International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Impact of Age, Gender and Comorbidities on COVID-19 Infection
Jyoti Mehta, Nidhi Jain, Jagdish Rawat
Introduction: Corona virus disease (COVID-19) is highly infectious and has great transmission rate. Research evidences show that age, gender, and comorbidities may be the risk factors for COVID-19 infection. In the present study, we aimed to study the impact of these risk factors i.e. age, gender and comorbidities on COVID-19 infection. Aim: To study the impact of age, gender and comorbidities on COVID-19 infection. Materials and Methods: The study was conducted in the Department of Physiology and Department of Respiratory Medicine, SGRRIMHS, Dehradun, prospectively in COVID-19 patients who were admitted to the Department of Respiratory Medicine, Shri Mahant Indiresh Hospital, SGRRIMHS, Dehradun, COVID ward with positive RT PCR (real-time reverse-transcriptase-polymerase-chain-reaction) test. Descriptive statistics were calculated. Results: The mean age of patients involved in the study was 58.7 ± 12.2 years and it was found that prevalence of COVID-19 infection is more in middle age group (40-60 year) individuals as compared to young (18-40 years) and elderly (above 60 years) individuals. Compared with females the prevalence of COVID-19 infection is more in males. In addition 47% patients had comorbidities and 53% patients were without comorbidities. The most frequent comorbidity observed among patients was hypertension followed by diabetes. Statistically high significant association was found among comorbidities in elderly (above 60 years) individuals. Comorbidities were found more among males as compared to females but no significant association was observed. Conclusion: Impact of Covid-19 infection was found more among middle age individuals, in men and in elderly individuals with coexisting comorbidities.

2. Histopathological Spectrum of Cervical Lesion in Different Age Groups in Central India Madhya Pradesh
Abha Patel, MariyaKhatoon Ansari, Priyanka Prajapati, Geeta Devi
Background: Cervical lesions are the leading cause of morbidity in Indian women and cervical cancer is the second most common cancer in women worldwide next to breast cancer. Objectives: To study the age distribution, clinical presentation, the relative frequency of various cervical lesions and histopathological features of cervical lesions. Materials and Methods: It’s a retrospective study of all specimen of cervical biopsies received from October 2021 to March 2023 in the Department of Pathology. Result: In a total of 107 cases studied 55 (51.4%) cases were non neoplastic, 14 (13%) were preinvasive and 38 (35%) cases were malignant. Cervicitis was the most common non-neoplastic lesion and squamous cell carcinoma was the most common cancer. Conclusion: Our study highlights a vast spectrum of cervical lesions in all age groups and therefore early detection and management of certain lesions can help in reducing morbidity.

3. Clinical Profile and Long-Term Follow-Up of Newly Diagnosed Hepatitis B Patients in Gujarat, India: A Retrospective Cohort Study
Bhavsinh Parmar, Jasmin Singh, Shah Harshilkumar Jitendrakumar
Introduction: Hepatitis B Virus (HBV) is a significant public health concern in India, with a prevalence of intermediate endemicity and potential complications such as liver cirrhosis and primary liver cancer. However, there is a lack of data on the clinical and demographic profile of hepatitis B patients in Gujarat, India. This study aims to explore the clinical features, course, and outcomes of newly diagnosed viral hepatitis B in this patient population, contributing to improved management and outcomes. Material and Methods: This retrospective cohort study was conducted at Pandit Dindayal Upadhyay Medical College and Civil Hospital, Rajkot, Gujarat, between July 2016 and July 2018. A total of 50 newly diagnosed hepatitis B cases were included in the study. Relevant demographic, clinical, and laboratory data were collected from medical records using a standardized data collection form. Descriptive statistics were used to analyze the data, including frequencies, proportions, means, and standard deviations. Ethical guidelines were followed, and patient confidentiality and privacy were maintained throughout the study. Results: The study included 50 newly diagnosed cases of hepatitis B, with a male-to-female ratio of 2.13:1. The age distribution revealed cases across various age groups, with the highest percentage (38%) observed in individuals above 50 years. The majority of participants belonged to the lower socio-economic group (84%) and had diverse occupations, with the highest proportion being laborers (44%). Clinical presentations varied, with fever (52%) being the most commonly reported symptom. Objective findings showed manifestations such as hepatomegaly (38%), splenomegaly (8%), and ascites (28%). Laboratory analysis indicated normal total count (86%), normal differential count (86%), and normal hemoglobin levels (72%) in most cases. Liver function parameters, including AST and ALT levels, showed improvement over time. Bilirubin levels also decreased, indicating improved liver function. Positive outcomes were observed in serum albumin (96%) and serum protein (96%) levels, as well as prothrombin time (80%) at 6 months. HBsAg positivity decreased to 6% at 6 months and remained stable at 1 year. Conclusion; The study highlights the diverse demographic characteristics, varied symptomatology, and potential risk factors associated with hepatitis B. Positive treatment responses, including improved liver function parameters and declining HBsAg positivity, demonstrate the effectiveness of management strategies. These findings contribute to a better understanding of viral hepatitis B and can guide efforts to enhance its management and outcomes in Gujarat, India.

4. Histopathological Spectrum of Lesions of Oral Cavity and  Oropharynx in A Tertiary Health Centre
Shruti Shemawat, Sakshi Apurva, Akshay Sharma, D.P Soni
Background: In day to day practice, the lesions of oral cavity and oropharynx are commonly encountered in India due to very high rate of tobacco consumption.  According to GATS (Global adult tobacco survey report) 2016-2017, India has the 2nd largest tobacco consuming population in the world, estimating over 267 million. There is a strong association between tobacco chewing in the form of gutka and cigarette smoking with pathological lesions, both pre-cancerous and cancerous. Sometimes malignant lesions of oral cavity can be missed clinically due to their presentations similar to that of benign counterparts, hence histopathological diagnosis becomes the mainstay for accurate diagnosis and early treatment. Aim: The present study aims at studying morphological spectrum of tumors and tumor like lesions of oral cavity and oropharynx, and their association with various habits. Study Design: Two years prospective study. Material and Method: It was a prospective study carried out in a tertiary care centre for a period of two year from august 2020 to august 2022. 205 cases of oral cavity and oropharynx lesions were included in this study. The tissues were processed and stained with routine hematoxylin and eosin and finally histopathological examination under light microscope was carried out. The data was analyzed using excel and SPSS software. Results: 205 cases were analyzed during a study period of 2 years. Male preponderance was observed with 144 males(70.2%)  and 61(29.8%) females. A wide age group ranging from 4 to 80 years were affected. Cystic and tumor like lesions were 43 (21%), inflammatory lesions were 19(9.3%), the benign tumors were 13 (6.3%), malignant tumors were 130 (63.4%).Buccal mucosa was the most commonly affected site.  The combined habit of tobacco chewing and smoking was commonly associated with development of malignant lesions in oral cavity and oropharynx. Conclusion: The incidence of the oral cavity and oropharynx lesions is relatively increasing. This can be attributed to increasing harmful habits of the people like tobacco chewing and smoking or may be due to increased public awareness about medical care. The ability to control oral malignancy will depend on two cornerstones: prevention and early diagnosis. Hence, doing aggressive campaigning regarding its prevention is of utmost need.

5. A Study of Spectrum of Histopathological Lesions in Gall Bladder in Cholecystectomy Specimens
Neha Mali, Priya Sunda, Surendra Prakash Vyas, Ajay Kumar Saini, Madhusudan Rankawat
Introduction: Gall bladder pathology is one of the most encountered in surgery opd and hence constitute a major part of specimen in pathology labs worldwide. This study is done to determine the incidence of various histopathological spectrum in cholecystectomy specimens and to emphasize the importance of histopathological examination of specimen of gallbladder. Histopathological study of gall bladder is important diagnostic modality for differentiation of benign from malignant tumours. Material and Methods: It is a hospital based combined retrospective and prospective study for 5 years. All the surgically excised specimens of gall bladder submitted constituted the material for study. Results: We studied total 2221 samples. The mean age of the study group was 45.86±15.08 years. There was female predominance with 1818 (81.9%) cases and 403 (18.1%) were males, with male to female ratio of 4.5: 1. Maximum number of cases were in age group of 41 – 60 with 892 (40.16%) cases. Non-neoplastic lesions were the most common (n=2190, 98.6%), followed by malignant cases (n=30, 1.4%) and 1 benign case. In non-neoplastic cases chronic non-specific cholecystitis 1820 (81.9%) was the most common finding followed by acute on chronic cholecystitis 207 cases (9.3%) and xanthogranulomatous cholecystitis 97 cases (4.4%). There were 2 cases of tubercular granulomatous cholecystitis. In malignant lesions there were adenocarcinoma 24 cases (1.1%), papillary adenocarcinoma 3 cases (0.1%), mucinous adenocarcinoma 2 cases (0.1%) and adenosquamous carcinoma 1 case (0.05%). Conclusion: The present study emphasised the need to examine all the cholecystectomy specimens and thorough sampling of thickened portion as well as any suspicious area in the gallbladder specimen should be done, in order to avoid missing gallbladder carcinoma cases.

6. Immunohistochemical Analysis of P53 Protein Expression in Oral Lesions
Kasapa Shyam Sunder
Background: The oncoprotein p53 actively contributes to the initiation and/or development of oral carcinogenesis. It has been demonstrated that many human solid tumors of squamous origin, including oral squamous cell carcinomas, express mutant p53. The current study aimed to determine the expression of p53 in oral cavity lesions and its associations with tobacco use, including eating betel nuts with or without tobacco. Methods: Tissue samples from cases of Cases that exhibit leukoplakia, erythroplakia, mucosal ulcer, and growth were obtained. A detailed history of smoking habits, betel nut chewing, and consumption of pan or gutkha, specifying the total duration, frequency per day, and the amount consumed daily. Three slices measuring 4-6 µ underwent immunohistochemical staining for p53 using autoimmunostainer (benchmark) to evaluate its expression. On IHC-stained sections, the analysis of p53-positive cells was carried out. Results: Out of the lesions the SCC well differentiated showed the highest intensity. Similarly, 50% of cases of moderately differentiated showed moderate intensity and high-intensity staining. All the benign, premalignant, and inflammatory lesions were found to be negative or weakly positive for p53 staining. The histopathological diagnosis most common lesion was squamous cell carcinoma moderately differentiated in n=16/30(53.33%) cases followed by SCC well differentiated in n=6/30(20%) cases. There were no cases of squamous cell poorly differentiated carcinoma detected in this study. Similarly n=5/30 (16.67%) were benign lesions n=2/30(6.67%) cases were premalignant and inflammatory lesions and n=1/30(3.33%). Conclusion: Based on the findings of the current study it can be concluded that oncoprotein p53 overexpression was found in cases with betel quid chewing and smoking and the intensity of expression was directly proportional to the amount of substance consumed or smoked per day. The existence of transforming proteins from viruses, natural radiation, relatively high genetic vulnerability, and other variables may all work in concert to increase the likelihood of malignant transformation in the cells.

