International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Bacteriological Profile of Neonatal Sepsis in Outborn Neonates in a Tertiary Hospital in New Delhi
Sanjay Chaudhary, Vandana Chugh, Neetu Chaudhary, Neeru Malik, Pawan Kumar
Background: Neonatal sepsis is a leading cause of neonatal morbidity and mortality in India. However, limited data is available on the causative pathogens for community acquired sepsis. The aim of this study was to identify causative bacteria of neonatal sepsis in outborn neonates so that empirical treatment in the periphery may be initiated accordingly. Material and Methods: In this prospective observational study 145 consecutively admitted outborn neonates with symptoms of sepsis were enrolled. After initial resuscitative measures, a detailed history and examination was done and all relevant investigations including blood culture was sent. Lumbar puncture was done in the presence of a positive blood culture or if the clinical picture was consistent with meningitis in early onset sepsis and in all cases of late onset sepsis. Result: There were 36(24.8%) neonates with Early onset (EOS) and 109(75.2 %) with Late onset (LOS). The septic screen was found to be positive in 115(79.3%) and negative in 30(20.7%) of cases. The blood culture was found to be positive in 42(28.9%) cases. Among the culture positive cases, most common organisms found were Klebsiella pneumoniae 14(33.3%) and Staphylococcus aureus 14(33.3%) followed by CONS 9(20.4%), Streptococcus species 3(7.1%) of cases. Categorical variables were presented as number and percentage and SPSS 21.0 was used for statistical analysis. Conclusion: Empirical therapy for suspected neonatal septicemia should cover both Gram-negative bacilli and Gram-positive bacteria.

2. A Retrospective Analysis of Clinical Profile of Snake Bite Victims in an Indian Tertiary Level Institute
Amitkumar Dilipkumar Modi, Komal Ravi Thaker, Harsiddh Thaker, Chandrashekhar Waghmare
Background and Objectives: Preventable mortality from snakebites hinges on timely intervention. In India, despite having a substantial number of venomous snakes and an ample supply of anti-venom, 50,000 deaths occur annually in 250,000 snakebite incidents. This alarming rate is attributed to the initial pursuit of unconventional remedies before seeking hospital care, highlighting the need for immediate medical attention. This study was done to evaluate the outcomes of individuals bitten by snake. Methodology: We conducted a retrospective review of all patients admitted to the intensive care unit for the management of snake bite. The collected data encompassed variables such as age, gender, timing and month of the incident, bite location, anti-snake venom dosage, timing of anti-snake venom administration, duration of mechanical ventilation, complications, and mortality. We utilized Pearson’s correlation test and paired samples t-test for statistical analyses. Results: Out of a total of 156 patients, comprehensive data were retrievable for 79 snake-bite victims. The predominant snake type was the Krait. Males constituted the majority, with ages ranging from 20 to 40 years. A significant positive correlation was observed between lag time and the total anti-snake venom dose. Majority of patients required mechanical ventilation. Cardiac arrest, ventilator-associated pneumonia, and anti-snake venom reactions were observed. The overall mortality rate was 5.06%. Conclusion: This study underscores the favourable outcomes for neurotoxic snakebite victims when promptly treated with anti-snake venom (ASV) and ventilator support. Delays in treatment or severe bites correlate with poorer outcomes. Adhering to national guidelines for ASV dosing proves effective in managing most cases.

3. A Study to Compare the Anti Inflammatory Activity of Tinospora Cordifolia with Sterile Normal Saline and Diclofenac Sodium in Male Wistar Albino Rats
Praneetha Banavatu, Shilpa Tejavath, Veeraiah Dakkumalla, Roopa Bagurubilli, T Jaya Chandra
Introduction: Herbal medication is commonly used in ancient as well as modern in many parts of the world in the treatment of acute inflammation (AI). A study was taken to compare the anti-inflammatory (AnI) effect of Tinospora cordifolia (TC) with sterile normal saline and diclofenac sodium in male wistar albino rats. Methods: It was a prospective research conducted in the department of Pharmacology, Dr Pinnamaneni Institute of Medical Sciences & Research Foundation between October 2014 and 2016. Male wistar albino rats weighing about 250-300gm were included. Animals were divided in to test, standard and control groups, sterile normal saline, diclofenac sodium and TC were admisntered, respectively; 6 animals each, respectively. TC were studied at 19.95mg/kg, 25.69mg/kg and 33.25mg/kg, categorized as 2A, 2B and 2C, respectively and 6 animals in each category. The medicament extracts were prepared as per the standard guidelines and admisntered intraperitoneal route. Carrageenan induced rat paw oedema model was used. Paw oedema volume up to the ankle joint was measured in the test animals at 0 and 3hours following carrageenan challenge by using mercury Plethysmograph filled with mercury. ANOVA, was used for the data analysis; P <0.05 was considered statistically significant. Results: The herbal medicament showed significant reduction in rat paw volume. When the test group was compared with the control and standard, there was a significant reduction in the paw volume. Comparison between the standard and test also showed statistically significant reduction in the paw volume. Conclusion: In the animal models also TC act as AnI agent. Due to the precautions there was minimal animal deaths. But small sample size, aqueous solution alone are the limitations of this research.

4. A Study on Effect of Anxiety on Quality of Life in Post-Menopausal Women
Akhila Sabbavarapu, Nimmidithalli Annapurna, P V V Lakshmi, P. Suseela Kumari, T Jaya Chandra
Introduction: Natural menopause is the permanent ending of menstruation. Studies have shown that menopause have a negative effect on quality of life (QOL). With these a study was conducted to assess the severity of anxiety in post-menopausal women (PMW). Methods: It was a cross sectional study conducted in the department of Psychiatry, GSL Medical College between November 2018 and March 2020. The PMW attended psychiatry on OPD basis and met ICD 10 criteria for anxiety were considered. Those with other psychiatric disorders, non-cooperative members were not considered. For all the eligible study participants, socio-demographic and clinical information was recorded with the help of a pre-tested proforma. Hamilton Anxiety Rating (HAM A) scale was applied to assess the severity of anxiety and utian quality of life (UQOL) scale was used to assess the QOL. Chi square test was used for the statistical analysis; P <0.05 was considered to be statistically significant. Results: The age of the participants was ranged between 45 – 65 years, maximum (81; 67.5%) in 45 – 55 years. When HAM A scale was applied, 40 found diagnosed have anxiety disorder. Statistically there was significant association between QOL and anxiety. Conclusion: Anxiety is one of the commonest psychological disorder among the PMW which needs to be attended with utmost care due to its further complications.

5. Assessment of the Impact of the Amount of Contrast Material Used in Abdominal CT Examinations Regarding the Diagnosis of Appendicolith
Manjit Kumar, Abhishek Agarwal, Archana Kumari
Aim: The aim of the present study was to investigate the impact of the amount of contrast material used in abdominal CT examinations regarding the diagnosis of appendicolith. Methods: This was a cross-sectional study that was performed to evaluate the diagnostic value of the CT examination in patients with acute appendicitis. One hundred patients that met the inclusion criteria entered the study using census method. Demographic data of patients including age, gender were obtained. Results: In 70 patients, the CT scan findings were favorable for acute appendicitis, and the diagnosis was confirmed by the post-appendectomy pathological testing. Among the individuals undergoing CT scans, 5 false positive and 8 false negative results were recorded. The CT scan revealed that the patients had reduced peritoneal fat as well as a retrocecal appendix. The sensitivity, specificity, positive and negative predictive value of CT scans based on pathology results were 88.6%, 82.8%, 95.5%, and 78.2%, respectively, in patients with low clinical suspicion. We evaluated the CT scan and ultrasonography based on the gender of patients. Conclusion: In the clinical cases that there is suspicion of acute appendicitis, nephrolithiasis and ureterolithiasis, the present study recommends the acquisition of an abdominal CT applying however the following workflow. The CT protocol should apply first a low-dose pelvis CT scan in the region of cecum without contrast material. Subsequently, a second CT scan should be acquired with the use of oral and IV contrast.

6. A Cross-Sectional Study to Characterize Dermoscopic Features of TSDF and to Correlate them with Potency and Duration of Application of the TCS
Aswini Kumar Das, Pratap Chandra Das, Pallavi Kashyap
Aim: This study was undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: The present study was conducted in the Department of Skin and V.D and 100 cases were included in the study. Patients (18 years or above) with clinical symptoms and signs suggestive of TSDF (redness, itching, acne, burning, swelling, photosensitivity, pigmentation and atrophy) and with history of application of TCS on the face for a period of more than one month Results: Females (70%) constituted the majority as compared to males. Most of the patients belonged to the age group of 18–30 years (56%) with a mean age of 34.6 ± 8.2 years. Duration of TCS application ranged less than one year and 1-10 years was 45% patients each. 80 (80%) patients had received some form of formal education, while 20 (20%) patients were illiterate. Presenting complaints of the patients were redness in 75 (75%), itching in 70 (70%), pigmentation in 58 (58%), burning in 64 (64%) and acne in 42 (42%) patients. Clinical findings noted in the patients were erythema in 86 (86%), hyperpigmentation in 85 (85%), and hypertrichosis in 60 (60%) followed by telangiectasia in 50 (50%) and wrinkles in 36 (36%). Polygonal and Y-shaped vessels, though, are categorized under linear vessels with branches, the term Y-shaped vessel was used when only one lateral branch was visible and polygonal vessel was used if multiple branches forming a network were seen. Comparison of dermoscopy findings with their corresponding clinical finding revealed that red diffuse areas, vessels, brown globules, white structureless areas, desquamation, hypertrichosis and white hair were observed in a statistically higher proportion of cases dermoscopically. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

7. A Hospital-Based Assessment of the Thyroid Function Test in Severity of Preeclampsia: A Comparative Study
Arafat Ahmad
Aim: The aim of the present study was to estimate thyroid function tests i.e. TSH, fT3 and fT4 levels in women with mild Preeclampsia and severe Preeclampsia. Methods: It was a cross sectional study carried out in the Department of Biochemistry. Total 90 pregnant women between 18 to 35 years visiting the gynecology and obstetrics OPD were included under study. Results: The mean values of maternal age in all three are not statistically significant. Mean values Group I was 24.72+2.48, Group II: 24.26+2.88, Group III: 23.47+2.38. Mean gestational age at the time of serum sampling in normal pregnant women was 35.15+1.45 and it decreases in mild (34.36+2.58) and severe PE (32.12+1.69) having highly significant P value. While SBP and DBP increases with severity of PE as compared to normal pregnant women having highly significant P value (<0.0001). Urine protein was nil in group I and it increases with severity of PE. Proteinuria and blood pressure are used as parameters for severity of PE. The mean value of birth weight is normal in healthy pregnant women 2.76+0.14 but it decreases in mild PE (2.55+0.05) to more decrease in severe PE (2.36+0.04) having highly significant p-value <0.0001. In our study, the mean level of TSH within normal level in normal pregnant women was 2.36+0.52 while in mild PE was 3.97+ 0.63 and in severe PE was 5.75+1.00 with highly significant P value<0.0001. Conclusion: Evaluating thyroid screening during pregnancy might be of help in preventing the occurrence of low birth weight and instituting timely intervention and appropriate measures in terms of possible thyroid hormone administration in preterm infants in future.

8. Assessing Variability in Morphology of the Renal Vein and to Measure Length of Renal Vein: an Anatomical Study
Rajesh Ranjan
Aim: The aim of the present study was to study the variability in morphology of the renal vein and to measure length of renal vein and to observe the variations in renal vein. Methods: The dissection was done in 30 embalmed cadavers in the Department of Anatomy. They included 20 male and 10 female cadavers. This was cross- sectional study. They were collected from the dissection hall of department of Human Anatomy of various medical colleges. Results: Tributaries that emerge from the kidney and join to form renal vein are called primary tributaries. These were present in 9 in right and 12 in left specimens. Statistically significant association was not found between presence of primary tributary of renal vein and side. Statistically significant difference found between length of renal vein of right and left side. Average length was more on left side (62.44 mm) than that of right side (26.98 mm). Conclusion: Detailed knowledge of variations of these vessels will definitely improve outcome of various urological, renal transplantation and laparoscopic surgeries. This knowledge will be of immense help to radiologists and oncologists who are dealing with this region. Also, a detailed knowledge and understanding of major congenital anomalies of the renal veins variations will provides safety guidelines for endovascular procedures.

