International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Thrombocytopenia in Hypertensive Disorder of Pregnancy in Bundelkhand Region
Sheela Jain, Atul Jain, Akhilesh Ratnakar 
Introduction: Thrombocytopenia in pregnancy is defined as a platelet count less than 150.000/ìL. Gestational thrombocytopenia is the most common cause of thrombocytopenia in pregnancy. It accounts for 80% of cases hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) is the second most common cause of thrombocytopenia in pregnancy. Thrombocytopenia may occur before the development of hypertension or may occur without it. It occurs in 17-50% of preeclamptic women. Lot of evidence suggest the role of platelet in the development of pre-eclampsia and intrauterine growth retardation. Objective of Study: (1). Prevalence of thrombocytopenia in hypertensive disorder of pregnancy in our set up. (2). Implication of thrombocytopenia on maternal and fetal outcome, in pre- eclampsia and eclampsia. Method and Material: It is a retrospective study. In this study, we analyzed 189 pregnant women with hypertensive disorder of pregnancy, delivered in Bundelkhand Medical College Sagar from jan.2019 to jan.2020. Their age, parity, platelet count, Hb%, LFT, coagulation profile, method of delivery and fetal outcome analyzed. Result: 147, (77.77%) primiparous and 42, (22.22%) multiparous.49, (25.92%) women have anaemia. 27, (14.28%) had alter liver function test. 42, (22.22%) patients had thrombocytopenia. 21 (11.11%), had derail coagulation profile. 09, (4.7%) maternal death, 33 (17.46%) intrauterine death reported. Out of 33 IUD that occur in pregnancy induced hypertension patients, 25(75.75%) had thrombocytopenia.) Out of 60 of eclampsia patients, 25(41.66%) had thrombocytopenia. chi square test value= 66.29 and p value=/< 0.0001. it means there is an association between platelet count and fetal outcome. Conclusion: Thrombocytopenia occurs only small percentage (13.17%) of preeclampsia patients. Even in those pre- eclampsia pregnancies in whom thrombocytopenia occur, only small percentage (11.11%) have bleeding disorder. Thus, we can conclude that thrombocytopenia is not a major complication in majority of pre-eclampsia patients. But still careful, management of labour and puerperium is recommended.

2. A Study on Cross Sectional Assessment of Attitudes of Nursing Students Towards Suicide Prevention
Sunil Kumar, Malkesh Meena, Shikha Goyal, Bharat Agarwal, Divya Sharma
Background: Suicide is a major public health problem affecting individuals and society at large. Those who attempt suicide require medical attention and they are at high risk for completing suicide. A patient with suicidal attempt interacts with health care professionals at various levels in health care system. Today’s nursing students are tomorrows’ nursing staff, who will serve the society at various levels in providing health care service so, identifying their attitude regarding suicide prevention is of paramount importance in achieving successful suicide prevention. The objectives of the current study were to assess the attitudes of nursing students towards suicide prevention and to find its correlation with socio demographic profile of the sample. Method: This current cross-sectional study was conducted on 227 nursing students enrolled in nursing courses at a tertiary health care centre in Rajasthan. A 14 item Attitudes to Suicide Prevention Scale was used. The study proforma containing socio demographic variables and the attitudes to suicide prevention scale was distributed to them in a classroom setting after obtaining consent. The data from fully completed proforma were entered in Microsoft Excel 2017 and then processed for cleaning and coding. The cleaned data were exported to SPSS version 25 and were analyzed. Results: Mean age of the sample was 20.49 years. Internal consistency was present in the scoring. The maximal response was positive on twelve statements and negative on two statements. Favorable response was expressed on eleven statements out of total fourteen statements. Better attitude was observed in BSc Nursing students than GNM students. Conclusions: Majority of nursing students had positive attitudes on most of the statements of the scale. A health professionals’ attitude towards suicide develops during their early years of training. Hence, timely focus on developing their attitudes and educating them about suicidal patients needs organized efforts. There is further need to correct negative attitudes and strengthen positive attitudes at various levels. It is urgent need of the hour to incorporate suicide prevention strategies in the core component of health care service delivery.

3. An Observation Study to Determine the Bacteriological Profile and Antibiogram in Cases of Pneumonia
Nilesh Kumar
Aim: Bacteriological profile and antibiogram in cases of pneumonia attending to tertiary care hospital. Methods: This study was carried out in the Department of Microbiology, Madhubani medical college Madhubani, Bihar, India, for 1 year  Clinically diagnosed cases of pneumonia (symptomatic), patients who developed symptoms of pneumonia after 48 hours of admission to the hospital and patients who developed symptoms 48 hours after being administered on the ventilator. 100 patients were included in this study. Results: Most of the samples collected were sputum (77, 77%) and 7(7%) were Endotracheal tube tips. Out of 100 samples which yielded causative agents, 83 yielded single isolate and 17 yielded double isolates. Amongst the bacteria isolated, 77(77%) were Gram positive and 23(23%) were Gram negative. Staphylococcus aureus (8,8%), Coagulase negative Staphylococcus(8,8%) and Pneumococci(2,2%) were the common Gram positive bacteria isolated. Among the Gram negative bacteria, the commonest organism isolated was Klebsiella species (35,35%) followed by Pseudomonas species (20, 29.4%), Acinetobacter (9,13.2%), E.coli (9,13.2%) and Providencia spp (25,25%). (Table 3). Methicillin resistance was seen in all 8 cases of Saphylococcus aureus isolates (100%) and in 8 case of CONS (8%). 82, 82%), Norfloxacin, Levofloxacin and Meropenam (72, 72% each). E.coli was sensitive to Amikacin (88,88%), Aztreonam (77, 77%), Nitrofurentoin, Netilmicin and Meropenam (66, 66% each). Conclusion: According to this study, most of the organisms are resistant to 3rd generation Cephalosporins. Further studies should closely examine the administration of initial therapy in pneumonia patients.

