International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Clinical Study on Patients with Duodenal Perforation
Bhagwan Raghunath Korde, Kapildev Ganeshrao Patil
Abstract
Background: Due to patient delays, surgical delays, and a shortage of antibiotics, perforated duodenal ulcers, the most serious consequence, used to have a high death rate. According to several writers, during the previous three decades, there has been a decrease in the incidence of peptic ulcer illness and perforation. The treatment of peptic ulcer disease has changed, and surgery has become less necessary as a result of advancements in the use of a variety of medications in medical therapy. Males are more likely to experience perforation in their third and fourth decades, and the epidemiological pattern varies globally. The incidence in Western nations is somewhat dropping. Throughout this time, there has been an increase in the age of ulcer perforation patients, with younger patients experiencing a decline in incidence and older patients experiencing an increase in incidence. While the rates of stomach ulcer perforation seem to have remained rather consistent, the majority of this temporal variance may be related to shifting rates of duodenal ulcers in men. Aim: The aim of the study was to review and study the factors influencing, the outcome of the duodenal perforations. Material and Method: The Department of Surgery carried out this cross-sectional investigation. The admitting surgeon made the diagnosis of duodenal ulcer perforation based on clinical characteristics, which was supported by radiographic data and limited during the procedure. Surgery was classified as urgent if it was performed within four hours of admission, same day (4–24 hours), or later in the same admission. Fifty cases of duodenal ulcer perforation that were admitted to the Department of Surgery are included in this study. The location and type of operation carried out were included in the operational information. The information will be placed into a proforma together with the patient’s course of hospitalization, therapeutic interventions, and demographic information. Results: Fifty patients in total were examined. With a mean age of 45.68 years, the age ranged from 20 to 50 years. The age range between 41 and 50 years old had the highest prevalence among 50 patients, followed by 21 to 29 years old. There are 46 (92%) men and 5 (8%) women in the current study, with a majority of men. The majority of patients are admitted in less than a day; pre-pyloric ulcers typically manifest in this manner. Two cases of ileal perforations were multiple, whereas duodenal ulcer perforations were single. Smoking is the primary risk factor for ulcer complications brought on by ARDS in 12% of patients (6 patients). Of these patients, 30% experienced wound issues, 2% died (1 patient), and 44% (22 patients) had no complications at all. Conclusion: Acute abdominal emergencies involving perforations of the duodenum are among the most frequent. Early hospital admission, early diagnosis, timely surgical treatment, and the use of suitable and sufficient antibiotics have all contributed to a decrease in the mortality rate from perforated duodenal ulcers. Patients with duodenal perforation may experience lower morbidity and mortality rates if they smoke, drink alcohol, and change their lifestyle. Acute abdominal emergencies involving perforations of the duodenum are among the most frequent. Peptic ulcer perforation is among the most frequent reasons that need for an urgent laparotomy. Men are more likely to be impacted, with a peak occurrence in their 30s. Pylorus and the duodenum are the most often perforated organs.

2. Digitalization of Informed Consent for Surgery: A Contemporary Perspective
Divyeshkumar Keshavjibhai Vadgama, Ojas Bharatkumar Solanki, Amitkumar Dilipkumar Modi, Piyush Makwana
Abstract
Background and Objectives: In the realm of surgical practice, informed consent holds a position of paramount significance. The utilization of digital media emerges as a promising approach to augment patients’ comprehension of the proposed surgical procedures. This study aimed to investigate the impact of incorporating an online digital educational presentation (DEP) alongside the conventional informed consent (CIC) for laproscopic cholecystectomy. Material and Methods: This prospective, randomized study involved allocation of 67 patients of laparoscopic cholecystectomy, into two groups: DEP+CIC (intervention, n=33) or CIC (control, n=34). The DEP entailed a comprehensive online 13-slide video-enhanced module that provided a detailed account of the risks, benefits, expectations, and anticipated outcomes associated with laparoscopic cholecystectomy. A 20-item MCQ test was used for assessment of baseline and post-consent comprehension, modified Client Satisfaction Questionnaire (CSQ-8), was used for patient satisfaction and the duration of the consent process was quantified in seconds using a stop watch. Results: Baseline demographic data and procedure-specific knowledge were equivalent between groups. Post-consent knowledge was significantly higher in the DEP+CIC vs CIC group. The duration of time to obtain informed consent was significantly shorter for the DEP+CIC group. Significantly higher patient satisfaction was observed in DEP+CIC group. Conclusion: The incorporation of an online DEP module into the conventional informed consent process for surgery resulted in enhanced patient comprehension, high levels of patient satisfaction and remarkable reduction in time required for consent.

3. An Observational Study to Evaluate the Efficacy and Tolerability of Sodium Valproate and Amitriptyline in Migraine Prevention
Balram Sai Prasanna
Abstract
Background: Migraine headaches are a recurring condition marked by intense and throbbing pain, typically localized to one side of the head. These headaches are frequently accompanied by symptoms like nausea, vomiting, and heightened sensitivity to light and sound. Typically, they persist for a duration ranging from four hours to three days. The current study was conducted to investigate the efficacy and tolerability of sodium valproate versus Amitriptyline in migraine prophylaxis. Methods: Patients were included in the study based on predefined inclusion and exclusion criteria. We collected data from 90 outpatient department (OPD) prescription sheets of individuals with migraine who were undergoing prophylactic therapy with either amitriptyline or sodium valproate in the Neurology Department. A record of the patient’s baseline characteristics was maintained in a case record form. Other data collected included the duration of symptoms, frequency of headaches, results of neurological examinations, as well as assessments of migraine pain severity and functional disability. Results: After 3 months, sodium valproate outperformed amitriptyline with a significantly higher percentage of patients experiencing >50% improvement in VAS score (68.29% vs. 50.00%, P = 0.012). The trend continued at 6 months, with sodium valproate surpassing amitriptyline in VAS score improvement (95.12% vs. 71.43%, P = 0.021). In terms of headache severity, a greater proportion of sodium valproate patients had ≥ 1-grade improvement at 3 months (90.24% vs. 76.19%, P = 0.047). Additionally, functional disability improvement was significantly higher for sodium valproate at 3 months (97.56% vs. 90.47%, P = 0.031). Overall, sodium valproate proved more effective in alleviating pain and improving headache and functional disability in migraine patients. Among 83 migraine subjects, 19 in the amitriptyline group and 22 in the sodium valproate group experienced adverse drug reactions. Conclusion: Sodium valproate outperforms amitriptyline in improving pain severity, headache intensity, and functional disability in migraine patients. These findings align with earlier research outcomes. Sedation and weight gain were the most common ADRs associated with both medications. Amitriptyline exhibited a higher incidence of ADRs among patients, particularly after the 6-month mark. The results of this investigation indicate that, for individuals with migraines, sodium valproate may represent a preferable choice over amitriptyline.

4. Computed Tomography in Diagnosing Appendicitis in Ultrasound Negative Patients
M. Kishore, Kishore Chautakuri, Sarah Aishwarya E, Abdul Rahman
Abstract
Background: Appendicitis is the most common cause of abdomen pain in patients admitted at the emergency department. The two most common modalities in use are abdominal helical computed tomography (CT) and abdominal ultrasound (US). Aim and Objective: To evaluate the accuracy of CT in identifying appendicitis in ultrasound negative cases. Material and Method: This was hospital based observation study conducted on 120 patients, visited to Department of Radiology, Government Medical College, Siddipet, due to the right lower quadrant pain and negative USG findings, for the duration of one year, after following inclusion and exclusion criteria given bellow and also after approval of institutional ethical committee. Results: In the study we have included 120 patients, after their consent, of them majority were males followed by females. Majority of patients were from the age group of 21 – 30 years of age followed by 10 – 20 years and more than 30 years. Sensitivity and specificity of computed tomography in predicting appendicitis was 100% and 90.54% with accuracy of 94.17%. Conclusion: CT is the gold standard imaging modality to diagnose acute appendicitis in order avoid appendicectomies in this Morden era but also ultrasound can be used as the first line imaging tool in diagnosing  appendicitis.

5. Association of Serum Ceruloplasmin and Uric Acid as Biomarkers for Coronary Artery Disease Diagnosis
Arun Kumar Patil, Chaitanya Y
Abstract
Background: Coronary artery disease (CAD) is the leading cause of death worldwide, ranking among the top eight fatal diseases. Atherosclerosis, characterized by the buildup of plaque in the arteries, is the hallmark of CAD. Oxidative stress, caused by reactive oxygen species (ROS), plays a crucial role in the development of atherosclerosis. LDL oxidation is a potent initiator of the pathological processes leading to CAD. The current study aimed to assess the risk of CAD in patients by utilizing serum ceruloplasmin and uric acid as potential biomarkers. Methods: This study was conducted in the Department of General Medicine, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of 50 subjects were included in the study. Group (T) labeled as “Cases,” comprised 25 patients diagnosed with coronary artery disease (CAD). Group (C) referred to as “Controls,” consisted of 25 individuals of various ages and both genders, who had come for routine health check-ups or volunteered for the study and were without any known medical conditions. Results: The levels of all eight are significantly higher in the CAD group than in the control group. The level of ceruloplasmin is significantly higher in the CAD group than in the control group (p=0.012).  The level of uric acid is significantly higher in the CAD group than in the control group (p=0.044). Overall, the findings of this table suggest that there is a strong positive correlation between serum ceruloplasmin and total cholesterol, LDL cholesterol, and uric acid in both the CVD group and the control group. There is a strong positive correlation between serum uric acid and both total cholesterol (r = 0.664) and LDL cholesterol (r = 0.662) in CAD cases. Conclusion: Serum levels of Ceruloplasmin and Uric Acid were significantly elevated in CAD cases compared to the control group. Furthermore, a positive correlation was established between these parameters. Consequently, this study suggests that Serum Ceruloplasmin and Uric Acid may serve as biomarkers for coronary artery disease.

6. A Hospital Based Clinical Study Assessing Functional Outcome with Different Modalities in Fixation of Proximal Humerus Shaft Fractures
Rupesh Kumar, Anjana, Shashikant Singh
Abstract
Aim: The aim of the present study was to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures. Methods: The present retrospective study was conducted in the Department of Orthopaedics for a period of 1 year. 50 cases who fulfilled the inclusion criteria were enrolled. Results: 46% of the cases were between 41-60 years with 32% between <18-40 years and 22% of cases >60 years of age. The age range was from 19 to 68 years with a mean age of 48.2 years. 52% of cases were females and 48% were males. 64% of the cases sustained fracture on the left side and 36% on right side. 84% of fractures were of closed type and 16% were open. As per Neer’s type of fracture classification, the most common type of fracture observed in our study cases was two-part fracture accounting to 40% of cases followed in order by three part (26%), four part observed in 24% of cases. 5 cases (10%) had fracture dislocation. Road traffic injury was the most common mechanism for injury in 60% of cases and next was a history of fall in 32% of cases and one case was electric shock and other was hit by an iron rod. 23 cases (46%) were managed by open reduction and internal fixation with locking compression plate using 4.5 mm cortical screw plates and 6.5 mm cancellous screws. Percutaneous pinning was done in 10 cases (20%). Open reduction with K-wire was done in 6 cases (12%) and open reduction with K-wire and cancellous screws in 3 cases (6%). Closed reduction with intramedullary nailing was done in 4 cases (8%). The mean scores observed on Neer’s score were pain (34.6 units), function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units). Conclusion: The present study concluded that good surgical skills, surgeons experience in selection of the type of surgery depending upon the factors like type of fracture are necessary to achieve correct and best outcome. Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures.

7. An Analytical Study to Determine the Association between Iron Deficiency Anemia and Febrile Seizure
Pawan Kumar Yadav
Abstract
Aim: The aim of the present study was to determine the association between iron deficiency anemia and febrile seizure. Methods: The study was a hospital-based case-control study which was conducted in the Department of Pediatrics in between the duration of 24 months. A total of 100 Children in the age group from 6 months to 5 years admitted with first episode of simple febrile seizure were taken as cases. The control group included 100 children in the same age group admitted with acute febrile illness without seizures. Results: Majority of children were males (58% and 55% in case and control group respectively). Majority of children belonged to lower socioeconomic class in both the study groups (82% and 64% among cases and controls respectively). Majority of children in both the groups were exclusively breastfed (81% and 72% in cases and control respectively). Initiation of complementary feeding at 6 months of age was poor in children with febrile seizure group compared to controls (22% versus 52%). Mean Hb level among cases was 7.63 g/dl whereas in controls it was 11.68 g/dl, which was statistically significant (p-value<0.001). Mean MCV and MCH levels in the cases were 64.6 fl, 24.06 pg and in controls, these values were 76.82 fl, 31.32 pg, respectively which was statistically significant. Mean RDW among cases was 16.04% compared to controls 11.22% which was statistically significant. Mean serum iron level was found to be low among cases compared to controls (43.47 mg/dl and 119.52 mg/dl respectively). Mean TIBC was 476.4 microgram/dl in cases and 302.8 mcg/dl in control, which was statistically significant (p value<0.001). Transferrin saturation was less among case group (12.08%) compared to controls (36%), the difference was statistically significant. Mean serum ferritin level was 20.50 mcg/l in the cases and 71.65 mcg/l in controls which was statistically significant. Conclusion: Iron deficiency anemia (IDA) was more frequent among children with febrile seizures. The result suggests that IDA may be a risk factor for febrile seizures. Early  detection  and  timely  correction  of  iron  deficiency may be of help for prevention of recurrence of febrile seizures in children of this age group.

8. A Study Evaluating the Association of Socio-Demographic Profile and Life-Style Factors with Acute Myocardial Infarction: An Observational Study
Birendra Kumar, Gitanjali Kumari
Abstract
Aim: The aim of the present study was to study the association of socio- demographic and life-style factors with acute myocardial infarction. Methods: A retrospective study conducted in the Department of General Medicine. Sample size was 200 patients. Patients of acute STEMI who were admitted in our ICCU and thrombolysed were included in this study. Results: In this study, 65% patients were males and 35% patients were females. In this study, there were 56% patients between 40-60 years. In this study, patients had BMI 3% patients had BMI <25 kg/m2, 72% patients had BMI between 25-30 kg/m2, 24% of the patients had BMI between 30-40 kg/m2. In this study 119 (59%) patients had AWMI indicating high prevalence of AWMI in STEMI. 39% patients had inferior wall MI. In our study 32% patients had diabetes. In our study, 45% patients had hypertension indicating it’s the one of the common cause for acute coronary syndrome. 60% had habit of smoking. In this study, 20 patients had depression even though it’s not a significant factor treating depression lowers the ACS risk. In our study patients only 40% patients had Serum cholesterol more than 200 mg/dl. In this study, 85% patients had TGL more than 200 mg/dl indicating TGL is more correlating with. In this study, 28% patients had LDL more than 100 mg/dl indicating LDL is not a good predictor of ACS. In this study, 56% patients had NON-HDL more than 130 mg/dl. Conclusion: Prevention and control of the risk factors for CAD can reduce the rate of CAD. This requires changes in the individual as well as at the community level. Modifying risk factors such as smoking, increased levels of body fat, consuming too much fat and salt, and a sedentary lifestyle together with the use of accessible and affordable preventive medicines, can lower the risk of CAD.

9. A Comparison of Functional Outcomes of Femoral Shaft Fractures Treated with Intramedullary Nailing and Plate Osteosynthesis
Shaheed Abdul Arshad, Mahesh Sagar Athinarapu, Phalgun Kumar. K, Samiullah MD
Abstract
Background: Femoral shaft fractures are most common in young people and older adults. These fractures are frequently caused by high-impact events such as motor vehicle accidents, falls from heights, and pedestrian accidents. In some cases, they are associated with injuries to multiple body systems. Given the substantial risks and potentially severe consequences, it is crucial to promptly assess and provide the appropriate treatment for these injuries. Methods: A total of 30 consecutive cases of femoral diaphyseal fractures divided into two group of 15 each with group I were the cases who underwent plate fixation and group II were the 15 cases who underwent intramedullary nailing were recruited. To confirm the diagnosis, a physical examination was conducted, which included assessing for the absence of an open wound communicating with the fracture hematoma in the thigh, and plain X-rays of the affected thigh with the hip and knee joints in two views (anteroposterior and lateral views) were performed. Results: The majority of shaft of femur fractures in both treatment groups were located in the middle third of the femur (66.67% in plate fixation group and 73.33% in intramedullary nail group). according to the Winquist and Hansen classification. As you can see, the majority of patients (80%) had Group I fractures, which were treated with plate fixation. Based on Thoresen’s criteria. In Group I, 7 patients (46.67%) had an excellent functional outcome, 4 patients (26.67%) had a good functional outcome, 2 patients (13.33%) had a fair functional outcome, and 2 patients (13.33%) had a poor functional outcome. In Group II, 12 patients (80%) had an excellent functional outcome, 2 patients (13.33%) had a good functional outcome, 1 patient (6.67%) had a fair functional outcome, and 0 patients (0.00%) had a poor functional outcome. Conclusion: Based on the findings of this study, we can conclude that the initial functional outcomes of closed femoral shaft fractures in adult patients are notably better when treated with locked intramedullary nailing compared to plating, as per the Thoresen criteria. Therefore, we recommend the use of the locked intramedullary nailing technique as a suitable approach for managing closed femoral shaft fractures in adults in order to achieve favorable outcomes.