7. A Study of Thyroid Swellings in Tertiary Care Center
Foram Parikh, Alpesh V. Patel, Nehal R. Patel
Background: The thyroid gland is unique among all the endocrine glands. Thyroid disorders are one of the common problems encountered in clinical practice with majority of benign in nature. Ultra-sonographic examination, Fine needle aspiration cytology, and Thyroid function tests are the investigations done to determine who needs surgery or can be managed conservatively. The ultimate test for diagnosis is by Histopathological examination of excised thyroid gland.  The purpose of this study is to highlight the different thyroid swelling in tertiary care center. Methods: A retrospective study with 100 patients of thyroid swellings was conducted from August 2022 to May 2023, after taking consent from each patient. Patients were clinically examined by inspection, palpation, percussion, auscultation and underwent thyroid function tests. Ultrasonography (USG) and fine needle aspiration cytology (FNAC) was done in all patients and also assessed with histopathological examination report. Results: A total of 100 subjects with thyroid swelling were identified in our study with 87 were females and 13 were males with maximum number of cases in 21-40 years. FNAC report revealed colloid nodule in 66%, followed by colloid goitre in 18% cases. 92% cases had non-neoplastic lesions with colloid goitre being most common comprising 80% cases. Conclusion: In our study, FNAC is required to confirm histopathological diagnosis. FNAC has an important role in initial evaluation of patients with thyroid swelling but histopathological examination of specimen is the gold-standard investigation for arriving at a correct diagnosis.

8. Fistulotomy in the Management of Perineo-Scrotal Anterior Fistula-In-Ano
Dharma Reddy, Vivaan Dutt, Sahana N, Gururaj Gundad
Introduction: Anterior fistulas opening over the scrotum or perineum, have long represented a surgical challenge. Objectives: To study the outcomes in 30 cases of anterior fistulas, treated with fistulotomy as a single stage procedure. Methods: In a prospective study, 30 patients with anterior fistulas were selected. Workup was done to delineate the course and type of fistula. The selected cases underwent fistulotomy as a single stage procedure. Outcomes of surgery were measured in terms of recurrence of symptoms, incontinence as measured by the Wexner score, and complications. Results: Over half the fistulae (53.3%) were found to be trans-sphincteric type according to Park’s classification. Post fistulotomy, 22 patients (73.3%) recovered completely. Four patients had minor complication of wound infection. Recurrence was noted in one of the patients. Two patients were found to have incontinence post-operatively at 3 months, with Wexner scores >10. However, only 1 patient had a significant incontinence at the 6-month post-operative follow up visit. Conclusion: Fistulotomy appears to be a simple and effective treatment modality for anterior fistulae. A comparative analysis with other surgical techniques is warranted.

9. Histopathological Changes in Tissues, At And Around the Ligature Mark: An Autopsy Based Study, at SCB Medical College and Hospital, Cuttack, Odisha
Geeta Sahu, Jayaprakash Parida, Dilleswari Pradhan, Lity Mohanty
Background: Death by hanging is one of the commonest methods of suicide that are chosen more often in our country with a common belief that it is an immediate and painless death. The person chooses any of the ligature material in his/her vicinity to execute the event of suicide. Period and point of suspension, built of the person, composition and texture of the ligature material, position, and type of knot ,all have a major role in production of the impression of the ligature mark around the neck. The histopathological findings of tissue samples taken from the ligature site play a major role in defining the ante mortem nature of the death. Here in this study we could determine array of HP changes in the vicinity of  the ligature mark and internal changes in structures like sub mandibular gland and carotid arteries in addition to certain conventional features. Aim and Objective: The aim of the study was to critically analyze the deaths due to compression of neck with ligature and to have a scientific corroboration in the context of histo-pathological and autopsy evidences. The objectives of this study was to analyze the gross pattern of compression on the neck, the microscopic features in the underlying tissues and its association with the configuration of ligature mark, and to evaluate the  histopathological changes in carotid arteries of either sides. Material and Methods: The present Prospective study described the histopathological changes in both epidermis and dermis and also changes in carotid artery and in sub cutaneous tissue. Observation: Total number of suicidal hanging cases included in the study was 67. The ligature  material, knot, ligature mark configuration along with histopathological changes were observed and evaluated. Conclusion: The histopathological findings of tissue samples taken from the ligature mark play a major role in defining the antemortem nature of the death.

10. A Clinical Comparative Study Between Levobupivacaine and Ropivacaine by Neurostimulation Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries
Preeti More, Shubhangi Omase
Introduction: Brachial plexus blockade is a time tested technique for upper limb surgeries. Supraclavicular approach with peripheral nerve stimulator using local anaesthetics for brachial plexus block is most suitable for upper limb surgeries and post-operative analgesia. A combination of local anaesthetics is used to increase the onset of duration and also prolong the duration of action of the block, most commonly used combination being lignocaine with bupivacaine. This clinical study was to compare the onset, duration, quality of sensory and motor blockade and postoperative analgesia between groups of patients receiving supraclavicular brachial plexus block with 0.5% ropivacaine or 0.5% levobupivacaine with 1% lignocaine under neurostimulation guidance using a peripheral nerve stimulator Methods and Materials: For this prospective study, 60 patients of both sexes ASA I/II were enrolled and divided into two groups, and supraclavicular brachial plexus block was performed using levobupivacaine 0.5% with 1% lignocaine and ropivacaine 0.5% with 1% lignocaine using peripheral nerve stimulation. The onset of sensory and motor block, their duration of action and postoperative analgesia were recorded. Results: No statistically significant difference was observed in the onset of sensory block in both the groups. Onset of motor blockade was significantly faster with ropivacaine (9.50 ± 2.403 min) as compared to levobupivacaine (12.33 ± 2.537 min; P < 0.05). Duration of sensory and motor block was significantly short for ropivacaine than levobupivacaine (P < 0.05). Levobupivacaine has significantly longer duration of analgesia (12.56 ± 1.30 h) as compared to ropivacaine (9.93 ± 1.7 h; P < 0.05). Conclusions: Levobupivacaine, a novel long-acting local anesthetic agent, has a better profile in terms of duration of analgesia, with a delayed wearing off of the motor blockade thus offers an alternative to ropivacaine for brachial plexus block in upper limb surgeries.

11. To Compare the Efficacy of Fistulogram and Pre-Op MRI in the Evaluation of Anal Fistula and Compare it to the Per-Op (Intra Operative) Findings
Dipen K Kotwal, Rahul B Parmar, Mrugank C Patel, Priyank A Menat, Hansaben N Rot
Background: An abnormal cavity or tract between the perianal skin and the anal canal is known as an anal fistula. In order to properly manage them and drain any abscess, surgical therapy of anal fistulas necessitates the identification of the primary and secondary tracts’ courses and their relationships with the sphincter musculature. Physical examinations by themselves are less effective than imaging methods at identifying these fistula characteristics, and recurrences are typically brought on by neglected or improperly managed infectious components. The best imaging technique for finding anal fistulas is magnetic resonance imaging (MRI), although there is disagreement over which patient groups should get preoperative MRIs.In the preoperative evaluation process, magnetic resonance imaging is significant. MRI aids in the detection of secondary infections, fistulous tracks, and the connection between a fistula and the anal sphincteric complex. Aim: The aim of the study is to compare the efficacy of a fistulogram and pre-op MRI in the evaluation of anal fistula and compare it to the per-op findings. Material and Method: This hospital-based prospective observational study was carried out in the General Surgery Department. One hundred instances in all were used for this investigation. This study includes patients with anorectal fistulas who were referred to the Department of Radio Diagnosis. With the patients’ fully informed agreement, an MR fistulogram was performed on them using a 1.5-Tesla equipment. Different MRI sequences were employed, including fat-suppressed oblique axial and coronal T1 and T2W FSE, contrast-enhanced oblique axial, coronal, and sagittal FAT SAT T1W FSE images, and oblique axial and coronal T1W FSE. Following written informed consent, MR imaging was used to assess the patients. Results: A referral for an MRI fistulogram was made for 100 individuals in total. They underwent surgery as a result, and the results of the operation were compared to those of the preoperative MRI. 75 out of 100 patients (75%) had a single internal opening, whereas 15 patients (15%) had several openings. In 32 cases (32%), the internal hole was most frequently detected at 6 o’clock. With regard to the location of the openings, the operative findings and the study were in good agreement. Conclusion: Despite being a rare condition, anal fistula can be persistent and recurrent. Numerous complications, including secondary tracks and abscess cavities, may manifest. There may be persistent and recurrent disease as a result of an inadequate assessment of these problems. Therefore, a thorough assessment of anal fistulas prior to surgery is necessary. Additionally, the interaction between the external sphincter and the fistulous pathways must be established in order to prevent damage to the sphincter and the subsequent fecal incontinence. All of these needs of surgeons are met by MRI, which also aids in surgical planning. The fistula’s finer anatomical characteristics are shown by MRI, which also shows secondary tracks and abscesses.

12. Comparative Study of Conventional Primary Skin Closure with Subcutaneous Negative Suction Drain Following Emergency Exploratory Laparotomy
Dipen K Kotwal, Mrugank C Patel, Rahul B Parmar, Priyank A Menat, Hansaben N Rot
Background: One of the procedures that are most frequently carried out during an emergency is a laparotomy. It is frequently carried out on patients who have a history of abdominal trauma or who have acute surgical problems including acute intestinal obstruction, gastrointestinal perforation, etc. who present to the surgical emergency department. Laparotomies can result in post-operative difficulties whether they are done on an elective or emergency basis. Especially after emergency laparotomies, problematic clinical issues such wound infections, wound dehiscence, and incisional hernia are common. As a result of wound infections, post-operative wound infections significantly affect healthcare resources and costs. In emergency laparotomy procedures, a variety of techniques are used to prevent post-operative wound problems, such as the placement of a subcutaneous drain and dry gauze dressing. Aim: The aim of the study is to Comparative Study Conventional Primary Skin Closure with Subcutaneous Negative Suction Drain Following Emergency Exploratory Laparotomy. Material and Method: This prospective comparison study was carried out in the General Surgery Department. The study included all patients undergoing emergency laparotomies who met the inclusion requirements. The patient underwent a thorough clinical examination, blood work, and imaging tests. Patients who met the study’s inclusion requirements were chosen at random. There were two groups of patients. Group A includes 100 patients with a subcutaneous closed suction drain, while Group B includes 100 patients without a drain. A clinical diagnosis is made and then supported by several diagnostic techniques. Results: A prospective comparison study was conducted. The trial involved 80 patients with perforative peritonitis of various etiologies who underwent exploratory laparotomy. Only 7.4% of patients in the DPC group had SSI, compared to 42.9% of individuals who received primary closure. The significance of this was statistical. DPC thus causes a substantial drop in SSI. These wounds were potentially infectious at the time of DPC. However, it hasn’t been thought of as SSI when infections are present in wounds that were left exposed for DPC. A closed negative subcutaneous drain was inserted in 100 out of a total of 200 patients. Out of 100 patients, 25 (or 25%) suffered problems from their wounds. 48 of the 100 patients (or 48%) who had surgery reported local problems. Conclusion: When compared to patients who had a negative suction drain implanted, a subcutaneous single closed suction drain dramatically reduces postoperative surgical site infection, seroma, postoperative pain, and the length of hospital stay. By reducing hospital stays and infections, it promotes quicker healing of wounds and lowers the financial burden placed on patients. We advise the use of closed negative pressure subcutaneous drain in all patients with contaminated or filthy wounds since postoperative consequences depend on the degree of contamination.