4. A Prospective Assessment of Enteric Perforation with Peritonintis in Relation to Epidemiology, Surgical Treatment and Outcome
Nilesh Kumar
Aim: To study enteric perforation with peritonintis in relation to epidemiology, surgical treatment and outcome. Methodology: The present prospective study was performed on 50 patients of enteric perforation with peritonitis admitted to Shree Narayan Medical institute and Hospital, Saharsa, Bihar, India for 12 months. All patients of enteric perforation peritonitis were included in this study. All patients of perforation peritonitis were evaluated by detailed history, Clinical examination and all vital parameters recorded. Apart from routine blood investigations, Widal test was done. Radiological examination includes flat plate abdomen in erect posture and X-ray chest. Biopsy from perforation margin was taken for histopathological examination. After initial resuscitation patient were treated by operative procedures. Postoperatively progress report, morbidity and mortality were observed. After confirmation of diagnosis of perforation, decision was taken regarding the operative intervention after considering the following points: time elapsed after acute onset of abdominal pain, general condition of patient. Results: In this study, mean age of patients was 29.64 ± 3.64 years (range; 18-60 years). The maximum number of patients with typhoid perforation (76%) was presented in 2nd & 3rd decade of life. Out of 50 patients, 38 were males and 12 were females with a ratio of 3:1. Incidence of typhoid perforation was maximum (50%) during the month of June to September. Rainy season favors the feco-oral route of transmission of typhoid bacilli. According to socioeconomic status, 44% cases were of middle class and 56% of lower class and none from higher socio-economic status. Of the 50 patients, exteriorization of the perforation as loop ileostomy was done in 30 patients (60%), primary repair was done in 6 patients (12%) and primary repair with proximal loop ileostomy was done in 11 patients (22%). Resection of perforated ileum with ileo ileal anastomosis was done in 2 cases (4%), resection of terminal ileum with end ileostomy was done in 1 case (2%). Mortality was highest in patients who underwent primary repair and proximal loop ileostomy (27.3%). Conclusion: The time interval between occurrence of perforation and starting of specific therapy is the most important factor in deciding the ultimate outcome of the typhoid perforation patient and operative procedure is another important factor in deciding the outcome.

5. Assessment of Quality of Life in Patients with Low Vision
Shreyanshi Sharma, Sushil Ojha
Background: Visual impairment’ includes both low vision and blindness. The present study was conducted to assess quality of life (QoL) in patients with low vision. Materials & Methods: 84 patients of low vision both genders were classified into 2 groups of 42 each. Group I were moderate visual impairment and group I had patients with visual acuity in better eye between 6/24 to 6/60 and group II were severe visual impairment with visual acuity in better eye between 5/60 to 3/60. Patients were interviewed as per NEI-VFQ. Results: Group I had 22 males and 20 females and group II had 21 males and 21 females. The mean score for part 1 was 38.2 and 40.6, for part 2 was 33.5 and 37.3, for part was 3 was 39.1 and 40.6, for part 4 was 86.2 and 82.9, for part 5 was 60.4 and 36.5, for part 6 was 45.7 and 44.2, for part 7 was 41.2 and 42.6, for part 8 was 46.5 and 44.2, for part 9 was 40.5 and 39.2, for part 10 was 55.4 and 53.1, for part 11 was 80.3 and 62.4, for part 12 was 60.3 and 59.2, for part 13 was 58.6 and 54.8, for part 14 was 27.4 and 41.5, for part 16 was 21.3 and 42.6, for part 17 was 36.3 and 47.5, for part 18 was 41.2 and 45.7, for part 19 was 84.3 and 83.1, for part 20 was 50.4 and 55.2, for part 21 was 38.2 and 36.5, for part 22 was 51.4 and 47.8, for part 23 was 63.1 and 45.2, for part 24 was 62.4 and 54.1, for part 25 was 39.2 and 45.2 in group I and II respectively. The difference was significant (P< 0.05). Conclusion: Low vision affects quality of life of patients in both categories.

6. Assessment of Safety Profile of Intravitreal Bevacizumab in Ocular Lesions
Shreyanshi Sharma, Sushil Ojha
Background: Diabetic macular edema (DME), age‑related macular degeneration (AMD), and retinal vein occlusion (RVO) are the major etiologic factors of visual impairment and loss of central vision worldwide. The present study was conducted to assess safety profile of intravitreal bevacizumab in ocular lesions. Materials & Methods: 78 patients of visual impairment of both genders was included. Injection bevacizumab was performed performed by a vitreoretinal fellow under all aseptic precautions using a single 26‑G needle prick technique. Patients were evaluated at baseline and post-injection at day 7 and 4 weeks. SD‑OCT was repeated at 4 weeks after each injection. ICG and DFA were repeated according to the condition of the disease and at the discretion of treating physician. Results: Common conditions were diabetic macular edema in 27, age related macular degeneration in 8, branched retinal vein occlusion in 6, central retinal vein occlusion in 10, vitreous hemorrhage in 5, polypoidal choroidal vasculopathy in 7, submacular hemorrhage in 7 and neovascular glaucoma in 8 patients. The difference was significant (P< 0.05). The mean injections required in diabetic macular edema was 2.98, in age related macular degeneration was 1.12, in branched retinal vein occlusion was 2.04, in central retinal vein occlusion was 2.11, in vitreous hemorrhage was 1.42, in polypoidal choroidal vasculopathy was 1.36, in submacular hemorrhage was 1.10 and in neovascular glaucoma was 1.02. Common adverse events were endophthalmitis in 3 and intraocular pressure rise in 5 cases. The difference was non- significant (P> 0.05). Conclusion: Bevacizumab is a safe and economical pharmacotherapeutic agent that is used to treat a various ocular disorders.

