption between the two groups. The history of hypertension was present in 28 patients out of which 12 patients were in Group I and 16 patients in Group II. There was no statistically significant difference in number of hypertensives between the two groups. Mean heart rate, systolic blood pressure and diastolic blood pressure between the two groups. There was a statistically significant difference in heart rate, SBP and DBP between the two groups. Conclusion: Hyperglycemia at admission in non-diabetic patients of acute ST elevation myocardial infarction is strongly associated with higher in hospital complications like cardiogenic shock, arrhythmias and AV block.

81. A Hospital-Based Observational Assessment of Pathological Jaundice in Late Preterm Neonates
Kumar Arpit, Rizwan Akhtar, Alka Singh
Abstract
Aim: The aim of the present study was to determine the incidence, progression and the predictors of pathological jaundice among the late preterm infants admitted in Paediatrics ward of a tertiary care centre. Material & Methods: A hospital based prospective cohort study was carried out in Department of Pediatrics for the period of two years, Sample size was 200 based on consecutive sampling. Results: In the present study, 70% were male and 30% were female. Of them, 45%, 43% and 12% were 36, 35 and 34 gestational weeks respectively. Their mean birth weight was 2307.3 grams while the median birth weight was 2500 grams with a minimum of 1300 grams and a maximum of 3400 grams. Majority (42%) of the neonates were of B+ve blood group followed by A +ve (23%), while O +ve and AB +ve blood groups were noted in 20% and 15% respectively. Majority of the neonates (60%) were exclusively breast fed. 18.0% and 22% were formula fed and mixed fed respectively. Pathological jaundice developed among 68% neonates. Pathological jaundice was higher among the neonates who were delivered at 34 weeks of gestation when compared to others but it was not found to be statistically significant (p=0.105). Pathological jaundice was found to be higher among the neonates who were exclusively breast fed (76.66%) when compared to formula feeding (61.11%) and mixed feeding (50%) but it was found to be statistically significant (p=0.048). Conclusion: Jaundice is condition that is often present and constitutes one of the major risks for neurodevelopmental issues in later life and the risk is further compounded by prematurity. Hence further studies with a larger sample size on a multicentric level could add robustness to our study thereby helping in better understanding and management of the condition.

82. A Hospital Based Clinical Study Determining the Effect of Adding Dexmedetomidine and Fentanyl to Levobupivacaine in Subarachnoid Block for LSCS on the Outcome of the Patient
Sumit Kumar Singh, Priyanka Awasthi, Anshu Kumari
Abstract
Aim: The aim of the present study was to determine the effect of adding dexmedetomidine and fentanyl to levobupivacaine in subarachnoid block for LSCS on the outcome of the patient. Methods: This comparative study was carried out in the Department of Anesthesiology for duration of six months and consisted of 150 patients. Patients were divided into three equal groups group I, group II and group III. Patients’ detailed demographics were recorded after taken written consent. Results: The mean age of the patients in group I was 28.42 ± 6.54 years with BMI 23.17±8.32, mean age in group II was 27.33 ±7.53 years with BMI 24.46 ± 6.14 and in group III mean age was 26.94 ±9.51 years with BMI 24.76 ±4.36. Patents arterial pressure and heart beat per minute recorded. In Group III and II (5.15±2.38 min, 6.04±5.16 min), the maximum in Group I (8.02± 2.18 min) time needed for the highest level of sensory block was the shortest gap between three categories (p < 0.001). Bromage Scale 3 was averaged in a similar way, less in Group III (2.88 ±1.52) and statistically significant across the three groups (p < 0.001). The time needed for sensory regression to level S1 (sensory block duration) in Group II was maximum (501.05 ± 14.38 min) and high between groups of three (p< 003). The time gap needed in Group II (403.37 ±10.05 min) and Group I (300.06±4.46 min) for the first analgesic requirement was highly important (p < 0.001) and the most significant. Frequency of side effects (Hypotension, Nausea/Vomiting, Respiratory depression) Shivering were also observed between the patients of these three groups. Conclusion: We concluded that for an adjuvant of 0.5percent isobaric levobupivalacaine, Intrathecal dexmedetomidine induces both prolonged motor blockage and post operative analgesia than fentanyl.

83. A Prospective Assessment of the Effect of Room Temperature & Refrigerated Storage on Complete Blood Counts and on Morphological Features in Peripheral Blood Smear on Automated Haematological Parameters
Manish Kumar Jha, Sunil Kumar, Richa Sharma, Poonam Kumari
Abstract
Aim: The aim of the present study to assess the effect of room temperature & refrigerated storage on complete blood counts and on morphological features in peripheral blood smear on automated haematological parameters. Methods: A prospective study was conducted at Department of Pathology, Darbhanga medical College and Hospital, Darbhanga, Bihar, India in between the duration of one year. Total 100 blood samples from outpatient & inpatient section irrespective of any specific criteria, age & gender were collected randomly. Results: We observed that there was statistical significance (P values < 0.05) in WBC counts in blood samples stored at room temperature. Degranulation, increased granularity in neutrophils, vacuolization & bleb formation in cytoplasm & lobulation, pyknosis, smudging & vacuoles in nucleus are morphological changes seen WBC in stored blood samples at room temperature. The P values are not < 0.05 i.e no statistical significance in variation of haemoglobin values & RBC counts stored at room temperature for 24 hrs. However, some morphological artifacts in RBCs such as crenated RBCs & loss of central pallor revealed with stored sample at room temperature. While, P value < 0.05 i.e statistical significant changes seen in platelet counts in room temperature storage of blood & also shows morphological changes like aggregation of platelets & large platelets. Conclusion: Blood samples stored at room temperature for 24 hrs results in changes in haematological parameters & morphology of cells. Hence, refrigerated storage at 4◦C is recommended for accurate results in case evaluation of delayed samples.