13. The Study of Diagnosis, Clinical Features and Management of Incisional Hernias
Mukka Gopinath, Venkatram Reddy Sankepalli
Background and Aim: This study examines the different causes, ways it presents, treatment options, and outcomes associated with an incisional hernia, which is a frequent complication of abdominal surgery and a significant contributor to patient suffering. Repair techniques may include anatomical approaches, the use of mesh, or laparoscopic methods. Methods: Upon admission, a comprehensive medical history was obtained from each patient, focusing on various aspects. In cases where patients with incisional hernia presented with intestinal obstruction in the emergency department, initial resuscitation was performed. The choice of surgical repair method depended on the size of the defect. For defects measuring 3 cm or less, the anatomical repair was performed, while defects larger than 3 cm were treated with only prolene mesh repair. Results: The most frequently reported symptom among the patients in this study was swelling, experienced by 67.5% of the participants. Pain was another common symptom, reported by 37.5% of the patients. In the present study, it was observed that 34 patients (68%) had a hernial defect larger than 3cm, while n=16 patients (32%) had a defect measuring 3 cm or smaller. Prolene mesh repair was conducted in 27 cases (67.5%), while anatomical repair using suturing was performed in 13 cases (32.5%). Conclusion: In this study, we found incisional hernias are more commonly observed in males compared to females. The most common risk factor for developing an incisional hernia in the postoperative period is wound infection. To minimize the risk of incisional hernia formation, the use of lower midline incisions should be limited whenever possible, as they are more prone to herniation.

14. Survival and Factors Affecting Survival of Preterm Neonated at A Tertiary Care Center at Rajasthan
Mohammed Rafiq, Kapil Kumar Tak, S. N. Swarnkar, Mradul Varshney
Prematurity is the leading cause of under-five children mortality globally. The WHO estimated around 15 million preterm births every year. India is one of the countries that reported the highest number of preterm births. Asia, along with sub-Saharan Africa, contributes to more than 60% of the world’s preterm babies and over 80% of the world’s neonatal deaths due to complications associated with preterm deliveries. Low birth weight is one of the associated factors with preterm deliveries which adds to the overall morbidity and mortality of preterm newborns. Method: This is an observational, retrospective cross-sectional study. Preterm births both inborn and outborn who got admitted in NICU from January 23 to April 23 were taken as cases. All term births that were considered controls were randomly taken. Results: A total of 268 newborns were admitted in the SNCU out of which 61 (23%) were preterm babies. The median gestational age of the preterm neonates was 31 weeks. On basis of maturity there were 30 (49.2%) late preterm, 29 (47.5%) very preterm and 2 (3.3%) extreme preterm newborns. The most common type of fetal presentation was vertex with 39 (63.93%) of all cases. Out of the total 61 cases studied 36 (59%) were born via normal vaginal deliveries while remaining 25 (41%) were born via caesarean section (CS). The mean birth weight of the neonates was 1.5 ± 0.41 kg. There were 23 (37.70%) deaths out of the total 61 preterm newborns. The most common associated morbidities underlaying preterm neonatal death in the present study were respiratory distress syndrome (29%), neonatal sepsis (25%), hypothermia (21%), perinatal asphyxia (7%), jaundice (4%) and hypoglycaemia (4%). The main causes of deaths in preterm neonates were recorded as respiratory distress syndrome in 10 (43.5%), Perinatal asphyxia 5 (21.7%), neonatal sepsis 4 (17.4%), seizures 2 (8.7%), interactable hypoglycaemia 1 (4.3%) and others 1 (4.3%) where no definitive cause could be diagnosed. On comparing birth weight and grade of prematurity, there was significant correlation between the maturity and birth weight of the newborns. The poor outcome depends on the birth weight, we observed that the chances of neonatal deaths increase significantly. On comparing the outcome with prematurity, we observed that the chances of deaths increase with the grade of prematurity. Conclusion: Prematurity and low birth weight predispose to neonatal deaths. Low birth weight has a significant association with prematurity. Both prematurity and low birth weight causes multiple complications like RDS, sepsis, etc and are responsible for premature deaths.

15. Maternal Thyroid Status in Pregnant Women and its Associations with Ferritin and Vitamin B12
Jagrati Kiran Naagar, Himanshy Rai, Siftie Banga, Puja Singh, Ranbeer Singh, Talha Saad
The purpose of this study is to determine the influence of maternal thyroid status on the levels of ferritin and Vitamin B12 in pregnant women in India. The thyroid plays a crucial role in maintaining overall health. A dysfunctional thyroid can negatively affect both the mother and the developing foetus during pregnancy. However, limited research has explored the interplay between maternal thyroid function and these micronutrients in the Indian population. Methods: A cross-sectional study design was employed, involving pregnant women attending antenatal clinics in the tertiary care center. TSH, free thyroxine(FT4), and triiodothyronine(T3) were measured in serum to assess maternal thyroid function. Ferritin and vitamin B12 levels were also measured using standardized laboratory methods. Data on demographic characteristics, medical history, and dietary intake were collected through questionnaires and medical records. Results: In preliminary results, pregnant women were more likely than expected to have thyroid dysfunction, including subclinical hypothyroidism or hyperthyroidism. Additionally, there was a significant correlation between maternal thyroid status and ferritin and vitamin B12 levels. Women with abnormal thyroid function had lower ferritin and vitamin B12 levels compared to those with normal thyroid function. Conclusion: Due to the high prevalence of hypothyroidism in pregnant women and its association with iron and vitamin B12 deficiency. Hence early detection of thyroid status and nutritional deficiencies in this population is imperative to stop the disorder’s negative effects on the mother and foetus.

16. Unravelling the Connections: Exploring Pregnancy-Induced Hypertension and Gestational Diabetes
Jagrati Kiran Naagar, Himanshy Rai, Siftie Banga, Puja Singh, Ranbeer Singh, Talha Saad, Amar Gangwani
Gestational diabetes and pregnancy-induced hypertension are both common. It’s not clear how they are connected, though. Birth certificates and hospital discharge information were used in the first population-based case-control study, which was carried out in Washington State between 1992 and 1998.
Consecutive cases of pregnancy-related hypertension were divided into four groups based on the International Classification of Diseases, Ninth Revision codes: eclampsia (n = 54), severe preeclampsia (n = 70), mild preeclampsia (n = 68), and gestational hypertension (n = 43). The outcomes of these cases were contrasted with controls (n = 102) who did not have pregnancy-induced hypertension.
In each case group, 1.29% eclamptic, 4.8% severe preeclamptics, and 4.6% both moderate preeclamptics and those with gestational hypertension, exhibited a greater prevalence of gestational hypertension than the controls (4.6%).
A higher risk of severe preeclampsia was associated with gestational diabetes (odds ratio (OR) = 1.6, 95% confidence interval (CI): 1.12, 2.2). In women who had subpar prenatal care, the odds ratios for eclampsia and severe preeclampsia were 4.18 and 3.15, respectively (p 0.05 for both).

17. Prevalence and Quantification of Aflatoxin M1 in Human Milk Associated with the Diet and Kitchen Microenvironment of Lactating Mothers in Rural Rajasthan: A Descriptive Study
Purva Shoor, Sudeepti Panat, Sweta Sinha, Vishal Bankwar, Prabha Shrivastav
Introduction: Aflatoxin M1, a metabolite of Aflatoxin B1 is secreted in human milk when the lactating mother consumes animal milk and other foods contaminated with Aspergillus moulds. AFM1 can cause loss of intestinal integrity, hepatic cancer or steatosis, and growth faltering at a later date among infants who were breast fed. This fungus is an agricultural by product. Our objective was to find out the burden of AFM1 concentration in human milk of lactating mothers residing in the rural field practice area of our medical college. We also described the frequency of common foods in mothers’ diet known to carry aflatoxins and their kitchen characteristics. Methods: 31 lactating mothers with infants less than 6 months of age were subjected to test their milk samples for AFM1. A test kit procured from VETMED Scientific, Bhopal was used to perform competitive ELISA. A pre-tested, semi-structured questionnaire was administered to gather further information. Results: All human samples were contaminated with AFM1. The range was from 39-5100 pg/ml; 5061. The Standard Deviation depicted large variations among samples. Most mothers (77.42%) consumed boiled animal milk every day, all fed on cereals daily. The women who consumed stale food, stored grains in damp kitchen, fed on direct or pasteurized animal milk, procured grains from Public Distribution System, with frequent kitchen turnover corresponded to very high median concentrations of AFM1. Conclusion: All lactating mothers were showing AFM1 concentration higher than safe limit (25 pg/ml). Diet pattern and food handling (FSSAI guidelines) must be taught to combat this risk.

18. Clinical Outcome Using Standard Therapeutic Regimen in Adult Patients with Tubercular Meningitis at A North Indian Tertiary Care Centre
Ajit Kumar Mishra, Shoebul Haque, Ajay Kumar Verma, Imran Rizvi, A K Sachan, R K Dixit
Tuberculous Meningitis is a dreaded medical condition with high mortality and morbidity. Survivors are left with severe medical conditions. Its therapeutic interventions are also equally challenging because of adverse drug reactions as well as compliance issues. Timely intervention and early diagnosis significantly determines mortality and morbidity in a resource poor and endemic country. Identifying prognostic factors and administration of standard therapeutic regimen are directly related to the survival of patients.


19. To Study the Thyroid Dysfunction among Patients with First Episode Depression A Hospital Based Study
Ajaz Ahmad Suhaff, Mohammad Maqbool Dar, Bilal A. Teli, Junaid Nabi Bhat
Background: Depression is a common, recurrent, clinically and biologically heterogeneous disorder. There has been established link between medical illnesses with depressive symptoms or depressive disorder. The lifetime prevalence of depression and anxiety is 11.8% to 36.8% in patients with previously known thyroid disorder. To study the prevalence of thyroid dysfunction in patients with first episode depression. Results: In our study out of 126 participants, majority of the participants were females 83 i.e,  (65.87),  aged 40-49 years (46.03%), married were 48.4% (n=61), and majority were uneducated 46.8% (n=59) and Unemployed 47.6% (n=60). Out of 126 participants 44.44% (n=56) had mild depression, 37.30% (n=47) had moderate depression and 18.25% (n=23) had severe depression. Out of 126 participants 21.42% (n=27) had thyroid dysfunction. 15.07 (n=19) participants had thyroid levels in hypothyroid range while as 6.34% (n=8) participants had thyroid levels in subclinical range. Conclusions: In conclusion, we would like to emphasize that high prevalence of thyroid disorder among depressive patients and routine evaluation of thyroid hormone in depressive patients. It is concluded that we should also evaluate thyroid functioning in all dimensions of depression.