7. Comparative Evaluation of effect of Telmisartan and Olmesartan on Blood Pressure and Fasting Blood Glucose Levels in Newly Diagnosed Hypertensive Patients: An Open Label Prospective Randomized Clinical Study
Preeti Nandu Dhongade, Maaz Hussain Syed, Prakash Narayan Khandelwal
Title: Comparative evaluation of effect of Telmisartan and Olmesartan on blood pressure and fasting blood glucose levels in newly diagnosed hypertensive patients: An open label prospective randomized clinical study. Introduction: Hypertension is responsible for development of diseases like stroke, ischemic heart disease and end organ damage. Angiotensin receptor blockers like Telmisartan & Olmesartan are first line drug for the treatment of hypertension. These drugs having pleotropic, anti-oxidant and anti-inflammatory effect. Primary objective of the study was to evaluate mean change in systolic and diastolic blood pressure from day 0 to 12th week. Secondary objectives were to determine the mean change in fasting blood sugar from day 0 to 12th week and to evaluate the safety of the study drugs. Material and Method: It was a prospective, open label, interventional, comparative, randomized study. Total of 109 newly diagnosed patients of hypertension were enrolled and divided in two groups. Patients in group A received tablet Telmisartan 40 mg once in a day and patients in group B received tablet Olmesartan 20 mg once in day. Results: In Telmisartan group, the baseline mean SBP and DBP was 151.6 ± 3.113 mm Hg and 90.83 ± 2.50 mm Hg which reduced to 137.16 ± 2.135 mm Hg and 81.79 ± 1.94 mm Hg respectively at 12th week and in Olmesartan group, the baseline mean SBP and DBP was 151.74 ± 4.54 mm Hg and 91.53 ± 3.28 mm Hg which reduced to 134.17 ± 3.43 mm Hg and 80.64 ± 2.76 mm Hg respectively at 12th week. The reduction in mean SBP and DBP was statistically significant at the end of therapy in both groups. There was no significant reduction in fasting blood glucose level in both study groups. Conclusion: Both Telmisartan and Olmesartan effectively controlled systolic and diastolic blood pressure in hypertensive patients but reduction was more significant in Olmesartan group. Both these drugs having no significant effect on fasting blood glucose level.

8. Psycho-sexual Effects of Tubal Ligation Among a Study Sample in Southern Rajasthan
Brajesh Kumar Pushp, Bajrang Lal, Kapil Dev Arya, Varsha Davis
Tubal ligation has been gaining demand and popularity in rural as well as urban populace as an effective method of birth control. The females who undergo this procedure may be experiencing a decrease in quality of life as it decreases their self body image. The present study was conducted to evaluate if the effects of tubal ligation manifest in a deleterious or positive manner on the quality of life of the women. The study utilized a pool of 50 adult females who had undergone tubal ligation in the past year and had consented to be a part of the study. The study revealed that there was a significant association of tubal ligation with anxiety/depression, self body image, sexual function among other factors. A consultation prior to tubal ligation and after the procedure can help alleviate the factors that can cause a fall in quality of life in the selected subjects.

9. Pattern of Anemia in Geriatric Patients:-A Hospital based Prospective Observational Study
Manju, Dhiraj Kapoor, Gopal Singh
Background: Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Material and Methods: Our study is hospital‑based prospective observational study, conducted in patients aged 60 years and above at Rural Tertiary care hospital Dr. RPGMC kangra at Tanda H.P. According to WHO, Anemia is defined as hemoglobin level less than 13 g/dl in men and 12 g/dl in women. Results:  Out 554 patients, 382 (69%) patients were found to be anemic. The male to female ratio was 1.36:1.  Anemia in males was 68.7% and in females 67.4% respectively. Based on peripheral smear all the patterns of anemia were found. Normocytic anemia was the commonest pattern constituting 76.35%. On the base of etiology  anemia of chronic disease (ACD) found  in 102 patients (26.7%) followed by iron deficiency anemia (IDA) in 99 patients (25.91%), hematological disorders in 81 (21.20%),  mixed in 13 (3.40%), vitamin B12 and folate deficiency in 14 (3.66%) and hypothyroidism in 3 patient (0.78%). Nutritional IDA was seen in seventeen patients. Conclusions: Substantial awareness of anemia in the elderly is justified due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and its etiological causes including gastrointestinal endoscopy and bone marrow if needed.

10.Visual Outcome in Patient Of Mature and Hypermature Cataract after Cataract Surgury
Choudhary R, Mashru M, Goyal R B
Introduction: Cataract is defined as an opacification of the crystalline lens leading to visual impairment, usually manifested in ageing people. Having cataract extraction on both eyes if, of course, there is a vision-disturbing cataract in the fellow eye, results in significantly better visual functional outcome than first eye surgery alone. Improvement and satisfaction with vision is most frequently found in patients going through surgery of both eyes with a short interval between procedures. Aim: Evaluate the visual outcome in patient of mature or hypermature cataract after cataract surgery on a long-term basis. Methodology: It was a prospective study conducted at Ophthalmology department of GMERS Medical College & Hospital, Gandhinagar, Gujarat. Patients who attended outpatient department of ophthalmology department of GMERS were included. Results: The majority (75%) of the patients were more than 60 years of age in our study. 88.2% of the patients with pre-operative poor vision were evaluated as having good vision at the end of 6 weeks post-operatively. Conclusion: MSICS promises to be a viable cost-effective alternative to the more expensive phacoemulsification.

11.An Observational Neuropharmacological Analytical Research Study on the Pharmacogenomic Mechanisms of Brain Organoids
Moumita Hazra
Introduction: Brain organoids recapitulate in vitro the specific stages of in vivo human brain development, thus offering an innovative tool by which to model human neurodevelopmental disease. Brain organoids can model congenital structural deficits or be subjected to environmental insult. Objectives: The objective of this study was an observational analytical molecular neuropharmacological research study on the pharmacogenomic mechanisms of brain organoids. Methods: In this study, at first, the records were identified, through database searching. The additional records were identified through other sources, which included the screened records, after the irrelevant studies were removed. From these screened records, few records were excluded, as per the exclusion criteria. Then, the full text articles were assessed for eligibility, from which few full text articles were excluded, according to the exclusion criteria, with adequate reasons. Then, rest of the studies were included, according to the inclusion criteria for the neuropharmacological analytical research study on the pharmacogenomic mechanisms of brain organoids. An observational analytical molecular neuropharmacological research study was also conducted. Results: This descriptive observational analytical research study described the molecular neuropharmacological and pharmacogenomic mechanisms of brain organoids, which elaborated this molecular pharmacological research analysis. Conclusions: To conclude, this observational clinical research provided a descriptive analysis on the pharmacogenomic mechanisms of brain organoids.