84. A Study to Evaluate the Clinical and Laboratory Characteristics of Typhoid Fever in Newborns and Children with a Potential Focus on Gender Difference: An Observational Study
Manish Ranjan, Arvind Kumar Yadav, Kripa Nath Mishra
Abstract
Aim: The aim of the present study was to assess the clinical and laboratory profile of typhoid fever in infants and children with possible gender differentiation. Methods: The present study was a hospital-based, prospective and a cross-sectional study that was carried out at Department of Pediatrics on 200 subjects that were selected using purposive sampling technique. Results: The majority of the patients fell between the age range of 5-15 years, accounting for 68% of the total population. This was followed by the age group of 1-5 years, which constituted 26% of the sample. The signs and symptoms of typhoid fever were examined based on age. The symptoms of headache, anorexia, and irritability demonstrated statistical significance in relation to typhoid fever (p<0.05). The indicators most often seen in the study population were abdominal distention, splenomegaly, and hepatomegaly. The presence of a coated tongue was seen only within the age range of 5 to 15 years. There was an absence of rose markings in all of the instances. Upon doing a study of the signs based on age, it was seen that there were no statistically significant variations in the occurrence rates of any indications among the three age cohorts. Four instances within the age range of 5-15 exhibited the presence of relative bradycardia, whereas its absence was seen in the other age groups. Anaemia was detected in a total of 116 individuals, constituting 58% of the sample population. Mean hemoglobin percentage of all cases involved in the study was 10.7% with SD of 1.5. Conclusion: Typhoid fever is a significant public health issue mostly impacting those in the school-age demographic. Public health interventions include many strategies aimed at promoting and safeguarding the well-being of populations. These measures encompass the supply of potable water, adequate sanitation facilities, dissemination of knowledge on diseases and their transmission, and promotion of optimal hygiene practices.

85. Institutional Based Cross-Sectional Study Assessing Knowledge and Practice of Nurses towards Prevention and Care of Pressure Ulcer and Associated Factors
Ratnesh Kumar, Pranav Kumar, Rajeev Ranjan Sinha
Abstract
Aim: The aim of the present study was to assess knowledge, practice and factors associated with pressure ulcer prevention among nurses in India. Methods: An institutional based cross-sectional study was conducted among nurses working in Hospital . The sample size was 200. Since the total number of nurses working in the hospital was 225, the study involved all of them to increase the power of the study. Results: All the nurses in the study were female. 70% were married and 52% belonged to 26-30 years. 80% had GNM diploma and 45% had 1-5 years of experiences. Nurses have poor knowledge regarding risk factors of pressure ulcer development, patient’s position every two hourly, knowledge about the use of the risk assessment scale fore pressure ulcers, in order to give pressure ulcer prevention education to patient’s and caregivers. Nurse’s job experience has a significant association with their practices and knowledge toward pressure ulcer prevention. Nurses overall knowledge and practices toward pressure ulcer are poor. The mean knowledge score of the nurses calculated to be 9.54 +_3.28 and the mean practice score was 5.25+_ 5.42. Conclusion: Nurses’ knowledge and practice regarding prevention of pressure ulcer was found to be inadequate. Having higher educational status, attending formal training, being more experienced showed a positive and significant association with knowledge; whereas inadequate facilities and equipments, dissatisfaction with the nursing leader- ship and staff shortage and were found to be associated with poor practice of pressure ulcer prevention.

86. Assessment of the Outcomes of Paediatric Femur Diaphyseal Fracture Treated with Locking Compression Plate: An Observational Study
Rupesh Kumar, Anjana, Shashikant Singh
Abstract
Aim: The aim of the present study was to evaluate the functional and radiological outcomes of paediatric femur diaphyseal fracture treated with locking compression plate. Material & Methods: The clinical, radiological and functional results of Submuscular plating were evaluated in 100 patients operated in between the duration of 24 months for fracture shaft humerus, shaft of femur and shaft of tibia. All the surgeries were carried out by a single surgical team at Department of orthopaedics. Results: Among the study group, 70 were males, and 30 were females. There was a male preponderance. The youngest age among patients was six years old and the oldest age was 14 years old. The average age was 10.60 (2.08) years. Right side fractures 55 (55%) were more compared to left side fractures 45 (45%). Considering the mode of injury, road traffic accident accounted for 57%, other injuries like fall during playing sports were seen in 17%, fall from height accounted for 9%. For types of fractures, 35 (35%) fractures were transverse, 25 (25%) fractures were comminuted, 31 (31%) fractures were oblique, and 9 (9%) fractures were spiral. In our study, the average union time in group one was 10.5 weeks. Early complications in the form of superficial infection were in 4 patients. Late complications in the form of thigh pain in 10 patients. Cases of knee stiffness and delayed union were in 6 patients each. The functional outcomes were evaluated and 92 (92%) were excellent, 6 (6%) were satisfactory and 2 (2%) were poor. Conclusion: Once properly planned and executed correctly the submuscular plating for diaphyseal long bone fractures is one of the reliable treatment modality. It is minimally invasive technique that allows early mobilization with satisfactory radiological and functional outcome with minimal complications.

87. An Observational Study to Assess the Total Leukocyte Count (TLC) and CRP in Diagnosis of Acute Appendicitis
Balkeshwar Kumar Suman, Santosh Kumar, Shri Krishna Ranjan
Abstract
Aim: The aim of the present study was to check the sensitivity and specificity of total leukocyte count in diagnosis of acute appendicitis and to check the sensitivity and specificity of CRP in diagnosis of acute appendicitis and to determine TLC and CRP efficacy in diagnosis of acute appendicitis. Methods: The study was conducted in Department of General Surgery. The data was studied for the period of 3 years. A total number of 100 cases were taken diagnosed as acute appendicitis. Results: 30 (30%) were female and 70 (70%) were male. Patient’s age group ranged from 14 years to 59 years. Maximum group of patients belonged to 21-30 years (25 patients i.e., 35%). Group A had inflamed appendix (75%) and the negative appendicectomy rate in this study is 25% (25) Group B. Distribution of cases by histopathology correlation in sex Group A 52 males and 23 females had inflamed appendix. Group B 18 males and 7 females had normal appendix. Among 75 Inflamed appendix cases, CRP was found to be raised in 60 cases and normal in 15 cases. Among 25 normal appendix cases, CRP was found to be raised in 7 cases and normal in 18 cases. Among 75 inflamed appendix cases, TLC was found to be raised in 59 cases and normal in 16 cases. Among 25 normal appendix cases, CRP was found to be raised in 10 cases and normal in 15 cases. Conclusion: TLC and CRP are useful in diagnosis of acute appendicitis. Appendicitis is common in adult and children. In the present study association of CRP and acute appendicitis has shown to be significant, but it cannot replace surgeon’s clinical acumen.