20. 6 Minute Walk Test Performance to Predict Postoperative Pulmonary Complications in Major Oncosurgeries
Tazeem Ayub, Majid Jehangir, Falak Ara, Waquar Amin Wani, Urfe Umbreen
Postoperative pulmonary complications (PPCs) are a major cause of perioperative morbidity, mortality and longer hospital stays. Certain tests(6-minute walk test) can be performed preoperatively to predict the risk of postoperative pulmonary complications. Aims and Objectives: To correlate 6-minute walk distance as a predictor of Postoperative Pulmonary Complications. Material and Methods: This prospective observational study, entitled “Performance of 6 minute walk test to predict postoperative pulmonary complications. The test was conducted as per American Thoracic Society (ATS) guidelines. Patients were encouraged to move at their normal pace and were given the option of pausing in between, on exhaustion while the timer was kept running. As the set time (6 minutes) elapsed, the patients were instructed to stop. Post-test hemodynamic parameters viz., blood pressure, heart rate, oxygen saturation were recorded. Level of dyspnoea was noted by asking them to mark it on the BORG scale22, compared to the pre-test dyspnoea level. Finally, the laps were counted and the total distance covered (6 MWD) calculated. Group 1 (No Postoperative Pulmonary Complications) and Group 2 (Postoperative Pulmonary Complications). Results: We observe that 6 minute walk distance for group 1 was significantly smaller compared to 6 minute walk distance for group 2 (423.4 vs 314.1) meters. Evidently, with a p-value of <0.001*, the difference between the groups was highly significant. The assessment of various risk factors for postoperative pulmonary complications (PPC) revealed that pre-test SPo2 < 96, 6MWD ≤ 328, FEV1 < 75 and FVC < 78 are the significant risk factors associated with PPC. Conclusion: In clinically high risk patients undergoing elective oncosurgeries, the preoperative 6MWT is an easy, safe and feasible test for routine preoperative evaluation and may predict patients with a higher likelihood of developing PPC.

21. A Cross Sectional Observational Assessment of the Prescription Pattern in Ischemic Heart Disease
Sushil Kumar, Asha Kumari, Ram Babu Raman
Aim: The aim of the present study was to analyze the drug prescribing pattern for treatment of ischemic heart disease. Methods: This was a cross sectional observational study conducted on ischemic heart disease patients admitted at inpatient department of Medicine in Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 18 months. The study consisted of analysis of drug utilization pattern of prescribed drugs. A total number of 200 patients were enrolled in the study. Results: IHD was more commonly seen in males (70%) than females (30%). IHD group patients were divided according to age in 7 classes. As per study analysis, IHD was most commonly seen in patients of age group of 61-70 year (60%). The mean age of study group was 64.36 Years. Most of the patients (80%) were having ST segment elevation myocardial infarction (STEMI). Majority of the patients were taking 7-8 drugs in the present study. Drugs prescribed to patients belong to various therapeutic classes ranging from anti-platelets, anticoagulants, anti- anginal, antithrombin, thrombolytic, hypolipidemics. The most commonly prescribed therapeutic class of drugs was anti-platelet (84%) followed by hypolipidemic (82%) and ACE inhibitors drugs (48%). Maximum drugs 70% were prescribed in oral formulations followed by intravenous (23%), subcutaneous (4%) and inhalation (3%). Conclusion: IHD was more common in males. The most commonly prescribed drug classes in IHD were anti-platelet drugs followed by hypolipidemics, anti-hypertensives, anti-anginal drugs and anticoagulants. Very few drugs were prescribed by generic name. Prescribing generic drugs might reduce the economic burden of the patients.

22. A Hospital Based Observational Assessment of the Pattern of Adverse Drug Reactions with Chemotherapeutic Drugs
Sushil Kumar, Asha Kumari, Veena Kumari
Aim:  The aim of the study was to assess the pattern of adverse reactions to chemotherapeutic agents commonly prescribed. Material & Methods: This was an observational, non-interventional and retrospective study conducted at the ADR monitoring centre (AMC) which was coordinated by the Department of Pharmacology Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Suspected ADR forms reported at the AMC of this hospital during the duration of 2 years were collected. During the study. Results: Among the 200 patients included in the study, 110 (55%) were females and 90 (45%) were males. Majority of the cases were seen in the age group of 51-60 years (26%). 140 (70%) patients were married. Most of them (82%) had never smoked, while some (14%) were ex‑smokers and a few others (4%) were current smokers. Most common ADRs were skin rashes (24%), followed by jaundice, urticaria and fixed drug eruptions. Maximum number of ADRs was suspected to be caused by Anti Tubercular drugs (32%), followed by anticancer drugs (14%), fluoroquinolones (13%), anti-fungal (10%), cephalosporins (8%), antiamoebic (5%) and vancomycin (4%). Least number of ADRs were suspected to be caused by macrolides, doxycycline, antimalarial, sulphonamides, dapsone, anti-HIV drugs, permethrin and aminoglycosides. Conclusion: ADRs due to antibiotics and anticancer drugs is a significant health problem.

23. Repair of Iatrogenic Furcal Perforation using Mineral Trioxide Aggregate (MTA): A Case Report
Monalisa Debbarma, Harbinder Singh
Furcal perforation is usually an undesired complication that can occur during preparation of endodontic access cavities or exploring canal orifice of multirooted teeth. Inadequacy of the repair materials has been a contributing factor to the poor outcome of repair procedures. On the basis of the recent physical and biologic property, mineral trioxide aggregate (MTA) may be suitable for closing the communication between the pulp chamber, underlying periodontal tissues and alveolar bone. The purpose of this case report is to describe the treatment of an iatrogenic furcal perforation using MTA in maxillary molar teeth. The perforation was cleaned with sodium hypochlorite (5.25%), saline solution and sealed with MTA. Finally, the tooth was endodontically treated and coronally restored with Glass ionomer cement and metal veneer crown.

24. Study of Adverse Donor Reactions in Whole Blood Donors in a Tertiary Care Hospital, Srinagar, North India
Rubiya Ryhan, Hilal Ahmad, Falak Ara, Irshad Ahmad, Javid Ahmad, Rumana Hamid
Aim: To estimate the frequency of adverse reactions occurring in whole blood donors and to assess the predisposing risk factors of these adverse reactions. Materials & Methods: The present study is a hospital based observational study carried in the department of blood transfusion and Immunohematology from Jan 2015 to Dec 2022. The donors who developed adverse reactions or adverse events were categorized with respect to: age, sex, hemoglobin, type & status of donor. Results: During this seven-year study period, a total of 76188 donors donated blood, out of which 5.5 % (4190/76188) donors experienced donation related adverse effects. Reaction rate among male & female donors were 5.3 % (3970 /75011) & 18.7 % (220 /1177) respectively. Most of the donors who experienced adverse effects or adverse reactions [6.1 % (2248/ 37332)] belong to the younger age groups. Age & gender had a significant effect on rate of reaction (p <0.001). Higher rate of adverse reactions [8.3 % (1236/ 14842)] were observed in donors with hemoglobin in the range of 12.5 – 13.4 g/dl. Also Significantly higher (p <0.001) rate of adverse reactions were observed among 1st time donors [8.9 % (2428/27292)] & replacement donors [7.8 % (1804/ 23145)]. Summary & Conclusion: Donation related adverse reactions or adverse effects are multifactorial determined by age, sex, hemoglobin, type & status of donor. Our study reinforces that blood donation is a safe procedure which could be made even more event free by analyzing adverse events, identifying the donors at risk of donor reactions and adopting appropriate donor motivational strategies, pre-donation counseling, and care during and after donation, strict adherence to guidelines in donor examination & selection.

25. Sensoneural Hearing Loss in Patients of Diabetes Mellitus in Pediatric and Adoloscent Age Group: A Cross Sectional Study
Vikas Devra, Mohammed Rafiq, Kapil Kumar Tak, S. N. Swarnkar, Mradul Varshney
Background: Hearing loss occurring in DM is usually bilateral and sensorineural in nature and is associated with progressive bilateral high tone hearing loss, which start earlier in patient with diabetes as compared to non-diabetics. Sensorineural hearing loss (SNHL) causes a loss of hearing more than 25dB frequency, with conductive and sensorineural gaps lower than 20dB. It affects the patient’s ability to learn, communicate, education, job prospects and social relationships. In children specially it causes delay and hindrance in overall development of the child. Methods: This study is a Prospective, Cross-Sectional study. A total of 100 patients in pediatric and adolescent age group (5 – 18 years) which are diagnosed cases of type 1 diabetes mellitus by systemetic sampling method between June 2022 to Sep 2022 who attended the hospital with complaints of hearing loss or symptoms of difficulty in hearing or tinnitus. Complete medical history including personal and family history was recorded. Complete examination was done including audiometric test using Pure Tone Audiometry OAE Tympanometry. Results: We studied a total of 100 cases. Out of a total 100 cases, 55 (55%) patients were male and 45 (45%) were female. The patients were between 5 years and 18 years of age. Maximum number of patients were found in 13 – 15 years age group with 42 cases (42%). The mean age was 12.41±2.3 years. All the patients were known cases of type‑1 DM. All the cases presented to the hospital with complaint of some degree of hearing loss. Maximum number of patients (n=46) having sensorineural hearing loss showed mild degree of deafness, (loss of 26–40 dB). Thirty-two patients showed moderate (41–55 dB) degree deafness, while the number of patients with moderately severe (56–70 dB) and severe (71–90 dB) degree deafness was 16 and 6, respectively. None of the cases showed profound hearing loss (>90 dB). Maximum number of cases (n=48) had been suffering from the disease for 1-5 years, forty-five patients had reported diabetes mellitus for 6–10 years and seven patients had this disease for more than 10 years. The maximum duration of disease encountered was 12 years. All the patients were taking Insulin therapy. The correlation of hearing loss with duration of disease was found to be highly significant (p-value = 0.0003) in our study. HbA1c was measured for each case and tallied with the level of SNHL. Of the 100 patients, 39 had HbA1c levels between 5.1% and 7.0%, 44 patients have 7.1%–9.0%, 11 patients in the 9.1%–11.0% group, 4 patients had 11.1%-13.0% whereas 2 patients had HbA1c >13.0. The correlation is significant with p-value = 0.0035. Conclusion: Senso neural hearing loss, although not a very common but is a important complication in patients with type 1 diabetes mellitus. Hearing loss affects the quality of life of the patients and especially in children and adolescent, it also affects the learning and overall development of the child. It is thus important that regular checkups and hearing evaluations should be done in patients of Type 1 Dm and interventions should be done to maintain the blood glucose levels within limits.