9. Assessment of Functional Outcome in Intertrochanteric Fractures between Dynamic Hip Screw and Proximal Femoral Nailing: A Comparative Study
Om Prakash Kunwar
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 two years 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.

10. Surveying Contraceptive Pill Perceptions among Women (20-45) in India: Insights into Practices, Knowledge, and Attitude
Rajasi Sengupta, Vaishnavi Mishra
A cross-sectional survey of 495 women aged 20 to 45 in India found a high level of awareness about contraceptive pills, with healthcare providers being the primary information source. However, knowledge gaps exist regarding specific contraceptive pill types. The survey revealed that 57% considered pills “very effective,” with birth control and menstrual regulation as primary usage motivations. Barriers include side effects and cultural considerations. Ethical considerations were prioritized, and the study used descriptive and inferential statistical analyses. The findings provide valuable insights for healthcare professionals, policymakers, and the public, guiding targeted interventions to address knowledge gaps and promote informed decision-making in reproductive health practices. The study contributes to the ongoing discourse on contraceptive perceptions in India’s diverse cultural landscape.

11. Understanding and Addressing Gaps in HPV Vaccination Uptake among Women Aged between 18-22
Rajasi Sengupta, Vaishnavi Mishra
This survey of 530 women aged 18-22 explores the landscape of HPV awareness and vaccination attitudes. While 90.6% demonstrated awareness of HPV, vaccination rates were lower at 59.5%, primarily attributed to a lack of information. The majority (92.5%) acknowledged the necessity of HPV vaccination, indicating positive attitudes. To bridge the awareness-action gap, targeted educational campaigns addressing information gaps and vaccine safety concerns are essential. Collaboration among healthcare providers, educational institutions, and public health organizations is pivotal in creating an environment conducive to informed decision-making and increasing HPV vaccination uptake in this demographic.

12. A Clinical Study of Fournier’s Gangrene
Akhilesh Ratnakar, Deepak Shrivastava, Sunil Kumar Saxena, Megha Shyam
Introduction: Fournier gangrene is necrotizing fasciitis or gangrene affecting the external genitalia and/or Perineum. Fournier’s gangrene is a surgical emergency, and because of differences in clinical presentation, patients may initially be encountered in a variety of clinical settings. Delay in diagnosis and treatment of this condition can be fatal, it is very important not to ignore symptoms, even if the symptoms are not specific. After Fournier’s gangrene is diagnosed, proper treatment is very important. It is more likely to occur in Diabetics, alcoholics, or those who are immunocompromised. Aim of study: To find out various etiological factors and course of management in patients presenting with Fournier gangrene in Bundelkhand medical college. Objectives: 1. To study the mode of presentation of the disease.  2. To find the factors associated with Fournier gangrene. 3. To find the commonest microorganism and antibiotic sensitivity associated with Fournier gangrene. Results: The commonest presenting features are scrotal pain, erythema and swelling at scrotum, fever, blisters or skin necrosis at scrotum. Alcoholism and Diabetes were the major risk factors. Commonest agent causing infection was found to be E. coli. Amikacin is the most sensitive antibiotic followed by Ceftriaxone and Meropenem.

13. A Drug Utilization Study in Patients Suffering from Breast Cancer at A Tertiary Care Teaching Hospital
Hardik Prajapati, Jatin Pathak, Kamalesh Bhatt, Darshan Dave, Minaxi Shah
Objective: To evaluate utilization patterns of drugs with their respective regimen in patients suffering from breast cancer at a tertiary care teaching hospital. Methods: This prospective, observational study was carried out at the Department of Pharmacology and Oncology, GCS Medical College, Hospital and Research Centre, Ahmedabad, to assess the drug utilization pattern in patients of breast cancer. The study was carried out over a period of 19 months from August 2019 to March 2021. A total of 67 patients were enrolled for the study. Patient’s demographic, clinical, and therapeutic data were collected from the files and in ward visits and analyzed in Microsoft Excel version 2015. Results: Diagnosis of breast carcinoma was highest in age bracket of 41–50 years (23 out of 67 patients) for this study. Most frequently prescribed regimen was Doxorubicin and Cyclophosphamide as regimen-1 (initial combination of anti-cancer drugs), commonest prescribed regimen-2 (first change in anticancer drug combination) was Docetaxel while Trastuzumab was commonest prescribed regimen-3 (subsequent change in anticancer drugs combination after initial change). Highest prescribed drugs were Cyclophosphamide (66), Doxorubicin (63) and Docetaxel (32) respectively. All patients were received various pre-chemotherapy and post-chemotherapy drugs to combat various toxicities of anticancer drug. Conclusion: The study results can help in generating local data regarding drug use pattern of the systemic chemotherapeutic agents in breast cancer patients and promote rational drug use.

14. Proportion and Clinical Profile of Epiretinal Membrane: A Descriptive Clinical Study
Jayasree Kottaram, Manjit P S , Vijayamma N
Introduction: Epiretinal Membrane is the most common type of fibrocellular proliferation which is found at vitreoretinal interface in ageing population. The avascular membrane, which is greyish and semi-translucent, can be observed on the surface of the retina, namely above the internal limiting membrane (ILM). There is a growing trend in the number of individuals who are receiving surgical treatment for epiretinal membrane. It gradually impacts the central vision and results in metamorphopsia. Advanced form of epiretinal membrane can cause significant loss of visual acuity and visual symptoms. Aim and Objectives: The aim of the study was to find out proportion and clinical profile of Epiretinal membrane among patients attending Ophthalmology OPD, Government Medical College, Kottayam, Kerala. Material and Methods: This study design was descriptive in nature, conducted in a hospital setting. Patients were selected from Ophthalmology OPD at the Ophthalmology department of the Government Medical College and Hospital in Kottayam, Kerala, India by simple random method. This was done after obtaining approval from the Scientific Review Committee and Institutional Ethics Committee and obtaining consent in writing from patients. Epiretinal membrane was diagnosed by Ophthalmological clinical examination and confirmed by OCT. The presence of other risk factors was assessed from history, clinical examination and B scan. The clinical profile of epiretinal membrane cases was analyzed. Statistical analysis was done using SPSS. Results: Proportion of epiretinal membrane was 10% in the study population. Majority of cases belonged to older age (61-80 yrs) group. Epiretinal membrane was commonly bilateral presentation. There was no significant difference in gender among cases. Diabetic mellitus (p=0.001) and dyslipidemia (p=0.003) had positive association with epiretinal membrane. Proliferative diabetic retinopathy (p=0.001), retinal surgeries, retinal vessel occlusion and posterior vitreous detachment had significant association with epiretinal membrane (p<0.001). Conclusion: The estimated proportion of Epiretinal membrane was 10%. The presence of epiretinal membrane in the study population was associated with age, dyslipidemia, diabetes mellitus, proliferative diabetic retinopathy, vessel occlusion, retinal surgeries and posterior vitreous detachment.

15. Recent Advances of Curcumin in the Treatment of Various Allied Disorders
Muzamil Muzaffar, Arifa Hassan, Mohd Rafi Reshi, Saman Anees, Maaz Naqvi
The Indian plant Curcuma longa L., popularly known as turmeric, produces curcumin, also known as curcuminoid. The main curcuminoids included in turmeric (Curcuma longa L.) rhizome include dihydrocurcumin, tetrahydrocurcumin, curcumin, bis-demethoxycurcumin, and demethoxycurcumin. Curcumin also contains anti-inflammatory, antioxidant, pro-apoptotic, anti-proliferative, antiparasitic, chemopreventive, chemotherapeutic, antinociceptive, preeclampsia, and antimalarial effects. The two major categories of pharmacologically potent secondary metabolites present in turmeric rhizome are curcuminoids and essential oil. Curcuminoids are isolated from turmeric rhizomes by using both conventional and modern extraction methods. Soxhlet extraction and maceration are two conventional extraction methods. Due to inadequate small intestine absorption, rapid liver metabolism, and rapid systemic clearance, curcumin has a low bioavailability in humans. The vast majority of curcumin consumed orally is removed through the faeces, with only a small, absorbed fraction of curcumin changing the metabolism.

16. Correlation of Age, Tumor Size, Grade, Lymph Node Metastasis and Skin Involvement in Breast Carcinoma- Hospital Based Study
Shah Mitesh, Agrawal Ruchi, Singh Puja, Gangwani Amar
Introduction: Breast carcinoma is one of the most common malignancy worldwide. Incidence of the disease is also increasing in India and can cross about 2 million till 2030. Various studies conducted worldwide had shown size of tumor, lymph node status, age and other variables are the prognostic markers for breast cancer. It had found that 4 or more lymph node involvement also affect survival. Aims and Objectives: To find the correlation of age, tumor size, grade, tumor architecture, nuclear pleomorphism, mitotic activity, lymph node metastasis and skin involvement in breast carcinoma. Method: Retrospective study was conducted in department of pathology, Bundelkhand Medical College, Sagar (M.P.) from 2019- september 2023. Data regarding age, tumor size, grade, tumor architecture, nuclear pleomorphism, mitotic activity, lymph node metastasis and skin involvement in breast carcinoma specimens was collected, assessed and statistically analyzed by Chi-square test. Result: Statistically significant correlation between tumor size and grade [corrected χ2 score is 16.93, corrected p value 0.009 (p <0.05)], tumor size and lymph node metastasis [χ2 score is 6.02, p value 0.049 (p<0.05)] along with mitotic activity and lymph node metastasis [corrected χ2 score is 6.46, corrected p value 0.04 (p<0.05)] found. Conclusion: Larger tumor size can have more probability of higher grade and lymph node metastasis. Higher the mitotic activity score more chances of spread to lymph nodes. Age, number of positive lymph nodes, skin invasion are independent risk factors.

17. A Clinical Study of the Factors Affecting the Outcome of Intestinal Resection and Anastomosis
Kyasa Shiva Kumar, Bushigampala Anil Kumar, V Shyam, Deepak Jadhav Maloth
Introduction: Anastomosis refers to a surgical procedure or a natural connection between two tubular structures, such as blood vessels, intestines or other hollow organs. Anastomotic leak is one of the most common and dreaded complications after the surgical procedure of intestinal anastomosis. Aim and Objective: To discuss about factors affecting the outcome of intestinal resection and Anastomosis. Materials and Method: This was prospective observational study conducted on 75 patients requiring intestinal resection and anastomosis admitted in department of general surgery, Chalmeda Anand Rao Institute of Medical sciences, Karimnagar, for the duration of one year, after approval of institutional ethical committee of our institute, consent from patients and after following inclusion and exclusion criteria. Results: 75 patients were included in the study, among which nearly 78% of the patients were from the age group of 20-60 years of age, 72% of the study population were male followed by female. 36% of the study population had comorbid condition and 57.3% of the study population underwent elective surgery followed by emergency. Leak were present among 12.96% of the population from male and 19.05%  from female, patients with elevated low albumin level leak was observed among 72.72% of the population. Conclusion: Levels of serum albumin can be used as a simple, reliable and economical prognostic marker in predicting the outcome of bowel anastomoses. This helps the surgeon in operative decision making as well as explaining the prognosis and operative risk to the patient.

18. A Patient with Recurrent Jaundice Diagnosed to be A Case of Mixed Etiology of Autoimmune and Genetic Disease: A Case Report
Jyoti Verma, Tabish Abbasi
An Adolescent 18 year old male patient had H/O recurrent jaundice. Patient was asymptomatic without any comorbities. Later he was found to be a case of autoimmune hepatitis and Gibert’s syndrome. Autoimmune profile was positive, other causes of indirect hyperbilirubinemia were excluded and Gilbert’s syndrome was diagnosed.

19. Prognostic Indicators of Mortality and Morbidity in Patients with Diabetic Soft Tissue Infection
V Shyam, Deepak Jadhav Maloth, Kyasa Shiva Kumar, Bushigampala Anil Kumar
Introduction: Soft tissue skin infections (SSTI’s) were first described in the Hippocratic era. Despite this well accepted management approach, the mortality rate remains between 16 – 34% in most major published series. Over the last decade, there has been an interest in understanding SSTIs better. Aim and Objectives: To determine the factors which increase the morbidity and mortality of a patient with diabetic soft tissue infection. Materials and Method: This was a Retrospective study conducted in department of General surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, for the duration of two years, in which total 160 patients were included after following inclusion and exclusion criteria, and approval institutional ethical committee and also after getting consent form the patients. Results: Of the 160 patients admitted, more than 80% of the patients were form the age group of 31 – 60 years, majority of the patients were male, and 58.1% of the  patients had duration less than or equal to 5 years and others had duration more than 5 years. in the multivariate analysis for this worse outcome like mortality and amputation, age(Years), duration of disease, comorbid condition, presence of sepsis, Glasgow coma scale, body surface area and depth of involvement found influencing factor and statistically significant (P-value<0.01). Conclusion: Age (Years), duration of disease, comorbid condition, presence of sepsis, Glasgow coma scale, body surface area and depth of involvement found influencing factor for worse outcome like mortality and amputation.