10. Comparison of Postoperative Analgesia between Two Pharmaceutical Forms of Diclofenac (Transdermal Patch versus Intravenous) for Patients Undergoing Inguinal Hernioplasty: A Randomized Control Study
Om Prakash Kumar, Saumya Sinha, Mukesh Kumar, Shubham Kumar
Abstract
Background: Perioperative pain control is an important factor since it affects the patient’s postoperative morbidity and outcome. Early mobilisation and discharge are facilitated by optimal pain management. Since oral drugs are not allowed in the early postoperative period, injectable analgesia is the most often used painkiller. With a better understanding of the pathophysiology of pain and newer drug delivery methods, efforts are being made to provide patients with adequate pain relief while maximising drug action and minimising systemic side effects, so that when the drug is administered in a suitable way, the patient is also comfortable with it. Methods: To compare the analgesic effects of diclofenac transdermal patch 100 mg and diclofenac intravenous 75 mg, we conducted a study on 50 patients with ASA I and II grades, ranging in age from 21 to 70 years, and of either gender. Using a computer-generated random number table, the participants were randomly split into 2 groups of 25 each: the group receiving a transdermal patch received a diclofenac patch; the group receiving an intravenous injection received an intravenous injection of diclofenac. By comparing the VAS score and hemodynamic response to pain in both research groups, the length of postoperative analgesia was determined. Both research groups’ total number of rescue analgesia prescriptions and their duration were documented. When a patient’s VAS score was higher than 3 in the first 24 hours, injection tramadol 2 mg/kg was administered. After administering the study medicines, adverse symptoms such as nausea, gastroenteritis, vomiting, erythema, and pruritis were seen. Results: Over time, the mean VAS change was similar across the two groups (p-value> 0.05). It was also determined that the two groups’ patterns of change were comparable (P value > 0.05). Effective analgesia might be achieved with either the diclofenac patch or intravenous The diclofenac patch resulted in a higher pain score 12 hours after surgery, compared to the intravenous. The duration in the patch group was longer than in the intravenous group (p < 0.05). There were fewer systemic adverse effects and fewer signs of local irritation with transdermal patch administration compared to intramuscular injection. Conclusions: It was concluded that Transdermal diclofenac patch (100 mg) is a better analgesic route than intravenous diclofenac (75 mg) for pre-emptive analgesia in patients undergoing inguinal hernioplasty.

11. Professional Quality of Life and Difficulties in Emotion Regulation of Dead Body Handlers in Kerala
Jomon Jacob, P.T. Baburaj, Deepu T., Seena Sebastian, Nisheed Aubid
Abstract
Introduction: The objective of the current study was to evaluate the professional quality of life and emotion regulation challenges faced by those who handle dead bodies on a daily basis, particularly forensic doctors. Methods: The study was survey research conducted for a period of one year by administering two instruments, namely the PROQL scale and the DERS scale, to 175 selected samples. The population of the study was all forensic doctors handling dead bodies. Results: The major findings of the study were that the majority of the dead body handlers, 114 or 65%, possessed moderate professional quality of life, and 125 or 71.4% of the total sample had moderate emotional regulation. People who directly handled dead bodies had more difficulties with emotion regulation and a poorer professional quality of life than those who indirectly handled people. Emotion regulation had a positive correlation with professional quality of life. Conclusion : The present study has shown that PROQL and emotion regulation were not poor among dead body handlers in Kerala. There was a significant correlation between PROQL and emotion regulation. Further research into the PROQL and emotion regulation can help formulate policies and practices aimed at improving the working conditions and well-being of dead body handlers, which will ultimately improve the quality of care provided to the deceased and their families.

12. A Study on Teenage Pregnancy and its Outcome from a Tertairy Care Setup
Aswini Vuyyuri, Sarojini Devi V
Abstract
Introduction: Teenage pregnancy (TP) a burning problem in developed as well as developing countries. Studies reported that nearly 10% of girls become pregnant by 16 years. With these a study was conducted to find the incidence and contributing factors of TP and its outcome. Methods: It was a prospective research. Pregnant women aged <19 years, both multi and primi gravida were included. Non cooperative women and pregnant women aged >19 years were not considered.  The clinical as well as obstetric history were recorded. Onset of menarche, details of menstrual history and the date of last menstrual period were noted and expected date of delivery (EDD) was calculated by Naegele’s rule. The EDD was conveyed, advised to attend the antenatal clinic regularly. Haemoglobin percentage, blood grouping, fasting blood sugar were estimated. Pelvic assessment was done at 38 week and admission was advised few days before the EDD, high risk members admitted two weeks before EDD. The post-natal follow up for general condition, evidence of infection and persistence of blood pressure in cases of hypertension were done. The particulars of the new born whether live or not, apgar score at one minute, maturity, weight, sex and any malformations if present were noted. Babies were admitted in NICU, if required. Perinatal mortality and maternal mortality were recorded. Results: Total 670 TP were included, 18.5±0.6653 was mean age. Highest number were reported in 19 years (379; 56.6%). Nearly 19.9% (133) were illiterates and just 3.9% (26) completed college education. Majority (66.9%; 448) were belong to upper lower socioeconomic category. In this study just 0.9% (6) were unmarried and most of the study members were gravida 1 (419; 62.5%). Anaemia was the commonest (74.7%; 501) comorbid condition. The incidence of abortion was 4.3%, oligohydramnious was the commonest (2.2%; 15) complication. Conclusion: TP is common in this area also. Anaemia is found to be the common clinical condition. Low socioeconomic status is the main contributory factor.

13. Usefulness of RET-He in Evaluation of Anemias in Pediatric Age Group in A Tertiary Care Centre, in Telangana, A Cross Sectional Study
Fakeha Firdous, Zu Afshan Sultana, Anjani M, Md. Saad Hussain, G J Vani Padmaja
Abstract
Introduction: Anemia in pediatric age group can be due to various etiologies ranging from simple nutritional cause to severe cause like haematological malignancy. Childhood anemias need to be evaluated thoroughly in order to reduce the morbidity of these children. Routine biochemical parameters are helpful in evaluating anemias. RET-He is an important marker for early detection of anemia, thereby reducing the morbidity of the cases. Aim: To study the usefulness of RET-He in anemic children by comparing it with other parameters of hemogram and HPLC. Materials and Methods: This cross sectional study was carried out in Pathology department of Tertiary care pediatric hospital in Telangana, India, from May 2022 to May 2023.The RET-He values were compared with various parameters in the hemogram along with HPLC of the patients. Results: A total of 172 cases were evaluated and the levels of RET –He was compared with other hemogram parameters and HPLC. Conclusion: It was concluded that reticulocyte haemoglobin levels provides us useful information for the early diagnosis, treatment and monitoring of anemias in pediatric age group.

14. A Prospective Observational Assessment on Pattern of Acute Poisoning Cases with Drug Utilization and their Outcome in a Tertiary Care Hospital
Choppadandi Anil, Sharan Kumar K B, Kasireddy Govardhan Reddy
Abstract
Introduction: Poisoning has become an important cause for concern not only in India but globally over the past few years. Pattern of poisoning varies depending upon geographical regions of the country. It is necessary to analyse epidemiologic data every year on acute poisoning cases at each medical setting for better handling and managing drug and antidote stockpiles. Aim and Objectives: To estimate the incidence, nature, severity, pattern of acute poisoning cases with drug utilization and treatment outcome, including drug overdose and venomous snakebites and also to suggest strategies to reduce associated morbidity and mortality in a tertiary care setting. Material and Method: A Prospective observational study was conducted on 362 patients of either of cases at CAIMS, a tertiary care teaching hospital, Karimnagar, for a period of one year starting from June 2022 to May 2023. Patients admitted with diagnosis of poisoning/animal bites in medical wards of hospital were enrolled in the study after obtaining informed consent and approval of Institutional ethical committee and following inclusion and exclusion criteria. Results: Of the total Male to female ratio was 3:1, majority from age group Male to female ratio was 3:1. intentional poisoning cases for suicidal attempt were 70.42.% and 29.58% cases were due to accidental poisoning. Incidence of acute poisoning cases was more common among males. Pesticides were commonly used agents for poisoning followed by others. Conclusion: From study we can conclude that, for the better management and prevention of poisoning cases, there should be need for a poison information centre. This study has managed to contribute significant additional information regarding the pattern and outcome of poisoning in a tertiary care hospital at a district level.

15. Clinical Study to Evaluate the Outcome of Conservatively Managing the Posterior Malleolus Fracture in a Trimalleolar Ankle Fracture
Gaurav Agarwal, Harshit Khare, Gaurav Jain
Abstract
Background: Ankle fractures are one of the most common lower limb injuries, accounting for about 9 % of all fractures.  The incidence of ankle fracture is roughly 187 cases per 1 lac people each year, out of which 7-11% constitutes the Trimalleolar ankle fracture. [1] The treatment of the posterior malleolus still remains controversial as to when to fix it and when to conservatively manage it, if at all. This Clinical study aimed at assessing the functional outcome of conservatively managing the posterior malleolar fragment of Trimalleolar ankle fractures based on functional scoring systems. Materials and Methods: 30 patients with Trimalleolar ankle fracture were managed with operative treatment for medial and lateral malleoli and conservative management for posterior malleoli. The functional outcome was evaluated at 6 months by AOFAS score. Result: The mean age in this study was 35.4 years (range 20 to 55 years) with male and right-side predominance. The mean follow up was 5.4 months (range 2 to 7 months). The mean AOFAS score at 6 months follow up was 88.6 (range 71 to 93), with 18 cases having an excellent score,7 cases of a good score and 5 cases with a fair result. None of cases had poor results. None of the patients have any limitation to the daily activities, wound dehiscence, gait abnormality, implant failure, non-union. 5 patients had limitation of recreational activities but without support. Conclusion: Conservatively managing the posterior malleolar fracture can give favourable functional outcome but requires further comparative studies and employ the use of CT for better diagnosis and decision making.

16. Age Distribution of Various Prostatic Lesions: Hospital Based Study
Shah Mitesh, Agrawal Ruchi, Gaur Rajesh
Abstract
Introduction: Benign prostatic hyperplasia and prostatic adenocarcinoma are the common prostatic diseases found in most of the patients. There is increase in incidence of BPH worldwide and predicts by the age of 60 years more than 50% of men will have microscopic evidence of the disease. Although the etiology of prostatic cancer remains unknown, the most consistent risk factors are advanced age and racial/ethnic factors. Hence present study was an effort to find age distribution of various prostatic lesions. Objectives: To determine the age distribution of patients with prostatic lesions of Gwalior region. Materials and Methods: Study was conducted in the Department of Pathology, Gajra Raja Medical College and J.A. Group of Hospitals, Gwalior (M.P.) over prostatic specimens that received over a period from 2015-2017. The prostatic specimens include transurethral resection of prostate chips, prostatectomy specimen and needle biopsy samples. Result: Among benign lesions 05 cases (5.5%) are in age group 40-49 years, 17 (18.7%) in 50-59 years, 35 (38.4%) in 60-69 years, 26 (28.5%) 70-79 years, and 07 (7.7%) in 80-89 years, 01 (1.1%) in 90-99 years. 2 cases (11.8%) of Prostate adenocarcinoma are in age group 40-49 years. 6 (35.3%), 5 (29.4%) and 4 (23.5%) cases are in 60-69, 70-79 and 80-89 years age group respectively. Correlation is statistically not significant. Highest Gleason score found was 8 and maximum number of Gleason score 8 cases are in age group 80-89 years. Conclusion: Present study shows both benign and malignant lesions are more common in older age group mostly above 60 years of age. Severity of prostatic adenocarcinoma also seems to be higher for older age patients.

17. Prescription Audit Study From a Tertiary Care Teaching Hospital in Telangana
Pendurthi Vidyasagar, Karrepu Sri Chaitanya Reddy, Cheemala Naresh Yadav, Yamini Vadlamannati, Naser Ashraf Tadvi
Abstract
Background: The inappropriate use of drugs is a global health problem, especially in developing country like India. Irrational prescriptions have an ill effect on health as well as health-care expenditure. Prescription auditing is a crucial tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. Methods: This observational cross-sectional study was conducted for a period of one month in GMC, GGH, Nalgonda. All prescriptions were analysed for Demographic data, medical components and WHO core drug use indicators. The obtained data was expressed in percentage and frequency. Results & Conclusion: The prescribing practices in this study were good regarding mentioning of general details of patients and hospital, and satisfactory regarding handwriting legibility of physicians and average number of drugs prescribed per prescription.

18. A Medication Audit to Assess the Knowledge and Practice Among Community Pharmacists Regarding Medication Dispensing and its Safety in Pregnancy
Nivethitha T, Vijayarangan S, Suguna Anbazhagan
Abstract
Introduction: Medication use during pregnancy is challenging because of the potential fetal risk associated with its use. Pharmacists are primary health care providers for a pregnant woman. Hence the main objectives of the study were to determine the knowledge among community pharmacists towards drug dispensing and its safety in pregnancy and also to assess the knowledge and practice gaps by performing a medication audit. Materials and Methods: The study was a mixed method study conducted among community pharmacists within the field practice area of Trichy SRM Medical College Hospital for 3 months. 260 pharmacists were enrolled. The knowledge was assessed by a pre-tested semi-structured questionnaire. A medication audit was performed of the medications dispensed to pregnant women by the community pharmacist for the past 3 months. Results: The average knowledge score was 6.64 ± 1.36. The knowledge scores were higher among B. Pharm graduates and (7±1.8), Pharmacists with experience 5 to 9 years (7.6±0.9) which were statistically significant (p<0.05). Pharmacists dispensed ≤ 50 prescriptions per day (n=135, 52%). Analgesicswere most frequently dispensed (n=115, 44%). None the prescribed drugs belonged to FDA Category X and were dispensed in the prescribed dose, duration and frequency. However, 202 pharmacists dispensed drugs without prescription, at patient request (n=83, 33%) and based on previous knowledge (n=52, 20%) and experience of the pharmacist (n=41, 16%). Conclusion: The community pharmacists had average knowledge and a gap between knowledge and practice. Hence there is a need for continuous education programmes to ensure safe and effective drug dispensingamong pregnant women.

19. Comparing IV Fentanyl Alone to a Combination of IV Fentanyl and Nebulized Lignocaine for Minimizing Hemodynamic Responses during Laryngoscopy and Endotracheal Intubation in Elective Surgeries under General Anesthesia
Kiruthika Rathinasabapathy, L. Uma Pradeepa, Devendran P, K Uma
Abstract
Background: Laryngoscopy and intubation are essential steps in the administration of general anesthesia for various surgical procedures. These procedures are critical tools for anesthesiologists in managing the airway, involving the manipulation of airway structures. The current study aimed to determine the efficacy of IV fentanyl 2µg/kg versus a combination of IV fentanyl 2µg/kg and 4% lignocaine nebulization 3mg/kg on hemodynamic responses during laryngoscopy and intubation. Methods: A total of 80 ASA I-II patients aged 18-45 years scheduled for elective surgeries under general anesthesia based on the inclusion and exclusion criteria were selected and randomly allocated for this comparative cross-sectional study. The study cases were divided into two groups. In Group A, Patients received IV fentanyl 2 μg/kg and in Group B patients received IV Fentanyl 2µg /kg with nebulized 4% lignocaine 3mg/kg. Results: The results indicated that the combination of IV fentanyl with nebulized lignocaine was effective in attenuating the hemodynamic response. The mean age and weight of the two study groups showed no statistical difference, and there was no significant difference in heart rate over time between the groups. Analysis of blood pressure revealed that systolic blood pressure in the Fentanyl-only group (Group A) was higher than the IV Fentanyl + Lignocaine nebulization group (Group B) from the 1st minute, with statistical significance observed after 6 minutes. Similarly, diastolic blood pressure in the Fentanyl-only group was higher than the IV Fentanyl + Lignocaine nebulization group from the 1st minute, with statistical significance (p < 0.05) noted at the 1st minute and 6 minutes onwards. Conclusion: Fentanyl and lidocaine nebulization were more effective than fentanyl alone in reducing SBP during anesthesia, particularly in the later stages of anesthesia. Fentanyl and lidocaine nebulization were more effective than fentanyl alone in reducing DBP during anesthesia, particularly in the later stages of anesthesia. No significant adverse effects were observed in either group.