88. A Comparative Study of Stoppa’s Repair versus Lichtenstein Technique for Surgical Management of Bilateral Inguinal Hernia
Sumit Sharma, Chillington Nonghuloo, Dankhara Nitinkumar Harjibhai
Abstract
Aim: The aim of the present study was to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair. Methods: Majority of the patients were males (M/F-group 1: 20/5; group 2: 21/4). Other preoperative variables-age, BMI, comorbidities, and smoking-did not show a statistically significant difference between the two groups. Results: The operative time was significantly shorter in group 2 patients (44.36±7.23 min), whereas it was 76.44±8.52 min in group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. In terms of postoperative complications, postoperative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups. Conclusion: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable post-operative outcomes and had similar problems. The majority of the patients were receptive to both approaches. The time it took for all groups to return to normal activity and work without pain was longer in Lichtenstein hernia repair most likely because the hernia procedures were bilateral.

89. Descriptive-Analytical Study to Evaluate Basic Needs and Related Factors in Parents of Children with Down Syndrome
Shruti, Arunika Prakash, Manoj Kumar Singh, Bhupendra Narain
Abstract
Aim: The aim of the present study was to examine the needs of the parents with issues related to living with a child with Down syndrome as well as the factors. Methods: This cross-sectional descriptive- analytical study was conducted on the families of children with Down syndrome at Upgraded Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India for 12 months and 200 individuals were selected in the study. Results: Among 200 participating parents, 104 (52%) were women, 184 (92%) were married (parents lived together), 50 (25%) had university education, 90 (45%) were employed, 16 (8%) had income of Rs >30,000 and 76 (38%) had 3 or more children. The highest average score was related to the need for freedom and the lowest average score was related to the need for power. There was a statistically significant difference between the scores of the parents of children with Down syndrome in Glasser’s basic needs scale (P<0.001). A statistically significant difference was observed between the scores of the need for power according to the educational level of the parents and a statistically significant difference was also observed between the scores of the need for power according to the level of the parents’ income. Conclusion: The findings of this study provide support for previous research that shows families having fewer demands and receiving higher levels of social support function better than individuals facing multiple demands and receiving limited social support. Compared to previous results, raising older children with Down syndrome is positively related to family functioning. This suggests that families may adapt over time.

90. Evaluation of the Role of CRP and Gastric Aspirate Polymorphs in Early Onset Neonatal Sepsis: An Observational Study
Vinay Kumar Yadav, Hemant Kumar, A. K. Jaiswal
Abstract
Aim: The aim of the present study was to evaluate the role of C-reactive protein and gastric aspirate polymorphs in early onset neonatal sepsis. Methods: This was a prospective observational study conducted in the Upgraded Department of Pediatrics, 100 babies who had clinical symptoms and signs of suspected neonatal sepsis/high risk factors for developing the sepsis, were included in the study. Results: Only 25 patients had TLC more than 25000 /dl. Maximum TLC value in the study was 42500 /dl. 70 patients showed positive CRP values. 65 patients had polymorphs in the GA more than 5 per high power field. By combination of any CRP and TLC specificity increased to 82%. While sensitivity approached to 100% when TLC with GA polymorphs and CRP with GA polymorphs were combined with significant p values of 0.001 and 0.015 respectively. When all the three parameters were combined together, both the sensitivity and specificity increased to 100% and 92.68% respectively with p values of 0.001. Conclusion: CRP showed high sensitivity while GA polymorphs showed high specificity. GA cytology as a screening tool for neonatal sepsis with intermediate sensitivity, specificity, positive predictive value and negative predictive values serves as good tool, added to a detailed antenatal history and clinical examination of the neonate.

91. Evaluation of the Indication and Outcome of Different Surgical Management Modalities in Local Complications of Acute Pancreatitis: Hospital Based Study
Sandeep Yadav , Madhu Priya
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 .50 patients required surgical intervention due to failure of endoscopic or radiological intervention or positions of lesions being inaccessible to these techniques. Results: Out of 50 patients, 54% were males. 50% had ethanol etiology and 34% 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 (20%). Conclusion: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

92.Hospital Based Observational Assessment of the Midshaft Clavicle Fracture Treated with Precontoured Locking Compression Plate
Mani Bhushan Prasad Singh
Abstract
Aim: The aim of the present study was to assess the midshaft clavicle fracture treated with precontoured locking compression plate. Methods: This study was prospective and observational study, conducted in Department of Orthopaedic for the period of 2 years. During study period 50 midshaft clavicle fractures were treated with precontoured locking compression plate at our hospital. Results: Mean age was 44.26 ± 12.58 years, majority were male (80%), had road traffic accident (82%) and unilateral clavicle fracture (96%). In present study, mean operation time was 44.36 ± 13.67 minutes and return to activity was noted in 7.73 ± 4.46 weeks. Complications noted were Dysthesia (6%), Wound dehiscence (4%) and Painful shoulder (8%). Majority fractures were healed at 12 weeks (52%), only 6 fractures (18%) required 14 weeks for healing. At 1 year follow-up, excellent Constant score was noted in 84% patients. Conclusion: Use of precontoured locking compression plates in unstable displaced comminuted fractures in middle third of clavicle give fracture stability, early union, allows early mobility and there by prevents shoulder stiffness and without motion limitation.

93. Comparative Evaluation between Stapled Haemorrhoidopexy and Open Haemorrhoidectomy in Patients with Grade II & Grade III Haemorrhoids: A Prospective Study
Rakesh Rawat, Meenakshi Singhal, Tuhin Ghulyani
Abstract
Background: Hemorrhoids are one of the most common anorectal conditions hampering day to day life of an individual. Stapled hemorrhoidectomy has been shown to be a better alternative to open hemorrhoidectomy with lesser postoperative pain & early resumption of daily activities. Aims & Objectives: To compare open hemorrhoidectomy and stapled hemorrhoidectomy in the surgical management of grade II & grade III hemorrhoids. Material & Methods: This prospective study recruited 70 (20-70 yrs ) patients with grade II and III haemorrhoids, undergoing either open or stapled haemorrhoidectomy. A detailed history taking, local & systemic examinations were conducted & the patients were randomized into two groups: Group O – Patients undergoing open haemorrhoids surgery (n= 35); Group S – Patients undergoing stapled haemorrhoids surgery(n=35). The parameters assessed were the duration of surgery, Intra-operative bleeding, post-op pain using Visual analogue scale, post-op complication – bleeding, urinary retention and anal incontinence, duration of post-op stay at the hospital. Results: The operating time, intraoperative bleeding, and postoperative pain Scores were statistically significantly higher in Group O as compared to Group S (p<0.05). Two patients in Group O & one in Group S experienced postoperative bleeding, which was managed by inj. tranexa i.v. 8 hourly. Postoperative urinary retention was observed in 4% of patients in Group O and 11% in Group S and was catheterized if needed. Faster resumption of daily activity with a lesser number of hospitalization days was observed in Group S as compared to Group O (p<0.05). Conclusion: Stapled hemorrhoidectomy offers promising results over open hemorrhoidectomy with less postoperative pain, reduced hospital stay& faster resumption of daily activity.