20. A Study of Multidetector Computed Tomography in Evaluation, Characterization and Classification of Traumatic, Inflammatory and Neoplastic Pancreatic Lesions
P V S Abhishek, Sandeep Chunduru, Adimulam Josthsna
Background: Currently, pancreatic lesions are becoming more frequent and are a major source of morbidity and mortality. Therefore, it is important to assess the imaging techniques that aid in the early diagnosis, assessment, and characterisation of these lesions. Early diagnosis of tiny pancreatic lesions is attainable with triphasic contrast studies and multidetector computed tomography, which both provides the best evaluation of pancreatic lesions. Aim and Objective: To assess the role of Multi detector Computed Tomography in evaluation, characterization and classification Of Traumatic, Inflammatory and Neoplastic Pancreatic Lesions. Materials and Methods:  This was prospective observational study in which total 78 patients of all ages who had been clinically suspected of having pancreatic diseases were referred to the radiology department were included in the study after following inclusion and exclusion criteria after getting ethical approval and consent from the patients. Results and Conclusion: Adenocarcinomas in particular have a male to female ratio of 1:4 and are more prevalent in females. Males frequently experience inflammation and trauma. In pancreatic neoplasm, the head of the pancreas is the most frequent site, solid tumours are more prevalent, and most of them are malignant. Mucinous cystadenoma was the most common benign tumor whereas Adenocarcinoma is the most common malignant tumor followed by secondary metastasis predominantly from liver. Conclusion: Neoplasms are more common in females, Inflammatory & trauma are common in males, with increase in age there is shift in frequency of cases from inflammatory to neoplasm.

21. Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage
Samira Mistri
Background and Aim: Carbetocin and oxytocin are prescribed for the purpose of preventing uterine atony-induced postpartum haemorrhage (PPH). A more recent substitute for oxytocin, carbetocin has a prolonged half-life and is more resistant to heat. Reduced PPH can be achieved through the preventative administration of uterotonics. Comparing the effects of oxytocin and carbetocin on placental separation, blood loss control, and the amount of additional uterotonic required during caesarean section (CS) in patients at high risk for primary PPH were the objectives of the present study. Material and Methods: One hundred elective CS-undergoing women were recruited for the investigation. They were separated into two groups at random. At delivery of the anterior shoulder, women in the carbetocin group (group A) were administered a bolus of 100 µg IV. Conversely, women in the oxytocin group (group B) were administered 20 IU of oxytocin in 1000 mL of 0.9% NaCl solution IV (at a rate of 150 mL per hour). The effects of carbetocin and oxytocin on blood pressure (BP) at 1 minute and 5 minutes after injection were evaluated in this study. The time required for placental separation, uterine tone, the necessity for supplementary uterotonic agents, and the decrease in haemoglobin level as determined by comparing the concentration of haemoglobin at admission and 24 hours postpartum, as well as the visual assessment of blood loss, were also evaluated and compared. Results: The oxytocin group exhibited early placental separation in 73% of patients (less than 30 seconds), whereas the carbetocin group demonstrated placental separation after more than one minute. In both research groups, haemoglobin levels were comparable before and after 24 hours from the time of delivery. In group A, the median haemoglobin value was 12.1 gm/dl prior to LSCS and 10.9 gm/dl following the procedure. Additionally, uterine tone was observed to increase in the oxytocin group within 30 seconds, whereas it took the carbetocin group 60 seconds to achieve the same result. However, the tone remained constant in the carbetocin group, and group A did not receive any further utero tonics. 45% of patients in the oxytocin group required additional uterotonics (p0.05). Conclusion: The administration of carbetocin via a single injection offers greater convenience compared to the requirement of a priming injection followed by several hours of oxytocin infusion.

22. Comparative Assessment of Butorphanol, Fentanyl and Nalbuphine for Total Intravenous Anaesthesia in Patients Undergoing Laparoscopic Cholecystectomy
Dhaval Patel, Ananyaruchi S Sharma, Hetal Sonavane, Hiren Dasharathbhai Patel, Vishal Jagadishkumar Mittal
Background and Aim: Opioids are a class of medicines that can be used to enhance Total Intravenous Anaesthesia (TIVA) in order to address the analgesic component. They not only reduce the need for potent anaesthetic agents during induction and maintenance, but they also allow for a more complete recovery from anaesthesia without excessively prolonging it. The purpose of this study was to assess the efficacy of an agonist antagonist type of opioid as an adjuvant to propofol-based TIVA, thereby replacing agonist opioids, which have higher adverse effect profiles and misuse potential, as well as being scheduled medications that are not widely available. Material and Methods: After receiving approval from the hospital’s ethics council, this prospective randomised trial was carried out in the department of anaesthesia and intensive care at a tertiary centre. A total of 150 patients were involved in this investigation. Patients in Group I received 25 g/kg of intravenous butorphanol, Group II received 2 g/kg of intravenous fentanyl, and Group III received 0.3 mg/kg of intravenous nalbuphine soon before anaesthesia induction. Intravenous propofol 2 mg/kg and vecuronium bromide 100g/kg injections were used primarily for induction. Anaesthesia was maintained with TIVA by infusing propofol according to the Bristol infusion schedule and administering muscle relaxant top-ups on an as-needed basis. The following parameters were recorded: hemodynamic monitoring, recovery characteristics (emergence and recovery time), duration of analgesia, sedation, and any adverse effects. Results: Butorphanol was reported to have a better stable state of haemodynamics throughout the intraoperative period than fentanyl and nalbuphine. Butorphanol again suppressed the pressor response better, albeit fentanyl also suppressed it to some extent. In terms of recovery metrics, butorphanol and nalbuphine recovered more slowly than fentanyl, whereas butorphanol produced better analgesia than the other two medications. Conclusion: Agonist-antagonist opioids have the potential to replace agonists due to their extended analgesia, low side effect profile, ease of availability, and lack of abuse potential. Because of their negative effects, abuse potential, and restricted availability as scheduled medications, agonists such as Fentanyl cannot be urged to supplement T1VA.

23. Incidence of Complications in Patients Diagnosed with Acute Appendicitis
Pradip Nautamlal Malaviya, Vijay Vasantlal Paria
Background and Aim: Acute appendicitis is still the most common general surgical emergency seen in most hospitals, as well as the leading cause of acute abdomen requiring surgical intervention. The purpose of this study was to find out how common complications were in patients with acute appendicitis. Material and Methods: The study included all patients with acute appendicitis who presented to Tertiary Care Teaching Institute of India throughout a one-year period. The current study included a sample size of 100 people. The sampling technique employed was a practical sampling technique. Clinical evaluation, tests such as WBC counts, X-ray erect abdomen, USG abdomen and pelvis, and management were all documented. The occurrences of complications were investigated. Except for those who did not react to antibiotics, appendicular mass patients were handled conservatively. Results: Overall complications were reported in 80 participants in our research of 100 patients with appendicitis. In this study, the most prevalent complication found in the paediatric age group was appendicular perforation, followed by peritonitis and small bowel blockage. In patients above the age of 18, the most prevalent consequence was surgical site infection (21%), followed by perforation (16%). Conclusion: In the current investigation, the most prevalent complication found in appendicular perforation patients was postoperative wound infection. Perioperative antibiotics have been demonstrated to reduce the incidence of postoperative wound infections and abscess formation.

24. Comparison of Dexmedetomidine/ Esmolol for Attenuation of Stress Response to Extubation and Emergence
Manisha. S. Kapdi, Shruti. Desai, Kirtan. Pandya, Nikunj Patel, Parth Prajapati, Rohit Chauhan
Background: endotracheal intubation & extubation are the procedures which cause stress response to airway manipulation which is hazardous for patients with low cardiorespiratory reserve. various pharmacological agents used to control it.
Aims & Objectives: To study the effect of dexmedetomidine (0.5µg/kg)/ Esmolol (0.5µg/kg) on hemodynamic responses during tracheal extubation, to compare the two groups with respect to hemodynamic parameters, time to extubate and quality of extubation & observe and compare sedation score in the two study groups. To study the side effects of drugs if any.
Group A:  Patients received 0.5 µg/kg of Esmolol diluted in 10 ml in normal saline IV over 10 minutes. Group B: patients received 0.5µg/kg of Dexmedetomidine diluted in 10 ml in normal saline Iv over 10 min. In all cases, anaesthesia techniques were similar irrespective of group. Study drug was given as described above and administered 15 minutes before estimated time of completion of surgery. Hemodynamic parameters like Heart rate, SBP, DBP, MAP, and SpO2 were monitored in all patients at baseline, after administration of study drug, at 5 and 10 minutes and post extubation at 1st, 3rd, 5th, 10th, 15th ,30th,45th and 60th minute. Time to emergence and extubate were noted. Extubation quality and sedation score were assessed by Extubation quality and five point scale respectively. Incidence of complications like bradycardia, hypotension, respiratory depression, laryngospasm and bronchospasm were noted. In our study following observations were made: Hemodynamic parameters like HR, SBP, DBP and MAP values were comparable at baseline in both groups. Reduction in HR and MAP were found a 5 and 10 minutes after drug administration and there was increase in HR and MAPat post extubation 1 and 3 minutes which were lower when compared to baseline. Thereafter at post extubation 5,10,15 and 30 minutes HR and MAP in group B was statistically significant lower compared to group A(p<0.05) and at post extubation 45- and 60-minutes values of HR and MAP were comparable. At all measurement point HR and MAP were remained below baseline value which signifies attenuation in hemodynamic parameters to extubation. Emergence time in group A and B were 9.13±1.32 and 10.5±1.66minutes respectively, while extubation time in group A and B were 12.3±1.39 and 14.13±2.11minutes respectively and shows that dexmedetomidine is associated with delaying in both emergence and extubation time and there was statistical significant difference(p<0.001) among two groups. We found that sedation score at all measurement point was higher in group B and there was statistically significant difference among two groups (P<0.05).  At post extubation 45- and 60-minutes sedation score was not statistically significant different (P>0.05). Group of dexmedetomidine is associated with more sedation without any respiratory depression.
Incidence of bradycardia  in group A was 6.66% and In group B 13%, and incidence of hypotension  In group A was 3.33% in group A and 10% in group B. No any case of respiratory depression, laryngospasm or bronchospasm was noted.