20. Prognostic Insights: Mortality Prediction in Dengue Patients at a Tertiary Care Center
Kinjal Patel, Nikhil Shah, Dipesh Patel, Purvi Patel
Abstract

Introduction: Dengue fever, a globally pervasive mosquito-borne viral infection, poses a significant health threat, particularly in tropical regions. While often presenting as a self-limiting febrile illness, a subset of patients can progress to severe forms, necessitating a deeper understanding of mortality predictors. This study explores critical factors such as severe plasma leakage, thrombocytopenia, age, and comorbidities that influence mortality in dengue patients. Recognizing these predictors is vital for early intervention, significantly impacting patient outcomes. Materials and Methods: In this study at NAMO Medical Education and Research Institute, Silvassa, we explored mortality predictors in dengue patients from January 1 to December 30, 2022. Our inclusive approach covered all ages and genders. Ethically approved, the study involved a meticulous review of medical records, assessing demographics, clinical data, and comorbidities. Patient evaluations included history, physical exams, and lab tests. Descriptive statistics and various tests identified mortality predictors. This comprehensive methodology unveils the intricate dynamics of mortality prediction in dengue patients. Results: In our study of 100 subjects, we observed a mean age of 40.2±15.2 years, with 59% males and 41% females. The mean hospital stay was 5.5 ± 3.2 days, and complications were reported in 39%, with an overall mortality rate of 11%. Comparing 11 non-survivors to 89 survivors, non-survivors were older (49.2 ± 18.5 years vs. 37.4 ± 15.3 years, P = 0.01) and exhibited higher rates of leukocytosis, elevated CRP, and acute kidney injury. Our univariate and multivariate analyses identified age, leukocytosis, and acute kidney injury as potential predictors of mortality, emphasizing their significance in determining outcomes in dengue patients. Conclusion: our study identifies advanced age, leukocytosis, elevated CRP, and acute kidney injury as significant predictors of mortality in dengue fever patients. These findings underscore the complexity of dengue prognosis and emphasize the importance of a multifaceted approach in clinical assessments.

21.Association between Sleep Disorders among Adult Patients in a Tertiary Care Center in North India
Satish Kumar Budania, Prabhukiran V Gogi , Hemant Kumar, Sachin B S, Sunil Kumar
Abstract
Objective: This study aimed to evaluate the association between sleep duration and hypertension among adults in tertiary hospital in India.  Methods: Baseline variables were collected from a representative sample of 200 adults aged 23–98 years in a tertiary hospital in North India who received physical examinations from January 2021 to December 2022. All participants were categorized into either a hypertension group or a non-hypertension group. Sleep duration was classified as short (<6 h/day), normal (6–8 h/day),or long (>8 h/day). Baseline variables were compared between individuals with and without hypertension by rank-sum tests for two independent samples or χ2 tests for nonparametric data. Multivariate logistic regression analysis was performed to evaluate the association between sleep duration and hypertension.  Results: The overall incidence of hypertension was 51.2%. Unadjusted analysis showed that the risk of hypertension was higher in individuals with short (<6h/day) or long (>8h/ day) sleep durations compared with those with a normal (6–8 h/day) sleep duration. The risk of hypertension was significantly increased by 30.1% in participants with a long (>8h/day) sleep duration compared with those with a normal (6–8h/day) sleep duration (OR = 1.301, P < 0.010, 95%CI = 1.149–1.475). The risk of hypertension was also increased by 1.1% in participants with a short (<6h/day) sleep duration compared with participants with a normal (6–8h/day) sleep duration, but the difference was not significant (OR = 1.011, P = 0.849, 95%CI = 0.905–1.129). After fully adjusting for confounding factors (model 4), the risk of hypertension was increased significantly (by 25%) in individuals with a short (<6h/day) sleep duration (OR = 1.25, P = 0.02, 95%CI= 1.036–1.508) but not in those with a long (>8h/day) sleep duration (17.5% increase) compared with participants with a normal (6–8h/day) sleep duration (OR = 1.175, P = 0.144, 95%CI = 0.946–1.460).  Conclusion: The results of this study indicate that a short (<6h/day) sleep duration is related to an increased risk of hypertension, suggesting that sleep helps to protect against hypertension.

22. A Study on Adverse Effects of Antiepileptic Drugs in a Tertiary Care Hospital
Kotra Vijay Kumar
Abstract
Background: A study was planned to overlook the adverse effects of antiepileptic drugs in tertiary care hospital Methods: It is a cross sectional study conducted on total of 184 patients in the medical department of tertiary care hospital. The data was entered in Microsoft excel. Inclusion criteria includes patients who are diagnosed with epilepsy and are aged greater than 17 years. Results: Among 184 patients 56.5% were male and 43.4% were female. About 43% were treated with monotherapy and  And 57% were treated with polytherapy. The most common side effect is sedation. The statistical analysis showed statistically significant between polytherapy and monotherapy patients against sedation (p value < 0.05) Discussion and Conclusion: Levetiracetam is the safest drug. According to a study, side effects due to polytherapy are more than side effects due to monotherapy. We can reduce adverse effects by reducing the combinational therapy.

23.Clinical Presentation and Management of Hydatidiform Mole Cases
Sushma Kumari, Priyanka Kumari
Abstract
Hydatidiform mole is an abnormal pregnancy of clinical and epidemiological importance because it affects women in the reproductive age group and is potentially fatal with a lot of associated morbidities. Hydatidiform mole is the non- malignant form of gestational trophoblastic neoplasia. The prevalence of 1:250 to 1:500 has been reported which vary widely in different parts of the world. Therefore, Knowledge of prevalence and associated risk factors may add value in the management outcomes of molar pregnancy in our setting.  Objectives of this study  was to determine the  clinical presentation and management outcome of Hydatidiform mole . We assessed 30 women who clinically diagnosed with hydatidiform mole in Tertiary Hospital during 2019-2021 . The diagnosis of HM was based on a pelvic ultrasonography, quantitative estimation of the serum We assessed 30 women who clinically diagnosed with hydatidiform mole Tertiary Hospital. 66.66 % cases had Uterine size> Gestational age. 93.33 % cases had Vaginal bleeding. 50% cases had Hyperthyroidism. 96.66 % cases were treated by Uterine suction evacuation and curettage. Hydatidiform mole remains an important cause of maternal morbidity which is largely due to poor and inadequate follow-up. Better outcome is possible with good patients’ counseling for improved follow up.

24.A Comparative Study of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Bupivacaine in Lower Abdominal, Perineal and Lower Limb Surgeries
Jayanta Padun, Barnita Basumatary, Arnav Das, Dibyajyoti Sonowal
Abstract
Introduction: Neuraxial administration of opioids along with local anaesthetics improves the quality of intraoperative analgesia and also provide postoperative pain relief for longer duration. Fentanyl in various doses( 10, 20, 30, 40 micrograms) when added to intrathecal bupivacaine significantly reduces somatic and visceral pain and prolongs the time of regression of sensory block. Dexmedetomidine has been used for premedication and as adjunct to general anaesthesia. It reduces opioid and inhalational anaesthetics requirements. Intrathecal α2-receptor agonists are found to have anti nociceptive action for both somatic and visceral pain. Aims and Objectives: To compare the subarachnoid block characteristics, quality of  analgesia, sedation, haemodynamic properties, sedation and any any adverse effects between dexmedetomidine and fentanyl as adjuvant with intrathecal bupivacaine Materials and Methods: Total 120 patients were randomly allocated in two groups. Group d (n=60) = received 5 micrograms (0.5ml) dexmedetomidine with 15 milligrams (3ml) of 0.5% hyperbaric bupivacaine intrathecally. Group f (n=60) = received 25 micrograms (0.5ml) of  fentanyl with 15 milligrams (3ml) of 0.5% hyperbaric bupivacaine intrathecally. Onset of analgesia, quality of motor block, haemodynamic properties, any adverse side effects were noted, Conclusions: In conclusion , dexmedetomidine (5 µg) seems to be a better alternative to fentanyl (25 µg) as additive to intrathecal hyperbaric 0.5% bupivacaine (15 mg), since it produces more prolonged sensory and motor block with similar kind of haemodynamic stability , better postoperative analgesic and sedation and is assaociated with lesser adverse effects.

25. A Correlative Study of Serum CRP with Thyroid Dysfunction in Covid-19 Patients Admitted in a Rural Referral Hospital
Amulya. T, Bhagyamma. S.N, Sandhya Rani B, Durga. T, Shyam Prasad B.R
Abstract
Introduction: A novel coronavirus, also known as SARS-COV-2 was responsible for the COVID-19 global pandemic that began in December 2019. There seems to be a complex interplay between the causative agent and the inflammatory-immune responses occurring in the body in response to the infection. The triggered immune response is believed to affect multiple systems including endocrine system. Serum C-reactive protein (CRP) is one of the sensitive markers for inflammatory response.  Aim: To study the correlation between serum CRP values and possible thyroid dysfunction in Covid-19 positive patients. Materials & Methods: A retrospective study was done on 50 patients who were admitted between May and October of 2021 with covid-19 infection at Government General Hospital, Ananthapuramu. The data regarding serum CRP and Thyroid parameters (Total T3, Total T4, TSH) was collected and analyzed for correlation between them by Pearson correlation using SPSS-25. Results: The study showed correlation coefficient (r) values between thyroid parameters and CRP as: Total T3 values are positively correlated with serum CRP levels in Covid-19 patients with a correlation coefficient, r=0.525 (p < 0.01). Total T4 values are positively correlated with serum CRP levels in Covid-19 patients with a correlation coefficient, r=0.9 (p<0.01). TSH values are negatively correlated with serum CRP levels in Covid-19 patients with a correlation coefficient, r = -0.475(p<0.01) Conclusion: There is a significant positive correlation between Total T3 & T4 values with CRP and a significant negative correlation was seen between TSH and the bio-inflammatory marker, CRP.

26.Comparative Study between Single vs Double Layer Intestinal Anastomosis
Juhi Singh, Anju Nagar, Dharmraj Meena, Meenesh Meena, Radheyshyam Meena
Abstract
Background: In gastrointestinal surgeries, intestinal anastomosis is a routine and important process. While double layer anastomosis was once thought to be secure, several surgeons now contend that single layer anastomosis with non-absorbable suture yields comparable outcomes. Methods: A single-centre retrospective cohort comparative study was conducted in the Department of General Surgery, Govt. Medical College and Hospital, Kota, Rajasthan, India during April 2022 to June, 2023. A total of 50 patients were taken, out of which 35 underwent double layer anastomosis and 15 patients had single layer anastomosis. Result: A total of fifty patients were enrolled; thirty-five underwent double layer anastomosis and fifteen underwent single layer anastomosis. Accordingly, the patients in each group were matched for diagnosis, sex, and age. Both the length of hospital stay and the mean time required for anastomosis were significantly shorter in Group-A. Compared to the double layer group, the single layer group experienced a faster postoperative return of bowel function. The double-layered group incurred a comparatively higher cost for the suture material used. However, there was no significant difference in the complication rates between the two groups. Conclusions: There is not much difference in development of complications in both the methods. Both have same efficacy, mean time taken return of bowel movements. A single layer requires less operating time and is more economical.

27. Efficacy of Suprascapular Nerve Block Guided by Anatomical Landmarks in Arthroscopic Shoulder Procedures to Alleviate Postoperative Pain
Ravindra Gandhi, Duraiya Gulamali
Abstract
Background and Aim: By enhancing perioperative pain management, regional anaesthesia in shoulder arthroscopy decreases the necessity for analgesics and their well-documented adverse effects. At times, a particular type of anaesthetic block may not be appropriate for the anatomy or comorbidities of a patient or its safe execution may necessitate the expertise of a specially trained anaesthetist. The purpose of this research is to assess the analgesic effectiveness of suprascapular nerve block during shoulder arthroscopic procedures. Material and Methods: The results of an observational investigation involving sixty patients who underwent arthroscopic surgery. Thirty patients out of sixty had undergone blind suprascapular nerve block; the remaining thirty patients had not been administered block. For both groups, pain scores (NRS), rescue analgesics for breakthrough pain, and total fentanyl consumption were documented. Results: Of the total number of cases, 51 were rotator cuff repair, 4 were SLAP repair and 5 were bankart repair. There was only a statistically significant difference in the NRS value between the groups in the immediate 0 hours postoperative period (p value > 0.05). At 1, 4, 8, and 12 hours, no statistically significant difference existed between the two groups. The acute pain service’s records were consulted to determine the total number of fentanyl doses required over a period of 12 hours. The doses required were greater in the GA-only group than in the GA+SNNB group. Conclusion: In comparison to patients who solely received IV PCA, the total opioid consumption of patients who received SSNB was not significantly reduced. It is our determination that blind SSNB does not provide an additional benefit in relation to alleviating discomfort during arthroscopic shoulder procedures. Additional research involving a more extensive cohort of patients may, nevertheless, contribute to a deeper understanding of this postoperative analgesic approach.

28. Determination of Foot Surface Area as a Ratio of Body Surface Area, in Maharashtra Population.
Ravindra Vedpathak, Nishigandha Sadamate, Ranjit S. Ambad, R. B. Vaidya
Abstract
Introduction: Estimation of Total Body Surface Area (TBSA) plays crucial role in variety of clinical conditions, such as Renal Clearance, Cardiac Index, Chemotherapy and Glucocorticoid dosage, and also in Thermal Burns related injuries.  In small and patchy burns patients hand is used to estimate percentage of burn which is traditionally 1%, Feet surface area values of this kind are usually estimated as a percentage of TBSA and it is 7% according to Lund and Browder chart. There is a discrepancy about what percentage of TBSA is continued by the Foot, therefor this study was designed to determine correctly the TBSA represented by the Foot surface area in Maharashtra population. Aim and Objective: To correlate morphometric measurements of Foot with the Total Body Surface Area. Materials and Methods: 512 healthy adult age group from 30 – 40 years of both sexes (255 male and 257 female) are selected. Right and Left Foot Surface area and Body Surface area was calculated using Du Bois  and  Du Bois  formula. Result : The mean Foot ratio of both sides for male and female was 3.28% and 3.18% respectively. Conclusion: The Hand surface area is around 3.25% of TBSA in Maharashtra population.

29. Evaluation of Immature Reticulocyte Fraction in Microcytic Hypochromic Anaemias of Paediatric Age Group in Tertiary Care Hospital-a Cross Sectional Study
Zu Afshan Sultana, Fakeha Firdous, Anjani M , Md. Saad Hussain, G J Vani Padmaja
Abstract
Microcytic hypochromic anemia is characterized by presence of microcytic and hypochromic RBC’s on peripheral smear and MCV of less than 80fl.It could be due to iron defeciency anemia or thalassemia or other causes. Differentiation between the thalassemia and non thalassemic microcytosis has important clinical implications, because each has a different causes, pathogenesis, prognosis and treatment.  The assessment of reticulocyte maturation is useful in understanding pathophysiology of anemias.  Immature Reticulocyte Fraction [IRF] represents the proportion of young reticulocytes with highest RNA content. It is a sensitive measure of erythropoiesis. Its clinical utility has been reported in a variety of conditions. It’s analysis has been made easy by the use of automated hematology analyzers.  In our study which was carried out in a tertiary pediatric hospital in Telangana, all microcytic hypochromic anemia patients in the age group of new born to 12 years of age were evaluated. IRF is an important parameter which helps in diagnosis and thereby helps in treatment at an early stage itself,thereby decreasing the morbidity in pediatric population . IRF helps in differentiating etiological causes of anemia like nutritional anemia, hemoglobinopathies and aplastic crisis.It also gives information about the recovery status of anemia cases on treatment.  IRF is a simple, quick, effective and cost effective tool on automated hematology analyzers, which helps in diagnosing anemia cases.