94. An Observational Assessment of the Role of Colposcopy and Paps Smear in Cervical Carcinoma Screening
Swati
Abstract
Aim: The aim of the present study was to evaluate screening of cervical carcinoma by paps smear and colposcopy. Methods: This study was conducted in Department of Obstetrics and Gynecology for the period of 6 months. The study constituted 100 women as subjects who attended the Gynecology OPD as well as ones admitted in gynecology ward at hospital fulfilling the inclusion and exclusion criteria. Results: Among 100 patients, 19% belongs to age group of 20-30 years, 52% among 31-40 years, 15% among 41-50 years, 14% among 51-60 years age group. The maximum cases belong to 31-40 years age group with mean age 36.04 years. According to Modified Kuppu-swamy classification, 56% of women were of Upper-lower class, 24% were of Lower-middle class and 20% were of Lower class. Significant differences noted between different classifications and age at 1st coitus, therefore, premalignant lesions are commonly associated with 1st coital history at an early age of life. On colposcopy examination, most of the cases show neoplastic proliferation (58 cases, 58%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). 46 cases (46%) were non-neoplastic. Conclusion: Colposcopy and pap smear test is widely accepted screening method. These are cost-effective non-invasive test for early detection of cervical malignancy and may be practiced in rural areas effectively. These may be highly effective to reduce the mortality and morbidity from cervical malignancy.

95. A Hospital-Based Study to Assess the Orthopaedic Management of Club Foot: Observational Research
Rajeev Kumar Rajak, Barun Kumar Golwara, Randhir Kumar
Abstract
Aim: The aim of the present study was to assess the orthopaedic management of club foot at tertiary health care centre. Methods: This was cross-sectional study carried out in the Department of Orthopaedics with idiopathic club foot less than one year age presented to the Orthopaedics Department during the four-years were included into the study. In the four-years period there were 100 patients after written explained consent were enrolled to study. All necessary details of the patients were noted like age, sex, pre interventions modified Pirani score noted. Results: The majority of the patients were in the age group of 0-3 (months) were 42%, followed by 3-6 were 32%, 6-9 were 16%, 9-12 were 10%. The majority of the patients were Female i.e. 60% and Male were 40%. In all the age groups the Post treatment Pirani score significantly differed as compared to pre-treatment score i.e. 0-3 were 5.32 ±2.18 and 1.55 ± 1.035 (t=8.82,df=72,p<0.01); 3-6 were 5.48± 0.82 and 1.58 ± 1.32 (t=12.58,df=56,p<0.001); 6-9 were 5.75 ± 2.15 and 2.18±0.96 (t=9.91df=26,p<0.05); 9-12 were 5.36 ± 1.24 and 1.86 ± 1.34 (t=10.20,df=24,p<0.001) were statistically significant. Conclusion: According to the results of our investigation, the ponsetti approach was very efficient in the management of idiopathic club foot, as measured by the Pirani score for club foot assessment almost all the patients were doing well with this treatment.

96. Clinical Profile and Outcome of First Cases of COVID-19 Patients Admitted at a Tertiary Care COVID Center in The South-eastern Region of Rajasthan
Rahul Chandel, Tuhin Ghulyani, Rakesh Rawat, Om Prakash Meena
Abstract
Background: The coronavirus disease 2019 also known as COVID-2019 is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus outbreak was first identified in Wuhan, China in December 2019. Aim: To report the clinical spectrum, laboratory findings, and outcome in the first cases of COVID-19 patients admitted patients at a tertiary COVID center in Kota, Rajasthan. Materials and Method: This was a prospective study over two months from April to May 2020, comprising a cohort of 95 patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) report for COVID-2019 infection and admitted at the hospital. Data was collected from 95 patients during the period from admission to discharge from the hospital. Results: In the group of 95 patients, 63 (66.3 %) were males and 32 (33.7%) were females with a mean age of 32.3 ± 13.1 and 31.4 ± 16.4 years, respectively. At the time of admission 71 (74.7%) patients were asymptomatic and common symptoms observed were cough (16.8%), sore throat (13.7%), fever (11.6%), and shortness of breath (3.2%) respectively. Important observations in laboratory investigations data were thrombocytopenia (n=24, 25.3%), leukopenia (n=23, 24.2%); in chest skiagrams 70 (73.7%) patients had bilateral lesions, zones affected were lower zone (n=43, 45.3%), combined middle & lower (n=22, 23.2%). High-flow nasal oxygen was required in seven cases. Azithromycin and hydroxychloroquine were administered to all patients. Ritonavir & lopinavir were given to 3 moderately severe cases. No mortality occurred in the cohort. Conclusion: The worldwide pandemic COVID-2019 has affected people in the Kota and Jhalawar districts of Rajasthan and an increasing number of patients were admitted to hospital. In this study, the population predominantly had mild symptoms and all recovered. Chest X-ray findings were usually abnormal even in asymptomatic and mild disease cases. There is a need to develop an effective vaccine & drugs. Preventive measures should be followed sincerely till the end of this pandemic.

97. A Comparative Study of Onlay versus Retrorectus Mesh Placement in Incisional Hernia Repair
Rakesh Rawat, Varsha Porwal, Tuhin Ghulyani
Abstract
Background: The incisional hernias are an iatrogenic complication, which has always been a challenge to the surgeons with respect to complications & recurrences. Various surgical techniques are in practice with data supporting the placement of retro‑rectus mesh repair over onlay mesh repair. Aims & Objectives: To evaluate & compare the efficacy of onlay mesh repair and retrorectus mesh placement for repair of incisional hernia. Material & Methods: In this prospective study 60 recruited patients with midline hernias up to 10 cm in diameter, who were admitted to the General surgery department of our tertiary care hospital from November 2021 till August 2023. The socio-demographic details & complete history taken & investigations carried out. Patients were randomized into two groups. Group A – patients who had undergone traditional on‑lay mesh repair (n=30); Group B – included patients who had undergone retro‑rectus mesh repair (n=30). Patients underwent either traditional on‑lay mesh repair or retro‑rectus mesh repair according to their groups. Surgery was completed in both groups. Parameters recorded were operating time, postoperative pain scores at 2, 5, and 7 days, Complications, and wound infection if present. Sutures were removed on the 14th post‑operative day & patients were discharged on the 15th post‑operative day if no complications were present. Follows were scheduled at 1 month, 3 months & 6 months. Results: The operative time was more for Group A patients as compared to Group B (p<0.05). In Group A, the postoperative pain scores on days 2, 5 & 7 were 7.21±0.57, 5.33±0.85 & 2.31±0.75. For Group B, the postoperative pain scores on days 2, 5 & 7 were 6.26±0.28, 4.06±0.339 & 1.42±0.84. The post-operative pain scores showed statistically significant higher values for Group A patients than for Group B(p<0.05). The complications in Group A were seroma, deep surgical site infection, mesh removal & recurrence which were statistically significantly higher than Group B(p<0.05). Conclusion: Retrorectus Mesh Repair is a technique-sensitive procedure with the advantage of reducing the recurrence rate and surgical site infection as compared to onlay mesh repair.