26. A Comparative  Study of Pulmonary Function  after Interscalene Brachial Plexus Block with Equipotent Doses of Ropivacaine and Bupivacaine in Adult Patients Undergoing Elective Upper Limb Surgery
Uma Majumdar, Anuradha Mitra, Subrata Ray
Background: Interscalene brachial plexus block (ISB) is a gold standard regional block for surgical procedures on the shoulder girdle and humerus shaft. Hemidiaphragmatic paralysis following ISB is almost inevitable . Its reduction would benefit patients with borderline respiratory function. To the best of our knowledge no study has compared the reduction in spirometric values by equipotent doses of Ropivacaine and Bupivacaine for ISB. Aims:  to compare the degree of phrenic nerve blockade through measurement of reduction in FEV1 and PEF caused by equipotent doses of Bupivacaine and Ropivacaine for ISB (group B and group R) using bedside spirometry. Methods:  Patients were randomly assigned to two groups: the Bupivacaine group [Group B (n=25): 20ml of 0.25% Bupivacaine for ISB] or the Ropivacaine group [Group R( n=25): 20ml of 0.375% Ropivacaine for ISB] . Before performing the ISB, bedside spirometry was performed using best of the three readings for FEV1 and PEF as baseline values. Readings were again taken at time points five minutes after performing the block, ten minutes, fifteen minutes and final readings were taken at the end of surgery. Results: FEV1 and PEFR values dropped in both groups. At the end of fifteen minutes, the PEFR in Group R was more than that in Group B (p=0.038) and the FEV1 in Group R was more than Group B (p=0.044). Conclusions: At fifteen minutes the Group R showed a smaller drop in PEFR and FEV1. Thus Ropivacaine 0.375% may be used preferentially over Bupivacaine 0.25% for ISB in patients with borderline respiratory function.

27. Occupational Health Hazards amongst Agricultural Workers Working in Rural Area
Samina Mustafa Ausvi, Meraj Mustafa Ausavi, Faizoddin Khaja Md
Background: Occupational diseases among farmers can be caused by exposure to multiple hazardous agents such as animal exposure, pesticide exposure, hazardous machinery handling etc. Aim and Objectives: To know about occupational health hazards in farmers working in rural areas. Material and Method: This was a community based cross sectional study, conducted to find out the various health hazards among farmers in filed practicing area. Total of 350 agricultural workers were recruited into the study by using simple random sampling after following inclusion and exclusion criteria. Predesigned and pretested proforma was used to collect data; The principal investigator interviewed the participants in local language using the predesigned proforma. Results: 59.1% of study population was male and 41.9% of the population was female. 80.9% of the population was lying in lower middle socio economic status. The present study observed that maximum health hazards were due to the exposure of pesticides, followed by animal attack, physical, hazards due to heat and cold, respiratory hazards and mechanical hazards. The present study also reported that near about 81.1 % study participants were aware about personal protective equipment’s. Conclusion: Majority of study population were males, who were suffered due to exposure of pesticides and animal attack, who were mostly illiterate and had poor knowledge about pesticide.

28. Effectiveness of Tranexamic Acid in Minimizing Perioperative Blood Loss during Orthopedic Surgeries on the Lower Limb
Mechineni Srivani
Background: The use of Tranexamic Acid (TXA) has been shown to significantly decrease blood loss in various surgical procedures and enhance survival rates in patients experiencing severe bleeding during orthopedic and trauma cases. The purpose of this study is to investigate the effects of tranexamic acid (TXA) on blood loss and hemodynamics in patients undergoing lower limb orthopedic surgeries. Methods: Selected patients were randomly allocated to two groups In Group (T), consisting of 20 patients, tranexamic acid (TXA) was administered. After a test dose of 1 mL, each patient received TXA intravenously at a dose of 15 mg/kg (up to a maximum of 1,000 mg) before the surgical incision. An additional dose of TXA at 5 mg/kg was repeated intravenously 4 hours after the initial dose (referred to as the TXA group). In Group (C), also comprising 20 patients, normal saline (placebo) was administered at the same time points as the TXA group, i.e., before the skin incision and repeated 4 hours later (referred to as the placebo group). Results: In the intraoperative period, the percentage of subjects requiring blood transfusion was remarkably lower in the tranexamic acid group, with only 10.0% needing transfusion, compared to 50.0% in the control group. This difference was found to be statistically significant (p<0.05). Thus, it can be concluded that tranexamic acid has the potential to reduce the need for blood transfusion by up to 40% in subjects. Conclusion: The results of this study demonstrated that the use of Tranexamic acid (TXA) leads to a substantial reduction of approximately 40% in blood loss and the need for blood transfusion in patients undergoing trauma surgeries. Therefore, the routine administration of TXA could be advantageous for patients undergoing Orthopedic procedures, where significant blood loss is anticipated.

29. Factors Influencing the Clinical and Radiological Outcomes of Busch-Hoffa Fracture: An Observational Study
Mumthashar Ahammed TA, Rajesh Purushothaman, Arun Prakash PJ
The aim of this study was to define the predicting factors and evaluate the prognosis of Background and Objectives: Sagittal lateral condyle fracture, coronal split fracture and medial condyle fracture are the three forms of partial articular fractures that make up distal femur AO type 33 B fractures. Coronal plane fractures of the distal femur, also known as Hoffa fractures, are less common than sagittal plane fractures. The mechanism of injury for lateral condylar fractures is frequently a direct anteroposterior force that impacts the flexed & abducted knee, whereas the cause of medial condylar fractures is a direct contact along the medial aspect of the knee in flexion. A variety of techniques have been used, including medial parapatellar for screw fixation of medial condylar Hoffa’s fracture, with or without posterior technique for open reduction of Hoffa’s fracture via screw or buttress plate fixation, while lateral parapatellar for lateral condylar Hoffa’s fixation. Material and Methods: The study was conducted as a hospital based prospective observational study at the Department of Orthopedics, Government Medical College and hospital of south India. Fifteen patients attending casualty/outpatient department with coronal fracture of femoral condyle were evaluated after receiving institutional ethical committee permission and the informed written consent. Cases were divided to subtypes based on Letenneur classification. Surgical approach, fixation technique, implant characteristics, quality of reduction was noted. Radiological outcome assessed with serial x-rays at 3, 6 months and further as required. Knee society clinical score (KSS) and International knee documentation committee (IKDC) was obtained at 6 months and on final follow up. All the data collected were coded and entered in Microsoft Excel sheet which was re-checked and analyzed using SPSS statistical software version 22. Results: This study indicates Hoffa fracture is common in young adult males with main mode of injury were automobile accidents and lateral condyle is commonly injured than medial condyle. In our study, majority of the patients managed using PA screws alone had excellent final outcome in both functionally and radiologically (p= 0.016). Among the study population, patients with anatomic reduction had good functional outcome in comparison with those with near anatomic reduction (p=0.073). The average time frame for good radiological union was 12±1.6 weeks. Mean knee society score of 77.0 was obtained in present study. Conclusion: The reestablishing of articular anatomy and its alignment is crucial for better surgical results. It is necessary to perform a closed or open reduction and a secure fixation using cannulated anteroposterior cancellous screws. For improved outcomes, a quality post-operative rehabilitation programme must be implemented.

30. Perinatal Morbidity and Mortality Pattern in Admitted Neonates With out of Hospital Birth History: A Descriptive Retrospective Study
Ravishankar Uikey, Rajendra Singh Kushwah
Background and Objectives: The current newborn mortality rate (NMR) in India is 24.9 per 1,000 live births, according to the National Family Health Survey-5 (NFHS-5) report. With all nations intending to reduce neonatal mortality to at least 12 deaths per 1,000 live births, a proposed Sustainable Development Goals (SDGs) objective for child mortality intends to end the avoidable deaths of newborns and children under the age of five by 2030. In order to improve newborn outcomes and lower the mortality rate, Special Newborn Care Units (SNCUs) should be established in each district. The study’s goal was to identify the illness distribution and contributing factors to infant death in tertiary neonatal care units. In order to apply measures for reducing avoidable causes of newborn morbidity, the research’s goal was to evaluate the common reasons for admission to the study center’s NICU and the outcomes of hospitalized neonates. Material and Methods: After receiving approval from the institutional ethical committee and the parents’ informed written consent, the descriptive, retrospective, clinical, hospital-based study involved 500 out-born neonates who were admitted to the Neonatal Intensive Care Unit (NICU) of the Department of Paediatrics at a Government Medical College and Hospital in central India between August 2014 and September 2016. Data on the admission of out born children, including the gender, age of gestation, weight for gestation, reasons for admission, length of hospitalization, complications faced, investigations conducted while in the hospital, and outcomes were retrieved. SPSS statistical software version 26 was used to analyze all of the gathered data. Results: Study comprised of total 500 neonates’ morbidity pattern showed maximum share of respiratory distress 329 cases (65.8%) followed by prematurity 17.4% (n=87) and neonatal jaundice 9% (n=45). Mortality was 142 cases (28.4%). Case fatality for respiratory distress syndrome was 46.4% (n=60), followed by non-nutritive sucking 21.49% (n=30), prematurity 15.49% (n=22) and hypoxic ischemic encephalopathy 9.2% (n=13). Conclusion: According to our research, the three main causes of newborn death are respiratory distress syndrome, preterm birth, and low birth weight. Health care managers at the community level should plan and carry out interventions to lower preterm birth, low birth weight, and birth asphyxia.

31. Role of C-Reactive Protein in Predicting the Severity of Acute Pancreatitis
G Hemanth, L Srinivas
Background: Intense abdominal pain is commonly caused by acute pancreatitis. The effectiveness of diagnostic markers such as pancreatic enzymes (such as amylase and lipase) in predicting outcomes has been disappointing. However, assessing C-reactive protein (CRP) offers a cost-effective and efficient alternative. In this study, we have investigated whether an early assessment of CRP levels can serve as a reliable predictor of morbidity and mortality in cases of acute pancreatitis. Methods: The patients were selected based on the inclusion and exclusion criteria and the demographic profile of the cases was recorded based on a pre-structured proforma. A detailed clinical examination was carried out on the patients and findings were noted. Serum C-reactive protein (CRP) levels were measured serially at 24 hrs, 48 hrs, and 72 hours following admission. At the 72-hour mark, computed tomography (CT) scans were conducted using oral and intravenous contrast agents to determine the CT severity index, including Balthazar’s and Ranson’s scores, as well as assess the CT grade and necrosis grade. Results: The comparison of CRP versus necrosis scores has been depicted in Figure 3. The sensitivity was 84.44% and Specificity was 80.53%. The correlation between the necrosis score in the CT severity index and serum CRP values was also determined. The duration of hospital admission was recorded as a marker of disease morbidity. A significant cutoff value of 100 mg/dl was used for CRP, although different studies cited in this research suggested different significant values (100 mg/dl and 150 mg/dl). Conclusion: Elevated CRP values beyond the significant range positively correlate with the occurrence of necrosis in pancreatitis. This information can aid in deciding which patients require a contrast-enhanced CT scan (CECT), considering that this investigation is both expensive and not readily accessible.