30. Agenesis of Thyroid Isthmus in Adult Human Cadavers.
Nishigandha Sadamate, Ravindra Vedpathak, Ranjit S. Ambad, Swati Belsare
Abstract
Introduction : The thyroid gland is the most common endocrine organ which gets operated throughout the globe. It is ensheathed by the pre-tracheal layer of deep cervical fascia. The two lobes are connected by a narrow median isthmus.  In our study, on the morphometric features of the thyroid gland it was found that, 4 out of 25 thyroid glands that were dissected, showed an absence of the isthmus. The respective lateral lobes were positioned independently on either side of the trachea. The incidence of agenesis of isthmus, along with the developmental and clinical significance are discussed. Aim and Objective : To study the morphometric features of the thyroid gland with its neurovascular relations.  Materials and Methods : The Morphometric study carried on 25 human adult cadavers aged between 40 to 70 years, out of which 19 were male and 6 were female cadaver. Various morphometric parameters like length of lobes, width of lobes, height of isthmus, levator thyroidae glandulae and pyramidal lobe were recorded. Observation : Absence of isthmus is rare in humans, In this morphometric study out of 25 thyroid glands only two glands with agenesis of thyroid isthmus. Conclusion : On the partial thyroidectomy, the surgeon should aware of the absence of the isthmus which  may be associated with absence of whole or part of the lobes. He should assess whether the remaining portion of thyroid gland is present and functioning otherwise patient may be inadvertently rendered hypothyroid.

31. Ascertain Fundamental and Legal Knowledge about the Art of Prescription Writing in Tertiary Care Hospital
Harcharan Singh, Monika Gaur, Urmila Choudhary and Dishika Choudhary
Abstract

Background- A medical student to become a prescribing physician, must acquire both the fundamental and regulatory understanding of prescription writing. Prescriptions become the most significant clinical pharmacology tool and proof of pharmaceutical access, prescription errors, prescribing errors, negligence, and subsequent litigations. Given the rising violence against doctors in India, a cross-sectional questionnaire-based study was conducted to assess participants’ understanding of the fundamental and legal aspects of writing prescriptions. Methodology- The basic and regulatory knowledge and awareness of 90 doctors was evaluated for arts of prescription writing by a novel questionnaire based on Indian regulatory guidelines. It was assessed for content validity and reliability. A total of 39 questions comprised of 70 statements categorised into three broad sections containing 13 questions in each were asked in 30 min. Results- Doctors’ knowledge of writing prescriptions is very limited. Most doctors do not knew that over-the-counter drugs do not require a prescription, that a pharmacist is the one who decodes their written prescriptions, that it is illegal to cross-prescribe (write a prescription for a drug from another system of medicine), or that they should not transcribe prescriptions over the phone. Conclusion- Prescription mistakes plague the practice of writing prescriptions for medication access. The doctors’ grasp of prescription writing basics and regulations is poor. It is therefore necessary to train them in prescription writing through standardized worldwide teaching modules. Prescription communications between physicians and patients must adhere to national regulatory requirements and be clear, accessible, thorough, and direct.

32.Evaluation of Glycaemic Status and Diabetic Kidney Disease among Patients with Type 2 Diabetes: A Cross-Sectional Analytical Study
Shubham Jain, Birata Debbarma, Devdas Rai
Abstract

Background: Diabetic kidney disease is a major risk factor for microvascular and macrovascular complications in diabetes patients but recently, fewer studies have correlated glycaemic status and diabetes kidney disease in south Indian population. Objective: To evaluate the relation between glycaemic status and diabetes kidney disease in type 2 diabetes mellitus (T2DM). Methods: This was a Cross-sectional analytical study among T2DM patients. Poor glycaemic status was defined as a serum value of glycosylated haemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values > 30 mg/dl in the first morning urine.  Results: 100 cases of Type 2 DM patients comprises  75% males. The prevalence of diabetes kidney disease was 60%. The prevalence of microalbuminuria in groups with poor glycaemic status was 46% and adequate glycaemic status was 40% only. The findings were statistically significant between poor glycaemic status and albuminuria(Microalbuminuria, Mean FBS 201.33 mg/dl, 95% CI 185.6-216.9, Macrolbumininuria, mean FBS 219.6 mg/dl, 95% CI 180.8-258.4). Conclusion: The prevalence of poor glycaemic status and Diabetes Kidney disease was high among T2DM patients.

33. Analysis of the Intraoperative and Postoperative Analgesic Efficacy of Transabdominal Block vs. Caudal Block in the Adolescents Experiencing Laparoscopic Appendectomy
Neha Rusia Saxena, Deepesh Saxena, Nitin Ojha, Pallavi Singh
Abstract
Background: Laparoscopic appendectomy is often conducted in the adolescents population. Regional anaesthesia for young patients is an adjunct to general anaesthesia, enabling conscious postoperative analgesia and minimizing hospitalization duration. The utilization of caudal anaesthesia with transversus abdominis plane (TAP) block is widespread due to its simplicity and efficacy in providing analgesia during surgical procedures. Nevertheless, its effectiveness in laparoscopic appendectomy has not been extensively evaluated. Aim and Objectives: This study aims to assess the effectiveness of caudal block and TAP block as pre-emptive analgesia utilizing ropivacaine in the context of opioid usage, postoperative visual analogue score (VAS), duration of analgesia, time until  rescue analgesia is needed, postoperative nausea and vomiting, and other potential side effects after elective laparoscopic appendectomy. Material and Methods: The study employed a prospective, double-blinded, comparative randomized experiment to investigate the effects of laparoscopic appendectomy on teenagers. The research comprised a total of sixty individuals aged between 13-17 years. The patients were assigned to one of two groups, each consisting of 30 individuals, using computer-generated randomization. Group I participants will undergo a caudal block procedure with the assistance of ultrasound guidance, using a 0.2% ropivacaine solution at a dosage of 1 mL/kg of body weight. Group II participants will undergo a TAP block procedure with the administration of 0.2% ropivacaine at a dosage of 1 mL/kg, guided by ultrasonography. Results: The total amount of opioid fentanyl used during surgery was 14.84 ± 18.77 in Group I and 25.51 ± 17.89 in Group II. This difference was of statistical significance (P = 0.0281). The Visual Analogue Scale (VAS) score was substantially lower in Group II when compared with Group I, with a p-value of less than 0.001. Conclusion: The caudal block is efficacious for managing intraoperative ailments whereas the TAP block is efficacious for managing postoperative ailments among adolescents having laparoscopic appendectomy.

34. Incidence of Hepatic Steatosis and Other Adverse Outcomes in Patients using Atorvastatin
Balram Sai Prasanna
Abstract
Background: Statins, widely prescribed for various chronic conditions such as cardiovascular diseases, cerebrovascular diseases, peripheral vascular diseases, and diabetes mellitus, have raised concerns regarding potential side effects with prolonged usage, including hepatic steatosis. We in the current study tried to analyze the incidence of hepatic steatosis in patients taking statins for long duration. Methods: Patients on prolonged statin therapy were selected. Lab investigations (ALT), (AST), and (ALP), and Lipid Profile: serum levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides to monitor lipid levels. Fasting Blood Sugar (FBS) Fasting blood glucose levels to identify patients with diabetes or impaired glucose metabolism. Abdominal ultrasound was done to detect fatty changes in the liver. Results: Overall, 34.33% of cases taking Atorvastatin tablets had fatty liver, while 65.67% did not. For diabetics, the prevalence of fatty liver was 36.84%, while for non-diabetics, it was 31.03%. The p-value for diabetics is 0.065, suggesting a possible association between diabetes and fatty liver change. The prevalence of fatty liver is slightly higher among diabetics than non-diabetics. The most common ADRs reported were fatigue (24 cases), myalgia (muscle pain) (16 cases), joint pain (12 cases), dysphagia (difficulty swallowing) (12 cases), and insomnia (11 cases) all were mild and self-limiting. Conclusion: This study concludes that prolonged statin use induces fatty acid synthesis, leading to the accumulation of excess fatty acids in visceral organs, particularly the liver, and consequently resulting in fatty liver. To minimize the overall occurrence of adverse effects associated with statin use and enhance patient quality of life, it is crucial to exercise caution when employing these medications and avoid prolonged administration.

35. Study of Lipid Profile Parameters in Type 2 Diabetes Mellitus Patients
Sandeep U, Meghna Mohan, Kiran D R.
Abstract
Dyslipidaemia is one of the common disorders which is seen in most of the diabetes patients, which causes cardio vascular disorders. This study was conducted to compare the lipid profile of diabetic patients and healthy controls. The patients admitted 50 representative cases with H/O Type 2 DM are taken as subjects for the study. Age and sex matches 50 non diabetic are taken as controls. Lipid profile and Hba1c was estimated. Total cholesterol, LDL, VLDL, Triglycerides, Hba1c were high in diabetics subjects as compared to normal control subjects. HDL was higher in normal control subjects. The difference between the control and the study groups was high and it was highly significant. The frequencies of the high TC, high TG and high LDL-C levels were  higher in the diabetic group, thus indicating that diabetic patients  were more prone for dyslipidaemia, which  could cause cardiovascular disorders.

36. Refractive Changes and Visual Acuity among Pregnant Women of Southern Rajasthan Region
Arun Kumar Samar, Isha Arora, Rajkumari Samar, Garima Tiwari
Abstract
Introduction: Changes in the eye have been linked to pregnancy; these changes may be natural, pathogenic, or an aggravation of pre-existing ocular diseases. Changes in refractive error (RE) and visual acuity (VA) are two examples of the physiological changes that might take place during pregnancy. Objective: The goal of the current study was to examine changes in VA and RE in pregnant women of Udaipur region during the course of second and third trimesters and six weeks after giving birth. Materials and Methods: Pregnant women in their second trimester who were attending an antenatal clinic were sequentially recruited for a longitudinal study. Information on their sociodemographic and clinical traits was gathered using a questionnaire. Measurements of visual acuity and refractive error were made during the second and third trimesters as well as six weeks following delivery. Result: The average age of women were 36.87 ± 6.35 years. In comparison to the second trimester, more women in the third trimester saw a worsening in Visual Acuity (VA) for distance. VA remained essentially changed during the course of the trial. Pregnant women experienced an increased myopic shift in the third trimester (40.83 % in left eye and 44.16 % in right eye) compared to the second trimester (35.83 % in left eye and 37.50 % in right eye). Simple myopia was the most prevalent refractive error among the women. Six weeks after delivery, these modifications disappeared. Conclusion: Pregnancy worsened Visual acuity (VA) for distance, and simple myopia was the most prevalent Refractive Error among pregnant women. However, during the postpartum phase, these modifications disappeared.

37. Comparison of First and Second Wave of COVID-19 in Relation to Clinical Profile & Laboratory Investigations at a Single Centre in Northern India- A Retrospective Study
Quazi Shahir Ahmed, Deepak Chopra, Kauser Sayedda, Nazia Siddiqui
Abstract
Introduction: SARS-CoV-2, a highly contagious virus, emerged and spread as a global pandemic in 2020. Its various mutants are continuously evolving though out the world. Repetitive waves of Covid-19 have drastically affected the whole world including India in terms of health and economy. The disease had a variable clinical course & laboratory investigation. Thus, in the present study, comparison was carried out between patients of first and second wave of Covid -19 regarding demographic profile, clinical severity, patients’ outcome & laboratory findings. Materials and Methods: 894 patients during first wave (01.08.2020 to 31.10.2020) & 367 patients during second wave (01.04.2021-01.06.2021) with laboratory confirmed diagnosis admitted at a tertiary care teaching Institute, in Northern India were enrolled in the study. Data was retrieved from Medical Records Department of the Institute. Result: About 86 % of the people were symptomatic at the time of presentation in first wave while it was nearly 99% in case of 2nd wave. (P<0.0001). Most common symptoms were fever, cough and breathlessness. 53 % of the population had at least one-comorbidity in first wave while it was 67.30% in second wave. (P<0.0001). 13.4% & 44.10 % of the study subjects belonged to severe category in first & second wave respectively. (P<0.0001). On comparing lab investigations of two waves, leukocytes & neutrophils counts were more (P<0.0001) while lymphocytes & platelets were less in second wave (P<0.0001). Gender comparisons (first wave) of renal function tests, serum creatinine came out to be significantly higher (P<0.0001) in males. Similarly, liver function tests & CRP were significantly higher in males (P<0.0001, P<0.05). D-dimer & random blood sugar values were not significantly different. (P>0.05). Reduced lymphocytes count & increased neutrophils count were more in males (P<0.01). As against first wave, males & females exhibited almost similar values of lymphocytes & neutrophils in second wave (P>0.05). Platelets were decreased in males. (P<0.001). Number of deaths was significantly more in second wave (p<0.0001). Conclusion: Second wave of Covid was significantly more aggressive. Significant laboratory findings differences in several parameters were observed in between two waves. Significant gender differences regarding lab investigations were also revealed in both the waves. Thus, knowledge of these differences is crucial for primary health care physicians to make the diagnosis and subsequent treatment strategies.

38. A Study of Posterior Reversible Encephalopathy Syndrome (PRES) in Eclampsia and in Severe Preeclampsia Patients with Neurological Symptoms
Srinka Mukherjee, Sumana Pal, Manami Roy, Prabodh S. Soreng, Debsadhan Biswas, Arka Bhattacharjee
Abstract
Background: PRES is an often underdiagnosed neurological disorder occurring as a complication of eclampsia and severe preeclampsia. It resolves completely in most patients but some may develop residual neurological deficits. Methods: An institution based prospective observational study done at Medical College, Kolkata in department of Obstetrics and Gynaecology. Study period was 18 months and sample size was 42. RESULTS: In our study we found that PRES occurred in 6 out of 11 patients with eclampsia (54 %) and 1 out of 31 patients with severe preeclampsia with neurological symptoms (3. 22%), higher values of serum LDH can be associated with the occurrence of PRES and most recovered fully with one death (2.38 % mortality) and 2 patients developing residual neurological deficit. Conclusion:  PRES has a stonger association with eclampsia than severe preeclampsia, certain biomarkers like LDH may have significant predictive value and prompt management of hypertensive disorders of pregnancy along with prevention of progression of preeclampsia as well as eclampsia may be key in preventing the development and fatal consequences of PRES.

39. The Role of Intraoperative Imprint Cytology in Case of Radiologically Proven Ovarian Complex Space Occupying Lesion
Sumana Pal, Srinka Mukherjee, Prabodh S. Soreng, Manami Roy, Senjuti Dasgupta
Abstract
Objective: To determine the role of intraoperative IC in radiologically proven ovarian complex SOL & to compare it with that of histopathology.  Background of Present Study: Ovarian neoplasms are a heterogenous group of benign & malignant tumours classified depending on different cells of origin. HPE however remains the gold standard in tissue diagnosis but takes about  10 to 15 days for results. Intraoperative pathology consultation is often required for guiding immediate surgical decisions to limit the extent of surgery or to perform radical surgery. Till date FS is the preferred method for providing rapid intraoperative diagnosis though it is technically more difficult than various cytological techniques. IC is easy to perform, gives  results in minutes, does not need any expensive machines and is thus useful in resource poor countries. Methodology: This study was carried out in Medical College Kolkata in approximately 12 month’s time period. A total number of 40 cases was studied. Surgical specimens from the operations done for radiologically proven ovarian complex SOL were taken in this study. During intra operative period IC was done on the operated specimens and they were also sent for HPE. The accuracy and diagnostic utility of IC was correlated with that of the HPE. Results: Of the 40 lesions studied by IC, 17 lesions were labelled as benign, 21 lesions as malignant and 2 lesions were borderline. Final histological diagnoses labelled 15 lesions as benign, 20  as malignant and 5 as borderline. Sensitivity, specificity were 100%  and 95% respectively for malignant tumours.

40. Clinical Profile of Neuropsychiatric Manifestations in Alcohol Use Disorder (Audit >8)
Pooja B.N., Kondal Reddy Sankepally, Sreekanth Rachakonda
Abstract
Aim of the Study: To observe the neuropsychiatric manifestations of Alcohol Use Disorder (AUDIT>8). Material & Methods: The study was performed over a period of 1 and half year from November 2019 to March 2021. We screened 256 in patients with history of alcohol abuse from General medicine wards in Tertiary care Hospital, Telangana, Hyderabad. Results: A total of 259 patients admitted in medicine wards with age >18 years and history of alcohol use were asked to fill the AUDIT form. Among them 131 patients scored <8 (excluded) and 128 patients scored >8 were considered for inclusion in the study. Of the 128 patients, based on exclusion criteria 48 patients were further eliminated. Finally 80 patients were included in the present study. Conclusion: Alcohol is a known behavioral risk factor for several non-communicable diseases such as coronary artery disease, liver disease and mental health disorders. n the present study, we found that, harmful alcohol use is associated with various medical, psychiatric and social issues in inpatients of medicine wards. This study is to identify the patients having harmful alcohol habits and identifying the subclinical neuropsychiatric manifestations associated with alcohol.