25. Functional Outcome of Lisfranc Injuries and its Clinical & Radiological Predictors: A Prospective, Hospital Based, Observational Study
Ali Mohammed P, Prasanna T Y, Nithin Chandrasekharan, K Senthil Kumar
Background and Objectives: A condition characterized by the misalignment of one or more metatarsals in relation to the tarsus is commonly known as a “Lisfranc injury.” In order to provide appropriate treatment and mitigate potential long-term repercussions, it is imperative to promptly and accurately diagnose these injuries. The primary objective of this study was to assess the clinical and radiological factors that influence the functional outcomes of different fixation techniques for treating Lisfranc fracture dislocations, as measured by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Material and Methods: The research was carried out as a prospective observational study at the Department of Orthopaedics, Government Medical College and Hospital in southern India. A total of 27 patients, aged between 18 and 70 years, who had undergone surgical fixation for lisfranc injury, were included in this study. The patients were followed up both clinically and by the use of follow-up x-rays. Prior to the study, approval was obtained from the institutional ethics committee, and all participants provided informed written consent. Outcome measures: The assessment of functional outcome was conducted on the AOFAS midfoot scale. The radiological assessment was conducted by evaluating many factors, including the extent of reduction, diastasis, and adherence to the Myerson criteria, using follow-up X-ray examinations. Results: The majority of patients, namely 19 individuals (70.3%), presented with a closed Lisfranc injury, whereas just 8 patients (29.6%) exhibited an open Lisfranc injury. Among the cohort of 27 patients, a total of 2 individuals received conservative treatment. Out of the 25 Lisfranc injuries that underwent surgical treatment, 14 patients (51.8%) experienced open reduction and internal fixation (ORIF) using K-wires. Additionally, 10 patients (37%) underwent fixation with screws, while 1 patient (4%) received dorsal plate fixation. Seventeen patients (68%) had satisfactory anatomical reduction, and this outcome was shown to be significantly correlated with improved functional outcome scores (p=0.004). The study observed that the functional outcome, as assessed by AOFAS mid-foot score, demonstrated outstanding results (95-100) in 5 instances (18.5%), good results (75-94) in 17 cases (63%), and fair results (50-74) in 5 cases (18.5%). No significant associations were seen between the cause of injury, related injuries, gender of the patient, and Myerson classification groups and the AOFAS midfoot score (p>0.05). Patients with closed Lisfranc injuries exhibited statistically significant improvements in AOFAS scores compared to those with open Lisfranc injuries (p=0.024). A statistically significant correlation was seen between the various treatment methods (K-wire, Screws, Plate, Conservative) & the AOFAS scores (p=0.042). The study observed that patients with diastasis less than 2mm & post-operative tarso-metatarsal sag less than 15 degrees on lateral view had superior functional results, as shown by the AOFAS score (p=0.036 and 0.007, respectively). Screw fixation demonstrates superior efficacy in producing a diastasis of less than 2mm when compared with K-wire and plate fixation, as indicated by a statistically significant p-value of 0.032. Conclusion: The current study demonstrates that screw fixation for achieving stable anatomical reduction is more effective than K-wire and plate fixation in restoring medial cuneiform-2nd metatarsal diastasis to less than 2mm and tarso-metatarsal sagittal angle to less than 15 degrees. These radiological outcomes are crucial in the treatment of Lisfranc injury. Patients who have restoration of both radiological and functional criteria have favorable outcomes, including improved AOFAS mid-foot scores and reduced likelihood of experiencing postoperative pain and arthritis.  Additional biomechanical investigations and clinical trials, encompassing a sufficient number of participants, are necessary in order to assess the efficacy and reliability of screws as a therapy modality for Lisfranc injuries.

26. Nerve Conduction Study in Vitamin B 12 Deficiency Patients
Shaik Meera Sharief, Arjuman Parveen Shaik, Shaik Auliya Parveen
Vitamin B12 deficiency is clinically recognized to be associated with neurological disorders, such as dementia, cognitive impairment, and depression. B12 deficiency may cause demyelination of nerves in the peripheral and central nervous system and has been associated with peripheral neuropathy, loss of sensation in peripheral nerves, and weakness in lower extremities in older adults. 30 Vitamin B12 deficient subjects and 30 normal subjets as control were included in study. Nerve conduction study was done using the AD instrument–Nicolet in both groups. Comparison of sensory nerve parameters in Control Group and Vitamin B12 deficient subjects, there is highly significant slowing of sensory nerves median & ulnar (p<0.001) and significant decrease in amplitude of Median nerve and ulnar nerve (p<0.01) in Vitamin B12 deficient subjects compared to controls. Early diagnosis of neuropathy due to Vitamin B12 deficiency is important, because a myriad of adverse outcomes that can be progressive and irreversible neurological abnormalities can be averted with substitutive treatment.

27. Effect of Ticagrelor Combined with Accupuncture in Myocardial Infarction and Its Effect on Serum Myocardial Enzymes, Cytokines and T Lymphocytes
Gitanjali Kothiyal, Upender Kumar, Ravinder Kumar Yadav
Background: Myocardial infarction (MI), a global health challenge, necessitates innovative strategies to optimize recovery beyond conventional interventions. This study explores the synergistic impact of Ticagrelor, an antiplatelet agent, and acupuncture, a traditional Chinese medicine practice, on post-MI outcomes. Materials and Methods: A randomized, double-blind, placebo-controlled trial enrolled 120 post-MI patients. Participants received Ticagrelor or placebo alongside acupuncture or sham acupuncture. Serum myocardial enzymes, cytokines, and T lymphocytes were assessed at baseline, 4, and 8 weeks. Adverse events were monitored. Results: The Ticagrelor and acupuncture group exhibited significant reductions in Troponin I, CK-MB, and LDH levels. Pro-inflammatory cytokines (IL-6, TNF-α) decreased notably, while anti-inflammatory IL-10 increased substantially. CD4+ and CD8+ T lymphocyte subsets showed favorable modulation. Adverse events were minimal, with no reports in the Ticagrelor and acupuncture group. Conclusion: Combining Ticagrelor and acupuncture post-MI demonstrates promising synergies in reducing myocardial damage, inflammation, and promoting immunomodulation. Safety profiles support its viability. This integrative approach enhances post-MI care, offering a comprehensive perspective on cardiovascular recovery.

28. Nerve Conduction Study in Vitamin B 12 Deficiency Patients
Shaik Meera Sharief, Arjuman Parveen Shaik, Shaik Auliya Parveen
Vitamin B12 deficiency is clinically recognized to be associated with neurological disorders, such as dementia, cognitive impairment, and depression. B12 deficiency may cause demyelination of nerves in the peripheral and central nervous system and has been associated with peripheral neuropathy, loss of sensation in peripheral nerves, and weakness in lower extremities in older adults . 30 Vitamin B12 deficient subjects and 30 normal subjets as control were included in study. Nerve conduction study was done using the AD instrument –Nicolet in both groups. Comparison of sensory nerve parameters in Control Group and Vitamin B12 deficient subjects  , there is highly significant slowing of sensory nerves median & ulnar (p<0.001) and significant decrease in amplitude of Median nerve and ulnar nerve (p<0.01) in Vitamin B12 deficient subjects compared to controls. Early diagnosis of neuropathy due to Vitamin B12 deficiency  is important, because a myriad of adverse outcomes that can be progressive and irreversible neurological abnormalities can be averted with substitutive treatment.

29. Clinical Research Studies Involving Biomarkers in Obesity Registered in Clinical Trials Registry: An Audit
Pallavi Palshikar, Kailas Gadekar, Prerna Kadam, Kartiki Aher, Smita Tiwari, Somnath Salgar
Background: The global obesity epidemic poses a significant public health challenge, increasing the risk of chronic diseases such as type 2 diabetes, coronary heart disease, and certain cancers, while also being linked to reduced life expectancy. The commonly used body mass index (BMI) is acknowledged as an imperfect measure of excessive body fat accumulation. Specific adipokines like leptin, adiponectin, and resistin are associated with obesity-related health outcomes, and ongoing biomarker research, employing high throughput methods, provides valuable insights into the etiology and pathophysiological pathways of obesity-related diseases. This study focuses on analyzing clinical research and trials within the obese population, as documented in the public domain in form of clinical trials registry, emphasizing the necessity for high-quality data to better understand ongoing and completed trials and improve personalized prevention strategies for individuals at high risk of obesity-related diseases. Aim and Objective: To analyse the research trials conducted in obese population with special reference to various biomarkers from data available on clinical trials registry website. Material & Methods: This was a retrospective audit-based study. The official website of was assessed for data regarding different studies related to obesity and biomarkers from January 2007 to December 2023. The data was analyzed according to the multiple parameters. Data analysis and statistical analysis was done by using descriptive statistics in MS Excel. Results: Primary outcome in majority studies was related to change in body weight/total fat mass which were mainly anti-obesity drug related trials. Around 22.81% studies belonged to Phase -1and Leptin (89.47%) followed by Adiponectin (47.37%) was the most studied biomarkers. Conclusion: In conclusion, this audit sheds light on the fact that anti-obesity research is more market driven and fails to focus on the greater good of the society. It emphasizes the importance of generating high-quality data focusing on affordable and sustainable modalities of weight reduction and it effect on various biomarkers the elucidate the mechanism of adverse outcomes on cardiometabolic health aspects of the masses.

30. Evaluation of the Role of Alvarado Score in the Diagnosis of Severity of Acute Appendicitis
Vishal S. Shah, Vikrant Akulwar, Parth S. Patel, Kalpesh A. Parmar
Background: Acute Appendicitis (AA) stands out as the most frequently encountered surgical issue within the abdominal area. Throughout the last century, there has been notable progress in diminishing the morbidity and mortality rates linked to this condition. Several scoring systems have been used to help diagnose acute appendicitis early and manage it promptly. These systems are accurate and reliable tools for distinguishing between acute appendicitis and other types of abdominal pain. The current study aimed to evaluate the efficacy of Alvarado scores in cases of acute appendicitis. Methods: Based on the inclusion and exclusion criteria a total of 80 cases of acute appendicitis were included in the study. Based on the total Alvarado scores, the patient groups were defined as follows: Total Score 7 – 10 (Group I) Total Score 5 – 6 (Group II), and Total Score 1 – 4 (Group III). The data details related to the surgical procedure, and the surgical grading of appendicitis. Histopathological (HP) grading data was also included. Results: the distribution of cases between age groups and Alvarado scores. The Alvarado score is a clinical scoring system used to predict the likelihood of acute appendicitis. A score of 5 or more is considered to be highly suggestive of appendicitis, while a score of 0 or 1 is considered to be very unlikely. The table shows that the majority of cases (48 out of 80) occurred in patients under the age of 20. Of these cases, 26 had an Alvarado score of 5 or more, 14 had a score of 2 to 4, and 9 had a score of 0 or 1. The P value of 0.268 indicates that there is no statistically significant difference in the distribution of Alvarado scores between age groups. Conclusion: The Alvarado scoring system emerged as a straightforward, rapid, dependable, and user-friendly tool. It significantly enhances the diagnostic confidence associated with clinical assessments of acute appendicitis. This scoring system exhibits a high level of sensitivity and positive predictive value. It remains a flexible tool, allowing for ongoing observation and critical re-evaluation of the clinical presentation’s progression.

31. Efficacy of Ultrasound-Guided Transversus Abdominis Plane for Post-Operative Analgesia in Abdominal Surgeries
Ketan Modi, Shweta Narsingani, Gaurav Kumar Prajapati, Balraj B. Joshi
Background and Aim: An effective postoperative analgesic technique for patients undertaking lower abdominal surgeries, transversus abdominis plane (TAP) block is among the innovative approaches utilised in this regard. In abdominal surgeries, the purpose of the present investigation is to compare the two TAP block techniques used for postoperative analgesia. Material and Methods: One year was devoted to the present cross-sectional investigation, which was conducted at the Tertiary Care Teaching Institute of India’s Department of Anaesthesia. Appendicectomy, appendicular perforation, umbilical, paraumbilical, incisional and ventral hernia repair, hysterectomy, exploratory laparotomy, and hysterectomy were among the procedures that one hundred patients were admitted for under general anaesthesia. For blind TAP block or USG-guided TAP block, they were separated into two groups. A TAP block containing 20cc of 0.25% Bupivacaine was administered to each group in the supine position at the conclusion of the procedure, prior to its reversal. Analogue scale pain scores were recorded during the twenty-four hours of patient follow-up. Rescue analgesic was intravenous diclofenac, while breakthrough pain was treated with intravenous tramadol. Complicated matters, including the total analgesic need for twenty-four hours, were documented. Results: Analgesia scores were comparable in both groups during the initial postoperative period (10 minutes to 20 minutes) following extubation. However, pain scores improved significantly (30 minutes, 60 minutes, 3 hours, 6 hours, and 12 hours), with USG-guided groups having lower scores (p0.05). Pain scores remained comparable after 16 hours, 20 hours, and 24 hours. A statistically significant difference in VAS scores was observed between the blind and USG-guided groups at multiple time intervals for a duration of 12 hours (p<0.05). The blind technique necessitated a significantly greater quantity of rescue analgesics than the USG-guided group. Conclusion: Utilising ultrasound to administer local anesthetic in the correct plane enables more precise administration; however, it necessitates an increased period of learning. As an uncomplicated, risk-free, and straightforward technique that provides superior analgesia, TAP block should be incorporated into multimodal analgesia and recovery strategies for patients undergoing abdominal surgery.