12.Is Lingual Graft better than Buccal Mucosal Graft in Substitution Urethroplasty for Anterior Urethral Stricture?
Narain Das Kewlani, Hement Kumar Ahirwar, Pragyey Nawlakhe, Bhupesh Kushram, Surendra Shrivastava
Background: Incidence of urethral stricture is on the rise due to rise in high velocity trauma rendering it a major problem to urologists. Stricture affects the quality of life of patients. Priniciple operative procedures for stricture urethra surgery are regeneration procedures, anastamotic and substitution urethroplasty. Oral mucosa is the best donor tissue for substitution urethroplasty (buccal graft from inner cheek and lingual graft from lateral and undersurface of tongue). Objective: To compare outcomes of lingual versus buccal mucosal graft urethroplasty and to compare the morbidity of donor site. Methods: Retrospective and Prospective study (6 years).Total 30 patients were included in the study (Group A- 15 patients of lingual graft prospectively and group B- 15 patients of buccal mucosal graft retrospectively). Outcome was compared in terms of patency (urethrogram), stream, uroflometry, restricture rate and donor site morbidity. Results: Urethrogram done after 1, 3 and 6 months showed that group A patients were better in terms of lumen patency compared to group B. Uroflometry revealed that postoperative mean peak flow rate was 0.8 ml/sec better in group A than group B patients. One patient in group B had restricture while none in group A (on 6 months follow up). There was significant donor site morbidity in group B. However, slurring of speech was seen only in one patient of group A. Conclusion: Our study showed that lingual graft is better than buccal graft for substitution urethroplasty (both for the donor and recipient site).

13.Assessment of Knowledge and Attitude of Interns in the Prevention and Control of COVID-19
Amarveer Singh Mehta, Priyanka Singla, Rachna  Dhingra, Dhananjay Kumar Singh, Harshdeep Joshi, Shamim Monga
Background: Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus, now called Severe Acute Respiratory Syndrome Coronavirus 2. The present study was conducted to assess knowledge and attitude of interns in the prevention and control of COVID-19. Materials & Methods:50 interns of both genders were included. A questionnaire assessed knowledge comprising of each item contained 3 options, namely, “true”, “false” and “don’t know”; 1 point was given for a correct answer, and 0 points were awarded for an incorrect answer or a “don’t know” response. The total score of this section ranged from 0 to 13, and higher scores were correlated with more knowledge. The attitude section included items, and a Likert scale was used to assess the level of agreement with the statements; response options ranged from 1 (strongly disagree) to 5 (strongly agree). Results: Out of 50 subjects, males were 22 and females were 28. What causes COVID- 19 replied correct by 94%, incubation period of COVID- 19 by 95%, overall mortality of COVID- 19 by 84%, what are laboratory test available by 98%, family gatherings may spread infection by 89%, washing hands frequently, wearing masks and other measures can effectively prevent infection by 99%, most have good prognosis by 82% and suspected and confirmed patients should be isolated and treated in designated hospitals by 94%. Attitude was strongly agree, agree, not sure, disagree and strongly disagree in response to I pay close attention to the development of the epidemic situation in 94%, 5%, 1% respectively, I think I am playing an important role in controlling the epidemic in 92%, 3%, 3%, 1% and 1% respectively. It is believed that the outbreak will soon be contained in 90%, 2%, 5%, 2% and 1% and I am willing to cooperate with the relevant departments to take prevention and control measures in 82%, 8%, 6%, 3% and 1% respectively. Conclusion: Interns had sufficient knowledge and attitude in the prevention and control of COVID-19.

14.Clinicohaematological Patterns of Anemia and Correlation with Clinical Conditions in Children Aged 5 to 12 Years in Tertiary Care Centre
Nawal Kapoor, Kirti Vishwakarma, Purnendu Lohia, Vipin Thakur, Ankur Singhai
Objective : To classify the haematological pattern, severity of anemia in children 5-12 years age admitted and to findits correlation with the clinical conditions. Methods: Crossectional study of 160 patients in two years was done. Patients satisfying the inclusion criteria were selected for study. Relevant clinical data were recorded in a structured proforma including detailed history was recorded with particular symptoms suggestive of anemia such as weakness and easily fatigability, breathlessness on exertion and pica. A thorough clinical examination of every child was done followed by routine investigations for anemia. Results: Patients between 7-8 year were found to be the most affected. Anemia was found to be more common in female children as compared to male children (F:M=1.13). Anemia is more common in undernourished child. Most common presenting symptoms were gastrointestinal including vomiting, diarrhea and pain abdomen. Most common sign was Pallor followed by other common signs included signs of dehydration associated with diarrhea, hepatosplenomegaly. microcytic hypochromic anemia was the most common morphological type of anemia and macrocytic anemia was the least common. Thalassemia cases were most common among hemolytic anemias. Iron Deficiency Anemia (Nutritional Anemia)was the most common etiology of anemia. Conclusion: Dietary deficits affect children aged 5 to 12, creating financial, emotional, and psychological burden for patients and their families, as well as depleting critical national resources. As a result, screening for these illnesses, as well as early detection of anemia and related problems, is essential.

15.Comparision of Incidence of Pregnancy Induced Hypertension in Pregnancy with Impaired Glucose Tolerance Vs Normal Glucose Tolerance
Juhi Loya, Rashmi Makhija, Pallavi Singh, Neha Tiwari
Objective: To find out what is the incidence and risk factors of pregnancy induced hypertension in patients with gestational diabetes mellitus. Methods: It was a prospective observational and analytical study of 200 patients according to inclusion and exclusion criteria. All patients were informed about the study and written consent was taken .Proper history and clinical details, antenatal risk factors were considered. All the patients enrolled in the study were subjected to GDM screening at 24-28 weeks and then depending upon the GDM screening they were divided as case and control group. They were followed upto the time of delivery. Results: There was increase in incidence of PIH with advance maternal age and higher BMI,. Higher incidence of PIH was found in primigravida . Most of the patients who developed PIH had HBA1C between 4.8-5.7% i.e 61.53% and 53.84% in GGI and GDM group respectively. In GGI, 92.30% and in GDM 76.92%,who developed PIH had first trimester FBS concentration <92 mg/dl, so in the present study correlation between FBS concentration with development of PIH could not be established. Most of the patients who developed PIH had underwent caesarean delivery, 84.61% in both groups, suggesting increase likelihood of caesarean delivery with development of PIH. Conclusion: By doing early detection and giving proper management with strict glycemic control we can decrease the incidence of preeclampsia. Regular and more frequent blood pressure monitoring is required in gestational diabetes pregnant women, so there by we can decrease the maternal morbidity and mortality.