41. A Study to Correlate Hba1c with Attention, Executive Function and Visual Reaction Time in Type 2 Diabetes Patients
Niranjan Bharti
Abstract
Aim: The aim of the present study was to correlate HbA1c with attention, executive function and visual reaction time in type 2 diabetes patients. Methods: This was a cross-sectional study done Department of Physiology on 100 type 2 diabetes mellitus subjects of either sex under the age group of 40-60 years in the Department of Physiology for the period of two years. The study was started after getting ethical clearance from the Institutional Ethical Committee. The subjects who are able to understand English were enrolled for the study. Written informed consent was taken and each subject was explained about the whole procedure and objective of the study. Results: The mean age and BMI of the patients were 58.06±4.48 and 24.56+1.94 respectively. There were 55 male and 45 females in the present study. Duration of disease was positively correlated (r=0.34) with score of Digit Vigilance Test and p value statistically significant (0.016). A positive correlation (r=0.24) was also seen with Visual Reaction time and p value statistically significant (0.046). Stroop test score also shows a positive correlation (r=0.16) but without any statistical significance. HbA1c was positively correlated(r=0.56) with the score of Digit Vigilance Test and p value statistically significant (0.01). A positive correlation (r=0.36) was also seen with Visual Reaction time and p value statistically significant (0.01). Stroop test score also shows a positive correlation (r=0.16) but without any statistical significance. Conclusion: With increase in duration of the disease and poor glycemic control, sustained attention and executive functions are declining. Also there is an increase in visual reaction time. Diabetes is a disease which requires proper self-care and monitoring. The decline in cognitive functions can affect their activities like glucose monitoring, medications or insulin injection patterns, diet and exercise timing.

42. An Observational Clinical Study in Laser Treatment of Hemorrhoids of Patients from Central Jail, Sagar
Akhilesh Ratnakar, Deepak Shrivstava, Sunil Kumar Saxena, Aditi Kumari
Abstract
Introduction: Haemorrhoidal disease remains a common condition with an estimated prevalence 10% of the adult population. It is present in almost half of the subjects over 50 years of age. The scalpel and conventional electro-surgery unit are the surgical options of choice for anorectal surgery. Lasers are an alternative to conventional surgical systems. Objective: To establish Laser treatment of haemorrhoids as a better alternative to conventional and stapler procedures for Haemorrhoids. Methods: We studied 105 patients with haemorrhoidal disease. We operated patients over a 6-month period, from 1 January 2023 to 30 June 2023. It included patients who underwent surgical treatment by Laser for first-, second- and a few cases of third stage haemorrhoidal disease. Results: Laser haemorrhoidoplasty is a minimally invasive surgical treatment of haemorrhoidal disease with little distortion of the anal canal and has good outcome, especially for first-, second-, and third-degree haemorrhoids. Conclusion: Less aggressiveness of Lasers on the anoderm and the anal canal results in less morbidity. Advanced forms such as grade 4 haemorrhoids and haemorrhoidal prolapse expose to complications under laser and remain as indications for removal by conventional surgery according to Milligan and Morgan.

43. Evaluation of Glycaemic Status and Diabetic Kidney Disease among Patients with Type 2 Diabetes: A Cross-Sectional Analytical Study
Shubham Jain, Birata Debbarma, Devdas Rai
Abstract
Background: Diabetic kidney disease is a major risk factor for microvascular and macrovascular complications in diabetes patients but recently, fewer studies have correlated glycaemic status and diabetes kidney disease in south Indian population. Objective: To evaluate the relation between glycaemic status and diabetes kidney disease in type 2 diabetes mellitus (T2DM). Methods: This was a Cross-sectional analytical study among T2DM patients. Poor glycaemic status was defined as a serum value of glycosylated haemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values > 30 mg/dl in the first morning urine. Results: 100 cases of Type 2 DM patients comprises  75% males. The prevalence of diabetes kidney disease was 60%. The prevalence of microalbuminuria in groups with poor glycaemic status was 46% and adequate glycaemic status was 40% only. The findings were statistically significant between poor glycaemic status and albuminuria(Microalbuminuria, Mean FBS 201.33 mg/dl, 95% CI 185.6-216.9, Macrolbumininuria, mean FBS 219.6 mg/dl, 95% CI 180.8-258.4). Conclusion: The prevalence of poor glycaemic status and Diabetes Kidney disease was high among T2DM patients.

44. A Morphometric Assessment of Diverse Locations of Greater Palatine Foramen in Dry Human Skulls
Rajesh Ranjan
Abstract
Aim: The aim of the present study was to measure the location of greater palatine foramen (GPF), according to clinically identifiable anatomical landmarks. Methods: The study was performed on 50 dry human skulls. The skulls were obtained from Department of Anatomy. Results: The situation of the GPF in relation to 3rd maxillary molar was in 20 of the skulls. The average values of the distance between the GPF & midline palatine suture (MPS) & posterior border of hard palate (PBHP) were 16.4 mm (SD 1.4) & 6.4 mm (SD 1.3), respectively. Conclusion: Diverse locations of greater palatine foramen arouse difficulties in locating exact position during anaesthesia. Therefore, understanding the different positions of greater palatine foramen can help surgeons to improve their surgical procedures.

45. Assessment of the Therapeutic Efficacy of Autologous PRFM versus Triple Combination Paste in Non-Healing Ulcers
Pratap Chandra Das, Aswini Kumar Das, Pallavi Kashyap
Abstract
Aim: The aim of the present study was to compare the therapeutic efficacy of autologous PRFM versus triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in non-healing ulcers. Methods: The present clinical trial was conducted in the Department of Skin and V.D for two years. A total of 50 patients were included in the study with the age range 20–70 years. Patients with non-healing ulcers were selected from the outpatient department. Results: A total of 50 cases of non-healing ulcers of varying etiologies were treated using autologous platelet rich fibrin (PRF) at weekly intervals for maximum frequency of 6 sittings respectively. Most of the patients belonged to the age group 40-50 years. The mean age of the patients was 36.4 ± 12.08 years. Out of 25 ulcers in group A, there were 8 (32%) venous ulcers, 3 (12%) traumatic ulcers, 7 (28%) diabetic ulcers and 6 (24%) trophic ulcers. Out of 25 ulcers in group B, there were 8 (32%) venous ulcers, 5 (20%) traumatic ulcers, 8 (32%) diabetic ulcers and 4 (16%) trophic ulcers.  The length of non-healing ulcer ranged from 3 months to 14 months with a mean of 6.54 ± 1.78 months. Group A showed a mean reduction in the ulcer area by 8.23 mm2 which was highly significant (P-value = 0.0002). Group B showed a mean reduction in the ulcer area by 4.79 mm2 which was also significant (P-value = 0.015). Conclusion: This procedure is simple, patient‑friendly, cost‑effective, painless and can be performed as an outpatient procedure. We concluded that autologous platelet-rich fibrin matrix is much more effective than the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in the treatment of non-healing ulcers.

46. A Study Assessing Clinico-Epidemiological and Outcome Assessment in Traumatic Spine Injuries: An Observational Study
Om Prakash Kunwar
Abstract
Aim: The aim of the present study was to assess the epidemiology, clinical features and early outcome in traumatic spine injuries at a tertiary hospital. Material & Methods: The present study was single-center, prospective, observational study, conducted in Department of Orthopedics for the period of 2 years. 100 patients were included in the study. Results: Out of 100 patients, most of the patients were in the age group 51-60 (32%) and 41-50 (30%). Mean age was 51.59 years. Majority of the patients were male 70% while 30% patients were female. In present study, majority of traumatic spine injuries were due to road traffic accidents (52%), followed by fall from height (45%) and assault (3%). Majority of spine fractures occurred at cervical (40%) followed by Lumbar (30%) followed by thoracic (20%) vertebral level. Out of 100 patients, 55 patients (55%) had no associated injuries. Common associated injuries were hemoperitoneum (12%), head injury (11%), fracture humerus (9%) and fracture clavicle (6%). Out of 100 patients, 54% patients had no Neurodeficit and 46% patients had Neurodeficit. On pre -operative assessment 50% patients had ASIA score of E, 11% had ASIA score of D, 17% had ASIA score of C, 7% had ASIA score of B and 15% had ASIA score of A. Follow up ASIA score after 2 weeks in patients was A in 14% patients, B in 8%, C in 16%, D in 12, E in 50%. Follow up ASIA score after 3 months in patients was A in 8% patients, B in 5%, C in 6%, D in 15%, E in 68%. Follow up ASIA score after 6 months in patients was A in 9% patients, B in 5%, C in 4%, D in 16%, E in 66%. Follow up ASIA score after 9 months in patients was A in 8% patients, B in 6%, C in 4%, D in 20, E in 60%. Follow up ASIA score after 12 months in patients was A in 12%, D in 28, E in 60%. Conclusion: Complication rates were higher in patients treated non-operatively. Leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long-standing bed sores.

47. An Analytical Assessment of Lipid Profile and Oxidative Stress in Patients of Ischemic and Hemorrhagic Stroke
Arafat Ahmad
Abstract
Aim: The aim of the present study was to assess the serum levels of total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), very low-density lipoprotein (VLDL) and triglyceride (TG) in patients of cerebrovascular stroke and controls. Methods: The present study was carried out in the Department of Biochemistry. Informed consent was taken from patient / relative and control subjects. The study was conducted for the period of one year. Study Groups: 100 Patients (age 30-90 years) of cerebrovascular stroke referred by various hospitals were selected. Results: The mean age of cases and controls were 57.53 ± 13.47 and 46.34 ± 7.83 years respectively Maximum number of cases was in the age group of 51-60 years (35%). On comparing mean cholesterol, TG, HDL, LDL and VLDL between cases and controls, the p value was < 0.01 in all above test parameters which was found to be statistically significant. On comparing, levels of total cholesterol, HDL cholesterol and LDL cholesterol between ischemic and hemorrhagic stroke, p value was statistically significant while difference between triglyceride level and VLDL was not significant. On comparing, the difference between mean MDA values of ischemic stroke and controls was found to be statistically significant (p<0.01). On comparison by student t test, the difference between mean SOD values of ischemic stroke and controls was found to be statistically significant (p<0.01). Also on comparison between hemorrhagic stroke and control the difference in mean MDA and SOD values was found to be statistically significant (p<0.01). Conclusion: The difference in lipid profile between ischemic and hemorrhagic stroke should be taken into consideration while starting statin therapy as primary preventive measure to reduce incidence of first stroke in high-risk patients, as well as during secondary prevention in case of ischemic strokes.

48. Assessment of the Significance of Various Pulmonary and Extra Pulmonary Abnormalities on HRCT of the Chest in Scleroderma Lung: an Observational Study
Abhishek Agarwal, Manjit Kumar, Archana Kumari
Abstract
Aim: The aim of the present study was to discuss the significance of various pulmonary and extra pulmonary abnormalities that may be identified on high-resolution computed tomography (HRCT) chest of systemic sclerosis (SSc) patients. Methods: The present study was a cross-sectional, observational including 100 patients in the Department of Radiology , Patients with clinical diagnosis of SSc having pulmonary involvement were included in the study. Pregnant females and patients having active chest infection or history of pulmonary tuberculosis were excluded. PFT was done for all the study patients. Other investigations done were chest radiography, as an initial imaging modality and relevant blood investigations as required. Results: Age ranged from 13 to 61 years (mean 35.5±10.2 years) and most of the patients belonged to 20-30 age group followed by 31-40 age group. All the patients had clinical complaints of skin thickening and tightness, barring a few. Mean duration of skin manifestations was 5.4±5.8 years. Other than skin thickening, dyspnoea and dry cough were the frequently associated symptoms. 35% patients had duration of <6 months. 55% had 61%-80% FEV. Chest radiography was not found to be a sensitive modality in evaluating ILD, particularly in the early stages of the disease. Among them, 55% had right lung involvement and 45% had left lung involvement. No significant upper and middle zone involvement was seen. Most common chest radiograph finding was fine or coarse reticular opacity. Conclusion: Systemic sclerosis commonly occurs in middle aged females; the presenting complaint being diffuse skin thickening over the limbs and face and dyspnoea on exertion with or without dry cough as the primary respiratory symptom. PFT reveals restrictive pattern. The limitations of chest radiography may overcome by HRCT chest. Non-specific interstitial pneumonia pattern is the most common ILD found in SSc.

49. Assessing Different Haemoglobin Estimation Methods: Comparative Study
Monalisa Kanungo, Surya Kant Nirala
Abstract
Aim: The aim of the present study was to assess the different haemoglobin estimation methods. Methods: This study was conducted on blood samples obtained in 2 ml blood in K3 EDTA vacutainer from various indoor wards and outdoor patient departments. 100 adult patients sent for Hb estimation from outpatient clinics and wards were included in the study. Results: Repeatability standard deviations of Sahli’s method, Drabkin’s method and cell counter respectively were 0.68 g/dl, 0.42 g/dl and 0.18 g/dl. When comparing Sahli’s method with Drabkin’s method and cell counter, we found p value of <0.0001, suggesting significant difference between two methods whereas Drabkin’s method was found to be comparable with cell counter with p value of >0.05. The result showed a mean difference of 0.455 and with significant p-value of <0.001. A significant difference was found in the mean values of colorimeter and 5 part (p<0.001) despite a significant correlation between these methods. Conclusion: Sahli’s method although cheap and easy, is inaccurate and has subjective bias. So it can be used for screening purpose, but not for diagnosis and follow up of anaemia, Haemoglobin measurement by Drabkin’s method is very cost effective and it is as efficient as cell counter. It is especially useful in fund deprived areas and where only haemoglobin value is required. Cell counter although highly accurate and versatile, requires good equipment, quality control, laboratory setup and trained personnel. So it should be preferably used when complete blood count is required. The result showed a mean difference of 0.455 and with significant p-value of <0.001. A significant difference was found in the mean values of colorimeter and 5 part (p<0.001) despite a significant correlation between these methods.

50. A Study to Assess the Diabetes and Hypertension among Patients with Psychiatric Illnesses Attending Outpatient Services
Ravikant Kumar, Manish Kumar
Abstract
Aim: The aim of the present study was to assess the Diabetes and Hypertension among patients with psychiatric illnesses attending outpatient services. Material & Methods: A cross-sectional observational study was conducted among 500 patients seeking psychiatric care at the out-patient of department of Psychiatry  carried out between the duration of 6 months. Results: The mean age of the entire sample population was 42.8 years, with mean age comparable between males and females. Males represented 40% of the study population. Mean body mass index (BMI) and mean blood pressure (BP) of the study population was 26.4 kg/m2 and 120.5/75.5 mmHg, respectively. A large proportion of patients did not smoke (90%) or consume alcohol (95%). 15% had diabetes and 8% and hypertension. 5% had both diabetes and hypertension. 46.66% of patients with diabetes had the condition for less than 5 years while 53.34% of patients with hypertension had the condition for at least 5 years or longer. More than 86.66% of patients with diabetes or hypertension were undergoing treatment for their physical NCD. Twenty patients (4%) had both diabetes and hypertension. Age, presence of a family history of any physical NCD and duration of psychiatric illness of ≥5years were significantly associated with the presence of diabetes or hypertension (p<0.05).Schizophrenia, schizotypal and delusional disorders were most prevalent among patients with diabetes or hypertension, and combinations of antipsychotics with other psychotropic medications were predominantly prescribed to patients with these physical NCDs. No association was observed between the psychiatric diagnosis or psychotropic medications with the presence of diabetes or hypertension. Conclusion: Diabetes and hypertension are common physical NCDs in patients with psychiatric illness. Therefore, it is important that psychiatrists be aware of and identify patients who are at risk for such NCDs.