32. Post MRM Early Complications in Low VS High BMI Patients; A Comparative Study
Akhilesh Ratnakar, Sunil Kumar Saxena, Jitendra Singh Dangi, Shivani Verma
Objective: To compare frequency of early complications in post-operative period of modified radical mastectomy in patients with low body fat percentage versus relatively higher body fat percentage. Study Design: Comparative observational study design being conducted from December 2022 to December 2023 in Bundelkhand medical college Sagar, District Sagar, Madhya Pradesh. Methodology: All the patients included in the study had all investigations done in our as well as their previous centres (blood work up, bone scans, x rays, ultrasounds etc.) along with detailed clinical examinations and operative procedure carried out with standard techniques and under aseptic conditions. Results: The total patients included in the study were 60 among which 30 had BMI of 17 to 24.9 and 30 had body mass index more than 25. All patients were in mean age group of >35 years and <60 years. Among patients with lower body mass index early post-operative complications were noted which is far more low than cases of higher BMI patients. Conclusion: For carcinoma breast Modified Radical Mastectomy remains mainstay of treatment but post-operative complications; surgical site infections and such delay in healing process, increase hospital stay and sometimes delay definitive managements like chemotherapy and radiotherapy.

33. Comparative Study of Diagnostic Accuracy of Minimally Invasive Pathological Techniques (FNAC) Impression Cytology with Clinical, Radiological and Histopathological Examinations in Diagnosis of Thyroid Nodule
Manojit Sarkar, Asis Kumar Saha
Introduction: Thyroid is one of the largest endocrine gland. Nervous system, endocrine System and immune system are connected physiologically and act in synchronized manner to mediate the body quick and precise response to environmental stress. Normal thyroid gland weighs 20-25 grams. Aims: To determine and compare the diagnostic accuracy of clinical assessment, radiological assessment, FNAC before surgical management, impression cytology during surgery and histopathological examination after surgical removal of the thyroid nodule. Materials and Methods: The present study was a prospective study. This Study was conducted from January 2017 to july 2018 at Department of surgery, NRS medical College & Hospital, Kolkata Result: In this study, we have concluded that FNAC has 94.4% sensitivity, 83.3% specificity with accuracy of 90%. In our study USG was more reproducible than Clinical Examination, where the former had 47%sensitivity, 76.9% specificity, 72.7% positive predictive value (PPV), 52.6% negative. predictive value (NPV), and 60% accuracy, whereas the latter  had 38.9% sensitivity, 75% specificity, 70% PPV, 45.00% NPV, and 53.3% accuracy. Ultrasonography had 47% sensitivity, 76.9% specificity, 72.7% positive predictive value (PPV), 52.6% negative predictive value (NPV), and 60% accuracy. Conclusion: With respect to sensitivity, in our study FNAC has the highest sensitivity (94.4), followed by Ultrasonography (47.0) and Clinical Examinations (38.9). With respect to Specificity, in our study FNAC has the highest specificity (83.3), followed by Ultrasonography (76.9) and Clinical Examinations (75.0). With respect to Accuracy, in our study FNAC has the highest accuracy (90.0), followed by Ultrasonography (60.0) and Clinical Examinations (53.3). Impression smear also cannot detect the margin status in thyroid specimens.

34. Evaluating the Effect of Prescribing Zinc Sulfate on Improving the Clinical Symptoms of Pneumonia in 2-59-Month-Old Children: A Hospital Based Study
Ajit Kumar Singh, Sachin Kumar, Nagendra Prasad Gupta
Aim: The aim of the present study was to investigate the effect of zinc sulfate on improving the clinical symptoms of pneumonia in 2-59- month-old children. Methods: This double-blind clinical trial study was performed on 100, 2-59-month-old children with diagnosis of pneumonia referring to the pediatric ward . The children with pneumonia were randomly assigned into intervention (n=50), and control (n=50) groups. Results: The gender distribution of the tested patients was 52% boys and 48% girls. There was no significant difference between the two groups in terms of age, gender, and weight. The mean age in the intervention group was 13.56+0.736 and in the control it was 11.97+0.712 (p>0.05). The mean age of hospitalization in the case and control groups was 12.58+0.732 and 10.92+0.720 months, respectively, which was not statistically significant (p=0.540). The mean duration of hospitalization cases and control groups was 5.4+0.314 and 5.10+0.302 days respectively; based on the Mann-Whitney test, there was no significant difference between the two groups (p=0.180). The serum level of zinc was calculated at the beginning of hospitalization and at the time of discharge for both intervention and control groups. The mean serum level of zinc in the intervention group (receiving zinc sulfate syrup) was 71.68+12.6 and 91.9+10.6 mcg/dl at the baseline and at the end of hospitalization respectively (p<0.001); while the mean serum level of zinc in the control group (receiving placebo) was 72.8+11.8 and 74.6+8.6 mcg/dl at the beginning and end of hospitalization respectively (p=0.55). According to Chi-square test, there was no significant difference between the two groups when comparing the presence or absence of tachypnea during hospitalization, as well as 12 and 24 hours post-hospitalization. However, at 36 hours post-hospitalization, there was a significant difference (p=0.03). Conclusion: Based on this study, it is suggested that prescription of oral zinc sulfate supplement be considered for pediatric patients hospitalized due to pneumonia, in addition to the standard and conventional pharmacotherapy of pneumonia.

35. A Cross-Sectional Study Evaluating Depression and Its Relationship with Stigma and Sociodemographic Variables
Ravikant Kumar
Aim: The aim of the present study was to identify interrelation between chief presenting complains of depressive disorder with level of stigma associated, with reference to patient’s socio economic and demographic back ground. Methods: This was a cross-sectional study conducted at the out-patient department (OPD) of Department of Psychiatry, 100 cases of Major Depressive Disorder were taken using convenience sampling method. Results: Study population consists of 30 (30%) male and 70 (70%) female. Mean age were 34.16 ± 9.71. Among them 80 (80%) were married, 12 (12%) unmarried and 8 (8%) widow. Majority of them were Hindu 75 (75%) and 25 (25%) Muslim by religion. Regarding educational status, 20 (20%) were illiterate, 7 (7%) can read and write only, 18 (18%) upto primary levels, 24 (24%) completed secondary level, 11 (11%) upto higher secondary level and 20 (20%) completed graduation. 52% of them from joint family and 48% having nuclear family background. Equal numbers of patients were from rural and urban area. 16% were belongs to upper middle class, 30% lower middle class, 20% lower and 34% poor. 20 (20.0%) complaint sadness, 48 (48%) pain and other somatic problems, 20 (20%) tension as most troubling and 12 (12%) complaint other problems. Mean HDRS Scores of patients complaint sadness was 24.08±4.71, among patients complained pain and other somatic symptoms it was only 17.79±1.31, whereas among the complainer of tension it was 21.25 and for others 21.71. This difference in means was highly significant statistically (one way ANOVA; df 3, F=14.54, p <0.001). Conclusion: Majority of patients with major depression reported somatic complaints as most troubling which may hinder early recognition. As stigma is positively related with depression severity it may acts as barrier to help seeking. Socio-demographic variables are unrelated with presentation of depression.

36. Role of Hormonal Profile in Diagnosis of Polycystic Ovarian Syndrome
Supriya Wagh, Anjali Waghmode, Pallavi Sonwane, Santosh G. Varma
Background: Polycystic ovarian syndrome (PCOS) is a multifactorial endocrine disorder observed in women of reproductive age. Due to the variability in clinical and ultrasound findings, the diagnosis is often delayed. So, biochemical markers to diagnose PCOS early and objectively are essential.In this project we studied the Anti-mullerian hormone, FSH, LH and testosterone levels in PCOS patients to see their correlation with PCOS. Aims and Objectives: To estimate the Anti-mullerian hormone, FSH, LH and testosterone in women with PCOS and establish the role of different hormones as a diagnostic marker of PCOS. Material & Methods: It was a case control study carried out in tertiary care centre. AMH, FSH, LH and testosterone levels were estimated by electrochemiluminescence method. Results: Difference between AMH, testosterone levels and LH:FSH ratio in the cases and the controls was statistically significant (p < 0.001). Conclusion: The hormonal assays- AMH, LH:FSH ratio and testosterone levels can be used for definitive diagnosis of PCOS along with the symptoms of PCOS.

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

38. A Prospective Case-Controlled Analysis of the Vaginal Birth with Previous Caesarean Section and its Outcome
Juhi Dhanawat
Aim: The aim of the present study was to analyse the vaginal birth with previous caesarean section and its outcome. Methods: This prospective controlled clinical study was department of obstetrics and Gynaecology over a 1-year period. During the study period there were 150 women who had undergone previous caesarean section. Out of them, 100 women (66.66%) fulfilled our criteria and were included in the study. A control group (n = 100) was matched from women without previous caesarean section. Results: There were no significant differences between the study group and control group in terms of age, parity, gestational age or obstetric and medical history. Oxytocin was used to augment labour in 8 cases (8%) but there was no uterine rupture recorded in these cases. Overall there were 2 cases (2%) of uterine dehiscence and 1 case (1%) of uterine rupture among the VBAC group. There were no maternal deaths and only 1 stillbirth after the case of uterine rupture. There was no significant difference between the groups in Apgar scores; 5% of neonates in the VBAC trial group had Apgar score < 6 compared with 5% in the control group (P > 0.05). We found 2 neonates (2%) weighed > 3500 g but < 4000 g in the case group. Of the women who successfully delivered vaginally, 75 (75%) were admitted during the first stage of labour and 25 women (25%) in the second stage versus 78 (78%) and 22 (22%) respectively in the control group. Conclusion: On the basis of these results, we conclude that for selected cases with one prior lower segment caesarean section who present in spontaneous active labour, a trial of vaginal delivery may have a high success rate with no increased risk of maternal and fetal morbidity or mortality.

39. Antibiotic Prescribing Patterns in a Rural Tertiary Care Hospital in Telangana, India
D Sudhamadhuri, Srinivas N, Nivedita Mohan, N. Sridevi
Introduction: Antimicrobial resistance (AMR) is a major global public health threat. The WHO Access, Watch, Reserve (AWaRe) antibiotic classification is aimed at improving the prescription patterns, and clinical outcomes, lowering the likelihood of AMR. The current study was conducted to analyse the prescription pattern and AWaRe classification of antibiotics prescribed in a rural tertiary care hospital in Telangana. Methods: A cross sectional prospective study was conducted by the Department Microbiology, Government General Hospital, Sangareddy. Hospitalised patients > 18 years, on antibiotic treatment due to infections were included in the study. Patients below 18 years and those not on antibiotics were not considered. Medical case sheets of the patients were analysed. Average number of drugs per prescription, percentage of antibiotics prescribed by generic name, percentage of antibiotics per prescription, percentage of injected antibiotics prescribed and percentage of antibiotics prescribed from essential drugs list or formulary were the WHO Core drug indicators (prescribing indicators) analysed and presented in percentages. Results: A total of 900 patients’s data were analysed. Female to Male ratio was 1.23. Most patients were between 21 – 40 years. The average duration of admission was 7.5 days. Diagnosis was mentioned on 95.45% case sheets. An average of 5.82 drugs were prescribed per patient. Surgical prophylaxis (46%) was the leading indication; 54.02% of prescribed drugs belonged to the WHO Access group. Around 20.85% antibiotics were prescribed by generic name. Drug dosage was mentioned in 94.80% prescriptions and frequency in 98.04% prescriptions. Duration of medication was mentioned in 97.27% prescriptions and 93.82% prescriptions have the doctor’s signature. Conclusions: Assessment of the prescription patterns in a hospital helps to monitor and ensure rational drug use. This is essential to achieve good quality healthcare for patients and for the community.