16.Knowledge, Attitudes and Safety Practices among Healthcare Workers at a Tertiary Center During Covid 19 Pandemic
Shabana Sultan, Rekha Wadhwani, Poorva Badkur, Neha Tiwari, Juhi Loya
Objective: COVID-19 is an ongoing pandemic, for which appropriate infection prevention and control measures need to be adopted. The pandemic caused by SARS-CoV-2 has swept through the world causing unprecedented loss of lives and livelihood. The objective of this study was to evaluate knowledge, attitude and practice regarding COVID-19 among health care worker in Sultania Zanana Hospital. Methods: This is a observational hospital-based study to asses knowledge, attitude and practice  related to COVID-19 among HCWs in the Department of Obstretics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal,  by using a pre-validated questionnaire. Results 76.3% documented that handwashing, sanitizing hands, using mask and PPE are efficient in stopping the transmission of COVID infection. 73.7% participants showed positive attitude for active participation to reduce COVID 19 infection and 89.5% were willing for vaccination. 81.6% participants were practicing social distancing and among them, 31.5% participants were practicing social distancing for more than 6 meters. About 78.9% participants were using mask with white side in and 21.1% were wearing mask with white side out. All the participants were practicing hand washing with soap and water .42.1% participants answered that surgical mask protect against infection whereas majority i.e. 57.9% participants followed by 34.2% participants were using PPE and mask respectively. Conclusion: Knowledge regarding COVID-19 protocols plays a key role in prevention and spread of the disease. Proper intervention through training programmes at regular time interval has great influence on various aspect of prevention and spread of the disease. Training programmes not only increase knowledge and awareness among health care professionals but also develops sense of responsibility, which reflects in their attitude and practices.

17.A Study on Correlation between Maternal Vitamin D Levels and Low Birth Weight Babies in Tertiary Care Centre: An Observational Study
Sweethi, R Padma Latha, Jyothi Tippoji, Gade Rama
Background: Vitamin D is a fat-soluble vitamin that plays a major role in calcium and phosphorus homeostasis and bone metabolism in the body. Maternal hypovitaminosis D may impair fetal growth and cause adverse pregnancy outcomes including intrauterine growth restriction and neonatal low birth weight. In the present Study we aimed to find out correlation between the vitamin D level and Low Birth Weight. Materials and Methodology: This is an observational Case-control study conducted in department of obstetrics and Gynaecology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar for the duration of one year. We have included 80 patients divided into cases and controls. Depending on mother’s 25(OH) Vitamin D level, all mothers were categorised in Deficient <25 ng/dl, Insufficient 25 to 50 ng/dl, Normal >50 ng/dl, Toxic level >250ng/dl.  Results: observed that maximum patients were from the age group of 21 – 30 years in cases as well as in controls. Among the cases 65% of the mothers were obese and 25% of the mothers were underweight. There was positive and significant correlation between birth weight and  Vitamin-D level. Conclusion: Neonatal low birth weight could be related to maternal vitamin D deficiency. Modifying maternal nutrition behaviour and vit D level could be beneficial on prevention of low birth weight, there is a need for recommendation for vitamin D supplementation during pregnancy.

18.A Study on Prevalence of the Adverse Drug Reactions and Dosage Pattern of Anti-Snake Venom
Choppadandi Anil, Kasireddy Govardhan Reddy, Mukkisa Sruthi
Background: Snake bite is a common, neglected and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. Anti-Snake venom (ASV) is the only promising lifesaving treatment for management of snake bite, till date. Adverse Drug reactions (ADR) is defined as “any noxious change which is suspected to be due to a drug, occurs at doses normally used in man, requires treatment or decrease in dose or indicates caution in the future use of the same drug”. Aims and Objectives: This study aimed to know prevalence of the Adverse Drug Reactions and dosage patterns of Anti-Snake Venom. Material and Methods: This prospective observational study was conducted in patients admitted with snake bite in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar during February 2020 to December 2021. Results: Among all 150 victims of snake bite, prevalence of Adverse Drug Reaction was found to be 33%. Patients were administered with ASV I, ASV II and ASV III. Male were dominant over the female in this study. There was a no significant correlation between the various manufacturers and incidence of adverse reactions. Conclusion: Though the incidence of ADR is more troublesome, ASV is the only safe and effective drug in preventing morbidity. Different manufacturers did not show any significant variations in the adverse reactions.

19.An Analytical Prospective Evaluation of Thyroid Profile in Full-Term Neonates Presented with Septic Shock
Chandan Kumar Mishra
Aim: To find the relationship between thyroid profile and septic shock in neonates and also to compare the thyroid profile in survivor and non-survivor groups of septic shock patients. Material & Methods: This analytical prospective study was carried out in the Neonatal Intensive Care Unit (NICU) of the Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India over a period of one year. A total of 220 neonates were selected in the study. All the full-term neonates (gestational age >37 completed weeks), admitted with features of sepsis between 72 hours to 28 days of life and with positive sepsis screening, were included in the study. Results: A total of 220 cases were enrolled, out of which, 62.73% were males and 37.27% were females. A statistically significant (p<0.0001) difference was observed in the thyroid profile of the neonates with septic shock than those without septic shock except for TSH (p>0.05). Only T3 was found to be significantly co-related with VIS in septic shock in all the groups (p<0.001). Conclusion: TSH, T3, T4, fT3, and fT4 levels are significantly low in patients suffering from the septic shock which may vary in the case of TSH. Also, there is a significant decrease in thyroid profile among septic shock non-survivors as compared to survivors.

20.Hospital-Based Retrospective Assessment Study Indications and Outcome of Surgical Management of Local Complications of Acute Pancreatitis
Md. Sarfraz Alam, Shahid Ahmed
Aim: To evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methodology: A  hospital-based  retrospective  study  was  conducted  in the department of surgery Jagannath Gupta institute of medical sciences and Hospital, Budge Budge, Kolkata, West Bengal, India after approval  from  the  institutional  ethical  committee.  A purposive sampling method was utilized to recruit the patients. Patients who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis for 10 months were included. Clinical, laboratory and imaging findings including, contrast-enhanced CT scan findings of all the cases, were recorded as per the proforma. In addition, the indication of each procedure, perioperative outcome and associated complications were evaluated in all the studied cases. All minimally invasive procedures were performed under general anesthesia by the surgical team experienced in pancreatic surgery. Results: 500 patients were admitted to the surgery department with the diagnosis of acute pancreatitis or with complications of acute pancreatitis. Among them, 80 patients had local complications due to acute pancreatitis. All patients were managed using the step-up approach, starting with conservative management and minimally invasive intervention when warranted. 24 patients required surgical intervention due to failure of endoscopic or radiological intervention or positions of lesions being inaccessible to these techniques. Among the 24 patients in the study, 4 patients had PPC, all of whom were managed with external drainage due to persistent symptoms. 6 patients who had ANC were initially subjected to conservative management. In addition, WON was noted in 4 patients and 10 patients had pseudo cyst. Due to clinical deterioration and high suspicion of infected necrosis in patients with WON, FNAC was performed in all patients, revealing growth in culture. Conclusion:Management of patients with local complications of pancreatitis is most effective at a specialized tertiary care centre with pancreatic surgeons. Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains an essential modality in managing the disease.