32. Estimation of Height from Percutaneous Tibial Length among Student Population in Two Medical Colleges in North India
Vijay Kumar, Somshekhar Sharma, Jaswinder Singh, Rajesh Chandra Sharma
Introduction: The origins of anthropometry are very ancient. As long ago as old Egypt and Greece. The word ‘Anthrapometry’ was first used in the seventeenth century by a German physician J. Sigismund Elshwltz (1623-88). Materials and Methods: This present study was conducted on 300 Medical male students of MBBS phase 2 and phase 3 studying in Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly and Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh. The age of the students ranged from 20-23 years who belonged to Uttar Pradesh and Delhi NCR region. The length of the tibia is defined as the direct distance between the medial most superficial point on upper border of medial condyle and tip of the medial malleous. The study subject was asked to sit with knee placed in the semi flexed position and the foot partly inverted to relax the soft tissues and facilitate bony landmarks prominent. Then, the bony landmarks are measured with the help of spreading callipers. Further, the measurement is confirmed by using measuring tape. Height was measured by measuring crown to heel standing erect posture with anthropometer. Measurements of length of right and left tibia were taken separately for calculation. Statistical analysis was done using SPSS software. Observations and Results: Linear regression formula was derived for estimation of height from percutanous length of right and left tibia. Y1=94.5+1.8X1 Y2=88.55+1.95X2 Where, Y1 and Y2 are estimated heights from length of right and left tibia. X1 and X2 represent the length of right and left tibia respectively. Conclusion: Regression formula obtained can be used for the estimation of height from the tibia bone in selected population.

33. A Prospective and Observational Study of Clinical Presentation, Stage of Disease and Outcome of Carcinoma Breast in A Tertiary Care Hospital
Krishnendu Mondal, Manojit Sarkar, Parvej Sultan, Asis Kumar Saha
Introduction: The carcinoma of breast due to its uncertain cause has drawn the attention of physicians throughout the ages. It is one of the commonest cancers occurring in female worldwide and it is a devastating illness both physically and mentally. Aims: To observe different stages of presentation, to observe the pathological types and receptor status and to find out different management protocols. Materials and Methods: The present study was conducted in Department of General surgery, NRS Medical College & Hospital, during the period from March 2020 to August 2021. 150 patients were included in this study. Result: In our study we grouped ca breast in 4 categories after obtaining the IHC report of ER, PR and her2 neu status from either pre op true cut biopsy or from excised specimen. A total of 87 patient (58%) were ER/PR +VE and her 2neu -VE followed by 33 cases (22%) who were negative for ER, PR or her 2neu (also known as triple negative breast carcinoma). 22 cases (14.67%) were ER or PR +VE and her 2neu +VE. Only 8 cases (5.33%) were in ER/PR -VE and her2neu +VE category. Conclusion: According to molecular subtype depending on receptor status ER/PR positive with Her 2 neu negative subtype (also known as luminal A) was found to be the most common subtype followed by triple negative breast carcinoma. Surgery and chemo/radio therapy is the mainstay of treatment. Modified radical mastectomy (MRM) was the most surgical treatment performed in early breast carcinoma and in locally advanced breast carcinoma after receiving neo adjuvant chemotherapy followed by palliative or simple mastectomy done in metastatic breast carcinoma.

34. Study of Serum Hs-CRP & Lipid Profile in Non-Alcoholic Fatty Liver Disease Patients in Tertiary Care Hospital of Central India
Kapil Raghuwanshi, Swapnesh Sagar, Sharad Manore, Bhavana Tiwari
Introduction: Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver damage ranging from simple steatosis to non-alcoholic steato hepatitis (NASH), increased liver fibrosis and rarely, progression to liver cirrhosis. It is frequently associated with obesity and metabolic syndrome. Chronic inflammation and altered lipid profile are frequently associated with the metabolic syndrome. High sensitive C-reactive protein (hs-CRP) an important diagnostic and prognostic marker for many systemic inflammatory diseases, as very low concentrations of CRP can be analyzed in the serum. High prevalence of NAFLD worldwide causes increased morbidity & mortality & have increased economic burden in the community. Pathogenesis of NAFLD may be associated with the destruction of hepatocytes resulting from immune and inflammatory mediators. Studies about the role of inflammation in the pathogenesis of NAFLD, shown conflicting and non-conclusive results hence any reliable clue will be considered valuable. Aims & Objective: To compare the serum levels of hs-CRP and lipid profile in patients of NAFLD and in healthy controls. Materials and Methods: This cross-sectional study included 50 patients of NAFLD (case group) and 50 age and gender matched healthy subjects (control group). Serum hs-CRP and lipid profile were measured for both the groups. Results: The mean concentrations of hs-CRP in the case group and the control group were 4.2±1.2 mg/l and 2.2±0.4 mg/l respectively. The difference is statistically significant (P < 0.05). In Our study we also found significantly altered lipid parameters in case group than in control group. (P < 0.05). Conclusion: This study has shown that inflammation and alteration in lipid profile is more evident in patients of NAFLD as compared to healthy subjects.

35. Association of Birth Asphyxia with Neonatal Mortality: Clinical, Hospital Based Study
Ravishankar Uikey, Manish Maran
Background and Objectives: The current newborn mortality rate (NMR) in India is 24.9 per 1,000 live births, according to the National Family Health Survey-5 (NFHS-5) report. With all nations intending to reduce neonatal mortality to at least 12 deaths per 1,000 live births, a proposed Sustainable Development Goals (SDGs) objective for child mortality intends to end the avoidable deaths of newborns and children under the age of five by 2030. In order to improve newborn outcomes and lower the mortality rate, Special Newborn Care Units (SNCUs) should be established in each district. Respiratory distress accounts for significant morbidity and mortality in neonates. It occurs in 4 to 6 percent of neonates. Many of the conditions causing respiratory distress are preventable. Early recognition and prompt management are required. The study’s goal was to identify the respiratory illness distribution and contribution to the neonatal death in tertiary neonatal care units. In order to apply measures for reducing avoidable causes of newborn morbidity, the research’s goal was to evaluate the common respiratory reasons for admission to the study center’s NICU and the outcomes of hospitalized neonates. Material and Methods: After receiving approval from the institutional ethical committee and the parents’ informed written consent, the descriptive, retrospective, clinical, hospital-based study involved 500 out-born neonates who were admitted to the Neonatal Intensive Care Unit (NICU) of the Department of Paediatrics at a Government Medical College and Hospital in central India between August 2014 and September 2016. Data on the admission of out born children, including the gender, age of gestation, weight for gestation, respiratory reasons for admission, length of hospitalization, complications faced, investigations conducted while in the hospital, and outcomes were retrieved. SPSS statistical software version 26 was used to analyze all of the gathered data. Results: Study comprised of total 500 neonates’ morbidity pattern showed maximum share of respiratory distress 329 cases (65.8%) followed by prematurity 17.4% (n=87) and neonatal jaundice 9% (n=45). 40.4% of respiratory distress was due to sepsis, followed by hypoxic ischemic encephalopathy (HIE) (20.9%). Mortality was 142 cases (28.4%). Case fatality for respiratory distress syndrome was 46.4% (n=60). Conclusion: According to our research, respiratory distress syndrome was found to be the main cause of newborn death. Health care managers at the community level should plan and carry out interventions to prevent birth asphyxia.

36. A Study on Laryngotracheal Trauma and Its Management
Mahesh Babu, Vamshi Krishna Rao K, M.S. Emmanuel
Background: Laryngotracheal wounds are rare; however, they have a significant mortality rate. Laryngeal injury forms less than 1% of all traumatic injuries. Despite being rare, they may be quite severe. Aim and Objective: To study laryngeal trauma and its management in our hospital settings. Material and Method: This was a prospective study conducted in Department of ENT, CAIMS Karimnagar, included 50 patients reported to OPD due to various aetiologies of Laryngeal trauma for the period of one year, after getting informed consent from patients, approved by institutional ethical committee and following inclusion and exclusion criteria. Results: Among all 50 participants who were included in the study, 64% of them were male and 36% were female and majority of the patients were from the age group of 21 – 40 years followed by < 20 Years. majority of the patients were reported due to the Blunt Injury (Road traffic accidents, Cut Throat and Hanging) followed by intubation injury (Post Intubation) and penetrating Injury. But after management of the patients with above treatment procedures there was significant difference observed in outcomes of the patients, after treatment out of 50 patients 41 patients were able to speak and 43 patients were able to swallow. Conclusion: The role of the CT scan is crucial in decision making in blunt trauma cases. A multidisciplinary approach is required in trauma patients to identify other co-existing injuries.

37. Serum Magnesium Levels in type II Diabetes Mellitus Patients with Special Reference to Long Term Complications of Diabetes (Study of 100 Patients)
Pooja Jariwala, Darshak Makawana, Patel Mittalben Maheshbhai, Madhvi Kareliya
Background and Objectives: Hypomagnesemia can be a consequence of hyperglycemia (as seen in increased urinary magnesium excretion along with glycosuria) and a cause of insulin resistance. The association between diabetes mellitus and hypomagnesaemia is compelling for its wide-ranging impact on diabetic control, its macro and micro-vascular complications, and ultimately on the therapy. Objectives: To estimate prevalence of hypomagnesaemia in patients with type 2 DM and to correlate the serum magnesium concentrations with micro and macrovascular complications of diabetes – retinopathy, nephropathy, neuropathy and ischemic heart disease. Material and Method: An observational study carried out for one year in 100 participants diagnosed with Type 2 diabetes mellitus in the age group of 30–80 years in medicine department, were included in the study. Serum Magnesium levels of all diabetic patients were investigated and compared with long term diabetes complications like diabetic retinopathy, nephropathy and neuropathy. Serum Magnesium levels were also compared with comorbid conditions like hypertension, Lipid profile and HbA1C for poor glycaemic control. Statistical analysis were carried out for correlation and test of significance. Result: Among 100 participants, males were 47% and females were 53 % with mean age of 55.04 ± 11.2 years. The average duration of diabetes in study population was 5.5 years and most of the patients were received oral hypoglycemic drugs for their diabetes treatment. 29% of participants had hypomagnesemia (serum Mg≤ 1.7mEq/L). Among the patients having hypoglycemia, 23.3% of participants were having hypertension, 31% were having retinopathy, 37.9% were having nephropathy and 69% were having neuropathy. In our study, retinopathy and neuropathy were significantly correlated with hypoglycaemia (p value <0.05). Among lipid profile, Serum triglyceride and serum HDL cholesterol were significantly and inversely correlated with hypomagnesemia. Poor glycemic control in patients with hypomagnesemia were also established due to significant correlation between High HbA1C level and hypomagnesemia. Conclusion: Hypomagnesemia was significantly associated with diabetic retinopathy and neuropathy, poor glycemic control and lipid profile abnormalities. Benefits of Mg supplementation on metabolic profile in diabetic subjects have been found in most, but not all clinical studies, and larger prospective studies are needed to support the potential role of dietary Mg supplementation as a possible public health strategy in diabetes risk.