98. An Observational Study to Evaluate the Trigger Tool Method (TTM) in Detection, Monitoring, and Reporting of Adverse Drug Reactions (ADRS)
Krishna Kant Nirala, Rohit Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the trigger tool method (TTM) in detection, monitoring, and reporting of adverse drug reactions (ADRs). Methods: This prospective, continuous, single‑center study was conducted in the Department of Pharmacology of ANMMCH, Gaya, Bihar, India in two phases over 15 months. Phase I (6 months) of the study was observational, whereas Phase II (9 months) was interventional. Results: A total of 350 patients were admitted during the Phase I (6 months) of which 200 patients, who met with the inclusion criteria were included. The mean age of patients was 44.36 ± 18.02 years, and mean length of hospital stay was 4.26 ± 3.27 days. Of 55 triggers (PTTL), a total of 34 triggers were found in 100 patients. DT (140 times) was the most commonly observed triggers followed by LT (100 times) and PT (50 times). It was apparent that more than one trigger was associated with a single ADR. It was further observed that patients in whom more than five triggers were present showed >30% “yield” in terms of detection of an ADR. Among positive triggers, nine DT were detected 65 times. While three PT, one ST, and one LT were detected 24 times, 16 times, and 1 time, respectively. Conclusion: The reporting system is operational at the study site and ADRs are being reported using a standard form. Patients recovering from the reactions following the withdrawal of the suspected drug, and the majority of ADRs were mild. TTM can be used as an add‑on tool to existing methods like spontaneous method for the health‑care professionals for better detection of ADRs in the pharmacovigilance program. However, further research is required to explore the feasibility and acceptability of TTM.

99. A Study to Assess the Electrocardiographic Changes in the COPD Patients and its Correlation with the Severity of Disease
Rajneesh Kumar, Abu Huraira, Himanshu Kumar, Hemant Narayan Ray
Abstract
Aim: The aim of the present study was to assess the electrocardiographic changes in the COPD patients and to correlate Electrocardiographic changes with the severity of disease. Methods: This hospital based cross sectional study was conducted at department of cardiology among patients of COPD who presents to our hospital during study period. Duration of study was 18 months. The present study included a total of 100 cases of COPD coming to our hospital during study period. Results: Male predominance was seen in the study group with 70% males to 30% females. A total of 58% cases were still smoking while 32% cases quit smoking after diagnosis of COPD. Out of the total 100 cases, 51% had mild symptoms, 36% had moderate symptoms while 13% had severe symptoms as per GOLD criteria. Severity assessment as per CAT scale showed 64% as low risk i.e. grade A and B while 32% were at high risk i.e., grade C and D. Most common ECG abnormality was arrhythmia among COPD cases (45%) followed by RAD – P wave (46.5%) and p-pulmonale (31%). Most common type of arrhythmia among COPD cases were sinus tachycardia (28%) followed by right bundle branch block (12%). Atrial fibrillation was seen in 1% cases. Gender distribution was comparable among cases with and without ECG changes (p-0.160). A significant association was observed between ECG changes in COPD cases with its severity. Prevalence of ECG changes increases from 37.5% in CAT grade A to 100% in grade D (p<0.01). Conclusion: COPD is more common in males and in the 5th and 6th decade of life. Most of the patients have mild to moderate disease at presentation. ECG abnormalities were common in cases of COPD, affecting seven out of ten cases and have a significant association with COPD and symptoms severity. The most common electrocardiographic abnormality seen was arrhythmias.

100. A Hospital Based Study to Assess the Effect of Radiotherapy on Minimizing Acute Rejection and Enhancing Wound Healing in Children with Deep Burns: An Observational Study
Setubandhu Tiwary, C. M. Narayan
Abstract
Aim: The aim of the present study was to assess the effect of radiotherapy on minimizing acute rejection and enhancing wound healing in children with deep burns. Methods: We conducted this prospective randomized controlled trial on 50 children (age: below 12 years) who were admitted to our burn unit for the period of 12 months. On admission, the total body surface area of the burn was calculated using Lund and Browder’s chart, and the patients received resuscitation treatment, including airway securing, fluid replacement, warming, and supportive medication, until their general condition stabilized. Results: Group 1 consisted of 25 patients (10 females and 15 males) with a mean age of 8.32 years (range: 1–12 years) and a mean percentage of burns of 33.3%. Group 2 included 25 patients (7 females and 18 males) with a mean age of 9.5 years (range: 2–12 years) and a mean percentage of burns of 28%. The mean values of the laboratory parameters (ESR, CRP, IL-6, and TNF) for all burn patients in the study showed a significant difference, with p  < 0.001. This finding demonstrates a significant decrease in values for graft radiotherapy, indicating minimal inflammatory and immune reactions. We found a difference in hospital stay duration between groups 1 and 2, with a mean of 32.4 and 22.0 days, respectively. Irradiation reduces immune reactions and the possibility of eschar tissue formation, resulting in the acceleration of wound epithelialization which reduces hospital stay duration and morbidity. Conclusion: The exposure of skin homografts from related living donors to a local low dose of radiotherapy can reduce a graft’s ability to initiate inflammatory and immunological reactions, thereby minimizing rejection of a graft and enhancing epithelialization in children with deep second- and third-degree burns.