51. A Prospective Study to Evaluate the Various Methods of Trochanteric Fracture Fixation: A Comparative Study
Randhir Kumar, Govind Mohan Jee
Abstract
Aim: The aim of the present study was to evaluate the various methods of trochanteric fracture fixation and their comparison in DMCH, Darbhanga, Bihar. Methods: This prospective study was conducted at Department of Orthopaedics for the period of 12 months on 50 patients who attended in OPD and emergency. Patients were included in the study as decided by inclusion and exclusion criteria and operative intervention for each group was decided on the basis of radiological examination. Results: Out of the 50 patients, 28 patients (56%) were male and 22 patients (44%) female. The age of patients recorded in our series ranged between 20-90 yrs. Mean age for PFN group was 57 years, mean age for DHS group was 59 years, and mean age for PFLCP group was 63 years. We found that intertrochanteric fracture due to domestic fall (60%) was most common mode of injury, followed by fracture due to road traffic injury (36%). According to AO classification 20 patients (40%) were stable and 30 patients (60%) were unstable. In our study we got most of patients with A3 type unstable fractures. In PFN group 8 patients, in DHS group 16 patients and in PFLCP group 6 patients were with A3 type fractures. While patients with A1 type fractures were least in numbers. In PFN group 3 patients, in DHS group 1 patient and in PFLCP group 1 patient were with A1 type fractures. In present study at 01 month and 3 months mean score showed significant improvement in PFN group. At 6 months, mean score showed highly significant improvement in PFN group. But at 1 year of follow up Harris Hip score showed insignificant difference in functional status of patients belong to either group. Conclusion: PFN had good to excellent outcomes. So PFN offers high rotational stability, compression at fracture site, create a shorter lever arm, so had decreased rate of mechanical failure, reduced hospital stay, early mobilization, less blood loss and less surgery time, early rehabilitation and faster union as compared to DHS and PFLCP.

52. An Observational Study to Assess the Thyroid Function Status among the Transfusion Dependent Thalassemic Children
Ajit Kumar Singh, Sachin Kumar, Nagendra Prasad Gupta
Abstract
Aim: The aim of the present study was to assess the thyroid function status among the transfusion dependent thalassemic children. Material & Methods: This was a cross sectional study conducted in the Department of Paediatrics for a period of 18 months. A total number of 100 children with transfusion dependent thalassemia who met the inclusion and exclusion criteria were studied. Demographic data as well as history of blood transfusion and chelation therapy were collected. Thyroid function and iron load status were evaluated by measuring serum FT4, TSH and ferritin levels. Results: Among them 28 (28%) were beta thalassemia major and 72 (72%) were Hb E beta thalassemia. Total male was 60 (60%) and female were 40 (40%). Mean weight and height were 33.67±10.42 kg and 132.4±13.4 cm respectively. Median weight for age Z score and median height for age Z score were -1.88 (-0.82 to -4.07) and -2.98 (-0.86 to -4.96) respectively. Mean BMI was 19.4±3.42 kg/m2. The mean age at first diagnosis was 17.3 (±7.65) months, mean age at first blood transfusion was 18.22±7.53 months, mean total duration of disease was 10.90±4.02 years, and mean total number of blood transfusion was 81.7±33.4 units. History of thalassemia in other family members was found in 25 patients (25%). Euthyroid patients were 90 (90%) and hypothyroid patients were 10 (10%). Among hypothyroid patients 8 (8%) patients were compensated and 2 (2%) was uncompensated hypothyroidism. Significant association was found between higher serum ferritin level (≥2000 ng/ml) and hypothyroidism in thalassemia patients (p<0.05). Conclusion: In the present study we documented hypothyroidism in transfusion dependent thalassemic children. Among them majority were compensated hypothyroidism. Higher number of blood transfusion and ferritin level ≥2000 ng/ml was found significantly associated with the development of hypothyroidism in thalassemic patients.

53. A Retrospective Study Assessing the Outcome and Complications of Emergency Inguinal Hernia Repair
Pawan Kumar Bharti, Katariwala Pratik Bharat Kumar, Abhijit Kumar
Abstract
Aim:  The aim of the present study was to assess the morbidity of Lichtenstein mesh hernioplasty in treating obstructed inguinal hernias. Material & Methods: It was a retrospective study undertaken in the Department of General Surgery for the duration of 1 year. 100 patients were operated & included in the study. Results: Age of the studied patients ranged from 18 to 86 years with mean age 49.61 ± 16.024 years. About 70% of the studied patients had no comorbidity. 70 of the studied patients had no postoperative complications. There was statistically significant decrease in postoperative VAS pain score over time, which decreased two hours postop to 1 in the first postoperative week. Conclusion: Standard lichtenstein mesh hernioplasty for obstructed inguinal hernia is a safe operation with acceptable risks of complications. However, patient selection and surgeon experience are important factors for the outcome.

54. Clinico-Demographic Profile and Complication of Invasive Fungal Sinusitis: An Observational Study
Jitendra Kumar
Abstract
Aim: The aim of the present study was to analyze various clinical presentation, underlying immunocompromised condition, complication of invasive fungal sinusitis. Material & Methods: This prospective analytic study was designed including 100 patients of both types of invasive fungal sinusitis that underwent treatment as inpatient basis for the duration of 12 months, at Department of ENT were included in this study. Patients giving consent are included in this study. Results: In this study of 100 cases of invasive fungal rhinosinusitis with a male preponderance 68% (n=68). In this study, patients having Diabetes Mellitus were more susceptible to both acute and chronic variant of invasive fungal sinusitis. In Some patients multiple underlying immunocompromised conditions were observed. The patients presented with symptoms of nasal obstruction (n=67) 67%, purulent rhinorrhea (n=45) 45%, headache (n=55) 55%, facial pain (n=21) 21%, and facial swelling (n=21) 21%, epistaxis (n=56) 56%, fever (n=33) 33%, decreased vision (n=9) 9%, diplopia (n=3) 4%. The rhinology findings like mucosal necrosis, black crust or debris, and pus in middle meatus and septum involvement were shown. Orbital cellulitis was the most common complication of invasive fungal rhino sinusitis. 12 patients had intracranial extension. Out of 100 patients 8 patients expired due to complication of fungal invasive fungal rhino sinusitis. Conclusion: Invasive fungal sinusitis was most commonly observed in 3rdand4thdecade of life with male predominance. Prolonged uncontrolled diabetic mellitus was the most common underlying immunocompromised status.  Mucor was the most common isolated fungal species. Preseptal cellulitis was the most common complication.

55. A Cross Sectional Epidemiological Assessment of Antibiotic Usage in Upper Respiratory Tract Infections (URTI) in Children: An Observational Study
Kartic Prasad Singh
Abstract
Aim:  The present 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. 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 200 patients were included in the study. Results: Out of 200 patients, boys were 90 and girls were 110. Age group 5-7 years had 32, 7-9 years had 38, 9-11 years had 72 and 11- 13 years had 58 children. Antibiotics prescribed in children were co‑amoxiclav in 70, amoxycillin in 58, ofloxacin in 42 and cefuroxime in 30. 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.

56. An Observational Hospital-Based Study Biochemical Analysis of Ascitic (Peritoneal) Fluid
Abdul Qaium
Abstract
Aim: The aim of the present study was to examine the role of biochemical testing in diagnosing the cause of ascitic fluid accumulation. Methods: The observational hospital-based study was carried on 200 indoor patients who were diagnosed as ascites on the basis of history, physical examination, ultrasonography, and of age >18 years were included in the study after getting the informed consent. Data was taken from medical records department. Patients who had a diagnostic paracentesis within 2 weeks (cause was already established), secondary cause of peritonitis and unwilling to participate in the study were excluded. Results: This study included 200 patients with age ranging from 20 to 78 years and majority of patients were aged between 41-50 years (n=50, 25%), only 20 patients 10% admitted with ascites of the age group between 18-30 years. The most common clinical feature was abdominal discomfort, followed by Anorexia, Icterus, Splenomegaly and Hepatomegaly. The most common etiology of Ascites was Liver cirrhosis (40%), followed by Tuberculosis (32%) then Malignancy (9%), and Congestive Heart Failure (6%). 80 of the 120 exudates were detected using the traditional cutoff for cell count greater than 500/mm3, but using the cutoff proposed in the present paper (300 cells/mm3), the detection increased to 98/120. Of the biochemical parameters studied, the AST ratio AF/S (> 0.5) detected the greater number of exudates correctly classified 96/120, while 14 of 80 transudates were falsely classified. Conclusion: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Biochemical testing of peritoneal and pleural fluids is carried out widely, although the range of tests likely to be useful is limited in comparison to the repertoire of tests available in a modern biochemistry laboratory.

57. A Hospital-Based Assessment of Stress and Psychiatric Morbidity among a Group of Pregnant versus Non-Pregnant Women in the Reproductive Age Group
Shyama Nand Roy
Abstract
Aim: The aim of the present study was to assess stress and psychiatric morbidity among a group of pregnant versus non-pregnant women in the reproductive age group using validated research tools. Methods: This was a comparative cross-sectional study among 200 pregnant and 100 non-pregnant using an interviewer-administered questionnaire. The study was conducted among women aged 18 to 45 years. Results: A total of 300 women of which 200 were pregnant and 100 were non-pregnant participated in the study. Their mean age were 30.1 ± 5.4  and  29.6 ± 8.4 years respectively. A significantly higher proportion 160 (80%) of the pregnant women compared with 52 (52%) were in the 25–39 age category (p < 0.001). A higher proportion of the pregnant women were married 190 (95%) compared with the non-pregnant women 60 (60%) which was statistically significant (p < 0.001). Among pregnant women, sociodemographic factors significantly associated with psychiatric morbidity. The highest proportion of psychiatric morbidity was found in women attending tertiary facilities, followed by secondary facilities and the least was in women from primary care facilities. In non-pregnant women, correlates of psychiatric morbidity were mainly family characteristics. Conclusion: The study concluded both working and non-working antenatal mothers were at more risk of developing stress. All antenatal mothers participated in this study had mild stress and there was significant difference between working and non-working antenatal mothers stress score. Psychiatric morbidity is high among women of reproductive age group with higher rates among pregnant women.

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

59. Assessment of the Transvenous Dual-Chamber Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava
Abu Huraira, Aman Sinha, Brajesh Kumar
Abstract
Aim: The aim of the present study was to assess the transvenous dual-chamber pacemaker implantation in patients with persistent left superior vena cava. Methods: The present study was conducted in the Department of Cardiology, 20 patients were enrolled retrospectively in this observational study. The present study was performed in accordance with the Declaration of Helsinki (2000), and  All patients and relatives were given full explanations of the procedures, and written in- formed consent was obtained from all subjects. Results: The average age of the 20 patients with PLSVC was 67 ± 13 years (52–77 years). Indications for pacing were symptomatic third-degree atrioventricular (AV) block in 2 (10%) and sick sinus syndrome in 18 patients (90%).  AV block after mitral valve replacement. The pacemaker pocket was performed entirely in the left subclavian region irrespectively of the PLSVC. Total procedure time and fluoroscopy time was 85.5 ± 12.4 min and 4.5 ± 1.2 min respectively. There were no complications during any of the procedures. Furthermore, no late complications such as lead fracture, lead dislodgement, pericardial tamponade, or chest pain were observed during a mean follow-up of 4 years. In addition, pacing impedance, pacing threshold, P-wave and R-wave amplitude did not change significantly during the follow-up. Conclusion: PPI through PLSVC may be technically feasible, safe, and effective. A venography in patients with PLSVC prior to pacemaker implantation is not necessary. Double active fixation leads may be standard for patients with PLSVC, and most of the ventricular leads could be placed at the RVOT septum.

60. A Study to Assess the Visual Outcome after Cataract Surgery in Rural Population: A Descriptive Observational Study
Deepak Kumar Sinha, Kumar Parmanand, Mrityunjay Kumar
Abstract
Aim: The aim of the present study was to assess the visual outcome after cataract surgery in rural population of Bihar. Material & Methods: We carried out a population-based cross-sectional study in the Bihar state . All the adults who were 50 years and older for over 1 year were included in the study. Results: The odds of poor visual outcomes among those aged over 80 years was 2.5 times higher than for those 50–59 years. The most likely causes were visual impairment and blindness in eyes with presenting visual acuity worse than 6/18. Factors associated with risk of poor visual outcomes were evaluated using univariate multivariate logistic regression. Conclusion: Cataract outcomes can be definitely improved with a good follow-up component in the cataract blindness program that results in elimination of the treatable causes for poor outcomes. Though the proportion of IOL implant surgery has increased, support services such as the availability of YAG lasers and infrastructure for follow-up have not kept pace. There is a need to enhance the cataract surgery program to include adequate infrastructure for postoperative monitoring and appropriate management. By improving this facility, the prevalence of visual impairment in pseudophakics can be minimized.

61. A Hospital Based Comparative Assessment of the Efficacy of Endoscopic Versus Microscopic Excision of Pituitary Adenoma
Rajeev Ranjan Raman, Anurag Sahu
Abstract
Aim: The aim of the present study was to compare the efficacy of endoscopic versus microscopic excision of pituitary adenoma. Methods: The present study was conducted in the Department of Neurosurgery and our study included 100 cases of pituitary adenoma. 60 cases underwent endonasal endoscopic transsphenoidal surgery whereas remaining 40 cases were operated using the microscopic transsphenoidal surgery. Results: The mean duration of symptoms in endoscopic group was 28.22±19.31 months (ranged from 15 days to 8 years), and in microscopic group, it was 22.6±18.02 months (ranged from 1 month to 5 years). Complete tumor excision was achieved in 40 (66.66%) patients in endoscopic group and in 22 (55%) patients in microscopic group. In endoscopic group, mean operative time was 1.88±0.32 hours (ranged 80–135 min). In microscopic group mean operative time was 2.28±0.12 hours (ranged 120–145 min). In endoscopic group, mean blood loss was 125.45±38.62 ml (ranged 60–190 ml), and in microscopic group, it was 178.22±40.024 ml (ranged 100–220 ml). Postoperative complication was present in both endoscopic and microscopic groups. Slightly higher percentage of complication such as diabetes insipidus, cerebrospinal fluid (CSF) leak and reoperation and sinusitis was observed in microscopic group as compared to endoscopic group. Reoperation was performed one for postoperative hematoma and one for CSF leak in both groups. All the patients after surgery had improvement in a headache and vision in both groups. There was no deterioration of endocrinal function in both groups. In endoscopic group, mean hospital stay was 9.12=8±2.621 (ranged 5–12 days), and in microscopic group, it was 10.05±2.154 (ranged 6–14 days). Conclusion: In pituitary surgery, endoscopic surgery had started new fields not only by direct endonasal approach but also by providing a panoramic view inside the sphenoid cavity and sella turcica. Endonasal endoscopic transsphenoidal pituitary adenoma surgery is a safe and effective procedure.

62. A Hospital Based Study to Assess the Role of Helicobacter Pylori Infection in the Pathogenesis of Minimal Hepatic Encephalopathy and Effect of its Eradication
Manish Kumar Bhaskar
Abstract
Aim: The aim of the study was to find the role of Helicobacter pylori infection in the pathogenesis of minimal hepatic encephalopathy and effect of its eradication. Methods: A prospective study was conducted in the Department of Gastroenterology for the period of 2 years. 200 patients were included in the study. In patients of suspected cirrhosis of liver ultrasound and endoscopic examination were performed. Results: Hepatitis B virus infection was the most common (35%) cause of cirrhosis. In the study group, most patients were in Child-Pugh class A (25%) or B (57.5%); most patients in Child-Pugh class C who were screened fulfilled one or more exclusion criteria. Presence of MHE had no significant relationship with age, sex, Child-Pugh grade, and cause of cirrhosis. H. Pylori infection was found in 90 of 140 patients with MHE (p< 0.001). Patients with MHE and H. Pylori infection showed a significant reduction in blood ammonia levels after anti-H. Pylori treatment (p<0.001). Conclusion: This study concluded that H Pylori infection plays a role in the causation of MHE in patients with liver cirrhosis. H Pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method. Eradication of H Pylori in cirrhotic patients may prevent hepatic encephalopathy (HE).

63. A Hospital Based Observational Study to Evaluate the Laboratory Profile of Dengue Patients
Amit Kumar Singh, Soumya Singh, Rituraj Lahkar, Umashanker Singh
Abstract
Aim:  The aim of the present study was to evaluate the laboratory profile of dengue patients. Material & Methods: A Prospective, observational study carried out at a Department of General Medicine during the duration of 10 months. Study population was all indoor patients with dengue fever having age group of more than 12 years. 100 patients with dengue fever were selected for study. Results: In our study out of 100 subjects, 60 were male and 40 were female. The age of the patient in our study group range between 13 to 80 years. Mean age of the study was 45.5 years. Most of the patients diagnosed as a dengue fever presents with fever, body ache, chills, generalized weakness and rarely some patient may present with rash, vomiting, melena, hematuria, itching, photophobia and neck stiffness accompanied by facial flush and other flu like symptoms. The fever usually continues for two days to seven days and can be as high as 41 degrees Celsius. Patients with fever accompanied with tachycardia, some patients also had bradycardia may be due to myocarditis. Few patients in our study were also had blanching, hypotention and neck stiffness. In our study the laboratory findings suggest that the dengue fever patient present with thrombocytopenia most commonly and associated with leukopenia. Conclusion: Dengue is a mild acute febrile illness; most of the patients do not develop complications and recover completely. Commonly patients present with fever, headache, and myalgia. The laboratory findings suggest that the dengue fever patient present with thrombocytopenia most commonly and associated with leukopenia.