40. Hospital Based Prospective Observational Study Evaluating Electrolyte Abnormalities in Patients with Perinatal Asphyxia
Rajni Kumari, Jeetendra Kumar, Sanjeev Kumar, Dheeraj Kumar
Aim: The aim of the study was to assess the electrolyte abnormalities among asphyxiated neonates. Background: In basic term birth asphyxia is delay in establishing spontaneous respiration upon delivery of a new-born. More precisely, birth asphyxia is defined as the presence of hypoxia, hypercapnia, and acidosis leading to systemic disturbances in the new-born probably electrolyte disturbance also. Knowledge of these electrolyte disturbances is very valuable as it can be an important parameter affecting perinatal morbidity, mortality and ongoing management. Material & Methods: This prospective observational study was conducted in NICU, BMIMS, Pawapuri, Nalanda, Bihar, during a study period of one year from May 2022 to April 2023 among asphyxiated neonates admitted at this institute and a total of 100 cases were enrolled in the study. Serum Sodium level has been estimated. Informed consent was obtained from the legal guardians of each participant. Results: The baseline characteristics of the participants in the study revealed that in 72% of instances, the mothers were primipara. Within the neonatal population, a majority of 60% consisted of males, while the remaining 40% were females. A mere 32% of the neonates under study had undergone consistent prenatal check-ups, while 58% had undergone sporadic check-ups, and 10% had not had any antenatal check-ups. Within the cohort of neonates under consideration, it was observed that 68% were delivered via the vaginal canal, while the remaining 32% were born by lower uterine segment cesarean section (LSCS). In 40% of instances, the domicile served as the location of delivery, while 24% of cases occurred at a clinic, and 36% took place at a hospital. Based on the classification of asphyxia, it was shown that 52% of infants exhibited moderate asphyxia, 20% had mild asphyxia, and 28% presented with severe asphyxia. Based on the analysis of blood sodium levels in newborns, it was observed that among the 20 mild instances, 15% exhibited hyponatremia, characterized by serum sodium levels below 130 mmol/l. Similarly, among the moderate asphyxia cases, 73.08% had hyponatremia, while 71.42% of the severe asphyxia cases exhibited the same condition. The sodium levels of the other subjects were within the usual range. Based on the assessment of blood potassium levels in newborns, it was shown that 15% of the 20 mild cases, 3.84% of the 52 intermediate cases, and 7.14% of the 28 severe cases had hypokalemia, characterized by a serum potassium level below 3.5 mmol/l. In contrast, it was observed that none of the 20 cases classified as mild, 9.62% of the 52 cases classified as moderate, and 28.58% of the 28 cases classified as severe had hyperkalemia or a blood potassium level over 6 mmol/l. Conclusion: The research findings indicate that perinatal asphyxia patients frequently experience electrolyte abnormalities. Specifically, infants with perinatal asphyxia exhibit a higher incidence of hyponatremia and hyperkalemia. Additionally, there is a significant correlation between the severity of asphyxia and the observed increases in serum creatinine and blood urea levels.

41. Evaluation of the Diagnostic Accuracy of Non-Invasive Hand Held Transcutaneous Bilirubinometer for the Diagnosis of Neonates with Hyperbilirubinemia
Rupesh Kumar, Juli, Akhilesh Kumar
Aim:  The aim of the present study was to assess the diagnostic accuracy of TCB compared with the total serum bilirubin (TSB) measurement in infants more than and equal to 35 weeks at different sites during the neonatal period and implementation of the results for better management of jaundiced neonates. Material & Methods: This is a prospective, observational, cross sectional, hospital-based study done on newborn babies between 350/7 weeks to 416/7 weeks of gestation for the duration of 12 months at Department of Pathology and Neonatology. 200 neonates were included in the study. Results: The mean birth weight of the sample is 2992 gm (95% CI-2906.39-2986.01) with a standard deviation of 390.7 gm. The neonate with minimum weight in the study population was of 2505 gm and maximum of 4000 gm. Mean transcutaneous bilirubin level measured at forehead is 12.38 mg/dl (95% confidence Interval-12.02-12.66) with a SD of 3.16 mg/dl. Mean transcutaneous bilirubin level measured at sternum is 12.32 mg/dl (95% confidence Interval-11.97-12.71) with a SD of 3.14 mg/dl. Mean serum bilirubin level is 12.98 mg/dl (95% confidence Interval-11.6-12.32) with a SD of 3.57 mg/dl. The correlation between the readings of serum and transcutaneous bilirubinometer <15 mg/dl is very high at forehead (r=0.96, p=0.001) and sternum (r=0.92, p=0.001). Our observation on visual assessment of jaundiced neonates 4% fall in Kramer’s stage 1, about 14% are found in Kramer stage 2, In stage 3 highest percentage 30% (n=60) of neonates are falling in, 25% (n=50) found in stage 4 and in a stage 5. 27% (n=54) neonates are seen. The sensitivity of TCB at sternum remains 100% at low risk zone as well as at high risk zone, when measured at >120-168 hrs of life. Conclusion: The findings of the present study indicate that the TCB is a reliable screening tool for hyperbilirubinemia in newborns >35 weeks of gestation, especially with bilirubin levels ≤15 mg/dl in 2-7 days of life. TCB can be a viable option for universal screening. Incorporating the use of TCB devices in clinical practice, can reduce the need for blood sampling for the management of neonatal jaundice.

42. A Hospital Based Study to Assess the Clinical Profile of Patients with Cardiomyopathy at a Tertiary Health Care Centre: An Observational Study
Mani Shankar Pandey
Aim: The aim of the present study was to assess the clinical profile of patients with cardiomyopathy at a tertiary health care centre. Methods: The present study was a prospective study carried out in the Department of Cardiology,  Study population was patients admitted with symptoms and signs of heart failure (Clinically suspected and echo cardiography proven) in Department of Medicine. After considering inclusion and exclusion criteria we studied 100 patients. Results: In our study, majority of the patients were from the age group of above 60 years (45%) followed by 40-59 years (31%). Patients in the age group of 20-39 years were 15%. Patients below 20 years were 9% of study population. Males pedominated female in our study (60%). Most common risk factor for development of cardiomyopathy was coronary artery disease (32%). Diabetes mellitus was seen in 24% patients. Other risk factors observed were alcoholism (21%), hypertension (16%), peripartum period (12%), HIV infection (5%), thyroid disease (5%), connective tissue disorder (5%) and neuromuscular disorder (4%). Dyspnoea was complained by all patients. Pedal oedema was seen in 85% of dilated cardiomyopathy patients and all patients of hypertrophic cardiomyopathy. Syncope and abdominal pain were seen in 3% and 25% patients with dilated cardiomyopathy. 95% of the study population had cardiomegaly. Pulmonary congestion was seen in 83% patients with cardiomegaly. Pleural effusion was seen in 17% patients. Conclusion: Most common type of cardiomyoipathy is Dilated cardiomyopathy followed by Hypertrophic cardiomyopathy and Restrictive cardiomyopathy. Biventricular failure was the most common clinical presentation followed by left heart failure and then right heart failure.

43. Outcome Assessment of Proximal Humeral Interlocking System Plating for Displaced Proximal Humerus Fractures
Abhishek Anand, Abhinav Kumar, Swati Singh, Puja Sinha
Aim: The aim of the present study was to assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures. Methods: The presents study was conducted in the Department of Orthopaedics, We treated 50 consecutive patients who had displaced proximal humeral fractures, with PHILOS (proximal humeral interlocking system) plating at a single large teaching hospital. The fracture was classified using Neer’s classification. Results: 70% were males as compared to 30% females. 66% had road traffic accidents mode of injury and 34% fell on surface. Maximum patients belonged to 56-75 years followed by 36-55 years age group. Most of the patients who were not able to do routine activity belonged to 76-95 years. 7 patients had pain in shoulder and 6 patients had stiff shoulder. Conclusion: Our results show that good fracture stability was achieved, and the functional outcome was very good in younger patients and it declined with increasing age. Early mobilization of the shoulder can be achieved without compromising fracture union.

44. An Observational Assessment of Modified Fine Graft (MMG) for Correcting Nasal Soft Triangle Deformity
Puja Priyadarshini, Satyendra Kumar Jha, Pranava Dutta Verma
Aim: The aim of the present study was to assess modified fine graft (MMG) for correcting nasal soft triangle deformity. Methods: This observational study was conducted on 50 rhinoplasty candidates with ST triangle deformity who underwent primary or secondary rhinoplasty to correct the deformity and soft triangle augmentation using an MFG by open method in the Department of Plastic Surgery Nalanda Medical College and Hospital, Patna, Bihar, India for the period of 18 months. Results: The mean age was 35.64±12.048 years (range 18 to 60 years). 42 (84%) were female, and 8 (16%) were male. 44 of the surgeries were primary rhinoplasty, and 6 were secondary rhinoplasty. After the operation, all four indicators of non- correction of ST triangle deformity, exposed graft, recurrence, and visibility were checked for all patients. Graft exposure, recurrence, and visibility were not reported in any of the patients. Conclusion: MFG was highly effective in correcting the deformity of the nasal ST triangle and did not cause serious complications in patients. Therefore, this method could be considered an appropriate method with great efficiency for correcting the nasal deformity of the soft triangle.

45. A Hospital Based Study to Assess Outcome of Tubeless Mini‑ Percutaneous Nephrolithotomy (PCNL) for the Treatment of Large (>20 Mm) Renal Stones
Nitesh Kumar, Shivanand Prakash, Karthik Maripeddi, Sunil Palve, Sanath T
Aim: The aim of this study was to evaluate the outcomes of tubeless mini‑ percutaneous nephrolithotomy (PCNL) for the treatment of large (>20 mm) renal stones. Methods: The study included consecutive adult patients who underwent mini‑PCNL for large (>20 mm) renal stones for the period of 1 years. Preoperative, operative, postoperative, and follow‑up data during outpatients’ visits were prospectively recorded and maintained using a computer database. The data were retrospectively analyzed. The study included 100 patients in the study. Results: The study included 200 patients with mean age 42.8 ± 12.8 years (range 18–79) and mean stone size 30.5 ± 9.7 mm (range 20–70). Mean operative time was 62.8 ± 30.4 min (range 25–180). The average number of tracts per renal unit was 1.26. Mean hospital stay was 2.9 ± 0.9 days. The overall intraoperative and 30‑day postoperative complication rate was 7%, with the majority being Clavien classification Grades I and II. Minor Grade (I–II) complications included postoperative fever requiring antibiotics in cases, postoperative haematuria requiring blood transfusion in two cases, severe postoperative pain requiring prolonged opioid analgesia in two cases, and perinephric hematoma that was managed conservatively in two cases. Grade III complications were observed in only 1% as one patient required renal angioembolization for severe hematuria 7 days following the procedure. On multivariate analysis, independent risk factor for significant residual stones was the presence of the stones in multiple sites inside the PCS (relative risk: 13.44, 95% confidence interval: 1.78–101.43, P = 0.012). Conclusion: Mini‑PCNL is a safe and effective treatment for the management of adult patients with large renal stones. Stones located in multiple sites inside the PCS is the only predictor of unsuccessful outcome.

46. A Study to Estimate Oxidative Stress and Antioxidant Status in Tropical Chronic Pancreatitis (TCP) and Alcoholic Chronic Pancreatitis (ACP) and its Correlation with Zinc Status
Manish Kumar Bhaskar
Aim: The aim of the present study was to estimate oxidative stress and antioxidant status in tropical chronic pancreatitis (TCP) and alcoholic chronic pancreatitis (ACP) and correlate with zinc status. Methods: The present study was conducted in the Department of Gastroenterology for two years and Chronic pancreatitis patients were recruited for the study and were diagnosed on the basis of presence of pancreatic calcification (US/CT) and/or parenchymal or ductal changes on imaging. 100 patients were included in the study. Results: Of the 100 patients, there were 50 TCP patients and 50 ACP patients. The mean age of all CP patients was comparable with the age of controls; however, TCP patients were younger than ACP patients. The mean body mass index was comparable in all three groups. The erythrocyte GSH, GPx, SOD, and plasma vitamin C levels were lower, and erythrocyte TBARS was higher in both TCP and ACP patients as compared to healthy controls. Plasma vitamin C was lower whereas, erythrocyte TBARS was higher in TCP patients as compared to ACP patients. Erythrocyte GSH level was significantly lower in ACP as compared to TCP patients. We found lower values of erythrocyte GSH, GPx, SOD, and plasma vitamin C and higher erythrocyte TBARS in both diabetic and non-diabetic CP patients as compared to healthy controls. However, we did not find differences between diabetic and non-diabetic TCP patients or between diabetic and non-diabetic ACP patients. Conclusion: Our study corroborates the role of oxidative stress in CP and suggests some differences in oxidative status in TCP and ACP patients. Zinc deficiency appears to affect oxidative status in CP patients.