21.A Prospective Observational Assessment of the Emerging Role of a Newborn Screening Program for Congenital Hypothyroidism
Jeetendra Mahato, Vivek Kumar, Gopal Shankar Sahani
Aim: To evaluate the incidence & screening of neonates for congenital hypothyroidism for timely diagnosis and integral psychomotor development. Material & Methods: This was a prospective study carried out in the Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, India, over a period of two years. All live newborn gestational age > 34weeks delivered and out born delivered with an age of fewer than five days. Results: A total of 1281 babies were enrolled, but 800 were an eligible candidate for the study period. Of the total eligible neonates, 651 were term babies and 149 were preterm babies with more than 34 weeks. Neonatal thyroid-stimulating hormone was estimated in all 783 neonates out of whom 4 cases were positive for CH, 14 cases had initially high values between 10-19 μIU/L. Conclusion: Timely diagnosis and treatment of CH are important in order to prevent its consequences. NBS is the need of the hour for early diagnosis of CH, which is simple, fast as well as cost-effective.

22.To Evaluate the Use of Electronic and Elastomeric Infusion Pumps for Administration of Local Anesthetics for Post-Operative Analgesia in the Major Abdominal Surgeries with Regard Side Effects, Patient Satisfaction and Rescue Analgesia
Ankita Singh
Aim: To evaluate the use of electronic and elastomeric infusion pumps for administration of local anesthetics for post-operative analgesia in the major abdominal surgeries with regard side effects, patient satisfaction, rescue analgesia. Material & Methods: After institutional ethics committee approval, a prospective, observational, comparative study was carried out in 80 patients of either sex between ages of 18 to 65 years undergoing major abdominal surgery. The patients were into two groups of 40 patients each, elastomeric pumps (Group A) or electronic pumps (group B). Results: 3 patients out of 40 patients in Elastomeric group, needed Rescue analgesia. 6 hrs. Mean satisfaction score was 7.30 in Elastomeric group and 7.00 in Electronic group. The Median and IQR was 8 and 1 in Elastomeric group and 7 and 2 in Electronic group. The difference was statistically insignificant. (P = 0.168). The side effects noted in both the groups were mild, clinically not incapacitating and responded readily to treatment. Conclusion: None of the patients in either group had any severe or incapacitating adverse effects. However, elastomeric group had hypotension and 10.0% in electronic group. One patient had bradycardia in electronic group.

23.Prospective, Randomized Comparative Assessment of Efficacy of Chloroquine Phosphate 0.03% And Sodium Carboxymethylcellulose 1% in Dry Eye
Kundan Kumar Singh
Aim: A comparative study of efficacy of chloroquine phosphate 0.03% and sodium carboxymethylcellulose 1% in dry eye. Methods: This prospective, randomized, study was done in the department of Opthalmology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 2 yeas. The protocol was composed of 2 phases: a 3-week treatment phase, and a 1-week post treatment phase. Eligible patients were between 20 to 68 years of age. Results: The group mean scores was found to be (2.89±0.12) at baseline and (0.32±0.04) after treatment (P< 0.001) with the net change -2.67 (95% CI of -2.93 to -2.42). It is also to be noted that CHQ also showed significant reduction in LGSS even at visit 1 & 2 (P<0.001). CMC treatment showed significant change in mean score only at visit 3 i.e. 1.21±0.11 (V3) from 1.88±0.13 (BL) with a net change of -0.97 (95% CI of – 1.31 to -1.65) (P<0.05) CHQ treated group reflected significant reduction in FLSS from 3.31±0.13 (BL) to 0.57±0.07 (V3) (p<0.001) with the net change of -2.84 (95% CI of -3.017 to -2.551). Significant reduction was noted at the end of visit 1 (Table 2). CMC treated group indicated significant reduction in FLSS only at visit 3 from 1.62±0.01 as compared to 2.81±0.14 at baseline (P <0.05) with a net change of just -0.49 (95% CI of -1.82 to -1.16). Further, the percentage improvement in CHQ and CMC groups were 50% and 29% respectively. Conclusion: The findings of this study support the continued investigation of the use of topical CHQ as a safe and effective treatment for DES. In conclusion, Chloroquine Phosphate eye drops can be a novel therapeutic approach for the restoration of tear formation for DES.

24.Comparison of Outcome Between Microscopic and Endoscopic Tympanoplasty Type 1
Mritunjay Shringirishi, Sujata Maini, Dinesh Patel, Anusha Shukla, Varchaswa Pandey
Objective: This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty and to analyze the outcomes in terms of the hearing gain, duration of surgery, and graft success rate. Methods: In this retrospective study, the outcomes of 120 patients (63 male and 57 female) who underwent type 1 tympanoplasty were evaluated. The age range of the patients was 20–60 years. Group 1 underwent tympanoplasty with an endoscopic technique (n = 60), and Group 2 underwent tympanoplasty with the conventional microscopic technique (n = 60). A boomerang-shaped chondroperichondrial graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, and graft success rate. Results: In both groups, the postoperative air–bone gap (ABG) was significantly lower than the preoperative ABG. The mean operative duration in Group 1 was significantly lower than that in Group 2 . At 12 months postoperatively, there were smaller perforations in four (12.5%) of the children in Group 1 and in two (5.71%) of the children in Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. The operative duration was shorter in Group 1 than in Group 2. Conclusion: With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate ,less pain and shorter operative time.