101. Prevalence of Suspected COVID-19 Cases in a Tertiary Healthcare Centre of Bihar, India and its Association with Selected Demographic Factors and Vaccination Status
Madhu Priya, Sandeep Yadav, Alok Pritam, Nipendra Anand, Randhir Kumar
Abstract
COVID-19 is a global issue and has been declared as pandemic by world health organization. The third COVID-19 wave, fueled by the new variant Omicron spread in India towards the end of 2021. This hospital based study was conducted among the patients attending flu clinic established during third wave of COVID-19 in NSMCH, Bihta over a period of two months to assess the prevalence of suspected cases of COVID-19 based on WHO clinical criteria for suspected cases. Out of 683 respondents, 362 (53%) were suspected COVID-19 cases and 321(47%) cases were not suspected cases. Out of 362 suspected cases, 244() were from age group 18-50 years, 60.5% were female, 80.1% were rural residents, 56.4% were employed and only 26.5% were vaccinated. There existed significant association between prevalence of suspected cases and age group, place of residence, employment status and vaccination status of suspected COVID-19 cases. This study revealed that socio-demographic factors and vaccination status of subjects had an important impact on prevalence of suspected COVID-19 cases. Early identification of the suspected cases of COVID-19 is of utmost importance to reduce the invasion of the virus and to reduce the morbidity and mortality caused by the virus.

102. Safety and Effectiveness of Subtenon’s Anesthesia versus Peribulbar Anesthesia in Small Incision Cataract Surgeries: A Comparative Study
Abhishek Kumar, Shilpi Agrawal
Abstract
Aim: The present study was conducted to compare the safety and effectiveness of subtenon’s anesthesia versus peribulbar anesthesia in small incision cataract surgeries. Methods: A prospective longitudinal study was conducted among 100 patients who attended Ophthalmology OPD of Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for cataract surgery. Informed consent was taken from the patients. Patients of both sexes opting for SICS were enrolled in our study. Results: In subtenon’s group out of 50 patients 16 (32%) were males, 34 (68%) were females. In peribulbar group out of 50 patients 17 (34%) were males, 33 (66%) were females. In our study, patient’s age in subtenon’s group was ranging from 40-80 years and in peribulbar group from 42-85 years. In subtenon’s group mean preop IOP was 15.65 mmHg +/- 1.16 SD. In peribulbar group it was 16.42 mmHg +/- 1.40 SD. In subtenon’s group at 5 minutes post-surgery mean IOP was 16.14 mmHg +/- 1.48 SD, in peribulbar group it was 16.64 mmHg +/- 1.48 SD. Out of 50 patients in subtenon’s group 8 (16%) had no chemosis, 42 (84%) had chemosis. In peribulbar group 37 (74%) had no chemosis, 13 (26%) had chemosis. In subtenon’s group 32 (64%) had no sensation or pain, 15 (30%) experienced sensation, 3 (6%) experienced mild pain. In peribulbar group 7 (14%) had no sensation or pain, 16 (32%) experienced sensation, 27 (54%) experienced pain. Out of 100 patients in subtenon’s group 11 (22%) had no SCH, 39 (78%) had SCH. In peribulbar group 42 (84%) had no SCH, 8 (16%) had SCH in one quadrant. In subtenon’s group 10 (20%) had no movements, 20 (40%) had flutter, 18 (36%) had partial movements, 2 (4%) had full movements. In peribulbar group 27 (54%) had no movements, 14 (28%) had flutter, 9 (18%) had partial movements. Conclusion: Subtenon’s anesthesia and peribulbar anesthesia provide adequate analgesia, akinesia during cataract surgery. However, there is slight difference between two groups in providing akinesia, Sub tenon’s anesthesia has some partial residual movements which can be negated with patient cooperation or fixation forceps. The residual partial movements of subtenon’s anesthesia did not hamper any steps in cataract surgery. Subtenon’s anesthesia is less painful during administration compared to peribulbar anesthesia.

103. Retrospective Analytical Assessment of the Correlation between High Resolution Computed Tomography of Temporal Bone and Intra-Operative Findings in Chronic Otitis Media: An Observational Study
Vijay Kumar, Sanjay Kumar Suman
Abstract
Aim: The aim of the present study was to investigate the correlation between the preoperative findings of high-resolution computed tomography (HRCT) of temporal bone in chronic otitis media (COM) and the intraoperative findings. Methods: This retrospective, analytical study was primarily conducted in patients with COM presenting at department of Radio diagnosis. All patients with COM and records of preoperative HRCT imaging of the diseases ear were considered eligible for participation. A written informed consent was obtained from each study participant prior to conducting the study. A total of 50 patients were included. Results: A total of 50 patients were included in the final analysis in which 18 (36%) were male patients and 32 (64%) were female patients undergoing surgery belonging to the age range of 9 to 50 years. The mean age of the analyzed patients was 29 years. On comparing the preoperative findings of the HRCT with the intraoperative findings, tympanic perforation was reported on the CT of 14 patients (28%); however, 16 patients with tympanic perforation were observed intraoperatively (32%). Regarding facial canal erosion, it was reported in the CT of just 2 cases (1%), whereas it was seen intraoperatively in 10 cases (5%). As for sigmoid plate erosion, there was similar observation in both preoperative CT and the intraoperative findings with 8 patients (16%) presenting with that findings. In the same context, exposure of the dura was reported similarly during both assessments with 4 cases (8%) presenting with exposed dura preoperatively in the CT report and during operation. Meanwhile, edema of the middle ear mucosa was documented based on the preoperative CT imaging in 4 cases (8%), whereas only 2 cases (1%) showed intraoperative edematous mucosa. In 60%, cholesteatoma was absent. Conclusion: In conclusion, HRCT has shown good results with significant correlation of diagnostic value in comparison with the findings during surgery. Preoperative CT scan is beneficial and contributory in relation to diagnosis and decision-making in indicating operation to patients with COM.

104. A Hospital Based Observational Assessment of Electrolyte Abnormalities among Children Hospitalized Due to Gastroenteritis
Rajni Kumari, Sanjeev Kumar, Vinod Kumar Mishra, Vijaydeep
Abstract
Aim: The aim of the present study was to evaluate the electrolyte abnormalities in children with gastroenteritis. Methods: It was an observational study conducted among children in the Department of Paediatrics , BMIMS, Pawapuri, with a sample size of 200 patients. The aim of this study is to determine the incidence of electrolyte abnormalities among gastroenteritis patients admitted over 1 year in the Department of Paediatrics. The protection of the privacy of the participants was ensured and no details were shared. Results: Among the whole sample of 200 patients, it is seen that 120 patients, constituting 60% of the total, are male, while the remaining 80 patients, accounting for 40% of the total, are female. The sample size was partitioned into three distinct age categories: infants (<1 year) comprising 60% of the sample, pre-schoolers (1-7 years) comprising 30% of the sample, and older children (>7 years) including 10% of the population. The prevailing salt aberration seen in this research is hyponatremia, which was identified in 104 individuals, accounting for 52% of the total sample. A same pattern was seen in a cohort of preschool children, consisting of 60 patients. Of these patients, 92 (46%) exhibited hyponatremia, 76 (38%) displayed normonatremia, and 16 (8%) presented with hypernatremia. Consequently, it was observed that hyponatremia was the prevailing condition among infants and pre-school children in terms of age, followed by normonatremia and hypernatremia. The majority of older children initially had normal sodium levels, which were subsequently followed by the development of hyponatremia and, in some cases, hypernatremia. Conclusion: Diarrhoea remains one of the major causes of death among infants. The major contributing factors for higher incidence and mortality rates are poor hygiene, unsafe drinking water, physiological conditions like malnutrition and weak immune system. Electrolyte abnormalities is the leading cause of morbidity and mortality. It is important to promptly identify and treat children who exhibit acute gastroenteritis together with electrolyte imbalances in order to mitigate the adverse health outcomes and fatalities associated with these conditions.