64. An Observational Study to Assess the Primary Lymphomas of the Genitourinary Tract
Amrit Kumar, Parwez Ahmad
Abstract
Aim: The aim of the present study was to assess the primary lymphomas of the genitourinary tract. Material & Methods: The present study was conducted in the Department of Surgery, for the period of 12 months and 200 patients were included in the study. Results: Median age at presentation was 71 years, with only 25% of cases occurring in patients younger than 60 years old. The predominant site of involvement was the kidney (70%). The most frequently encountered stage at presentation was stage I (40% of cases), followed by stage IV (32% of cases). The majority of cases did not receive radiation therapy or undergo cancer-directed surgery while 35% of the patients only underwent cancer-directed surgery, 5% received only radiation therapy, and 6% had multimodal treatment (radiation therapy combined with cancer-directed surgery). In terms of histology, the three most prevalent types of PUTL were DLBCL followed by marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma and follicular lymphoma.  Variables that were included were age, race, treatment, site, stage, year, gender and type of lymphoma. Older age groups had worse CCS. Male gender also conferred a worse prognosis. Compared with stage III-IV, patients with stage I disease had better CSS. Stage II did not reach statistical significance. Cancer-directed surgery and multimodal treatment (surgery plus radiation therapy) were associated with a mortality benefit, while the administration of radiation therapy alone did not improve outcomes. DLBCL carried the worst prognosis, with follicular and MALT lymphomas demonstrating better outcomes. Conclusion: We found that primary urinary tract DLBCL carries a worse prognosis than nodal DBLCL in both early and late stages. In addition, surgery may be beneficial for patients with PUTL. The survival of patients with PUTL in the past two decades has not improved significantly despite the introduction of modern therapies such as rituximab. Therefore, better therapies are needed.

65. A Retrospective Study Assessing the Outcome and Complications of Emergency Inguinal Hernia Repair
Abhijit Kumar, Sujeet Kumar
Abstract
Aim:  The aim of the present study was to assess the morbidity of Lichtenstein mesh hernioplasty in treating obstructed inguinal hernias. Material & Methods: It was a retrospective study undertaken in the Department of General Surgery for the duration of 2 years. 100 patients were operated & included in the study. Results: Age of the studied patients ranged from 18 to 86 years with mean age 49.61 ± 16.024 years. About 70% of the studied patients had no comorbidity. 70 of the studied patients had no postoperative complications. There was statistically significant decrease in postoperative VAS pain score over time, which decreased two hours postop to 1 in the first postoperative week. Conclusion: Standard lichtenstein mesh hernioplasty for obstructed inguinal hernia is a safe operation with acceptable risks of complications. However, patient selection and surgeon experience are important factors for the outcome.

66. An Observational Assessment of Endoscopic Transcortical Transventricular Management of Cystic Craniopharyngioma
Dhiraj Kumar, Mukesh Kumar, Anil Kumar Peethambaran
Abstract
Aim: The aim of the present study was to assess the endoscopic transcortical transventricular management of cystic craniopharyngioma. Methods: The present study was conducted in the Department of Neurosurgery, Medical College Trivandrum Thiruvananthapuram, Kerala, India and data of patients who underwent transcortical transventricular endoscopic approach and reservoir placement for cystic craniopharyngioma were reviewed retrospectively from August 2016 to August 2018. 10 patients were included in the study. Results: The mean age was 22.6 years (range 2–49 years) with a slight female preponderance. Headache (75%) was the most common presentation followed by vomiting (55%) and vision disturbances (45%). An equal number of patients presented with motor weakness and memory disturbances (12%). 5 patients presented with altered behavior and 5 patients with polyuria. Most of the patients had a single cyst. All patients had hydrocephalus. The presurgery hormone evaluation showed that 10% of patients had hypocortisolemia and 6% of patients had marginally increased prolactin levels. The follow-up duration ranged from 3 to 72 months with a median of 18 months. 38 (38%) patients had improvement in vision. 20 (20%) patients required thyroid hormone replacement and 18 patients (18%) steroid replacement. 42 (42%) patients received radiotherapy. 28 (28%) cases had a cyst recurrence and required repeat intervention. Conclusion: Transventricular endoscopy is a versatile procedure that plays an important part in the management of craniopharyngioma, especially for those lesions with a predominant cystic component growing within the third ventricle. It has been used to fenestrate cystic tumors into the ventricles or subarachnoid space (ventriculocystostomy or cystocisternostomy), to establish CSF flow in case of hydrocephalus, for delivery of intracavitary chemotherapy, and to achieve variable extent of resection as a first step of combined procedure.

67. Impact of Two Distinct Forms of Physical Activity on Heart Rate Variability (HRV) in Young Healthy Individuals
Gaurav Sinha, Indira Mishra, Sandeep Kumar, Pandurang M. Narhare
Abstract
Aim:  The aim of the present study was to compare the effect of two types of physical activity i.e. aerobic exercise and yoga on HRV in young healthy subjects. Methods: The present study was conducted in the Department of Physiology and 120 healthy volunteers aged 30-40 years were selected for this study. Results: In all the age groups, the mean age was not statistically significant (p> 0.05). There were male predominance in all the three group.The study showed increased LF in control group followed by athletes and Yoga group, also decreased HR, HF and LF/HF ratio in yoga group. Conclusion: Our study results of yoga show reduction in LF component, significant decrease in HR & increase in HF component compared to aerobic exercise which coincides with the findings of other studies. This supports that yoga influences autonomic nervous system by increasing parasympathetic activity. Our study indicates that parasympathetic activity is substantially greater in yoga practitioners followed by athletes and control.

67. Impact of Two Distinct Forms of Physical Activity on Heart Rate Variability (HRV) in Young Healthy Individuals
Gaurav Sinha, Indira Mishra, Sandeep Kumar, Pandurang M. Narhare
Abstract
Aim:  The aim of the present study was to compare the effect of two types of physical activity i.e. aerobic exercise and yoga on HRV in young healthy subjects. Methods: The present study was conducted in the Department of Physiology and 120 healthy volunteers aged 30-40 years were selected for this study. Results: In all the age groups, the mean age was not statistically significant (p> 0.05). There were male predominance in all the three group.The study showed increased LF in control group followed by athletes and Yoga group, also decreased HR, HF and LF/HF ratio in yoga group. Conclusion: Our study results of yoga show reduction in LF component, significant decrease in HR & increase in HF component compared to aerobic exercise which coincides with the findings of other studies. This supports that yoga influences autonomic nervous system by increasing parasympathetic activity. Our study indicates that parasympathetic activity is substantially greater in yoga practitioners followed by athletes and control.

68. A Retrospective Study Assessing the Outcome of Repair and Resection of the Occipital Encephalocele
Gaurav Srivastava
Abstract
Aim: The aim of this study was to find the outcome of repair and resection of the occipital encephalocele. Material & Methods: A retrospective study of 50 exclusively occipital encephalocele patients was conducted in between the duration of 1 year in the Department of Neurosurgery, Kashi Neuron Multispeciality Hospital, Ramnagar Varanasi UP, India. The medical records of all operated cases of occipital encephalocele were reviewed, and relevant data such as age, sex, location of encephalocele, the size of the lesion, operative method, seizure, and hydrocephalus along with postoperative complications were recorded for analysis. Results: Of 50 patients, 19 were males and 31 females. The average age of the patients at the time of presentation was 2.4 months, ranging (4 days to 1.33 years). Most of the patients 58% belonged to 3 months age followed by 24% in 3-6 months age group. All patients presented with swelling on the head just after birth. A visible mass was situated in either the occipital (supratorcular or infratorcular). Any overlying skin varied from a thick and wrinkled to a thin or shiny covering. 18 patients (36%) presented with enlarged head circumference with associated hydrocephalus and 2 patients (4%) diagnosed with Dandy–Walker cyst. 32 (4%) patients were suspected developmental delay and mental disorders. 8 (16%) patients also had seizure. 10 (20%) patients admitted with the complication of sac rupture with cerebrospinal fluid (CSF) leakage, 1 (2%) patients having rupture of sac after the admission and 1 (2%) patients admitted with the complaint of haemorrhage from the thin and shiny covering skin of the sac. Postoperatively, only 2 (4%) patients had CSF leakage from the repaired wound. 3 (6%) patients developed Hydrocephalus after the repair of protrude sac. Conclusion: Encephalocele is commonly seen in the practice of neurosurgery in the world. Modern neuroimaging, neurosurgical techniques, and neonatal neurological intensive care have greatly improved morbidity and mortality in the care of encephalocele.

69. A Hospital-Based Study to Determine the Incidence of CAUTI and Etiology with Antibiotic Susceptibility
Alpana Singh, Ajay Kumar
Abstract
Aim: The aim of the present study was to determine the etiology with antibiotic susceptibility and also to calculate CAUTI rate. Material & Methods: The study was conducted on 100 patients who admitted in intensive care unit (ICU) in Department of Microbiology for the period of 12 months. Patients who were on urinary catheter insertion for >48 hours were included in the study. Results: There were 75 male and 25 females in the present study. Most of the patients belonged 25-45 years. The most common uropathogens were E. coli and Klebsiella pneumoniae followed by Pseudomonas aeruginosa and Acinetobacter species from the cases of CAUTI. Imipenem was the single best antibiotic for all pathogens except Pseudomonas aeruginosa where Amikacin was the drug of choice. The Acinetobacter species also showed very high resistance to all antibiotics except Imipenem. Conclusion: CAUTI remained a great burden to patient safety and a challenge to the infection control team. Implementation of proper care bundles and continuous education to health care workers plays a key role in reducing the CAUTI rates, thereby decreasing the morbidity and hospital stay to the patients.

70. A Morphometric Study to Define Anatomical Variations in Foramen Ovale: An Observational Study
Archana Kumari, Kumari Suman, Shishir Kumar
Abstract
Aim: The aim of the present study was to define anatomical variations in foramen ovale. Method: The study was carried out on 50 foramen ovale using 250 dry adult human skull bones of unknown sex and the bones were taken from the Department of Anatomy. Skulls which were fractured at the surrounding of foramen ovale were not included in the study. Results: Out of 50 foramen ovale, minimum to maximum anteroposterior diameter on left side were 3.1 mm- 8.0 mm and on right side were 3.4 mm-8.4 mm. Average anteroposterior diameter on left side was 5.6 ±1.412 mm and on right side was 5.5±1.375 mm. Minimum transverse diameter on left side was 2.3 mm and on right side was 2.8 mm. Maximum transverse diameter was 6.5 mm and 5.6 mm on left and right sides respectively. Majority of the foramen were oval shaped and it was seen in 27 sides (left 12, right 15), almond shape was seen in 13 sides (7 left, 6 right), round shape was seen in 8 sides (4 left, 4 right), slit like foramen was seen in 2 sides (1 left, 1 right). Incidences of various shapes of the foramen ovale were oval 54%, almond 26%, round 16% and slit like 4%. Out of 50 foramina, bony spine was observed in 3 followed by 2 bony plate 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 Foramne ovale is important foramina of the skull base.

71. An Observational Study to Determine the Link between Vitamin D and Cellular Senescence Measured With the Enzyme Telomerase in Pre-HTN
Rasikh M. Azaz Alim
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 from in the Department of Physiology. Inclusion criteria for the pre- hypertensive group (pre-HTN) (n =75) 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 = 75) 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 150 apparently healthy individuals. 75 were pre- hypertensive with the age of 22.58±1.56 and the age of controls was 18.82±1.24. Out of 150, 45 males, 30 females were in pre- HTN group and 40 males, 35 females were 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.

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

73. A Relative Assessment of the Occurrence of various Pathological Conditions Presenting as Thyroid Swelling: A Clinicopathological Study
Namira Azmi, Priyanshu Shekhar, Sanjay Kumar, Satyendra Sharma
Abstract
Aim:  The aim of the present study was to assess the relative occurrence of various pathological conditions presenting as thyroid swelling and the clinicopathological examination of swelling. Material & Methods: A prospective hospital-based study carried out on 100 cases of thyroid swelling attending the Department of ENT having adequate diagnostic and treatment facilities during the period of 2 years. Results: In this study of 100 subjects, maximum patients were in the age group of 31 to 40 years (33%), followed by 41 to 50 years (24%). The youngest patient in our study was 11 years while oldest was 74 years. Mean age of presentation was 40.88 years. 75 (75%) subjects were females while 25 (25%) subjects were male. All cases presented with swelling in front of neck (100%). Associated complaints were 7 (7%) subjects of bulky thyroid swelling complained of difficulty in swallowing, 4 (4%) subjects complained pain in neck, 2 (2%) subject presented with cervical lymphadenopathy and 1 (1%) subjects with hoarseness of voice. Most of the thyroid swellings were firm in consistency 47 (47%) followed by nodular 19 (19%), cystic consistency in 13 (13%) cases and soft consistency in 9 (9%) cases. Hard swellings accounted for 12 (12%) cases, most of which turned out to be malignant. On USG, Colloid nodule was found followed by Multinodular goitre, neoplastic etiology, solitary thyroid nodule and colloid cyst. FNAC findings were colloid goitre (61%), nodular goitre (19%), follicular neoplasm (10%), papillary carcinoma (9%) and medullary carcinoma (01%). The sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for diagnosis of thyroid swellings were 56.64%, 100%, 100% and 92%, respectively. Conclusion: FNAC is an easy, rapid, reliable, cost-effective, minimally invasive and    readily repeatable technique for diagnosis of thyroid swellings. The common false negative diagnosis is seen in follicular pattern cases, cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma.

74. An Assessment of the Spectrum of Renal and Perinephric Space Infection among Urology Patients
Bishwanath Prasad, Rajesh Jain, Sujeet Kumar Bharti
Abstract
Aim: The aim of the present study was assess the spectrum of renal and perinephric space infection among urology patients. Methods: The present study was conducted in the Department of General Surgery for the period of 24 months. 200 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 200 patients aged 10-70, 130 (65%) men and 70 (35%) females had renal and perirenal space infections. Young people aged 21-30 dominated. Fever (96%) was the most prevalent symptom at presentation, followed by flank discomfort (43%), weakness, and fatigue (73%). The average symptom duration was 23 days (7-60 days). Clinical examination revealed all patients were febrile (range 99-103° F) with 90% costovertebral pain. It was shown that 96 (48%) patients had renal abscess, 84 (42%) perinephric, and 20 (10%) emphysematous pyelonephritis. Patients with diabetes (36%), ureteric (32%), and renal (24%), were predisposed. Antibiotics alone were given to 120 patients and antibiotics+PCD to 40. Eight individuals had pus and debris leakage. Conclusion: Renal and perinephric space infection is a deadly urological issue. High suspicion, timely diagnosis, antibiotics, and surgery may reduce mortality.

75. A Radiographic Evaluation of the Outcome of Sonography and Mammography in Women with Breast Pain
Manish Kumar, Sanjeev Kumar Dwivedi
Abstract
Aim: The aim of the present study was to assess the outcome of sonography and mammography in women with breast pain. Methods: All women with diffuse & focal breast pain referred to the Department of Radiology, During the study period a total of 450 patients underwent Breast Imaging. Pain alone was mentioned as reason of referral in 100 cases (22.22%). Results: The mean age of patients in the study was 36.23 (range 17-60 years). 20 patients (20%) had family history of breast cancer and 10 (10%) had history of Hormone use at the time of examinations. The Imaging findings on the painful; breasts were: 70 (70%) normal, 28 (28%) Benign and 2 (2%) had suspicious imaging findings of malignancy.  The findings in the rest of the breasts were mild alteration in density and echo texture. FNA cytology examination was suspicious for cancer in 2 patients and 30 was benign. The negative predictive value in our study was 90%. Conclusion: Sonography and mammography for breast discomfort look comforting to patients and professionals. Breast imaging in women with painful breasts appears to be most useful for reassurance, since no abnormalities are commonly found, benign radiological abnormalities seldom have clinical repercussions, and malignancy in painful areas is rare.