38. Present Scenario in Pharma Research and Business Management
Avani Reddy Alla, Kevin T Cherian, Ramya Surapaneni, Vijay Kumar Gajula, Srikanth Sangoju, Jyothi Sabbani, Prathyusha Bandari, Sunil Kumar Adepu
The Indian pharmaceutical industry truly came into its own after gaining independence. Today, it stands as the fourth largest market for generic pharmaceuticals globally. In terms of volume, it ranks fourth, while in terms of value, it holds the thirteenth position among global pharmaceutical markets. Furthermore, the industry demonstrates consistent growth.
To uphold the quality, safety, and effectiveness of medicinal products for sales, imports, and manufacturing, a robust regulatory system is in place. The regulatory framework governing India’s pharmaceutical industry is among the most stringent in the country. Given the rapid and continuous changes in this field, it is crucial to comprehend the regulatory landscape. Regulatory bodies bear the responsibility of ensuring a steady supply of high-quality medications at affordable prices to the Indian population, which places a significant burden on them.

39. A Cross-sectional Study Assessing the Lung Ultrasound as a Complementary Imaging Tool for Chest X-ray in the Evaluation of Dyspnea
Preeti Meena, Rajeev Ranjan
Aim: The aim of the present study was to assess the role of lung ultrasound: a complementary imaging tool for chest x-ray in the evaluation of dyspnea. Material & Methods: A cross-sectional study, conducted over the duration of one year in the Department of Radiology, Lord Buddha koshi medical college and Hospital, Saharsa, Bihar, India. The study population comprised 50 patients of either sex, presenting with a complaint of dyspnea. All patients with a clinical history suggestive of acute coronary syndrome as a cause of dyspnea, patients on invasive ventilatory support, or with suspected/known metabolic causes of dyspnea were excluded from the study. Results: The most common non-translobar consolidation was seen “Fractal sign/shred sign.” Translobar consolidation was identified by the “Lung sign.” Six patients with “Unilateral lung rockets” were also diagnosed with pneumonia. Pleural effusion was found in patients with pneumonia, pulmonary edema and hydropneumothorax in the study. Visualization of the “Lung line” identified was seen as the presence of pleural effusion. Internal septations and internal echoes were used to help characterize the collection as an empyema. Out of 50 cases included in our study, 46 cases showed concordant diagnosis on ultrasound and chest X-ray (92%). Chest X-ray was found to have a sensitivity, specificity, positive predictive value, and negative predictive value of 100%. Conclusion: A high concordance was noted between ultrasound and chest X-ray for diagnosis of all pathologies studied (p < 0.01), the highest noted in pneumonia/pleural effusion and diffuse interstitial syndrome (κ ¼ 0.9). Hence, ultrasound may be considered a complimentary imaging modality for Chest-X-ray in the evaluation of dyspnoea.

40. Comparative of the Effect of 0.0625% Bupivacaine with 2% Fentanyl and 0.125% Bupivacaine with 2% Fentanyl Epidural Infusion on Haemodynamic Parameters in Infraumbilical Surgeries
Rajeev Kumar, Asif Siddiqui
Aim: The aim of the study was to compare effect of 0.0625% bupivacaine with 2% fentanyl and 0.125% bupivacaine with 2% fentanyl epidural infusion on haemodynamic parameters for 48 hrs in infraumbilical surgeries and VAS as the secondary objective with preserved hemodynamic parameters. Methods: The proposed study was conducted at Department of Anesthesiology,Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for 18 months. A total of 50 patients with consenting candidates who satisfy necessary inclusion/exclusion criteria during the 18 months period were included. Patients accepted in ASA I and II in whom surgeries were performed by infra umbilical incision and required epidural infusion were included. Results: Among study population, 21 (42%) of them had diagnosis of Carcinoma Ovary and 20 (40%) had diagnosis of Fibroid Uterus followed by 3 (6%) had diagnosis of Carcinoma Endometrium. There was no statistically significant difference between two groups in parameter Pulse Rate, Respiration rate, Diastolic Blood Pressure (P>0.05). There was no statistical difference of mean systolic pressure between two groups at starting period, 3 hrs, 6 hrs, 9 hrs, 12 hrs, 15 hrs, 18 hrs, 21 hrs, 24 hrs and 48 hrs (p>0.05) of infusion. There was no statistical difference of mean diastolic pressure between two groups at starting period, 3 hrs, 9 hrs, 12 hrs, 15 hrs, 21 hrs, 24 hrs and 48 hrs (p>0.05). There is statistical difference between two groups at 6 hrs and 18 hrs. Conclusion: The study showed that the infusion of 0.125% bupivacaine with 2 μg fentanyl lead to stoppage of infusion in 12 patients in view of Hypotension and no significant changes in VAS score was noted in two groups of patients.

41. Study of Various Platelet Indices in Patients of Sepsis and Correlation of Platelet Count and Indices with Severity of Sepsis
Manish Gautam, Binod Kumar
Aim: The objective of the study was to assess the various platelet indices – Mean platelet volume (MPV), Platelet distribution width (PDW), Plateletcrit (PCT) and Platelet large cell ratio (PLCR) in patients of sepsis and correlation of platelet count and indices with severity of sepsis. Methods: The present study was conducted in the Department of General Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India and total of 60 patients of either sex admitted to a Department of General Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India with clinical features, lab investigations and/or radiological features suggestive of sepsis were enrolled over a period of one year. Results: Mean Respiratory rate in Group I patients is 22.69±1.61 and among Group II patients is 29.92±3.407. On statistical analysis it was found to be significant (p <0.01). Mean values of diastolic B.P in group I & II (80.66±10.5 & 62.42±4.97 respectively) were also statistically significant. Similarly mean values of systolic B.P among the two groups were also found to be statistically significant. Mean hemoglobin in the Survivors group and Non survivors’ group was 12.62±2.21 and 9.51±1.16 respectively. The values on statistical analysis were found to be significant (p <0.01). Mean Total Leucocyte count value among the two groups was 13.22±1.31 and 17.78±2.601 respectively. It also came out to be statistically significant. Conclusion: Our study reported statistically significant decreased levels of mean platelet counts among the patients who expired (Non survivors) due to sepsis as compared to the patients who Survived sepsis (Survivors). The study also reported statistically significant increased levels of Mean platelet volume and Mean platelet distribution width among the Non survivors’ group as compared to the Survivors group.

42. Assessment to Evaluate the Pattern of Cervical Pap Smear Cytology at a Tertiary Hospital and Its Correlation with Clinical Findings
Kamlesh Kumar, Ankit Gaba, Vidyut Prakash
Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. Aim: The aim of the study to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Material and Methods: The prospective study was carried out at Department of Pathology, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India for 12 months. The cellular material obtained on the spatula and cytobrush was quickly smeared on a clean glass slide, labelled, fixed in 95% ethyl alcohol immediately and subsequently stained by Pap stain. After staining, slides were mounted with DPX (Dibutyl phthalate Polystyrene Xylene), screened and reported by cytopathologist under light microscope. Results: Total 1200 cervico-vaginal smears studied during study period on patients, ranging from 18 to 65 years. Cytological findings broadly classified into unsatisfactory smears, normal and abnormal smears. There were 910(75.83%) abnormal Pap smears (benign cellular changes of inflammation as well as Epithelial Cell Abnormalities (ECA), with 265(22.08) normal cases and 25 (2.08%) unsatisfactory or inadequate samples. The age range of patients with epithelial cell abnormality was 22 to 65 years and the mean age was 44.1±12.7 years. They represented 2.5% of abnormal Pap smears and 1.67% of total smears taken. Total 623 (51.92%) showed inflammatory lesion, 14 (1.17%) showed atrophy, 10 (0.83%) showed ASCUS, 6 (0.5%) showed ASC-H, 6 (0.5%) showed HSIL, 2 (0.17%) showed SCC, 3 (0.25%) AGUS, 193 (16.08%) showed metaplasia, 2 (0.17%) had radiation changes. Conclusion: Proper implementation of Pap screening programme, incidence of invasive cervical malignancy can be prevented due to early detection of cervical premalignant lesions.

43. Predictors of Outcome in Emphysematous Pyelonephritis: A Case Based Study
Sanjay Parashar, Sweta Swaika, Nikhil Agrawal, Sachin Singh Yadav
Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection which results in gas within the renal parenchyma, collecting system, or perinephric tissue. Objective: To analyze the characteristics of patients with EPN with respect to patient demographics, diagnostic investigations, microbiological findings, treatment modality and outcome, and the influence of prognostic factors on the outcome. Materials and Methods: The study was carried out in the Department of Urology at GRMC, Gwalior which is the only tertiary care hospital. The study involved 30 consecutive diagnosed cases of EPN admitted during the period 2022 to 2023. The diagnosis of EPN was based on clinical features and documentation of gas within the renal parenchyma, collecting system, or perinephric tissue on computed tomography (CT) of abdomen. We retrospectively reviewed the clinical, laboratory, radiological, and microbiological findings, treatment modality, and outcome of these patients. Results: The subjects had a mean age of 49 ± 1.3 years (range 20–70 years). All the study subjects had DM (23 type 2 and 3 type 1); the mean duration of diabetes was 6.8 ± 5.3 years and two patients had their DM diagnosed during the episode of EPN. Four patients including two with type 2 diabetes had diabetic ketoacidosis while four others had nonketotic hyperosmolar state. Two patients had renal stones, one of whom had grade III hydroureteronephrosis. Of 26 patients, 20 (76.9%) had two or more bad prognostic factors. Conclusions: In this series of patients with EPN, all had DM, nearly all were women, and E. coli was the most frequently isolated pathogen. Nearly a third of our patients had bilateral disease. We recommend early aggressive medical treatment and suggest that nephrectomy should be considered only if patients deteriorate or do not improve on conservative treatment.

44. Determine the Relationship of the Subjective, Objective and Radiographic Method of Treatment: A Retrospective Study
Mukesh Kumar
Aim and Objective: The aim of the study was to determine relationship of the subjective, objective and radiographic method of treatment. Material and Methods: A prospective study was conducted in the Department of orthopaedics for the period of 12 Months. Three methods of treatment were utilized: open reduction and internal fixation (ORIF), closed reduction and casting (CR), and external skeletal fixation with pins-in-plaster (PIP). The method of treatment was chosen by the attending surgeon based upon his experience and the type of injury. Results: Union occurred in 92 percent of radius fractures and 95 percent of ulna fractures, with an average time to union of 15.4 weeks for the radius and 16.8 weeks for the ulna. Union was more frequent after closed than after open fractures. This difference was most apparent in radius fractures where 13 percent of open fractures developed nonunions, compared to only 3 percent of closed injuries (p = 0.140). Also, the average time to union was 16 percent longer for open than for closed fractures of the radius (p = 0.022), and 35 percent longer for open fractures of the ulna (p = 0.010). Neither the frequency of nor the time to union varied significantly with the method of treatment. The amount of forearm rotation lost was directly proportional to the loss of normal alignment, reaching a mean of 39 degrees when the combined malalignment of the radius and ulna exceeded thirty degrees (p = 0.07). Conclusion: For this series of 120 adult patients, the end results following treatment of fractures of the shafts of the radius and ulna were good to excellent regardless of the method of treatment chosen. Except for a longer time to union and a higher infection rate, the outcomes of open and closed fractures were very similar. The presence of associated injuries was a strong predictor of a compromised end result.