47. Vitamin D Deficiency in Newly Diagnosed Type II Diabetes Mellitus Patients: A Case Control Study
Amit Kumar Singh, Soumya Singh, Rituraj Lahkar, Umashanker Singh
Aim: The aim of the present study was to assess the prevalence of Vitamin D deficiency in newly diagnosed type II diabetes Mellitus patients at a tertiary health care centre. Material & Methods: A comparative study carried out at Department of General Medicine. Study population was newly diagnosed patients of type II diabetes Mellitus and their healthy controls. Total 100 cases were enrolled and their healthy controls were 100. Controls were subjects without diabetes mellitus and matched for age and gender. Results: Mean age of the cases was 50.5±2.5 years and mean age of the control group was 51.7±3.2 years. The age difference in both the group was statistically not significant (p= 0.32). Thus both the groups were comparable. Cases were having significantly higher weight as compared to controls (p=0.001). The difference in the mean height of both the groups was statistically not significant (p=0.75). BMI of the cases was significantly higher than control group (p=0.001). As the cases were diabetic, blood sugar level was higher in that group. Mean HbA1C in cases was 8.4±1.8 and control was 6.4±0.9. The difference was statistically significant (p=0.0001). Mean systolic blood pressure in cases and controls were 130.8±15.5 mm of Hg and 128.2±12.4 mm of Hg respectively. Mean diastolic blood pressure in cases was 79.1±8.04 mm of Hg and 78.2±5.6 mm of Hg respectively. There were 103 (51.50%) females and 97 (48.50%) males in the cases (new onset Type 2 Diabetes Mellitus), whereas 62 (51.67%) females and 58 (48.33%) males in controls (without Type 2 Diabetes Mellitus). Maximum patients were above 55 years of age in cases and controls. Conclusion: Vit D concentration in diabetic patients was significantly lower in comparison to non-diabetic individuals.

48. An Observational Study to Investigate the Association of Homocystine Level and Lipid Profiles with Ischemic Heart Disease
Pramod, Aishwerya, Girish Narayan Mishra
Aim: The aim of the present study was to evaluate the mortality in ST-segment elevation acute myocardial infarction in diabetic patients. Methods: The present study consisted of 100 patients of acute ST-segment elevation myocardial infarction (STEMI) of both genders at Department of cardiology. All were enrolled with their written consent. Results: The age group <40 years had 4 patients in group I and 5 in group II, 40-50 years had 9 in group I and 8 in group II, 50-60 years had 14 in group I and 15 in group II and >60 years had 23 in group I and 22 in group II. The difference was significant (P< 0.05). The site was anterior in 12 in group I and 10 in group II, inferior in 28 in group I and 23 in group II, inferior+ right ventricular in 7 in group I and 10 in group II and lateral in 3 in group I and 7 in group II. The difference was significant (P< 0.05). 7 patients in group I and 2 in group II had mortality in which streptokinase was given and 15 in group I and 6 in group II had mortality in which streptokinase was not given. The difference was significant (P< 0.05). The type of treatment given was streptokinase was 92, aspirin in 100, beta- blockers in 75, ACE inhibitors in 85, statins in 94 and diuretics in 60 patients. The difference was significant (P< 0.05). Conclusion: Diabetic patients who were not on streptokinase had higher mortality as compared to non- diabetics.

49. Asymptomatic Bacteriuria-Effect of Screening and Treatment on Fetal Outcome
R. Suchitra, Bhaskara Priscilla, B.V. Satish Kumar, Shreenivas Shouri
Background: Urinary tract infection (UTI) is the most common urologic concern in pregnancy and is categorised as complicated UTI as there is more risk of persistence, recurrence following treatment and progression to acute pyelonephritis. Aim: To determine the association between urinary tract infection and pregnancy outcome. Materials and Methods: A Prospective randomised Study. Materials and Methods: 12 months (August 2021-August 2022) The study was done from June 2020 to June 2023 among the expectant women attending Government Medical College, Ananthapuramu hospital prenatal clinic. The study’s subjects were antenatal women irrespective of parity & age who attended the hospital for the first time in their antenatal period between 12-16 weeks of gestational age. Results: At 12 to 16 weeks of gestation, 200 of the 250 prenatal patients in the outpatient clinic at the Government medical college Hospital , Anantapuramu were screened.  The remaining 50 were taken for statistical analysis. Asymptomatic bacteriuria was present in 9.5%  of this population.

50. A Hospital-based Study to Evaluate the Mortality in ST-Segment Elevation Acute Myocardial Infarction in Diabetic Patients
Pramod, Aishwerya, Girish Narayan Mishra
Aim: The aim of the present study was to evaluate the mortality in ST-segment elevation acute myocardial infarction in diabetic patients. Methods: The present study consisted of 100 patients of acute ST-segment elevation myocardial infarction (STEMI) of both genders at Department of cardiology. All were enrolled with their written consent. Results: The age group <40 years had 4 patients in group I and 5 in group II, 40-50 years had 9 in group I and 8 in group II, 50-60 years had 14 in group I and 15 in group II and >60 years had 23 in group I and 22 in group II. The difference was significant (P< 0.05). The site was anterior in 12 in group I and 10 in group II, inferior in 28 in group I and 23 in group II, inferior+ right ventricular in 7 in group I and 10 in group II and lateral in 3 in group I and 7 in group II. The difference was significant (P< 0.05). 7 patients in group I and 2 in group II had mortality in which streptokinase was given and 15 in group I and 6 in group II had mortality in which streptokinase was not given. The difference was significant (P< 0.05). The type of treatment given was streptokinase was 92, aspirin in 100, beta- blockers in 75, ACE inhibitors in 85, statins in 94 and diuretics in 60 patients. The difference was significant (P< 0.05). Conclusion: Diabetic patients who were not on streptokinase had higher mortality as compared to non- diabetics.

51. Assessment of Surgical Management of Distal Femur Fracture using Locking Compression Plate: A Retrospective Study
Ahmad Yacoub Salim Al-Masa’efah
Aim: The aim of the present study was to evaluate the functional and radiological outcome in distal femur fractures treated with locking compression plate. Methods: The present study was conducted at King Hussein Medical Centre, Jordanian Royal Medical Services, Amman, Jordan. 50 patients were included in the study. Results: Participants in the study varied in age from 22 to 76, with an average age of 51.29±12.58. Twenty-one women and 29 men were patients. Patients over 60 dominated the population. The most common fractures were extra-articular (68%), complete articular (26%), and partial articular (6%), according to Muller AO-classification. Ten patients (34%) had left-sided femur fractures, whereas 68% had right-sided fractures. Fifteen (30%) patients received fractures from automobile accidents, whereas thirty-five (70%) from falls. Before leaving the hospital, 90% of patients had normal radiographs, 6% had delayed union, and 4% had superficial infection, all of which were addressed. Scores for the Oxford knee test ranged from 38 to 44, with an average of 42.56±1.64. Results were exceptional in 64% of 32 patients, good in 36% (18 individuals), and mediocre or unsatisfactory in the absence of ratings. Conclusion: LCP has shown very good radiological and functional outcomes with hundred percent union of the distal femur fractures. Hence it can be used successfully in distal femur fractures.

52. To Examine Students’ Viewpoint on Active Learning Techniques: A Comparative Study
Gaurav Sinha, Sandeep Kumar, Pandurang M. Narhare
Aim: The aim of the present study was to assess the students’ perspective regarding active learning methods and to compare outcome of active learning method to previous traditional teaching methods. Methods: The present study was carried out in the Physiology Department .Students and faculty were informed and introduced to active learning strategy regarding a particular topic. Results: The mean value and standard deviation for Group 1 consisting of 50 participants and Group 2 consisting of 50 study participants were 32.44+8.12 and 26.64+8.32 respectively. It indicated that students of active learning group performed significantly better than students with traditional learning methods (P < 0.0001).Majority of students were in favor of this new teaching method. Students developed more interest and better understanding in lectures. Group study discussion leads them to develop their knowledge more in comparison to traditional methods and also better interactions and environment created due to this method. Pause period method made a good impact in understanding the topic. Furthermore, the use of MCQs, models and role plays created more healthy surroundings in understanding renal physiology. Students’ also find it easy to correlate with clinical content. Even students were keen to attend more seminars like this, also ready to increase more number of tests and short work assignments. Majority of students’ felt a healthy change in atmosphere due to these new methods. Conclusion: Active learning method definitely helps in better understanding of the subject in comparison with the old didactic method of teaching. This conclusion suggests that we should need to promote active learning methods more in different fields so that the development of knowledge occurs in way which is beneficial to all. These new methods also developed interest of teacher and due to this a student- teacher relationship also became better.

53. A Prospective Analysis of the Risk Factors for Surgical Site Wound Infection and Related Complications
Alpana Singh, Ajay Kumar
Aim: The aim of the present study was to assess the incidence and associated comorbidities which influence the surgical site wound infection. Material & Methods: A prospective study was conducted in Department of Microbiology. Total 200 patients operated for general surgical procedures in between the periods of 12 months were included for the present study. Results: The incidence rate of Surgical Site Infections (SSIs) increased with age, ranging from 22.50% in the 18-29 age group to 35% in those aged 60 and above. The incidence of SSIs was higher among males (26.66%) than females (25%). The incidence rate of Surgical Site Infections (SSIs) showed a positive correlation with increasing BMI, from 20% in underweight subjects to 33.33% in obese subjects. Subjects from urban areas had a higher incidence rate of SSIs (30%) compared to those from rural areas (20%). The rate of SSIs was higher in subjects undergoing elective surgeries (30.47%) compared to emergency surgeries (20%). Subjects who were obese had an SSI rate of 43.33%. Among subjects with diabetes, 60% developed SSIs, and among those with anaemia, 37.50% developed SSIs. Conclusion: Our study provides valuable insights into the risk factors associated with SSIs, including age, BMI, and comorbidities. Future research should focus on longitudinal studies to understand the temporal relationship between these factors and SSIs. Interventions targeting these risk factors could potentially reduce the incidence of SSIs.

54. A Retrospective Observational Assessment of the Endocrine Outcomes after Endoscopic Transsphenoidal Surgery for Non- Functioning Pituitary Adenomas
Gaurav Srivastava
Aim: The aim of the present study was to analyze the remission and preservation of hormones, endocrinological and anatomical complications and visual improvement after endoscopic transsphenoidal surgery (ETS). Methods: The present retrospective observational study consisted of all consecutive cases of pituitary adenoma treated with endoscopic transsphenoidal surgery (ETS) in department of Neurosurgery, Kashi Neuron Multispeciality Hospital Ramnagar Varanasi UP, India for the period of 1 year, a total of 50 patients, diagnosed with pituitary adenoma and underwent transsphenoidal surgery, were included. Results: Of   these, 30 patients were diagnosed with non-functioning pituitary adenoma, and 20 were diagnosed with functioning pituitary adenoma. The non- functioning pituitary group consisted of 18 males and 12 females, while the functioning pituitary group consisted of 11 males and 9 females. 8 of non-functioning pituitary adenoma patients were 50–59 years-old, while 8 of the functioning pituitary adenoma patients were < 30 years-old. In the non-functioning pituitary adenoma group, vision and hormones improved in 16.66% (n = 5) patients, while 83.34% (n = 25) did not report any changes within three months post- operation. In the group of patients with tumour that has invaded into the cavernous sinus, vision was improved in 3 patients, while 9 patients did not exhibit any changes. Of these, 3 patients experienced impaired endocrine function post-operatively, while that in the remaining 9 remained normal. The     functioning group consisted of 17 acromegaly patients and 3 cushing disease patients.  All the hormones were normalised after decompression surgery. This phenomenon was apparent for cortisol, thyroxine, TSH, and prolactin. All the hormones were normalised after decompression   surgery. This phenomenon was apparent for cortisol, thyroxine, TSH, and prolactin. Conclusion: Hormonal preservation and recovery are crucial for assessing the outcome of the surgery and the quality of life of the patient. With the advancement of endoscopy, MRI, and other modern technologies, the operation outcome has significantly improved with fewer post-operative complications.

55. Study to Correlate HbA1c with Attention, Executive Function and Visual Reaction Time in Type 2 Diabetes Patients
Rasikh M. Azaz Alim
Aim: The aim of the present study was to correlate duration of disease with attention, executive function and visual reaction time in type 2 diabetes patients and to correlate HbA1c with attention, executive function and visual reaction time in type 2 diabetes patients. Methods: This was a cross-sectional study done 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 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.

56. A Hospital Based Retrospective Assessment of Deviated Nasal Septum Based on Mladina’s Classification and its Association with Symptomatology and Post Septoplasty Complications
Md. Tausiful Haque, Manish Kumar, Satyendra Sharma
Aim: The aim of the present study was to identify the most common radiological classification with relation to clinical presentation and post-operative complications of deviated nasal septum and their relation to the deviation severity. Methods: A retrospective record-based study were taken targeting all patients with clinically diagnosed with deviated nasal septum and undergone surgical intervention at department of ENT The study included 50 patients with DNS whose ages ranged from 18 to 40-year-old. Results: In the present study, maximum patients had type II followed by type III and type IV degree of deviated nasal septum. Nasal obstruction was the most frequent for all types of DNS followed by snoring followed by nasal discharge. Regarding type IV, the second most reported complaint was frontal headache which also the same for type VII DNS. As for post-operative complications, nasal obstruction was the most recorded complication followed by external nose deformity, dental anesthesia, smell disturbance and infection. As for complications distribution according to DNS type, nasal obstruction, external nose deformity, and smell disturbance were the most recorded for type I DNS. For type II, nasal obstruction and dental anesthesia were the most frequent post-operative complications. Conclusion: In conclusion, more than one third of the cases had type II deviation followed by type III and type IV equally. Type II & IV are the most sever types respectively according to clinical presentation and post-operative complications. However, studies with larger samples are required to support the finding in our study.