76. A Study on Use of Partogram in Management of Labour in Patients with Previous LSCS
Sulekha Kumari, Sangita Jain, Rashmita
Abstract
Aim: To study the progress of labor in all ANCs with previous LSCS consenting for vaginal delivery using partogram and to note the feto-maternal outcome. Methods: A retrospective observational study was conducted at Department of Obstetrics and Gynecology, Shri Ramkrishna Institute of Medical Sciences and Sanaka Hospital, Durgapur, West Bengal, India for a duration of 1 year with previous LSCS for trial of labor who fulfilled the inclusion criteria. Detailed history regarding age, parity, duration of pregnancy and labour pain was taken from every patient. Examination was done including general physical examination, abdominal examination for fundal height, lie, presentation, engagement, amount of liquor, palpable uterine contraction and fetal heart rate. Pelvic examination was done for pelvic assessment and Bishop score. All the data were entered in a predesigned proforma. The course of labour in all the patients were recorded on WHO modified partograph. Statistical analysis was done using SPSS software. Result: Out of 60 women who participated in the study 36 (60%) were primigravida and 24 (40%) were multipara. The mean age of the participants was 25.36 years and the mean duration gestation was 281.9 days. The mean duration for delivery after Alert ETD was 4.3 hours. In our study, out of 60 participants, labor was induced only in 13% of the cases. The mean duration for delivery after Alert ETD was 4.7 ± 1.9 hours in the primigravida and 3.7 ± 1.8 hours in multipara, but these differences were not statistically significant. Conclusion: The partogram reduced feto-maternal problems and assisted in the early detection of deviations from normal labor, allowing for prompt management. The participants who passed the partogram alert line were taken for LSCS, showing that the partogram was more effective. Maternal difficulties in patients who have had past LSCS, such as obstructed labor, protracted labor, scar dehiscence and scar rupture, as well as additional complications such as PPH, cervical tears/vaginal lacerations, can be avoided with the use of a partogram.

77. Histopathological Spectrum of Ovarian Tumors
Pramod Solanki, Anshul Kumar
Abstract
Background: Ovaries can develop a wide spectrum of tumors including varied histological patterns, from epithelial tissue to specialized germinal and embryonal cells that release hormones, due to their intricate and unique nature as organs. Ovarian cancer is the fifth most common cancer among women and the second most common gynecologic malignancy. It is the most common cause of death from cancer of the female genital tract. Ovarian cancers account for about 25% of malignant tumors of the female genital tract and 4% of all female cancers. After the cervix, the ovary is the organ in the female genital system most frequently afflicted by cancer in India. Two thirds of ovarian tumors are surface epithelial tumors, but 90% of ovarian malignancies are malignant forms. Material and Method: This descriptive study was conducted by the Department of Pathology. This study includes the 100 ovarian tumor specimens that were sent to the hospital’s Department of Pathology for histological examination. Specimens that were frequently brought into the pathology department were used in a study. They got permission rather frequently. The tissue portion being studied was provided at no additional expense to the patient. Patient privacy was protected throughout the whole trial. To make new slides from the paraffin-embedded blocks and stain them for H and E, standard procedures were followed. In preserved gross specimens from the pathology department, gross findings were searched for. Age and laterality were taken from the histopathology record section of the test requisition forms. Results: Out of the 100 ovarian diseases cases that were examined, 60 of them were non-neoplastic, while the other 40 were cancerous. Eighty out of the hundred tumors, or 90.6%, were found to be present between the third and sixth decade. Merely 10% of tumors were observed in those under 20 years old and those beyond 60 years old. Of the malignant lesions, 50.94% of the cases occurred in the age range of 20 to 39 years. Every age group experienced non-neoplastic lesions, although the 40–59 age group accounted for 56.66% of all occurrences, or the majority of instances. The tumors were primarily unilateral. Of the 100 tumors, 30 (or 28%) presented bilaterally. Conclusion: In our study, non-neoplastic ovarian lesions were more commonly observed than neoplastic lesions, and benign tumors were more common than malignant ones. Surface epithelial tumors were the most common histologic type in all age groups. The most common kind of ovarian cancer found was serous adenocarcinoma. By the time they become advanced, ovarian tumors act like “Silent Killers.” Whether malignant or non-neoplastic, ovarian lesions often present with similar clinical and radiological features.

78. Biomarkers for Preterm Delivery Prediction: A Hospital-Based Investigation
Swati Sharma, Namarta Kumari, Akshita Agrawal, Suhani Manhas
Abstract
Introduction: One important factor that influences morbidity and newborn mortality is preterm delivery (PTD). Severe neonatal disease or even death is a risk for preterm newborns. One of the most serious risks to the developing baby and one of the unsolved issues in clinical obstetrics is preterm delivery (PTD); a predictive biomarker for this condition has to be found. Thus, the purpose of this research was to evaluate the blood concentrations of iron, ceruloplasmin, haemoglobin, and alkaline ferritin phosphatase in both preterm and full-term deliveries. Materials & Methods: The study’s sixty individuals are divided into thirty who presented with preterm labor and delivery and thirty who served as controls by giving birth at term. When a patient was in labor, blood samples were taken for the measurement of ceruloplasmin, iron, ferritin, and alkaline phosphatase. Results: Comparing preterm delivery to full term delivery, there was a significant rise (P ≤0.05) in serum alkaline phosphatase levels. Preterm delivery was associated with considerably higher serum ceruloplasmin levels than full-term delivery. (P ≤ 0.05). Comparing preterm to full term birth, there was a substantial rise (P<0.001) in serum ferritin levels. Compared to full-term deliveries, preterm deliveries did not significantly raise serum iron levels. (P ≤ 0.05). Conclusion: Serum levels of alkaline phosphatase, ferritin, and ceruloplasmin rise significantly in preterm birth compared to full term delivery, suggesting that these biomarkers may be utilized as predictive indicators for preterm birth. These criteria are also inexpensive, easy to use, and time-efficient. They also show signs of subclinical pregnancy infections, which may contribute to preterm delivery.

79. Pediatric Surgery: The Safety of Post-Operative Epidural Analgesia
Hemant Kumar, Aruna Mahanta, Suyash Garg, M Shiva
Abstract
Background: Early ambulation and discharge as well as a reduction in the requirement for both narcotic and non-narcotic analgesics have been linked to regional analgesia. It produces profound analgesia with little change in physiology. The psychological conditions during this pain-free phase are excellent for the healing child and family. Additionally, since most blocks have a fairly predictable duration of action, it is possible to carefully time the administration of a second analgesic medication to take effect when the block wears off. When general anesthesia is technically challenging or linked to a higher risk of morbidity and death, regional anesthesia can also be helpful. Material and Method: The present study was carried out on sixty in the department of Anaesthesia. The study was carried out on Thirty paediatric patients admitted in surgical and orthopaedic units of the tertiary care hospital. Results: Mean Weight in group A was 9.75 Kg with range of approximately 7 to 12 Kg and in group B the mean weight was 22.59 Kg with the range of approximately 15 to 29 Kg. The mean dose on the basis of weight, was 8.0 ± 0.72 mg/Kg in group A and 9.0 ± 0.59 mg/kg in group B. The mean volume of local anaesthetic solution (1.5%) came out to be 6.58 ±2.41 ml for group A and for group B it was 14.11±5.19 ml. Conclusion: Following the procedure, the patient wakes up pain-free, the child is much easier to handle, and the attendants’ worry decreases significantly as the patient lies comfortably following the procedure. Using an epidural block can help prevent many of the negative consequences of general anesthesia when it is the only anesthetic approach employed.

80. Pattern of Infections in the Children Suffering with Nephrotic Syndrome
Saurabh Singh, Pankaj Kumar Jain, Mukesh Ramajibhai, Archita Jain
Abstract
Background: Children with nephrotic syndrome are more susceptible to infection due to both the illness itself and the use of several immunosuppressive drugs. Most frequently, infections result in relapses that increase the risk of morbidity and death, require hospitalization, and require treatment. Due to infections, children with nephrotic syndrome (NS) have a high rate of morbidity and death. The reported forms of infections differ widely, and little is known about how patient features or therapy may impact the likelihood of infection. Considering this, our aim was to look into the pattern and frequency of infections in children with nephrotic syndrome. Due to infections, children with nephrotic syndrome still experience high rates of morbidity and death. It might also be the reason for a bad reaction to steroid treatment, the onset of illness, or relapses. Aim: The purpose of this study was to ascertain the kind and incidence of severe infections in children with nephrotic syndrome. Material and Method: This cross-sectional study was descriptive in nature and was conducted by the Department of Pediatrics. All children aged 2 to 12 who fulfilled the criteria for nephrotic syndrome as defined by the Study of Kidney Disease in Children (ISKDC) were included, regardless of whether they were infected. This covered every case of relapse that was brought into the hospital’s pediatric unit while the trial was underway. Acute or chronic renal insufficiency, as well as urogenital anomalies, were excluded from the study. During this time, ninety children were eligible for the study; however, ten of them either ran out of the hospital or refused to take part. Thus, a total of eighty children participated in the study. After obtaining signed informed consent, we started enrolling people in the ongoing trial. Written, informed consent was provided by patients or their guardians who wished to take part in the trial. Results: There were 51 (63.75%) episodes of major infections in 48 children with nephrotic syndrome. Three children had multiple infections. Thirty-Seven (46.25%) episodes of major infections occurred during relapses and 14 (17.5%) during the initial episode of nephrotic syndrome. Conclusion: Children with NS are prone to infections; peritonitis, pneumonia, urinary tract infections, and diarrhea are the most common ailments. When an infection arises, these children’s hospital stays are far longer than those of nephrotic children who do not have an infection. Given the prevalence of pneumococcal infection in our study, we advise more widespread pneumococcal vaccination coverage in such youngsters. In conclusion, major infections—especially during relapses—remain a major risk factor for kids with nephrotic syndrome. Drug-resistant organisms should be taken into account while treating infections in children with nephrotic syndrome.

81. A Clinicopathological Study of Stomach Carcinoma in a Tertiary Care Hospital
Satyajeet Sharma, Brijendra Kumar Tiwari, Durgesh Yadav, Ashutosh Singh
Abstract
Introduction: Cancer is the biggest problem facing today’s society. Statistics on fatalities indicate that this is the second most common condition worldwide, after cardiovascular problems. Globally, stomach cancer ranks as the second leading cause of death. People in different parts of the world and in different nations are affected by stomach cancer in different ways. In India, it remains the fifth most common cancer in men and the seventh most common cancer in women. Conversely, India is recognized as the region with the lowest incidence of stomach cancer due to its lower incidence compared to the rest of the world. Material and Methods: Type of study: Prospective observational study. Place of study: Department of surgery of tertiary care hospital. Sample size: A total of 100 individuals were identified as having stomach cancer and were monitored. Results: Maximum no. of had Abdominal pain (96) Followed by Nausea (89) and Vomiting (88). After that 83 patients were having Anorexia while 71 patients had Weight loss followed by Melena, Mass and Dysphagia. Conclusion: According to our research, stomach cancer risk rises with age, particularly beyond the age of forty. Eliminating stomach cramping agents like alcohol, drugs, tobacco, and cigarettes lowers the risk of cancer and upset stomach. Extra caution should be used when managing weight gain, and testing for abdominal discomfort may be an important diagnostic tool in the future.

82. The Use of Ultrasound in the Evaluation and Differential Diagnosis of Pregnancy-Related Pelvic Pain
Madhav Mayank Sharma, Satyajeet Sharma, Bhupendra Singh, Navsangeet Singh
Abstract
Background:  Pregnant women often have pelvic pain (PP), which can be brought on by a number of illnesses, such as vascular, gynecological, gastrointestinal, and obstetric conditions. The mother’s and the fetus’s health depend on an early diagnosis, correct treatment, and both. These are quite difficult, though. Pregnancy-related physiological changes should be taken into account as a potential source of diagnostic confusion. Since ultrasound (US) is commonly accessible, non-ionizing radiation is used, and it is the first-line imaging modality in this situation. When there is suspicion of an ectopic pregnancy, US may be definitive in making the diagnosis if it finds no fetal cardiac activity. Similarly, when there is suspicion of acute appendicitis, US may reveal a dilated, peristaltic, and blind-ending tubular structure emerging from the cecum. It can be challenging to detect and manage acute pelvic pain in expectant and new mothers. The most often utilized imaging modality for assessing expectant and recent mothers is still ultrasound. Aim: The aim of the study was to assess ultrasonography in evaluating several causes of pain in the pelvis during early pregnancy. Material and Method: This cross-sectional investigation was carried out in the General Surgery Department. For the study, 200 individuals with pelvic pain during the first trimester who were admitted to the labor ward are chosen. Participants in the research are those who have complained of lower abdomen pain and have had amenorrhea for up to three months. A trans abdominal ultrasound equipment with two dimensions. It has been demonstrated that sonar, a non-invasive technique, is completely safe for the fetus even after repeated exposures at any phase of pregnancy. An ultrasonography was performed on these 200 patients who had complained of lower abdomen pain and had experienced amenorrhea for three months. Urine β HCG analysis was also conducted. Informed written consent was taken from the patients or their guardians willing to participate in the study. Results: 200 patients with pelvic pain are reported; 20(31.4%) patients had bleeding, 20(16.9%) had fibroids out of 100 patients, 25(17.4%) had cysts and 12(5.5%) patients had an ectopic pregnancy, 100 patients were not counted for bleeding status in which 87(94.5%) patients had no ectopic pregnancy & 13 (5.5%) patients had an ectopic pregnancy.100 patients were counted for bleeding status, in which 6 (5.6%) patients had ectopic pregnancy & 94(94.4%) patients had no ectopic pregnancy, 100 patients were not counted for bleeding status which 99 (99.6%) patients had no fibroids & 1(0.4%) patients had fibroids. 100 patients were count for bleeding status, in which 87(52.8%) patients had fibroids & 13(47.2%) patients had no fibroids. Conclusion: It has been demonstrated that ultrasonography is a crucial diagnostic tool in obstetrics. It is a readily available diagnostic method that aids in the early detection of problems related to bleeding during the first trimester. It was shown to be crucial in the diagnosis of first-trimester hemorrhage in the aforementioned investigation. Relying solely on the patient’s history and clinical findings may cause a delay in diagnosis, a number of difficulties, and an increase in the patient’s morbidity.

83. Ophthalmic Manifestations of Hematopoietic Malignancy
Lakshmi Kuniyal, Arpita Gupta
Abstract
Background: Hematological diseases encompass problems of plasma proteins, coagulation, and erythrocytes, leukocytes, and platelets. These conditions can either directly impact the eye or cause ophthalmic symptoms that develop later on in the illness. Ocular symptoms can frequently be the first sign of hematological disorders. The majority of individuals who present with ocular symptoms are symptomatic and need to see an ophthalmologist. Any area of the eye can be affected by hematological illnesses, and each disease may have a different set of symptoms. Intraretinal bleeding, cotton wool patches, and conjunctival pallor and hemorrhages are typical symptoms. It is not typical to have bleeding symptoms in the orbit, anterior segment, optic nerve, or retinal infiltrates. Aim: To study the incidence of ocular involvement in systemic hematological disorders. Material and Method: This prospective, non-interventional descriptive study was carried out in the ophthalmology department. The ophthalmology department evaluated forty patients with hematological problems. A proforma was created that had the following information: a brief medical history, an ocular history, anterior and posterior segment exams, and a hematological profile of the patient. Every patient received a thorough examination of the anterior and posterior segments, which included measurements of intraocular pressure, best corrected visual acuity, slit lamp assessment of the anterior segment, dilated retinal examination with an indirect, direct ophthalmoscope, and slit lamp biomicroscopy with a Volk 78 D lens. In cases when fundus photography was performed, good results were obtained. All participants gave their written, informed consent for the treatments and the use of the health information in their medical records. Results: Ocular characteristics were discovered in 20 patients and 40 patients with hematological malignancies. Twelve women and 28 men made up the forty patients that were part in this study. Ocular findings were present in 14 of the 28 males and in 7 of the 12 females. A anterior segment finding was present in one male and one female among the ocular characteristics. There were 2 males and 2 females with neurological involvement. Analysis of the posterior segment revealed that it was involved more frequently than the anterior segment or neurological involvement, with findings found in 11 males and 4 females. With the exception of AML (acute myeloid leukemia), which had an equal frequency, and CML, where there was one case with anterior segment findings and one with posterior segment findings, the incidence of posterior segment findings was higher in each of the individual diseases than the incidence of anterior segment findings. Conclusion: The ocular pathological findings in individuals being monitored for hematological malignancies are reported and evaluated in this study. Numerous cases demonstrate the potential for ocular involvement in these hematological illnesses as well as significant clinical symptoms that may be noted in each. Furthermore, these cases highlight the need of eye care for patients with hematologic malignancies, especially dry eye illness, given the development of innovative antineoplastic medicines that may increase life expectancy.

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