45. Clinical Research on Non-Venereal Genital Dermatoses in Adult Males at Bihar State
Sudhir Kumar Shreevastav
Aim: A clinical study on non-venereal genital dermatoses in adult males at a tertiary care center. Methods: The prospective analytical study was conducted in the Department of skin and VD for one year. A total of consecutive 100 male patients with genital lesions of non-venereal origin were included in this study. All male patients >18 years of age who presented with genital complaints were screened for non-venereal dermatoses. The external genitalia was examined, and findings were noted. A detailed physical examination was done to see any associated lesions elsewhere in the body. Investigations such as Gram‑stain, KOH mount, venereal disease research laboratory test, HIV test and histopathological examination were done as and when required establishing the diagnosis. Results: Most patients belong to the age group of 20‑30 years (45%), followed by the age group of 30‑40 years (22%). 75 patients (75%) were from the urban area while 25 patients (25%) belong to rural background. 57 (57%) patients were married and the remaining 43 (43%) patients were unmarried. Scrotum was involved in 62% and penis in 30% while both scrotum and penis were affected in 8% cases.28 % patients were farmers while 18% patients were students. A total of 16 types of non-venereal dermatoses were noted in this study. The most common disorder was vitiligo present in 20 cases, followed by pearly penile papule, which accounted for 15 cases. The other disorder encountered included fixed drug eruption (FDE) in 13; scabies in 8, scrotal dermatitis and lichen planus in 8 cases each etc. Conclusion: Contrary to normal belief all the lesions on genitalia are not sexually transmitted. It is very important to distinguish between venereal and non-venereal genital dermatoses, as these non-venereal disorders are a considerable concern to patients causing mental distress and feeling of guilt.

46. Seroprevalence of Dengue and Chikungunya Virus Co-Infection in a Tertiary Care Hospital, Warangal, Telangana
Swetha Kamble, Usha Rani Vadlamanu, Archana Bathula, S. Sreedevi, Srujana Ravula, Sadia Sulthana, T Jaya Chandra
Introduction: Dengue and Chikungunya are rapidly spreading viral infections and they have common clinical presentation. Chikungunya is often misdiagnosed, tested rarely. Thus, the individuals suspected with dengue and/or chikungunya should be tested for both especially in the endemic areas. With this a study was taken to detect the seroprevalence of the current coinfection. Materials and Methods: This was a prospective study conducted in the Kakatiya Medical College, Hanamkonda, from August 2022 to March 2023. Clinically suspected patients of dengue and/or chikungunya patients from various inpatient departments of MGM Hospital, Warangal were included.  Serum samples were tested for the NS1 antigen and IgM antibodies of dengue and chikungunya both by ELISA method. Results: out of the 3096 samples, the coinfection positivity was 8.6%. Dengue positivity was 10.27% and 4% (123) were chikungunya positive. Majority of coinfection was found in < 10 years group. In the dengue mono-infection the male female ratio was 1.33 and it was 1.15 among the chikungunya mono-infection. Fever was detected in all. The seasonal distribution of DENV and CHIKV coinfection was predominated in September followed by November. Conclusion: Due to the increase prevalence of these viral infections, all the clinically suspected cases should be tested for both the pathogens especially in the endemic area. This may help to implement proper mosquito control measures as well as spread of the infections.

47. Association of Physical Activity Levels with Diabetes Prevalence: A Cross-Sectional Survey
Rakesh Bhaisare, Rajesh Atal 
Background: The prevalence of diabetes in the United States has increased rapidly over the past decade, and the incidence of diabetes has also been increasing in recent years. However, little is known about the association between physical activity and diabetes prevalence. Methods: A cross-sectional survey comprising 1,500 individuals, aged 18 to 75 years, was conducted. Data were collected through structured interviews, anthropometric measurements, and clinical evaluations. Logistic regression analyses were conducted to investigate the correlation between the prevalence and levels of physical activity. Results: A significant association was observed between levels of exercise and reduced diabetes prevalence (p 0.05). The OR (95% confidence interval) for diabetes in high activity group was 0.65 (CI: 0.50-0.85), indicating a 35% reduction in the odds of diabetes compared to the sedentary group. Stratified analyses based on age, gender, and body mass index categories revealed consistent associations between higher physical activity levels and a reduced prevalence of diabetic complications across various demographic strata. Conclusions: The results of our study provide substantial empirical support for the inverse correlation between a higher level of physical exercise and the risk of diabetes. Interventions promoting and facilitating routine physical activity within varied demographic groups may assume a crucial role in alleviating this pervasive global health concern.

48. An Evaluation of Intraoperative Complications and Visual Outcomes after Phacoemulsification for Cataract
Monika Agarwal, Pankaj Varshney, Dhananjay Kumar
Aim: The aim of the present study was to assess the intraoperative complications while phacoemulsification in cataract surgery and determine the visual outcomes after phacoemulsification for cataract. Material & Methods: A prospective observational study involving patients undergoing cataract surgery, conducted at Department of Ophthalmology. The study was conducted over a period of two years among 200 patients to study the intraoperative complications and visual outcome after phacoemulsification. Results: In terms of age, 2% patients were aged ≤40 years, 8% were 41–50 years, 40% were 51–60 years, 41% were 61–70 years, 8% were 71–80 years, and 1% of cases were older than 80 years. 52% were male and 55% had right eye involved. Majority patients had posterior capsular rent with vitreous disturbance, followed by iridodialysis, scleral tunnel with premature entry, descemet stripping, nucleus drop into the vitreous, zonular dialysis with vitreous disturbance, IOL drop, positive pressure, button holding of the flap and expulsive haemorrhage. According to the type of surgery done the number of patients having intraoperative complications were, one in conventional ECCE with PCIOL, one in phaco with foldable IOL, 12 in phaco with non-foldable IOL, 165 in MSICS with PCIOL, 20 in MSICS with ACIOL and 1 in MSICS+PCIOL+trabeculectomy. Conclusion: Although the risk of problems from cataract surgery using the phacoemulsification technique is lower, anticipating of these risks, as well as preparation and preventative measures, may help to reduce the risk of difficulties.

49. A Comparative Study on Self-Gripping Mesh vs. Polypropylene Mesh in Lichtenstein’s Open Inguinal Hernioplasty
N Durga Prasad, Kamadi Ramarao, P. Anusha, K. Sailaja
Introduction: Inguinal hernia (IH) stands out as one of the most prevalent conditions in society. The present study was taken with an aim to compare  postoperative  pain (POP) and operation time undergoing  Lichtenstein’s  tension  free  IH repair  with  self-fixating  mesh  with  conventional polypropylene mesh. Methods: It was a prospective research conducted in government Medical College, Eluru. Study was conducted for a period of 8 months, from July to October 2021. Study protocol was approved by Institutional ethical committee. An informed written consent was taken from all the study participants. The study included patients of both gender, >18 years with uncomplicated IH visited department of general surgery and underwent open Lichtenstein Hernioplasty (LH) were included. The patients were categorized intothe study group, underwent hernioplasty with self-gripping mesh and the control group with polypropylene mesh using traditional suturing as per the protocol. The surgical procedures were performed by a single surgeon on both groups. Chisqaure test was used for statistical analysis and P <0.05 were considered to be statistically significant. Results: Total 113 members were included, 55 and 58, respectively in study and control group. Gender wise statistically there was no significant difference between the groups. The mean time for the procedure was 31.2+4.35 and 41.6+5.1 mints, respectively for the groups; statistically there was significant difference between the groups in mean time (t value = -13.71; P<0.001). The median pain score was 0 for the study group and 2 for the control group; statistically there was significant difference (Z score = 6.223; P<0.002). Conclusion: The use of self-fixating mesh proved effective in minimizing POP and reducing operating time in patients undergoing Lichtenstein’s tension-free IH repair, as compared to conventional polypropylene mesh. Additionally, the self-adhesive mesh demonstrated comparable efficacy to conventional polypropylene mesh in preventing hernia recurrences among patients undergoing Lichtenstein’s tension-free IH repair.

50. The Diagnostic Use of Multidetector Computed Tomography for Intestinal Obstruction
Deepak Agrawal, Nidhi Agrawal
Background: CT is becoming a standard tool for intestinal blockage diagnosis. An accurate CT evaluation is currently the gold standard and the usual course of action for patients with suspected bowel obstruction, as the proportion of patients requiring surgery has decreased and the management of blockage has altered considerably. In general surgery units, intestinal blockage is a frequent surgical emergency that significantly increases patient morbidity and medical expenses. When diagnosing intestinal blockage, computed tomography (CT) has proven to be a crucial diagnostic tool that aids in the decision to proceed with early surgery. The CT provides details on the obstruction’s location, etiology, and any consequences, including intestinal ischemia and closed-loop obstruction. Aim: The aim of this study was to discuss the usefulness of MDCT in the evaluation of intestinal obstruction, the underlying causes, and the related conditions. Material and Method: At the Department of Radiology, a prospective cohort research was carried out. In this investigation, twenty patients were involved. Before any patient was enrolled in the trial, their informed written consent was obtained. Patients with one or more of the following symptoms—constipation, acute abdomen, nausea, vomiting, and difficulty passing stool—were referred for MDCT examination. Patients who have been diagnosed with intestinal obstruction through preliminary investigations using abdominal radiography or ultrasonography and who are at least 18 years old and have a clinical suspicion of intestinal obstruction are referred for Contrast Enhanced Computed Tomography (CECT) from the emergency room or outpatient department (OPD). Of these patients, 15 were male and 5 were female. Results: The dilated bowel loops in the referred patients were: 11/20 patients with small bowel dilatation (55%), 8/20 patients with large bowel dilatation (40%), and 1/20 patients with small and large bowel dilatation (5%). A high incidence of intestinal obstruction is noted in the age group above 50 years. According to our research, blocked hernias and adhesive intestinal obstruction are the primary causes of SBO. According to our study, the primary causes of large bowel obstruction are intussusception and cancer sigmoid. The frequency of intussusception was highest in the age group over 18, the prevalence of sticky was highest in the age group between 18 and 50, and the prevalence of cancer sigmoid and obstructed hernias was highest in the age group over 50. These findings were obtained by correlating the patient age group with the cause of obstruction. Conclusion: When it comes to determining the level and source of obstruction, MDCT is incredibly accurate. When diagnosing intestinal blockage, the MDCT has good diagnostic accuracy. As with other similar research, the results of this investigation demonstrated that CT is the preferred method for diagnosing intestinal blockage, identifying its cause, identifying the transition point, and predicting bowel ischemia. As a result, radiologists can help surgeons plan ahead for pre-operative care and management of patients who come with intestinal obstruction. When it comes to the diagnosis of different small intestinal disorders, MDCT is crucial. The MDCT evaluates both obstructive and non-obstructive lesions well.

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