25.A Comparative Study of Dynamic Hip Screw and Dynamic Condylar Screw in The Management of Unstable Intertrochanteric Fractures
Mukara Prakash, Bolloju Keshavarao, Banoth Vishwanath Naik, Jatoth Venkateswarlu
Background: Unstable intertrochanteric fractures of the femur have been recognized as a major challenge by the orthopedic community, not solely for achieving fracture union, but for restoration of optimal function in the shortest possible time, that too with minimal complications. We in the current study tried to evaluate the overall outcomes by using Dynamic Hip screw (DHS) and Dynamic condylar screw (DCS) in unstable intertrochanteric fractures. Methods: The present study consists of n=40 adult patients with unstable intertrochanteric fractures, among these n=20 cases were treated with Dynamic Hip Screw and other n=20 cases are treated with Dynamic Condylar Screw. The patients were evaluated as per the history, and mode of injury. Necessary radiological investigations and hematology profile was done upon admission. Results: Good and excellent results based on the functional outcomes were found in 50% of cases of DHS groups. Similarly good and excellent functional results were found in 80% of the DCS groups additionally no case in the DCS group was found to have a poor result whereas 20% of DHS cases were with poor functional outcomes details given in table 4. Five cases in DHS groups and 2 cases in DCS groups had shortening ranging from 1 to 3 cm All these cases had unsatisfactory fixations. Implant breakage that occurred in DCS fixation was due to early weight-bearing by the patient against the advice. Conclusion: We found DCS performed better than DHS in terms of overall functional outcome, less incidence of post-operative shortening, varus collapse screw back-outs, and almost similar rates of fracture union. Hence DCS may be considered a better implant than DHS in treating the unstable intertrochanteric fractures.

26.Estimation of Dengue Sero-Positivity Among Clinically Suspected Patients Attending a Tertiary Care Center in Bihar State
Shanti Bhushan
Aim: To estimate prevalence of dengue viral infection among suspected patients attending a tertiary care center in Bihar State. Material & Method: Total 200 samples were tested for dengue sero-positivity. Data was recorded and analyzed. The present study is a retrospective study to observe prevalence of dengue infection, Patients clinically suspected of having dengue infection and advised for dengue investigation for establishing the diagnosis were enrolled in the study, irrespective of their age or sex, over one-year period. Results: Total 200 samples were tested during a period of one year. Out of which 63 (31.5%) showed laboratory evidence of dengue; either for NS1 Ag or IgMAb or for both. Maximum samples were received during monsoon and post-monsoon period i.e., August to November. Conclusion: The present study confirms that dengue is mainly a disease of rainy season and also identifies certain vulnerable groups for effective planning of interventions.

27.A Hospital Based Comparative Clinical Assessment of Post-Dural Puncture Headache Using Three Different Types of Needles on Sub Arachnoid Block
Ravindra Kumar Singh, Nawin Kumar, Meenakshi Singh
Objective: To compare the effects on post dural puncture head ache /sequel two with two different types pencil point needles, and one conventional cutting type of needle in patients undergoing lower abdominal surgical and gynecological operative procedures. Materials and Methods: Patient was randomly allocated in to three groups. B.P., ECG, HR and SPO2 monitored non-invasively rate, of injection 1ml/15sec, volume 3ml of 0.5% bupivacaine heavy, lateral position and L3-4 interspace, were kept constant.  The following parameters were compared: Number of attempts, PDPH, Back ache, NPDPH, and Patient acceptability. The results were compared statistically using Fischer exact test, Analysis of variance and Chi square test. Results: Inter space is statistically similar between three groups of patients with P=0.527. Highest number of complications is seen in group I (13.3%), followed by group III (10%) and group II (6.6 %) respectively. Conclusion: All three types of needles were easy to insert when used with an introducer. Thus pencil point Whitacre needle is better choice in view of low incidence of PDPH. However, cost factor which again should be weighed against the complication.

28.A Contemplation of Renal Calculi and it’s Metabolic Evaluation in Bundelkhand Region
Akhilesh Ratnakar, Deepak Shrivastava, Sheela Jain, Omkar Thakur, Dushyant Kumar Rohit
Introduction: Kidney stones develop as a result of various metabolic disorders which affect various elements in the body especially calcium. Study was done to record the metabolic evaluation of kidney stone patients and to identify metabolic abnormality, and treating the same. Nephrolithiasis is a major public health problem worldwide. In recent years, growing evidence suggest that this disease may originate from underlying metabolic disorders. This is the first study that reports the frequency of different metabolic abnormalities among patients with nephrolithiasis in Bundelkhand Region. Material and Methods: A prospective observational study, of hundred patients with the history of pain in flanks radiating to front and analyzing them for any metabolic abnormality. We analyzed urine samples for volume, creatinine, calcium, citrate, oxalate, uric acid, sodium, and cystine. Fasting blood samples were assessed for serum calcium, phosphorus, sodium, potassium, uric acid, albumin, creatinine and blood urea nitrogen. Results: Out of the 200 patients, 140 were males and 60 were females. Patients underwent metabolic evaluation, in which 110 male, 30 female patients had a metabolic abnormality remaining male and female patients had no abnormality. The common abnormality found was hyproxaluria, followed by hypercalciuria -hypocitraturia and hypernatriuria of the cases. Conclusion:Metabolic evaluation is a must which greatly help to diagnose kidney stone and reduce the risk of stone recurrence, Although, high calcium excretion was the most frequent metabolic derangement in several similar studies, it is not frequent among nephrolithiasis patients. Instead, other metabolic risk factors were in higher frequencies.

29.Patterns and Distribution of Dental Caries and Dental Fluorosis in Areas with Varying Degrees of Fluoride Ion Concentration in Drinking Water: A Systemic Review and Meta analysis
Navneet Singh Kathuria, Gagandeep Kaur Sidhu, Jaskirat Sidhu, Prabhpreet Oberoi, Vijayendra Pandey
Introduction: The current study was commenced to review the literature systematically  to assess the patterns and distribution of dental caries and dental fluorosis in areas with varying degrees of fluoride ion concentration in drinking water. Materials and Methods: The inclusion criteria were framed as per recommended by PRISMA guidelines. Results: Overall, a total of 52 articles were identified from the search of major databases and manual scanning of reference lists of relevant articles. After initial screening based on titles and abstracts, full texts of 18 articles were retrieved for further evaluation. 13 articles were excluded. This left a total of 5 articles for inclusion in the review. Across 5 studies providing relevant data,  indicated positive and statistically significant correlation between daily intake of fluoride and dental fluorosis and no relation was observed between water fluoride levels and the prevalence of dental caries. Conclusion: The study concluded that there was a positive and statistically significant correlation between daily intake of fluoride and dental fluorosis and no relation was observed between water fluoride levels and the prevalence of dental caries.