105. A Hospital Based Comparison of the Safety and Effectiveness of Subtenon’s Anesthesia V/S Peribulbar Anesthesia in Small Incision Cataract Surgeries
Mrityunjay Kumar, Kumar Parmanand, Deepak Kumar Sinha
Abstract
Aim: The present study was conducted to compare the safety and effectiveness of subtenon’s anesthesia verusus peribulbar anesthesia in small incision cataract surgeries. Methods: A prospective longitudinal study was conducted among 200 patients who attended Ophthalmology OPD at for cataract surgery, patients of both sexes opting for SICS were enrolled in our study. Results: In subtenon’s group out of 100 patients 30 (30%) were males, 70 (70%) were females. In peribulbar group out of 100 patients 32 (32%) were males, 68 (68%) were females. Student T test showed no significant difference in sex distribution of study groups. In our study, patient’s age in subtenon’s group was ranging from 40-80 years and in peribulbar group from 42-85 years. Student T test showed no significant difference in age distribution of the study groups. (P value = 0.332). In subtenon’s group mean IOP was 15.75 mmHg +/- 1.14 SD. In peribulbar group it was 16.32 mmHg +/- 1.36 SD. Student T test showed no statistical significant difference in the pre operative intraocular pressure between two groups. (P value = 0.07). In subtenon’s group mean IOP was 21.23 mmHg +/- 4.26 SD, In peribulbar group it was 27.63 mmHg +/- 6.34 SD. Student T test showed significant difference. (P value = 0.001). In subtenon’s group mean IOP was 16.14 mmHg +/- 1.44 SD, In peribulbar group it was 16.64 mmHg +/- 1.48 SD. Student T test showed no significant difference between the two groups. (P value = 0.07). Chi-square test showed significant difference between two groups in terms of chemosis, analgesia, SCH ans akinesia after 5 minutes. Conclusion: Subtenon’s anesthesia and peribulbar anesthesia provide adequate analgesia, akinesia during cataract surgery. However there is slight difference between two groups in providing akinesia, Subtenon’s anesthesia has some partial residual movements which can be negotiated with patient cooperation or fixation forceps. The residual partial movements of subtenon’s anesthesia did not hamper any steps in cataract surgery. Subtenon’s anesthesia is less painful during administration compared to peribulbar anesthesia.

106. Treatment of Fracture of Shaft of Humerus using Dynamic Compression Plating versus Interlock Nailing: Comparative Study
Abhinav Kumar, Abhishek Anand, Swati Singh, Puja Sinha
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 in the Department of Orthopaedics. The average follow-up period was one year (range 10–24 months). 100 patients were included in the study. Results: There was preponderance of male over female with majority population in 31-40 years age group. The youngest patient was of 28 years and oldest was of 65 years male. Mean age was 38.62 years. In our study, majority of cases were of road traffic accident (85%) followed by history of fall from height (10%) and only 4 cases of assault. Middle third shaft fractures were more common (53%) followed by lower and upper third respectively. Transverse fractures were maximum in number (45%) followed by oblique (29%). There were 13 spiral and 13 comminuted fractures. There were 75 (75%) close fractures and 25 (25%) open fractures. There were 25 cases (25%) of preoperative radial nerve palsy. Out of 25 cases, 23 had recovered completely. There was no iatrogenic nerve palsy seen in our study. Out of 25 cases explored nerve was found to be intact in 23 cases and contused in 2 cases. Most of cases (16) of radial nerve palsy were associated with fracture of middle third shaft humerus. 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.

107. Assessing Role of the Electrophysiological Studies in Patients with Lumbar Disc Disease: An Observational Study
Rajeev Ranjan Raman, Anurag Sahu
Abstract
Aim: The aim of the present study was to assess the role of the electrophysiological studies in patients with lumbar disc disease. Methods: This study was conducted in the Department of Neurosurgery. study was conducted for the period of 3 years on 200 patients with lumbar disc prolapse, and all these patients were subjected to surgery. Results: A total of 200 patients were 72% male and 28% female. Low back pain was the most prevalent symptom in 96% of patients, followed by leg pain in 75%, lower limb numbness in 26%, and bowel and bladder control lessness in 6%. According to EMG abnormalities, L4–L5 and L5–S1 were the most common levels of intervertebral disc prolapse, accounting for 32% and 31% of cases, respectively. L5–S1 was seen in 27% of patients with L2–L3, L3–L4, and L4–L5 PIVDs and 4% of L3–L4, L4–L5 PIVDs. The EMG results of 140 (70%) of the 200 patients coincided with surgical findings, whereas 60 (30%) did not. Post-surgery, 40 patients had normal H-reflex latency, whereas 40 had extended latency. Overall, 80 patients exhibited improvement. After surgery, NCV values improve significantly. Conclusion: The EMG approach is very accurate in both detecting and precisely locating compressive nerve root lesions caused by disc prolapse. EMG is precise when it is connected with the surgical results.