57. Outcome of Submuscular Plating for Diaphyseal Long Bone Fractures: An Observational Study
Shivendra Kumar, Waseem Akram, Arora Bakul
Aim: The aim of the present study was to evaluate the functional and radiological outcomes of paediatric femur diaphyseal fracture treated with locking compression plate. Material & Methods: Clinical, radiographic, and functional effects of submuscular plating were assessed in 70 patients operated on for fracture shaft humerus, femur, and tibia within 2 years. One surgical team performed all procedures at Department of Orthopedics. Results: The research group included 49 men and 21 women. Males predominated. The youngest patient was six and the oldest was 14. The mean age was 11.49 (2.08). Right side fractures 40 (57.14%) outnumbered left side fractures 30 (42.86%). 25 (35.71%) fractures were transverse, 18 (25.72%) comminuted, 21 (30%) oblique, and 6 (8.57%) spiral. Injury modes included road traffic accidents (60%), sports falls (15.71%), and height falls (8.57%). After evaluating functional results, 64 (91.42%) were outstanding, 5 (7.14%) were adequate, and 1 (1.42%) were bad. Conclusion: When properly designed and implemented, submuscular plating for diaphyseal long bone fractures is a viable therapy. It is minimally invasive and permits early mobility with good radiological and functional results and few problems.

58. A Study to Evaluate the Trigger Tool Method (TTM) in Detection, Monitoring, and Reporting of Adverse Drug Reactions (ADRS)
Prakash Tomar, Sima Rastogi
Aim: The aim of the present study was to evaluate the trigger tool method (TTM) in detection, monitoring, and reporting of adverse drug reactions (ADRs). Methods: This was prospective, interventional, single center study conducted at Shree Narayan Medical Institute and Hospital, Saharsa on a permanent basis, posted in Department of Medicine.  A total 650 patients were admitted during the study period in the respective medicine unit. Results: Of the 650 patient cases, triggers were observed in 80 patients (12.30%). Among 95 patient’s cases with triggers, 60 (75%) patients did not suffer from an ADR, while 20 (25%) suffered one or more ADRs. A list of 17 triggers was given to 30 nurses for identification of ADEs. List of 17 triggers consists of 9 DT, 1 LT and 7 PT. Of these 17 triggers, 14 triggers were identified by nurses in the study population and 3 triggers were not observed. These 14 triggers were noticed 130 times, with an average 12.53 triggers observed per patient. These included DT (100 times), LT (0 times) and PT (30 times). Triggers were identified for a minimum once and maximum 3 times in 95 patients. Of the various triggers observed, 7 drug triggers and 4 patient triggers were related to ADRs. Hence 11 triggers (64.70%) were positive (related to ADRs), out of total 17 triggers under evaluation. A total 24 ADRs were observed in 25 inpatients during study period. One or more triggers were observed in these patients. The commonly detected ADRs were gastritis, thrombophlebitis, diarrhea and vomiting. Chills, cough, headache, joint pain, metallic taste, pruritus and weight gain were also observed. Conclusion: The reporting system is operational at the study site and ADRs are being reported using a standard form. Patients recovering from the reactions following the withdrawal of the suspected drug, and the majority of ADRs were mild. TTM can be used as an add‑on tool to existing methods like spontaneous method for the health‑care professionals for better detection of ADRs in the pharmacovigilance program. However, further research is required to explore the feasibility and acceptability of TTM.

59. Importance of Mammography and Sonography in Fat Necrosis: Clinicopathological Study
Manish Kumar, Sanjeev Kumar Dwivedi
Aim: The aim of the present study was to analyze the importance of mammography and sonography in fat necrosis. Methods: A prospective clinicopathological study was conducted on 40 female patients of different age groups from 30 to 60 years. Patients’ information is collected from at Department of Radiology for one year. Results: Forty lesions were identified on mammograms. The predominant mammographic features of the 40 lesions apparent on mammograms were as follows, 10 (25%) radiolucent oil cyst (either with or without curvilinear mural calcification), 4 (10%) round opacity, 6 (15%) asymmetrical opacity or heterogenicity of the subcutaneous tissues 10 (25%) dystrophic calcifications, 2 (8%) clustered pleomorphic microcalcifications and 2 (8%) suspicious speculated mass. Forty lesions were identified at sonography. The predominant US features of the 40 lesions apparent on sonograms were as follows 5 (12.5%) solid appearing masses, 6 (15%) anechoic masses with posterior acoustic enhancement (cyst), 6 (15%) anechoic masses with posterior acoustic shadowing (cyst with mural calcification), 4 (10%) cystic masses with internal echoes 2 (5%) cystic masses with mural nodule and 10 (25%) increased echogenicity of the subcutaneous tissues (small cysts inside this area±). In 7 (17.5%) masses, no discrete lesion could be identified on sonograms. Conclusion: In conclusion, there is a wide range of mammographic and ultrasonographic patterns of fat necrosis.

60. A Study Assessing Histopathological Features and Classify Tumors of Prostate as Per Recommendations of WHO: An Observational Study
Sawan Kumar, Ankit Gaba, Rajeev Bhardwaj
Aim: The aim of the present study was to assess the incidence, age distribution, gross and histopathological features of lesions of prostate and to classify tumours of prostate as per recommendations of WHO. Methods: An observational study conducted in the Department of Pathology for the period of 2 years and 100 patients were included in the study. Results: Most prostatic samples were benign (90%), whereas 9% were cancerous. Our analysis found 1 case of Prostatic Intra-epithelial Neoplasia (PIN). BPH was most common in those aged 61–70, with 39 cases (39%). Six BPH patients (6%) had chronic prostatitis and two (2%) had acute prostatitis. Three BPH patients (3%) had basal cell hyperplasia and one had squamous metaplasia. We recorded 10 prostate cancer cases utilizing modified Gleason Grading. Gleason’s score 7 was the most common in 3 of 10 adenocarcinomas. Conclusion: Adenocarcinoma was most common in those aged 61–70. All prostate biopsies must be examined for premalignant abnormalities, proliferative activity, and inflammation. Successful prostate cancer therapy depends on histology detection and classification.

61. A Hospital-Based Study Assessing Effect of Anti-Hypertensive Drugs on Arterial Blood Pressure, Heart Rate and Renal Function Tests
Sima Rastogi, Prakash Tomar, Rajeev Ranjan Sinha
Aim: The aim of the present study was to study effect of amlodipine, atenolol, enalapril and chlorothiazide on arterial blood pressure, heart rate and renal function tests. Methods: The study was carried out in the Department of Pharmacology. Total 160 patients with hypertension were included in the study. These patients were assigned to one of the 4 groups randomly. 4 There were 40 patients in each group. Patient prescribed with tablet amlodipine 5mg or 10 mg was be considered as Group I, likewise, prescription of tablet atenolol 25 mg or 50 mg was be considered as group II, prescription of tablet enalapril 2.5 mg or 5 mg was considered as group III and prescription of tablet thiazide diuretics 12.5 mg or 25 mg was be considered as group IV. Results: The effects of drugs on systolic blood pressure (mmHg) before & after were studied. Mean change in systolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Enalapril followed by thiazides, Atenolol & Amlodipine. The effects of drugs on diastolic blood pressure (mmHg) before & after were studied. Mean change in diastolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Atenolol followed by amlodipine, enalapril & thiazide. The effects of drugs on mean heart rate before & after were studied. Mean change in systolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Atenolol followed by enalapril, amlodipine & thiazides. Conclusion: Antihypertensives have effect on blood pressure, heart rate, renal functions. Patient’s renal function, heart rate should always be considered while prescribing antihypertensive drugs.

62. A Study Assessing Conversion Rate and the Factors Responsible for Conversion of Laparoscopic to Open Cholecystectomy: An Observational Study
Rajesh Jain, Bishwanath Prasad, Sujeet Kumar Bharti
Aim: This study was conducted in an effort to determine the conversion rate and also identify the factors responsible for conversion of laparoscopic to open cholecystectomy. Methods: This was a prospective clinical study consisting of 100 patients undergoing laparoscopic cholecystectomy in the Department of Surgery for one year. Results: In 100 cases, 32 were males and 68 were females. The mean age was 43.7 in this research. Patients aged 17–75. At 41-50 years old, the incidence was highest, followed by 31-40. Out of 100 patients, 74 (74%) experienced right hypochondrium discomfort, 20 (20%) had epigastric pain, and 6 (6%) were asymptomatic. 32 individuals had nausea and abdominal discomfort, 20 had vomiting, and 17 both. 16% had hypertension and 11% had diabetes. 72 individuals had single calculi on ultrasonography, whereas 28 had multiple calculi. We found that thick adhesions (40%) and aberrant anatomy (10%) occluded individual anatomy at Calot’s triangle, resulting in almost half of conversions. Conclusion: Our research shows that even while the rate of conversion to open surgery and complication rate is low in competent hands, the surgeon should maintain a low conversion threshold and consider it as a step in the patient’s interest rather than an insult.

63. A Study to Evaluate the Practical Results of ACL Restoration with the Use of a Quadrupled Hamstring Graft
Arora Bakul, Shivendra Kumar, Waseem Akram
Aim: The objective of the present study was to assess the functional outcome of anatomical reconstruction of ACL with quadrupled hamstring graft. Methods: The current research lasted for two years and included one hundred patients who received quadrupled hamstring grafts for anterior cruciate ligament restoration at the Orthopedics Department. Results: Patients ranged in age from 21 to 52. Age 18-25 (42%) had the most patients, followed by 26-29 (28%). Mean age was 29.2 years. The majority of our 100 patients were male (82%), with 18 (18%) female. Left knee injuries occurred in 16 individuals (15%) and right knee injuries in 85 (85%). RTA caused 70% of ACL injuries. Sports (17%) was next. Some patients (13%) were wounded by ordinary activities like slip-and-fall. 41% had instability and 29% had knee discomfort. 10% reported knee locking, 20% instability and knee discomfort. Diagnostic arthroscopy before ACL surgery indicates 35% medial and 12% lateral meniscal tears. In 8%, both menisci were damaged. 45 percent were isolated ACL tears. At 9 months, 80% of patients received outstanding scores, up from 56% at 3 months. 14% of patients had excellent scores at 9 months and 6% had fair scores. No patient scored poorly. Conclusion: Quadrupled hamstring graft ACL restoration improves clinical results. Hamstring grafts lessen donor site morbidity and anterior knee discomfort over time. Low graft rejection and failure improve subjective and objective functional outcomes.

64. Evaluation of Fetal Outcome by USG Colour Doppler in Patients of PIH and IUGR
Sangita Jain, Sulekha Kumari, Rashmita
Background: Hypertensive disorders and intrauterine growth restriction are common complications encountered during pregnancy. This study was conducted to observe the usefulness of systolic/ diastolic (S/D) ratio in umbilical artery to predict perinatal outcome in pregnancies complicated with hypertensive disorders and intrauterine growth restriction (IUGR). Methods: It was a prospective observational which was conducted on patients undergoing at Department of Obstetrics and Gynecology, Icare Institute Of Medical Sciences & Research & Dr B C Roy Hospital, Haldia, West Bengal, India for one year.  All patients were subjected to umbilical artery Doppler velocimetry waveform on weekly basis or every third  day. Results: Out of 100 patients, 42 patients (42%) had PIH and 32 (32%) had IUGR. 26 cases (26.9%) had both PIH and IUGR. Among the 100  patients, 60 patients (42.9%) of the patients had abnormal doppler. Abnormal doppler were associated with APGAR score of less than 7 at 5 minutes in the newborn. Abnormal perinatal outcome was more in abnormal doppler than normal doppler and the finding was statistically significant (pH<0.05). Conclusions: Overall sensitivity and diagnostic accuracy of Doppler is better to detecting adverse perinatal outcomes.

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