30.Sleep Patterns and BMI Corelations Among Medical Professionals in a Tertiary Hospital in Maharashtra
Jagdish N. Gindodia
Abstract: Obesity and its associated risks are a leading public health concern. Sleep deprivation is speculated to boost appetite. Medical professionals are prone to sleep deprivation. Thus this study was designed to ascertain association between BMI and sleep deprivation among Medical students and professionals. Materials and Methods: Medicals Professionals and students were properly examined to exclude those suffering from any major diseases, psychiatric problems, alcoholics or sleep medication. Height & weight were examined to calculate BMI. Sleep quality & duration was assessed by a self-report questionnaire, PSQI. Pearson’s correlation was used to find the association among parameters. Results: 41.3%(102) had overweight BMI of ≥23; 38.1%(94) had poor sleep quality with PSQI score >5 and 43.3%(107) are sleep deprived with sleep duration 5-6 hours. Analysis showed highly significant negative correlation between BMI & sleep duration with ‘p’ value <0.01 and also highly significant positive correlation between BMI & PSQI score with ‘p’ value <0.01. Conclusions: It was found that with increase in BMI there is decrease in sleep duration as well as reduction in sleep quality which again leads to obesity as a vicious cycle. Hence proper education about sleep and life style modification is needed to medical professionals to prevent obesity and its associated comorbidities among them.

31. A Study on Impact of Glycemic Abnormalities on Coronary Artery Disease
Palak Agrawal
Introduction: Patients with Type 2 Diabetes Mellitus have found to be more susceptible to dysfunctioning of coronary microvessel, leading to the  vasoconstriction of coronary micro vessels and hence, the arterial supply decreases significantly, compromising the oxygen and nutritional supply to areas of greater need. Type 2 Diabetes Mellitus causes endothelial dysfunction through a variety of mechanisms, including dyslipidemia, the production of advanced glycated end products, glucose buildup within the endothelium, etc. Endothelial dysfunction, on the other hand, induces or worsens type 2 diabetes mellitus by preventing glucose or insulin from reaching target tissues in a timely manner. Aims and Objective: To statistically find out the correlation between abnormal variation of glucose level on the endothelial function of coronary vessels. Materials And Methods: The prospective study has assessed the glucose variability with mean level of glucose and its maximum and minimum level. The study also determined the levels of mean absolute glucose, continuous overlapping net glycemic action and Mean amplitude of glucose excursion. The study employed student t-test and Mann Whitney U-test for statistical analysis. Result: The study found that Mean Amplitude Of Glycemic Excursions had negative correlation with that of coronary endothelial function (P<0.05). Several parameters were analyzed statistically with other variables of coronary function. Conclusion: This study has shown that higher the glucose variability, more is the impairment of coronary endothelial function. The study has also concluded that Mean Amplitude Of Glycemic Excursions was negative relationship with endothelial function and peripheral endothelial function was not found to have significant association with  Glucose Variability.

32. Management of Calcaneum Fracture in Adults Treated with Plating
Mohkam Singh, Rakesh Kumar Gupta
Background: About 60% of all tarsal bone fractures are calcaneum fractures. 70% of all calcaneal fractures are intra-articular fractures. There are disagreements on how to operate on calcaneum fractures. In order to quantify the functional results of calcaneum fractures treated with open reduction and internal fixation with plate and screws, this study was conducted. Calcaneum intraarticular fractures are not unusual. The calcaneus is the tarsal bone that fractures most commonly. 60% of tarsal bone injuries and 2% of all fractures are calcaneal fractures. The most frequent mode of injury is axial loading, which results in bilateral calcaneal fractures when someone falls from a height. It is necessary to rule out further fractures such pelvic and spinal fractures that are linked to falls from height. Thanks to improved knowledge of fracture patterns and the availability of superior implants, the care of Calcaneal fractures has changed over the past several years from conservative to surgical management. Aim: To study the treatment of adult calcaneum fractures using plating. The goal of the current study is to evaluate the surgical outcomes of Calcaneal fractures treated with improved implants after intra-articular reduction. Material and Method: Patients who were hospitalized from the hospital’s emergency and outpatient departments were the subjects of the study at the department of orthopedics. Twenty-five patients (20 men and 5 women) who met the inclusion and exclusion criteria for the study had 26 fractures that we assessed. All patients gave their informed consent. Results: We used plating, such as locking the calcaneal plate, to treat a total of 26 calcaneal fractures in 25 patients. There was a tendency for right-sided fractures among the 25. There were no lost patients to follow-up. Most of the patients were adults in the 30- to 45-year age range. The oldest and youngest patients were 53 and 19 years old, respectively. Therefore, falls from a height occurred most frequently when people were engaged in the construction industry. A small proportion of fractures occurred as a result of four-wheeler-related traffic accidents. In this investigation, there was a minor tendency toward right-side fractures. Compound fractures and bilateral fractures were excluded from this investigation. Conclusion: Open reduction and internal fixation with an expanded lateral approach and calcaneum locking plates and screws produce a high percentage of positive outcomes in displaced intra-articular calcaneum fractures and very few negative outcomes. For the treatment of displaced intra-articular calcaneum fractures, it may therefore be a superior alternative.

33. Estimating Preoperative Bilirubin Level and its Role in Predicting the Severity Complicated Appendicitis
Barun Kumar
Aim: The aim of the present study was to identify whether preoperative bilirubin level can predict the severity complicated appendicitis. Material & Methods: The study was conducted in the Department of General Surgery, Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India for 12 months  on 200 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant results for predicting complications were analyzed. Results: In our study 60 (60%) were males and 40 (40%) were females. Out of the 200 cases 90 were complicated. 124 cases had elevated bilirubin and 76 cases had normal bilirubin. Out of 200 cases 90 patients had a total leucocyte count more than 11000. Conclusion: Patients with appendicitis with elevated bilirubin levels have more chance for complications like perforation, gangrene and suppuration.

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