108. An Observational Study to Evaluate Endoscopic, 24-H Gastric and Esophageal Acid Profile among Patients with Gerd in Relation to H. Pylori, as the Latter Might Alter Gastric Acid Secretion
Manish Kumar Bhaskar
Abstract
Aim: The aim of the present study was to evaluate the endoscopic, 24-h gastric and esophageal acid profile among patients with GERD in relation to H. pylori, as the latter might alter gastric acid secretion. Methods: In this observational study, patients with heartburn of more than two months duration, referred to the Department of Gastroenterology for two years .One hundred patients were included. Results: One hundred patients (mean age 42.6 (12.8) years; 73 [73%] men) fulfilled the criteria for diagnosis of GERD, had Carlsson-Dent score ≥6.0, had erosive esophagitis (EE); responded to omeprazole, had significant reflux on 24-h pH metry. Of 100 patients with GERD, 45 (45%) had H. pylori infection. Patients with and without H. pylori infection were comparable in respect to age, gender and Carlsson- Dent score. The average gastric pH, % time gastric pH <4, <3, <2 were comparable among the two groups; percentage of time gastric pH <1.5 was higher in patients without H. pylori infection. Patients with GERD with and without H. pylori infection had comparable esophageal pH metry findings. Patients older than 40 years without H. pylori infection had lower average esophageal pH and longer reflux time in minutes than those with H. pylori infection. Patients with higher LA had more esophageal acid exposure than those with ENRD and LA-A both the gastric acid profile was comparable among them. Gastric acid profile (% time gastric pH <1.5) showed a trend from pangastritis < normal gastric mucosa < antral gastritis. Patients with antral gastritis had more acidic stomach than those with pangastritis. Conclusion: In conclusion, our study showed that presence of H. pylori in patients with GERD was associated with less acidic stomach and milder esophagitis. Patients without H. pylori infection and higher age especially males are at a higher risk of developing EE.

109. Hospital-Based, Observational Study Assessing Relations of Regulatory T Cells with Hepatitis Markers in Chronic Hepatitis B Virus Infection
Rajnish Kumar, Anup Kumar Das
Abstract
Aim: The aim of this study was to assess the Treg in peripheral blood of chronic hepatitis B (CHB) virus infected patients and to evaluate the presence of a possible relation between them and hepatitis B markers. Methods: The Hospital-based, observational study was conducted in the Department of Medicine, Assam Medical College for the period of one year (July 2018 to June 2019). The study was conducted on 63 patients fulfilling the inclusion criteria attending the outpatient Department or admitted in the Department of Medicine, Assam Medical College, and Hospital during the study period. Results: In the present study, the maximum cases were in the age group between 30-39 years. Among the study population, 69.84% patient were male and 30.16% were female. HBsAg and HBsAb had 100% biomarkers. The percentages of CD4+CD25+, CD4+CD25+Foxp3+, CD4+CD25high, CD4+CD25 highFoxp3+, and CD4+CD25—Foxp3+ T cells were significantly higher in CHB patients than in healthy controls. The percentages of CD4+ CD25+ Foxp3+, CD4+CD25high Foxp3+, and CD4+CD25—Foxp3+ T cells secreting IL-10 were higher in CHB patients than in healthy controls but the difference in the percent- age of CD4+ CD25+ Foxp3+ IL10+ T cells between the two groups was not statistically significant. The percentage of CD4+CD25+T cells was significantly higher in CHBeAg+ve patients than in CHBeAg-ve ones. Otherwise, no statistically significant differences were observed between CHBeAg+ve patients and CHBeAg-ve ones in the other measured cell percentages.

110. A Community-Based Assessment of the Feeding Practice during Diarrheal Episodes among Children Aged 6 to 23 Months: an Observational Study
Ruby Kumari, Chandan Kumar, Rakesh Kumar, Kishore Kumar Sinha
Abstract
Aim: The purpose of this study was to assess feeding practice during diarrheal episodes among children aged 6 to 23 months in Bihar region. Methods: A community-based cross-sectional study was conducted in Department of Pediatrics, Jawaharlal Nehru medical College and Hospital, Bhagalpur, Bihar, India. All selected children of age 6 to 23 months included during the study period from january 2022 to December  2022 . 500 children were included in the study. Results: A total of 500 participants were included in the study. Majority of mothers were house wives in occupation 400 (80%). Almost all the respondent mothers were married 490 (98%) and 430 (86%) had children under 5 years. 31% had education above grade 9. All mothers of the study participants were visiting health facility for antenatal care during pregnancy of the index child and all study participants were started vaccination. Mother of most study participants delivered their children at health facilities 400 (80%), got information about feeding practice during diarrheal episode 340 (68%), sought medical care during the illness 430 (86%), and increased food and fluid during diarrheal episode 350 (70%). Boy children were about 1.6 times more likely to get increased food and fluid than girl children. Mothers who have one under five children were 2 times more likely to have proper feeding practice during diarrheal episode as compared to those who have two and more under-five children. The likelihood of increasing food and fluid during diarrheal episodes was 2 times higher among children from maternal age of 30-39 years than those from 20-29 years. Mothers who got information about feeding practices during diarrheal episodes were 2 times more likely to increase food and fluid to their children compared to their counterparts. Conclusion: In this study educational status, number of antenatal care visits, sex of child, number of under-5 children, maternal age, and information about feeding practice were independently associated with proper feeding practice during diarrheal episode.

111. A Retrospective Study Determining the Predictors of HealthRelated Quality of Life after Total Knee Arthroplasty
Sanjeet Kumar, Rajeev Kumar Rajak
Abstract
Aim: The aim of the present study was to evaluate the health related quality of life patients compared to healthy people and the factors affecting the health related quality of life after total knee arthroplasty. Methods: The present study was conducted in the Department of Orthopedics, Government medical college West Champaran, Bettiah, Bihar, India for 18 months and 200 patients with OA of the knee who underwent TKA were compared with 200 healthy controls. Results: The mean age of the case and control groups was 66.74 ± 7.71 and 66.89 ± 6.95 years, respectively. (p:0.89) 170 (85%) of case group and 168 (84%) controls were women. The mean follow-up of the patients was 25.8 ± 3.65 months. No significant difference was observed in demographic characteristics between the two groups. (P > 0.05). The mean overall SF-36 score 12 months after surgery significantly improved compared to before surgery (64.21 ± 22.2 vs. 37.55 ± 15.13, p < 0.001). Also, the mean score in all SF-36 subscales improved significantly twelve months after TKA compared to before surgery. (p < 0.05). No significant difference was observed in the MCS score in the two groups. The results of the univariate analysis showed that age, sex, BMI, Educational Level, Number of comorbidities, and Complications were significantly associated with the health related quality of life of patients. (p < 0.05). The results of multivariate analysis showed that female gender, BMI > 30(kg/m2), number of comorbidities > 2, bilateral TKA, non-compliance, and complications were significantly related to the decrease in patients’ health related quality of life. Conclusion: Our study showed that TKA can significantly improve the health related quality of life of patients compared to before surgery. Twelve months after TKA, the mean overall SF-36 score in patients who underwent TKA was similar to the healthy population except for the two subscales of happiness/vitality and physical performance.

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